The ARIZOTA Legislative and Government Affairs Committee has been very busy during 2011, and not just because of the severe budget problems in Arizona.  In addition to the 2011 session of the Legislature, where the main focus was the budget (particularly AHCCCS and its budget), the Committee has been working on significantly more projects than usual, including:  the possible new RFP from AzEIP and DES on Pediatric Developmental Disability (which was started in 2010); the Industrial Commission Fee Schedule (which ARIZOTA is working on for 2012); and the proposed statutory changes from the Arizona Board of Occupational Therapy Examiners (which includes the supervision issues).

AHCCCS:  There are major changes to AHCCCS and its budget, both from the Legislature and from Governor Brewer and AHCCCS itself. Most important, AHCCCS needed to renew its waiver from the Federal Government, which expires on October 1, 2011.  On September 30, the federal CMS approved the new waiver, continuing the program for another 5 years. Earlier this year, AHCCCS announced major program changes, based on items that are not mandated by federal law. Two of these—a freeze on new enrollment of childless adults (the so-called Prop 204 population) and elimination of the “spend down” program (which granted coverage to persons with income above AHCCCS eligibility whose medical bills had reduced their income and assets)—were implemented earlier and also received CMS approval. For ARIZOTA, the most direct impact comes from an additional 5% cut in reimbursement rates to all health care providers.  CMS has not yet approved this change, but it takes effect October 1, 2011 and remains in effect unless and until there is further action. Savings from these changes has been targeted at $400-500 million.

The Legislature also acted on a number of AHCCCS matters. It required AHCCCS to implement programs to meet the appropriated target even if federal CMS did not approve all waivers, established monthly premiums and co-pays, and transferred children’s rehabilitation services from DHS to AHCCCS. (Chapter 31, SB 1619—the health care budget bill, which also indicated that AHCCCS should reinstate the organ transplant program). AHCCCS health plans also must provide hospice care under Chapter 13, HB 2099 (a logical choice, since hospice care is generally very cost-effective).

OTHER LEGISLATION:  The Legislature passed three session law measures affecting health care (session law does not amend any statutory provisions, but directs agencies or others to take certain actions). DHS is required to adopt rules by 1/1/14 to establish emergency stroke protocols and standards for hospital and rehabilitation stroke care (Chapter 47, HB 2157), and to adopt rules on health care institutions to promote licensure of integrated health programs that provide both behavioral and physical health services (Chapter 96, HB 2634).  DES is required to interview by 11/15/11 and report by 12/1/11 on placement options for persons with cognitive or developmental disabilities who are served by intermediate care or skilled nursing facilities (Chapter 246, SB 1190).

Also related to DD, all statutes are changed to refer to “developmental disability” or “intellectual disability”  rather than older terms such as mental retardation (Chapter 89, HB 2213), and the Developmental Disability Advisory Council is continued for 10 years, with a membership that is increased from 12 to 17 (Chapter 160, SB 1232). Four bills involve matters that are of interest to
ARIZOTA members, or relate to regulation of the profession:  Chapter 192 (SB 1429) provides that students in licensed health provider postsecondary institutions are not liable for medical malpractice while under supervision by a licensed provider, unless gross negligence is established by clear and convincing evidence.  Chapter 118 (HB 2520) provides that advisory letters and letters of concern issued by a professional regulatory board are no longer public. Chapter 167 (SB 1521) requires schools to adopt policies on head injuries and concussions, including removal from athletic activity until evaluated by a health care provider. And very significant, Chapter 268 (HB 2620) regulates health information organizations that electronically store or transfer individual health information and provides individual patient rights.

VETOES:  Governor Brewer vetoed two health care related bills. SB 1592 would have authorized the Governor to enter an interstate compact to regulate health care at the state, rather than the federal, level.  SB 1593 would have allowed out-of-state insurers regulated elsewhere to write coverage in Arizona, and in-state insurers to reduce mandated coverages to compete.

DES/DDD/AzEIP:  ARIZOTA has been working on the issue of a proposed new RFP for pediatric DD clients since last summer.  Both the Committee and the TriAlliance (OT, PT and
Speech) have developed extensive position papers, and earlier this year, met with the new Director of DES, Clarence Carter.  The result was a Request For Information issued by AzEIP, which had a comment deadline of 9/30/11.  The TriAlliance comments are either already posted on-line, or will be shortly.

ICA Fee Schedule: The Committee has continued to track all developments on the fee schedule, and is in the process of preparing for the 2012 process, which begins next spring and is likely to affect some of the OT reimbursement codes.

ABOTE Legislation: ABOTE created a subcommittee, which recently reported back to the full board, on potential legislative changes—particularly changes to clarify the confusion that has arisen regarding the supervision rules.  Committee member Chris Merchant participated in the subcommittee meetings, and the Committee reviewed the subcommittee product.  As soon as the Board takes action on how it will proceed, the Committee will be able to recommend a position for ARIZOTA.

All ARIZOTA members should feel free to contact the Committee with issues, questions or concerns.  Thank you.