Bill Text: AZ HB2090 | 2011 | Fiftieth Legislature 1st Regular | Introduced
Bill Title: AHCCCS; children; coverage
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-01-19 - Referred to House HHS Committee [HB2090 Detail]
Download: Arizona-2011-HB2090-Introduced.html
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REFERENCE TITLE: AHCCCS; children; coverage |
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State of Arizona House of Representatives Fiftieth Legislature First Regular Session 2011
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HB 2090 |
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Introduced by Representative Heinz
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AN ACT
Amending sections 36-2912, 36-2982 and 36-2986, Arizona Revised Statutes; repealing sections 36-2985 and 42-5017, Arizona Revised Statutes; making an appropriation; relating to the children's health insurance program.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 36-2912, Arizona Revised Statutes, is amended to read:
36-2912. Healthcare group coverage; program requirements for small businesses and public employers; related requirements; definitions
A. The administration shall administer a healthcare group program to allow willing contractors to deliver health care services to persons defined as eligible pursuant to section 36‑2901, paragraph 6, subdivisions (b), (c), (d) and (e). In counties with a population of less than five hundred thousand persons, the administration may contract directly with any health care provider or entity. The administration may enter into a contract with another entity to provide administrative functions for the healthcare group program.
B. Employers with two eligible employees or up to an average of fifty eligible employees under section 36‑2901, paragraph 6, subdivision (d):
1. May contract with the administration to be the exclusive health benefit plan if the employer has five or fewer eligible employees and enrolls one hundred per cent of these employees into the health benefit plan.
2. May contract with the administration for coverage available pursuant to this section if the employer has six or more eligible employees and enrolls eighty per cent of these employees into the healthcare group program.
3. Shall have a minimum of two and a maximum of fifty eligible employees at the effective date of their first contract with the administration.
C. The administration shall not enroll an employer group in healthcare group sooner than ninety days after the date that the employer's health insurance coverage under an accountable health plan is discontinued. Enrollment in healthcare group is effective on the first day of the month after the ninety day period. This subsection does not apply to an employer group if the employer's accountable health plan discontinues offering the health plan of which the employer is a member.
D. Employees with proof of other existing health care coverage who elect not to participate in the healthcare group program shall not be considered when determining the percentage of enrollment requirements under subsection B of this section if either:
1. Group health coverage is provided through a spouse, parent or legal guardian, or insured through individual insurance or another employer.
2. Medical assistance is provided by a government subsidized health care program.
3. Medical assistance is provided pursuant to section 36‑2982, subsection I H.
E. An employer shall not offer coverage made available pursuant to this section to persons defined as eligible pursuant to section 36‑2901, paragraph 6, subdivision (b), (c), (d) or (e) as a substitute for a federally designated plan.
F. An employee or dependent defined as eligible pursuant to section 36‑2901, paragraph 6, subdivision (b), (c), (d) or (e) may participate in healthcare group on a voluntary basis only.
G. Notwithstanding subsection B, paragraph 2 of this section, the administration shall adopt rules to allow a business that offers healthcare group coverage pursuant to this section to continue coverage if it expands its employment to include more than fifty employees.
H. The administration shall provide eligible employees with disclosure information about the health benefit plan.
I. The director shall:
1. Require that any contractor that provides covered services to persons defined as eligible pursuant to section 36‑2901, paragraph 6, subdivision (a) provide separate audited reports on the assets, liabilities and financial status of any corporate activity involving providing coverage pursuant to this section to persons defined as eligible pursuant to section 36‑2901, paragraph 6, subdivision (b), (c), (d) or (e).
2. Prohibit the administration and program contractors from reimbursing a noncontracting hospital for services provided to a member at a noncontracting hospital except for services for an emergency medical condition.
3. Require that a contractor, the administration or an accountable health plan negotiate reimbursement rates. The reimbursement rate for an emergency medical condition for a noncontracting hospital is:
(a) In counties with a population of more than five hundred thousand persons, one hundred fourteen per cent of the reimbursement rates established pursuant to section 36‑2903.01, subsection H. The hospital shall notify the contractor when a member is stabilized.
(b) In counties with a population of less than five hundred thousand persons, one hundred twenty-five per cent of the reimbursement rates established pursuant to section 36-2903.01, subsection H. The hospital shall notify the contractor when a member is stabilized.
4. Use monies from the healthcare group fund established by section 36‑2912.01 for the administration's costs of operating the healthcare group program.
5. Ensure that the contractors are required to meet contract terms as are necessary in the judgment of the director to ensure adequate performance by the contractor. Contract provisions shall include, at a minimum, the maintenance of deposits, performance bonds, financial reserves or other financial security. The director may waive requirements for the posting of bonds or security for contractors that have posted other security, equal to or greater than that required for the healthcare group program, with the administration or the department of insurance for the performance of health service contracts if funds would be available to the administration from the other security on the contractor's default. In waiving, or approving waivers of, any requirements established pursuant to this section, the director shall ensure that the administration has taken into account all the obligations to which a contractor's security is associated. The director may also adopt rules that provide for the withholding or forfeiture of payments to be made to a contractor for the failure of the contractor to comply with provisions of its contract or with provisions of adopted rules.
6. Adopt rules.
7. Provide reinsurance to the contractors for clean claims based on thresholds established by the administration. For the purposes of this paragraph, "clean claims" has the same meaning prescribed in section 36‑2904.
J. With respect to services provided by contractors to persons defined as eligible pursuant to section 36‑2901, paragraph 6, subdivision (b), (c), (d) or (e), a contractor is the payor of last resort and has the same lien or subrogation rights as those held by health care services organizations licensed pursuant to title 20, chapter 4, article 9.
K. The administration shall offer a health benefit plan on a guaranteed issuance basis to small employers as required by this section. All small employers qualify for this guaranteed offer of coverage. The administration shall offer to all small employers the available health benefit plan and shall accept any small employer that applies and meets the eligibility requirements. In addition to the requirements prescribed in this section, for any offering of any health benefit plan to a small employer, as part of the administration's solicitation and sales materials, the administration shall make a reasonable disclosure to the employer of the availability of the information described in this subsection and, on request of the employer, shall provide that information to the employer. The administration shall provide information concerning the following:
1. Provisions of coverage relating to the following, if applicable:
(a) The administration's right to establish premiums and to change premium rates and the factors that may affect changes in premium rates.
(b) Renewability of coverage.
(c) Any preexisting condition exclusion.
(d) The geographic areas served by the contractor.
2. The benefits and premiums available under all health benefit plans for which the employer is qualified.
L. The administration shall describe the information required by subsection K of this section in language that is understandable by the average small employer and with a level of detail that is sufficient to reasonably inform a small employer of the employer's rights and obligations under the health benefit plan. This requirement is satisfied if the administration provides the following information:
1. An outline of coverage that describes the benefits in summary form.
2. The rate or rating schedule that applies to the product, preexisting condition exclusion or affiliation period.
3. The minimum employer contribution and group participation rules that apply to any particular type of coverage.
4. In the case of a network plan, a map or listing of the areas served.
M. A contractor is not required to disclose any information that is proprietary and protected trade secret information under applicable law.
N. At least sixty days before the date of expiration of a health benefit plan, the administration shall provide a written notice to the employer of the terms for renewal of the plan.
O. The administration shall increase or decrease premiums based on actuarial reviews by an independent actuary of the projected and actual costs of providing health care benefits to eligible members. Before changing premiums, the administration must give sixty days' written notice to the employer. For each contract period the administration shall set premiums that in the aggregate cover projected medical and administrative costs for that contract period and that are determined pursuant to generally accepted actuarial principles and practices by an independent actuary.
P. The administration shall consider age, sex, health status-related factors, group size, geographic area and community rating when it establishes premiums for the healthcare group program.
Q. Except as provided in subsection R of this section, a health benefit plan may not deny, limit or condition the coverage or benefits based on a person's health status‑related factors or a lack of evidence of insurability. A health benefit plan shall not provide or offer any service, benefit or coverage that is not part of the health benefit plan contract.
R. A health benefit plan shall not exclude coverage for preexisting conditions, except that:
1. A health benefit plan may exclude coverage for preexisting conditions for a period of not more than twelve months or, in the case of a late enrollee, eighteen months. The exclusion of coverage does not apply to services that are furnished to newborns who were otherwise covered from the time of their birth or to persons who satisfy the portability requirements under this section.
2. The contractor shall reduce the period of any applicable preexisting condition exclusion by the aggregate of the periods of creditable coverage that apply to the individual.
S. The contractor shall calculate creditable coverage according to the following:
1. The contractor shall give an individual credit for each portion of each month the individual was covered by creditable coverage.
2. The contractor shall not count a period of creditable coverage for an individual enrolled in a health benefit plan if after the period of coverage and before the enrollment date there were sixty‑three consecutive days during which the individual was not covered under any creditable coverage.
3. The contractor shall give credit in the calculation of creditable coverage for any period that an individual is in a waiting period for any health coverage.
T. The contractor shall not count a period of creditable coverage with respect to enrollment of an individual if, after the most recent period of creditable coverage and before the enrollment date, sixty‑three consecutive days lapse during all of which the individual was not covered under any creditable coverage. The contractor shall not include in the determination of the period of continuous coverage described in this section any period that an individual is in a waiting period for health insurance coverage offered by a health care insurer or is in a waiting period for benefits under a health benefit plan offered by a contractor. In determining the extent to which an individual has satisfied any portion of any applicable preexisting condition period, the contractor shall count a period of creditable coverage without regard to the specific benefits covered during that period. A contractor shall not impose any preexisting condition exclusion in the case of an individual who is covered under creditable coverage thirty‑one days after the individual's date of birth. A contractor shall not impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before age eighteen and who is covered under creditable coverage thirty‑one days after the adoption or placement for adoption.
U. The written certification provided by the administration must include:
1. The period of creditable coverage of the individual under the contractor and any applicable coverage under a COBRA continuation provision.
2. Any applicable waiting period or affiliation period imposed on an individual for any coverage under the health plan.
V. The administration shall issue and accept a written certification of the period of creditable coverage of the individual that contains at least the following information:
1. The date that the certificate is issued.
2. The name of the individual or dependent for whom the certificate applies and any other information that is necessary to allow the issuer providing the coverage specified in the certificate to identify the individual, including the individual's identification number under the policy and the name of the policyholder if the certificate is for or includes a dependent.
3. The name, address and telephone number of the issuer providing the certificate.
4. The telephone number to call for further information regarding the certificate.
5. One of the following:
(a) A statement that the individual has at least eighteen months of creditable coverage. For the purposes of this subdivision, "eighteen months" means five hundred forty‑six days.
(b) Both the date that the individual first sought coverage, as evidenced by a substantially complete application, and the date that creditable coverage began.
6. The date creditable coverage ended, unless the certificate indicates that creditable coverage is continuing from the date of the certificate.
W. The administration shall provide any certification pursuant to this section within thirty days after the event that triggered the issuance of the certification. Periods of creditable coverage for an individual are established by presentation of the certifications in this section.
X. The healthcare group program shall comply with all applicable federal requirements.
Y. Healthcare group may pay a commission to an insurance producer. To receive a commission, the producer must certify that to the best of the producer's knowledge the employer group has not had insurance in the ninety days before applying to healthcare group. For the purposes of this subsection, "commission" means a one time payment on the initial enrollment of an employer.
Z. On or before June 15 and November 15 of each year, the director shall submit a report to the joint legislative budget committee regarding the number and type of businesses participating in healthcare group and that includes updated information on healthcare group marketing activities. The director, within thirty days of implementation, shall notify the joint legislative budget committee of any changes in healthcare group benefits or cost sharing arrangements.
AA. The administration shall submit the following to the joint legislative budget committee:
1. Quarterly reports regarding the financial condition of the healthcare group program. The reports shall include the number of persons and employer groups enrolled in the program and medical loss information and projections.
2. An annual financial audit.
3. The analysis that is used to determine premiums pursuant to subsection O of this section.
BB. Beginning July 1, 2009, and Each fiscal year thereafter, healthcare group shall limit employer group enrollment to not more than five per cent more than the number of employer groups enrolled in the program at the end of the preceding fiscal year. Healthcare group shall give enrollment priority to uninsured groups.
CC. For the purposes of this section:
1. "Accountable health plan" has the same meaning prescribed in section 20-2301.
2. "COBRA continuation provision" means:
(a) Section 4980B, except subsection (f)(1) as it relates to pediatric vaccines, of the internal revenue code of 1986.
(b) Title I, subtitle B, part 6, except section 609, of the employee retirement income security act of 1974.
(c) Title XXII of the public health service act.
(d) Any similar provision of the law of this state or any other state.
3. "Creditable coverage" means coverage solely for an individual, other than limited benefits coverage, under any of the following:
(a) An employee welfare benefit plan that provides medical care to employees or the employees' dependents directly or through insurance, reimbursement or otherwise pursuant to the employee retirement income security act of 1974.
(b) A church plan as defined in the employee retirement income security act of 1974.
(c) A health benefits plan, as defined in section 20‑2301, issued by a health plan.
(d) Part A or part B of title XVIII of the social security act.
(e) Title XIX of the social security act, other than coverage consisting solely of benefits under section 1928.
(f) Title 10, chapter 55 of the United States Code.
(g) A medical care program of the Indian health service or of a tribal organization.
(h) A health benefits risk pool operated by any state of the United States.
(i) A health plan offered pursuant to title 5, chapter 89 of the United States Code.
(j) A public health plan as defined by federal law.
(k) A health benefit plan pursuant to section 5(e) of the peace corps act (22 United States Code section 2504(e)).
(l) A policy or contract, including short‑term limited duration insurance, issued on an individual basis by an insurer, a health care services organization, a hospital service corporation, a medical service corporation or a hospital, medical, dental and optometric service corporation or made available to persons defined as eligible under section 36‑2901, paragraph 6, subdivisions (b), (c), (d) and (e).
(m) A policy or contract issued by a health care insurer or the administration to a member of a bona fide association.
4. "Eligible employee" means a person who is one of the following:
(a) Eligible pursuant to section 36‑2901, paragraph 6, subdivisions (b), (c), (d) and (e).
(b) A person who works for an employer for a minimum of twenty hours per week or who is self‑employed for at least twenty hours per week.
(c) An employee who elects coverage pursuant to section 36‑2982, subsection I H. The restriction prohibiting employees employed by public agencies prescribed in section 36‑2982, subsection I H does not apply to this subdivision.
(d) A person who meets all of the eligibility requirements, who is eligible for a federal health coverage tax credit pursuant to section 35 of the internal revenue code of 1986 and who applies for health care coverage through the healthcare group program. The requirement that a person be employed with a small business that elects healthcare group coverage does not apply to this eligibility group.
5. "Emergency medical condition" has the same meaning prescribed in the emergency medical treatment and active labor act (P.L. 99-272; 100 Stat. 164; 42 United States Code section 1395dd(e)).
6. "Genetic information" means information about genes, gene products and inherited characteristics that may derive from the individual or a family member, including information regarding carrier status and information derived from laboratory tests that identify mutations in specific genes or chromosomes, physical medical examinations, family histories and direct analyses of genes or chromosomes.
7. "Health benefit plan" means coverage offered by the administration for the healthcare group program pursuant to this section.
8. "Health status‑related factor" means any factor in relation to the health of the individual or a dependent of the individual enrolled or to be enrolled in a health plan including:
(a) Health status.
(b) Medical condition, including physical and mental illness.
(c) Claims experience.
(d) Receipt of health care.
(e) Medical history.
(f) Genetic information.
(g) Evidence of insurability, including conditions arising out of acts of domestic violence as defined in section 20‑448.
(h) The existence of a physical or mental disability.
9. "Hospital" means a health care institution licensed as a hospital pursuant to chapter 4, article 2 of this title.
10. "Late enrollee" means an employee or dependent who requests enrollment in a health benefit plan after the initial enrollment period that is provided under the terms of the health benefit plan if the initial enrollment period is at least thirty‑one days. Coverage for a late enrollee begins on the date the person becomes a dependent if a request for enrollment is received within thirty‑one days after the person becomes a dependent. An employee or dependent shall not be considered a late enrollee if:
(a) The person:
(i) At the time of the initial enrollment period was covered under a public or private health insurance policy or any other health benefit plan.
(ii) Lost coverage under a public or private health insurance policy or any other health benefit plan due to the employee's termination of employment or eligibility, the reduction in the number of hours of employment, the termination of the other plan's coverage, the death of the spouse, legal separation or divorce or the termination of employer contributions toward the coverage.
(iii) Requests enrollment within thirty‑one days after the termination of creditable coverage that is provided under a COBRA continuation provision.
(iv) Requests enrollment within thirty‑one days after the date of marriage.
(b) The person is employed by an employer that offers multiple health benefit plans and the person elects a different plan during an open enrollment period.
(c) The person becomes a dependent of an eligible person through marriage, birth, adoption or placement for adoption and requests enrollment no later than thirty‑one days after becoming a dependent.
11. "Preexisting condition" means a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within not more than six months before the date of the enrollment of the individual under a health benefit plan issued by a contractor. Preexisting condition does not include a genetic condition in the absence of a diagnosis of the condition related to the genetic information.
12. "Preexisting condition limitation" or "preexisting condition exclusion" means a limitation or exclusion of benefits for a preexisting condition under a health benefit plan offered by a contractor.
13. "Small employer" means an employer who employs at least one but not more than fifty eligible employees on a typical business day during any one calendar year.
14. "Waiting period" means the period that must pass before a potential participant or eligible employee in a health benefit plan offered by a health plan is eligible to be covered for benefits as determined by the individual's employer.
Sec. 2. Section 36-2982, Arizona Revised Statutes, is amended to read:
36-2982. Children's health insurance program; administration; nonentitlement; enrollment eligibility
A. The children's health insurance program is established for children who are eligible pursuant to section 36‑2981, paragraph 6. The administration shall administer the program. All covered services shall be provided by health plans that have contracts with the administration pursuant to section 36‑2906, by a qualifying plan or by either tribal facilities or the Indian health service for Native Americans who are eligible for the program and who elect to receive services through the Indian health service or a tribal facility.
B. This article does not create a legal entitlement for any applicant or member who is eligible for the program. Total enrollment is limited based on the annual appropriations made by the legislature and the enrollment cap prescribed in section 36‑2985.
C. The director shall take all steps necessary to implement the administrative structure for the program and to begin delivering services to persons within sixty days after approval of the state plan by the United States department of health and human services.
D. The administration shall perform eligibility determinations for persons applying for eligibility and annual redeterminations for continued eligibility pursuant to this article.
E. The administration shall adopt rules for the collection of copayments from members whose income does not exceed one hundred fifty per cent of the federal poverty level and for the collection of copayments and premiums from members whose income exceeds one hundred fifty per cent of the federal poverty level. The director shall adopt rules for disenrolling a member if the member does not pay the premium required pursuant to this section. The director shall adopt rules to prescribe the circumstances under which the administration shall grant a hardship exemption to the disenrollment requirements of this subsection for a member who is no longer able to pay the premium.
F. Before enrollment, a member, or if the member is a minor, that member's parent or legal guardian, shall select an available health plan in the member's geographic service area or a qualifying health plan offered in the county, and may select a primary care physician or primary care practitioner from among the available physicians and practitioners participating with the contractor in which the member is enrolled. The contractors shall only reimburse costs of services or related services provided by or under referral from a primary care physician or primary care practitioner participating in the contract in which the member is enrolled, except for emergency services that shall be reimbursed pursuant to section 36‑2987. The director shall establish requirements as to the minimum time period that a member is assigned to specific contractors.
G. Eligibility for the program is creditable coverage as defined in section 20‑1379.
H. On application for eligibility for the program, the member, or if the member is a minor, the member's parent or guardian, shall receive an application for and a program description of the premium sharing program.
I. H. Notwithstanding section 36‑2983, the administration may purchase for a member employer sponsored group health insurance with state and federal monies available pursuant to this article, subject to any restrictions imposed by the federal health care financing administration centers for medicare and medicaid services. This subsection does not apply to members who are eligible for health benefits coverage under a state health benefits plan based on a family member's employment with a public agency in this state.
Sec. 3. Repeal
Section 36-2985, Arizona Revised Statutes, is repealed.
Sec. 4. Section 36-2986, Arizona Revised Statutes, is amended to read:
36-2986. Administration; powers and duties of director
A. The director has full operational authority to adopt rules or to use the appropriate rules adopted for article 1 of this chapter to implement this article, including any of the following:
1. Contract administration and oversight of contractors.
2. Development of a complete system of accounts and controls for the program including provisions designed to ensure that covered health and medical services provided through the system are not used unnecessarily or unreasonably including inpatient behavioral health services provided in a hospital.
3. Establishment of peer review and utilization review functions for all contractors.
4. Development and management of a contractor payment system.
5. Establishment and management of a comprehensive system for assuring quality of care.
6. Establishment and management of a system to prevent fraud by members, contractors and health care providers.
7. Development of an outreach program. The administration shall coordinate with public and private entities to provide outreach services for children under this article. Priority shall be given to those families who are moving off welfare. Outreach activities shall include strategies to inform communities, including tribal communities, about the program, ensure a wide distribution of applications and provide training for other entities to assist with the application process.
8. Coordination of benefits provided under this article for any member. The director may require that contractors and noncontracting providers are responsible for the coordination of benefits for services provided under this article. Requirements for coordination of benefits by noncontracting providers under this section are limited to coordination with standard health insurance and disability insurance policies and similar programs for health coverage. The director may require members to assign to the administration rights to all types of medical benefits to which the person is entitled, including first party medical benefits under automobile insurance policies. The state has a right of subrogation against any other person or firm to enforce the assignment of medical benefits. The provisions of this paragraph are controlling over the provisions of any insurance policy that provides benefits to a member if the policy is inconsistent with this paragraph.
9. Development and management of an eligibility, enrollment and redetermination system, including a process for quality control.
10. Establishment and maintenance of an encounter claims system that ensures that ninety per cent of the clean claims are paid within thirty days after receipt and ninety‑nine per cent of the remaining clean claims are paid within ninety days after receipt by the administration or contractor unless an alternative payment schedule is agreed to by the contractor and the provider. For the purposes of this paragraph, "clean claims" has the same meaning prescribed in section 36‑2904, subsection G.
11. Establishment of standards for the coordination of medical care and member transfers.
12. Requiring contractors to submit encounter data in a form specified by the director.
13. Assessing civil penalties for improper billing as prescribed in section 36‑2903.01, subsection L.
B. Notwithstanding any other law, if Congress amends title XXI of the social security act and the administration is required to make conforming changes to rules adopted pursuant to this article, the administration shall request a hearing with the joint health committee of reference for review of the proposed rule changes.
C. The director may subcontract distinct administrative functions to one or more persons who may be contractors within the system.
D. The director shall require as a condition of a contract with any contractor that all records relating to contract compliance are available for inspection by the administration and that these records be maintained by the contractor for five years. The director shall also require that these records are available by a contractor on request of the secretary of the United States department of health and human services.
E. Subject to existing law relating to privilege and protection, the director shall prescribe by rule the types of information that are confidential and circumstances under which this information may be used or released, including requirements for physician‑patient confidentiality. Notwithstanding any other law, these rules shall be designed to provide for the exchange of necessary information for the purposes of eligibility determination under this article. Notwithstanding any other law, a member's medical record shall be released without the member's consent in situations of suspected cases of fraud or abuse relating to the system to an officer of this state's certified Arizona health care cost containment system fraud control unit who has submitted a written request for the medical record.
F. The director shall provide for the transition of members between contractors and noncontracting providers and the transfer of members who have been determined eligible from hospitals that do not have contracts to care for these persons.
G. To the extent that services are furnished pursuant to this article, a contractor is not subject to title 20 unless the contractor is a qualifying plan and has elected to provide services pursuant to this article.
H. As a condition of a contract, the director shall require contract terms that are necessary to ensure adequate performance by the contractor. Contract provisions required by the director include the maintenance of deposits, performance bonds, financial reserves or other financial security. The director may waive requirements for the posting of bonds or security for contractors who have posted other security, equal to or greater than that required by the administration, with a state agency for the performance of health service contracts if monies would be available from that security for the system on default by the contractor.
I. The director shall establish solvency requirements in contract that may include withholding or forfeiture of payments to be made to a contractor by the administration for the failure of the contractor to comply with a provision of the contract with the administration. The director may also require contract terms allowing the administration to operate a contractor directly under circumstances specified in the contract. The administration shall operate the contractor only as long as it is necessary to assure delivery of uninterrupted care to members enrolled with the contractor and to accomplish the orderly transition of members to other contractors or until the contractor reorganizes or otherwise corrects the contract performance failure. The administration shall not operate a contractor unless, before that action, the administration delivers notice to the contractor providing an opportunity for a hearing in accordance with procedures established by the director. Notwithstanding the provisions of a contract, if the administration finds that the public health, safety or welfare requires emergency action, it may operate as the contractor on notice to the contractor and pending an administrative hearing, which it shall promptly institute.
J. For the sole purpose of matters concerning and directly related to this article, the administration is exempt from section 41‑192.
K. The director may withhold payments to a noncontracting provider if the noncontracting provider does not comply with this article or adopted rules that relate to the specific services rendered and billed to the administration.
L. The director shall:
1. Prescribe uniform forms to be used by all contractors and furnish uniform forms and procedures, including methods of identification of members. The rules shall include requirements that an applicant personally complete or assist in the completion of eligibility application forms, except in situations in which the person is disabled.
2. By rule, establish a grievance and appeal procedure that conforms with the process and the time frames specified in article 1 of this chapter. If the program is suspended or terminated pursuant to section 36‑2985, an applicant or member is not entitled to contest the denial, suspension or termination of eligibility for the program.
3. Apply for and accept federal monies available under title XXI of the social security act. Available state monies appropriated to the administration for the operation of the program shall be used as matching monies to secure federal monies pursuant to this subsection.
M. The administration is entitled to all rights provided to the administration for liens and release of claims as specified in sections 36‑2915 and 36‑2916 and shall coordinate benefits pursuant to section 36‑2903, subsection F and be a payor of last resort for persons who are eligible pursuant to this article.
N. The director shall follow the same procedures for review committees, immunity and confidentiality that are prescribed in article 1 of this chapter.
Sec. 5. Repeal
Section 42-5017, Arizona Revised Statutes, is repealed.
Sec. 6. Services to children; waiver
On or before October 1, 2011, the Arizona health care cost containment system administration shall request a waiver from the centers for medicare and medicaid services to allow services to all children who are eligible pursuant to section 36-2981, Arizona Revised Statutes.
Sec. 7. Appropriation; services to eligible children; exemption
A. The sum of $13,600,000 is appropriated from the state general fund in fiscal year 2011-2012 to the Arizona health care cost containment system administration for services to children who are eligible pursuant to section 36-2981, Arizona Revised Statutes.
B. The appropriation made in subsection A of this section is exempt from the provisions of section 35-190, Arizona Revised Statutes, relating to lapsing of appropriations.
Sec. 8. Requirements for enactment; two-thirds vote
Pursuant to article IX, section 22, Constitution of Arizona, this act is effective only on the affirmative vote of at least two-thirds of the members of each house of the legislature and is effective immediately on the signature of the governor or, if the governor vetoes this act, on the subsequent affirmative vote of at least three-fourths of the members of each house of the legislature.
