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HB 2449

Concerning use of cannabis tax revenue for professional health care services.

2023-2024 Regular Session Introduced by Greg Cheney and 15 co-sponsors

AHCCCS tightens enrollment by expanding automated data checks, curbs self-attestation, and imposes stricter hospital presumptive-eligibility rules with penalties and CMS waivers.

First reading, referred to Appropriations.
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Bill Summary · HB 2449

Summary — HB 2449 (Arizona)

Title: AHCCCS; enrollment verification; presumptive eligibility
Introduced: February 5, 2025 | Status (from header): Referred to Rules Committee
Note: the provided document bundle contains text from multiple versions of the Arizona bill (Introduced / House Engrossed / Senate Engrossed). It also appears to include unrelated Illinois bill language and mixed legislative-action entries; this summary focuses on the Arizona AHCCCS provisions (adding ARS §§ 36‑2903.17–36‑2903.18).

Purpose / Intent

The bill requires the Arizona Health Care Cost Containment System (AHCCCS) administration to increase automated data verification of member eligibility and to narrow and tighten rules and oversight for hospital “presumptive eligibility” determinations. It seeks to reduce reliance on applicant self‑attestation, improve fraud detection, and impose standards, reporting, training and sanctions for hospitals that make presumptive eligibility determinations.

Key provisions

  1. Data matching and eligibility reviews (ARS § 36‑2903.17)

    • AHCCCS must enter a data‑matching agreement with the Department of Revenue to identify members with lottery/gambling winnings of $3,000+ and review at least monthly; undisclosed winnings identified count as an eligibility violation.
    • Monthly review of death records from the Department of Health Services; adjust eligibility as needed.
    • Quarterly review of information from Department of Economic Security and (in some versions) the Industrial Commission regarding unemployment, employment status, wages.
    • Monthly review of indicators of changed residency, including out‑of‑state EBT transactions.
    • Quarterly review of Department of Revenue tax records for income/wage/residency changes.
    • Unless federal law requires otherwise, AHCCCS may not accept self‑attestation of income, residency, age, household composition, caretaker status or other coverage without independent verification before enrollment and may not seek authority to waive periodic income‑data checks.
    • AHCCCS may accept assessments from an exchange but must independently verify eligibility (may not accept exchange determinations).
    • AHCCCS may enter MOUs with other state agencies and contract with vendors to obtain additional data.
    • AHCCCS must submit any required CMS (federal) waiver requests to implement these processes on or before April 1, 2026.

  2. Presumptive eligibility limits, standards and hospital oversight (ARS § 36‑2903.18)

    • AHCCCS must seek a Section 1115 waiver from CMS to (a) eliminate mandatory hospital presumptive eligibility and (b) restrict presumptive eligibility determinations to children and pregnant women; if denied, resubmit within 12 months of each denial.
    • AHCCCS may not designate itself as a qualified health entity for presumptive determinations unless federal law requires it.
    • Requirements for qualified hospitals when making presumptive eligibility determinations:
      • Notify AHCCCS within 5 working days of each determination.
      • Assist presumptively eligible individuals to complete and submit full AHCCCS applications.
      • Provide written, plain‑language, large‑print notice to applicants about the application deadline and coverage end dates.
    • AHCCCS shall apply standards to monitor the accuracy of hospital determinations (timely submission of presumptive eligibility card, whether a full application was filed before expiration, and whether the individual was later found eligible).
    • Progressive enforcement for violations: written notices, mandatory training for hospital staff after repeat findings, available appeal procedures, and eventual loss of hospital qualification to make presumptive eligibility determinations after repeated failures (detailed sanctions escalate across first/second/third violations).

Who is affected

  • AHCCCS administration (new data‑sharing, verification, reporting and waiver responsibilities).
  • AHCCCS members/enrollees (stricter verification, potential reevaluations and terminations if data indicate ineligibility).
  • Hospitals designated to make presumptive eligibility determinations (additional reporting, assistance obligations, training requirements, and risk of decertification).
  • State agencies (Department of Revenue, Department of Health Services, Department of Economic Security, Industrial Commission) — required or enabled to provide data under MOUs.
  • Potential vendors / contractors providing eligibility‑related data services.
  • CMS (federal approval required via Section 1115 and other waivers).

Procedural / timeline notes

  • AHCCCS must submit necessary waiver requests to CMS by April 1, 2026 (per the bill).
  • For the Section 1115 waiver limiting presumptive eligibility, AHCCCS must resubmit requests within 12 months after any denial.
  • Several provisions are qualified by “unless required by federal law,” meaning federal Medicaid rules and CMS approvals could limit or alter implementation.

Potential impacts / considerations

  • Likely increases in administrative workload and IT/data‑sharing needs for AHCCCS and partner agencies; possible contracting for vendor services.
  • Greater detection of undisclosed income/assets and potential reduction in erroneous enrollments, but also increased risk of temporary coverage disruption if verification processes are slower or more burdensome.
  • Hospitals will incur compliance costs (reporting, training, assistance to applicants) and face stronger penalties for noncompliance.
  • Privacy and data‑security considerations arise from expanded interagency data matching and vendor contracts.
  • Implementation depends on federal CMS approvals for waivers; key elements cannot be enacted unilaterally where federal rules govern.

If you want, I can produce a short one‑page fact sheet for hospitals, AHCCCS members, or a timeline checklist for AHCCCS to implement the bill’s requirements.

Compiled from official sources — confirm details with the bill’s official record.

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