36-2932

36-2932. Arizona long-term care system; powers
and duties of the director; expenditure limitation

A. The Arizona long-term care system is established. The system includes the
management and delivery of hospitalization, medical care, institutional services and home
and community based services to members through the administration, the program
contractors and providers pursuant to this article together with federal participation
under title XIX of the social security act. The director in the performance of all duties
shall consider the use of existing programs, rules and procedures in the counties and
department where appropriate in meeting federal requirements.

B. The administration has full operational responsibility for the system which
shall include the following:

1. Contracting with and certification of program contractors in compliance with all
applicable federal laws.

2. Approving the program contractors' comprehensive service delivery plans pursuant
to section 36-2940.

3. Providing by rule for the ability of the director to review and approve or
disapprove program contractors' request for proposals for providers and provider
subcontracts.

4. Providing technical assistance to the program contractors.

5. Developing a uniform accounting system to be implemented by program contractors
and providers of institutional services and home and community based services.

6. Conducting quality control on eligibility determinations and preadmission
screenings.

7. Establishing and managing a comprehensive system for assuring the quality of
care delivered by the system as required by federal law.

8. Establishing an enrollment system.

9. Establishing a member case management tracking system.

10. Establishing and managing a method to prevent fraud by applicants, members,
eligible persons, program contractors, providers and noncontracting providers as required
by federal law.

11. Coordinating benefits as provided in section 36-2946.

12. Establishing standards for the coordination of services.

13. Establishing financial and performance audit requirements for program
contractors, providers and noncontracting providers.

14. Prescribing remedies as required pursuant to 42 United States Code section
1396r. These remedies may include the appointment of temporary management by the
director, acting in collaboration with the director of the department of health services,
in order to continue operation of a nursing care institution providing services pursuant
to this article.

15. Establishing a system to implement medical child support requirements, as
required by federal law. The administration may enter into an intergovernmental agreement
with the department of economic security to implement this paragraph.

16. Establishing requirements and guidelines for the review of trusts for the
purposes of establishing eligibility for the system pursuant to section 36-2934.01 and
posteligibilty treatment of income pursuant to subsection L of this section.

17. Accepting the delegation of authority from the department of health services to
enforce rules that prescribe minimum certification standards for adult foster care
providers pursuant to section 36-410, subsection B. The administration may contract with
another entity to perform the certification functions.

18. Assessing civil penalties for improper billing as prescribed in section
36-2903.01, subsection L.

C. For nursing care institutions and hospices that provide services pursuant to
this article, the director shall periodically as deemed necessary and as required by
federal law contract for a financial audit of the institutions and hospices that is
certified by a certified public accountant in accordance with generally accepted auditing
standards or conduct or contract for a financial audit or review of the institutions and
hospices. The director shall notify the nursing care institution and hospice at least
sixty days before beginning a periodic audit. The administration shall reimburse a
nursing care institution or hospice for any additional expenses incurred for professional
accounting services obtained in response to a specific request by the administration. On
request, the director of the administration shall provide a copy of an audit performed
pursuant to this subsection to the director of the department of health services or that
person's designee.

D. Notwithstanding any other provision of this article, the administration may
contract by an intergovernmental agreement with an Indian tribe, a tribal council or a
tribal organization for the provision of long-term care services pursuant to section
36-2939, subsection A, paragraphs 1, 2, 3 and 4 and the home and community based services
pursuant to section 36-2939, subsection B, paragraph 2 and subsection C, subject to the
restrictions in section 36-2939, subsections D and E for eligible members.

E. The director shall require as a condition of a contract that all records
relating to contract compliance are available for inspection by the administration
subject to subsection F of this section and that these records are maintained for five
years. The director shall also require that these records are available on request of the
secretary of the United States department of health and human services or its successor
agency.

F. Subject to applicable law relating to privilege and protection, the director
shall adopt rules prescribing the types of information that are confidential and
circumstances under which that information may be used or released, including
requirements for physician-patient confidentiality. Notwithstanding any other law, these
rules shall provide for the exchange of necessary information among the program
contractors, the administration and the department for the purposes of eligibility
determination under this article.

G. The director shall adopt rules which specify methods for the transition of
members into, within and out of the system. The rules shall include provisions for the
transfer of members, the transfer of medical records and the initiation and termination
of services.

H. The director shall adopt rules which provide for withholding or forfeiting
payments made to a program contractor if it fails to comply with a provision of its
contract or with the director's rules.

I. The director shall:

1. Establish by rule the time frames and procedures for all grievances and requests
for hearings consistent with section 36-2903.01, subsection B, paragraph 4.

2. Apply for and accept federal monies available under title XIX of the social
security act in support of the system. In addition, the director may apply for and
accept grants, contracts and private donations in support of the system.

3. Not less than thirty days before the administration implements a policy or a
change to an existing policy relating to reimbursement, provide notice to interested
parties. Parties interested in receiving notification of policy changes shall submit a
written request for notification to the administration.

J. The director may apply for federal monies available for the support of programs
to investigate and prosecute violations arising from the administration and operation of
the system. Available state monies appropriated for the administration of the system may
be used as matching monies to secure federal monies pursuant to this subsection.

K. The director shall adopt rules which establish requirements of state residency
and qualified alien status as prescribed in section 36-2903.03. The administration shall
enforce these requirements as part of the eligibility determination process. The rules
shall also provide for the determination of the applicant's county of residence for the
purpose of assignment of the appropriate program contractor.

L. The director shall adopt rules in accordance with the state plan regarding
posteligibility treatment of income and resources which determine the portion of a
member's income which shall be available for payment for services under this article.
The rules shall provide that a portion of income may be retained for:

1. A personal needs allowance for members receiving institutional services of at
least fifteen per cent of the maximum monthly supplemental security income payment for an
individual or a personal needs allowance for members receiving home and community based
services based on a reasonable assessment of need.

2. The maintenance needs of a spouse or family at home shall be in accordance with
federal law. The minimum resource allowance for the spouse or family at home is twelve
thousand dollars adjusted annually by the same percentage as the percentage change in the
consumer price index for all urban consumers (all items; United States city average)
between September 1988 and the September before the calendar year involved.

3. Expenses incurred for noncovered medical or remedial care that are not subject
to payment by a third party payor.

M. In addition to the rules otherwise specified in this article, the director may
adopt necessary rules pursuant to title 41, chapter 6 to carry out this article. Rules
adopted by the director pursuant to this subsection may consider the differences between
rural and urban conditions on the delivery of services.

N. The director shall not adopt any rule or enter into or approve any contract or
subcontract which does not conform to federal requirements or which may cause the system
to lose any federal monies to which it is otherwise entitled.

O. The administration, program contractors and providers may establish and maintain
review committees dealing with the delivery of care. Review committees and their staff
are subject to the same requirements, protections, privileges and immunities prescribed
pursuant to section 36-2917.

P. If the director determines that the financial viability of a nursing care
institution or hospice is in question the director may require a nursing care institution
and a hospice providing services pursuant to this article to submit quarterly financial
statements within thirty days after the end of its financial quarter unless the director
grants an extension in writing before that date. Quarterly financial statements submitted
to the department shall include the following:

1. A balance sheet detailing the institution's assets, liabilities and net worth.

2. A statement of income and expenses, including current personnel costs and
full-time equivalent statistics.

Q. The director may require monthly financial statements if the director determines
that the financial viability of a nursing care institution or hospice is in
question. The director shall prescribe the requirements of these statements.

R. The total amount of state monies that may be spent in any fiscal year by the
administration for long-term care shall not exceed the amount appropriated or authorized
by section 35-173 for that purpose. This article shall not be construed to impose a duty
on an officer, agent or employee of this state to discharge a responsibility or to create
any right in a person or group if the discharge or right would require an expenditure of
state monies in excess of the expenditure authorized by legislative appropriation for
that specific purpose.