36-2988

36-2988. Delivery of services; health plans;
requirements

A. To the extent possible, the administration shall use contractors that have a
contract with the administration pursuant to article 1 of this chapter or qualifying
plans to provide services to members who qualify for the program.

B. The administration has full authority to amend existing contracts awarded
pursuant to article 1 of this chapter.

C. As determined by the director, reinsurance may be provided against expenses in
excess of a specified amount on behalf of any member for covered emergency services,
inpatient services or outpatient services in the same manner as reinsurance provided
under article 1 of this chapter. Subject to the approval of the director, reinsurance
may be obtained against expenses in excess of a specified amount on behalf of any member.

D. Notwithstanding any other law, the administration may procure, provide or
coordinate covered services by interagency agreement with authorized agencies of this
state for distinct groups of members, including persons eligible for children's
rehabilitative services through the department of health services and members eligible
for comprehensive medical and dental benefits through the department of economic
security.

E. After contracts are awarded pursuant to this section, the director may negotiate
with any successful bidder for the expansion or contraction of services or service areas.

F. Payments to contractors shall be made monthly and may be subject to contract
provisions requiring the retention of a specified percentage of the payment by the
director, a reserve fund or any other contract provisions by which adjustments to the
payments are made based on utilization efficiency, including incentives for maintaining
quality care and minimizing unnecessary inpatient services. Reserve monies withheld from
contractors shall be distributed to providers who meet performance standards established
by the director. Any reserve fund established pursuant to this subsection shall be
established as a separate account within the Arizona health care cost containment system.

G. The director may negotiate at any time with a hospital on behalf of a contractor
for inpatient hospital services and outpatient hospital services provided pursuant to the
requirements specified in section 36-2904.

H. A contractor may require that subcontracting providers or noncontracting
providers be paid for covered services, other than hospital services, according to the
capped fee-for-service schedule adopted by the administration or at lower rates as may be
negotiated by the contractor.

I. A school district may perform outreach and information activities that relate to
this article, with permission of the school principal and school district. The
administration and contractors may collaborate with entities such as community based
organizations, faith based organizations, schools and school districts for outreach and
information activities related to this article. Outreach and information activities
shall not include delivery of services, screening activities, eligibility determination
or enrollment related to this article. Outreach and information activities include
promotion of health care coverage, participation in school events and distribution of
applications and materials to pupils and their families. Outreach and information
activities performed by the administration, contractors or a school district shall not
reduce or interfere with classroom instruction time.

J. The administration is exempt from the procurement code pursuant to section
41-2501.