Ariz. Admin. Code § 6-6-2114

Current through Register Vol. 30, No. 50, December 13, 2024

Section R6-6-2114 - Rate Setting

A. The Division may establish a rate structure for community developmental disability services, including the rate structure for provider organizations, professional independent providers and individual independent providers. Each fiscal year, the Division shall review the reimbursement rates for Arizona long-term care services and state only programs and may update the rate structure.

1. The Division shall contract with an independent consulting firm for an annual review of the adequacy and appropriateness of reimbursement rates to providers of community developmental disability services.

2. The Division shall complete a study of reimbursement rates for each community developmental disability service contracted for by the Division no less than once every five years.

3. The Division may require, and Qualified Vendors and Individual Independent Providers shall provide, financial data to the Division in the form and format prescribed by the Division to assist in the annual review. The Division shall seek provider recommendations regarding the form and format.

4. The Division shall annually establish a schedule that identifies which community developmental disability services will be reviewed for adequacy and appropriateness, and which community developmental disability services will be included in the rate reimbursement study.

5. The Department shall determine if the independent consulting firm shall perform one or more of the following activities to measure the adequacy and appropriateness of the reimbursement rates:

a. Review the Department's current rate structure,

b. Conduct a provider cost survey,

c. Compare the Department's rates to rates for similar services used by other state agencies, and

d. Develop independent rate models for community developmental disabilities services.

6. The Assistant Director may consider evidence of the adequacy and appropriateness of the Division's reimbursement rates gathered from R6-6-2114(5)(a) through (d), the rate study, or other relevant data sources to determine whether a new rate needs to be created or an existing rate needs to be revised.

7. After considering the evidence in the adequacy and appropriateness review, the Assistant Director may establish a rate change for each service reviewed, based on the availability of funds.

8. After considering the evidence in the study of reimbursement rates and independent rate models, the Assistant Director may propose a new rate.

9. The Division shall provide public notice if rates for a community developmental disability service are to be established or revised. The Division shall include in the notice the proposed rate or rate change, the effective date of the rate change, where those rates shall be available for review and, if a rate for a service is being established for the first time, any phase-in schedule for the rate change.

10. The Division may provide a public comment period regarding the rate change.

11. The Assistant Director shall review any public comments received about the proposed rate, rate change or phase-in schedule, existing service history or current purchase of service information about the rates and any other information and may make adjustments to the proposed rate, rate change or phase-in schedule prior to finalizing the rate and the phase-in schedule.

12. The Division shall provide public notice of the final rates and phase-in schedule.

13. The Division shall adjust rates in accordance with legislatively mandated and appropriated increases or decreases.

14. The Division shall maintain rate schedules for providers of community developmental disability services at the central office of the Division for reference use during customary business hours.

B. When the rate for a service is established for the first time, the Assistant Director may implement the rate through a phase-in schedule not to exceed three years in duration.

1. When current rates are below the newly established rate, the Division may phase in the implementation of the new rates as follows:

a. In the first and second year of the new rate, providers may receive an incremental increase of the difference between their prior rate and the new rate;

b. In the third year, the providers shall receive the full rate.

2. When current rates are above the newly established rate, the Division may phase in the implementation of the new rates as follows:

a. In the first and second year of the new rate, providers may receive an incremental rate decrease from their prior rate to the new rate;

b. In the third year, the providers shall receive the new rate.

C. For a negotiated rate agreement, the Division may:

1. Hold discussions with any or all applicants regarding their offers;

2. Issue a written request for a final proposal revision to responsive applicants, which shall set forth the date, time, and place for the submission of the final proposal revision. If the applicant does not submit a notice of withdrawal or a final proposal revision in response to the Division's request, the Division shall use the applicant's most recent offer as the final proposal revision; and

3. Determine that an additional final proposal revision is needed.

D. The Division shall include in a negotiated rate agreement the effective date of the negotiated rate.

Ariz. Admin. Code § R6-6-2114

New Section made by exempt rulemaking at 9 A.A.R. 170, effective February 1, 2003 (Supp. 03-1). Amended by exempt rulemaking at 9 A.A.R. 4656, effective October 9, 2003 (Supp. 03-4).