The proposed bill would amend current statutes related to managed care organizations (MCOs) under the Arizona Health Care Cost Containment System (AHCCCS) by introducing new requirements for terminating contracts with high-volume service providers. Specifically, MCOs would be required to provide written notice to the administration at least ninety days prior to terminating a high-volume service provider's contract without cause, including documentation of the provider's high-volume status, a network adequacy study, and an assessment of the termination's impact on network adequacy. Additionally, the administration must review the network adequacy study and confirm that standards will continue to be met before any termination can proceed. The bill also defines "high-volume service provider" and outlines the necessary components of the network adequacy study, which includes evaluating service provider-to-enrollee ratios and appointment wait times. Furthermore, if an MCO declines to contract with a service provider based on network adequacy, it must submit a detailed network adequacy study to the administration, which will be made publicly available. Overall, these updates aim to enhance accountability and ensure continued access to care for members relying on high-volume service providers.

Statutes affected:
Introduced Version: 36-2930.07, 36-2961, 36-3414
Senate Engrossed Version: 36-2930.07, 36-2961, 36-3414