Bill > SB1713

This bill establishes a new framework for how the Arizona Health Care Cost Containment System Administration (AHCCCS), which manages the state's Medicaid program, contracts with managed care organizations (MCOs), often referred to as contractors. The core of this new system is the "Arizona hybrid model," a performance-based approach that will replace traditional procurement methods like requests for proposals. Instead of evaluating proposals, AHCCCS will assess contractors based on objective, measurable performance metrics outlined in a "performance rubric" and "operational factors" such as claims processing, network adequacy, and member experience. This evaluation will occur during an initial four-year "performance and operations phase," and the results will be the primary basis for deciding whether to continue, expand, limit, or terminate a contractor's agreement. The bill also introduces definitions for terms like "incumbent contractor" (those already serving a program) and "nonincumbent contractor" (new or existing entities seeking to serve a program they don't currently manage), and sets specific requirements for contractor eligibility, operational readiness, and hospital contracting practices to ensure fair competition and access to care. Importantly, the bill exempts AHCCCS from certain standard rulemaking procedures for implementing these changes, requiring only public notice and hearings. The legislature's intent is to create a more transparent, accountable, and stable contracting system that prioritizes demonstrated performance over subjective evaluations.

Health and Social Services

https://apps.azleg.gov/BillStatus/BillOverview/85363