Sec 36-3410. Regional behavioral health authorities; contracts; monthly summaries; inspection; copying fee; children's behavioral health and seriously mentally ill services

A. If the administration contracts with behavioral health contractors that would act as regional behavioral health authorities or directly with a service provider for behavioral health services, the administration and each behavioral health contractor or service provider shall prepare and make available monthly summary statements, in a format prescribed by the administration, that separately detail by title XIX and nontitle XIX and by service category and service type, as defined by contract with the administration, the number of clients served, the units of service provided and the state and federal monies distributed through the administration to each regional behavioral health authority or direct contract service provider and the amounts distributed by each regional behavioral health authority or direct contract service provider to its subcontractors. The director may require additional information in the monthly statement that the director determines to be critical for proper regulation and oversight of the regional behavioral health authority or the direct contract service provider.

B. For services provided directly by a regional behavioral health authority, the maximum reimbursement to that regional behavioral health authority shall be thirty percent above the Arizona health care cost containment system fee for service rate for the particular service rendered.

C. Except as provided in subsections D and E of this section, behavioral health contractors under contract with the administration to act as regional behavioral health authorities may perform only managed care functions. Regional behavioral health authorities and their subsidiaries shall not deliver behavioral health services directly to clients.

D. If a direct services behavioral health provider experiences contract performance failure, the regional behavioral health authority, after receiving approval from the administration, may provide direct care services for only as long as necessary to ensure delivery of uninterrupted care to clients and either:

1. Accomplish the orderly transition of those members to a new provider or other existing providers.

2. Until the provider in question reorganizes or otherwise corrects the contract performance failure.

E. Subsection C of this section does not apply to a regional behavioral health authority operated by a federally recognized Indian tribe.

F. In the contracts specified under subsection A of this section, the administration may include a provision to charge, payable to the department of health services, for services provided at the state hospital. The charges are only for clients on whose behalf the contractor has been paid by the administration.

G. The summaries and the contracts on which they are based are open to public inspection. The administration and each regional behavioral health authority or direct contract service provider shall make the summaries available for inspection and copying at the office of each regional behavioral health authority or direct contract service provider and at the administration.

H. The administration and a regional behavioral health authority or direct contract service provider shall charge a copying fee that is not in excess of the actual cost of reproduction or the amount charged by the secretary of state pursuant to section 41-126, whichever is less.

I. Copying fees received by the administration, pursuant to subsection H of this section, shall be placed in the Arizona health care cost containment system fund established by section 36-2913.

J. Monies appropriated each fiscal year for children's behavioral health services shall be spent on services only as prescribed by the appropriation and may not be used for any other purpose.

K. Monies appropriated each fiscal year for seriously mentally ill services shall be spent on services only as prescribed by the appropriation and shall not be used for any other purpose.

(L15, Ch. 195, sec. 69. Eff. 7/1/16)