36-2913. Systems funds; funding

649 words·~3 min read·/az/title-36/36-2913

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

A. The Arizona health care cost containment system fund, long-term care system fund and the third-party liability and recovery audit fund are established. The funds shall be used to pay administrative and program costs associated with the operation of the system established pursuant to this article and the long-term care system established pursuant to article 2 of this chapter.

B. Separate accounts, including but not limited to a reserve fund, may be established within the funds. Different accounts within the funds shall be established in order to separately account for expense and income activity associated with the system established pursuant to this article and article 2 of this chapter.

C. The Arizona health care cost containment system fund and long-term care system fund shall be comprised of:

1. Monies paid by each of the counties of this state of the amounts determined or withheld by the state treasurer pursuant to section 11-292.

2. Monies paid by each county resolving to participate in the system equal to the actual cost, as limited by the board of supervisors, together with employee contributions of providing hospitalization and medical care under the system to full-time officers and employees of the county and its departments and agencies.

3. Monies paid by this state equal to the actual cost, as limited by section 38-651, together with employee contributions of providing hospitalization and medical care under the system to full-time officers and employees of this state, of its departments and agencies and of cities, towns and school districts of this state.

4. Monies drawn against appropriations made by this state for the costs of operating the Arizona health care cost containment system or the long-term care system. Monies shall be drawn against appropriations and transferred from the fund from which they were appropriated on an as needed basis only.

5. Gifts, donations and grants from any source.

6. Federal monies made available to this state for the operation of the Arizona health care cost containment system or the long-term care system.

7. Interest paid on monies deposited in the fund.

8. Reimbursements for data collection.

D. The third-party liability and recovery audit fund is comprised of monies paid by first-party payors, third-party payors, lien and estate recoveries and medical service providers for recovery audit contractor findings.

E. All monies in the funds other than monies appropriated by the state shall not lapse.

F. All monies drawn against appropriations made by this state remaining in the funds at the end of the fiscal year shall revert to the fund from which they were appropriated and drawn, and the appropriation shall lapse in accordance with section 35-190. Notwithstanding the provisions of section 35-191, subsection B, the period for administrative adjustments shall extend for only six months for appropriations made for system covered services.

G. Notwithstanding sections 35-190 and 35-191, all approved claims for system covered services presented after the close of the fiscal year in which they were incurred shall be paid either in accordance with subsection F of this section or in the current fiscal year with the monies available in the funds established by this section.

H. Claims for system covered services that are determined valid by the director pursuant to section 36-2904, subsection G and the department's grievance and appeal procedure shall be paid from the funds established by this section.

I. For purposes of this section, system covered services exclude administrative charges for operating expenses.

J. All payments for claims from the funds established by this section shall be accounted for by the administration by the fiscal year in which the claims were incurred, regardless of the fiscal year in which the payments were made.

K. Notwithstanding any other law, county owned or contracted providers and special health care district owned or contracted providers are subject to all claims processing and payment requirements or limitations of this chapter that are applicable to noncounty providers.