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The law mandates that, beginning October 1, 2017, physicians must consult a prescription monitoring program (PMP) prior to prescribing an opioid analgesics or benzodiazepine in schedules II-IV.
Under the new regulations, Arizona health care institutions must establish and implement more comprehensive plans and procedures for prescribing or ordering an opioid or administering an opioid.
Physicians who prescribe opioids, and health care institutions licensed by Arizona’s Department of Health Services, should be aware of this new law, and new rule. If you have any questions regarding these new laws, or would like assistance with updating your policies and procedures to conform to these requirements, please feel free to contact Milligan Lawless.
 SB 1283 (2016), signed by Arizona Governor Doug Ducey in 2016 amended A. R. S. § 36-2606.
 9 AZ Adc. Ch.10, Ariz. Admin. Code R9-10-120.
In an article entitled “Failure in an M&A Transaction for the Physician Owner,” Milligan Lawless partner Steve Lawrence provides tips on how to avoid pitfalls during the M&A Transaction Process.
To read the full article Click Here.
Beginning October 1, 2014, House Bill 2045 will require the Arizona Health Care Costs Containment System Administration (“AHCCCS”) to pay hospitals based on diagnosis, which will replace the current methodology of paying by length of stay. AHCCCS will have authority to make additional adjustments to the payments based on other factors, including the number of beds, available specialty services, and geographic location.
H.B. 2045 also requires physicians to report the “direct pay price” of the 25 most common procedures performed. Hospitals with at least fifty inpatient beds must report the prices of their 50 most common inpatient and outpatient services. These prices will be made public by AHCCCS. “Direct pay price” generally means the price that will be charged by a health care provider for a service regardless of the payor. Practices with fewer than three “health care providers,” which includes more types of providers than medical physicians, are exempt from the reporting requirement. Providers that fail to comply with these requirements may be liable for unprofessional conduct. These provisions may require a review of the physician’s fee schedule, which could impact the determination of usual, customary, and reasonable charges.
In connection with the requirement to report prices, health care providers will also need to obtain the signature of patients who are enrollees of health systems or networks with which the health care provider is contracted.
See H.B. 2045 here.
See the press release for H.B. 2045 here.
Medicare and AHCCCS have requirements that may affect a provider’s policy for assessing missed appointment fees to the beneficiaries of those programs.
Medicare policy prohibits charging Medicare beneficiaries for covered services other than the applicable deductible and coinsurance amounts. CMS took the position that missed appointment fees are not charges for covered services but are instead charges for missed business opportunities. CMS nevertheless requires that Part B suppliers, including physicians, can charge beneficiaries a missed appointment fee so long as the fee is assessed equally against all patients, including non-Medicare beneficiaries. There is no restriction on the amount that may be assessed.
AHCCCS is a different story. The Federal government has placed significant restrictions on a provider’s ability to assess fees for missed appointments, notwithstanding A.R.S. § 36-2930.01, which permits providers to assess a $25 fee for missed appointments. As part of the Section 1115 Waiver, under which AHCCCS operates, the Federal government permits a missed appointment fee to be charged subject to several restrictions, including the following:
1. The fee is no greater than $3;
2. The provider must submit a policy to AHCCCS for approval prior to assessing the fee;
3. The provider must notify the beneficiary of the policy on an annual basis;
4. The provider must have a policy of notifying the beneficiary of upcoming appointments;
5. The fee may be assessed only against beneficiaries that live outside of Maricopa and Pima counties;
6. Providers must notifying AHCCCS beneficiaries, on an annual basis, of the fee related policies; and
7. The provider must keep an accounting of occasions the fee is assessed.
The government could argue that failure to comply with these restrictions is a violation of the Provider Agreement with AHCCCS. The Federal government’s approval for assessing the fee must be renewed again prior to January 1, 2013. If the policy is not renewed, then the assessment of a fee for late appointments would be a violation of Medicaid regulations.
For more information on missed appointment fees for Medicare, click here (See Section 30.3.13).