HB 2753 — graduate medical education; residency programs

Preventive dental services.

7.

Emergency services performed at the qualifying community health center.

8.

Transportation for patients to and from the qualifying community health center if these patients would not receive care without this assistance.

B.

A contract entered into pursuant to subsection A of this section may include urgent care services for walk-in patients.

C.

Each contract shall require that the qualifying community health center provide the services prescribed in subsection A of this section to persons who the QUALIFYING COMMUNITY HEALTH center determines:

AreSUPPORTS residentsAND ofEXPANDS thisTHE state.NUMBER OF PRIMARY CARE RESIDENCY POSITIONS.

ArePROVIDES withoutSUPPORT medicalAND insuranceTECHNICAL policyASSISTANCE coverage.FOR STARTING OR EXPANDING PRIMARY CARE RESIDENCY PROGRAMS IN RURAL AREAS AND HEALTH PROFESSIONAL SHORTAGE AREAS.

DoFACILITATES notINFORMATION haveAND aRESOURCE familySHARING incomeAND ofPROVIDES moreTRAINING thanAND twoTECHNICAL hundredASSISTANCE, percentINCLUDING ofPRECEPTOR theTRAINING federalAND povertyDEVELOPMENT, guidelines.CONTINUING EDUCATION, MEDICAL LIBRARY ACCESS AND OTHER FUNCTIONS, TO SUPPORT THE SUCCESS OF QUALIFYING COMMUNITY HEALTH CENTER, - 1 - H.B.

4.2753 RURAL HEALTH CLINIC AND TRIBAL HEALTH FACILITY PRIMARY CARE RESIDENCY PROGRAMS.

Have provided verification that the person is not eligible for enrollment in the Arizona health care cost containment system pursuant to this chapter.

5.

Have provided verification that the person is not eligible for medicare.

D.

The department of health services shall directly administer the program and issue requests for proposals for the contracts prescribed in this section.

Contracts established pursuant to subsection A of this section shall be signed by the department and the contractor before the transmission of any tobacco tax and health care fund monies to the contractor.

PersonsF. who meet the eligibility criteria established in subsection C or H of this section shall be charged for services based on a sliding fee schedule approved by the department of health services.

-2-The Senatedirector Amendmentsshall submit a written report on or before November 15 of each year to H.B.the governor, the president of the senate and the speaker of the house of representatives.

2753The F.report shall contain the following:

In awarding contracts, the department of health services may give preference to qualifying community health centers that have a sliding fee schedule.

Monies shall be used for the number of patients that exceeds the number of uninsured sliding fee schedule patients that the qualifying community health center served during fiscal year 1994.

Each qualifying community health center shall make its sliding fee schedule available to the public on request.

The contract shall require the qualifying community health center to apply a sliding fee schedule to all of its uninsured patients.

G.

The department of health services may examine the records of each qualifying community health center and conduct audits necessary to determine that the eligibility determinations were performed accurately and to verify the number of uninsured patients served by the qualifying community health center as a result of receiving tobacco tax and health care fund monies by the contract established pursuant to subsection A of this section.

H.

Contracts established pursuant to subsection A of this section shall require qualifying community health center contractors to submit information as required pursuant to section 36-2907.07 for program evaluations.

I.

Beginning March 1, 2022, The administration shall establish, contingent on approval by the centers for medicare and medicaid services, a separate graduate medical education AND ADVANCED PRACTICE REGISTERED NURSE RESIDENCY OR FELLOWSHIP program to reimburse qualifying community health centers, and rural health clinics AND TRIBAL HEALTH FACILITIES that have an approved primary care graduate medical education OR ADVANCED PRACTICE REGISTERED NURSE RESIDENCY OR FELLOWSHIP program.

The administration shall:

DistributeThe tofiscal qualifyingstatus community health centers, and rural health clinics AND TRIBAL HEALTH FACILITIES any monies appropriated for graduate medical education for the direct and indirect costs of primaryeach carecenter. graduate medical education AND ADVANCED PRACTICE REGISTERED NURSE -3- Senate Amendments to H.B.

2753 RESIDENCY OR FELLOWSHIP programs that are established by qualifying community health centers, and rural health clinics AND TRIBAL HEALTH FACILITIES and that are approved by the administration.

AdoptInformation rulesregarding specifyingcenter theeducation, formulaoutreach byand whichtraining theprograms. monies are distributed.

RequireInformation eachregarding primaryplacement care graduate medical education AND ADVANCED PRACTICE REGISTERED NURSE RESIDENCY OR FELLOWSHIP program that receives monies pursuant to paragraph 1 of thishealth subsectioncare topersonnel identifyin andareas report to the administrationdirector thedetermines numberare ofunderserved newby residencythese ANDprofessionals. FELLOWSHIP positions created with those monies, including positions in rural areas.

Each program shall also report information related to the number of funded residency AND FELLOWSHIP positions that resulted in physicians AND ADVANCED PRACTICE REGISTERED NURSES locating their practices in this state.

The administration shall report to the joint legislative budget committee on or before July 1 of each year on the number of new residency AND FELLOWSHIP positions as reported by the primary care graduate medical education AND ADVANCED PRACTICE REGISTERED NURSE RESIDENCY OR FELLOWSHIP programs pursuant to this paragraph.

CoordinateAn withassessment local, county and tribal governments and any university under the jurisdiction of thesystem Arizonaaccomplishments. board of regents that may provide monies in addition to any state general fund monies appropriated for primary care graduate medical education AND ADVANCED PRACTICE REGISTERED NURSE RESIDENCY OR FELLOWSHIP PROGRAMS in order to qualify for additional matching federal monies for programs or positions in a specific locality.

Payments by the administration pursuant to this paragraph may be limited to those providers designated by the funding entity and may be based on any methodology deemed appropriate by the administration, including replacing any payments that might otherwise have been paid pursuant to paragraph 1 of this subsection had sufficient state general fund monies or other monies been appropriated to fully fund those payments.

These programs, positions and payment methodologies must be approved by the administration and the centers for medicare and medicaid -4- Senate Amendments to H.B.

2753 services.

The administration shall report to the president of the senate, the speaker of the house of representatives and the director of the joint legislative budget committee on or before July 1 of each year on the amount of monies contributed and the number of residency AND FELLOWSHIP positions funded by local, county and tribal governments and any university under the jurisdiction of the Arizona board of regents, including the amount of federal matching monies used.

IFRecommendations THEfor ADMINISTRATIONpossible HASlegislative NOTaction. RECEIVED APPROVAL FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES ON OR BEFORE JUNE 1, 2024, DISTRIBUTE THE MONIES FOR THAT FISCAL YEAR TO THE QUALIFYING COMMUNITY HEALTH CENTERS, RURAL HEALTH CLINICS AND TRIBAL HEALTH FACILITIES THAT HAVE APPROVED PRIMARY CARE GRADUATE MEDICAL EDUCATION OR ADVANCED PRACTICE REGISTERED NURSE RESIDENCY OR FELLOWSHIP PROGRAMS.

IFF. THE CENTERS FOR MEDICAID AND MEDICARE SERVICES' APPROVAL IS RECEIVED AFTER JUNE 1, 2024, THESE MONIES MAY QUALIFY AS THE REQUIRED MATCH FOR THE SUBSEQUENT FISCAL YEAR.

J.G.

ForThe thesystem purposesshall ofprovide thisexpertise section:and administrative services to each center.

,H. 1.

"QualifyingFOR communityTHE healthPURPOSES center"OF meansTHIS aSECTION: community-based primary care facility that provides medical care in medically underserved areas as provided in section 36-2352, or in medically underserved areas or medically underserved populations as designated by the United States department of health and human services, through the employment of physicians, professional nurses, physician assistants or other health care technical and paraprofessional personnel.

1.

"PRIMARY CARE" MEANS FAMILY MEDICINE, INTERNAL MEDICINE, PEDIATRICS, PEDIATRIC INTERNAL MEDICINE, PSYCHIATRY, OBSTETRICS AND GYNECOLOGY, GERIATRICS OR GENERAL SURGERY.

2203)."2203). Renumber to conform -5- Senate Amendments to H.B.

2753Sec. Page 2, line 42, after "education;" insert "advanced practice registered nurse programs;" Page 3, line 1, strike "paragraph 4," Line 3, after "education" insert "or advanced practice registered nurse residency or fellowship programs" Amend title to conform JOHN KAVANAGH 2753KAVANAGH.docx 03/27/2023 02:58 PM C:

MH2. -6-

Appropriation;

Arizona area health education system;

primary care residency programs;

exemption;

definition A.

The sum of $5,000,000 is appropriated onetime from the state general fund in fiscal year 2023-2024 to the Arizona area health education system for the purposes of section 15-1643, subsection E, Arizona Revised Statutes, as added by this act.

The Arizona area health education system may use up to $500,000 of the appropriation to support a collaborative of qualifying community health centers', rural health clinics' and tribal health facilities primary care residency programs.

B.

The appropriation made in subsection A of this section is exempt from the provisions of section 35-190, Arizona Revised Statutes, relating to lapsing of appropriations.

C.

For the purposes of this section, "tribal health facility" has the same meaning prescribed in section 15-1643, Arizona Revised Statutes, as amended by this act.

Sec.

3.

Appropriations;

Arizona health care cost containment system administration;

primary care graduate medical education;

exemption;

definition A.

The sum of $5,000,000 is appropriated from the state general fund in each of fiscal years 2023-2024, 2024-2025 and 2025-2026 to the Arizona health care cost containment system administration for the - 2 - H.B.

2753 purposes of section 36-2907.06, subsection I, paragraph 4, Arizona Revised Statutes, for the direct and indirect costs of primary care graduate medical education at qualifying community health centers, rural health clinics and tribal health facilities.

B.

The appropriation made in subsection A of this section is exempt from the provisions of section 35-190, Arizona Revised Statutes, relating to lapsing of appropriations.

C.

For the purposes of this section, "tribal health facility" has the same meaning prescribed in section 15-1643, Arizona Revised Statutes, as amended by this act.

- 3 -