Arizona Administrative Code
Title 6 - ECONOMIC SECURITY
Chapter 6 - DEPARTMENT OF ECONOMIC SECURITY - DEVELOPMENTAL DISABILITIES
Article 21 - DIVISION PROCUREMENT AND RATE SETTING - QUALIFIED VENDORS
Section R6-6-2114 - Rate Setting
Universal Citation: AZ Admin Code R 6-6-2114
Current through Register Vol. 31, No. 12, March 21, 2025
A. The Division may establish a rate structure for community developmental disability services, including the rate structure for provider organizations, professional independent providers and individual independent providers. Each fiscal year, the Division shall review the reimbursement rates for Arizona long-term care services and state only programs and may update the rate structure.
1. The Division shall contract
with an independent consulting firm for an annual review of the adequacy and
appropriateness of reimbursement rates to providers of community developmental
disability services.
2. The
Division shall complete a study of reimbursement rates for each community
developmental disability service contracted for by the Division no less than
once every five years.
3. The
Division may require, and Qualified Vendors and Individual Independent
Providers shall provide, financial data to the Division in the form and format
prescribed by the Division to assist in the annual review. The Division shall
seek provider recommendations regarding the form and format.
4. The Division shall annually establish a
schedule that identifies which community developmental disability services will
be reviewed for adequacy and appropriateness, and which community developmental
disability services will be included in the rate reimbursement study.
5. The Department shall determine if the
independent consulting firm shall perform one or more of the following
activities to measure the adequacy and appropriateness of the reimbursement
rates:
a. Review the Department's current rate
structure,
b. Conduct a provider
cost survey,
c. Compare the
Department's rates to rates for similar services used by other state agencies,
and
d. Develop independent rate
models for community developmental disabilities services.
6. The Assistant Director may consider
evidence of the adequacy and appropriateness of the Division's reimbursement
rates gathered from
R6-6-2114(5)(a) through
(d), the rate study, or other relevant data
sources to determine whether a new rate needs to be created or an existing rate
needs to be revised.
7. After
considering the evidence in the adequacy and appropriateness review, the
Assistant Director may establish a rate change for each service reviewed, based
on the availability of funds.
8.
After considering the evidence in the study of reimbursement rates and
independent rate models, the Assistant Director may propose a new
rate.
9. The Division shall provide
public notice if rates for a community developmental disability service are to
be established or revised. The Division shall include in the notice the
proposed rate or rate change, the effective date of the rate change, where
those rates shall be available for review and, if a rate for a service is being
established for the first time, any phase-in schedule for the rate
change.
10. The Division may
provide a public comment period regarding the rate change.
11. The Assistant Director shall review any
public comments received about the proposed rate, rate change or phase-in
schedule, existing service history or current purchase of service information
about the rates and any other information and may make adjustments to the
proposed rate, rate change or phase-in schedule prior to finalizing the rate
and the phase-in schedule.
12. The
Division shall provide public notice of the final rates and phase-in
schedule.
13. The Division shall
adjust rates in accordance with legislatively mandated and appropriated
increases or decreases.
14. The
Division shall maintain rate schedules for providers of community developmental
disability services at the central office of the Division for reference use
during customary business hours.
B. When the rate for a service is established for the first time, the Assistant Director may implement the rate through a phase-in schedule not to exceed three years in duration.
1. When current rates are below the newly
established rate, the Division may phase in the implementation of the new rates
as follows:
a. In the first and second year of
the new rate, providers may receive an incremental increase of the difference
between their prior rate and the new rate;
b. In the third year, the providers shall
receive the full rate.
2. When current rates are above the newly
established rate, the Division may phase in the implementation of the new rates
as follows:
a. In the first and second year of
the new rate, providers may receive an incremental rate decrease from their
prior rate to the new rate;
b. In
the third year, the providers shall receive the new rate.
C. For a negotiated rate agreement, the Division may:
1. Hold
discussions with any or all applicants regarding their offers;
2. Issue a written request for a final
proposal revision to responsive applicants, which shall set forth the date,
time, and place for the submission of the final proposal revision. If the
applicant does not submit a notice of withdrawal or a final proposal revision
in response to the Division's request, the Division shall use the applicant's
most recent offer as the final proposal revision; and
3. Determine that an additional final
proposal revision is needed.
D. The Division shall include in a negotiated rate agreement the effective date of the negotiated rate.
Disclaimer: These regulations may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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