By Reagan Priest | State Affairs
Sen. Carine Werner wants to take away the Arizona Health Care Cost Containment System’s oversight of a Medicaid program for Native American Arizonans in the wake of the sober living home fraud scheme.
At yet another hearing focused on AHCCCS’ crackdown on “good” sober living home providers, Werner announced Senate Bill 1611 (American Indian Health Program; administration), a measure that would require the department to contract out its program integrity and care management functions for the AIHP program.
“This was a system that lost track of people, failed to pay providers who were doing the right thing, and could not explain what happened when patients fell through the cracks,” Werner said in a statement after the hearing. “When that happens, lives are put at risk.”
AIHP is an AHCCCS health care plan specifically providing coverage to American Indians and Alaska Natives that were exploited by fraudulent sober living home providers who enrolled eligible Arizonans into the program to receive payments for services not rendered. In the last year, Senate HHS has focused on how AHCCCS’ attempts to rein in AIHP fraud have negatively impacted legitimate sober living home providers.
Werner’s bill would keep many AIHP administrative functions within AHCCCS, like rate setting and claim processing. However, the agency would be required to find a contractor, approved by the Legislature, to provide oversight functions to ensure the AIHP program is administered without fraud and without discriminating against legitimate providers.
