2012 Legislative Summary 2012 AHCCCS Legislative Summary HB2007 Sponsor Disposition Effective Date Summary ALTCS; eligibility Representative Fillmore Failed to Pass the House • Reduces the ALTCS eligibility limit by 50% HB2013 Sponsor Disposition Effective Date Summary ALTCS; respite care; yearly limitation Representative Fillmore Failed to Pass the House HB2015 Sponsor Disposition Effective Date Summary superior court; prohibited costs; counseling Representative Fillmore Failed to Pass the House HB2045 Sponsor Disposition Effective Date Summary healthcare group; sole proprietors Representative Farley Failed to Pass the House HB2081 Sponsor Disposition Effective Date Summary regional behavioral health authorities Representative Ableser Failed to Pass the House • • • • • • HB2146 Sponsor Disposition Effective Date Summary Reduces respite coverage by 50% Prohibits the state from paying for anger management counseling Reinstates eligibility for sole proprietors in Healthcare Group Requires that DHS contract with 2 or more RBHAs in counties with more than 800,000 persons Allows DHS to contract with any willing provider for services rather than a RBHA Requires DHS to transfer all behavioral treatment services to RBHA beginning 1/1/13 special audit; AHCCCS Representative Seel Failed to Pass the House • Requires the Auditor General to conduct an audit on AHCCCS TPL activities 2 HB2207 Sponsor Disposition Effective Date Summary HB2235 Sponsor Disposition Effective Date Summary HB2236 Sponsor Disposition Effective Date Summary AHCCCS; service providers Representative Farley Failed to Pass the House • Requires AHCCCS to adopt rules requiring there to be at least 2 subcontractors for each type of service AHCCCS; children; coverage Representative Heinz Failed to Pass the House • Appropriates $13.6 M to AHCCCS to lift the KidsCare freeze AHCCCS; children; coverage Representative Heinz Failed to Pass the House • Reinstates services performed by a podiatrist for the adult population HB2237 Sponsor Disposition Effective Date Summary AHCCCS; temporary medical coverage Representative Heinz Failed to Pass the House HB2238 Sponsor Disposition Effective Date Summary medical expense deduction program; reinstatement Representative Heinz Failed to Pass the House HB2305 Sponsor Disposition Effective Date Summary HB2324 Sponsor Disposition Effective Date Summary • • Establishes the Temporary Medical Coverage Program for individuals over income due to a disability payment but who are not yet eligible for Medicare Reinstates the Medical Expense Deduction Program AHCCCS; large employers Representative Patterson Failed to Pass the House • Requires employers who employ 100+ employees to reimburse AHCCCS for the cost of covering any of its employees AHCCCS; SCHIP; membership transition Representative Tovar Failed to Pass the House • Requires AHCCCS to transition any child whose household income exceeds the limit for Medicaid to the KidsCare Program 3 HB2329 Sponsor Disposition Effective Date Summary AHCCCS; SCHIP; military personnel children Representative Tovar Failed to Pass the House HB2334 Sponsor Disposition Effective Date Summary behavioral health authorities; requirements Representative Jones Failed to Pass the House HB2369 Sponsor Disposition Effective Date Summary electronic medical records Representative Carter Enacted; Chapter 184 August 2, 2012 • Makes modifications to previously enacted legislation regulating the use of electronic medical records HB2451 Sponsor Disposition Effective Date Summary HB2452 Sponsor Disposition Effective Date Summary HB2453 Sponsor Disposition Effective Date Summary HB2454 Sponsor Disposition Effective Date Summary • • Requires AHCCCS to enroll children of veterans who meet income requirements in KidsCare Requires DHS to form an advisory panel to consider the award of a RBHA contract AHCCCS; SCHIP; eligibility Representative Alston Failed to Pass the House • Expands KidsCare to include the children of state employees who meet income requirements AHCCCS; SCHIP; siblings; membership Representative Alston Failed to Pass the House • Expands KidsCare to include newborn or adopted siblings of current enrollees AHCCCS; SCHIP; pregnant women Representative Alston Failed to Pass the House • Expands KidsCare to include pregnant women under age 19 AHCCCS; SCHIP; income eligibility Representative Alston Failed to Pass the House • Expands KidsCare to include children between 100%-150% FPL 4 HB2472 Sponsor Disposition Effective Date Summary HB2480 Sponsor Disposition Effective Date Summary AHCCCS; cancer screening Representative Brophy McGee Failed to Pass the Senate • Clarifies that women who are screened and diagnosed through Well-Woman Health check are eligible for the BCCP program AHCCCS; third party coverage Representative Seel Failed to Pass the House • Requires AHCCCS to conduct an audit of the primacy of its payments by July 1 of each year HB2483 Sponsor Disposition Effective Date Summary AHCCCS; third party liability; requested proposals Representative Seel Failed to Pass the House HB2533 Sponsor Disposition Effective Date Summary developmental disabilities; contracted care providers Representative Ash Failed to Pass the House HB2534 Sponsor Disposition Effective Date Summary • • Prohibits AHCCCS and DES from issuing new, or revising existing contractual requirements, directives, policies or rules or any other authoritative action that will increase costs to direct care workers AHCCCS; payment methodology Representative Ash Enacted; Chapter 122 • • HB2526 Sponsor Disposition Effective Date Summary Requires AHCCCS to issue an RFP for TPL and coordination of benefits Requires AHCCCS to convene a hospital workgroup to develop a new diagnosis-related group payment methodology to replace the tiered per diem payment methodology, which was scheduled to sunset October 1, 2013 Requires AHCCCS to obtain legislative approval prior to making any changes to the inpatient payment methodology skilled nursing facility; provider assessments Representative Ash Enacted; Chapter 213 • Implements a provider assessment for nursing facilities 5 HB2568 Sponsor Disposition Effective Date Summary surrogacy; health insurance Olson Failed to Pass the Senate • • HB2580 Sponsor Disposition Effective Date Summary AHCCCS; fraud prevention Seel Failed to Pass the House • • HB2581 Sponsor Disposition Effective Date Summary HB2582 Sponsor Disposition Effective Date Summary HB2591 Sponsor Disposition Effective Date Summary HB2595 Sponsor Disposition Effective Date Summary Requires a parent entering into a surrogacy contract to provide private health insurance coverage for the surrogate mother for the pregnancy Includes birth and six weeks post-partum care Requires a provider to verify the enrollment and eligibility of an AHCCCS member prior to treatment Prohibits AHCCCS from processing a claim without documentation of the verification from the provider AHCCCS; nonemergency transportation; reimbursement Seel Failed to Pass the House • Requires AHCCCS to limit NEMT to the cost of bus transportation in areas where bus service is available AHCCCS; food stamps; identification card Seel Failed to Pass the House • Requires AHCCCS and DES to issue member safety orange identification cards to AHCCCS and food stamp recipients DES; public assistance program Judd Failed to Pass the House • Requires DES to establish the Public Assistance Education program to teach recipients of Title 36 and 46 benefits and the fundamentals of medical care, nutrition, hygiene and responsibility Arizona health task force Judd Failed to Pass the House • Establishes a task force, including the Director of AHCCCS, to study and make recommendations on how to reduce malnutrition in Arizona 6 HB2655 Sponsor Disposition Effective Date Summary HB2698 Sponsor Disposition Effective Date Summary HB2703 Sponsor Disposition Effective Date Summary developmental disability services; providers; monitoring Ash Enacted; Chapter 127 August 2, 2013 • Stipulates that if a provider receives deemed status, that provider shall only be subject to inspection every three years • If a provider scores a 95% or better during a monitoring visit, that provider is subject to inspection every year, instead of every six months AHCCCS; dental care; contractor Yee Failed to Pass the House • AHCCCS; hospital; emergency care; funding Alston Failed to Pass the House • • HB2766 Sponsor Disposition Effective Date Summary HB2768 Sponsor Disposition Effective Date Summary Requires the AHCCCS Director to take action to obtain federal matching funds of monies in the T.E.S. fund Exempts AHCCCS from rulemaking, except requires a 30-day public comment period AHCCCS; preventative services; reimbursement Alston Failed to Pass the House • A provider who is willing to accept AHCCCS reimbursement rates for preventive services is a qualified plan service provider who is qualified for AHCCCS reimbursement AHCCCS; children’s health share program Alston Failed to Pass the House • • HB2783 Sponsor Disposition Effective Date Beginning Jan. 1, 2013, requires AHCCCS to carve out dental care by issuing an RFP for two or more qualified dental health plans Beginning July 1, 2013, establishes a children’s health share program, with eligibility at 350% FPL Requires the Director to implement enrollment, cost sharing, and benefits by rule health insurance exchange Alston Failed to Pass the House 7 Summary • • HB2796 Sponsor Disposition Effective Date Summary behavioral health services; direct contracts Hobbs Failed to Pass the House • • • HB2800 Sponsor Disposition Effective Date Summary HCR2024 Sponsor Disposition Effective Date Summary Beginning Oct. 1, 2013, requires DES to provide behavioral health services to children in the CMDP program in counties with a population over 500K Transfers the carve-out for provision of BH services for this population from DHS to DES Transfers and appropriates an unspecified amount from DHS to DES in FY 2013 public funding; family planning; prohibition Olson Enacted; Chapter 288 August 2, 2012 • Subject to applicable federal requirements, prioritizes the distribution of public funds for family planning services, as follows: a) public health care facilities; b) hospitals and FQHCs; c) rural health clinics; and d) PCPs • Restricts the state from contracting with a provider for family planning services, if the provider also performs non-federally qualified abortions, and gives enforcement authority to the AG or county attorney • Reverts public monies that were appropriated in violation of this act to their original fund • Contains a severability clause AHCCCS; verification system Seel Failed to Pass the House • • HCR2040 Sponsor Disposition Effective Date Establishes a health insurance exchange (HIX) and a 9-member HIX Governing Board (incl. directors of AHCCCS and DOI) Outlines the Board’s duties and authority, outlines the HIX and health benefit plan certification, and establishes HIX Fund Requires a provider to verify the enrollment and eligibility of an AHCCCS member prior to treatment Prohibits AHCCCS from processing a claim without documentation of the verification from the provider AHCCCS; recovery audit; recovery methodology Seel Failed to Pass the House 8 Summary • • SB1086 Sponsor Disposition Effective Date Summary SB1102 Sponsor Disposition Effective Date Summary SB1400 Sponsor Disposition Effective Date Summary AHCCCS; ALTCS; reimbursement rates Gray Failed to Pass the Senate • Prohibits the contractor who worked on the previous DD/EPD provider rate studies from working on future studies foster care; relatives; AHCCCS Landrum Taylor Failed to Pass the Senate • Makes foster children who are placed with relatives eligible for AHCCCS AHCCCS; hemophilia; grant program Murphy Failed to Pass the Senate • • • SB1473 Sponsor Disposition Effective Date Summary Requires AHCCCS to conduct an audit of the primacy of its payments by July 1 of each year Requires AHCCCS to issue an RFP for TPL and coordination of benefits Beginning Oct. 1, 2012, requires AHCCCS to establish a program to assist its members who have hemophilia and related bleeding disorders to obtain services through private insurers Requires AHCCCS to issue an annual grant to a statewide hemophilia organization to administer the program Appropriates an unspecified amount to AHCCCS Admin. in FY 2013 to issue the grant AHCCCS; dental care; contractor Gray Failed to Pass the Senate • Beginning January 1, 2013, requires the AHCCCS Admin. to issue an RFP for two or more qualified dental health plans for delivery of all dental services 9 FY 2012-2013 Feed Bill Summary (HB2852 & SB1523) Item FTEs Operating Lump Sum DES Eligibility Prop 204 Administration Prop 204 DES Eligibility Traditional Medicaid Services Prop 204 Services KidsCare CRS DSH DSH- Vouluntary Match Rural Hospitals ALTCS GME TOTAL APPROPRIATION & EXPENDITURE AUTHORITY FUND SOURCES General Fund Budget Neutrality Compliance Fund Children’s Health Insurance Program Fund Health care group fund Prescription Drug Rebate Fund Tobacco Tax & Healthcare FundEmergency Health Service Account Tobacco Tax & Healthcare FundMedically Needy Account Expenditure Authority Page # 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 FY 2011-2012 FY 2012-2013 Appropriation Appropriation 2,975.4 2,217.3 $79.9 M $77.9M $54.5M $53.7M $6.7M $6.6M $38.2M $37.7M $2.9B $3.4B $1B $1.2B $36M $21.6M $110.1M $128.6M $13.5M $13.5M $28.5M $13.9M $13.9M $1.2B $1.2B $91M $5.5B $6.2B $1.3B $3.2M $30.2M $3.5M $20.1M $19.2M $1.4B $3.2M $18.1M $2.3M $70M $19.2M $38.3M $38.3M $4.2B $4.7B Disproportionate Share (Page 6)  Stipulates that the $13.5M appropriation for disproportionate share payments for FY 2011-2012 includes $4.2M for Maricopa County Healthcare District and $9.3 M for private qualifying disproportionate share hospitals Graduate Medical Education & Disproportionate Share Voluntary Payments (Page 6) • Stipulates that any monies received for GME, including federal matching monies by in excess of $91M and any monies received for DSH in excess of $28.5M may be distributed by AHCCCS Administration in FY 2013 • Before the expenditure of the increased monies, AHCCCS is required to notify JLBC and OSPB of the amount to be included in the distribution 10 Supplemental Payments • Appropriates $51.5M from the Prescription Drug Rebate Fund; $112.6M from the General Fund and $372.5 M in federal expenditure authority to AHCCCS for supplemental payments for FY 2011-2012 (Page 54) • Allows AHCCCS to transfer up to $1.4M from the Traditional Medicaid Services line item for FY 2011-2012 to the Attorney General for costs associated with Tobacco Settlement litigation (Page 54) HCBS Supplemental Reduction (Page 54) • Reduces $12.3M from DES for HCBS LTC Services in FY 2012 DHS Supplemental FY 2012 (Page 55) • Appropriates $12.3M General Fund, $33.9M Prescription Drug Rebate Fund and $93.5 in federal Medicaid expenditure authority for Medicaid capitation payments Reporting Requirements (Page 6)  Requires AHCCCS to report these amounts from sources other than AHCCCS to JLBC  Provides that prior to making fee-for-service program changes that pertain to fee-for-service categories AHCCCS must report the expenditure plan for review by JLBC (Page 5)  Requires AHCCCS to annually report capitation rate changes for the following fiscal year (Page 5) o Limits reports on capitation rate changes to a range of no more than 2% (Page 5)  Requires AHCCCS to report proposed changes in policy that would impact the amount, sufficiency, duration and scope of health care services and who may provide services (Page 5-6) o AHCCCS must prepare a fiscal analysis on the impact of proposed changes on the following year’s capitation rates o If the analysis suggests additional state costs equal to or greater than $500K, AHCCCS shall submit the proposed policy changes to JLBC  By January 7, 2013, requires AHCCCS and DHS to report to JLBC on the total amount of the Medicaid reconciliation payments and penalties received since July 1, 2012 (Page 55) o Requires AHCCCS and DHS to provide the same information for FY 2012-2013 by June 30, 2014 (Page 55)  Requires each agency to report the number of filled FTE positions to JLBC by September 1, 2012(60)  Stipulates legislative intent that all agencies continue to report expenditures to JLBC (59) Notes  Notes that the amounts appropriated in the DES line item shall be used for IGAs with DES for eligibility determinations and other functions (Page 5)  Allows that the General Fund may be used for eligibility determinations and other functions administered by the Division of Benefits and Medical Eligibility based on the results of the Arizona Random Moment Sampling Survey (Page 5)  Stipulates that the amounts included in the Prop 204 AHCCCS Administration, Prop 204 DES Eligibility and Prop 204 Services special line items include all sources of funding as prescribed in 362901.01, subsection B (Prop 204 fund sources) (Page 5)  Notes that all ALTCS funds that pass through AHCCCS to DES for developmental disabilities shall not count against ALTCS expenditure authority (Page 6)  Provides that the county portion of the FY 2012-2013 nonfederal portion of the costs of providing ALTCS is included in the expenditure fund source (Page 6) 11    Allows AHCCCS to transfer up to $1.2 M from the Traditional Medicaid Services line item for FY 2012-2013 to the Attorney General for costs associated with Tobacco Settlement Litigation (Page 6) Stipulates that the nonappropriated portion of the prescription drug rebate fund is included in the federal portion of the expenditure authority fund source (Page 6) Allows DHS to use monies in the IGA and ISA fund as the state Medicaid match for CRS and behavioral health services (Page 53) Personnel Provisions • Provides for a one-time employee retention payment to be made to all state employees who are uncovered as of September 29, 2012 • Requires that the payment be equal to 5% of the employee’s annual salary, prorated for the remainder of the fiscal year, and evenly distributed throughout each remaining pay period FY 2012-2013 Budget Reconciliation Bill Summary (HB2857 & SB1258) Item Summary Reconciliation - Stipulates that when funds are appropriated to AHCCCS and DHS and the program or purpose for the appropriation is subject to reimbursement for reconciliation payments from or penalties against program contractors or health plans, the Agency and Department are required to deposit any such reimbursement or penalty into the State General Fund or the Fund from which the appropriation was originally made Prohibits AHCCCS and DHS from allowing reconciliation payments or penalties to be credited against future payments to the program contractor or health plan 1 Changes on Page 1 Removes the $40 cap on the fee DHS may charge for the second Newborn Screening specimen and hearing test Ambulance Rates Removes the requirement that ambulance reimbursement rates be tied to the rate approved by DHS Breast and Clarifies that women must be screened by a Cervical Cancer provider or entity that is recognized by the Well Treatment Woman Healthcheck program and be under Program 250% FPL in order to qualify for the Breast and Cervical Cancer Treatment program 2 2-3 3 4-5 4 6 - Newborn Screening Section (Note: This language is intended to direct DHS to 12 expand the pool of providers eligible to participate in Well Woman Health check) Behavioral Requires the Directors of JLBC and OSPB to Health submit an annual report to JLBC by October 1st, Expenditures which details each year’s Medicaid and nonMedicaid behavioral health expenditures, including behavioral health demographics, utilization and expenditures, medical necessity oversight practices, tracking of high cost beneficiaries, mortality trends, placement trends, program integrity and access to services Retroactive -Establishes FY 2011-2012 DSH distributions as Disproportionate follows: Share - $55,507,900 for qualifying non-state operated hospitals o Caps the DSH payment for MIHS at $89,877,700 - $28,474,900 for ASH - $9,284,800 for private DSH hospitals: o Limits payments to mandatory DSH qualifying hospitals; or o Hospitals in Yuma County with at least 300 beds - Stipulates that DSH payments in FY 2010-2011 and 2011-2012 include amounts for DSH hospitals designated by political subdivisions, tribal governments and universities - Applies retroactively to May 31, 2012 Repeal RuleMaking Exemption Exemption from Rule Making 5 6 6 7-8 Repeals AHCCCS’s rule-making authority granted under the FY 2011-2012 budget 7 8 - Provides that any rules adopted by AHCCCS in accordance with the FY 2011-2012 exemption shall remain in effect through December 31, 2013 - Prohibits AHCCCS from continuing any of these program changes without statutory authority after December 31, 2013 8 8 13 FY 2012-2013 ALTCS County Contributions FY 2012-2013 Disproportionate Share County Proportional Share Contributions County Acute Care Contributions - Establishes the ALTCS County Contributions for FY2012-2013 as follows: - Apache: $611,200 - Cochise: $5,266,800 - Coconino: $1,834,500 - Gila: $2,146,400 - Graham: $1,434,200 - Greenlee: $192,800 - LaPaz: $625,200 - Maricopa: $148,533,600 - Mohave: $8,000,100 - Navajo: $2,529,300 - Pima: $39,316,400 - Pinal: $15,081,500 - Santa Cruz: $1,904,900 - Yavapai: $8,450,900 - Yuma: $7,292,700 - If ALTCS costs exceeds $the amount specified in the General Appropriations Act, authorizes the State Treasurer to collect the difference between the amount collected and the county share -Establishes FY 2012-2013 DSH distributions as follows: - $89,877,700 for qualifying non-state operated hospitals - $28,474,900 for ASH - $9,284,800 for private DSH hospitals: o Limits payments to mandatory DSH qualifying hospitals; or o Hospitals in Yuma County with at least 300 beds - Stipulates that DSH payments in FY 2012-2013 include amounts for DSH hospitals designated by political subdivisions, tribal governments and universities Requires AHCCCS to transfer funds to the counties as necessary to comply with the proportional share requirements in PPACA by December 31, 2013 - Establishes the Acute Care County Contributions for FY2012-2013 as follows: - Apache: $268,800 - Cochise: $2,214,800 - Coconino: $742,900 - Gila: $1,413,200 9 9 13 11-12 14 12 15 13-14 14 - Graham: $536,200 - Greenlee: $190,700 - LaPaz: $212,100 - Maricopa: $20,225,200 - Mohave: $1,237,700 - Navajo: $310,800 - Pima: $14,951,800 - Pinal: $2,715,600 - Santa Cruz: $482,800 - Yavapai: $1,427,800 - Yuma: $1,325,100 - Authorizes the State Treasurer to withhold county funds as necessary to meet the requirements of this section - Establishes payment procedures to comply with the requirements of this section - Stipulates legislative intent that Maricopa County’s contribution shall be reduced each year in accordance with changes in the GDP price deflator Hospitalization & Medical Care Contributions - Establishes county withholding for Hospitalization & Medical Care for FY20132013 as follows: - Apache: $87,300 - Cochise: $162,700 - Coconino: $160,500 - Gila: $65,900 - Graham: $46,800 - Greenlee: $12,000 - LaPaz: $24,900 - Mohave: $187,400 - Navajo: $122,800 - Pima: $1,115,900 - Pinal: $218,300 - Santa Cruz: $51,600 - Yavapai: $206,200 - Yuma: $183,900 - Authorizes the State Treasurer to withhold county funds as necessary to meet the requirements of this section - Establishes payment procedures to comply with the requirements of this section - Allocates $2,646,200 of amounts withheld for the county Acute Care contribution for Hospitalization & Medicare Care Services 16 14-15 15 administered by AHCCCS County Expenditure Limitation: Prop 204 Administration Ambulance Services Hospital Reimbursement Inflation Adjustment Freeze Reimbursement Rate Reduction Authority Risk Contingency Medicare Settlement Rule-Making Exemption Federal Hospital Funding Rule-Making Exemption Prescription Drugs Rule-Making Exemption Prescription - Stipulates that county contributions for the administration of Prop 204 are excluded from county expenditure limitations 17 15 - Notwithstanding 36-2239, subsection H, from October 1, 2012- September 30, 2013, requires AHCCCS to reimburse ambulance providers in an amount equal to 68.59% of the DHS rate For the Contract Year beginning October 1, 2012, notwithstanding 36-2903.01, subsection G, paragraph 3 and any related rules, allows AHCCCS to elect not to adjust the outpatient hospital fee schedule by any inflation index For rates effective October 1, 2012 through September 30, 2013, allows AHCCCS to continue the 5% rate reduction that was in effect on October 1, 2011 From October 1, 2012 through September 30, 2013, allows AHCCCS to continue the risk contingency rate setting and funding for all managed care organizations that was in place from October 1, 2010 through September 30, 2011 -Allows AHCCCS to participate in any special disability 1115 waiver offered by CMS and stipulates that any credits received are to be used in the fiscal year when such credits are made available to fund the state’s share of federal financial participation - Requires AHCCCS to report any credits to JLBC by December 31, 2012 and June 30, 2013 -Allows AHCCCS to apply for a Waiver to draw FFP for trauma centers, emergency departments and rural hospitals until January 1, 2014 - Provides a rule-making exemption for the implementation of such a program -Provides a rule-making exemption until October 1, 2012 for the revision of the reimbursement methodology for community health center prescription drug provider rates Provides a rule-making exemption until December 31, 2012 for the revision of ambulance provider rates 18 15 19 15 20 15 21 15 22 16 23 16 24 16 25 16 16 Drugs DES; Long-Term Care Fund AHCCCS Dental Contractor Compliance Implementation of Program False Claims Act Outpatient Hospital Fee Schedule Rates Capitation Rate Increases For FY 2012-2013, allows DES to use monies in the Long-Term Care Fund Requires AHCCCS to monitor contractor compliance and performance requirements in the provision of covered dental services to eligible members Stipulates that it is the intent of the Legislature for FY 2012-2013 that AHCCCS implement a program within the available appropriation Stipulates that it is the intent of the Legislature that AHCCCS comply with the requirements of the False Claims Act and maximize savings in, and continue to consider best available technologies in detecting fraud in, the administration’s programs Stipulates that it is the intent of the Legislature that AHCCCS revise its rules to eliminate the automatic adjustments to outpatient hospital fee schedule rates by any inflation index Stipulates that it is the intent of the Legislature that AHCCCS capitation rate increases no exceed 3% in FY 2013-2014 and 2014-2015 27 16-17 31 17 31 17 33 17 34 17 35 18 17