Chapter 22. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION

A. Income exclusions. The exclusions in R9-22-1420(C) apply to the MED family unit. B. Income standard. 1. The Department shall divide the annual FPL for the MED family unit that is in effect during each month of the income period by 12 to determine the monthly FPL. 2. The Depart…

A. Including countable resources. The Department shall include the resources not excluded that belong to and are available to members of the family of a qualified alien under A.R.S. § 36-2903.03 and the sponsor and sponsor's spouse of a person who is a qualified alien. B. Ownersh…

A. A MED family unit is eligible on the day the income and resource eligibility requirements are met but no earlier than the first day of the month of application. If the family unit meets the income requirements in the application month but does not meet the resource limit until…

The Department shall approve eligibility for six months. Changes in circumstances do not affect eligibility for the first three months. Notes Ariz. Admin. Code § R9-22-1440 New Section made by final rulemaking at 11 A.A.R. 4942, effective December 31, 2005 (Supp. 05-4).

A. Adverse actions. An applicant or member may appeal by requesting a hearing from the Department concerning any of the following adverse actions: 1. Complete or partial denial of eligibility under R9-22-1413; 2. Suspension, termination, or reduction of AHCCCS medical coverage un…

The Department shall not approve any individual or family who has applied on or after May 1, 2011 as eligible for MED coverage. With respect to any applications that are pending as of May 1, 2011, the Department shall not approve any individual or family as eligible for MED cover…

A. General. The Administration shall determine eligibility for AHCCCS medical coverage for the following applicants or members using the eligibility criteria and requirements in this Article and Article 3: 1. A person who is aged, blind, or disabled and does not receive SSI cash;…

A. General income eligibility. Except as provided under subsection (B) of this rule, the Administration or its designee shall count the identified income under 42 U.S.C. 1382 a and 20 CFR 416 Subpart K. B. Exceptions. 1. In-kind support and maintenance under 42 U.S.C. 1382 a(a)(2…

A. To be eligible for AHCCCS medical coverage, an applicant shall meet the conditions of eligibility and requirements in this Article and: 1. Meet one of the income tests described in subsection (B) or (C), or 2. The special requirements in R9-22-1505. B. The Administration shall…

A. The following are considered special groups: 1. A person meeting the requirements in A.R.S. § 36-2903.03 who: a. Is aged, blind, or disabled under 42 CFR 435.520, 42 CFR 435.530, or 42 CFR 435.540 as of October 1, 2012, which are incorporated by reference and on file with the …

A. Notwithstanding Article 3, a qualified hospital may determine Hospital Presumptive Eligibility (HPE), on the basis of pre-liminary information, that an individual is eligible for AHCCCS medical coverage during the presumptive eligibility period described in this section, if th…

Notes Ariz. Admin. Code § R9-22-1602 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1603 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1604 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1605 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1606 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1607 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1608 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Amended by final rulemaking at 6 A.A.R. 2435, effective June 9, 2000 (Supp. 00-2). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effecti…

Notes Ariz. Admin. Code § R9-22-1609 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Amended by final rulemaking at 6 A.A.R. 2435, effective June 9, 2000 (Supp. 00-2). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effecti…

Notes Ariz. Admin. Code § R9-22-1610 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Amended by final rulemaking at 6 A.A.R. 2435, effective June 9, 2000 (Supp. 00-2). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effecti…

Notes Ariz. Admin. Code § R9-22-1611 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Amended by final rulemaking at 6 A.A.R. 2435, effective June 9, 2000 (Supp. 00-2). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effecti…

Notes Ariz. Admin. Code § R9-22-1612 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1614 New Section made by exempt rulemaking at 12 A.A.R. 3892, effective October 1, 2006 (Supp. 06-3). Section expired under A.R.S. § 41-1056(E) at 17 A.A.R. 2384, effective October 31, 2011 (Supp. 11-4).

Notes Ariz. Admin. Code § R9-22-1615 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1616 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Amended by final rulemaking at 6 A.A.R. 2435, effective June 9, 2000 (Supp. 00-2). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effecti…

Notes Ariz. Admin. Code § R9-22-1618 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1619 New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed by exempt rulemaking at 7 A.A.R. 4593, effective October 1, 2001 (Supp. 01-3). New Section made by exempt rulemaking at 12 A.A.R.…

Notes Ariz. Admin. Code § R9-22-1621

Notes Ariz. Admin. Code § R9-22-1632

Notes Ariz. Admin. Code § R9-22-1635

In addition to definitions contained in A.R.S. § 36-2901, the words and phrases in this Chapter have the following meanings unless the context explicitly requires another meaning: "Annual enrollment choice" means the annual opportunity for a person to change contractors. "Auto-as…

A. General enrollment requirements. The Administration shall enroll a member with a contractor as described in this Section, unless the member has pre-selected a contractor on the application: 1. Except as provided in subsections (A)(3), (A)(5), and (C), a member who is determine…

A. Effective date of enrollment. A member's date of enrollment is the date enrollment action is taken by the Administration. However, if a plan change occurs for an annual enrollment choice, the effective date is the month of the member's enrollment anniversary date. B. Financial…

A. General. 1. The Administration shall enroll a newborn child of an eligible mother with an available contractor or IHS, based on the mother's enrollment. 2. The Administration shall auto-assign a newborn child of an eligible mother who is not enrolled with a contractor or IHS o…

A. General. Except for members enrolled with IHS or CMDP, the Administration shall provide a guaranteed enrollment period for a one-time period that begins on the effective date of the member's initial enrollment with a contractor and ends on the last day of the fifth full calend…

"Administration" has the meaning defined in A.R.S. § 36-2901. "Affiliation" has the meaning defined in 42 C.F.R. § 424.502. "Managing employee" has the meaning defined in 42 C.F.R. § 455.101. "Member" has the meaning defined in A.R.S. § 36-2901. "Person with an ownership or contr…

A. In addition to such grounds for exclusion set for in Subsections A and B of A.R.S. § 36-2930.05, the Administration, in its sole discretion, may exclude: 1. Any individual or entity which has failed to comply with any requirement, term, or condition set forth in any agreement …

A. Pursuant to A.R.S. § 36-2930.05 and 42 C.F.R. § 1002.210, any exclusion from participation in the system shall be for such period as determined in the discretion of the Administration, but in no event shall such period be less than five years. B. In determining the period of e…

A. Any exclusion of an individual or entity pursuant to A.R.S. § 36-2930.05 is an appealable agency action subject to the Uniform Administrative Appeals Procedures, A.R.S. § 41-1092, et seq. B. The Administration shall set forth in the notice of an appealable agency action requir…

A. If the period of exclusion has expired, an individual or entity may apply for reinstatement of participation in the system by submission of the following: 1. An application for participation as a provider. 2. Information to demonstrate reasonable assurances that the type of ac…

A. If an application for reinstatement is denied, the Administration shall give written notice to the requesting individual or entity. B. Within 30 days of the date on the notice of denial of reinstatement, the excluded individual or entity may submit documentary evidence and wri…

The Administration shall determine eligibility for AHCCCS medical services, under Article 2 of this Chapter, using the eligibility criteria and requirements under this Article for an applicant or member who is: 1. At least 16 years of age, but less than 65 years of age, 2. Employ…

The Administration shall comply with the confidentiality rule under R9-22-512(C) . Notes Ariz. Admin. Code § R9-22-1902 New Section made by exempt rulemaking at 9 A.A.R. 95, effective January 1, 2003 (Supp. 02-4). Amended by final rulemaking at 15 A.A.R. 220, effective March 7, 2…

A. A person may apply by submitting an application to an Administration office. B. The application date is the date the application is received at an Administration office or outstation location approved by the Director as described under R9-22-1406(A). C. The provisions in R9-22…

The Administration shall send an applicant a written notice of the decision regarding the application. This notice shall include a statement of the action, and: 1. If approved, the notice shall contain:a. The effective date of eligibility, b. The amount the person shall pay, and …

An applicant or member shall report and verify changes, as described under R9-22-306, to the Administration. Notes Ariz. Admin. Code § R9-22-1905 New Section made by exempt rulemaking at 9 A.A.R. 95, effective January 1, 2003 (Supp. 02-4). Amended by final rulemaking at 15 A.A.R.…

The processing of a redetermination or change shall result in one of the following actions: 1. No change in eligibility or premium, 2. Discontinuance of eligibility if a condition of eligibility is no longer met, 3. A change in premium amount, or 4. A change in the coverage group…