Title 36, Public Health and Safety

For program contractors pursuant to section 36-2940: 1. The administration shall make at least monthly capitation payments to the department consisting of a portion of the capitation rate provided by the federal government. Prior to making the capitation payment, the administrati…

A. Subcontracts for services rendered by providers pursuant to section 36-2940 shall be awarded through competitive statewide proposals in as nearly the same manner as that provided in section 41-2534. If there is not a sufficient number of qualified proposals, a subcontract may …

A. For each county that has a population of five hundred thousand persons or less and that was not approved as a program contractor before January 1, 1994 or that officially states that it wishes to end its status as a program contractor, the director at least every five years sh…

A. Notwithstanding any other law, beginning on October 1, 2003, each program contractor shall pay to the director of the department of insurance and financial institutions a tax equal to two percent of the total capitation, including reinsurance, and any other reimbursement paid …

A. If there is an insufficient number of qualified bids in a county pursuant to section 36-2944, or for those members not enrolled with program contractors, the director on the approval of the legal advisor of the administration may: 1. Execute discount advance payment contracts …

A. The administration shall coordinate benefits provided under this article to a member so that any costs for services payable by the system are costs avoided or recovered from any available third party payor. The administration may require that the program contractors are respon…

A. Program contractors shall establish and submit to the director for the director's approval utilization control systems comprised of prior authorization, concurrent review and retrospective review of services. B. If a member is no longer eligible for the system, the program con…

On oral or written notice from the member or person that the member or person believes the claims to be covered by the system, a provider or noncontracting provider shall not do either of the following unless the provider or noncontracting provider has verified through the admini…

To the extent that services are provided pursuant to this article, a provider or program contractor is not subject to the provisions of title 20.

A. Subject to the approval of the centers for medicare and medicaid services, beginning on January 1, 2002, the Arizona health care cost containment system administration shall provide services pursuant to this article to any person with a disability who is defined as eligible pu…

A. Notwithstanding any law to the contrary, a person enrolled in the Arizona long-term care system may employ another person to provide self-directed attendant care services that would otherwise be considered within the scope of nursing care pursuant to title 32, chapter 15 if: 1…

A. Each county or special health care district that is a program contractor pursuant to section 36-2940 shall establish and maintain a county or special health care district long-term care system fund as a separate fund to distinguish its revenues and its expenditures pursuant to…

A. The department shall establish and maintain a department long-term care system fund, which is a separate fund to distinguish its revenues and its expenditures pursuant to this article from other programs funded or administered by the department. Subject to legislative appropri…

If the director determines through the grievance and appeal procedure pursuant to a grievance or appeal filed by an applicant that the administration made an error in eligibility determination pursuant to section 36-2933 and a person was incorrectly determined to be ineligible to…

A. Notwithstanding section 36-2940, the director shall adopt rules which provide that the administration shall withhold or forfeit capitation payments to the program contractor pursuant to section 36-2940 if the program contractor provides inappropriate services to a person deter…

A. The administration is entitled to a lien for the charges for hospital, medical or long-term care and treatment of an injured person for which the administration or a program contractor is responsible pursuant to this article, on any and all claims for damages accruing to the p…

A. No person may present or cause to be presented to the administration or to a program contractor: 1. A claim for an item or service that the person knows or has reason to know was not provided as claimed. 2. A claim for an item or service that the person knows or has reason to …

If at any time federal monies as described in section 36-2932, subsection I, paragraph 2 are denied, not renewed or become unavailable for any reason the provisions of this article relating to the operation of the system are suspended and the director shall notify each program co…

A. The department shall contract with an independent consulting firm for an annual study of the adequacy and appropriateness of title XIX reimbursement rates to service providers for the persons with developmental disabilities program of both the Arizona long-term care system and…

The department shall annually determine the cost-effectiveness study rate for persons who are receiving developmental disability services pursuant to chapter 5.1 of this title and provide that rate to the Arizona health care cost containment system administration. On or before Ju…

In this article, unless the context otherwise requires: 1. "Administration" means the Arizona health care cost containment system administration. 2. "Department" means the department of economic security. 3. "Parent" means a parent of or the legally responsible individual for the…

A. The department shall implement the following: 1. An electronic visit verification system that delineates that a parent or a nonparent provider is providing the direct care services. 2. Unique modifiers for delineating both: (a) Whether a parent or nonparent provided the direct…

A. Except as otherwise provided in the minor child's plan of care, a parent may provide attendant care services and habilitation services under the program only between 6:00 a.m. and 10:00 p.m. B. A parent may be employed by only a single agency to provide attendant care services…

In this article, unless the context otherwise requires: 1. "Administration" means the Arizona health care cost containment system administration. 2. "Contractor" means a person or entity that has a prepaid capitated contract with the administration pursuant to section 36-2904 to …

A. Subject to continued federal financial participation as provided in sections 36-2919 and 36-2958, the director shall plan for and take all steps necessary to implement the qualified medicare beneficiary program under title XIX of the social security act, as amended. B. The adm…

A. The administration shall determine the eligibility of all applicants who may be eligible as qualified medicare beneficiaries only. The administration shall ensure that the calculation of income eligibility requirements is in accordance with federal law and the section 1115 wai…

A. For purposes of this section all contractors and program contractors are required to provide services to members. B. For a member who is dually eligible the director may implement a policy permitting a choice of contractors or program contractors to the extent the director dee…

The administration shall determine the eligibility of all persons who are specified low income medicare beneficiaries in accordance with federal law. The administration shall pay the monthly premiums under part B of title XVIII of the social security act on behalf of each specifi…

A. The administration shall determine the eligibility of all persons who are determined to be qualifying individuals pursuant to section 36-2971, paragraphs 12 and 13. B. The administration shall pay the medicare part B monthly premiums on behalf of each qualifying individual 1 a…

(Conditionally Rpld.) In this article, unless the context otherwise requires: 1. "Administration" means the Arizona health care cost containment system administration. 2. "Applicant" means a person who applies for enrollment in the pilot program. 3. "Behavioral health services" h…

(Conditionally Rpld.) A. Subject to the approval of the centers for medicare and medicaid services, available appropriations and the enrollment cap prescribed in subsection F of this section, the seriously mentally ill enhanced residential treatment pilot program is established f…

(Conditionally Rpld.) A. Subject to the approval of the centers for medicare and medicaid services, available monies and the enrollment cap prescribed in section 36-2979.01, subsection F, to be eligible for the pilot program, an individual must meet all of the following criteria:…

(Conditionally Rpld.) A. An individual who seeks to enroll in the pilot program shall apply through the individual's contractor. After determining the individual meets the SMI enhanced level of care criteria, the contractor shall forward the application to the administration for …

(Conditionally Rpld.) A. Subject to the approval of the centers for medicare and medicaid services, available appropriations and the enrollment cap prescribed in section 36-2979.01, subsection F, each contractor shall provide enrolled members with the following services: 1. All s…

(Conditionally Rpld.) A. The contractor shall develop and maintain a written service plan for each member. The service plan must: 1. Be based on a comprehensive assessment of the member's behavioral health, functional and safety needs. 2. Identify the specific services and suppor…

(Conditionally Rpld.) A. Providers of enhanced residential treatment services shall document behavioral interventions, crisis support and staffing adjustments before initiating the discharge of any member. B. A provider of enhanced residential treatment services shall implement t…

(Conditionally Rpld.) A. A member or applicant aggrieved by an action of the administration or a contractor relating to eligibility, enrollment or services under this article has the right to file a grievance or appeal pursuant to section 36-3413 and, if applicable, to a hearing …

(Conditionally Rpld.) Beginning one year after pilot program implementation and each year thereafter for the duration of the pilot program, the administration shall submit a report to the governor, the president of the senate and the speaker of the house of representatives that i…

(Conditionally Rpld.) A. The administration shall seek and maintain any necessary federal approvals and may operate the pilot program pursuant to one or more approved medicaid state plan authorities, waivers or demonstration authorities, including those authorized under 42 United…

dual enrollment prohibited (Conditionally Rpld.) A. Services provided under this article shall supplement but not replace any other benefits or services for which a member is otherwise eligible. B. The administration shall coordinate benefits with other payors, including medicare…

In this article, unless the context otherwise requires: 1. "Administration" means the Arizona health care cost containment system administration. 2. "Contractor" means a health plan that contracts with the administration to provide hospitalization and medical care to members acco…

A. The children's health insurance program is established for children who are eligible pursuant to section 36-2981, paragraph 6. The administration shall administer the program. All covered services shall be provided by health plans that have contracts with the administration pu…

A. The administration shall establish a streamlined eligibility process for applicants to the program and shall issue a certificate of eligibility at the time eligibility for the program is determined. Eligibility shall be based on gross household income for a member as defined i…

A. If the director determines that federal and state monies appropriated for the program are insufficient, the administration shall immediately notify the governor, the president of the senate and the speaker of the house of representatives and may stop processing all new applica…

A. The director has full operational authority to adopt rules or to use the appropriate rules adopted for article 1 of this chapter to implement this article, including any of the following: 1. Contract administration and oversight of contractors. 2. Development of a complete sys…

A. For inpatient hospital services, the administration shall reimburse the Indian health service or a tribal facility based on the reimbursement rates for the Indian health service as published annually in the federal register. For outpatient services, the administration shall re…