Title 36 — Public Health and Safety
55 chapters · 1,413 sections in this title.
A.R.S. § 36-2907.09 Direct service contracts; reporting
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(Conditionally Rpld.) The director of the department of health services shall provide to the legislature the following information for services provided pursuant to sections 36-2907.06 and 36-2907.08: 1. The number of members served. 2. The number of encounters and the average co…
A.R.S. § 36-2907.10 Transplants; extended eligibility
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A. If during a redetermination process for eligibility pursuant to this article a person who is enrolled and who is eligible pursuant to this article for a medically necessary and appropriate transplant pursuant to section 36-2907, subsection A, paragraph 10 is determined ineligi…
A.R.S. § 36-2907.11 Retaining transplant status
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A. If during a redetermination process for eligibility pursuant to this article a person who is eligible for a medically necessary and appropriate transplant as determined by the administration pursuant to section 36-2907, subsection A, paragraph 10 is determined ineligible for c…
A.R.S. § 36-2907.12 Transplants; tobacco tax allocation
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Subject to the availability of monies in the medically needy account established by section 36-774, the administration shall withdraw the amount necessary to pay the state share of costs for providing eligibility for transplant recipients who agree to enter into contractual agree…
A.R.S. § 36-2907.13 Arizona health care cost containment system; teledentistry
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[Repealed or reserved.]
A.R.S. § 36-2907.14 AHCCCS; contractors; opioid treatment programs; reimbursement; report; definitions
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A. Pursuant to section 36-2907, the administration and its contractors may reimburse an opioid treatment program provider for enrolled members only if the provider demonstrates enforcement of each plan contained in the annual report pursuant to subsection B of this section and th…
A.R.S. § 36-2907.15 Opioid use disorder treatment; standards; centers of excellence; annual report
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A. On or before December 31, 2019, the administration and the department of health services shall establish standards for designating centers of excellence for treating opioid use disorder statewide. The director of the Arizona health care cost containment system shall publish th…
A.R.S. § 36-2907.16 Organ harvesting; insurance coverage limitations
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A. Subject to the approval of the centers for medicare and medicaid services, the administration may limit coverage to a member for a human organ transplant or posttransplant care if either of the following applies: 1. The transplant operation is performed in the People's Republi…
A.R.S. § 36-2908 Provision of emergency and specialty services; reimbursement
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A. Subject to the provisions of section 36-2909, services provided to members under this article who have been determined eligible but who have not yet enrolled in the system and who are in need of medical services on an emergency basis after they have been determined eligible, i…
A.R.S. § 36-2909 Emergency hospital services; retroactive coverage; costs
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A. If a member receives emergency hospitalization and medical care on or after the date of eligibility determination or the eligibility effective date from a hospital that does not have a contract to care for the person, the administration or the contractor is liable only for the…
A.R.S. § 36-2910 Notification to system of nonemergency services
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A. Except as otherwise specifically provided by this article, the system is financially responsible for only the costs of care provided by contractors to members. B. For purposes of eligibility determination and enrollment in the system, the director may adopt rules to establish …
A.R.S. § 36-2911 Payment of monthly premiums
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A. The administration shall pay medicare part B premiums pursuant to federal law for and on behalf of a member who is eligible pursuant to section 36-2901, paragraph 6, subdivision (a), item (i) or (ii) and who is enrolled pursuant to this article and article 2 of this chapter. B…
A.R.S. § 36-2912 Children's rehabilitative services program; definition
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A. The administration shall: 1. Establish a children's rehabilitative services program for children who have a chronic illness or physical disability and shall develop, implement, monitor, supervise, control and establish policies for that program. 2. Develop and implement polici…
A.R.S. § 36-2913 Systems funds; funding
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A. The Arizona health care cost containment system fund, long-term care system fund and the third-party liability and recovery audit fund are established. The funds shall be used to pay administrative and program costs associated with the operation of the system established pursu…
A.R.S. § 36-2914 Medical care consortiums; lawful trade practices
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Notwithstanding title 44, chapter 10, article 1, actions taken by providers, potential providers, contractors and other bidders in specific accordance with this article in forming consortiums or in otherwise entering into contracts to provide medical care shall be deemed to be co…
A.R.S. § 36-2915 Lien of administration on damages recovered by injured person; perfection, recording, assignment and notice of lien
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A. The administration is entitled to a lien for the charges for hospital or medical care and treatment of an injured person for which the administration or a contractor is responsible, on any and all claims of liability or indemnity for damages accruing to the person to whom hosp…
A.R.S. § 36-2916 Release of claim by injured person ineffective as to system; action to enforce lien; release of lien
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A. A release of a claim on which a lien is imposed pursuant to section 36-2915 is not valid or effective as against the lien unless the director joins in the release or executes a release of the lien. B. If any amount has been or is to be collected by the injured person or his le…
A.R.S. § 36-2917 Review committees; immunity; confidentiality; definition
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A. Any person who, in good faith and without malice and in connection with duties or functions of a review committee of the system, takes an action or makes a decision or recommendation as a member, agent or employee of a review committee of the system or related to the duties or…
A.R.S. § 36-2917.01 Clinical oversight review committee; duties; annual report
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A. The director shall establish an internal clinical oversight review committee to review clinical data specific to agency initiatives and populations identified by the director, including data on behavioral health services for persons receiving behavioral health services adminis…
A.R.S. § 36-2918 Prohibited acts; penalties; subpoena power
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A. A person may not present or cause to be presented to this state or to a contractor: 1. A claim for a medical or other item or service that the person knows or has reason to know was not provided as claimed. 2. A claim for a medical or other item or service that the person know…
A.R.S. § 36-2918.01 Duty to report fraud or abuse; immunity
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A. All contractors, subcontracted providers of care and noncontracting providers shall notify the director or the director's designee immediately in a written report of any cases of suspected fraud or abuse. The director shall review the report and conduct a preliminary investiga…
A.R.S. § 36-2919 Absence of federal financial participation; effect on system operation
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If at any time federal monies as described in section 36-2903.01, subsection B, paragraph 5 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 provide…
A.R.S. § 36-2920 Monthly financial report
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A. The director shall submit a monthly report to the president of the senate and the speaker of the house of representatives of the following: 1. The actual year to date expenditures and projected annual expenditures. 2. The actual member months by rate code. 3. The actual caselo…
A.R.S. § 36-2922 Medical services stabilization fund; definition
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A. Subject to the availability of monies, the medical services stabilization fund is established. The administration shall administer the fund as directed by the joint legislative budget committee pursuant to subsection E of this section. B. The fund shall be used only to offset …
A.R.S. § 36-2923 Insurer claims data reporting requirements; administration as payor of last resort; report; definition
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A. A health care insurer shall: 1. Provide all enrollment information necessary to determine the time period in which a person who is defined as an eligible person pursuant to section 36-2901, paragraph 6, subdivision (a) or that person's spouse or dependents may be or may have b…
A.R.S. § 36-2924 Child care and AHCCCS joint program
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The department of economic security and the Arizona health care cost containment system administration shall establish and, as provided in the empower waiver, maintain a joint program that extends child care for twenty-four months and Arizona health care cost containment system b…
A.R.S. § 36-2925 Information system; administrative services; agreements with other states; report
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A. Notwithstanding any other law, the administration may enter into an agreement with other states to design, develop, install and operate an information system and related services or other administrative services. B. An agreement entered into pursuant to this section shall requ…
A.R.S. § 36-2926 Use of cost savings; preparation of budget recommendations; cooperation of other agencies
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A. The administration shall use the cost savings generated from agreements entered into pursuant to section 36-2925 to supplement monies that are appropriated by the legislature. The administration shall use the cost savings to: 1. Subject to title 41, chapter 4, article 4, devel…
A.R.S. § 36-2927 Intergovernmental service fund; funding
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A. The intergovernmental service fund is established. The administration shall administer the fund as a continuing appropriation. On notice from the administration, the state treasurer shall invest and divest monies in the fund as provided by section 35-313, and monies earned fro…
A.R.S. § 36-2928 Budget neutrality compliance fund; nonlapsing
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A. The budget neutrality compliance fund is established consisting of third party liability recoveries pursuant to section 36-2913, county contributions deposited pursuant to section 11-292, subsection O and section 11-300, subsection E and appropriations. The administration shal…
A.R.S. § 36-2929 Services to persons with disabilities; eligibility; premiums
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B. A person meets the income requirements of this section if the person's countable income does not exceed two hundred fifty per cent of the federal poverty guidelines. The administration shall use the supplemental security income methodology. For the purposes of this subsection,…
A.R.S. § 36-2930 Prescription drug rebate fund; exemption; definition
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A. The prescription drug rebate fund is established consisting of prescription drug rebate collections, interest from prescription drug rebate late payments and federal monies made available to this state for the operation of the Arizona health care cost containment system prescr…
A.R.S. § 36-2930.01 Members; missed medical appointments; fee; provider remedy
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If a member misses a scheduled appointment with a physician or primary care practitioner who provides medical services pursuant to this article without canceling the appointment before the time for which it is scheduled, the physician or primary care practitioner may prohibit the…
A.R.S. § 36-2930.02 Intergovernmental agreements for county behavioral health services fund; purpose
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The intergovernmental agreements for county behavioral health services fund is established consisting of county monies received by the administration to provide behavioral health services to persons identified through agreements with the counties. The administration shall adminis…
A.R.S. § 36-2930.03 340B drug pricing; requirements; applicability; annual report; definitions
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1. 340B covered entities shall submit point-of-sale prescription and physician-administered drug claims for members for drugs that are identified in the 340B pricing file, whether or not the drugs are purchased under the 340B drug pricing program. The claims shall include a profe…
A.R.S. § 36-2930.04 Delivery system reform incentive payment fund; purpose; exemption; expenditure plan review
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B. The administration shall administer the fund, and the fund is continuously appropriated. On notice from the administration, the state treasurer shall invest and divest monies in the fund as provided by section 35-313, and monies earned from investment shall be credited to the …
A.R.S. § 36-2930.05 Provider participation; grounds for exclusion; rules; definition
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A. The administration shall exclude from participation in the system any individual or entity that meets any basis for mandatory exclusion described in 42 Code of Federal Regulations section 1001.101. B. The administration, in its sole discretion, may exclude from participation i…
A.R.S. § 36-2930.06 Substance use disorder services fund; AHCCCS administration; use of monies
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A. The substance use disorder services fund is established consisting of monies appropriated to the fund, any gifts or donations to the fund and interest earned on those monies. The director shall administer the fund. B. Monies in the fund: 1. Do not revert to the state general f…
A.R.S. § 36-2931 Definitions
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In this article, unless the context otherwise requires: 1. "Administration" means the Arizona health care cost containment system administration. 2. "Capitation rate" means a mode of payment which the program contractor receives for the delivery of services to members pursuant to…
A.R.S. § 36-2932 Arizona long-term care system; powers and duties of the director; expenditure limitation
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A. The Arizona long-term care system is established. The system includes the management and delivery of hospitalization, medical care, institutional services and home and community based services to members through the administration, the program contractors and providers pursuan…
A.R.S. § 36-2933 Eligibility determination; application; enrollment
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A. A person who is seeking services pursuant to this article shall submit an application for eligibility for the system to the administration which shall review the completed application to determine if the person meets the residency and if applicable, the alienage requirements a…
A.R.S. § 36-2934 Eligibility criteria; qualifications for coverage; liquidation of assets
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A. A person meets the eligibility criteria of this article and the section 1115 waiver if the person satisfies one of the following: 1. Is eligible pursuant to section 36-2901, paragraph 6, subdivision (a), item (i) or (ii) on the date of application for medical assistance under …
A.R.S. § 36-2934.01 Creation of trusts; eligibility for the system; share of cost
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A. The administration has sole authority to qualify any trusts that are created pursuant to section 1917(d)(4)(A), (B) and (C) of the social security act and shall require that the trustee provide the following information and assurances when the trustee submits trust documents t…
A.R.S. § 36-2934.02 Financial instruments; eligibility for the system
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A. The administration has sole authority to determine the effect of annuities, promissory notes, loan agreements and related financial instruments on a person's eligibility pursuant to this article. B. An irrevocable annuity purchased with an applicant's assets is treated as a tr…
A.R.S. § 36-2935 Estate recovery program; liens
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A. The director shall adopt rules in accordance with state and federal law to allow the administration to file a claim against a member's estate to recover paid assistance. The administration is also entitled to a lien on a member's property to recover paid assistance the member …
A.R.S. § 36-2936 Preadmission screening programs; functional tests; screening review
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A. The director shall adopt rules establishing a uniform statewide preadmission screening program to determine if a person who has met the eligibility criteria prescribed in section 36-2934 is eligible for institutional services pursuant to this article. To be eligible for instit…
A.R.S. § 36-2937 Effective date of program contractor's responsibility
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A. If a person is eligible for services under article 1 of this chapter, the provider with whom the member is enrolled under article 1 of this chapter is responsible for providing services covered under article 1 of this chapter until the date of eligibility for the system specif…
A.R.S. § 36-2938 Case management; definition
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A. The director shall adopt rules establishing a uniform statewide case management program to ensure the most appropriate placement and cost effective delivery of services to members by the program contractors pursuant to this article. The case management program shall include th…
A.R.S. § 36-2939 Long-term care system services; definitions
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A. The following services shall be provided by the program contractors to members who are determined to need institutional services pursuant to this article: 1. Nursing facility services other than services in an institution for tuberculosis or mental disease. 2. Notwithstanding …
A.R.S. § 36-2940 Program contractors; annual plan
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A. The administration shall contract with the program contractors pursuant to this section or section 36-2944 using a contract as prescribed by the director. The department shall be a program contractor and provide services pursuant to this article either directly or through subc…