Title 36 — Public Health and Safety

1. "Administration" means the Arizona health care cost containment system administration. 2. "Administrator" means the administrator of the Arizona health care cost containment system. 3. "Contractor" means a person or entity that has a prepaid capitated contract with the adminis…

(Caution: 1998 Prop. 105 Applies) A. For the purposes of section 36-2901, "eligible person" includes any person who has an income level that, at a minimum, is between zero and one hundred per cent of the federal poverty guidelines as published annually by the United States depart…

(Caution: 1998 Prop 105 Applies) A. The Arizona tobacco litigation settlement fund is established consisting of all monies that this state receives pursuant to the tobacco litigation master settlement agreement entered into on November 23, 1998 and interest earned on these monies…

A. The administration shall adopt rules for a streamlined eligibility determination process for any person who applies to be an eligible person as defined in section 36-2901, paragraph 6, subdivision (a), item (iv). The administration shall adopt these rules in accordance with st…

A. The administration shall adopt rules for a streamlined medical expense deduction eligibility process to determine eligibility for any person who applies to be an eligible person as defined in section 36-2901, paragraph 6, subdivision (a), item (v). The administration shall ado…

1. Has been screened for breast and cervical cancer by a provider or entity that is recognized by the well woman healthcheck program administered by the department of health services as part of its program under title XV of the public health service act and that operates consiste…

Capitation rate adjustments shall be limited to utilization of existing services and inflation unless policy changes, including creation or expansion of programs, have been approved by the legislature or are specifically required by federal law or court mandate.

(Conditionally Rpld.) A. Beginning January 1, 2014, for the purposes of section 36-2901, "eligible person" includes a person who is eligible pursuant to 42 United States Code section 1396a(a)(10)(A)(i)(VIII) and whose household's modified adjusted gross income is more than one hu…

(Conditionally Rpld.) A. The director shall establish, administer and collect an assessment on hospital revenues, discharges or bed days for the purpose of funding the nonfederal share of the costs, except for costs of the services described in section 36-2907, subsection F, that…

A. The hospital assessment fund is established consisting of monies collected pursuant to section 36-2901.08. The director shall administer the fund. B. The director shall use fund monies only as necessary to supplement monies in the proposition 204 protection account established…

A. There is established the Arizona health care cost containment system administration. B. The administration shall be administered by a director appointed by the governor and confirmed by the senate. C. The director of the administration is eligible to receive compensation pursu…

A. The Arizona advisory council on Indian health care is established to give tribal governments, tribal organizations and urban Indian health care organizations in this state representation in shaping medicaid and health care policies and laws that impact the populations they ser…

A. The Arizona advisory council on Indian health care shall: 1. Hire and employ a director who shall hire and employ staff, subject to legislative appropriation, for purposes relating to the functions of the council. The staff shall provide technical assistance to tribal governme…

A. The Arizona health care cost containment system is established consisting of contracts with contractors for the provision of hospitalization and medical care coverage to members. Except as specifically required by federal law and by section 36-2909, the system is only responsi…

B. The director shall: 1. Prescribe uniform forms to be used by all contractors. The rules shall require a written and signed application by the applicant or an applicant's authorized representative, or, if the person is incompetent or incapacitated, a family member or a person a…

A. The administration shall develop by rule a standard for contractors to use to monitor the quality of health care received by members. Each contractor shall adopt and use the standard developed by the administration. B. The director shall periodically determine whether each con…

A. A person who is applying for eligibility under this chapter shall provide verification of United States citizenship or documented verification of qualified alien status. Beginning July 1, 2006, an applicant who is applying for services pursuant to this chapter shall provide sa…

A. The administration shall determine the eligibility of any eligible person as defined in section 36-2901, paragraph 6, subdivision (a), item (iii). Subject to the approval of the centers for medicare and medicaid services, the administration or the administration's designee sha…

A. The director shall adopt rules to prescribe a uniform application and eligibility process for participants in the premium sharing program, the children's health insurance program and healthcare group. B. The administration shall coordinate application screening for the program…

The administration shall cooperate with the Arizona-Mexico commission in the governor's office and with researchers at universities in this state to collect data and conduct projects in the United States and Mexico on issues that are within the scope of the administration's dutie…

(Caution: 1998 Prop. 105 applies) A. The trauma and emergency services fund is established consisting of monies deposited pursuant to section 5-601.02(H)(3)(b)(ii) and interest earned on those monies. The Arizona health care cost containment system administration shall administer…

A. On or before October 1 each year, the Arizona health care cost containment system administration shall report to the speaker of the house of representatives, the president of the senate, the chairpersons of the appropriations committees of the house of representatives and the …

A. On or before March 30 of each year, the director shall apply to the centers for medicare and medicaid services for waivers or amendments to the current section 1115 waiver to allow this state to: 1. Institute a work requirement for all able-bodied adults receiving services pur…

A. A contractor shall intervene if a member has ten or more prescriptions for controlled substances within a three-month period. B. A contractor shall monitor prescriptions that are filled by members and shall intervene with both the prescriber and the member when excessive amoun…

A. A contractor shall intervene if a member inappropriately seeks care at a hospital emergency department four times or more in a six-month period to educate the member regarding the proper use of emergency services. B. A contractor shall report to the administration in a manner …

On or before January 2, 2020 and each year thereafter, the director of the Arizona health care cost containment system administration and the director of the department of health services shall submit a joint report on hospital charge master transparency to the governor, the spea…

A. On or before January 2, 2020 and each year thereafter, the director of the Arizona health care cost containment system administration shall submit a report to the director of the joint legislative budget committee on the availability of inpatient psychiatric treatment both for…

B. Contracted housing program administrators may not sell or otherwise share any member's personal health information, unless authorized or required by state or federal law, including the health insurance portability and accountability act privacy standards (45 Code of Federal Re…

B. Beginning October 1, 2025, in addition to any other qualifications, peer specialists shall complete training that is developed by the administration and that includes psychosis-specific content, including anosognosia. C. On or before November 1, 2024 and each November 1 therea…

[Repealed or reserved.]

1. Require contractors to provide to members continuous glucose monitors through both a pharmacy benefit and a durable medical equipment benefit and to allow a member's prescribing provider to determine the appropriate option for the member. 2. Update the coverage criteria for co…

A. The administration may expend public funds appropriated for the purposes of this article and shall execute prepaid capitated health services contracts, pursuant to section 36-2906, with group disability insurers, hospital and medical service corporations, health care services …

A. Notwithstanding any other law, beginning on October 1, 2003, each 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 to the c…

A. Notwithstanding any other law, beginning on October 1, 2003, pursuant to this chapter the administration shall establish and operate a program for inpatient hospital reimbursement in each county with a population of more than five hundred thousand persons. B. Beginning on Octo…

A. If monies are appropriated for rural hospitals, the Arizona health care cost containment system administration shall request the centers for medicare and medicaid services to approve federal matching medicaid funding for the purposes specified in this section. B. The administr…

If a behavioral health inpatient facility, as defined in rule by the director of the department of health services, and a contractor or regional behavioral health authority do not enter into a contract, the reimbursement level for behavioral health services provided on dates of a…

A. A person shall not provide or cause to be provided false or fraudulent information to the state as part of an application for the system under section 36-2901, paragraph 6, subdivision (a). B. A person who violates subsection A of this section, who is determined eligible for t…

A. To prevent multiple enrollment for services provided by the system, the administration shall work with the department of economic security to expand that department's finger imaging eligibility program to specific programs that are selected by the director of the administratio…

A. Notwithstanding section 36-2989, for contract years beginning October 1, 2008, the administration may expend monies to provide nicotine replacement therapies and tobacco use medications to members eligible pursuant to this article or article 2 or 3 of this chapter. B. The admi…

A. The administration shall: 1. Supervise the administrator. 2. Review the proposals. 3. Award contracts. B. The director shall prepare and issue a request for proposal, including a proposed contract format, in each of the counties of this state, at least once every five years, t…

A. Entities, including insurers as defined in section 20-104, hospital, medical, dental and optometric service corporations as defined in title 20, chapter 4, article 3 and health care services organizations as defined in section 20-1051, are prohibited from contracting with the …

A. Subject to the limits and exclusions specified in this section, contractors shall provide the following medically necessary health and medical services: 1. Inpatient hospital services that are ordinarily furnished by a hospital to care for and treat inpatients and that are pro…

A. Any coverage that is offered by a contractor providing services to persons eligible pursuant to section 36-2901 and that contains a prescription drug benefit shall cover amino acid-based formula that is ordered by a physician or a registered nurse practitioner if: 1. The perso…

A. The administration shall establish a benchmark benefit package pursuant to section 6044 of the deficit reduction act of 2005 and section 1937 of the social security act. B. Enrollment in the benchmark benefit package is mandatory for persons who are eligible pursuant to: 1. Se…

1. Labeled indications for tests that are approved or cleared by the United States food and drug administration or indicated tests for a drug that is approved by the United States food and drug administration. 2. Centers for medicare and medicaid services national coverage determ…

A woman whose eligibility under section 36-2901, paragraph 6, subdivision (a), item (ii) ended no earlier than March 1, 1995 and who is not otherwise enrolled in the system is eligible to receive voluntary family planning services for two years, if approval of the waiver requesti…

A. Subject to the availability of monies, the administration shall enter into an intergovernmental agreement pursuant to title 11, chapter 7, article 3 with the department of health services to establish community based primary care programs to contract with providers to provide …

(Conditionally Rpld.) A. Subject to the availability of monies, the administration shall enter into an intergovernmental agreement pursuant to title 11, chapter 7, article 3 with the department of health services to contract with qualifying community health centers to provide pri…

A. Subject to the availability of monies, the administration may enter into an intergovernmental agreement pursuant to title 11, chapter 7, article 3 to contract with the auditor general to conduct or cause to conduct program evaluations of programs that both receive tobacco tax …

(Conditionally Rpld.) A. Beginning on October 1, 1996, the basic children's medical services program is established to provide grants to hospitals that exclusively serve the medical needs of children or that operate programs designed primarily for children. The director of the de…