Title 36, Public Health and Safety

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…

A. The administration shall require its contracted housing program administrators to review and minimize duplicative paperwork requirements for and limit the number of contractors and entities that unnecessarily receive personal health information of members with serious mental i…

A. The administration shall develop and implement processes to monitor its contractors' oversight of peer specialists to ensure that the peer specialists meet qualifications and receive the required supervision and training. B. Beginning October 1, 2025, in addition to any other …

A health care institution that provides inpatient behavioral health services to a patient with a designation of serious mental illness by the administration shall provide, on the patient's discharge, an accurate list of all necessary medications, including psychiatric medications…

The administration shall: 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 th…

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 authorize this state to make payments for covered services that are provided to American Indian or Ala…

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 …

On or before December 1 of each year, the administration shall annually report to the joint legislative budget committee, the governor, the president of the senate, the speaker of the house of representatives and the members of the senate and house of representatives health and h…

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…

A. The administration and its contractors shall provide biomarker testing for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of a member's disease or condition to guide treatment decisions when the test provides clinical utility as demonstrated…

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…

(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. 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. 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…

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…

In addition to services provided pursuant to section 36-2907, subsection A, paragraph 7, the Arizona health care cost containment system administration shall implement teledentistry services for enrolled members who are under twenty-one years of age.

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. 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. 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. 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…