Title 36 — Public Health and Safety

(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…

(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…

[Repealed or reserved.]

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…

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. 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. 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. 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. 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…

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. 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. 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. 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. 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. 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…