Title 36, Public Health and Safety

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…

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…

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. 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. The Arizona rural health transformation fund is established consisting of monies received by this state through the rural health transformation program prescribed in section 71401 of Public Law 119-21. The administration shall administer the fund. Monies in the fund are contin…

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. 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…

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. 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. 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. 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. 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. 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. 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…

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…

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. Beginning the later of January 1, 2017 or on approval by the centers for medicare and medicaid services: 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, …

A. The delivery system reform incentive payment fund is established. The fund shall be used to pay all costs incurred pursuant to the section 1115 waiver authority associated with delivery system reform incentive payments and designated state health programs. B. The administratio…

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. 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…

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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…

A. The administration shall establish capitation rates based on an actuarial study for the department. The capitation rate shall be based on the estimated cost of providing services pursuant to this article to members who have been determined eligible pursuant to section 36-2933.…

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…