reglab/housing_qa huggingface dataset:
AZ Rev Stat § 36-2958 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2958 - Absence of federal financial participation; effect on system operation

36-2958.  Absence of federal financial participation;  effect on system operation If at any time federal monies as described in section 36-2932,  subsection I,  paragraph 2 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 program contractor of that fact. Neither the administration nor a program contractor shall provide services otherwise authorized by this article or be liable for the cost of services provided if federal monies are unavailable.
AZ Rev Stat § 36-2959 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2959 - Reimbursement rates; capitation rates; annual review

36-2959.  Reimbursement rates;  capitation rates;  annual review A. The department shall contract with an independent consulting firm for an annual study of the adequacy and appropriateness of title XIX reimbursement rates to service providers for the persons with developmental disabilities program of both the Arizona long-term care system and the state only program. The consultant shall also include a recommendation for annual inflationary costs. Unless modified in response to federal or state law,  the independent consulting firm shall include,  in its recommendation,  costs arising from amendments to existing contracts. The department may require,  and the department's contracted providers shall provide,  financial data to the department in the format prescribed by the department to assist in the study. A complete study of reimbursement rates shall be completed no less than once every five years. B. 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. C. The administration shall contract with an independent consulting firm for an annual study of the adequacy and appropriateness of title XIX reimbursement rates to service providers for the elderly and physical disability program of the Arizona long-term care system. The administration may require,  and the administration's contracted providers shall provide,  financial data to the administration in the format prescribed by the administration to assist in the study. A complete study of reimbursement rates shall be completed no less than once every five years. In determining the adequacy of the rates in the five year study,  the consulting firm shall examine in detail the costs associated with the delivery of services,  including programmatic,  administrative and indirect costs in providing services in rural and urban Arizona. D. The department and the administration shall provide each of their reports to the joint legislative budget committee and the administration by October 1 of each year.  E. The department shall include the results of the study in its yearly capitation rate request to the administration. F. If results of the study are not completely incorporated into the capitation rate,  the administration shall provide a report to the joint legislative budget committee within thirty days of setting the final capitation rate,  including reasons for differences between the rate and the study.
AZ Rev Stat § 36-2960 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2960 - Persons with developmental disabilities; cost-effectiveness study rate; report

36-2960.  Persons with developmental disabilities;  cost-effectiveness study rate;  report The department shall annually determine the cost-effectiveness study rate for persons who are receiving developmental disability services pursuant to chapter 5.1 of this title and provide that rate to the Arizona health care cost containment system administration. On or before June 15 of each year,  the department shall report to the joint legislative budget committee the cost-effectiveness study rate for persons receiving developmental disability services that was determined for the subsequent fiscal year.
AZ Rev Stat § 36-2972 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2972 - Rights, authority and responsibilities of the director and the administration

36-2972.  Rights,  authority and responsibilities of the director and the administration A. Subject to continued federal financial participation as provided in sections 36-2919 and 36-2958,  the director shall plan for and take all steps necessary to implement the qualified medicare beneficiary program under title XIX of the social security act,  as amended. B. The administration and the director have full operational responsibility for this article. Except as provided in this article or required by federal law or the section 1115 waiver,  the provisions of articles 1 and 2 of this chapter are fully applicable to this article and the director and administration have all the rights,  powers,  duties and responsibilities accorded to the system under articles 1 and 2 of this chapter. Services shall be delivered in accordance with federal law and the section 1115 waiver for articles 1 and 2 of this chapter. C. The administration shall coordinate benefits provided under this article to members so that costs for services payable by the system are costs avoided or recovered from a third party payor. The director may require that program contractors,  contractors and noncontracting providers are responsible for the coordination of benefits for services provided pursuant to this article. Benefit coordination requirements for noncontracting providers are limited to coordination of benefits with standard health insurance and disability or medicare supplemental health insurance policies and similar programs for health coverage. The director shall require members to assign to the system rights to all types of medical benefits to which the member is entitled. D. Notwithstanding section 36-2911,  the program contractors or contractors shall pay all premiums,  deductibles and coinsurance amounts for the member to obtain coverage or secure services as required by the administration. For members not enrolled with a contractor or program contractor the administration may pay the premiums,  deductibles and coinsurance amounts.
AZ Rev Stat § 36-2973 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2973 - Qualified medicare beneficiary only; eligibility determination; application; enrollment

36-2973.  Qualified medicare beneficiary only;  eligibility determination;  application;  enrollment A. The administration shall determine the eligibility of all applicants who may be eligible as qualified medicare beneficiaries only. The administration shall ensure that the calculation of income eligibility requirements is in accordance with federal law and the section 1115 waiver. On determination of qualified medicare beneficiary only eligibility,  the administration shall enroll the member in the system. B. The administration may enroll the member who has been determined eligible as a qualified medicare beneficiary only in a fee-for-service arrangement. The director may enter into a contract with a medicare risk contractor that,  in accordance with section 1876 of the social security act,  has a contract with the health care financing administration and may pay premiums for enrollment of that member.
AZ Rev Stat § 36-2974 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2974 - Dual eligibles; qualifications for coverage; enrollment

36-2974.  Dual eligibles;  qualifications for coverage;  enrollment A. For purposes of this section all contractors and program contractors are required to provide services to members. B. For a member who is dually eligible the director may implement a policy permitting a choice of contractors or program contractors to the extent the director deems feasible consistent with the section 1115 waiver and federal law. If the director does not implement a choice of contractor policy,  the director may enroll the member,  at the time eligibility is determined,  with an available contractor or program contractor located in the geographic area of the member's residence. C. The department shall assist the administration in the screening of all persons who are applying to become eligible pursuant to section 36-2901,  paragraph 6,  subdivision (a) and who are entitled to services under title XVIII but not title XVI of the social security act to determine if the person meets the eligibility criteria of this section. If a person is determined to be eligible pursuant to section 36-2901,  paragraph 6,  subdivision (a) and this article,  the administration shall make the person dually eligible. On determination of dual eligibility the administration shall enroll the person pursuant to this article and notify the person of the dual eligibility. D. The administration shall screen all persons who are entitled to services under title XVIII of the social security act and who are applying to become eligible pursuant to section 36-2901,  paragraph 6,  subdivision (a),  as prescribed by title XVI of the social security act or section 36-2931,  paragraph 5,  to determine if the person meets the eligibility criteria of this section. If a person is determined to be eligible pursuant to section 36-2901,  paragraph 6,  subdivision (a) or section 36-2931,  paragraph 5 and this article,  the administration shall make the person dually eligible. On determination of dual eligibility by the administration,  the administration shall enroll the person pursuant to this article and notify the person of the dual eligibility. E. Calculation of income and resource eligibility requirements by the department and the administration pursuant to this section shall be in accordance with title XIX of the social security act,  as amended. F. Program contractors and contractors shall pay medicare deductibles,  coinsurance and copayment amounts for services provided to dual eligibles pursuant to this article and as required by the administration for services that are provided by or under referral from a primary care physician or primary care practitioner.
AZ Rev Stat § 36-2975 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2975 - Specified low income medicare beneficiary; eligibility

36-2975.  Specified low income medicare beneficiary;  eligibility The administration shall determine the eligibility of all persons who are specified low income medicare beneficiaries in accordance with federal law. The administration shall pay the monthly premiums under part B of title XVIII of the social security act on behalf of each specified low income medicare beneficiary.
AZ Rev Stat § 36-2976 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2976 - Qualifying individuals

36-2976.  Qualifying individuals A. The administration shall determine the eligibility of all persons who are determined to be qualifying individuals pursuant to section 36-2971,  paragraphs 12 and 13. B. The administration shall pay the medicare part B monthly premiums on behalf of each qualifying individual 1 and shall pay the medicare part B monthly amount that is attributable to home health coverage for each qualifying individual 2.
AZ Rev Stat § 36-2981 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2981 - Definitions

36-2981.  Definitions In this article,  unless the context otherwise requires: 1. " Administration"  means the Arizona health care cost containment system administration. 2. " Contractor"  means a health plan that contracts with the administration for the provision of hospitalization and medical care to members according to the provisions of this article or a qualifying plan. 3. " Director"  means the director of the administration. 4. " Federal poverty level"  means the federal poverty level guidelines published annually by the United States department of health and human services. 5. " Health plan"  means an entity that contracts with the administration for services provided pursuant to article 1 of this chapter. 6. " Member"  means a person who is eligible for and enrolled in the program,  who is under nineteen years of age and whose gross household income meets the following requirements: (a) Beginning on November 1,  1998 through September 30,  1999,  has income at or below one hundred fifty per cent of the federal poverty level. (b) Beginning on October 1,  1999 and for each fiscal year thereafter,  has income at or below two hundred per cent of the federal poverty level. 7. " Noncontracting provider"  means an entity that provides hospital or medical care but does not have a contract or subcontract with the administration. 8. " Physician"  means a person licensed pursuant to title 32,  chapter 13 or 17. 9. " Prepaid capitated"  means a method of payment by which a contractor delivers health care services for the duration of a contract to a specified number of members based on a fixed rate per member,  per month without regard to the number of members who receive care or the amount of health care services provided to a member. 10. " Primary care physician"  means a physician who is a family practitioner,  general practitioner,  pediatrician,  general internist,  obstetrician or gynecologist. 11. " Primary care practitioner"  means a nurse practitioner who is certified pursuant to title 32,  chapter 15 or a physician assistant who is licensed pursuant to title 32,  chapter 25 and who is acting within the respective scope of practice of those chapters. 12. " Program"  means the children's health insurance program. 13. " Qualifying plan"  means a contractor that contracts with the state pursuant to section 38-651 to provide health and accident insurance for state employees and that provides services to members pursuant to section 36-2989,  subsection A. 14. " Special health care district"  means a special health care district organized pursuant to title 48,  chapter 31. 15. " Tribal facility"  means a facility that is operated by an Indian tribe and that is authorized to provide services pursuant to Public Law 93-638,  as amended.
AZ Rev Stat § 36-2985 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2985 - Notice of program suspension; spending limit

36-2985.  Notice of program suspension;  spending limit A. If the director determines that federal and state monies appropriated for the program are insufficient,  the administration shall immediately notify the governor,  the president of the senate and the speaker of the house of representatives and may stop processing all new applications. B. The total amount of state monies that the administration may spend in any fiscal year for health care provided under this article shall not exceed the amount appropriated or authorized by section 35-173. C. This article does not impose a duty on an officer,  agent or employee of this state to discharge a responsibility or create any right in a person or group if the discharge or right would require an expenditure of state monies in excess of the expenditure authorized by legislative appropriation for that specific purpose.
AZ Rev Stat § 36-2990 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2990 - Quality of health care monitoring standard; development; adoption; use; additional monitoring; costs

36-2990.  Quality of health care monitoring standard;  development;  adoption;  use;  additional monitoring;  costs A. The administration shall develop standards of care that each contractor shall use to monitor the quality of health care received by members. B. The director shall periodically determine whether each contractor has properly adopted and implemented standards to ensure the quality of health care. If the director determines that a contractor is out of compliance,  the director shall undertake additional efforts to monitor and assess the quality of health care provided by that contractor for the period of time that the director deems necessary. The director shall determine the cost incurred in undertaking these special efforts and shall deduct that amount from any payment owed to the contractor.
AZ Rev Stat § 36-2991 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2991 - Fraud; penalties; enforcement; violation; classification

36-2991.  Fraud;  penalties;  enforcement;  violation;  classification A. A person shall not provide or cause to be provided false or fraudulent information on an application for eligibility pursuant to this article. B. A person who violates subsection A of this section,  who is determined eligible for services pursuant to this article and who would have been determined ineligible if the person had provided true and correct information is subject,  in addition to any other penalties that may be prescribed by federal or state law,  to a civil penalty of not more than the amount incurred by the system,  including capitation payments made on behalf of the person. In addition,  the person's eligibility may be discontinued in accordance with rules adopted by the director. C. In addition to the requirements of state law,  any applicable fraud and abuse controls that are enacted under federal law apply to persons who are eligible for services under this article and to contractors and noncontracting providers who provide services under this article. D. The director shall make the determination to assess a civil penalty and is responsible for collection of the penalty. The director may adopt rules that prescribe procedures for the determination and collection of civil penalties. The director may compromise civil penalties imposed under this section in accordance with criteria established in rules. E. The director shall adopt rules providing for the appeal of a decision by a person adversely affected by a determination made by the director under this section. The director's final decision is subject to judicial review pursuant to title 12,  chapter 7,  article 6. F. Amounts paid by the state and recovered under this section shall be deposited in the state general fund,  and any applicable federal share shall be returned to the United States department of health and human services. G. If a civil penalty imposed pursuant to subsection D of this section is not paid,  the state may file an action to collect the civil penalty in the superior court in Maricopa county. Matters that were raised or could have been raised in a hearing before the director or in an appeal pursuant to title 12,  chapter 7,  article 6 may not be raised as a defense to the civil action. An action brought pursuant to this subsection shall be initiated within six years after the date the claim is presented. H. A person who knowingly aids or abets another person pursuant to section 13-301,  13-302 or 13-303 in the commission of an offense under this section or section 13-3713 is guilty of a class 5 felony.
AZ Rev Stat § 36-2992 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2992 - Duty to report fraud or abuse; immunity; unprofessional conduct

36-2992.  Duty to report fraud or abuse;  immunity;  unprofessional conduct A. All contractors and noncontracting providers shall advise 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 investigation to determine if there is a sufficient basis to warrant a full investigation. If the findings of a preliminary investigation give the director reason to believe that an incident of fraud or abuse has occurred,  the matter shall be referred to the attorney general. B. Any person making a complaint or furnishing a report,  information or records in good faith pursuant to this section is immune from any civil liability by reason of that action unless that person has been charged with or is suspected of the reported fraud or abuse. C. Any health care provider who fails to report pursuant to this section commits an act of unprofessional conduct and is subject to disciplinary action by the provider's licensing board or department.
AZ Rev Stat § 36-2994 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2994 - Monthly financial report

36-2994.  Monthly financial report A. The director shall include in the monthly report submitted to the president of the senate and the speaker of the house of representatives pursuant to section 36-2920 the following information about the program: 1. The actual year to date expenditures and projected annual expenditures. 2. The actual member months. 3. Monies recovered monthly from third party payors. 4. The amount and origin of any donation or grant from a private entity and the impact on the implementation of the program. B. The report shall be submitted on or before the twenty-fifth day of the following month. C. The director shall provide a copy of the monthly report to the chairmen of the house of representatives and senate standing committees on appropriations and health.
AZ Rev Stat § 36-2995 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2995 - Children's health insurance program fund; sources of monies; use; reversion; claims

36-2995.  Children's health insurance program fund;  sources of monies;  use;  reversion;  claims A. The children's health insurance program fund is established. The administration shall administer the fund and shall use fund monies to pay administrative and program costs associated with the operation of the program established by this article. B. Separate accounting shall be made for each source of monies received pursuant to subsection C of this section for expenses and income activity associated with the program established pursuant to this article. C. Monies in the fund are comprised of: 1. Federal monies available to this state for the operation of the program. 2. Tobacco tax and state general fund monies appropriated as state matching monies. 3. Gifts,  donations and grants from any source. 4. Interest paid on monies deposited in the fund. 5. Third party liability recoveries. D. If a gift,  a donation or a grant of over ten thousand dollars received from any private source contains a condition,  the administration shall first meet with the joint legislative study committee on the integration of health care services to review the condition before it spends that gift,  donation or grant. E. All monies in the fund other than monies appropriated by this state do not lapse. F. Monies appropriated from the medically needy account of the tobacco tax and health care fund are exempt from section 35-190 relating to lapsing of appropriations. Notwithstanding section 35-191,  subsection B,  the period for administrative adjustments extends for only six months for appropriations made for administration covered services. G. Notwithstanding sections 35-190 and 35-191,  all approved claims for system covered services presented after the end of the fiscal year in which they were incurred shall be paid either in accordance with this section or in the current fiscal year with the monies available in the funds established by this section. H. Claims for covered services that are determined to be valid by the director and the grievance and appeal procedure shall be paid from the children's health insurance program fund. I. All payments for claims from the children's health insurance program fund shall be accounted for by the administration by the fiscal year in which the claims were incurred,  regardless of the fiscal year in which the payments were made. J. Notwithstanding any other law,  county owned or contracted providers and special health care district owned or contracted providers are subject to all claims processing and payment requirements or limitations of this chapter that are applicable to noncounty providers.