reglab/housing_qa huggingface dataset:
AZ Rev Stat § 36-2938 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2938 - Case management; definition

36-2938.  Case management;  definition 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 the development by the program contractor of a long-term care service plan for each member. This plan shall include a cost benefit analysis for institutional or home and community based services. In developing this plan,  the program contractor may use the information obtained from the preadmission screening conducted pursuant to section 36-2936 to determine the types of services a member should receive. B. Each program contractor shall provide continual case management services to members in compliance with the uniform statewide case management program established pursuant to subsection A of this section. C. Except for retroactive coverage,  a program contractor shall only provide payment or reimbursement for services provided pursuant to this article under referral from its case management unit. D. For the purposes of this section,  " case management"  means a service that will direct members to the most appropriate amount,  duration and type of services and continually monitor and reassess a member's need for services provided pursuant to this article.
AZ Rev Stat § 36-2940 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2940 - Program contractors; annual plan

36-2940.  Program contractors;  annual plan 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 subcontracts with providers or through noncontracting providers to members who are defined as persons with developmental disabilities pursuant to section 36-551 and who are enrolled with the program contractor by the system.  B. Each program contractor pursuant to this section shall annually submit to the director a comprehensive plan for the delivery of services to members. The plan shall include necessary information as determined by the director.
AZ Rev Stat § 36-2941 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2941 - Establishment of capitation rates

36-2941.  Establishment of capitation rates 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. B. At least thirty days before finalizing the capitation rates,  the administration shall send written notice of the proposed capitation rates to the department. C. 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.
AZ Rev Stat § 36-2942 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2942 - Payments to the department

36-2942.  Payments to the department 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 administration may retain a specific percentage of the federal portion of the capitation rate for third party payments collected pursuant to this section. 2. The administration shall make at least monthly payments to the department with that portion of federal monies available for administrative costs. 3. Any portion of the capitation rate pursuant to paragraph 1 of this subsection or administrative costs pursuant to paragraph 2 of this section not paid for by federal monies shall be paid by the department. 4. Payments made pursuant to paragraph 1 of this subsection shall begin after a member is enrolled in the system. 5. The department is responsible for any costs of providing services to members that exceed the capitation rate. 6. The director shall require contract terms necessary to ensure adequate performance by the department of the provisions of each contract executed pursuant to this section.
AZ Rev Stat § 36-2943 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2943 - Provider subcontracts; hospital reimbursement

36-2943.  Provider subcontracts;  hospital reimbursement 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 be negotiated with a provider and shall be awarded pursuant to section 41-2536. In order to deliver covered services to members enrolled or expected to be enrolled in the system within a county,  the program contractor may negotiate and award without bid a provider subcontract if during the contract year there is an insufficient number of subcontracts awarded to providers. The term of the subcontract shall not extend beyond the next bid and subcontract award process as provided in this section,  and the subcontract shall be at rates no greater than the weighted average rates for the appropriate level of care paid to similar providers in the same county. This section does not allow a program contractor to forego the competitive bid process pursuant to section 41-2534 unless there is an unanticipated increase in members enrolled in the system or a decrease in available beds brought about by the closure of a facility operated by a provider that is unable to be absorbed by current contracting providers located in the same general area. Before soliciting subcontracts without the competitive bid process,  the program contractor shall receive approval from the director. B. Hospitals that render care to members shall be paid by the program contractor as prescribed in section 36-2903.01,  or such lower rate as may be negotiated by the program contractor. C. The director may ensure through the subcontracts pursuant to subsection A of this section that at least ten per cent of the members are provided services pursuant to this article on a capitation basis. D. A claim for an authorized service submitted by a licensed skilled nursing facility,  an assisted living Arizona long-term care system provider or a home and community based Arizona long-term care system provider that renders care to members pursuant to this article shall be adjudicated within thirty calendar days after receipt by the program contractor. Any clean claim for an authorized service provided to a member that is not paid within thirty calendar days after the claim is received accrues interest at the rate of one per cent per month from the date the claim is submitted. The interest is prorated on a daily basis and must be paid by the program contractor at the time the clean claim is paid.
AZ Rev Stat § 36-2945 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2945 - Provision of services without contract; requirements

36-2945.  Provision of services without contract;  requirements 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 for institutional and hospital services. 2. Execute capped fee-for-service contracts for other services. Any capped fee-for-service contract shall provide for reimbursement at a level which does not exceed a capped fee-for-service schedule adopted by the director. B. During any period in which services are needed and no contract exists,  or for those members not enrolled with program contractors,  the director on the approval of the legal advisor of the administration may do either of the following: 1. Pay noncontracting providers for services,  other than hospital services,  on a capped fee-for-service basis for members. However,  the director shall not pay any amount for services which exceeds a maximum amount set forth in a capped fee-for-service schedule adopted by the director. 2. Pay a hospital subject to the reimbursement level limitation prescribed in section 36-2903.01. C. If services are provided in the absence of a contract,  the director shall continue to attempt to procure by the bid process as provided in section 36-2944 contracts for such services as specified in this subsection. D. The director may adopt rules or require contractual provisions that prescribe requirements and time limits for submittal of and payment for claims submitted for services to the administration. E. Notwithstanding section 35-190,  the director may pay claims arising during the fiscal year for a period of six months after the close of the fiscal year.
AZ Rev Stat § 36-2946 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2946 - Coordination of benefits; third party payments

36-2946.  Coordination of benefits;  third party payments 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 responsible for the coordination of benefits provided pursuant to this article. The system shall act as a payor of last resort for members unless specifically prohibited by federal law. The director shall require members to assign to the system rights to all types of medical benefits to which the member is entitled,  including first party medical benefits under automobile insurance policies. This state has a right to subrogation against any other person to enforce the assignment of medical benefits. The provisions of this subsection are controlling over the provisions of an insurance policy which provides benefits to a member if the policy is inconsistent with the provisions of this subsection. The administration shall monitor third party payments collected by providers and noncontracting providers. For purposes of this section,  benefits from third party payors do not include monies available under the older Americans act of 1965,  a social services block grant or an optional state supplemental payment program if federal monies are available for home and community based services pursuant to section 36-2939,  subsection D. B. Notwithstanding subsection A of this section,  beginning on the first day of the first calendar quarter following the adjournment of the first regular session of the fortieth legislature and in accordance with section 4402 of the omnibus budget reconciliation act of 1990,  if the administration determines that according to federal guidelines it is more cost effective for a person defined as eligible under section 36-2934 to be enrolled in a group health insurance plan in which the person is entitled to be enrolled,  the administration shall pay all of that person's premiums,  deductibles,  coinsurance and other cost sharing obligations for services covered under section 36-2934. The person shall apply for enrollment in the group health insurance plan as a condition of eligibility under section 36-2934.
AZ Rev Stat § 36-2947 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2947 - Program contractors; additional responsibilities

36-2947.  Program contractors;  additional responsibilities 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 contractor and the department shall notify the administration in accordance with rules adopted pursuant to section 36-2932,  subsection G. If that member may be eligible for services under article 1 of this chapter,  the program contractor shall refer the person to the administration and arrange for the transfer of records to the appropriate provider as defined in section 36-2901 on notice by the administration.
AZ Rev Stat § 36-2948 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2948 - Prohibited collection practices

36-2948.  Prohibited collection practices On oral or written notice from the member or person that the member or person believes the claims to be covered by the system,  a provider or noncontracting provider shall not do either of the following unless the provider or noncontracting provider has verified through the administration that the member or person has not yet been determined eligible or was not,  at the time services were rendered,  eligible or enrolled: 1. Charge,  submit a claim to or demand or otherwise collect payment from a member or person who has been determined eligible unless specifically authorized by this article or rules adopted pursuant to this article. 2. Refer or report a member or person who has been determined eligible to a collection agency or credit reporting agency for the failure of the member or person who has been determined eligible to pay charges for system covered care or services unless specifically authorized by this article or rules adopted pursuant to this article.
AZ Rev Stat § 36-2949 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2949 - Exemption from insurance law

36-2949.  Exemption from insurance law To the extent that services are provided pursuant to this article,  a provider or program contractor is not subject to the provisions of title 20.
AZ Rev Stat § 36-2950 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2950 - Services to persons with disabilities; eligibility; premiums

36-2950.  Services to persons with disabilities;  eligibility;  premiums 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 pursuant to section 36-2931,  paragraph 5,  subdivision (d),  who meets the income requirements of subsection B of this section and who has too much income or resources to qualify for the system pursuant to section 36-2934. B. A person meets the income requirements of this section if the person's countable income does not exceed two hundred fifty per cent of the federal poverty guidelines. The administration shall use the supplemental security income methodology. For purposes of this subsection,  countable income does not include the person's unearned income,  the person's spouse's or any other family member's earned or unearned income or a deduction for a minor child. C. The administration shall adopt rules for the collection of premiums from persons who qualify for services pursuant to this section. The premium shall not exceed two per cent of the person s countable income. D. The administration shall develop and implement a process for eligibility determinations for persons who apply for eligibility and annual redeterminations for continued eligibility. The administration shall also develop and implement a process to determine medically improved disabilities. The administration may enter into an intergovernmental agreement with the department of economic security or may contract with participating health plans to conduct eligibility determinations or redeterminations. The administration may not use a resource test to determine or redetermine eligibility.
AZ Rev Stat § 36-2951 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2951 - Self-directed attendant care services; rules; definition

36-2951.  Self-directed attendant care services;  rules;  definition A. Notwithstanding any law to the contrary,  a person enrolled in the Arizona long-term care system may employ another person to provide self-directed attendant care services that would otherwise be considered within the scope of nursing care pursuant to title 32,  chapter 15 if: 1. The person receiving these services is in stable condition,  is not a resident in a medical facility and is competent to give directions to the attendant. 2. The person receiving these services has a functional disability and requires a service that could have been performed by that person except for the disability. 3. The attendant offers only services that are prescribed by the administration by rule.  B. The administration shall adopt rules prescribing the types of self-directed attendant care services that may be delivered pursuant to this section. Before it adopts these rules,  the administration shall submit the proposed rules to the state board of nursing for its review and approval. C. For the purposes of this section,  " self-directed attendant care"  means a service provided by an attendant caregiver who is hired to provide personal care,  homemaker and general supervision services to a participant in the Arizona long-term care system.
AZ Rev Stat § 36-2953 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2953 - Department long-term care system fund; uniform accounting; reporting requirements

36-2953.  Department long-term care system fund;  uniform accounting;  reporting requirements A. The department shall establish and maintain a department long-term care system fund,  which is a separate fund to distinguish its revenues and its expenditures pursuant to this article from other programs funded or administered by the department. Subject to legislative appropriation,  the fund shall be used to pay administrative and program costs associated with the operation of the system. The department long-term care system fund shall be divided as follows: 1. An account for eligibility determination pursuant to section 36-2933,  if the administration enters into an interagency agreement with the department pursuant to section 36-2933,  subsection E. 2. An account for the provision of long-term care services as prescribed in section 36-2939,  subsections A and B. B. The department long-term care system fund shall be composed of: 1. Monies paid by the administration pursuant to the contract. 2. Amounts paid by third-party payors. 3. Gifts,  donations and grants from any source. 4. State appropriations for the department long-term care system pursuant to this article. 5. Interest on monies deposited in the long-term care system fund. C. The department shall submit a prospective long-term care budget as prescribed by the administration. D. The administration shall prescribe a uniform accounting system for the fund established pursuant to subsection A of this section. Technical assistance shall be provided by the administration to the department in order to facilitate the implementation of the uniform accounting system. E. The department shall submit an annual audited financial and programmatic report for the preceding fiscal year as required by the administration. The report shall include beginning and ending fund balances,  revenues and expenditures,  including specific identification of administrative costs for the system. The report shall include the number of members served by the system and the cost incurred for various types of services provided to members in a format prescribed by the director. F. The department shall submit additional utilization and financial reports as required by the director. G. The director shall make at least an annual review of the department's records and accounts. H. All monies from capitated payments in the department long-term care system fund that are unexpended and unencumbered at the end of the fiscal year revert to the state general fund on or before June 30 of the following fiscal year. The transfer amount may be adjusted for reported but unpaid claims and estimated incurred but unreported claims,  subject to approval by the administration. The transfer amount may not be adjusted to pay nonmedicaid claims incurred by the division of developmental disabilities.
AZ Rev Stat § 36-2954 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2954 - Erroneous eligibility determination; state liability

36-2954.  Erroneous eligibility determination;  state liability If the director determines through the grievance and appeal procedure pursuant to a grievance or appeal filed by an applicant that the administration made an error in eligibility determination pursuant to section 36-2933 and a person was incorrectly determined to be ineligible to receive institutional or home and community based services,  the administration shall reimburse a provider or noncontracting provider for unreimbursed services provided to the applicant. The administration shall only make reimbursements for services pursuant to this article and from the date the person was incorrectly determined to be ineligible so long as the person remains eligible or until the person is enrolled in the system,  whichever is applicable.
AZ Rev Stat § 36-2955 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2955 - Inappropriate services; federal sanctions

36-2955.  Inappropriate services;  federal sanctions A. Notwithstanding section 36-2940,  the director shall adopt rules which provide that the administration shall withhold or forfeit capitation payments to the program contractor pursuant to section 36-2940 if the program contractor provides inappropriate services to a person determined eligible pursuant to section 36-2933 in an amount which equals the cost of the appropriate services. B. The cost of any federal sanctions or penalties placed on the administration for errors made by the program contractor pursuant to section 36-2940 such as inappropriate provision of services shall be recouped from the program contractor.
AZ Rev Stat § 36-2956 (2021)
2021 Arizona Revised Statutes|Title 36 - Public Health and Safety|§ 36-2956 - Liens on damages for injuries; notification

36-2956.  Liens on damages for injuries;  notification  A. The administration is entitled to a lien for the charges for hospital,  medical or long-term care and treatment of an injured person for which the administration or a program contractor is responsible pursuant to this article,  on any and all claims for damages accruing to the person to whom hospital or medical service is rendered,  or to the legal representative of such person,  on account of injuries giving rise to such claims and which necessitated such hospital or medical care and treatment. Recovery of charges pursuant to this section shall be in a manner as nearly as possible the same as the procedures prescribed in sections 36-2915 and 36-2916. B. The member or the member's legal representative must provide written notice to the administration within twenty calendar days after the commencement of a civil action or other proceeding to establish the liability of any third party or to collect monies payable from accident insurance,  liability insurance,  workers' compensation,  health insurance,  medical payment insurance,  underinsured coverage,  uninsured coverage or any other first or third party source.