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2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2927 - Intergovernmental service fund; funding

36-2927.
Intergovernmental service fund;  funding
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 from investment shall be credited to the fund.
B. The fund shall be used to pay all costs,  including staff positions,  incurred pursuant to an agreement entered into pursuant to section 36-2925 and for the purposes authorized by section 36-2926.
C. Separate accounts may be established within the fund for each agreement and the activities authorized by section 36-2926.
D. The intergovernmental service fund consists of:
1. All monies deposited in the fund pursuant to an agreement authorized by section 36-2925.
2. The cost savings that are received pursuant to section 36-2925,  subsection D and that are earned from the appropriations made by this state for the costs of operating the system in this chapter.
3. Federal monies available to this state for the operation of the system in this chapter.
4. Gifts,  donations and grants from any source.
5. Interest on monies deposited in the fund.
E. Monies in the fund are exempt from the provisions of section 35-190 relating to lapsing of appropriations. The cost savings that are earned from appropriations made by this state and remaining in the fund at the end of the fiscal year do not revert to the fund from which they were appropriated.
F. The administration may continue to make expenditures from the fund,  subject to the availability of monies in the fund,  to fulfill its commitments under an agreement authorized by section 36-2925 for costs incurred but not processed by the administration during the fiscal years in which the agreement was in effect.
G. The administration shall account for all payments from the intergovernmental service fund by the fiscal year in which the costs were incurred,  regardless of the fiscal year in which the payments were made.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2928 - Budget neutrality compliance fund; nonlapsing

36-2928.
Budget neutrality compliance fund;  nonlapsing
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 shall administer the fund. Monies in the fund are continuously appropriated and do not revert to the state general fund.
B. 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 from investment shall be credited to the Arizona tobacco litigation settlement fund established by section 36-2901.02.
C. The administration shall use any remaining fund monies to pay for expenditures made pursuant to section 36-2901.02,  subsection B,  paragraph 1 if sufficient monies are not available in the Arizona tobacco litigation settlement fund established by section 36-2901.02,  except that the administration shall use fund monies deposited pursuant to section 11-292,  subsection P for any direct and indirect eligibility costs associated with the expansion of program services.
D. On or before June 30 of each year,  the administration shall transfer from the Arizona tobacco litigation settlement fund established by section 36-2901.02 an amount necessary to reimburse the fund established pursuant to this section for its expenditures made to cover costs associated with the expanded definition of eligibility pursuant to section 36-2901.01,  36-2901.04 or 36-2903.03.
E. Notwithstanding subsection C of this section,  in fiscal year 2001-2002,  the administration shall use forty-six million seven hundred thirty-six thousand dollars of fund monies for maintenance of effort for the state match for persons who are determined eligible pursuant to section 36-2901.01,  36-2901.04 or 36-2903.03. Beginning in fiscal year 2002-2003 and each fiscal year thereafter,  the administration shall adjust this amount for inflation based on the GDP price deflator as defined in section 41-563.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2929 - Services to persons with disabilities; eligibility; premiums

36-2929.
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 36-2901,  paragraph 6,  subdivision (g),  who meets the income requirements of subsection B of this section and who has too much income to qualify for the system pursuant to section 36-2901,  paragraph 6,  subdivision (a).
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 the 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.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2930 - Prescription drug rebate fund; exemption; definition

36-2930.
Prescription drug rebate fund;  exemption;  definition
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 prescription drug rebate program. The administration shall administer the fund. Nonfederal monies in the fund are subject to annual legislative appropriation. Federal monies in the fund are continuously appropriated and are exempt from the provisions of section 35-190 relating to the lapsing of appropriations.
B. Monies in the fund shall be used to return the federal share of prescription drug rebate collections and interest from late payments to the centers for medicare and medicaid services by offsetting future federal draws,  to pay for the administrative costs of the prescription drug rebate program and as the nonfederal share for payments to contractors or providers in the administration's medical services programs. The nonfederal share of prescription drug rebate collections and interest from late payments include rebates relating to programs administered by the department of economic security,  the department of child safety,  the department of health services and other governmental entities that contribute to the nonfederal share for prescription drugs.
C. For the purposes of this section,  " administrative costs of the prescription drug rebate program"  includes:
1. Payments to the prescription drug rebate vendor.
2. Administrative costs of the administration in support of the prescription drug rebate program.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2930.01 - Members; missed medical appointments; fee; provider remedy

36-2930.01.
Members;  missed medical appointments;  fee;  provider remedy
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 member from rescheduling until the member has paid a twenty-five dollar missed appointment fee to the provider.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2930.02 - Intergovernmental agreements for county behavioral health services fund; purpose

36-2930.02.
Intergovernmental agreements for county behavioral health services fund;  purpose
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 administer the fund. Monies in the fund are continuously appropriated.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2930.04 - Delivery system reform incentive payment fund; purpose; exemption; expenditure plan review

36-2930.04.
Delivery system reform incentive payment fund;  purpose;  exemption;  expenditure plan review
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 administration shall administer the fund,  and the fund is continuously appropriated. 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 from investment shall be credited to the fund.
C. Separate accounts may be established within the fund for each designated state health program.
D. The delivery system reform incentive payment fund consists of:
1. All monies deposited in the fund pursuant to the section 1115 waiver authority associated with delivery system reform incentive payments and designated state health programs.
2. Gifts,  donations and grants from any source.
3. Federal monies available to this state.
4. Interest on monies deposited in the fund.
E. Monies in the fund are exempt from the provisions of section 35-190,  relating to lapsing of appropriations.
F. Before the initial deposit of any monies in the fund,  the administration shall submit an expenditure plan for review by the joint legislative budget committee.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2930.05 - Provider participation; grounds for exclusion; rules; definition

36-2930.05.
Provider participation;  grounds for exclusion;  rules;  definition
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 in the system any individual or entity that has done any of the following:
1. Met any basis for permissive exclusion described in 42 Code of Federal Regulations section 1002.210.
2. Committed any act prohibited by section 36-2918 or 36-2957.
3. Been found liable for the neglect of a patient that results in death or injury.
4. Engaged in the unlawful disposal of medical waste in violation of federal,  state or local law.
5. Submitted a claim for a procedure performed in association with an abortion in violation of federal or state law.
6. Failed to segregate taxpayer dollars from abortions,  including the use of taxpayer dollars for any overhead expenses attributable to abortions.
7. Failed to comply with federal or state law requiring mandatory reporting of sexual abuse,  sexual assault,  child or sex trafficking or statutory rape.
C. The delineation of grounds for exclusion pursuant to subsections A and B of this section does not exclude any other basis for exclusion pursuant to state law or any rule adopted by the administration.
D. The director shall adopt rules that prescribe procedures for determining the length of exclusion,  appealing the exclusion determination and requesting reinstatement following an exclusion.
E. For the purposes of this section,  " exclude"  means that items and services furnished,  ordered or prescribed by a specified individual or entity will not be reimbursed by the administration,  a contractor or any agent of the administration or a contractor. Exclude includes the termination of a provider agreement or the administration's refusal to enter into a provider agreement.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2930.06 - Substance use disorder services fund; AHCCCS administration; use of monies

36-2930.06.
Substance use disorder services fund;  AHCCCS administration;  use of monies
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 fund.
2. Are exempt from the provisions of section 35-190,  relating to lapsing of appropriations.
3. Are continuously appropriated.
C. The administration shall enter into agreements with one or more contractors for substance use disorder services using monies from the substance use disorder services fund. In addition to terms and conditions the director deems appropriate,  the agreement between the administration and each contractor shall require that:
1. The monies allocated in the agreement not be used for persons who are eligible under title XIX or title XXI of the social security act. Preference shall be given to persons with lower household incomes.
2. The contractor coordinate benefits provided under this section with any third parties that are legally responsible for the cost of services.
3. The contractor make payments to providers based on contracts with providers or,  in the absence of a contract,  at the capped fee schedule established by the administration.
4. The contractor submit expenditure reports monthly in a format determined by the director for reimbursement of services provided under the agreement. The agreement may also provide for additional reimbursement for administering the agreement in an amount not to exceed eight percent of the expenditures for services.
5. The administration not be held financially responsible to the contractor for any costs incurred by the contractor in excess of the monies allocated in the agreement.
D. The system shall act as payor of last resort for persons who are eligible pursuant to this section. On receipt of services under this section,  a person is deemed to have assigned to the system all rights to any type of medical benefit to which the person is entitled.
E. This section does not:
1. Establish an entitlement for any individual to receive any particular service.
2. Establish a duty on the part of the administration to provide services or spend monies in excess of the monies in the fund.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2931 - Definitions

36-2931.
Definitions
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 this article and which is based on a fixed rate per person notwithstanding the amount of services provided to a member.
3. " Department"  means the department of economic security.
4. " Director"  means the director of the Arizona health care cost containment system administration.
5. " Eligible person"  means a person who:
(a) Is a resident of this state and a United States citizen or a person who meets the requirements for qualified alien status as determined pursuant to section 36-2903.03,  who entered the United States on or before August 21,  1996 or who entered the United States on or after August 22,  1996 and who is a member of an exception group under Public Law 104-193,  section 412.
(b) Meets the eligibility criteria pursuant to section 36-2934.
(c) Needs institutional services as determined pursuant to section 36-2936.
(d) Is defined as eligible pursuant to section 1902(a)(10)(A)(ii)(XV) and (XVI) of title XIX of the social security act and who meets the income requirements of section 36-2950.
6. " Home and community based services"  means services described in section 36-2939,  subsection B,  paragraph 2 and subsection C.
7. " Institutional services"  means services described in section 36-2939,  subsection A,  paragraph 1 and subsection B,  paragraph 1.
8. " Member"  means an eligible person who is enrolled in the system.
9. " Noncontracting provider"  means a person who provides services as prescribed by section 36-2939 and who does not have a subcontract with a program contractor.
10. " Program contractor"  means the department or any other entity that contracts with the administration pursuant to section 36-2940 or 36-2944 to provide services to members pursuant to this article.
11. " Provider"  means a person who subcontracts with a program contractor for the delivery of services to members pursuant to this article.
12. " Special health care district"  means a special health care district organized pursuant to title 48,  chapter 31.
13. " State plan"  means a written agreement between the centers for medicare and medicaid services and the Arizona health care cost containment system administration that describes eligibility,  covered services and the requirements for participation in the medicaid program except those requirements that are waived pursuant to the research and demonstration waiver pursuant to section 1115 of the social security act.
14. " System"  means the Arizona long-term care system.
15. " Uniform accounting system"  means a standard method of collecting,  recording and safeguarding Arizona long-term care system data.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2933 - Eligibility determination; application; enrollment

36-2933.
Eligibility determination;  application;  enrollment
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 adopted pursuant to section 36-2932,  subsection K and the eligibility criteria prescribed in section 36-2934.
B. The administration shall conduct a preadmission screening pursuant to section 36-2936 to determine if the applicant is eligible for services.
C. A person who is a resident of this state and,  if not a citizen of the United States,  who meets the alienage requirements of federal law and who meets the eligibility criteria prescribed in section 36-2934 and who is determined eligible for services pursuant to section 36-2936 shall be enrolled in the system,  unless such person is enrolled in the Arizona health care cost containment system pursuant to article 1 of this chapter and only needs convalescent care as defined by the director by rule.
D. On enrollment in the system,  the administration shall conduct post-eligibility treatment of income and resources of the member as prescribed in section 36-2932,  subsection L.
E. The director may enter into an interagency agreement with the department under which the department may:
1. Determine whether all persons with developmental disabilities as defined in section 36-551 who apply to the system meet the eligibility criteria prescribed in subsection A of this section.
2. Conduct preadmission screening pursuant to subsection B of this section on persons with developmental disabilities as defined in section 36-551 to determine if the applicant is eligible for services.
3. Conduct post-eligibility treatment of income and resources pursuant to subsection D of this section for a member who has a developmental disability as defined in section 36-551.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2934.02 - Financial instruments; eligibility for the system

36-2934.02.
Financial instruments;  eligibility for the system
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 transfer with uncompensated value pursuant to section 36-2934,  subsection B unless it meets all of the following:
1. It is purchased from a life insurance company or another commercial company that sells annuities as part of the normal course of business.
2. It provides substantially equal monthly payments of principal and does not have a balloon or deferred payment of interest or principal.
3. It is an annuity currently issuing payments for the person or that person's spouse.
4. It will return the full principal and interest within the annuitant's life expectancy.
C. An irrevocable annuity that meets the requirements of subsection B of this section is a transfer with compensated value.
D. The fair market value of a promissory note,  loan agreement or related financial instrument that is negotiable,  assignable and enforceable is a countable resource.
E. A promissory note,  loan agreement or related financial instrument that does not comply with subsection D of this section is a transfer with uncompensated value. For a promissory note,  loan agreement or related instrument that does comply with subsection D of this section,  the difference between the outstanding principal balance and the fair market value is a transfer with uncompensated value.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2935 - Estate recovery program; liens

36-2935.
Estate recovery program;  liens
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 receives.
B. A member's personal representative must notify the administration of the member's estate or property within three months after the member's death if the member was at least fifty-five years of age and the administration has not already filed a statement of claim in the estate proceedings.
C. As nearly as is possible,  the administration shall recover charges pursuant to the procedures prescribed in sections 36-2915 and 36-2916. If both the administration and a county have valid liens for paid assistance provided to the same member,  or if both the administration and a special health care district have valid claims for paid assistance provided to the same member,  the value of the property shall be divided between the administration,  the special health care district and the county pro rata according to the amounts of their respective liens.
D. The administration shall impose liens in a manner consistent with federal law.
E. This section also applies to persons who are eligible pursuant to section 36-2901,  paragraph 6,  subdivision (a) and who receive medical assistance under article 1 of this chapter.
2023 Arizona Revised Statutes › Title 36 - Public Health and Safety › § 36-2937 - Effective date of program contractor's responsibility

36-2937.
Effective date of program contractor's responsibility
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 specified in contract or until the eligible person or member is no longer eligible under article 1 of this chapter,  whichever occurs first.
B. For a person who is not a member or eligible person under article 1 of this chapter on the date of eligibility for the system,  the program contractor is responsible beginning on the date specified in contract for providing services pursuant to this article. If the person is retroactively eligible pursuant to federal law prior to the date that the program contractor assumes responsibility,  the administration shall reimburse noncontracting providers from the Arizona long-term care fund for services which are covered under this article and which are provided to an eligible person during the period of retroactive eligibility. No reimbursement may be made for a service provided during the period of retroactive eligibility that does not qualify for monies under title XIX of the social security act. The director shall adopt rules prescribing reimbursement levels for services provided during the period of retroactive eligibility which are consistent with federal law. Covered inpatient hospital services provided during the period of retroactive eligibility shall not be reimbursed at a level higher than prescribed in section 36-2903.01.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.