reglab/statecodes huggingface dataset:
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - SCOPE OF SERVICES › Section R9-31-215 - Other Medical Professional Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. The following medical professional
				services are covered services if a member receives these services in an
				inpatient, outpatient, or office setting:
1.
				Dialysis;
2. The following family
				planning services if provided to delay or prevent pregnancy:
a. Medications,
b. Supplies,
c. Devices, and
d. Surgical procedures.
3. Family planning services are limited to:
a. Contraceptive counseling, medication,
				supplies, and associated medical and laboratory examinations, including HIV
				blood screening as part of a package of sexually transmitted disease tests
				provided with a family planning service; and
b. Natural family planning education or
				referral;
4. Midwifery
				services provided by a nurse practitioner certified in midwifery;
5. Podiatry services if ordered by a member's
				primary care provider as specified in A.R.S. §
										36-2989;
6. Respiratory therapy;
7. Ambulatory and outpatient surgery
				facilities services;
8. Home health
				services in A.R.S. §
										36-2989;
9. Private or special duty nursing
				services;
10. Rehabilitation
				services including physical therapy, occupational therapy, speech therapy, and
				audiology provided under this Article;
11. Total parenteral nutrition services,
				(which are the provision of total caloric needs by intravenous route for
				individuals with severe pathology of the alimentary tract);
12. Inpatient chemotherapy;
13. Outpatient chemotherapy; and
14. Hospice care under R9-22-213.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - SCOPE OF SERVICES › Section R9-31-216 - NF, Alternative HCBS Setting, or HCBS

Current through Register Vol. 30, No. 28, July 12, 2024
Services provided in a NF, including room and board,
				  alternative HCBS setting, or HCBS shall be covered as specified in A.A.C.
				  R9-22-216.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-301 - Expenditure Limit and Enrollment

Current through Register Vol. 30, No. 28, July 12, 2024
A. Title XXI will accept
				enrollees subject to the availability of federal funds. If the Director
				determines that monies may be insufficient for the program, the Administration
				shall stop processing applications for the program as specified in A.R.S.
				§
									36-2985.
B.
				After the Administration has verified that federal funding is sufficient, it
				will resume processing applications as specified in A.R.S. §
									36-2985.
C. The
				Administration shall immediately stop processing all applications and shall
				provide advance notice to a member that the program will terminate under A.R.S.
				§
									36-2985.
D. A
				child is not entitled to a hearing under Chapter 34, if the program is
				suspended or terminated.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-302 - General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. Administration. The Administration or its
				designee shall administer the program as specified in A.R.S. §
									36-2982.
				The requirements described under Chapter 22, Article 3, except for R9-22-303,
				R9-22-305(1),
				R9-22-306(A)(4)(a) and (b), R9-22-306(B)(2)(b) and (c), R9-22-306(B)(3)(c)(iv),
				(vii) and (xi),
				R9-22-306(B)(4),
				R9-22-306(B)(5)
				and
				R9-22-307,
				apply to this Chapter.
B.Eligibility
				determination processing time.
When an application is
				  complete, the Administration or its designee shall mail notification to the
				  applicant regarding the eligibility determination no more than 30 days from the
				  date of application except when there is an emergency beyond the
				  Administration's or its designee's control.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-303 - Eligibility Criteria

Current through Register Vol. 30, No. 28, July 12, 2024
Eligibility. To be eligible for the program, an applicant
				  shall meet all the following eligibility requirements in addition to
				  R9-31-302:
1. Age. Is less than 19 years of age. A
				child's coverage shall continue through the month in which a child turns age 19
				if the child is otherwise eligible;
2. Income. Meets the
				income requirements in
				R9-31-304;
3.
				Cost sharing. Pays the cost sharing premium amount when premiums are required
				as specified in A.R.S. §§
									36-2982
				and
				36-2903.01;
4. Other federal program. Is not eligible for Medicaid
				or other federally operated or financed health care insurance program, except
				the Indian Health Service as specified in A.R.S. §
									36-2983;
5. Patient in an institution for mental disease. Is
				not a patient in an institution for mental disease at the time of application,
				or at the time of redetermination, as specified in A.R.S. §
									36-2983;
6.
				Other health coverage. Is not covered under:
a. An employer's group health insurance
				plan,
b. Family or individual
				health insurance, or
c. Other
				health insurance;
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-304 - Income Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A. Income
				standard. The combined gross income of the household income group members as
				specified in subsection (C) shall not exceed the percentage of the appropriate
				FPL under A.R.S. §
									36-2981
				for the Title XXI household income group size.
B. Calculating monthly income. The
				Administration or its designee shall calculate monthly income under
				R9-22-1423.
C. The Administration or its designee shall
				include the income of persons described under
				R9-22-1420(B).
D. Income
				disregards. When determining gross income of the household, the Administration
				or its designee shall disregard income as described under
				R9-22-1421(A).
E. Effective date of initial
				eligibility.
1. For an eligibility
				determination completed by the 25th day of the month, eligibility shall begin
				on the first day of the month following the determination of
				eligibility.
2. For an eligibility
				determination completed after the 25th day of the month, eligibility shall
				begin on the first day of the second month following the determination of
				eligibility.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-305 - Verification

Current through Register Vol. 30, No. 28, July 12, 2024
Verification. An applicant or a member shall provide the
				  Administration or its designee with verification or authorize the release of
				  verification to the Administration or its designee of all information necessary
				  to complete the determination of eligibility as described under
				  R9-22-304.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-306 - Enrollment

Current through Register Vol. 30, No. 28, July 12, 2024
Enrollment requirements applicable to the KidsCare program are described under
				  Chapter 22, Article 17.
.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-307 - Guaranteed Enrollment

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Guaranteed Enrollment. A child who is determined eligible for Title XXI shall
				be guaranteed a one-time, 12-month period of continuous coverage unless a
				child:
1. Attains age 19,
2. Is no longer a resident of the
				state,
3. Is an inmate of a public
				institution,
4. Is determined to
				have been ineligible at the time of approval,
5. Obtains private or group health
				coverage,
6. Is adopted and the new
				household does not meet the qualifications of this program,
7. Is a patient in an institution for mental
				diseases,
8. Has whereabouts that
				are unknown, or
9. Has a head of
				household who:
a. Does not pay cost sharing
				premium amount when premiums are required as specified in A.R.S. §§
											36-2982
				and
				36-2903.01
				and as specified in this Chapter,
b. Voluntarily withdraws from the program,
				or
c. Fails to cooperate in meeting
				the requirements of the program.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-308 - Changes and Redeterminations

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Reporting Changes. A member or a member's parent or guardian shall report the
				following changes to the Administration or its designee:
1. Any increase in income that will begin or
				continue into the following month,
2. Any change of address,
3. The addition or departure of a household
				member,
4. Any health coverage
				under private or group health insurance,
5. Employment of a member or a parent with a
				state agency,
6. Incarceration of a
				member, and
7. Any other changes
				that may impact eligibility or premiums.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-309 - Newborn Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Eligibility. A child born to a Title XXI member, is eligible for 12 months of
				coverage without filing an application under Title XXI provided:
1. The child continues to live with the
				child's mother during the 12-month period; and
2. One of the events as specified in
				R9-31-307(A) does not occur.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-310 - Notice Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
Notice
				  Requirements. The notice requirements as described in
				  R9-22-312 apply to
				  this Chapter.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 3 - ELIGIBILITY AND ENROLLMENT › Section R9-31-311 - Children's Rehabilitative Services (CRS) Eligibility Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
Beginning October 1, 2013, an enrolled KidsCare member who is
				  determined to need active treatment for one or more of the qualifying medical
				  condition(s) in
				  R9-22-1303
				  shall be enrolled with the CRS contractor as described under Chapter 22,
				  Article 13.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 5 - GENERAL PROVISIONS AND STANDARDS › Section R9-31-501 - General Provisions and Standards - Related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
Definitions. In this Chapter, unless the context explicitly
				  requires another meaning terms are defined in
				  R9-31-101
				  or cross-referenced to the location of the definition.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 5 - GENERAL PROVISIONS AND STANDARDS › Section R9-31-502 - Pre-existing Conditions

Current through Register Vol. 30, No. 28, July 12, 2024
A contractor shall comply with the pre-existing condition
				  requirements in A.A.C.
				  R9-22-502.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 5 - GENERAL PROVISIONS AND STANDARDS › Section R9-31-504 - Marketing; Prohibition against Inducements; Misrepresentations; Discrimination; Sanctions

Current through Register Vol. 30, No. 28, July 12, 2024
A contractor or any person or entity acting as the
				  contractor's marketing representative shall follow the requirements in A.A.C.
				  R9-22-504.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 5 - GENERAL PROVISIONS AND STANDARDS › Section R9-31-509 - Transition and Coordination of Member Care

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration or a contractor shall conduct transition
				  and coordination of member care as described in A.A.C.
				  R9-22-509.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 5 - GENERAL PROVISIONS AND STANDARDS › Section R9-31-512 - Release of Safeguarded Information

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration, a contractor, provider, and
				  noncontracting provider shall meet the requirements specified in A.A.C.
				  R9-22-512
				  regarding release of safeguarded information for an applicant or member.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 5 - GENERAL PROVISIONS AND STANDARDS › Section R9-31-518 - Information to Enrolled Members

Current through Register Vol. 30, No. 28, July 12, 2024
A contractor shall provide information to enrolled members as
				  described under
				  R9-22-518.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 5 - GENERAL PROVISIONS AND STANDARDS › Section R9-31-522 - Quality Management/utilization Management (QM/UM) Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A contractor shall comply with Quality Management/Utilization
				  Management (QM/UM) requirements as described under A.A.C.
				  R9-22-522.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-31-601 - General Provisions

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				Director has full operational authority to adopt rules and to use the
				appropriate rules for contract administration and oversight of contractors
				under A.R.S. §
									36-2986.
				The Administration shall administer the program under A.R.S. § 36
				-2982.
B. The Administration shall
				award contracts under A.R.S. §
									36-2986
				to provide services under A.R.S. §
									36-2989.
C. The Administration shall follow the
				provisions under 9 A.A.C. 22, Article 6 for members, unless otherwise specified
				in this Chapter.
D. The
				Administration is exempt from the procurement code under A.R.S. §
									36-2988
				and §
									41-2501.
E. The Administration and contractors shall
				retain all contract records for five years under A.R.S. §
									36-2986
				and dispose of the records under A.R.S. §
									41-2550.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-31-602 - RFP

Current through Register Vol. 30, No. 28, July 12, 2024
The RFP for a contractor serving members who qualify for the
				  program shall be under A.R.S. §
									36-2986
				  and A.A.C.
				  R9-22-602.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-31-603 - Contract Award

Current through Register Vol. 30, No. 28, July 12, 2024
The contract award shall be under A.R.S. §
									36-2986
				  and A.A.C.
				  R9-22-603.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-31-604 - Contract or Proposal Protests; Appeals

Current through Register Vol. 30, No. 28, July 12, 2024
Contract or proposal protests or appeals shall be under
				  A.A.C.
				  R9-22-604.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-31-605 - Waiver of Contractor's Subcontract with Hospitals

Current through Register Vol. 30, No. 28, July 12, 2024
A waiver of a contractor's subcontract with a hospital shall
				  be under A.A.C.
				  R9-22-605.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-31-606 - Contract Compliance Sanction

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall follow sanction provisions under
				  A.A.C.
				  R9-22-606.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 7 - STANDARDS FOR PAYMENTS › Section R9-31-701 - Standards for Payments Related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
Definitions. The words and phrases in this Article have the
				  following meanings unless the context explicitly requires another
				  meaning:
"Covered charges" means billed charges that represent
				  medically necessary, reasonable, and customary items of expense for Title
				  XXI-covered services that meet medical review criteria of the Administration or
				  contractor.
"Medical review" means a review involving clinical judgment
				  of a claim or a request for a service before or after it is paid or rendered to
				  ensure that the services provided to the member are medically necessary and
				  covered services and that the provider obtains required authorizations. The
				  criteria for medical review are established by the contractor based on medical
				  practice standards that are updated periodically to reflect changes in medical
				  care.
"Outlier" means a hospital claim or encounter in which the
				  Title XXI inpatient hospital days of care have operating costs per day that
				  meet the criteria in A.A.C.
				  R9-22-712.
"Tiered per diem" means a payment structure in which payment
				  is made on a per-day basis depending upon the tier into which the Title XXI
				  inpatient hospital day of care is assigned.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 7 - STANDARDS FOR PAYMENTS › Section R9-31-701.10 - General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
The following Sections of A.A.C. Chapter 22, Articles 2 and 7
				  are applicable to reimbursement for AHCCCS-covered services provided to a
				  member under the KidsCare program, except that the term "Children's Health
				  Insurance Program Fund" shall be substituted for "AHCCCS fund" and "A.R.S.
				  §
									36-2986
				  " shall be substituted for "A.R.S. §
									36-2903:"
1. Scope of the Administration's and
				Contractor's Liability, R9-22-701.10;
2. Charges to Members, R9-22-702;
3. Payments by the Administration and
				Payments by Contractors, R9-22-703 and R9-22-705;
4. Payments for Newborns,
				R9-22-707;
5. Contractor's
				Liability to Hospitals for the Provision of Emergency and Post-stabilization
				Care, R9-22-709;
6. Payments for
				Non-hospital Services, R9-22-710;
7. Copayments, R9-22-711;
8. Specialty Contracts, R9-22-712(G)(3),
				R9-22-712.01(10) and Article 2;
9.
				Overpayment and Recovery of Indebtedness, R9-22-713;
10. Payments to Providers,
				R9-22-714;
11. Hospital Rate
				Negotiations, R9-22-715;
12.
				Contractor Performance Measure Outcomes, R9-22-719; and
13. Reinsurance, R9-22-720.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1001 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
The definitions in A.R.S. §
									36-2981,
				  A.A.C.
				  R9-22-1001, and
				  A.A.C.
				  R9-31-101
				  apply to this Article.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1002 - General Provisions

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS is the payor of last resort unless specifically
				  prohibited by applicable state or federal law.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1003 - Cost Avoidance

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1003 apply
				  to this Section except:
1. Replace the
				reference to "Article 2," with 9 A.A.C. 31, Article 2; and
2. This Section applies to Title XXI covered
				services.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1004 - Member Participation

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1004
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1005 - Collections

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1005 apply to
				  this Section except:
1. Replace the
				reference to "Article 2," with 9 A.A.C. 31, Article 2;
2. This Section applies to Title XXI
				fee-for-service and reinsurance payments.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1006 - AHCCCS Monitoring Responsibilities

Current through Register Vol. 30, No. 28, July 12, 2024
With the exception of long-term care insurance, the
				  provisions in A.A.C.
				  R9-22-1006
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1007 - Notification for Perfection, Recording, and Assignment of Title XXI Liens

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1007
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1008 - Notification Information for Liens

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1008
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 10 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-31-1009 - Notification of Health Insurance Information

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1009
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 11 - CIVIL MONETARY PENALTIES AND ASSESSMENTS › Section R9-31-1101 - Basis for Civil Monetary Penalties and Assessments for Fraudulent Claims

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall use the provisions in 9 A.A.C. 22, Article 11
				  for the determination and collection of penalties and assessments.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 12 - BEHAVIORAL HEALTH SERVICES › Section R9-31-1201 - Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
The requirements, services and definitions under Chapter 22,
				  Article 2 and Article 12 apply to behavioral health services provided under
				  this Article.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1401 - Purpose

Current through Register Vol. 30, No. 28, July 12, 2024
This Article contains the requirements for the payment of a
				  premium for a child determined eligible under Article 3 of this Chapter to the
				  Administration by a member and the processing of a premium by the
				  Administration.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1402 - Premium Amount for a Member Who Is a Child Determined Eligible under Article 3 of This Chapter

Current through Register Vol. 30, No. 28, July 12, 2024
A. For the
				purposes of this Article, a premium is a monthly amount that an enrolled member
				pays to the Administration to remain eligible for Title XXI.
B. When the household income is greater than
				the income limit described under
				R9-22-1427(D)
				and less than or equal to 150 percent of the FPL, the monthly premium is $10
				for one eligible child and $15 for two or more eligible children.
C. When household income is greater than 150
				percent of the FPL and less than or equal to 175 percent of the FPL, the
				monthly premium payment is $40 for one eligible child and $60 for two or more
				eligible children.
D. When
				household income is greater than 175 percent of the FPL and less than or equal
				to 200 percent of the FPL, the monthly premium is $50 for one eligible child
				and $70 for two or more eligible children.
E. A household's premium payments as
				specified in this Section shall not exceed five percent of a household's gross
				income.
F. A member's newborn is
				enrolled immediately upon the Administration receiving notification of the
				child's birth. Upon enrollment, the household's premium is
				redetermined.
G. To remain
				eligible, the premium amount shall be paid according to this Article.
H. American Indians are exempt from paying
				premiums.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1404 - Hardship Exemption for a Member Who Is a Child Determined Eligible under Article 3 of This Chapter

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Definitions. The following definitions apply to this Section:
1. "Major expense" means the expense is more
				than 10 percent of the household's countable income under
				R9-31-304.
2. "Medically necessary" has the same meaning
				as defined in A.A.C. R9-22-101.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1409 - Payment Due Date for Current Month

Current through Register Vol. 30, No. 28, July 12, 2024
The monthly premium payment is due on the 15th day of the
				  month for coverage of that month. This would be considered a current payment.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1410 - Payment Received Date

Current through Register Vol. 30, No. 28, July 12, 2024
A payment is considered received on the date that the
				  Administration receives and credits the payment to the member's account.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1411 - Past Due Payment

Current through Register Vol. 30, No. 28, July 12, 2024
A. Past due
				payment date. A payment is considered past due if the Administration receives
				the payment after the 15th day of the month.
B. Payment not received. If payment for a
				month is not received in full by the last working day of the month in which the
				payment is due, the Administration shall include the past and current due
				amounts in the next billing statement.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1412 - Payment Type

Current through Register Vol. 30, No. 28, July 12, 2024
A premium shall be paid to the Administration by a:
1. Cashier's check,
2. Personal check,
3. Money order,
4. Electronic debit, or
5. Other form approved by the Administration.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1413 - Returned Check

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall not accept a personal check when the
				  premium has been previously paid with a personal check that was returned to the
				  Administration because of insufficient funds.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1414 - Payment in Advance

Current through Register Vol. 30, No. 28, July 12, 2024
A premium may be paid in advance.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1415 - Reimbursement of a Premium

Current through Register Vol. 30, No. 28, July 12, 2024
A. A
				premium paid in advance is nonrefundable, unless the member is disenrolled at
				least 15 days prior to the month of coverage.
B. A premium paid during an appeal and
				request for hearing process is applied as specified in R9-31-1419.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1416 - Allocation of Payment for an Eligible Member

Current through Register Vol. 30, No. 28, July 12, 2024
Except for payments specified in
				  R9-31-1419
				  of this Article, all payments received for eligible members shall first be
				  applied to any past due amounts for prior months owed to the Administration for
				  a child determined eligible under Article 3 of this Chapter. Any remaining
				  amounts shall then be applied to the amount due for the current month for a
				  child eligible under Article 3 of this Chapter
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1417 - Change in Premium Amount

Current through Register Vol. 30, No. 28, July 12, 2024
A. When
				there is a decrease in the premium amount and the change is processed by the
				25th day of the month, then the effective date of the change shall begin on
				first day following the month in which the amount of the premium change is
				processed.
B. When there is a
				decrease in the premium amount and the change is processed after the 25th day
				of the month, then the effective date of the change shall begin on the first
				day of the second month in which the amount of the premium change is
				processed.
C. When there is an
				increase in the premium amount, the effective date of the change shall begin
				with the first month following advance notice of at least ten days.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1418 - Discontinuance for Failure to Pay Premium

Current through Register Vol. 30, No. 28, July 12, 2024
A. Discontinuance notice. The Administration
				shall send an adverse action notice to discontinue eligibility if the
				Administration does not receive the past and current due premium amounts by the
				15th day of the current month. The Administration shall follow the
				discontinuance notice requirements under
				R9-31-310(B).
B. Discontinuance rescinded. The
				Administration shall rescind the discontinuance and continue eligibility if the
				past due amount for at least one prior month is received by the Administration
				in full before the effective date of the discontinuance.
C. Discontinuance of eligibility. Except as
				provided in
				R9-31-1419,
				the Administration shall discontinue eligibility on the effective date of the
				discontinuance if the past due amount for at least one prior month is not
				received by the Administration in full before the effective date of the
				discontinuance.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1419 - Premium Payment during the Appeal and Request for Hearing Process

Current through Register Vol. 30, No. 28, July 12, 2024
A. Discontinuance
				of eligibility. To receive coverage from the time an appeal and request for
				hearing is filed for a discontinuance of eligibility until a Director's
				decision is made.
1. A member shall:
a. File an appeal and request for hearing
				prior to the effective date of the discontinuance.
b. Submit the full monthly premium amount to
				the Administration prior to the date of the discontinuance, and
c. Continue to pay the full monthly premium
				amount each month during the hearing process.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 14 - PREMIUMS FOR A CHILD DETERMINED ELIGIBLE UNDER ARTICLE 3 › Section R9-31-1420 - Payment of a Premium

Current through Register Vol. 30, No. 28, July 12, 2024
When a member was discontinued with an unpaid premium, the
				  parent or other responsible person shall pay the past due premium amounts for a
				  child to the Administration or the child will remain ineligible for 60 days
				  before the person can attain eligibility again.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 16 - SERVICES FOR AMERICAN INDIANS › Section R9-31-1601 - General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. An
				American Indian who is a member may receive:
1. Covered acute care services specified in
				this Chapter from:
a. Indian Health Service
				(IHS) under A.R.S. §
											36-2982
				if IHS has a signed agreement with the Administration,
b. A Tribal Facility under A.R.S. §
											36-2982,
c. A contractor under A.R.S. §
											36-2901,
				or
d. An AHCCCS registered
				provider.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 32

Current through Register Vol. 30, No. 28, July 12, 2024
9 A.A.C. 32, which formerly contained the rules for AHCCCS -
				Prescription Medication Coverage Pilot Program, repealed by summary rulemaking
				at 9 A.A.R. 4385, with an interim effective date of October 10, 2003. The
				rescinded Chapter is on file in the Office of the Secretary of State (Supp.
				03-3). Notice of Final Summary rulemaking published at 10 A.A.R. 902; interim
				effective date of October 10, 2003 becomes permanent effective date April 4,
				2004 (Supp. 04-1).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-101 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
In addition to the definitions in A.R.S. §§ 36-551
				  and  36-591.01, the following definitions apply in this Chapter unless otherwise
				  specified:
1. "Accreditation" means
				recognition as having met the operating standards and criteria of a nationally
				recognized accreditation organization.
2. "Applicant" means an
				individual or business organization requesting a license under R9-33-104 to
				open a group home or behavioral-supported group home.
3.
				"Application packet" means the forms, documents, and additional information the
				Department requires to be submitted by an applicant.
4. "Business
				organization" means the same as "entity" in A.R.S. §
									10-140.
5.
				"Controlling person" means a person who, with respect to a business
				organization:
a. Through ownership, has the
				power to vote at least 10% of the outstanding voting securities of the business
				organization;
b. If the business
				organization is a partnership, is a general partner, or is a limited partner
				who holds at least 10% of the voting rights of the partnership;
c. If the business organization is a
				corporation, association, or limited liability company, is the president, the
				chief executive officer, the incorporator, an agent, or any person who owns or
				controls at least 10% of the voting securities; or
d. Holds a beneficial interest in 10% or more
				of the liabilities of the business organization.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-102 - Requirement for Licensure

Current through Register Vol. 30, No. 28, July 12, 2024
A. An applicant
				shall obtain a license to operate a group home or behavioral-supported group
				home from the Department before providing supervision or habilitation to an
				individual with a cognitive disability, developmental disability, dual
				diagnosis, or challenging behavior in a group home or behavioral-supported
				group home.
B. A license to operate
				a group home or behavioral-supported group home is valid for the following, as
				indicated on the license:
1. Address of the
				group home or behavioral-supported group home;
2. Name of the licensee;
3. Name of the group home or
				behavioral-supported group home, if applicable;
4. Fire risk prevention level; and
5. Licensing period for the group home or
				behavioral-supported group home.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-103 - Individuals to Act for Applicant or Licensee

Current through Register Vol. 30, No. 28, July 12, 2024
When an applicant or licensee is required by this Chapter to
				  provide information on or sign an application form or other document, the
				  following shall satisfy the requirement on behalf of the applicant or
				  licensee:
1. If the applicant or
				licensee is an individual, the individual; and
2. If the applicant or licensee is a business
				organization, the individual who the business organization has designated to
				act on the business organization's behalf for purposes of this Chapter and who:
a. Is a controlling person of the business
				organization,
b. Is a U.S. citizen
				or legal resident, and
c. Has an
				Arizona address.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-104 - Application and Inspection

Current through Register Vol. 30, No. 28, July 12, 2024
A. For a license to
				operate a group home or behavioral-supported group home, an applicant shall
				submit to the Department a completed application that contains:
1. An application in a Department provided
				format that includes:
a. The applicant's
				name;
b. The proposed group home's
				or behavioral-supported group home's name, if any;
c. The address and telephone number of the
				proposed group home or behavioral-supported group home;
d. The applicant's address and telephone
				number, if different from the address or telephone number of the proposed group
				home or behavioral-supported group home;
e. The applicant's e-mail address;
f. The name and contact information of an
				individual acting on behalf of the applicant according to R9-33-103, if
				applicable;
g. Whether the
				applicant agrees to allow the Department to submit supplemental requests for
				information under R9-33-108(C)(4);
h. Whether the applicant is a current service
				provider or intends to become a service provider;
i. The fire risk prevention level at which
				the applicant anticipates operating the group home or behavioral-supported
				group home; and
j. The applicant's
				signature and the date signed;
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-105 - License Renewal

Current through Register Vol. 30, No. 28, July 12, 2024
A. At least 60 days
				before the expiration date indicated on a license to operate a group home or
				behavioral-supported group home, for renewal of the license to operate a group
				home or behavioral-supported group home, a licensee shall submit to the
				Department the information and documents in R9-33-104(A)(3)(a) and
				R9-33-104(A)(4).
B. The Department
				shall renew or deny renewal of a license to operate a group home or
				behavioral-supported group home as provided in R9-33-108.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-106 - Changes Affecting a License

Current through Register Vol. 30, No. 28, July 12, 2024
A. A licensee shall
				notify the Department in writing at least 30 days before the effective date of:
1. Termination of operation of a group home
				or behavioral-supported group home;
2. Termination of a service provider contract
				with the Division;
3. A change in
				the ownership of the group home or behavioral-supported group home;
4. A change in the name of the group home or
				behavioral-supported group home;
5.
				If the licensee is an individual, a legal change of the licensee's
				name;
6. Construction or
				modification of the facility or another structure on the premises other than
				construction or modification undertaken, in accordance with R9-33-203(A);
				or
7. If approved by the Division,
				a change in the group home's or behavioral-supported group home's fire risk
				prevention level.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-107 - Investigation of Complaints

Current through Register Vol. 30, No. 28, July 12, 2024
A. Upon receipt of a
				complaint or information indicating that a group home or behavioral-supported
				group home may not be in compliance with A.R.S. Title 36, Chapter 5.1 or this
				Chapter, the Department may:
1. Investigate
				the complaint or information about noncompliance within 30 days after receipt
				of the complaint or information about noncompliance;
2. Develop a written report documenting the
				investigation;
3. Provide the
				licensee with the written report in subsection (A)(2); and
4. If the complaint or information about
				noncompliance was substantiated, notify the Division of the outcome of the
				investigation.