Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 1 - DEFINITIONS › Section R9-28-101 - General Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
A. Location
				of definitions. Definitions applicable to Chapter 28 are found in the
				following:
Definition Section or Citation
"210"
				  42
				  CFR 435.211
"217"
				  42 CFR
				  435.217
"236"
				  42
				  CFR 435.236
"Acute"
				  R9-28-301
"ADHS"
				  R9-22-101
"ADL"
				  R9-28-101
"Administration" A.R.S. §
										36-2931
"Advance notice"
				  R9-28-411
"Aged"
				  R9-28-402
"Aggregate"
				  R9-22-701
"Aggression"
				  R9-28-301
"AHCCCS"
				  R9-22-101
"AHCCCS registered provider"
				  R9-22-101
"ALTCS"
				  R9-28-101
"ALTCS acute care services"
				  R9-28-401
"Alternative HCBS setting"
				  R9-28-101
"Ambulance" A.R.S. §
										36-2201
"Ambulation"
				  R9-28-301
"Applicant"
				  R9-22-101
"Assessor"
				  R9-28-301
"Auto-assignment algorithm" or "Algorithm"
				  R9-22-1701
"Bathing"
				  R9-28-301
"Bathing or showering"
				  R9-28-301
"Bed hold"
				  R9-28-102
"Behavior intervention"
				  R9-28-102
"Behavior management services"
				  R9-22-1201
"Behavioral health evaluation"
				  R9-22-1201
"Behavioral health medical practitioner"
				  R9-22-1201
"Behavioral health professional"
				  R9-20-101
"Behavioral health service"
				  R9-20-101
"Behavioral health technician"
				  R9-20-101
"Billed charges"
				  R9-22-701
"Blind"
				  42 U.S.C.
				  1382 c(a)(2)
"Capped fee-for-service"
				  R9-22-101
"Case management plan"
				  R9-28-101
"Case management"
				  R9-28-1101
"Case manager"
				  R9-28-101
"Case record"
				  R9-22-101
"Categorically-eligible"
				  R9-22-101
"Certification"
				  R9-28-501
"Certified psychiatric nurse practitioner"
				  R9-22-1201
"CFR"
				  R9-28-101
"Child"
				  R9-22-1503
"Clarity of communication"
				  R9-28-301
"Clean claim" A.R.S. §
										36-2904
"Clinical supervision"
				  R9-22-201
"CMS"
				  R9-22-101
"Community mobility"
				  R9-28-301
"Community spouse"
				  R9-28-401
"Consecutive days"
				  R9-28-801
"Continence"
				  R9-28-301
"Contract"
				  R9-22-101
"Contract year"
				  R9-22-101
"Contractor" A.R.S. §
										36-2901
"Cost avoid"
				  R9-22-1201 or
				  R9-22-1001
"County of fiscal responsibility"
				  R9-28-701
"Covered services"
				  R9-28-101
"CPT"
				  R9-22-701
"Crawling and standing"
				  R9-28-301
"CSRD"
				  R9-28-401
"Current"
				  R9-28-301
"Day"
				  R9-22-101
				  or
				  R9-22-1101
"De novo hearing"
				  42
				  CFR 431.201
"Department" A.R.S. §
										36-2901
"Developmental disability" or "DD" A.R.S. §
										36-551
"Diagnostic services"
				  R9-22-101
"Director"
				  R9-22-101
"Disabled"
				  R9-28-402
"Disenrollment"
				  R9-22-1701
"Disruptive behavior"
				  R9-28-301
"DME"
				  R9-22-101
"Dressing"
				  R9-28-301
"Eating"
				  R9-28-301
"Eating or drinking"
				  R9-28-301
"Emergency medical services for the non-FES member"
				  R9-22-201
"Emotional and cognitive functioning"
				  R9-28-301
"Employed"
				  R9-28-1320
"Encounter"
				  R9-22-701
"Enrollment"
				  R9-22-1701
"EPD"
				  R9-28-301
"E.P.S.D.T. services"
				  42
				  CFR 440.40(b)
"Estate" A.R.S. §
										14-1201
"Experimental services"
				  R9-22-203
"Expressive verbal communication"
				  R9-28-301
"Facility"
				  R9-22-101
"Factor"
				  42 CFR
				  447.10
"Fair consideration"
				  R9-28-401
"FBR"
				  R9-22-101
"Federal financial participation" or "FFP"
				  42 CFR
				  400.203
"Fee-For-Service" or "FFS"
				  R9-22-101
"File"
				  R9-28-801
				  "First continuous period of institutionalization"
				  R9-28-401
"Food preparation"
				  R9-28-301
"Frequency"
				  R9-28-301
"Functional assessment"
				  R9-28-301
"Grievance"
				  R9-34-202
"Grooming"
				  R9-28-301
"GSA"
				  R9-22-101
"Guardian" A.R.S. §
										14-5311
"Hand use"
				  R9-28-301
"HCBS" or "Home and community based services" A.R.S. §
										36-2931
"Health care practitioner"
				  R9-22-1201
"History"
				  R9-28-301
"Home"
				  R9-28-101 and
				  R9-28-801
"Home health services"
				  R9-22-201
"Hospice" A.R.S. §
										36-401
"Hospital"
				  R9-22-101
"ICF-MR" or "Intermediate care facility for the
mentally retarded"
				  42 U.S.C.
				  1396 d(d)
"IADL"
				  R9-28-101
"IHS"
				  R9-22-101
"IMD" or "Institution for mental
diseases"
				  42 CFR
				  435.1010
"Immediate risk of institutionalization"
				  R9-28-301
"Individual Representative"
				  R9-28-509
"Institutionalized"
				  R9-28-401
"Institutionalized spouse"
				  R9-28-101
"Interested Party"
				  R9-28-106
"Intergovernmental agreement" or "IGA"
				  R9-28-1101
"Intervention"
				  R9-28-301
"JCAHO"
				  R9-28-101
"License" or "licensure"
				  R9-22-101
"Medical assessment"
				  R9-28-301
"Medical or nursing services and treatments" or "services and
				  treatments"
				  R9-28-301
"Medical record"
				  R9-22-101
"Medical services" A.R.S. §
										36-401
"Medically eligible"
				  R9-28-401
"Medically necessary"
				  R9-22-101
"Member" A.R.S. § 36-2931 and
				  R9-28-901
"Mental disorder" A.R.S. §
										36-501
"MMMNA"
				  R9-28-401
"Mobility"
				  R9-28-301
"Natural Support Services"
				  R9-28-101
"Noncontracting provider" A.R.S. §
										36-2931
"Nursing facility" or "NF"
				  42 U.S.C.
				  1396 r(a)
"Occupational therapy"
				  R9-22-201
"Orientation"
				  R9-28-301
"Partial care"
				  R9-22-1201
"PAS"
				  R9-28-103
"Personal hygiene"
				  R9-28-301
"Pharmaceutical service"
				  R9-22-201
"Physical therapy"
				  R9-22-201
"Physically disabled"
				  R9-28-301
"Physician"
				  R9-22-101
"Physician consultant"
				  R9-28-301
"Post-stabilization care services"
				  42 CFR
				  438.114
"Practitioner"
				  R9-22-101
"Primary care provider" or "(PCP)"
				  R9-22-101
"Primary care provider services"
				  R9-22-201
"Prior authorization"
				  R9-22-101
"Prior period coverage" or "PPC"
				  R9-22-101
"Program contractor" A.R.S. §
										36-2931
"Provider" A.R.S. §
										36-2931
"Psychiatrist"
				  R9-22-1201
"Psychologist"
				  R9-22-1201
"Psychosocial rehabilitation services"
				  R9-22-201
"Qualified behavioral health service provider"
				  R9-28-1101
"Quality management"
				  R9-22-501
"Radiology"
				  R9-22-101
"Reassessment"
				  R9-28-103
"Recover"
				  R9-28-901
"Redetermination"
				  R9-28-401
"Referral"
				  R9-22-101
"Regional behavioral health authority" or "RBHA" A.R.S.
				  §
										36-3401
"Reinsurance"
				  R9-22-701
"Representative"
				  R9-28-401
"Resistiveness"
				  R9-28-301
"Respiratory therapy"
				  R9-22-201
"Respite care"
				  R9-28-102
"RFP"
				  R9-22-101
"Room and board"
				  R9-28-102
"Rolling and sitting"
				  R9-28-301
"Running or wandering away"
				  R9-28-301
"Scope of services"
				  R9-28-102
"Section 1115 Waiver" A.R.S. §
										36-2901
"Self-injurious behavior"
				  R9-28-301
"Sensory"
				  R9-28-301
"Seriously mentally ill" or "SMI" A.R.S. §
										36-550
"Social worker"
				  R9-28-301
"Special diet"
				  R9-28-301
"Speech therapy"
				  R9-22-201
"Spouse"
				  R9-28-401
"SSA"
				  42 CFR
				  1000.10
"SSI"
				  42 CFR
				  435.4
"Subcontract"
				  R9-22-101
"TEFRA lien"
				  R9-28-801
"Therapeutic leave"
				  R9-28-501
"Toileting"
				  R9-28-301
"Transferring"
				  R9-28-301
"TRBHA"
				  R9-22-1201
"Tribal contractor"
				  R9-28-1101
"Tribal facility" A.R.S. §
										36-2981
"Utilization management/review"
				  R9-22-501
"Ventilator dependent"
				  R9-28-102
"Verbal or physical threatening"
				  R9-28-301
"Vision"
				  R9-28-301
"Wandering"
				  R9-28-301
"Wheelchair mobility"
				  R9-28-301
B. General definitions. In
				addition to definitions contained in A.R.S. §§
									36-551,
				36-2901,
				36-2931,
				and 9 A.A.C. 22, Article 1, the following words and phrases have the following
				meanings unless the context of the Chapter explicitly requires another meaning:
"ADL" or "Activities of Daily Living" mean activities a
				  member must perform daily for the member's regular day-to-day necessities,
				  including but not limited to mobility, transferring, bathing, dressing,
				  grooming, eating, and toileting.
"ALTCS" means the Arizona Long-term Care System as authorized
				  by A.R.S. §
										36-2932.
"Alternative HCBS setting" means a living arrangement
				  approved by the Director and licensed or certified by a regulatory agency of
				  the state, where a member may reside and receive HCBS, including:
For a person with a developmental disability specified in
				  A.R.S. §
										36-551:
Community residential setting defined in A.R.S. §
										36-551;
Group home defined in A.R.S. §
										36-551;
State-operated group home under A.R.S. §
										36-591;
Group foster home under
				  R6-5-5903;
Licensed residential facility for a person with traumatic
				  brain injury under A.R.S. §
										36-2939;
Behavioral health adult therapeutic home under 9 A.A.C 20,
				  Articles 1 and 15;
Level 2 and Level 3 behavioral health residential agencies
				  under 9 A.A.C. 20, Articles 1, 4, 5, and 6; and
Rural substance abuse transitional centers under 9 A.A.C. 20,
				  Articles 1 and 14; and
For a person who is Elderly and Physically Disabled (EPD)
				  under
				  R9-28-301, and the
				  facility, setting, or institution is registered with AHCCCS:
Adult foster care defined in A.R.S. §
										36-401
				  and as authorized in A.R.S. §
										36-2939;
Assisted living home or assisted living center, units only,
				  under A.R.S. §
										36-401,
				  and as authorized in A.R.S. §
										36-2939;
Licensed residential facility for a person with a traumatic
				  brain injury specified in A.R.S. §
										36-2939;
Behavioral health adult therapeutic home under 9 A.A.C. 20,
				  Articles 1 and 15;
Level 2 and Level 3 behavioral health residential agencies
				  under 9 A.A.C. 20, Articles 1, 4, 5, and 6; and
Rural substance abuse transitional centers under 9 A.A.C. 20,
				  Articles 1 and 14.
"Case management plan" means a service plan developed by a
				  case manager that involves the overall management of a member's care, and the
				  continued monitoring and reassessment of the member's need for services.
"Case manager" means a person who is either a degreed social
				  worker, a licensed registered nurse, or has a minimum of two years of
				  experience in providing case management services to a person who is EPD.
"CFR" means Code of Federal Regulations, unless otherwise
				  specified in this Chapter.
"Covered services" means the health and medical services
				  described in Articles 2 and 11 of this Chapter as being eligible for
				  reimbursement by AHCCCS.
"Home" means a residential dwelling that is owned, rented,
				  leased, or occupied by a member, at no cost to the member, including a house, a
				  mobile home, an apartment, or other similar shelter. A home is not a facility,
				  a setting, or an institution, or a portion of any of these that is licensed or
				  certified by a regulatory agency of the state as a:
Health care institution under A.R.S. §
										36-401;
Residential care institution under A.R.S. §
										36-401;
Community residential setting under A.R.S. §
										36-551;
				  or
Behavioral health facility under 9 A.A.C. 20, Articles 1, 4,
				  5, and 6.
"IADL" or "Instrumental Activities of Daily Living" mean
				  activities related to independent living that a member must perform, including
				  but not limited to:
Preparing meals,
Managing money,
Shopping for groceries or personal items,
Performing light or heavy housework, and
Use of the telephone.
"IHS" means the Indian Health Service.
"Institutionalized spouse" means the same as defined in
				  42
				  U.S.C. 1396r-5.
"JCAHO" means the Joint Commission on Accreditation of
				  Healthcare Organizations.
"Natural Support Services" are services provided voluntarily
				  by a person not legally obligated to provide those services. The services are
				  specified in the service plan as described under
				  R9-28-510 and
				  cannot supplant other covered services.