Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-201 - Scope of Services-related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
In addition to definitions contained in A.R.S. §
									36-2901,
				  the words and phrases in this Chapter have the following meanings unless the
				  context explicitly requires another meaning:
"Anticipatory guidance" means a person responsible for a
				  child receives information and guidance of what the person should expect of the
				  child's development and how to help the child stay healthy.
"Behavioral health recipient" means a Title XIX or Title XXI
				  acute care member who is eligible for, and is receiving, behavioral health
				  services through ADHS/DBHS.
"Benefit year" means a one-year time period of October 1st
				  through September 30th.
"Emergency behavioral health condition for a non-FES member"
				  means a condition manifesting itself by acute symptoms of sufficient severity,
				  including severe pain, such that a prudent layperson who possesses an average
				  knowledge of health and medicine could reasonably expect the absence of
				  immediate medical attention to result in:
Placing the health of the person, including mental health, in
				  serious jeopardy;
Serious impairment to bodily functions;
Serious dysfunction of any bodily organ or part; or
Serious physical harm to another person.
"Emergency behavioral health services for a non-FES member"
				  means those behavioral health services provided for the treatment of an
				  emergency behavioral health condition.
"Emergency medical condition for a non-FES member" means
				  treatment for a medical condition, including labor and delivery, which
				  manifests itself by acute symptoms of sufficient severity, including severe
				  pain, such that a prudent layperson who possesses an average knowledge of
				  health and medicine, could reasonably expect the absence of immediate medical
				  attention to result in:
Placing the member's health in serious jeopardy,
Serious impairment to bodily functions, or
Serious dysfunction of any bodily organ or part.
"Emergency medical services for a non-FES member" means
				  services provided for the treatment of an emergency medical condition.
"Hearing aid" means an instrument or device designed for, or
				  represented by the supplier as aiding or compensating for impaired or defective
				  human hearing, and includes any parts, attachments, or accessories of the
				  instrument or device.
"Home health services" means services and supplies that are
				  provided by a home health agency that coordinates in-home intermittent services
				  for curative, habilitative care, including home-health aide services, licensed
				  nurse services, and medical supplies, equipment, and appliances.
"Occupational therapy" means medically prescribed treatment
				  provided by or under the supervision of a licensed occupational therapist, to
				  restore or improve an individual's ability to perform tasks required for
				  independent functioning.
"Pharmaceutical service" means medically necessary
				  medications that are prescribed by a physician, practitioner, or dentist under
				  R9-22-209.
"Physical therapy" means treatment services to restore or
				  improve muscle tone, joint mobility, or physical function provided by or under
				  the supervision of a registered physical therapist.
Post-stabilization services" means covered services related
				  to an emergency medical or behavioral health condition provided after the
				  condition is stabilized.
"Primary care provider services" means healthcare services
				  provided by and within the scope of practice, as defined by law, of a licensed
				  physician, certified nurse practitioner, or licensed physician
				  assistant.
"Psychosocial rehabilitation services" means services that
				  provide education, coaching, and training to address or prevent residual
				  functional deficits and may include services that may assist a member to secure
				  and maintain employment. Psychosocial rehabilitation services may
				  include:
Living skills training,
Cognitive rehabilitation,
Health promotion,
Supported employment, and
Other services that increase social and communication skills
				  to maximize a member's ability to participate in the community and function
				  independently.
"RBHA" or "Regional Behavioral Health Authority" means the
				  same as in A.R.S. §
									36-3401.
"Residual functional deficit" means a member's inability to
				  return to a previous level of functioning, usually after experiencing a severe
				  psychotic break or state of decompensation.
"Respiratory therapy" means treatment services to restore,
				  maintain, or improve respiratory functions that are provided by, or under the
				  supervision of, a respiratory therapist licensed according to A.R.S. Title 32,
				  Chapter 35.
"Scope of services" means the covered, limited, and excluded
				  services under Articles 2 and 12 of this Chapter.
"Speech therapy" means medically prescribed diagnostic and
				  treatment services provided by or under the supervision of a certified speech
				  therapist.
"Sterilization" means a medically necessary procedure, not
				  for the purpose of family planning, to render an eligible person or member
				  barren in order to:
Prevent the progression of disease, disability, or adverse
				  health conditions; or
Prolong life and promote physical health.
"Substance abuse" means the chronic, habitual, or compulsive
				  use of any chemical matter that, when introduced into the body, is capable of
				  altering human behavior or mental functioning and, with extended use, may cause
				  psychological dependence and impaired mental, social or educational
				  functioning. Nicotine addiction is not considered substance abuse for adults
				  who are 21 years of age or older.
,