Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - DEFINITIONS › Section R9-31-101 - Location of Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
A. Location
				of definitions. Definitions applicable to 9 A.A.C. 31 are found in the
				following.
Definition
Section or Citation
"ADHS"
R9-22-102
"Administration"
A.R.S. §
														36-2901
"Adverse action"
R9-34-102
"Aggregate"
R9-22-701
"AHCCCS"
R9-31-101
"AHCCCS registered provider"
R9-22-101
"Ambulance"
A.R.S. §
														36-2201
"Applicant"
R9-31-101
"Application"
R9-31-101
"Behavior management service"
R9-31-1201
"Behavioral health evaluation"
R9-31-1201
"Behavioral health medical
							 practitioner"
R9-31-1201
"Behavioral health professional"
R9-31-1201
"Behavioral health service"
R9-31-1201
"Behavioral health technician"
R9-31-1201
"Billed charges"
R9-22-701
"Capital costs"
R9-22-701
"Certified nurse practitioner"
R9-31-102
"Certified psychiatric nurse
							 practitioner"
R9-31-1201
"Child"
42 U.S.C. § 1397jj
"Chronically ill"
A.R.S. §
														36-2983
"Clean claim"
A.R.S. §
														36-2904
"Clinical supervision"
R9-22-102
"CMDP"
R9-31-103
"Continuous stay"
R9-22-101
"Contract"
R9-22-101
"Contractor"
A.R.S. §
														36-2901
"Contract year"
R9-31-101
"Cost avoid"
R9-22-1201
"Cost-to-Charge"
R9-22-701
"Covered charges"
R9-31-107
"Covered services"
R9-22-102
"CPT"
R9-22-701
"CRS"
R9-31-103
"Date of eligibility posting"
R9-22-701
"Day"
R9-22-101
"De novo hearing"
42
							 CFR 431.201
"Dentures" and "Denture services"
R9-22-102
"DES"
R9-31-103
"Determination"
R9-31-103
"Diagnostic services"
R9-22-102
"Director"
A.R.S. §
														36-2981
"DME"
R9-22-102
"DRI inflation factor"
R9-22-701
"Emergency medical condition"
42 U.S.C. § 1396b(v)
"Emergency medical services for the
							 non-FES"
member
R9-22-102
"Encounter"
R9-22-701
"Enrollment"
R9-31-103
"Experimental services"
R9-22-101
"Facility"
R9-22-101
"Factor"
R9-22-101
"Federal Poverty Level" or "FPL"
A.R.S. §
														36-2981
"First-party liability"
R9-22-1001
"Grievance"
R9-34-202
"Group Health Plan"
42 U.S.C. § 1397jj
"GSA"
R9-22-101
"Head of Household"
R9-31-103
"Health care practitioner"
R9-31-1201
"Hearing aid"
R9-22-102
"Home health services"
R9-22-102
"Hospital"
R9-22-101
"Household income"
R9-31-103
"ICU"
R9-22-701
"IGA"
R9-31-116
"IHS"
R9-31-116
"IHS" or "Tribal Facility Provider"
R9-31-116
"Information"
R9-31-103
"Institution for Mental Diseases" or
							 "IMD"
42 CFR
							 435.1010 and
							 R9-22-102
"Inmate of a public institution"
42 CFR
							 435.1010
"Inpatient hospital services"
R9-31-101
"License" or "licensure"
R9-22-101
"Medical record"
R9-22-101
"Medical review"
R9-31-107
"Medical services"
R9-22-101
"Medical supplies"
R9-22-102
"Member"
A.R.S. §
														36-2981
"Mental disorder"
A.R.S. §
														36-501
"Native American"
R9-31-101
"New hospital"
R9-22-701
"NF" or "nursing facility"
42 U.S.C. § 1396r(a)
"NICU"
R9-22-701
"Noncontracting provider"
A.R.S. §
														36-2981
"Occupational therapy"
R9-22-102
"Offeror"
R9-31-106
"Operating costs"
R9-22-701
"Outlier"
R9-31-107
"Outpatient hospital service"
R9-22-701
"Ownership change"
R9-22-701
"Partial care"
R9-22-1201
"Peer group"
R9-22-701
"Pharmaceutical service"
R9-22-102
"Physical therapy"
R9-22-102
"Physician"
A.R.S. §
														36-2981
"Post stabilization care services"
42 CFR
							 438.114
"Practitioner"
R9-22-102
"Prepaid capitated"
A.R.S. §
														36-2981
"Prescription"
R9-22-102
"Primary care physician"
A.R.S. §
														36-2981
"Primary care practitioner"
A.R.S. §
														36-2981
"Primary care provider (PCP)"
R9-22-102
"Primary care provider services"
R9-22-102
"Prior authorization"
R9-22-102
"Program"
A.R.S. §
														36-2981
"Proposal"
R9-31-106
"Prospective rates"
R9-22-701
"Provider"
A.R.S. §
														36-2931
"Psychiatrist"
A.R.S. §
														36-501
"Psychologist"
A.R.S. §
														36-501
"Psychosocial rehabilitation"
R9-22-102
"Qualified alien"
A.R.S. §
														36-2903.03
"Qualifying plan"
A.R.S. §
														36-2981
"Quality management"
R9-22-501
"Radiology"
R9-22-102
"Rebase"
R9-22-701
"Redetermination"
R9-31-103
"Referral"
R9-22-101
"Regional Behavioral Health Authority" or
							 "RBHA"
A.R.S. §
														36-3401
"Rehabilitation services"
R9-22-102
"Reinsurance"
R9-22-701
"Remittance advice"
R9-22-701
"RFP"
R9-31-106
"Respiratory therapy"
R9-22-102
"Scope of services"
R9-22-102
"Seriously ill"
R9-31-101
"Service location"
R9-22-101
"Service site"
R9-22-101
"SMI" or "Seriously mentally ill"
A.R.S. §
														36-550
"Specialist"
R9-22-102
"Speech therapy"
R9-22-102
"Spouse"
R9-31-103
"SSI-MAO"
R9-31-103
"Stabilize"
42 U.S.C. § 1395dd
"Standard of care"
R9-22-101
"Sterilization"
R9-22-102
"Subcontract"
R9-22-101
"Subcontractor"
R9-31-101
"Third-party"
R9-22-1001
"Third-party liability"
R9-22-1001
"Tier"
R9-22-701
"Tiered per diem"
R9-31-107
"TRBHA" or "Tribal Regional Behavioral
Health Authority"
R9-31-1201
"Tribal facility"
A.R.S. §
														36-2981
"Utilization management"
R9-22-501
B.
				General definitions. The words and phrases in this Chapter have the following
				meanings unless the context explicitly requires another meaning:
"ADHS" has the same meaning as in A.A.C.
				  R9-22-102.
"AHCCCS" means the Arizona Health Care Cost Containment
				  System, which is composed of the Administration, contractors, and other
				  arrangements through which health care services are provided to a
				  member.
"Applicant" means a person who submits, or whose
				  representative submits, a written, signed, and dated application for Title XXI
				  medical coverage.
"Application" means an official request for Title XXI medical
				  coverage made under this Chapter.
"Contract year" means the period beginning on October 1 and
				  continuing until September 30 of the following year.
"Inpatient hospital services" means medically necessary
				  services that require an inpatient stay in an acute care hospital and that are
				  provided by or under the direction of a physician or other health care
				  practitioner upon referral from a member's primary care provider.
"Native American" means Indian as specified in
				  42
				  CFR 137.10.
"Seriously ill" means a medical or psychiatric condition
				  manifesting itself by acute symptoms that left untreated may result in:
Death,
Disability,
Disfigurement, or
Dysfunction.
"Subcontractor" means a person, agency, or organization that
				  enters into an agreement with a contractor or subcontractor to provide
				  services.