reglab/statecodes huggingface dataset:
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 13 - FREEDOM TO WORK › Section R9-28-1320 - Additional Eligibility Criteria for the Basic Coverage Group

Current through Register Vol. 30, No. 28, July 12, 2024
As a condition of eligibility, an applicant or member shall
				  be employed. Employed means that an applicant or member is paid for working and
				  Social Security or Medicare taxes are paid on the applicant's or member's
				  income.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 13 - FREEDOM TO WORK › Section R9-28-1321 - Share of Cost

Current through Register Vol. 30, No. 28, July 12, 2024
The Director shall determine the amount a person shall pay
				  for the cost of ALTCS services (share-of-cost) under A.R.S. §
									36-2932(L)
				   and
				  42
				  CFR 435.725 or
				  42
				  CFR 435.726. Share of cost shall be
				  calculated for people who reside in a medical institution for an entire
				  calendar month under
				  R9-28-408(G)
				  and
				  R9-28-410(C)
				   except that the personal-needs allowance
				  shall be increased by 50 percent of the member's earned
				  income.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 13 - FREEDOM TO WORK › Section R9-28-1323 - Enrollment

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall enroll members under
				  R9-28-412
				  through
				  R9-28-418.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 13 - FREEDOM TO WORK › Section R9-28-1324 - Redetermination of Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Redetermination. Except as provided in subsection (B), the Administration shall
				complete a redetermination of eligibility at least once a year.
B. Change in circumstance. The Administration
				may complete a redetermination of eligibility if there is a change in the
				member's circumstances, including a change in disability or employment that may
				affect eligibility.
C. Medical
				Improvement. If a member is no longer disabled under Article 3 of this Chapter,
				the Administration shall determine if the member is eligible under other
				coverage groups.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 1 - DEFINITIONS › Section R9-29-101 - Location of Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
A. Location
				of definitions. Definitions applicable to this Chapter are found in the
				following:
Definition
Section or Citation
"Federal poverty level" or "FPL"
A.R.S. §
													36-2981
"Medicare Cost Sharing"
R9-29-101
"Non-QMB Dual"
R9-29-101
"QI-1"
R9-29-101
"QMB Dual"
R9-29-101
"QMB Only"
R9-29-101
"SLMB"
R9-29-101
B.
				General definitions. In addition to definitions contained in A.R.S. §
									36-2971,
				the words and phrases in this Chapter have the following meanings unless the
				context explicitly requires another meaning:
"Medicare Cost Sharing" (MCS). The MCS Program is
				  administered by the Administration and provides help to Medicare beneficiaries
				  with costs related to Medicare services. MCS is also referred to as the
				  "Medicare Savings Programs."
"Non-QMB Dual" means a person who qualifies to receive both
				  Medicare and Medicaid services, but does not qualify for the QMB
				  program.
"QI-1" means a person who qualifies as a Medicare beneficiary
				  and for cost sharing assistance with the person's Part B premium known as
				  Qualified Individual-1 (QI-1). This person does not qualify for QMB due to the
				  person's income exceeding the QMB and SLMB FPL level.
"QMB Dual" means a person determined eligible under Article 2
				  of this Chapter for Qualified Medicare Beneficiary (QMB) and eligible for Acute
				  Care services provided for in 9 A.A.C. 22 or ALTCS services provided for in 9
				  A.A.C. 28. A QMB Dual person receives both Medicare and Medicaid services and
				  cost sharing assistance. For the purpose of Article 2 of this Chapter, QMB
				  includes members defined in A.R.S. §
										36-2971(5).
"QMB Only" means a person who qualifies to receive Medicare
				  services only and cost-sharing assistance known as Qualified Medicare
				  Beneficiary program (QMB). For the purpose of Article 2 of this Chapter, QMB
				  includes members defined in A.R.S. §
										36-2971(5).
"SLMB" means a person who qualifies as a Medicare beneficiary
				  and for cost sharing assistance with the person's Part B premium known as
				  Specified Low Income Medicare Beneficiary (SLMB). This person does not qualify
				  for QMB due to the person's income exceeding the QMB FPL
				  level.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-201 - General

Current through Register Vol. 30, No. 28, July 12, 2024
A. Eligibility
				determination. AHCCCS shall determine eligibility for a QMB, SLMB, or QI-1
				under this Article.
B.
				Confidentiality. The Administration shall maintain the confidentiality of an
				applicant or member's records and limit the release of safeguarded information
				under A.A.C. R9-22-512.
C. The
				Administration will accept applications for the QI-1 program subject to the
				availability of funds. If the Director determines that monies may be
				insufficient for the program, the Administration shall stop processing
				applications for the program. If the Administration stops processing an
				application because the monies are insufficient, the Administration shall place
				an applicant on a waiting list and notify the applicant. After the
				Administration has verified that funding is sufficient, it will resume
				processing applications.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-202 - Application Process

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				Administration shall provide the opportunity to apply without delay.
B. To apply for the MCS Program, a person
				shall submit an application form prescribed by AHCCCS unless the person's
				application has been referred by the Social Security Administration as part of
				the Extra Help program described under A.A.C. R9-30-101.
C. An application shall be submitted by a
				person listed in A.A.C. R9-22-1406(B) unless the person's application has been
				referred by the Social Security Administration as part of the Extra Help
				program described under A.A.C. R9-30-101.
D. The date of application is the date a
				signed application is received as described under A.A.C. R9-22-1406 or the date
				of an application referred by the Social Security Administration as part of the
				Extra Help program described under A.A.C. R9-30-101.
E. Applicant's representative. AHCCCS shall
				allow a person of an applicant's choice to accompany, assist, and represent the
				applicant in the application process or assistance can be provided by AHCCCS.
				If requested, AHCCCS shall help a person complete an application.
F. AHCCCS shall determine whether an
				application is complete under A.A.C. R9-22-1406.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-203 - Assignment of Rights

Current through Register Vol. 30, No. 28, July 12, 2024
A person determined eligible for QMB benefits assigns rights
				  to medical benefits to which the person is entitled to AHCCCS, under A.R.S.
				  §§
									36-2903
				  and
				  36-2972.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-204 - Eligibility Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
To be eligible for MCS a person shall:
1. Provide information necessary to establish
				paternity and enforce medical support obligations, when requested by AHCCCS for
				the QMB program,
2. Furnish a SSN
				or apply for a SSN,
3. Be a United
				States citizen or a qualified alien under A.R.S. §
									36-2903.03,
4. Be a resident of Arizona,
5. Apply for potential benefits that may be
				available to the person, if requested by AHCCCS,
6. Provide verification, or authorize the
				release of verification, for all information necessary to complete the
				determination of eligibility, and
7. Receive Medicare Part A benefits or be
				determined conditionally entitled to Medicare Part A benefits by the Social
				Security Administration.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-205 - Income Standards

Current through Register Vol. 30, No. 28, July 12, 2024
A. To be
				eligible, a person's income shall meet the following federal poverty levels
				(FPL), adjusted annually:
1. QMB. Income is
				equal to or less than 100 percent of the FPL.
2. SLMB. Income is greater than 100 percent
				but equal to or less than 120 percent of the FPL.
3. QI-1. Income is at least 120 percent but
				equal to or less than 135 percent of the FPL.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-206 - Institutionalized Person

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1402 apply to this
				  Article for an institutionalized person.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-207 - Resources

Current through Register Vol. 30, No. 28, July 12, 2024
Resources such as, cash, financial accounts, real property,
				  vehicles, trusts, and life insurance are not considered in determining a
				  person's QMB, SLMB or QI-1 eligibility.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-208 - Eligibility Determination

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				AHCCCS shall make an eligibility determination within 45 days of the date of
				application, except when:
1. The agency
				cannot reach a decision because the applicant delays or fails to take a
				required action, or
2. When there
				is an administrative or other emergency beyond the agency's control.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-209 - Notice of Eligibility Determination

Current through Register Vol. 30, No. 28, July 12, 2024
A. Notice. AHCCCS shall send an applicant
				written notice of the eligibility decision. The notice shall include a
				statement of the action and an explanation of the person's hearing rights
				specified in Article 5.
B.
				Approval. If AHCCCS determines that the applicant is eligible, the notice shall
				contain the effective date of eligibility.
C. Denial. If AHCCCS determines that the
				applicant is not eligible, the notice shall contain:
1. The effective date of the
				decision;
2. A statement detailing
				the reason for the decision, including specific financial calculations and the
				financial eligibility standard if applicable; and
3. The legal authority supporting the
				decision.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-210 - Effective Date of Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
AQMB. The effective date of eligibility is
				the first day of the month following the month in which AHCCCS makes the
				eligibility decision.
BSLMB.
				Eligibility is effective on the first day of the month that all eligibility
				requirements are met, including the prior quarter period.
CQI-1. Eligibility is effective on the first
				day of the month that all eligibility requirements are met, including the prior
				quarter period and no earlier than the first day of the current calendar year.
				QI-1 members are entitled to receive cost sharing assistance through the end of
				the calendar year in which they qualified for the program.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-211 - Discontinuance

Current through Register Vol. 30, No. 28, July 12, 2024
A. Discontinuance.
				AHCCCS shall discontinue a person's eligibility if any of the conditions of
				eligibility under this Article are not met.
B. Notice. AHCCCS shall follow the
				discontinuance notice requirements under A.A.C. R9-22-1415, except where it
				states "Department" replace the term with "Administration."
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-212 - Renewals

Current through Register Vol. 30, No. 28, July 12, 2024
A. QMB and SLMB.
				AHCCCS shall renew a person's eligibility for QMB or SLMB at least one time
				every 12 months.
B. QI-1. A person
				receiving QI-1 benefits shall reapply every 12 months.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 2 - ELIGIBILITY › Section R9-29-213 - Reporting Changes

Current through Register Vol. 30, No. 28, July 12, 2024
A person eligible under this Article shall report to an ALTCS
				  or Social Security Insurance Medical Assistance Only (SSI-MAO) office the
				  following changes for the person, the person's spouse, or the person's
				  dependent children:
1. A change of
				address;
2. An admission to, or
				discharge from, a public institution, as specified in A.A.C.
				R9-22-1402;
3. A change in
				household composition;
4. A change
				in income;
5. A determination of
				eligibility for other benefits;
6.
				A death;
7. A change in marital
				status;
8. A change in Arizona
				state residency;
9. A change in
				citizenship or alien status;
10.
				Receipt of a SSN;
11. A change in
				Medicare receipt or eligibility; and
12. For QMB recipients, a change in first- or
				third-party liability that may be responsible for payment of all or a portion
				of the person's medical costs.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 3 - BENEFITS AND SERVICES › Section R9-29-301 - QMB Only

Current through Register Vol. 30, No. 28, July 12, 2024
A. QMB benefits.
				For a person determined eligible as a QMB Only, the Administration shall
				provide payment of:
1. Medicare Part A
				premium,
2. Medicare Part B
				premium, and
3. Medicare
				coinsurance and Medicare deductible for Medicare services covered under Title
				XVIII of the Social Security Act to the provider.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 3 - BENEFITS AND SERVICES › Section R9-29-302 - QMB Dual Member

Current through Register Vol. 30, No. 28, July 12, 2024
A. Covered
				services. A person determined to be a QMB Dual eligible member shall receive
				medical services provided under 9 A.A.C. 22, Article 2, or services provided
				under 9 A.A.C. 28, Article 2, in addition to the Medicare-related payments
				under
				R9-29-301(A).
B. Premiums. The Administration pays Medicare
				part A and B premiums for a QMB Dual member enrolled with a contractor in a
				plan or AHCCCS Fee-For-Service.
C.
				The Administration's payment responsibilities.
1. The Administration shall pay the following
				costs for members not enrolled with contractors. When services are received
				from an AHCCCS registered provider and the service is covered:
a. By Medicare only, the Administration shall
				pay the Medicare coinsurance and deductible.
b. By Medicaid only, the Administration shall
				pay the lesser of billed charges or the Capped Fee-For-Service Schedule rate
				for the services covered under 9 A.A.C. 22, Article 2 and 9 A.A.C. 28, Article
				2.
c. By both Medicare and
				Medicaid, the Administration shall pay Medicare coinsurance and
				deductible.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 3 - BENEFITS AND SERVICES › Section R9-29-303 - Non-QMB Dual Member

Current through Register Vol. 30, No. 28, July 12, 2024
A. Covered
				services. A person determined to be a Non-QMB Dual eligible member shall
				receive medical services and provisions under 9 A.A.C. 22, Article 2, or
				services and provisions under 9 A.A.C. 28, Article 2.
B. Premiums. The Administration pays Medicare
				part B premiums for a Non-QMB dual member enrolled with a contractor in a plan
				or AHCCCS Fee-For-Service for the following individuals:
1. An individual described in
				42 CFR
				431.625;
2. An individual enrolled in ALTCS but who
				does not qualify as a QMB, SLMB or QI;
3. An individual who is eligible for Medicaid
				under a mandatory or optional Title XIX coverage group for the aged, blind, or
				disabled (SSI-MAO);
4. An
				individual who is eligible for continued coverage while eligibility
				redetermination is pending as described under
				42 CFR
				435.1003;
5. An individual who is in the guaranteed
				enrollment period described in
				42
				CFR 435.212 and the state was paying the
				individual's Part B premium before eligibility terminated.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 3 - BENEFITS AND SERVICES › Section R9-29-304 - SLMB and QI-1

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall pay the Medicare Part B premiums.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 5 - GRIEVANCE SYSTEM PROCESS › Section R9-29-501 - General Provisions for a Grievance and a Request for Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A request for hearing under this Chapter shall comply with 9
				  A.A.C. 34. For the purposes of this Article, "hearing" means an administrative
				  hearing under Title 41, Chapter 6, Article 10.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 29 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE COST SHARING PROGRAM › Article 6 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-29-601 - First- and Third-party Liability and Recoveries

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions specified in 9 A.A.C. 22, Article 10 apply to
				  this Section. For the purposes of this Article, "third-party liability" means
				  the resources available from a person, entity, or program that is or may be, by
				  agreement, circumstance, or otherwise, liable to pay all or part of the medical
				  expenses incurred by an applicant or member.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 1 - DEFINITIONS › Section R9-30-101 - General Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
In addition to definitions contained under
				  20
				  CFR 418.3010, the words and phrases in this
				  Chapter have the following meanings unless the context explicitly requires
				  another meaning:
"Act" means the Social Security Act.
"AHCCCS" means the Arizona Health Care Cost Containment
				  System.
"Extra Help" means the subsidies that are available for
				  Medicare Part D premiums, deductibles, and co-payments in accordance with
				  Section 1860D-14 of the Social Security Act (
				  42
				  U.S.C. 1395w-114 ).
"SSA" means the Social Security
				  Administration.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-201 - General

Current through Register Vol. 30, No. 28, July 12, 2024
A. In accordance
				with the requirements of Section 1860D-14(a)(3) of the Act (
				42 U.S.C.
				1395 w - 114(a)(3) ), the applicant may apply
				for Extra Help with the SSA or with AHCCCS. AHCCCS shall offer to help an
				applicant complete the SSA's application for Extra Help. If the applicant
				declines to apply with SSA for the Extra Help program, AHCCCS shall determine
				eligibility for Extra Help under this Article.
B. Confidentiality. The Administration shall
				maintain the confidentiality of an Extra Help applicant's or member's records
				and limit the release of safeguarded information under R9-22-512.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-202 - Opportunity to Apply

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall provide the opportunity to apply
				  without delay.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-203 - How to File an Application

Current through Register Vol. 30, No. 28, July 12, 2024
A. To
				apply for the Extra Help with AHCCCS, a person shall submit a written
				application form prescribed by AHCCCS to any AHCCCS office or outstation
				location.
B. The application is
				considered filed and complete under R9-22-1501(D).
C. An application shall be submitted by:
1. The applicant, or
2. The applicant's personal representative.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-204 - Assistance with an Application

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				AHCCCS shall allow a personal representative of an applicant's choice to
				accompany, assist, and represent the applicant in the application
				process.
B. Assistance by AHCCCS.
				If requested, AHCCCS shall help a person complete an application.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-205 - Social Security Number (SSN)

Current through Register Vol. 30, No. 28, July 12, 2024
To be eligible for Extra Help, a person shall furnish a SSN
				  or apply for a SSN.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-206 - Residency

Current through Register Vol. 30, No. 28, July 12, 2024
To be eligible for Extra Help, a person shall reside in
				  Arizona.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-207 - Income

Current through Register Vol. 30, No. 28, July 12, 2024
A. AHCCCS shall
				calculate countable income under
				20 CFR 418.3301
				through
				418.3350,
				as of December 30, 2005, which is incorporated by reference and on file with
				the Administration, and available from the U.S. Government Printing Office,
				Mail Stop: IDCC, 732 N. Capitol Street, NW, Washington, DC, 20401. This
				incorporation by reference contains no future editions or amendments.
B. AHCCCS shall determine income eligibility
				under
				42 CFR
				423.773 as of January 28, 2005, which is
				incorporated by reference and on file with the Administration, and available
				from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
				Street, NW, Washington, DC, 20401. This incorporation by reference contains no
				future editions or amendments.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-208 - Ineligible Person

Current through Register Vol. 30, No. 28, July 12, 2024
A person residing in a penal institution is not eligible
				  under this Article.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-209 - Resources

Current through Register Vol. 30, No. 28, July 12, 2024
A. AHCCCS shall
				calculate countable resources under
				20 CFR
				418.3401 through
				418.3425,
				as of December 30, 2005, which is incorporated by reference and on file with
				the Administration, and available from the U.S. Government Printing Office,
				Mail Stop: IDCC, 732 N. Capitol Street, NW, Washington, DC, 20401. This
				incorporation by reference contains no future editions or amendments.
B. AHCCCS shall determine resource
				eligibility under
				42 CFR
				423.773, as of January 28, 2005, which is
				incorporated by reference and on file with the Administration, and available
				from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
				Street, NW, Washington, DC, 20401. This incorporation by reference contains no
				future editions or amendments.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-210 - Verification

Current through Register Vol. 30, No. 28, July 12, 2024
To be eligible for Extra Help, a person shall provide
				  verification, or authorize the release of verification, for all information
				  necessary to complete the determination of eligibility.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-211 - Medicare Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A person is not eligible for Extra Help unless the person is
				  a Medicare beneficiary as defined in
				  20
				  CFR 418.3010, December 30, 2005, which is
				  incorporated by reference and on file with the Administration, and available
				  from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
				  Street, NW, Washington, DC, 20401. This incorporation by reference contains no
				  future editions or amendments.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-212 - Eligibility Determination

Current through Register Vol. 30, No. 28, July 12, 2024
Determinations of eligibility for Extra Help under this
				  Article are made by AHCCCS within 45 days of the date of the application being
				  filed if the individual applies with AHCCCS.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-213 - Determination of Extra Help Amount

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall determine the amount of an applicant or member's
				  Extra Help under
				  42 CFR
				  423.773,
				  42 CFR 423.780,
				  and
				  42 CFR
				  423.782, as of January 28, 2005, which are
				  incorporated by reference and on file with the Administration, and available
				  from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
				  Street, NW, Washington, DC, 20401. This incorporation by reference contains no
				  future editions or amendments.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-214 - Notice of Eligibility Determination by AHCCCS

Current through Register Vol. 30, No. 28, July 12, 2024
A. Notice. The administration shall send an
				applicant written notice of the eligibility decision. The notice shall include
				a statement of the action and an explanation of an applicant or member's
				hearing rights under 9 A.A.C. 34, Article 1.
B. Approval. If AHCCCS determines that the
				applicant is eligible, the notice shall contain the effective date of
				eligibility and the amount of the Extra Help.
C. Denial. If AHCCCS determines that the
				applicant is not eligible, the notice shall contain:
1. The effective date of the
				decision;
2. A statement detailing
				the reason for the decision, including specific financial calculations and the
				financial eligibility standard, if applicable; and
3. The legal authority supporting the
				decision.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-215 - Effective Date of Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
The effective date of eligibility is the first day of the
				  first month that the applicant is eligible for Extra Help under this Article,
				  but no earlier than the month in which the applicant applies or January 1,
				  2006, whichever is later.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-216 - Discontinuance of Eligibility or Change in the Extra Help Amount

Current through Register Vol. 30, No. 28, July 12, 2024
A. Discontinuance.
				AHCCCS shall discontinue a person's eligibility if any of the conditions of
				eligibility under this Article are not met.
B. Change in the amount of subsidy. AHCCCS
				will adjust the amount of the Extra Help, if a change in countable income or a
				change in countable resources causes the subsidy amount to change.
C. Notice.
1. AHCCCS shall follow the discontinuance
				notice requirements under R9-22-1501(K).
2. AHCCCS will issue a notice if there is a
				change in the amount of the Extra Help.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-217 - Redetermination

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall redetermine an individual's eligibility at least
				  every 12 months.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 2 - ELIGIBILITY › Section R9-30-218 - Reporting Changes

Current through Register Vol. 30, No. 28, July 12, 2024
A member shall report any changes to AHCCCS, under
				  R9-22-1501(H).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 3 - SERVICES › Section R9-30-301 - Legal Obligations

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration and Administration's designee are under no
				  legal obligation to provide pharmaceutical services to individuals approved for
				  Extra Help. Pharmaceutical services are provided by Medicare.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 4 - GRIEVANCE SYSTEM › Section R9-30-401 - State Fair Hearing Request

Current through Register Vol. 30, No. 28, July 12, 2024
A request for State Fair Hearing under this Chapter shall
				  comply with 9 A.A.C. 34, Article 1.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 30 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - MEDICARE PART D PRESCRIPTION COVERAGE EXTRA HELP SUBSIDY PROGRAM › Article 4 - GRIEVANCE SYSTEM › Section R9-30-402 - State Fair Hearing for an Applicant or a Member

Current through Register Vol. 30, No. 28, July 12, 2024
A State Fair Hearing for a member or an applicant under this
				  Chapter shall comply with 9 A.A.C. 34, Article 1.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - DEFINITIONS › Section R9-31-102 - Scope of Services-related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
Definitions. The words and phrases in this Chapter have the
				  following meanings unless the context explicitly requires another
				  meaning:
"Certified nurse practitioner" means a registered nurse
				  practitioner as certified by the Arizona Board of Nursing according to A.R.S.
				  Title 32, Ch. 15.
"Psychosocial rehabilitation services" means the same as in
				  R9-22-102.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - DEFINITIONS › Section R9-31-106 - Request for Proposal (RFP) Related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
Definitions. The words and phrases in this Chapter have the
				  following meanings unless the context explicitly requires another
				  meaning:
1. "Offeror" means a person
				or other entity that submits a proposal to the Administration in response to an
				RFP.
2. "Proposal" means all
				documents including best and final offers submitted by an offeror in response
				to a Request for Proposals by the Administration.
3. "RFP" means Request for Proposals
				including all documents, whether attached or incorporated by reference, which
				are used by the Administration for soliciting a proposal according to this
				Article.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 31 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - DEFINITIONS › Section R9-31-116 - Services for Native Americans Related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
Definitions. The words and phrases in this Chapter have the
				  following meanings unless the context explicitly requires another
				  meaning:
"IGA" means intergovernmental agreement.
"IHS" means Indian Health Service.
"IHS or Tribal Facility Provider" means a person who is
				  authorized by the IHS or Tribal Facility to provide covered services to members
				  and:
Is an AHCCCS registered provider, and
Is certified by the IHS or Tribal Facility as meeting all
				  applicable federal and state requirements.
"TRBHA" means a Tribal Regional Behavioral Health Authority
				  operated by a tribal government through an IGA with ADHS for the provision of
				  behavioral health services to a Native American member residing on reservation.
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 R9-31-201 - General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				Administration shall administer the Children's Health Insurance Program under
				A.R.S. §
									36-2982.
B. Scope of services for American Indian
				fee-for-service members is under Article 16 of this Chapter.
C. A contractor or RBHA shall provide
				behavioral health services under Articles 12 and 16.
D. In addition to other requirements and
				limitations specified in this Chapter, the following general requirements
				apply:
1. Only medically necessary, cost
				effective, and federally- reimbursable and state-reimbursable services are
				covered services.
2. The
				Administration or a contractor may waive the covered services referral
				requirements of this Article.
3.
				Except as authorized by a contractor, a primary care provider, practitioner, or
				dentist shall provide or direct the member's covered services. Delegation of
				the provision of care to a practitioner does not diminish the role or
				responsibility of the primary care provider.
4. A contractor shall offer a female member
				direct access to preventive and routine services from gynecology providers
				within the contractor's network without a referral from a primary care
				provider.
5. A member may receive
				behavioral health services as specified in 9 A.A.C. 22, Articles 2 and
				12.
6. A member may receive
				treatment that is considered the standard of care, or that is approved by the
				AHCCCS Chief Medical Officer after appropriate input from providers who are
				considered experts in the field by the professional medical
				community.
7. An AHCCCS registered
				provider shall provide covered services within the provider's scope of
				practice.
8. In addition to the
				specific exclusions and limitations otherwise specified under this Article, the
				following are not covered:
a. A service that
				is determined by the AHCCCS Chief Medical Officer to be experimental or
				provided primarily for the purpose of research;
b. Services or items furnished gratuitously;
				and
c. Personal care items, except
				as specified in R9-31-212.
9. Medical or behavioral health services are
				not covered if provided to:
a. An inmate of a
				public institution;
b. A person who
				is a resident of an institution for the treatment of tuberculosis; or
c. A person who is in an IMD at the time of
				application, unless provided under Article 12 of this Chapter.
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 R9-31-204 - Inpatient General Hospital Services

Current through Register Vol. 30, No. 28, July 12, 2024
A contractor, fee-for-service provider, or noncontracting
				  provider shall render inpatient general hospital services including:
1. Hospital accommodations and appropriate
				staffing, supplies, equipment, and services for:
a. Maternity care, including labor, delivery,
				recovery room, birthing center, and newborn nursery;
b. Neonatal intensive care unit
				(NICU);
c. Intensive care unit
				(ICU);
d. Surgery, including
				surgery room and recovery room;
e.
				Nursery and related services;
f.
				Routine care; and
g. Emergency
				behavioral health services under 9 A.A.C. 31, Article 12.
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 R9-31-205 - Attending Physician, Practitioner, and Primary Care Provider Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. A primary care
				provider shall provide primary care provider services within the provider's
				scope of practice under A.R.S. Title 32. A member may receive primary care
				provider services in an inpatient or outpatient setting including at a minimum:
1. Periodic health examination and
				assessment,
2. Evaluation and
				diagnostic workup,
3. Medically
				necessary treatment,
4.
				Prescriptions for medication and medically necessary supplies or
				equipment,
5. Referral to a
				specialist or other health care professional if medically necessary as
				specified in A.R.S. §
										36-2989,
6. Patient education,
7. Home visits if medically
				necessary,
8. Covered
				immunizations, and
9. Covered
				preventive health services.
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 R9-31-206 - Organ and Tissue Transplantation Services

Current through Register Vol. 30, No. 28, July 12, 2024
The following organ and tissue transplantation services shall
				  be covered for a member as specified in A.R.S. §
									36-2989
				  if prior authorized and coordinated with a member's contractor:
1. Kidney transplantation;
2. Simultaneous Kidney/Pancreas
				transplant;
3. Cornea
				transplantation;
4. Heart
				transplantation;
5. Liver
				transplantation;
6. Autologous and
				allogeneic bone marrow transplantation;
7. Lung transplantation;
8. Heart-lung transplantation;
9. Other organ transplantation if the
				transplantation is required by federal law and if other statutory criteria are
				met; and
10. Immunosuppressant
				medications, chemotherapy, and other related services.
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 R9-31-207 - Dental Services

Current through Register Vol. 30, No. 28, July 12, 2024
Medically necessary dental services are provided for children
				  under age 19 under A.R.S. § 36-2989 and
				  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 R9-31-208 - Laboratory, Radiology, and Medical Imaging Services

Current through Register Vol. 30, No. 28, July 12, 2024
An AHCCCS-registered provider shall provide laboratory,
				  radiology, and medical imaging services for children under age 19, under A.R.S.
				  § 36-2989 and
				  R9-22-208.
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 R9-31-209 - Pharmaceutical Services

Current through Register Vol. 30, No. 28, July 12, 2024
Pharmaceutical services are provided for children under age
				  19 under
				  R9-22-209.
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 R9-31-210 - Emergency Medical Services

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Emergency medical services shall be provided based on the prudent layperson
				standard to a member by licensed providers registered with AHCCCS to provide
				services under A.R.S. §
									36-2989.
B. The provider of emergency services shall
				verify eligibility and enrollment status through the Administration to
				determine the need for notification to a contractor or a RBHA for a member and
				to determine the party responsible for payment of services rendered.
C. Access to an emergency room and emergency
				medical services shall be available 24 hours per day, seven days per week in
				each contractor's service area. The use of examining or treatment rooms shall
				be available when required by a physician or practitioner for the provision of
				emergency services.
D. Behavioral
				Health Evaluation provided by a psychiatrist or psychologist shall be covered
				as an emergency service, so long as it meets the requirements of 9 A.A.C. 31,
				Article 12.
E. Emergency services
				do not require prior authorization but providers shall comply with the
				following notification requirements:
1.
				Providers and noncontracting providers furnishing emergency services to a
				member shall notify the member's contractor within 12 hours of the time the
				member presents for services;
2. If
				a member's medical condition is determined not to be an emergency medical
				condition under Article 1 of this Chapter, the provider shall notify the
				member's contractor before initiation of treatment and follow the prior
				authorization requirements and protocol of the contractor regarding treatment
				of the member's nonemergent condition. Failure to provide timely notice or
				comply with prior authorization requirements of the contractor constitutes
				cause for denial of payment.
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 R9-31-211 - Transportation Services

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall provide transportation services
				  under A.A.C.
				  R9-22-211.
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 R9-31-212 - Durable Medical Equipment, Orthotic and Prosthetic Devices, and Medical Supplies

Current through Register Vol. 30, No. 28, July 12, 2024
As specified in A.R.S. §
									36-2989,
				  DME, orthotic and prosthetic devices, and medical supplies, including
				  incontinence briefs, are covered services if provided in compliance with
				  requirements of this Chapter and A.A.C.
				  R9-22-212.
				  For purposes of this Section, where the term "AHCCCS services" is used in
				  R9-22-212,
				  it is replaced with the term "Title XXI services."
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 R9-31-213 - Health Risk Assessment and Screening Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. As authorized by A.R.S. §
									36-2989,
				the following services shall be covered for a member:
1. Screening services, including:
a. Comprehensive health, behavioral health
				and developmental histories;
b.
				Comprehensive unclothed physical examination;
c. Appropriate immunizations according to age
				and health history; and
d. Health
				education, including anticipatory guidance.