reglab/statecodes huggingface dataset:
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 4 - APPEALS, GRIEVANCES, AND REQUESTS FOR INVESTIGATION FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Section R9-21-408 - Further Appeal to Administrative Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A. Any grievant or
				the client who is the subject of the grievance who is dissatisfied with the
				Director's decision of the Administration may request a state fair hearing
				before an Administrative Law Judge.
1. Within
				30 days of the date of the Director's decision, the appealing party shall file
				with the Administration a notice requesting a state fair hearing.
2. Upon receipt of the notice, the
				Administration shall send a copy to the parties, and to the Office of Human
				Rights and the Independent Oversight Committee for clients who are in need of
				special assistance.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 4 - APPEALS, GRIEVANCES, AND REQUESTS FOR INVESTIGATION FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Section R9-21-409 - Notice and Records

Current through Register Vol. 30, No. 28, July 12, 2024
A. Notice to
				clients. All clients shall be informed of their right to file a grievance or
				request for investigation under these rules.
1. Notice of this grievance and investigation
				process shall be included in the information posted or otherwise provided to
				every current and new client and employee. Special efforts shall be made to
				inform current and new residents of mental health facilities of this process
				and of the right to file a grievance or request for investigation;
2. A copy of a brief memorandum explaining
				these rules shall be given to every current and new resident of a inpatient
				facility;
3. Such memorandum and
				blank copies of the forms for filing a grievance, request for investigation,
				and appeal shall be posted in a prominent place in plain sight on every unit of
				an inpatient facility or in a program operated by a service provider;
				and
4. Such memoranda, forms and
				copies of these rules shall be available at each inpatient facility, health
				plan and service provider upon request by any person at any time.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 4 - APPEALS, GRIEVANCES, AND REQUESTS FOR INVESTIGATION FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Section R9-21-410 - Miscellaneous

Current through Register Vol. 30, No. 28, July 12, 2024
A. Disqualification
				of official. The agency director, investigator, or any other official with
				authority to act on a grievance or request for investigation shall disqualify
				himself from acting, if such official cannot act on the matter impartially and
				objectively, in fact or in appearance. In the event of such disqualification,
				the official shall forthwith prepare and forward a written, dated memorandum
				explaining the reasons for the decision to the Administration, as appropriate,
				who shall, within 10 days of receipt of the memorandum make a determination
				upon the appropriateness of the disqualification and notify.
B. Request for extension of time.
1. The investigator or any other official of
				a mental health agency acting according to this Article may secure an extension
				of any time limit provided in this Article with the permission of the health
				plan.
2. The investigator or any
				other official of an inpatient facility operated exclusively by a n
				governmental entity acting according to this Article may secure an extension of
				any time limit provided in this Article with the permission of the CEO of the
				entity or his designee.
3. The
				investigator or any other official of the Administration acting according to
				this Article may secure an extension of any time limit provided in this Article
				with the permission of the Administration or designee.
4. An extension of time may only be granted
				upon a showing of necessity and a showing that the delay will not pose a threat
				to the safety or security of the client.
5. A request for extension shall be in
				writing, with copies to all parties. The request shall explain why an extension
				is needed and propose a new time limit which does not unreasonably postpone a
				final resolution of the matter.
6.
				Such request shall be submitted to and acted upon prior to the expiration of
				the original time limit. Failure of the relevant official to act within the
				time allowed shall constitute a denial of the request for an
				extension.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-501 - Court-ordered Evaluation

Current through Register Vol. 30, No. 28, July 12, 2024
A. An application
				for court-ordered evaluation shall, according to A.R.S. §
									36-521, be made on AHCCCS form
				MH-100, Titled "Application for Involuntary Evaluation," set forth in Exhibit
				A.
B. Any mental health agency or
				service provider that receives an application for court-ordered evaluation
				shall immediately refer the applicant for pre-petition screening and
				petitioning for court-ordered evaluation, provided for in A.R.S. Title 36,
				Chapter 5, Article 4, to:
1. A health plan;
				or
2. If a county has not
				contracted with a health plan for pre-petition screening and petitioning for
				court-ordered evaluation, the county.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit A - Application for Involuntary Evaluation

Current through Register Vol. 30, No. 28, July 12, 2024
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ADHS/BHS Form MH-100 (9/93)
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit B - Petition for Court-ordered Evaluation

Current through Register Vol. 30, No. 28, July 12, 2024
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ADHS/BHS Form MH-105 (9/93)
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-502 - Emergency Admission for Evaluation

Current through Register Vol. 30, No. 28, July 12, 2024
A. An application
				for emergency evaluation pursuant to A.R.S. §
									36-524 may be made to any
				evaluation agency licensed and approved by the Administration to provide such
				services on AHCCCS form MH-104, Titled "Application for Emergency Admission for
				Evaluation," set forth in Exhibit C.
B. Prior to admission of an individual under
				this rule, the evaluation agency shall notify the appropriate health plan of
				the potential admission so that the health plan may first:
1. Offer and provide services or treatment to
				the individual as an alternative to admission; or
2. Authorize admission of the
				individual.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit C - Application for Emergency Admission for Evaluation

Current through Register Vol. 30, No. 28, July 12, 2024
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Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-503 - Voluntary Admission for Evaluation

Current through Register Vol. 30, No. 28, July 12, 2024
A. An application
				for voluntary evaluation pursuant to A.R.S. §
									36-522 shall be submitted on
				AHCCCS form MH-103, Titled "Application for Voluntary Evaluation," set forth in
				Exhibit D to a mental health agency.
B. If a health plan receives an application
				according to subsection (A), the health plan shall provide for such evaluation
				under A.R.S. §
									36-522 for any individual who:
1. Voluntarily makes application as provided
				in subsection (A);
2. Gives
				informed consent; and
3. Has not
				been adjudicated as an incapacitated person pursuant to A.R.S. Title 14,
				Chapter 5, or Title 36, Chapter 5.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit D - Application for Voluntary Evaluation

Current through Register Vol. 30, No. 28, July 12, 2024
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ADHS/BHS Form MH-103 (9/93)
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-504 - Court-ordered Treatment

Current through Register Vol. 30, No. 28, July 12, 2024
A. The health plan
				shall perform, either directly or by contract, all treatment required by A.R.S.
				Title 36, Chapter 5, Article 5 and this Article. In order to perform these
				functions, the health plan or its contractor must be licensed by the Department
				of Health Services.
B. A mental
				health agency may provide court-ordered treatment pursuant to A.R.S. Title 36,
				Chapter 5, Article 5, other than through contract with the health plan,
				provided that:
1. The mental health agency is
				licensed by the Department to provide the court-ordered treatment;
2. The mental health agency complies with all
				applicable requirements under A.R.S. Title 36, Chapter 5, Article 5;
				and
3. The individual ordered to
				undergo treatment is not a client of the health plan.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit E - Affidavit

Current through Register Vol. 30, No. 28, July 12, 2024
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ADHS/BHS Form MH-112 Addendum No. 2 (9/93)
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit F - Petition for Court-ordered Treatment

Current through Register Vol. 30, No. 28, July 12, 2024
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Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-505 - Coordination of Court-ordered Treatment Plans with ISPs and ITDPs

Current through Register Vol. 30, No. 28, July 12, 2024
A. All inpatient
				and outpatient treatment plans prepared for clients according to A.R.S.
				§§
									36-533,
				36-540 and
				36-540.01, and any modifications
				to the treatment plans, shall be developed and implemented according to the
				individual service planning procedures in Article 3 of this Chapter, including
				the right of the client to request different services and to appeal the
				treatment plan.
B. If a client's
				ISP or ITDP is inconsistent with an inpatient or outpatient treatment plan
				ordered by the court, the mental health agency or health plan, whichever is
				appropriate, shall recommend to the court that the court-ordered plan be
				amended so that it is consistent with the client's ISP or ITDP.
C. If, during the period a client is on
				outpatient status, an emergency occurs that satisfies the standards for
				emergency admission under A.R.S. §§
									36-524 and
				36-526, and that requires
				immediate revocation or modification of an outpatient order, a modification may
				be submitted to the court in consultation with the client's clinical team
				without complying with the individual service planning procedures, provided
				that the client and clinical team subsequently review any such modification
				according to the individual service planning procedures in Article 3 of this
				Chapter.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-506 - Review of Court-ordered Individual

Current through Register Vol. 30, No. 28, July 12, 2024
A. The mental health treatment agency that
				provides care for an individual ordered by a court to undergo treatment shall:
1. Assure that an examination and review of a
				court-ordered individual is accomplished in an effective and timely fashion,
				but not less than 30 days prior to expiration of any treatment portion of the
				order.
2. Require written
				documentation of the examination and review.
3. Maintain a special record that shall
				include:
a. The expiration date of any
				treatment portion of the court-ordered treatment; and
b. The date by which the review and
				examination must be initiated.
4. Establish specific dates by which the
				review and examination will be accomplished.
5. Conduct the review and examination by the
				specified dates.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-507 - Transfers of Court-ordered Persons

Current through Register Vol. 30, No. 28, July 12, 2024
A. For the purpose
				of this Section, "non-client" means an individual who have a qualifying serious
				mental illness but is not currently being evaluated or treated for a mental
				disorder by or through a health plan.
B. An individual ordered by the court to
				undergo treatment and without a guardian may be transferred from a mental
				health agency to another mental health agency, provided that the medical
				director of the mental health agency initiating the transfer has established
				that:
1. There is no reason to believe the
				individual will suffer more serious physical harm or serious illness as a
				result of the transfer; and
2. The
				individual is being transferred to a level and kind of treatment more
				appropriate to the individual's treatment needs and has been accepted for
				transfer by the medical director of the receiving mental health agency pursuant
				to subsection (D).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-508 - Requests for Notification

Current through Register Vol. 30, No. 28, July 12, 2024
A. At any time
				during a specified period of court-ordered treatment in which an individual has
				been found to be a danger to others, a relative or victim wishing to be
				notified in the event of a individual being released prior to the expiration of
				the period of court-ordered treatment shall file a demand, according to A.R.S.
				§
									36-541.01(D), on
				AHCCCS form MH-127 in Exhibit G.
B.
				At any time during a specified period of court-ordered treatment in which an
				individual has been found to be a danger to others, a person other than a
				relative or victim wishing to be notified in the event of an individual being
				released prior to the expiration of the period of court-ordered treatment shall
				file a petition and form of order, to A.R.S. §
									36-541.01(D)  on
				AHCCCS form MH-128 in Exhibit H.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit G - Demand for Notice by Relative or Victim

Current through Register Vol. 30, No. 28, July 12, 2024
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ADHS/BHS Form MH-127 (9/93)
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit H - Petition for Notice

Current through Register Vol. 30, No. 28, July 12, 2024
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ADHS/BHS Form MH-128 (9/93)
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-509 - Voluntary Admission for Treatment

Current through Register Vol. 30, No. 28, July 12, 2024
A. Application for
				admission for voluntary treatment according to A.R.S. §
									36-518 shall be made to a mental
				health agency on AHCCCS form MH-210, Titled "Application for Voluntary
				Treatment," in Exhibit I, by any individual who:
1. Voluntarily makes application as provided
				in subsection (A);
2. Gives
				informed consent;
3. Has not been
				adjudicated as an incapacitated person according to A.R.S. Title 14, Chapter 5,
				or Title 36, Chapter 5; and
4. If a
				minor, is appropriately admitted according to A.R.S. §
										36-518.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Exhibit I - Application for Voluntary Treatment

Current through Register Vol. 30, No. 28, July 12, 2024
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ADHS/BHS Form MH-210 (9/93)
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-510 - Informed Consent in Voluntary Application for Admission and Treatment

Current through Register Vol. 30, No. 28, July 12, 2024
A. Prior to
				beginning any course of medication or other treatment for an individual who is
				subject to voluntary admission under A.R.S. §§
									36-518
				and
				36-522, a
				mental health agency shall obtain an informed consent to treatment and enter it
				in the medical record. For all clients, the informed consent shall be obtained
				according to R9-21-206.01.
B. For
				clients, the mental health agency shall make reasonable inquiry into an
				individual's capacity to give informed consent, record these findings, and
				enter these findings in the client's ISP or record pursuant to Articles 2 and 3
				of this Chapter. For non-clients, the agency shall adopt admission procedures
				that shall include the following:
1. The
				medical director or the medical director's designee shall make reasonable
				inquiry into an individual's capacity to give informed consent.
2. The medical director or the medical
				director's designee shall record his findings regarding the individual's
				capacity to give and of having given informed consent.
3. That the findings of the medical director
				or the medical director's designee shall be entered into the individual's
				record.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-511 - Use of Psychotropic Medication

Current through Register Vol. 30, No. 28, July 12, 2024
A. Psychotropic medications may only be
				ordered for individuals undergoing court-ordered evaluation according to
				R9-21-204 or R9-21-207.
B.
				Psychotropic medications may not be ordered for and administered to individuals
				undergoing court-ordered treatment, except as follows:
1. In an emergency involving the safety of
				the individual or another, as documented in the individual's medical
				record;
2. If the individual or
				guardian gives an informed consent to use the medication;
3. If provision for use of the medications
				shall be contained in the individual's treatment plan or ISP. At a minimum, the
				plan shall specify:
a. A description of the
				circumstances under which the medication may be used.
b. A description of the objectives that are
				expected to be achieved by use of the medication. This description must
				indicate how the individual's condition would be improved by using the
				medication and indicate what result would be expected if the medication were
				not used; or
4.
				According to R9-21-204 or R9-21-207.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-512 - Seclusion and Restraint

Current through Register Vol. 30, No. 28, July 12, 2024
Individuals undergoing court-ordered evaluation or
				  court-ordered treatment shall not be placed in seclusion or restraint except as
				  permitted by Article 2 of this Chapter, and specifically
				  R9-21-204.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 21 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM (AHCCCS) BEHAVIORAL HEALTH SERVICES FOR PERSONS WITH SERIOUS MENTAL ILLNESS › Article 5 - COURT-ORDERED EVALUATION AND TREATMENT › Section R9-21-513 - Renumbered

Current through Register Vol. 30, No. 28, July 12, 2024
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-202 - General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. For the
				purposes of this Article, the following definitions apply:
1. "Authorization" means written, verbal, or
				electronic authorization by:
a. The
				Administration for services rendered to a fee-for-service member, or
b. The contractor for services rendered to a
				prepaid capitated member.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-203 - Experimental Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. Experimental
				services are not covered. A service is not experimental if:
1. It is generally and widely accepted as a
				standard of care in the practice of medicine in the United States and is a safe
				and effective treatment for the condition for which it is intended or
				used.
2. The service does not meet
				the standard in subsection (A)(1), but the service has been demonstrated to be
				safe and effective for the condition for which it is intended or used based on
				the weight of the evidence in peer-reviewed articles in medical journals
				published in the United States.
3.
				The service does not meet the standard in subsection (A)(2) because the
				condition for which the service is intended or used is rare, but the service
				has been demonstrated to be safe and effective for the condition for which it
				is intended or used based on the weight of opinions from specialists who
				provide the service or related services.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-204 - Inpatient General Hospital Services

Current through Register Vol. 30, No. 28, July 12, 2024
A.The following
				limitations apply to inpatient general hospital services that are provided by
				FFS providers.
1. Providers shall obtain prior
				authorization from the Administration for the following inpatient hospital
				services:
a. Nonemergency and elective
				admission, including psychiatric hospitalization;
b. Elective surgery; and
c. Services or items provided to cosmetically
				reconstruct or improve personal appearance after an illness or
				injury.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-205 - Attending Physician, Practitioner, and Primary Care Provider Services

Current through Register Vol. 30, No. 28, July 12, 2024
A.A primary care
				provider, attending physician, or practitioner 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 and equipment;
5. Referral to a specialist or other health
				care professional if medically necessary;
6. Patient education;
7. Home visits if medically necessary;
				and
8. Preventive health services,
				such as, well visits, immunizations, colo-noscopies, mammograms and PAP
				smears.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-206 - Organ and Tissue Transplant Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. Organ and tissue transplant services are
				covered for a member if prior authorized and coordinated with the member's
				contractor, or the Administration. Only the following transplants are covered
				for individuals 21 years of age or older:
1.
				Heart, including transplants for the treatment of non-ischemic
				cardiomyopathy;
2. Liver, including
				transplants for patients with hepatitis C;
3. Kidney (cadaveric and live
				donor),
4. Simultaneous
				Pancreas/Kidney (SPK),
5.
				Autologous and Allogeneic related and unrelated Hematopoietic Cell
				transplants;
6. Cornea;
7. Bone;
8. Lung; and
9. Pancreas after a kidney transplant
				(PAK).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-207 - Dental Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				Administration or a contractor shall cover dental services for a member less
				than 21 years of age under R9-22-213.
B. For individuals age 21 years of age or
				older, the Administration or a contractor shall cover medical and surgical
				services furnished by a dentist only to the extent such services may be
				performed under state law either by a physician or by a dentist and such
				services would be considered a physician service if furnished by a physician.
1. Except as specified in subsection (C),
				such services must be related to the treatment of a medical condition such as
				acute pain, infection, or fracture of the jaw. Covered dental services include
				examination of the oral cavity, radiographs, complex oral surgical procedures
				such as treatment of maxillofacial fractures, administration of an appropriate
				level of anesthesia and the prescription of pain medication and
				antibiotics.
2. Such services do
				not include services that physicians are not generally competent to perform
				such as dental cleanings, routine dental examinations, dental restorations
				including crowns and fillings, extractions, pulpotomies, root canals, and the
				construction or delivery of complete or partial dentures. Diagnosis and
				treatment of temporomandibular joint dysfunction are not covered except for the
				reduction of trauma.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-208 - Laboratory, Radiology, and Medical Imaging Services

Current through Register Vol. 30, No. 28, July 12, 2024
Laboratory, radiology, and medical imaging services are
				  covered services if:
1. Prescribed by
				the member's attending physician, practitioner, primary care provider or a
				dentist, or prescribed by a physician or practitioner upon referral from the
				primary care provider or dentist.
2. Provided by licensed health care providers
				in a:
a. Hospital,
b. Clinic,
c. Physician's office, or
d. Other health care facility.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-209 - Pharmaceutical Services

Current through Register Vol. 30, No. 28, July 12, 2024
A.An inpatient
				or outpatient provider, including a hospital, clinic, other appropriately
				licensed health care facility, and pharmacy may provide covered pharmaceutical
				services.
B.The Administration or a
				contractor shall require a provider to make pharmaceutical services:
1. Available during customary business hours,
				and
2. Located within reasonable
				travel distance of a member's residence.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-210 - Emergency Medical Services for Non-FES Members

Current through Register Vol. 30, No. 28, July 12, 2024
A.General provisions.
1. Applicability. This Section applies to
				emergency medical services for non-FES members. Provisions regarding emergency
				behavioral health services for non-FES members are in
				R9-22-210.01.
				Provisions regarding emergency medical and behavioral health services for FES
				members are in
				R9-22-217.
2. Definitions.
a. For the purposes of this Section,
				"contractor" has the same meaning as in A.R.S. §
											36-2901.
				Contractor does not include ADHS/DBHS or a subcontractor of
				ADHS/DBHS.
b. For the purposes of
				this Section and R9-22-210.01, "fiscal agent" means a person who bills and
				accepts payment for a hospital or emergency room provider.
3. Verification. A provider of emergency
				medical services shall verify a person's eligibility status with AHCCCS, and if
				eligible, determine whether the person is enrolled with AHCCCS as non-FES FFS
				or is enrolled with a contractor.
4. Prior authorization.
a. Emergency medical services. A provider is
				not required to obtain prior authorization for emergency medical
				services.
b. Non-emergency medical
				services. If a non-FES member's medical condition does not require emergency
				medical services, the provider shall obtain prior authorization as required by
				the terms of the provider agreement under
				R9-22-714(A)
				or the provider's subcontract with the contractor, whichever is
				applicable.
5.
				Prohibition against denial of payment. Neither the Administration nor a
				contractor shall:
a. Limit what constitutes
				an emergency medical condition on the basis of lists of diagnoses or
				symptoms,
b. Deny or limit payment
				because the provider failed to obtain prior authorization for emergency
				services,
c. Deny or limit payment
				because the provider does not have a subcontract.
6. Grounds for denial. The Administration and
				a contractor may deny payment for emergency medical services for reasons
				including but not limited to:
a. The claim was
				not a clean claim;
b. The claim was
				not submitted timely; and
c. The
				provider failed to provide timely notification under subsection (B)(4) to the
				contractor or the Administration, as appropriate, and the contractor does not
				have actual notice from any other source that the member has presented for
				services.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-211 - Transportation Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. Emergency
				ambulance services.
1. A member shall receive
				medically necessary emergency transportation in a ground or air ambulance:
a. To the nearest appropriate provider or
				medical facility capable of meeting the member's medical needs, and
b. If no other appropriate means of
				transportation is available.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-212 - Durable Medical Equipment, Orthotic and Prosthetic Devices, and Medical Supplies

Current through Register Vol. 30, No. 28, July 12, 2024
A. Durable
				medical equipment, orthotic and prosthetic devices, and medical supplies,
				including incontinence briefs as specified in subsection (E), are covered
				services to the extent permitted in this Section if provided in compliance with
				requirements of this Chapter; and
1.
				Prescribed by the primary care provider, attending physician, or practitioner;
				or
2. Prescribed by a specialist
				upon referral from the primary care provider, attending physician, or
				practitioner; and
3. Authorized as
				required by the Administration, contractor, or contractor's designee.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-213 - Early and Periodic Screening, Diagnosis, and Treatment Services (E.P.S.D.T.)

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				following E.P.S.D.T. services are covered for a member less than 21 years of
				age:
1. Screening services including:
a. Comprehensive health and developmental
				history;
b. Comprehensive unclothed
				physical examination;
c.
				Appropriate immunizations according to age and health history;
d. Laboratory tests; and
e. Health education, including anticipatory
				guidance;
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-215 - 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:
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, medications,
				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;
b. Sterilization; and
c. Natural family planning education or
				referral;
4. Midwifery
				services provided by a certified nurse practitioner in midwifery;
5. Midwifery services for low-risk
				pregnancies and home deliveries provided by a licensed midwife;
6. Respiratory therapy;
7. Ambulatory and outpatient surgery
				facilities services;
8. Home health
				services under A.R.S. §
										36-2907(D);
9. Private or special duty nursing
				services;
10. Rehabilitation
				services including physical therapy, occupational therapy, speech therapy, and
				audiology within limitations in subsection (C);
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; and
12. Chemotherapy.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-216 - NF, Alternative HCBS Setting, or HCBS

Current through Register Vol. 30, No. 28, July 12, 2024
A. Services provided in a NF, including room
				and board, an alternative HCBS setting as defined in R9-28-101, or a HCBS as
				defined in A.R.S. §
									36-2939
				are covered for a maximum of 90 days per contract year if the member's medical
				condition would otherwise require hospitalization.
B. Except as otherwise provided in 9 A.A.C.
				28, the following services are not itemized for separate billing if provided in
				a NF, alternative HCBS setting, or HCBS:
1.
				Nursing services, including:
a. Administering
				medication;
b. Tube
				feedings;
c. Personal care
				services, including but not limited to assistance with bathing and
				grooming;
d. Routine testing of
				vital signs; and
e. Maintenance of
				a catheter;
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 2 - SCOPE OF SERVICES › Section R9-22-217 - Services Included in the Federal Emergency Services Program

Current through Register Vol. 30, No. 28, July 12, 2024
A. Definition.
				Notwithstanding the definition in
				R9-22-201,
				for the purposes of this Section, an emergency medical or behavioral health
				condition for a FES member means a medical condition or a behavioral health
				condition, including labor and delivery, manifesting itself by acute symptoms
				of sufficient severity, including severe pain, such that the absence of
				immediate medical attention could reasonably be expected to result in:
1. Placing the member's health in serious
				jeopardy,
2. Serious impairment to
				bodily functions,
3. Serious
				dysfunction of any bodily organ or part, or
4. Serious physical harm to another
				person.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 3 - GENERAL ELIGIBILITY REQUIREMENTS › Section R9-22-301 - General Eligibility Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
Definitions. In addition to definitions contained in
				  R9-22-101
				  and A.R.S. §
									36-2901,
				  the words and phrases in this Article, Article 14 and Article 15 have the
				  following meanings unless the context explicitly requires another
				  meaning:
"Applicant," notwithstanding
				  R9-22-101,
				  means a person listed on an application for whom AHCCCS coverage is being
				  sought.
"BHS" means the division of Behavioral Health Services within
				  the Arizona Department of Health Services.
"CRS" means the program administered by the Administration or
				  its designee that provides covered medical services and covered support
				  services in accordance with A.R.S.
				  36-261.
"DCSS" means the Division of Child Support Services, which is
				  the division within the Department that administers the Title IV-D program and
				  includes a contract agent operating a child support enforcement program on
				  behalf of the Department.
"FAA" means the Family Assistance Administration, the
				  administration within the Department's Division of Benefits and Medical
				  Eligibility with responsibility for providing cash and food stamp assistance to
				  a member and for determining eligibility for AHCCCS medical coverage.
"Income" means combined earned and unearned income.
"Medical support" means to provide health care coverage in
				  the form of health insurance or court-ordered payment for medical care.
"Member" means an applicant who has been determined to
				  qualify for AHCCCS coverage by the Administration or its designee.
"Pre-enrollment process" means the process that provides an
				  applicant the opportunity to choose an AHCCCS health plan before the
				  determination of eligibility is completed.
"Resources" means real and personal property, including
				  liquid assets.
"Sponsor" means an individual who signs the USCIS I-864
				  Affidavit of Support agreeing to support a non-citizen as a condition of the
				  non-citizen's admission for permanent residence in the United States.
"Sponsor deemed income" means the unearned income deemed
				  available to the applicant named on the USCIS I-864 Affidavit of
				  Support.
"SVES" means the State Verification and Exchange System, a
				  system through which the Department exchanges income and benefit information
				  with the Internal Revenue Service, Social Security Administration, and State
				  Wage and Unemployment Insurance Benefit data files.
"USCIS" means the United States Citizen and Immigration
				  Services.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 3 - GENERAL ELIGIBILITY REQUIREMENTS › Section R9-22-302 - AHCCCS Eligibility Application

Current through Register Vol. 30, No. 28, July 12, 2024
Application Process
1. Right to apply. A person may apply for
				AHCCCS medical coverage by submitting an Administration-approved application to
				the Administration or its designee, an FAA office, or one of the following
				outstation locations:
a. A BHS site;
b. A Federally Qualified Health Center or
				disproportionate share hospital under
				42 U.S.C.
				1396r-4; or
c. Any other site, including a hospital,
				approved by the Administration or its designee.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 3 - GENERAL ELIGIBILITY REQUIREMENTS › Section R9-22-303 - Prior Quarter Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A. Subject
				to CMS approval, prior quarter coverage eligibility shall be limited to
				applicants who meet the requirements in (B) and who also:
1. Are eligible during any of the three
				months prior to application; and
2.
				Received one or more covered services described in 9 A.A.C. 22, Article 2 and
				Article 12, and 9 A.A.C. 28, Article 2 during the month; and
3. Would have qualified for Medicaid at the
				time services were received if the person had applied regardless of whether the
				person is alive when the application is made.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 3 - GENERAL ELIGIBILITY REQUIREMENTS › Section R9-22-304 - Verification of Eligibility Information

Current through Register Vol. 30, No. 28, July 12, 2024
A. Except as provided in subsection (E), if
				information provided by or on behalf of an applicant or member on an
				application, renewal form or otherwise does not conflict with information
				obtained by the agency through an electronic data match, the Administration or
				its designee shall determine or renew eligibility based on such
				information.
B. The Administration
				or its designee shall not require an applicant, member, or representative to
				provide additional verification unless the verification cannot be obtained
				electronically or the verification obtained electronically conflicts with
				information provided by or on behalf of the applicant or member.
C. If information provided by or on behalf of
				an applicant or member does conflict with information obtained through an
				electronic data match, the applicant or member shall provide the Administration
				or its designee with information or documentation necessary to verify
				eligibility, including evidence originating from an agency, organization, or an
				individual with actual knowledge of the information.
D. Income information obtained through an
				electronic data match shall be considered reasonably compatible with income
				information provided by or on behalf of an individual if both meet or both
				exceed the applicable income limit.
E. The Administration or its designee shall
				not accept the applicant's or member's statement by itself as verification of:
1. SSN;
2. Qualified alien status, except as
				described under
				42 USC
				1320 b - 7(d)(4) (A; or
3. Citizenship, except as described under
				42 USC
				1396 a(ee)(1).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 3 - GENERAL ELIGIBILITY REQUIREMENTS › Section R9-22-306 - Administration, Administration's Designee or Member Responsibilities

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				Administration or its designee is responsible for the following:
1. The Administration or its designee shall
				determine eligibility within 90 days for an applicant applying on the basis of
				disability and 45 days for all other applicants, unless:
a. The agency cannot reach a decision because
				the applicant or an examining physician delays or fails to take a required
				action, or
b. When there is an
				administrative or other emergency beyond the agency's control.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 3 - GENERAL ELIGIBILITY REQUIREMENTS › Section R9-22-307 - Approval or Denial of Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A. Approval. If the applicant meets all the
				eligibility requirements and conditions of eligibility of this Article, the
				Administration or its designee shall approve the application and provide the
				applicant with an approval notice. The approval notice shall contain:
1. The name of each approved
				applicant,
2. The effective date of
				eligibility for each approved applicant,
3. The reason and the legal citations if a
				member is approved for only emergency medical services, and
4. The applicant's right to appeal the
				decision.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 3 - GENERAL ELIGIBILITY REQUIREMENTS › Section R9-22-308 - Reinstating Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration or its designee shall reopen an
				  application or reinstate eligibility of a member when any of the following
				  conditions are met:
1. The denial or
				discontinuance of eligibility was due to an administrative error,
2. The discontinuance of eligibility was due
				to noncompliance with a condition of eligibility and the applicant or member
				complies prior to the effective date of the discontinuance,
3. The member informs the Administration or
				its designee of a change of circumstances prior to the effective date of the
				discontinuance, that would allow for continued eligibility, or
4. Following a discontinuance, the member
				qualifies for continuation of medical coverage pending an appeal.