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 5 - PROGRAM CONTRACTOR AND PROVIDER STANDARDS › Section R9-28-507 - Program Contractor General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. To participate in the ALTCS program,
				through a program contractor or directly through the Administration, a provider
				of ALTCS-covered services shall be registered with the
				Administration.
B. An ALTCS program
				contractor shall ensure that providers of service meet the requirements of this
				Article.
C. Each ALTCS program
				contractor shall maintain member service records for five years, that include,
				at a minimum, a case management plan, medical records, encounter data,
				grievances, complaints, and service information for each ALTCS
				member.
D. An ALTCS program
				contractor shall produce and distribute informational materials that are
				approved by the Administration to each enrolled ALTCS member or designated
				representative within 12 business days after the program contractor receives
				notification of enrollment from the Administration. The program contractor
				shall ensure that the informational materials include:
1. A description of all covered services as
				specified in contract;
2. An
				explanation of service limitations and exclusions;
3. An explanation of the procedure for
				obtaining services, including a notice stating that the program contractor is
				liable only for those services authorized by an ALTCS member's case
				manager;
4. An explanation of the
				procedure for obtaining emergency services;
5. An explanation of the procedure for filing
				a grievance and appeal; and
6. An
				explanation of when plan changes may occur as specified in contract.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 5 - PROGRAM CONTRACTOR AND PROVIDER STANDARDS › Section R9-28-509 - Agency with Choice

Current through Register Vol. 30, No. 28, July 12, 2024
A. Definitions.
				The following words and phrases, in addition to definitions contained in A.R.S.
				§§
									36-2901
				and
				36-2931,
				and 9 A.A.C. 22, Article 1, have the following meanings specific to this
				Section:
"Agency" means a provider of home and community based
				  services, other than an individual, that has a co-employment relationship with
				  one or more members for purposes of this Section.
"Co-employment relationship" means a situation where the
				  Agency serves as the legal employer of record and the ALTCS member or
				  authorized representative assumes certain responsibilities related to directing
				  and or managing care.
"Individual's representative" means a parent, family member,
				  guardian, advocate, or other person authorized by the member to serve as a
				  representative in connection with the provision of services and supports. This
				  authorization should be in writing, when feasible, or by another method that
				  clearly indicates the individual's free choice. An individual's representative
				  may not also be a paid caregiver of an individual receiving services and
				  supports.
"Standardized training" means minimum training standards
				  required of all paid caregivers by the Administration as specified in
				  contract.
B. Purpose. The
				Agency with Choice program is an ALTCS member directed service model for the
				provision of home and community based services. Under this model, the ALTCS
				member or individual's representative and the agency enter into a co-employment
				relationship.
C. In lieu of
				receiving HCBS services under a traditional service model, a member or the
				member's individual's representative may choose to participate in the Agency
				with Choice service model. Under the Agency with Choice service model, the
				agency shall maintain the authority to hire and fire paid caregivers and
				provide standardized training to the caregiver, and the member or individual
				representative may elect to recruit, select, dismiss, determine duties,
				schedule, specify training to meet the unique needs of the member, and
				supervise the paid caregivers on a day-to-day basis.
D. Setting. This program is applicable to
				ALTCS members who reside in their own home.
E. A member who chooses to receive services
				under the Agency with Choice service model is not precluded from receiving
				medically necessary, cost-effective services and supports from other agencies
				or providers if the services provided are not duplicative of the specific
				attendant care or skilled service already received through the contractor.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 5 - PROGRAM CONTRACTOR AND PROVIDER STANDARDS › Section R9-28-510 - Case Management

Current through Register Vol. 30, No. 28, July 12, 2024
A. A
				program contractor shall assign to each member a case manager to identify,
				plan, coordinate, monitor, and reassess the need for and provision of long-term
				care services.
B. A case manager
				shall:
1. Ensure that appropriate ALTCS
				placement and services are provided for a member within 30 days of
				enrollment;
2. Develop a service
				plan by:
a. Completing a case management plan
				when a member is enrolled in ALTCS and authorizing services for a member who
				continues to be financially and medically eligible for services;
b. Ensuring that a member participates in the
				preparation of the member's case management plan;
c. Specifying the paid and natural support
				services to be received by the member, including the duration, scope of
				services, units of service, frequency of service delivery, provider of
				services, and effective time period; and
d. Coordinating with the primary care
				provider in determining the necessary services for the member, including
				hospital and medical services;
3. Submit a written justification to the case
				manager's supervisor to include HCBS in the case management plan if the
				services exceed 80 percent of the institutional cost;
4. Manage a case management plan by:
a. Re-evaluating and revising the case
				management plan when the member transfers to another facility, transfers to a
				hospital, has a change in level of care; and
b. Monitoring receipt of services by a
				member;
5. Assist the
				member to maintain or progress toward the highest level of
				functioning;
6. Ensure that records
				are transferred when the member is transferred from a facility or provider to a
				new facility or provider;
7.
				Perform additional monitoring of a member with rehabilitation potential and
				whose condition is fragile or unstable, whose case management plan is
				marginally cost effective, or whose use of medical and hospital services is
				unusual;
8. Arrange behavioral
				health services, if necessary. The case manager shall have initial and
				quarterly consultation and collaboration with a behavioral health professional
				to review the treatment plan, unless the case manager meets the definition of a
				behavioral health professional under A.A.C. R9-20-101.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 5 - PROGRAM CONTRACTOR AND PROVIDER STANDARDS › Section R9-28-511 - Quality Management/utilization Management (QM/UM) Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A program contractor shall:
1. Comply with all requirements specified in
				A.A.C.
				R9-22-522;
				and
2. Submit a quarterly
				utilization control report within time lines specified in contract, and meet
				the requirements in 42 CFR 456 Subparts C, D, and F, October 1, 2004,
				incorporated by reference in R9-28-505.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 5 - PROGRAM CONTRACTOR AND PROVIDER STANDARDS › Section R9-28-513 - Program Compliance Audits

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall meet the requirements specified
				  under A.A.C.
				  R9-22-521
				  for a program contractor.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 5 - PROGRAM CONTRACTOR AND PROVIDER STANDARDS › Section R9-28-514 - Release of Safeguarded Information by the Administration and Contractors

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration, program contractors, providers, and
				  noncontracting providers shall meet the requirements specified under A.A.C.
				  R9-22-512
				  for an ALTCS applicant, or member.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-28-601 - General Provisions

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				Director has full operational authority to adopt rules for the RFP process and
				the award of contract under A.R.S. §
									36-2944.
B. The Administration shall follow the
				provisions under 9 A.A.C. 22, Article 6 for members, subject to limitations and
				exclusions under that Article, unless otherwise specified in this
				Chapter.
C. The Administration
				shall award contracts under A.R.S. §
									36-2932
				to provide services under A.R.S. §
									36-2939.
D. The Administration is exempt from the
				procurement code under A.R.S. §
									41-2501.
E. The Administration and contractors shall
				retain all records relating to contract compliance for five years under A.R.S.
				§
									36-2932
				and dispose of the records under A.R.S. §
									41-2550.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-28-602 - RFP

Current through Register Vol. 30, No. 28, July 12, 2024
The ALTCS RFP for a program contractor serving members who
				  are EPD shall meet the requirements of A.R.S. §§
									36-2944,
				  A.R.S. §
									36-2939,
				  A.A.C.
				  R9-22-602, and Articles 2 and
				  11 of this Chapter.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-28-603 - Contract Award

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall award a contract under A.R.S. §
									36-2944
				  and A.A.C.
				  R9-22-603.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-28-604 - Contract or Proposal Protests; Appeals

Current through Register Vol. 30, No. 28, July 12, 2024
Contract or proposal protests or appeals shall be under
				  A.A.C.
				  R9-22-604
				  and 9 A.A.C. 34.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-28-605 - Waiver of Contractor's Subcontract with Hospitals

Current through Register Vol. 30, No. 28, July 12, 2024
A contractor's subcontract with hospitals may be waived under
				  A.A.C.
				  R9-22-605.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 6 - RFP AND CONTRACT PROCESS › Section R9-28-606 - Contract Compliance Sanction

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				The Administration shall follow sanction provisions under A.A.C.
				R9-22-606.
B. The Administration
				shall apply remedies found in 42 CFR 488, Subpart F, effective January 1, 2012,
				incorporated by reference and on file with the Administration and the Office of
				the Secretary of State, for a nursing facility that does not meet requirements
				of participation under
				42 U.S.C.
				1396 r. This incorporation by reference
				contains no future editions or amendments.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 7 - STANDARDS FOR PAYMENTS › Section R9-28-701 - Standards for Payment Related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
Definitions. In this Article, in addition to definitions
				  contained in A.R.S. §§
									36-2901
				  and
				  36-2931,
				  and 9 A.A.C. 22, Article 1, the following phrase has the following meaning
				  unless the context of the Article explicitly requires another meaning:
"County of fiscal responsibility" means the county that is
				  financially responsible for the state's share of ALTCS
				  funding.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 7 - STANDARDS FOR PAYMENTS › Section R9-28-701.10 - General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
The following Sections of A.A.C. Chapter 22, Articles 2 and
				  7, are applicable to reimbursement for services provided under the ALTCS
				  program, except that the term "program contractor" shall be substituted for
				  "contractor."
1. Scope of the
				Administration's and Contractor's Liability, R9-22-701.10;
2. Charges to Members, R9-22-702;
3. Payments by the Administration or by a
				program contractor, R9-22-703 and R9-22-705;
4. Contractor's Liability to Hospitals for
				the Provision of Emergency and Post-stabilization Care, R9-22-709;
5. Payment for Non-hospital services,
				R9-22-710;
6. Specialty Contracts,
				R9-22-712(G)(3), R9-22-712.01(10) and Article 2;
7. Payments by the Administration for
				Hospital Services Provided to an Eligible Person, R9-22-712; R9-22-712.01 and
				R9-22-712.10;
8. Overpayment and
				Recovery of Indebtedness, R9-22-713;
9. Payments to Providers,
				R9-22-714;
10. Hospital Rate
				Negotiations, R9-22-715; and
11.
				Reinsurance, R9-22-720.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 7 - STANDARDS FOR PAYMENTS › Section R9-28-702 - Nursing Facility Assessment

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				For purposes of R9-28-702 and R9-28-703, in addition to the definitions under
				A.R.S. §
									36-2999.51, the
				following terms have the following meaning unless the context specifically
				requires another meaning:
"820 transaction" means the standard health care premium
				  payments transaction required by
				  45 CFR
				  162.1702.
"Assessment year" means the 12 month period beginning October
				  1st each year.
"Medicaid patient days" means patient days reported on the
				  Nursing Care Institution Uniform Accounting Report (UAR) as attributable to
				  AHCCCS and its contractors as the primary payor.
"Medicare days" means resident days where the Medicare
				  program, a Medicare advantage or special needs plan, or the Medicare hospice
				  program is the primary payor.
"Medicare patient days" means patient days reported on the
				  Nursing Care Institution UAR as Skilled Medicare Patient Days or Part
				  C/Advantage/Medicare Replacement Days.
"Nursing Care Institution UAR" means the Nursing Care
				  Institution Uniform Accounting Report described by R911-204.
B. Subject to Centers for Medicare and
				Medicaid Services (CMS) approval, effective October 1, 2012, nursing facilities
				shall be subject to a provider assessment payable on a quarterly
				basis.
C. All nursing facilities
				licensed in the state of Arizona shall be subject to the provider assessment
				except for:
1. A continuing care retirement
				community,
2. A facility with 58 or
				fewer beds, according to the Arizona Department of Health Services, Division of
				Licensing Services, Provider & Facility Database,
3. A facility designated by the Arizona
				Department of Health Services as an Intermediate Care Facility for the
				Intellectually Disabled,
4. A
				tribally owned or operated facility located on a reservation,
5. Arizona Veteran's Homes, or
6. Facilities located outside of the State of
				Arizona
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 7 - STANDARDS FOR PAYMENTS › Section R9-28-703 - Nursing Facility Supplemental Payments

Current through Register Vol. 30, No. 28, July 12, 2024
A.Nursing Facility Supplemental Payments
1. Using Medicaid resident bed day
				information from the most recent and complete twelve months of adjudicated
				claims and encounter data, for every combination of contractor and every
				facility eligible for a supplemental payment, the Administration shall
				determine annually a ratio equal to the number of bed days for the facility
				paid by each contractor divided by the total number of bed days paid to all
				facilities by all contractors and the Administration.
2. Using the same information as used in
				(A)(1), for every facility eligible for a supplemental payment, the
				Administration shall determine annually a ratio equal to the number of bed days
				for the facility paid by the Administration divided by the total number of bed
				days paid to all facilities by all contractors and the
				Administration.
3. Quarterly, each
				contractor shall make payments to each facility in an amount equal to 98% of
				the amounts identified as Nursing Facility Enhanced Payments in the 820
				transaction sent from AHCCCS to the contractor for the quarter multiplied by
				the percentage determined in subsection (A)(1) applicable to the contractor and
				to each facility.
4. Quarterly, the
				Administration shall make payments to each facility in an amount equal to 99%
				of the amounts collected during the preceding quarter under
				R9-28-702,
				less amounts collected and used to fund the Nursing Facility Enhanced Payments
				included in the capitation paid to contractors and the corresponding federal
				financial participation, multiplied by the percentage determined in subsection
				(A)(2) applicable to the Administration and to each facility. The
				Administration shall make the supplemental payments to the nursing facilities
				within 20 calendar days of the determination of the quarterly supplemental
				payment.
5. Neither the
				Administration nor its contractors shall be required to make quarterly payments
				to facilities otherwise required by subsections (A)(3) or (A)(4) until the
				amount available in the nursing facility assessment fund established by A.R.S.
				§
										36-2999.53,
				plus the corresponding federal financial participation, is equal to or greater
				than 101% of the amount necessary to make such payments in full.
6. Contractors shall not be required to make
				quarterly payments to a facility otherwise required by subsection (A)(3) until
				the Administration has made a retroactive adjustment to the capitation rates
				paid to contractors to correct the Nursing Facility Enhanced Payments based on
				actual member months for the specified quarter.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 7 - STANDARDS FOR PAYMENTS › Section R9-28-707

Current through Register Vol. 30, No. 28, July 12, 2024
The following Section was amended under an exemption from
					 the provisions of the Administrative Procedure Act which means that the
					 amendment was not reviewed by the Governor's Regulatory Review Council; the
					 agency did not submit a notice of proposed rulemaking for publication in the
					 Arizona Administrative Register; the agency was not required to hold public
					 hearings on the rulemaking; and the Attorney General has not certified the
					 rule. This Section was subsequently amended through the regular rulemaking
					 process.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 7 - STANDARDS FOR PAYMENTS › Section R9-28-712 - County of Fiscal Responsibility

Current through Register Vol. 30, No. 28, July 12, 2024
A. General requirements.
1. The Administration shall determine the
				county of fiscal responsibility under A.R.S. §
										36-2913
				for an applicant or member who is elderly or physically disabled.
2. A program contractor shall cover services
				and provisions specified in 9 A.A.C. 22, Articles 2 and 7 and Article 11 of
				this Chapter.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 8 - TEFRA LIENS AND RECOVERIES › Section R9-28-801 - Definitions Related to TEFRA Liens

Current through Register Vol. 30, No. 28, July 12, 2024
In addition to the definitions in A.R.S. §§
									36-2901
				  and
				  36-2931, 9
				  A.A.C. 22, Article 1, and 9 A.A.C. 28, Article 1, the following definitions
				  apply to this Article: "Consecutive days" means days following one after the
				  other without an interruption resulting from a discharge.
"File" means the date that AHCCCS receives a request for a
				  State Fair Hearing under
				  R9-28-805,
				  as established by a date stamp on the request or other record of
				  receipt.
"Home" means property in which a member has an ownership
				  interest and that serves as the member's principal place of residence. This
				  property includes the shelter in which a member resides, the land on which the
				  shelter is located, and related outbuildings.
"Recover" means that AHCCCS takes action to collect from a
				  claim.
"TEFRA lien" means a lien under
				  42
				  U.S.C. 1396p of the Tax Equity and Fiscal
				  Responsibility Act of 1982. This type of lien is placed on an AHCCCS member's
				  interest in any real property before the member is deceased.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 8 - TEFRA LIENS AND RECOVERIES › Section R9-28-802 - TEFRA Liens - Filings

Current through Register Vol. 30, No. 28, July 12, 2024
A. Except for
				members under
				R9-28-803,
				AHCCCS shall file a TEFRA lien against the real property of all members who
				are:
1. Receiving ALTCS services,
				and
2.
Permanently
				  institutionalized.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 8 - TEFRA LIENS AND RECOVERIES › Section R9-28-803 - TEFRA Liens - Prohibitions

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall not file a TEFRA lien against a member's home if
				  one of the following individuals is lawfully residing in the member's
				  home:
1. Member's spouse;
2. Member's child who is under the age of
				21;
3. Member's child who is blind
				or disabled under
				42
				U.S.C. 1382c; or
4. Member's sibling who has an equity
				interest in the home and who was residing in the member's home for at least one
				year immediately before the date the member was admitted to a nursing facility,
				ICF/IID, or other medical institution as defined under
				42 CFR
				435.1010.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 8 - TEFRA LIENS AND RECOVERIES › Section R9-28-804 - TEFRA Liens - AHCCCS Notice of Intent

Current through Register Vol. 30, No. 28, July 12, 2024
A. Time-frame. At least 30 days before filing
				a TEFRA lien, AHCCCS shall send the member or member's representative a Notice
				of Intent.
B. Content of the Notice
				of Intent. The Notice of Intent shall include the following information:
1. A description of a TEFRA lien and the
				action that AHCCCS intends to take,
2. How a TEFRA lien affects a member's
				property,
3. The legal authority
				for filing a TEFRA lien,
4. The
				time-frames and procedures involved in filing a TEFRA lien, and
5. The member's right to request an
				exemption.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 8 - TEFRA LIENS AND RECOVERIES › Section R9-28-805 - TEFRA Liens and Estate Recovery - Member's Request for a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A. If the member or
				member's representative does not request an exemption under R9-28-804(C), the
				Administration shall send the member or representative a Notice of TEFRA Lien.
				The member or representative may file a request for a State Fair Hearing within
				30 days of the receipt of the Notice of TEFRA Lien.
B. If the member requests an exemption and
				the request is denied, the Administration shall send the member or
				representative a Denial of a Request for Exemption. The member or
				representative may file a request for a State Fair Hearing within 30 days of
				the receipt of the Denial of Request for Exemption. After the 30-day time-frame
				to file a State Fair Hearing, the member or representative is sent a Notice of
				a TEFRA Lien.
C. Hearings regarding
				TEFRA liens shall be conducted under 9 A.A.C. 34.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 8 - TEFRA LIENS AND RECOVERIES › Section R9-28-806 - TEFRA Liens - Recovery

Current through Register Vol. 30, No. 28, July 12, 2024
A. AHCCCS shall
				seek to recover a TEFRA lien for the amount of the medical assistance provided
				up to the amount of the sale upon the sale or transfer of the real property
				subject to the lien made prior to the member's death.
B. After the member's death, AHCCCS shall
				seek to recover a TEFRA lien for the amount of the medical assistance received
				by the member at the age of 55 years or older from the member's estate after
				the sale or transfer of the real property subject to the lien. However, AHCCCS
				shall not seek to recover the TEFRA lien or attempt recovery against any real
				property subject to the TEFRA lien so long as the member is survived by the
				member's:
1. Spouse;
2. Child under the age of 21; or
3. Child who receives benefits under either
				Title II or Title XVI of the Social Security Act as blind or disabled, as
				defined under
				42
				U.S.C. 1382c.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 8 - TEFRA LIENS AND RECOVERIES › Section R9-28-807 - TEFRA Liens - Release

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall issue a release of a TEFRA lien within 30 days
				  of:
1. Satisfaction of the lien;
				or
2. Notice that the member has
				been discharged from the nursing facility, ICF/IID, or other medical
				institution, defined under
				42 CFR
				435.1010, and the member has returned home
				and is physically residing in the home with the intention of remaining in the
				home. Discharge to an alternative HCBS setting defined at
				R9-28-101
				does not constitute a return to the home.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-901 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
In addition to the definitions in A.R.S. §§
									36-2901
				  and
				  36-2931, 9
				  A.A.C. 22, Article 1, and 9 A.A.C. 28, Article 1, the following definitions
				  apply to this Article:
"Estate" has the meaning in A.R.S. §
									14-1201.
"Member" means a person eligible for AHCCCS-covered services
				  under A.R.S. Title 36, Chapter 29, Article 2.
"Recover" means that AHCCCS takes action to collect from a
				  claim.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-902 - General Provisions

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1002
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-903 - Cost Avoidance

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1003 apply
				  to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-904 - Member Participation

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1004
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-905 - Collections

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1005 apply to
				  this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-906 - AHCCCS Monitoring Responsibilities

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1006
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-907 - Notification for Perfection, Recording, and Assignment of AHCCCS Liens

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1007
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-908 - Notification Information for Liens

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1008
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-909 - Notification of Health Insurance Information

Current through Register Vol. 30, No. 28, July 12, 2024
The provisions in A.A.C.
				  R9-22-1009
				  apply to this Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-910 - Recoveries

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall recover funds paid before or after the death of
				  a member for ALTCS benefits including: capitation payments, Medicare Parts A
				  and B premium payments, coinsurance and deductibles paid by AHCCCS,
				  fee-for-service payments, and reinsurance payments from:
1. The estate of a member who was 55 years of
				age or older when the member received benefits; or
2. The estate or the property of a member
				under A.R.S. §§ 36-2935, 36-2956, and
				42 U.S.C.
				1396 p.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-911 - Estate Recovery and Undue Hardship

Current through Register Vol. 30, No. 28, July 12, 2024
A. Any recovery of a claim by AHCCCS against
				a member's estate shall be made only after the death of the member's surviving
				spouse and only at a time:
1. When there
				exists no surviving minor child under age 21; and
2. When there exists no surviving child who
				receives benefits under either Title II or Title XVI of the Social Security Act
				because the child is blind or disabled as defined in
				42 U.S.C.
				1382 c.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 9 - FIRST- AND THIRD-PARTY LIABILITY AND RECOVERIES › Section R9-28-912 - Partial Recovery

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall use the following factors in determining whether
				  to seek a partial recovery of funds when an heir or devisee does not meet the
				  requirements of
				  R9-28-911
				  and requests a partial recovery:
1.
				Financial and medical hardship to the heir or devisee;
2. Income of the heir or devisee and whether
				the heir or devisee's household gross annual income is less than 100 percent of
				the FPL;
3. Resources of the heir
				or devisee;
4. Value and type of
				assets;
5. Amount of AHCCCS' claim
				against the estate; and
6. Whether
				other creditors have filed claims against the estate or have foreclosed on the
				property.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 10 - CIVIL MONETARY PENALTIES AND ASSESSMENTS › Section R9-28-1001 - Basis for Civil Monetary Penalties and Assessments for Fraudulent Claims

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall use the provisions in 9 A.A.C. 22, Article 11
				  for the determination and collection of penalties and
				  assessments.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 11 - BEHAVIORAL HEALTH SERVICES › Section R9-28-1101 - General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
General requirements. The following general requirements
				  apply to behavioral health services provided under this Article, and Chapter 22
				  subject to all exclusions and limitations.
.
1.
				Definitions. The definitions in A.A.C.
				R9-22-1201 and
				R9-22-101
				apply to this Article, in addition to the following definitions:
"Case manager" means an individual responsible for
				  coordinating the physical health services or behavioral health services
				  provided to a patient at the health care institution.
"Contractor" means an ALTCS contractor or as previously known
				  as program contractor. "Cost avoid" means the same as in A.A.C.
				  R9-22-1201.
"Intergovernmental agreement" or "IGA" means an agreement for
				  services or joint or cooperative action between the Administration and a tribal
				  contractor.
"Qualified behavioral health service provider" means a
				  behavioral health service provider that meets the requirements of
				  R9-28-1106.
"Tribal contractor" means a tribal organization (The Tribe)
				  or urban Indian organization defined in
				  25
				  U.S.C. 1603 and recognized by CMS as meeting
				  the requirements of
				  42 U.S.C.
				  1396 d(b), that provides or is accountable
				  for providing the services or delivering the items described in the
				  intergovernmental agreement.
2. Case management. A
				tribal contractor shall provide case management services to FFS American Indian
				members living on or off-reservation as delineated in the IGA.
3.
				Reimbursement. For FFS American Indians, the Administration is exclusively
				responsible for providing reimbursement for covered behavioral health services
				that are authorized by a tribal contractor or the Administration under the
				intergovernmental agreement as specified in this Article. A contractor is
				exclusively responsible for providing reimbursement for covered behavioral
				health services that are authorized by a contractor as specified in this
				Article.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 11 - BEHAVIORAL HEALTH SERVICES › Section R9-28-1102 - ALTCS Contractor or Tribal Contractor Responsibilities

Current through Register Vol. 30, No. 28, July 12, 2024
A. ALTCS
				contractor. A contractor shall arrange for behavioral health services to all
				enrolled members, including American Indian members who are not enrolled with a
				tribal contractor .
B. Tribal
				contractor. A tribal contractor shall provide behavioral health services to a
				American Indian member who is enrolled with a tribal contractor as prescribed
				in
				R9-28-1101.
				When a tribal contractor determines that an EPD American Indian member residing
				on a reservation needs behavioral health services under R9-28-415, the member
				shall receive services as authorized by the Administration or a tribal
				contractor under A.A.C.
				R9-22-1205
				from any AHCCCS-registered provider.
C. A program or tribal contractor shall
				cooperate when a transition of care occurs and ensure that medical records are
				transferred in accordance with A.R.S. §§ 36-2932, 36-509, and
				R9-28-514
				when a member transitions from:
1. A
				behavioral health provider to another behavioral health provider,
2. A RBHA or TRBHA to a contractor,
3. A contractor or tribal contractor to a
				RBHA or TRBHA, or
4. A contractor
				to a tribal contractor or vice versa.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 11 - BEHAVIORAL HEALTH SERVICES › Section R9-28-1103 - Eligibility for Covered Services

Current through Register Vol. 30, No. 28, July 12, 2024
A. Eligibility for covered services. A member
				determined eligible under A.R.S. §
									36-2934
				shall receive medically necessary covered services specified under Chapter 22,
				Article 2 and 12.
B. Behavioral
				health services are covered as specified in Chapter 22, Article 2 and
				12.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 11 - BEHAVIORAL HEALTH SERVICES › Section R9-28-1104 - General Service Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. Services. Behavioral health services
				include both mental health and substance abuse services and are subject to the
				provisions under Chapter 22, Article 2 and 12.
B. Enrollment of American Indian member. The
				Administration shall enroll an EPD American Indian member with a tribal
				contractor on a FFS basis if:
1. The member
				lives on-reservation of a American Indian tribal organization that is an ALTCS
				tribal contractor, or
2. The member
				lived on-reservation of a American Indian tribal organization that is an ALTCS
				tribal contractor immediately before placement in an off-reservation Nursing
				Facility or an alternative HCBS setting.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 11 - BEHAVIORAL HEALTH SERVICES › Section R9-28-1105 - Scope of Behavioral Health Services

Current through Register Vol. 30, No. 28, July 12, 2024
Scope of
				  Services. The provisions of A.A.C.
				  R9-22-1205
				  are the scope of behavioral health services for a member under this Article.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 28 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ARIZONA LONG-TERM CARE SYSTEM › Article 11 - BEHAVIORAL HEALTH SERVICES › Section R9-28-1106 - Standards for Service Providers

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Applicability. The provisions of A.A.C.
				R9-22-1206 are the
				general provisions and standards for service providers. References in A.A.C.
				R9-22-1206 to ADHS/DBHS
				or to a RBHA apply to a contractor.
B. The Administration or a contractor shall
				cost avoid any behavioral health service claims if the Administration or the
				contractor establishes the probable existence of first-party liability or
				third-party liability.
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 R9-28-1301 - General Freedom to Work Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall determine eligibility for AHCCCS
				  medical services under Article 2 of this Chapter and A.A.C.
				  R9-22-1901.
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 R9-28-1302 - General Administration Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall comply with the confidentiality rule
				  under A.A.C.
				  R9-22-512(C).
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 R9-28-1303 - Application for Coverage

Current through Register Vol. 30, No. 28, July 12, 2024
A. A person
				may apply by submitting an application to an Administration office.
B. The application date is the date the
				application is received at an Administration office.
C. The provisions of A.A.C. R9-22-1406(B) and
				(D) apply to this Section.
D. An
				applicant or representative who files an application may withdraw the
				application either orally or in writing. The Administration shall send an
				applicant withdrawing an application a denial notice under
				R9-28-1304.
E. Except as provided
				in
				42 CFR
				435.911, the Administration shall determine
				eligibility within 45 days.
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 R9-28-1304 - Notice of Approval or Denial

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall send an applicant a written notice
				  of the decision regarding the application. This notice shall include a
				  statement of the action and:
1. If
				approved:
a. The effective date of
				eligibility,
b. The amount the
				person shall pay, and
c. An
				explanation of the person's hearing rights specified in 9 A.A.C. 34;
				or
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 R9-28-1305 - Reporting and Verifying Changes

Current through Register Vol. 30, No. 28, July 12, 2024
An applicant or member shall report and verify changes as
				  described under
				  R9-28-411(A),
				  to the Administration, including any changes in the spouse's income that may
				  affect the share of cost.
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 R9-28-1306 - Actions That Result from a Redetermination or Change

Current through Register Vol. 30, No. 28, July 12, 2024
The processing of a redetermination or change shall result in
				  one of the following actions:
1. No
				change in eligibility, share-of-cost, or premium,
2. Discontinuance of eligibility if a
				condition of eligibility is no longer met,
3. A change in the person's
				share-of-cost,
4. A change in
				premium amount, or
5. A change in
				the coverage group under which a person receives AHCCCS medical
				coverage.
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 R9-28-1307 - Notice of Adverse Action

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				requirements under R9-28-411(D)(1) apply.
B. Advance notice of a change in eligibility,
				share of cost, or premium amount. Advance notice means a notice of proposed
				action that is issued to the member at least 10 days before the effective date
				of the proposed action. Except under subsection (C), advance notice shall be
				issued whenever an adverse action is taken to:
1. Discontinue eligibility,
2. Increase a person's
				share-of-cost,
3. Increase the
				premium amount, or
4. Reduce
				benefits from ALTCS to acute care services.
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 R9-28-1308 - Request for Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
An applicant or member may request a hearing under 9 A.A.C.
				  34.
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 R9-28-1309 - Conditions of Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
An applicant or member shall meet the following conditions to
				  qualify for the Freedom to Work program:
1. Furnish a valid Social Security Number
				(SSN);
2. Be a resident of
				Arizona;
3. Be a citizen of the
				United States, or meet requirements for a qualified alien under A.R.S. §
									36-2903.03(B);
4. Be at least 16 years of age, but less than
				65 years of age;
5. Have countable
				income that does not exceed 250 percent of FPL. The Administration shall count
				income under
				42 U.S.C.
				1382 a and 20 CFR 416 Subpart K with the
				following exceptions:
a. The unearned income
				of the applicant or member shall be disregarded,
b. The income of a spouse or other family
				members shall be disregarded, and
c. The deduction for a minor child shall not
				apply;
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 R9-28-1313 - Premium Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. As a
				condition of eligibility, an applicant or member shall:
1. Pay the premium required under subsection
				(B).
2. Not have any unpaid
				premiums that exceed the premium amount for one month.
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 R9-28-1316 - Institutionalized Person

Current through Register Vol. 30, No. 28, July 12, 2024
A person is not eligible for AHCCCS medical coverage if the
				  person is:
1. An inmate of a public
				institution and federal financial participation (FFP) is not available,
				or
2. Older than age 20 but younger
				than age 65 and is residing in an Institution for Mental Disease under
				42 CFR
				435.1009 except when allowed under the
				Administration's Section 1115 IMD waiver or allowed under a managed care
				contract approved by CMS.