reglab/statecodes huggingface dataset:
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1423 - Calculations and Use of Methods Listed in R9-22-1422 Based on Frequency of Income

Current through Register Vol. 30, No. 28, July 12, 2024
A. Monthly
				income. If otherwise countable income is received monthly or in a lump sum, the
				Administration or its designee shall use the unconverted method for calculating
				monthly income.
1. Lump sum means a
				nonrecurring payment that serves as a complete payment.
2. Lump sum payments include but are not
				limited to: rebates or credits; inheritances; insurance settlements; and
				payments for prior months from such sources as Social Security, Railroad
				Retirement, or other benefits.
3. A
				lump sum payment may include a portion intended for the current
				month.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1424 - Use of Methods Listed in R9-22-1423 Based on Type of Income

Current through Register Vol. 30, No. 28, July 12, 2024
A. New income.
1. Description. New income is income received
				from a new source during the first calendar month that the income is received
				from the source.
2. Calculating
				monthly income.
a. If a full month's income is
				received, the Administration or its designee shall use the appropriate method
				described in
				R9-22-1423
				to calculate the monthly income.
b.
				If less than a full month's income is received, the Administration or its
				designee shall use the unconverted method to calculate the monthly
				income.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1427 - Eligibility under Magi

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Caretaker Relatives. An individual is eligible for AHCCCS medical coverage as a
				Caretaker Relative when the individual meets the following requirements:
1. Is a caretaker relative as defined in
				R9-22-1401.
2. The total countable
				income under R9-1420(B) does not exceed 106 percent of the FPL for the number
				of people in the MAGI income group.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1428 - Postpartum Extended Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A. Eligibility for 12-months postpartum
				coverage. Individuals who applied and were determined eligible while pregnant,
				including prior quarter months under R9-22-303(A), remain eligible through the
				last day of the month in which a 12-month postpartum period, beginning on the
				last day of the pregnancy, ends.
B.
				Copayments during the Postpartum Extended Eligibility period. Individuals
				eligible under this section are subject to copayments after the end of the
				60-day postpartum period described in R9-22-1427.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1429 - Eligibility for a Newborn

Current through Register Vol. 30, No. 28, July 12, 2024
A child born to a mother eligible for and receiving medical
				  coverage under this Article, Article 15 of the Chapter, or 9 A.A.C. 28, is
				  automatically eligible for AHCCCS medical coverage for a period not to exceed
				  12 months . Automatic eligibility begins on the child's date of birth and ends
				  with the last day of the month in which the child turns age
				  one.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1432 - Young Adult Transitional Insurance

Current through Register Vol. 30, No. 28, July 12, 2024
1. Is 18 through 25 years of age;
2. Was in the custody of the Department of
				Economic Security under A.R.S. Title 8, Chapter 5 or Chapter 10 on the
				individual's 18th birthday;
3. Was
				eligible for and receiving AHCCCS Medical Coverage on the individual's 18th
				birthday; and
4. Is not eligible
				for AHCCCS Medical Coverage under
				42 U.S.C.
				1396 a(a)(10)(A)(i)(I) - (VII).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1435 - Eligibility for a Person with Medical Expenses Whose Income Is over 100 Percent Fpl

Current through Register Vol. 30, No. 28, July 12, 2024
An applicant who is not eligible for AHCCCS medical coverage
				  due to excess income may become AHCCCS eligible by deducting medical expenses
				  from the applicant's income. This coverage is called Medical Expense Deduction
				  (MED).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1436 - Med Family Unit

Current through Register Vol. 30, No. 28, July 12, 2024
A. For the purpose
				of this Section, a child is an unmarried person under age 18.
B. The Department shall consider each of the
				following to be a family when living together:
1. A parent and the parent's
				children;
2. A married couple
				without children;
3. A married
				couple and the children of either or both spouses;
4. Unmarried parents who live with at least
				one child in common, and the parents' other children, whether in common or not;
				and
5. A person without
				children.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1437 - Med Income Eligibility Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. Income exclusions. The exclusions in
				R9-22-1420(C) apply to the MED family unit.
B. Income standard.
1. The Department shall divide the annual FPL
				for the MED family unit that is in effect during each month of the income
				period by 12 to determine the monthly FPL.
2. The Department shall add the monthly FPLs
				for the income period and multiply the resulting amount by 40
				percent.
3. Changes to the annual
				FPL are implemented in April of each year.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1438 - Med Resource Eligibility Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. Including countable resources. The
				Department shall include the resources not excluded that belong to and are
				available to members of the family of a qualified alien under A.R.S. §
									36-2903.03
				and the sponsor and sponsor's spouse of a person who is a qualified
				alien.
B. Ownership and
				availability. The Department shall evaluate the ownership of resources to
				determine the availability of resources to a person listed in subsection (A).
1. Jointly owned resources with ownership
				records containing the words "and" or "and/or" between the owners' names are
				available to each owner except if one of the owners refuses to sell. A consent
				to sale is not required if all owners are members of the MED family
				unit.
2. Jointly owned resources
				with ownership records containing the word "or" between the owners' names are
				presumed to be available in full to each owner. The applicant or member may
				rebut the presumption by providing clear and convincing evidence of intent to
				establish a different type of ownership. If the presumption is rebutted, the
				resource is available to the owners:
a.
				Consistent with the intent of the owners, or
b. Based on each owner's proportionate net
				contribution if there is not clear and convincing evidence of a different
				allocation.
3. The
				Department shall establish availability of a trust under
				42 U.S.C.
				1396 p(d)(4)(A) or (C).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1439 - Med Effective Date of Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A. A MED family unit is eligible on the day
				the income and resource eligibility requirements are met but no earlier than
				the first day of the month of application. If the family unit meets the income
				requirements in the application month but does not meet the resource limit
				until the following month, the family unit's effective date of eligibility is
				the first day of the month following the month of application.
B. The Department shall adjust the effective
				date of eligibility under subsection (A) to an earlier date if:
1. A member presents verification of
				additional allowable medical expenses incurred on an earlier date during the
				medical expense deduction period that allow the member to meet the income
				requirements, and
2. The member
				presents the verification within 60 days of approval of eligibility under this
				Section.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1440 - Med Eligibility Period

Current through Register Vol. 30, No. 28, July 12, 2024
The Department shall approve eligibility for six months.
				  Changes in circumstances do not affect eligibility for the first three months.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1441 - Eligibility Appeals

Current through Register Vol. 30, No. 28, July 12, 2024
A. Adverse
				actions. An applicant or member may appeal by requesting a hearing from the
				Department concerning any of the following adverse actions:
1. Complete or partial denial of eligibility
				under
				R9-22-1413;
2. Suspension, termination, or reduction of
				AHCCCS medical coverage under R9-22-1415;
3. Delay in the eligibility determination
				beyond the time-frames under this Article;
4. The imposition of or increase in a premium
				or copayment; or
5. The effective
				date of eligibility.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 14 - AHCCCS MEDICAL COVERAGE FOR HOUSEHOLDS › Section R9-22-1442 - Cessation of Med Coverage

Current through Register Vol. 30, No. 28, July 12, 2024
The Department shall not approve any individual or family who
				  has applied on or after May 1, 2011 as eligible for MED coverage. With respect
				  to any applications that are pending as of May 1, 2011, the Department shall
				  not approve any individual or family as eligible for MED coverage who has not
				  met all eligibility requirements prior to May 1, 2011.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 15 - AHCCCS MEDICAL COVERAGE FOR PEOPLE WHO ARE AGED, BLIND, OR DISABLED › Section R9-22-1501 - General Information

Current through Register Vol. 30, No. 28, July 12, 2024
A. General.
				The Administration shall determine eligibility for AHCCCS medical coverage for
				the following applicants or members using the eligibility criteria and
				requirements in this Article and Article 3:
1. A person who is aged, blind, or disabled
				and does not receive SSI cash; and
2. A person terminated from the SSI cash
				program under
				R9-22-1505.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 15 - AHCCCS MEDICAL COVERAGE FOR PEOPLE WHO ARE AGED, BLIND, OR DISABLED › Section R9-22-1503 - Financial Eligibility Criteria

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				General income eligibility. Except as provided under subsection (B) of this
				rule, the Administration or its designee shall count the identified income
				under
				42 U.S.C.
				1382 a and 20 CFR 416 Subpart K .
B. Exceptions.
1. In-kind support and maintenance under
				42 U.S.C.
				1382 a(a)(2)(A) is excluded.
2. For a person living with a spouse, the
				Administration or its designee calculates net income for an eligible couple
				under
				20 CFR
				416.1160 as of April 1, 2013, which is
				incorporated by reference and on file with the Administration, and available
				from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
				Street, NW, Washington, DC, 20401. This incorporation by reference contains no
				future editions or amendments, even if the spouse is not eligible for or
				applying for SSI or coverage under this Article.
3. In determining the net income of a married
				couple living with a child or the net income of a person who is not living with
				a spouse but living with a child, a child allocation is allowed as a deduction
				from the combined net income of the couple for each child regardless of whether
				the child is ineligible or eligible. For the purposes of this Section, a child
				means a person who is unmarried, natural or adopted, and under age 18 or under
				age 22 if a full-time student. Each child's allocation deduction is reduced by
				that child's income, including public income maintenance payments, using the
				methodology under
				20 CFR
				416.1163(b)(1) and (2) as of
				April 1, 2013, which is incorporated by reference and on file with the
				Administration, and available from the U.S. Government Printing Office, Mail
				Stop: IDCC, 732 N. Capitol Street, NW, Washington, DC, 20401. This
				incorporation by reference contains no future editions or amendments.
4. In determining the income deemed available
				to an applicant who is a child from an ineligible parent or parents, an
				allocation for each eligible or ineligible child of the parent is allowed as a
				deduction from the parent's income under
				20 CFR
				416.1165(b). The child's
				allocation is reduced by that child's income, including public income
				maintenance payments.
5. In
				determining the income of a person who receives an annual Title II Cost of
				Living Allowance (COLA) increase, the COLA amount is disregarded from January
				until the Administration applies the effective income limits under
				R9-22-1504
				based on the FPL for the calendar year.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 15 - AHCCCS MEDICAL COVERAGE FOR PEOPLE WHO ARE AGED, BLIND, OR DISABLED › Section R9-22-1504 - Eligibility for a Person Who Is Aged, Blind, or Disabled

Current through Register Vol. 30, No. 28, July 12, 2024
A. To be eligible for AHCCCS medical
				coverage, an applicant shall meet the conditions of eligibility and
				requirements in this Article and:
1. Meet one
				of the income tests described in subsection (B) or (C), or
2. The special requirements in
				R9-22-1505.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 15 - AHCCCS MEDICAL COVERAGE FOR PEOPLE WHO ARE AGED, BLIND, OR DISABLED › Section R9-22-1505 - Eligibility for Special Groups

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				The following are considered special groups:
1. A person meeting the requirements in
				A.R.S. §
										36-2903.03
				who:
a. Is aged, blind, or disabled under
				42 CFR
				435.520,
				42 CFR
				435.530, or
				42 CFR
				435.540 as of October 1, 2012, which are
				incorporated by reference and on file with the Administration, and available
				from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
				Street, NW, Washington, DC, 20401. This incorporation by reference contains no
				future editions or amendments.
b.
				Received SSI cash or AHCCCS medical coverage under this subsection, or
				subsections (A)(2), (A)(3), or (A)(4) on or before August 21, 1996;
c. Was residing in the United States under
				color of law on or before August 21, 1996; and
d. Meets the requirements under this
				Article;
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 16 - HOSPITAL PRESUMPTIVE ELIGIBILITY › Section R9-22-1601 - General Eligibility Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. Notwithstanding Article 3, a qualified
				hospital may determine Hospital Presumptive Eligibility (HPE), on the basis of
				pre-liminary information, that an individual is eligible for AHCCCS medical
				coverage during the presumptive eligibility period described in this section,
				if the individual is a United States citizen or eligible qualified alien, and
				the individual is:
1. Pregnant with gross
				household income that does not exceed 156% of the FPL;
2. An adult who meets the requirements of
				R9-22-1427(E);
3. A caretaker
				relative as defined in
				R9-22-1401(B)
				with gross household income that does not exceed 106% of the FPL;
4. Under age 19 with gross household income
				that does not exceed the limit set in R9-22-1427(D) for the child's
				age;
5. A woman screened for breast
				or cervical cancer by an Arizona program of the National Breast and Cervical
				Cancer Early Detection Program who meets the requirements of
				R9-22-2003(A);
				or
6. A former foster care child
				who meets the requirements of
				R9-22-1432.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 17 - ENROLLMENT › Section R9-22-1701 - Enrollment-related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
In addition to definitions contained in A.R.S. §
									36-2901,
				  the words and phrases in this Chapter have the following meanings unless the
				  context explicitly requires another meaning:
"Annual enrollment choice" means the annual opportunity for a
				  person to change contractors.
"Auto-assignment algorithm" or "Algorithm" means a formula
				  used by the Administration to assign to a contractor a member who did not make
				  a timely choice under
				  R9-22-1702.
"CMDP" means Comprehensive Medical and Dental Program.
"Disenrollment" means the discontinuance of a person's
				  entitlement to receive covered services from a contractor of record.
"Enrollment" means the process by which an eligible person
				  becomes a member of a contractor's plan.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 17 - ENROLLMENT › Section R9-22-1702 - Enrollment of a Member with an AHCCCS Contractor

Current through Register Vol. 30, No. 28, July 12, 2024
A. General enrollment requirements. The
				Administration shall enroll a member with a contractor as described in this
				Section, unless the member has pre-selected a contractor on the application:
1. Except as provided in subsections (A)(3),
				(A)(5), and (C), a member who is determined to be eligible under this Chapter
				and resides in an area served by more than one contractor, may choose an
				available contractor serving the member's GSA within 30 days from the date of
				notice of enrollment. A Native American member may select IHS or another
				available contractor.
2. If the
				member does not make a choice under subsection (A)(1), the Administration shall
				immediately auto-assign the member to:
a. IHS
				if the member is a Native American living on a reservation,
b. A contractor based on family continuity,
				or
c. A contractor by using the
				auto-assignment algorithm.
3. If the member's period of ineligibility
				and disenrollment from the contractor of record is for a period of less than 90
				days, the Administration shall enroll the member with the member's most recent
				contractor of record, if available, except if:
a. The member no longer resides in the
				contractor's GSA;
b. The
				contractor's contract is suspended or terminated;
c. The member was previously enrolled with
				CMDP but at the time of re-enrollment the member is not a foster care
				child;
d. The member chooses
				another contractor or chooses IHS, if available to the member, during the
				annual enrollment choice period; or
e. The member was previously enrolled with a
				contractor but at the time of re-enrollment the member is a foster care
				child.
4. When the
				member's disenrollment period is more than 90 days, the member may select a
				contractor as described in subsection (A)(1).
5. The Administration shall not enroll a
				member with a contractor if a member:
a. Is
				eligible for the FESP under R9-22-1419;
b. Is eligible for less than 30 days from the
				date the Administration receives notification of a member's eligibility, except
				for a member who is enrolled with CMDP or IHS;
c. Is eligible only for a retroactive period
				of eligibility, except for a member who is enrolled with CMDP or IHS;
				or
d. Resides in an area not served
				by a contractor.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 17 - ENROLLMENT › Section R9-22-1703 - Effective Date of Enrollment with a Contractor

Current through Register Vol. 30, No. 28, July 12, 2024
A. Effective date of enrollment. A member's
				date of enrollment is the date enrollment action is taken by the
				Administration. However, if a plan change occurs for an annual enrollment
				choice, the effective date is the month of the member's enrollment anniversary
				date.
B. Financial liability of the
				contractor. The contractor shall be financially liable for an enrolled member's
				care as specified in contract.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 17 - ENROLLMENT › Section R9-22-1704 - Newborn Enrollment

Current through Register Vol. 30, No. 28, July 12, 2024
A. General.
1. The Administration shall enroll a newborn
				child of an eligible mother with an available contractor or IHS, based on the
				mother's enrollment.
2. The
				Administration shall auto-assign a newborn child of an eligible mother who is
				not enrolled with a contractor or IHS or who is enrolled with CMDP. When a
				mother enrolled in CMDP has a newborn and the newborn is surrendered to
				Administration on Children, Youth and Families (ACYF), the newborn is then
				enrolled with CMDP.
3. The
				Administration shall notify the mother of the right to choose a different
				contractor for her newborn child. The mother may make her choice within 30 days
				from the date of notice of enrollment.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 17 - ENROLLMENT › Section R9-22-1705 - Guaranteed Enrollment Period

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				General. Except for members enrolled with IHS or CMDP, the Administration shall
				provide a guaranteed enrollment period for a one-time period that begins on the
				effective date of the member's initial enrollment with a contractor and ends on
				the last day of the fifth full calendar month after the date of the member's
				initial enrollment.
B. Exceptions
				to guaranteed period. The Administration shall not grant a guaranteed
				enrollment period or shall terminate a guaranteed enrollment period as provided
				in subsection (C), if the member:
1. Did not
				meet the conditions of eligibility when initially enrolled with the
				contractor;
2. Except as provided
				in 9 A.A.C. 22, Article 12, is an inmate of a public institution as defined in
				42 CFR
				435.1010;
3. Dies;
4. Moves out-of-state;
5. Voluntarily withdraws from the AHCCCS
				program;
6. Is adopted;
				or
7. Has whereabouts that are
				unknown.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 18 - PROVIDER EXCLUSION RULES › Section R9-22-1801 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
"Administration" has the meaning defined in A.R.S. §
									36-2901.
"Affiliation" has the meaning defined in
				  42 C.F.R. §
										424.502.
"Managing employee" has the meaning defined in
				  42 C.F.R. §
										455.101.
"Member" has the meaning defined in A.R.S. §
									36-2901.
"Person with an ownership or control interest" has the
				  meaning defined in 42 C.F.R.
				  §
										455.101 and
				  42 C.F.R. §
										455.102.
"System" has the meaning defined in A.R.S. §
									36-2901.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 18 - PROVIDER EXCLUSION RULES › Section R9-22-1802 - Basis for Exclusion

Current through Register Vol. 30, No. 28, July 12, 2024
A. In
				addition to such grounds for exclusion set for in Subsections A and B of A.R.S.
				§
									36-2930.05, the Administration, in
				its sole discretion, may exclude:
1. Any
				individual or entity which has failed to comply with any requirement, term, or
				condition set forth in any agreement with the Administration;
2. Any individual or entity which has failed
				to remit any indebtedness or overpayment as required by A.A.C.
				R9-22-713;
3. Any entity which has a managing employee
				or any entity with a person with an ownership or control interest that:
a. Has failed to remit any indebtedness or
				overpayment as required by A.A.C.
				R9-22-713;
b. Has an affiliation with an organization
				which has failed to remit any indebtedness or overpayment as required by A.A.C.
				R9-22-713;
4. Any individual or any entity with a
				managing employee or a person with an ownership or control interest that has
				been convicted of a criminal offense which the Administration, in its sole
				discretion, determines may represent an undue risk of fraud, waste, or abuse of
				the system or an undue risk of harm to members;
5. Any individual or entity who employs any
				person to furnish items or services who has been excluded from participation in
				the system pursuant to A.R.S. §
										36-2930.05;
6. Any individual who is or was a managing
				employee or a person with an ownership or control interest who participated in,
				condoned, or was willfully ignorant of any action or failure to act of an
				entity which was or could have been the basis for exclusion of the
				entity;
7. Any individual who was
				an organizer, leader, manager, or supervisor of any entity activity which was
				or could have been the basis for exclusion of the entity; or
8. Any individual or entity in order to
				protect the health of members.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 18 - PROVIDER EXCLUSION RULES › Section R9-22-1803 - Period of Exclusion

Current through Register Vol. 30, No. 28, July 12, 2024
A. Pursuant
				to A.R.S. § 36-2930.05 and
				42 C.F.R. §
										1002.210, any exclusion from participation in
				the system shall be for such period as determined in the discretion of the
				Administration, but in no event shall such period be less than five
				years.
B. In determining the period
				of exclusion, the Administration, in its sole discretion, may consider
				aggravating and mitigating factors set forth in any provision of Code of
				Federal Regulations Chapter 42 part 1001, Subpart C or part 1003.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 18 - PROVIDER EXCLUSION RULES › Section R9-22-1804 - Appeal of Exclusion

Current through Register Vol. 30, No. 28, July 12, 2024
A. Any
				exclusion of an individual or entity pursuant to A.R.S. §
									36-2930.05 is an appealable agency
				action subject to the Uniform Administrative Appeals Procedures, A.R.S. §
									41-1092, et seq.
B. The Administration shall set forth in the
				notice of an appealable agency action required by A.R.S. §
									41-1092.03 the period of exclusion
				and the earliest date on which AHCCCS will consider a request for
				reinstatement.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 18 - PROVIDER EXCLUSION RULES › Section R9-22-1805 - Reinstatement of Participation

Current through Register Vol. 30, No. 28, July 12, 2024
A. If the period of exclusion has expired, an
				individual or entity may apply for reinstatement of participation in the system
				by submission of the following:
1. An
				application for participation as a provider.
2. Information to demonstrate reasonable
				assurances that the type of actions that formed the basis for the original
				exclusion have not recurred and will not recur.
3. Such other information as may be requested
				by the Administration.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 18 - PROVIDER EXCLUSION RULES › Section R9-22-1806 - Denial of Reinstatement

Current through Register Vol. 30, No. 28, July 12, 2024
A. If
				an application for reinstatement is denied, the Administration shall give
				written notice to the requesting individual or entity.
B. Within 30 days of the date on the notice
				of denial of reinstatement, the excluded individual or entity may submit
				documentary evidence and written argument against the continued
				exclusion.
C. After evaluating any
				additional evidence submitted by the excluded individual or entity (or at the
				end of the 30-day period if none is submitted), the Administration will send
				written notice either confirming the denial and indicating that a subsequent
				request for reinstatement will not be considered until at least one year after
				the date of the denial or approving the request for reinstatement of
				participation.
D. Any notice
				confirming a denial of reinstatement is an appealable agency action subject to
				the Uniform Administrative Appeals Procedures, A.R.S. §
									41-1092, et seq.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1901 - General Freedom to Work Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
Under
				  42 U.S.C.
				  1396 a(a)(10)(A)(ii)(XV) and (XVI), the
				  Administration shall determine eligibility for AHCCCS medical services, under
				  Article 2 of this Chapter, using the eligibility criteria and requirements
				  under this Article for an applicant or member who is:
1. At least 16 years of age, but less than 65
				years of age,
2. Employed,
				and
3. Not income eligible under
				A.R.S. §
									36-2901(6)(a).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1902 - General Administration Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall comply with the confidentiality rule
				  under
				  R9-22-512(C).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1903 - 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 or outstation location
				approved by the Director as described under R9-22-1406(A).
C. The provisions in R9-22-1406(B) and (D)
				apply to this Section.
D. The
				applicant or representative who files the application may withdraw the
				application for coverage either orally or in writing. An applicant withdrawing
				an application shall receive a denial notice under
				R9-22-1904.
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 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1904 - 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, the notice shall contain:
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.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1905 - 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
				  R9-22-1501(H),
				  to the Administration.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1906 - 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 or premium,
2. Discontinuance of eligibility if a
				condition of eligibility is no longer met,
3. A change in premium amount, or
4. A change in the coverage group under which
				a person receives AHCCCS medical coverage.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1907 - Notice of Adverse Action Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. The requirements under R9-22-1501(K)(1)
				apply.
B. Advance notice of a
				change in eligibility 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 discontinue
				eligibility, or increase the premium amount.
C. Exceptions from advance notice. A notice
				shall be issued to the member to discontinue eligibility no later than the
				effective date of action if:
1. A member
				provides a clearly written statement, signed by that member, that services are
				no longer wanted.
2. A member
				provides information that requires termination of eligibility or reduction of
				services, indicates that the member understands that this must be the result of
				supplying that information, and the member signs a written statement waiving
				advance notice;
3. A member cannot
				be located and mail sent to the member's last known address has been returned
				as undeliverable subject to reinstatement of discontinued services under
				42 CFR
				431.231(d);
4. A member has been admitted to a public
				institution where a person is ineligible for coverage;
5. A member has been approved for Medicaid in
				another state; or
6. The
				Administration receives information confirming the death of a member.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1908 - 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 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1909 - 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
				the 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
				member shall be disregarded, and
c.
				The deduction for a minor child shall not apply;
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1910 - Prior Quarter Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A person may be made eligible during a prior quarter period
				  when applying for the Freedom to Work program, as described under Article
				  3.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1913 - 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 for more than one month's premium amount.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1915 - 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 if federal financial participation (FFP) is not available,
				or
2. Age 21 through age 64 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.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1918 - Additional Eligibility Criteria for the Basic Coverage Group

Current through Register Vol. 30, No. 28, July 12, 2024
An applicant or member shall meet the following eligibility
				  criteria:
1. Disabled. As a condition
				of eligibility, an applicant or member shall be disabled. Disabled means a
				person who has been determined disabled by the Department of Economic Security,
				Disability Determination Services Administration, under
				42 U.S.C.
				1382 c(a)(3)(A) through (E), except
				employment activity, earnings, and substantial gainful activity shall not be
				considered in determining whether the individual meets the definition of
				disability.
2. Employed. As a
				condition of eligibility, an applicant or member shall be employed. Employed
				means that an applicant or member is paid for working and Social Security or
				Medicare taxes are paid on the applicant or member's work.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1919 - Additional Eligibility Criteria for the Medically Improved Group

Current through Register Vol. 30, No. 28, July 12, 2024
As a condition of eligibility for the Medically Improved
				  Group, a member shall:
1. Be employed.
				Under this Section, employed means an individual who:
a. Earns at least the minimum wage and works
				at least 40 hours per month, or
b.
				Has gross monthly earnings at least equal to those earned by an individual who
				is earning the minimum wage working 40 hours per month.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1921 - Enrollment

Current through Register Vol. 30, No. 28, July 12, 2024
The Administration shall enroll members under Article 17 of
				  this Chapter. If a member has not paid a required premium, the Administration
				  shall not grant a guaranteed enrollment period.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 19 - FREEDOM TO WORK › Section R9-22-1922 - Redetermination of Eligibility

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Redetermination. Except as provided in subsection (B), the Administration shall
				complete a redetermination of eligibility at least once a year.
B. Change in circumstance. The Administration
				may complete a redetermination of eligibility if there is a change in the
				member's circumstances, including a change in disability or employment that may
				affect eligibility.
C. Medical
				Improvement. If a member is no longer disabled under R9-22-1918, the
				Administration shall determine if the member is eligible under other coverage
				groups including the medically improved group.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 20 - BREAST AND CERVICAL CANCER TREATMENT PROGRAM › Section R9-22-2001 - Breast and Cervical Cancer Treatment Program Related Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
In addition to definitions contained in A.R.S. §
									36-2901,
				  the words and phrases in this Chapter have the following meaning unless the
				  context explicitly requires another meaning:
"AZ-NBCCEDP" means the Arizona programs of the National
				  Breast and Cervical Cancer Early Detection Program. AZ-NBCCEDP provides breast
				  and cervical cancer screening and diagnosis in Arizona.
"Cryotherapy" means the destruction of abnormal tissue using
				  an extremely cold temperature.
"LEEP" means the loop electrosurgical excision procedure that
				  passes an electric current through a thin wire loop.
"Peer-reviewed study" means that, prior to publication, a
				  medical study has been subjected to the review of medical experts who:
Have expertise in the subject matter of the study,
Evaluate the science and methodology of the study,
Are selected by the editorial staff of the publication,
				  and
Review the study without knowledge of the identity or
				  qualifications of the author.
"WWHP" means the Well Women Healthcheck Program administered
				  by the Arizona Department of Health Services. The WWHP is one of the programs
				  within AZ-NBCCEDP that provides breast and cervical cancer screening and
				  diagnosis.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 20 - BREAST AND CERVICAL CANCER TREATMENT PROGRAM › Section R9-22-2002 - General Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Confidentiality. The Administration shall maintain the confidentiality of a
				woman's records and shall not disclose a woman's financial, medical, or other
				confidential information except as allowed under R9-22-512.
B. Covered services. A woman who is eligible
				under this Article receives all medically necessary services under Articles 2
				and 12 of this Chapter.
C. Choice
				of health plan. A woman who is eligible under this Article shall be enrolled
				with a contractor under Article 17 of this Chapter.
D. A Native American woman who receives
				services through Indian Health Service (IHS) or through a tribal health program
				qualifies for services provided under this Article if all eligibility
				requirements are met.
E. A woman
				qualified under this Article shall pay co-pays as described in R9-22-711.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 20 - BREAST AND CERVICAL CANCER TREATMENT PROGRAM › Section R9-22-2003 - Eligibility Criteria

Current through Register Vol. 30, No. 28, July 12, 2024
A. General. To
				be eligible under this Article, a woman shall meet the requirements of this
				Article and:
1. Be screened for breast and
				cervical cancer through AZ-NBCCEDP;
2. Be less than 65 years of age;
3. Be ineligible for Title XIX under Articles
				14 and 15 in this Chapter;
4.
				Receive a positive screen under subsection (A)(1), a confirmed diagnosis
				through AZ-NBCCEDP, and need treatment for breast cancer or cervical cancer,
				including a pre-cancerous cervical lesion, as specified in
				R9-22-2004;
5. Not be covered under
				creditable coverage as specified in Section 2701(c) of the Public Health
				Services Act,
				42 U.S.C.
				300 gg(c). For purposes of this Article, IHS
				or Tribal health coverage is not considered creditable coverage as specified in
				42 U.S.C.
				1396 a(a)(10)(A)(ii), as amended by the
				Native American Breast and Cervical Cancer Treatment Technical Amendment Act of
				2002; and
6. Meet the requirements
				under R9-22-1417 and R9-22-1418.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION › Article 20 - BREAST AND CERVICAL CANCER TREATMENT PROGRAM › Section R9-22-2004 - Treatment

Current through Register Vol. 30, No. 28, July 12, 2024
A. Breast cancer.
				Coverage for treatment for breast cancer under this Article shall conclude on
				the last provider visit for the specific treatment of the cancer or at the end
				of hormonal therapy for the cancer, whichever is later. For purposes of this
				subsection treatment means:
1. Lumpectomy or
				surgical removal of breast cancer;
2. Chemotherapy;
3. Radiation therapy; and
4. A treatment for breast cancer that, as
				determined by the AHCCCS Chief Medical Officer, is considered the standard of
				care as supported by a peer-reviewed study published in a medical
				journal.