36-2931. Definitions In this article, unless the context otherwise requires: 1. " Administration" means the Arizona health care cost containment system administration. 2. " Capitation rate" means a mode of payment which the program contractor receives for the delivery of services to members pursuant to this article and which is based on a fixed rate […]
36-2932. Arizona long-term care system; powers and duties of the director; expenditure limitation A. The Arizona long-term care system is established. The system includes the management and delivery of hospitalization, medical care, institutional services and home and community based services to members through the administration, the program contractors and providers pursuant to this article together […]
36-2933. Eligibility determination; application; enrollment A. A person who is seeking services pursuant to this article shall submit an application for eligibility for the system to the administration which shall review the completed application to determine if the person meets the residency and if applicable, the alienage requirements adopted pursuant to section 36-2932, subsection K […]
36-2934. Eligibility criteria; qualifications for coverage; liquidation of assets A. A person meets the eligibility criteria of this article and the section 1115 waiver if the person satisfies one of the following: 1. Is eligible pursuant to section 36-2901, paragraph 6, subdivision (a), item (i) or (ii) on the date of application for medical assistance […]
36-2934.01. Creation of trusts; eligibility for the system; share of cost A. The administration has sole authority to qualify any trusts that are created pursuant to section 1917(d)(4)(A), (B) and (C) of the social security act and shall require that the trustee provide the following information and assurances when the trustee submits trust documents to […]
36-2934.02. Financial instruments; eligibility for the system A. The administration has sole authority to determine the effect of annuities, promissory notes, loan agreements and related financial instruments on a person’s eligibility pursuant to this article. B. An irrevocable annuity purchased with an applicant’s assets is treated as a transfer with uncompensated value pursuant to section […]
36-2935. Estate recovery program; liens A. The director shall adopt rules in accordance with state and federal law to allow the administration to file a claim against a member’s estate to recover paid assistance. The administration is also entitled to a lien on a member’s property to recover paid assistance the member receives. B. A […]
36-2936. Preadmission screening programs; functional tests; screening review A. The director shall adopt rules establishing a uniform statewide preadmission screening program to determine if a person who has met the eligibility criteria prescribed in section 36-2934 is eligible for institutional services pursuant to this article. To be eligible for institutional services or home and community […]
36-2937. Effective date of program contractor’s responsibility A. If a person is eligible for services under article 1 of this chapter, the provider with whom the member is enrolled under article 1 of this chapter is responsible for providing services covered under article 1 of this chapter until the date of eligibility for the system […]
36-2938. Case management; definition A. The director shall adopt rules establishing a uniform statewide case management program to ensure the most appropriate placement and cost effective delivery of services to members by the program contractors pursuant to this article. The case management program shall include the development by the program contractor of a long-term care […]
36-2939. Long-term care system services; definition A. The following services shall be provided by the program contractors to members who are determined to need institutional services pursuant to this article: 1. Nursing facility services other than services in an institution for tuberculosis or mental disease. 2. Notwithstanding any other law, behavioral health services if these […]
36-2940. Program contractors; annual plan A. The administration shall contract with the program contractors pursuant to this section or section 36-2944 using a contract as prescribed by the director. The department shall be a program contractor and provide services pursuant to this article either directly or through subcontracts with providers or through noncontracting providers to […]
36-2941. Establishment of capitation rates A. The administration shall establish capitation rates based on an actuarial study for the department. The capitation rate shall be based on the estimated cost of providing services pursuant to this article to members who have been determined eligible pursuant to section 36-2933. B. At least thirty days before finalizing […]
36-2942. Payments to the department For program contractors pursuant to section 36-2940: 1. The administration shall make at least monthly capitation payments to the department consisting of a portion of the capitation rate provided by the federal government. Prior to making the capitation payment, the administration may retain a specific percentage of the federal portion […]
36-2943. Provider subcontracts; hospital reimbursement A. Subcontracts for services rendered by providers pursuant to section 36-2940 shall be awarded through competitive statewide proposals in as nearly the same manner as that provided in section 41-2534. If there is not a sufficient number of qualified proposals, a subcontract may be negotiated with a provider and shall […]
36-2944. Qualified plan health service contracts; proposals; administration; contract terms A. For each county that has a population of four hundred thousand persons or less according to the most recent United States decennial census and that was not approved as a program contractor before January 1, 1994 or that officially states that it wishes to […]
36-2944.01. Removal of medicaid special exemption for payments to program contractors; civil penalty A. Notwithstanding any other law, beginning on October 1, 2003, each program contractor shall pay to the director of the department of insurance and financial institutions a tax equal to two percent of the total capitation, including reinsurance, and any other reimbursement […]
36-2945. Provision of services without contract; requirements A. If there is an insufficient number of qualified bids in a county pursuant to section 36-2944, or for those members not enrolled with program contractors, the director on the approval of the legal advisor of the administration may: 1. Execute discount advance payment contracts for institutional and […]
36-2946. Coordination of benefits; third party payments A. The administration shall coordinate benefits provided under this article to a member so that any costs for services payable by the system are costs avoided or recovered from any available third party payor. The administration may require that the program contractors are responsible for the coordination of […]
36-2947. Program contractors; additional responsibilities A. Program contractors shall establish and submit to the director for the director’s approval utilization control systems comprised of prior authorization, concurrent review and retrospective review of services. B. If a member is no longer eligible for the system, the program contractor and the department shall notify the administration in […]
