36-2981. Definitions In this article, unless the context otherwise requires: 1. " Administration" means the Arizona health care cost containment system administration. 2. " Contractor" means a health plan that contracts with the administration for the provision of hospitalization and medical care to members according to the provisions of this article or a qualifying plan. […]
36-2982. Children’s health insurance program; administration; nonentitlement; enrollment; eligibility A. The children’s health insurance program is established for children who are eligible pursuant to section 36-2981, paragraph 6. The administration shall administer the program. All covered services shall be provided by health plans that have contracts with the administration pursuant to section 36-2906, by a […]
36-2983. Eligibility for the program A. The administration shall establish a streamlined eligibility process for applicants to the program and shall issue a certificate of eligibility at the time eligibility for the program is determined. Eligibility shall be based on gross household income for a member as defined in section 36-2981. The administration shall not […]
36-2985. Notice of program suspension; spending limit A. If the director determines that federal and state monies appropriated for the program are insufficient, the administration shall immediately notify the governor, the president of the senate and the speaker of the house of representatives and may stop processing all new applications. B. The total amount of […]
36-2986. Administration; powers and duties of director A. The director has full operational authority to adopt rules or to use the appropriate rules adopted for article 1 of this chapter to implement this article, including any of the following: 1. Contract administration and oversight of contractors. 2. Development of a complete system of accounts and […]
36-2987. Reimbursement for the program A. For inpatient hospital services, the administration shall reimburse the Indian health service or a tribal facility based on the reimbursement rates for the Indian health service as published annually in the federal register. For outpatient services, the administration shall reimburse the Indian health service or a tribal facility based […]
36-2988. Delivery of services; health plans; requirements A. To the extent possible, the administration shall use contractors that have a contract with the administration pursuant to article 1 of this chapter or qualifying plans to provide services to members who qualify for the program. B. The administration has full authority to amend existing contracts awarded […]
36-2989. Covered health and medical services; modifications; related delivery of service requirements A. Except as provided in this section, health and medical services prescribed in section 36-2907 are covered services and include: 1. Inpatient hospital services that are ordinarily furnished by a hospital for the care and treatment of inpatients, that are medically necessary and […]
36-2990. Quality of health care monitoring standard; development; adoption; use; additional monitoring; costs A. The administration shall develop standards of care that each contractor shall use to monitor the quality of health care received by members. B. The director shall periodically determine whether each contractor has properly adopted and implemented standards to ensure the quality […]
36-2991. Fraud; penalties; enforcement; violation; classification A. A person shall not provide or cause to be provided false or fraudulent information on an application for eligibility pursuant to this article. B. A person who violates subsection A of this section, who is determined eligible for services pursuant to this article and who would have been […]
36-2992. Duty to report fraud or abuse; immunity; unprofessional conduct A. All contractors and noncontracting providers shall advise the director or the director’s designee immediately in a written report of any cases of suspected fraud or abuse. The director shall review the report and conduct a preliminary investigation to determine if there is a sufficient […]
36-2993. Prohibited acts; penalties A. A person shall not present or cause to be presented to this state or to a contractor: 1. A claim for a medical service or any other item that the person knows or has reason to know was not provided as claimed. 2. A claim for a medical service or […]
36-2994. Monthly financial report A. The director shall include in the monthly report submitted to the president of the senate and the speaker of the house of representatives pursuant to section 36-2920 the following information about the program: 1. The actual year to date expenditures and projected annual expenditures. 2. The actual member months. 3. […]
36-2995. Children’s health insurance program fund; sources of monies; use; reversion; claims A. The children’s health insurance program fund is established. The administration shall administer the fund and shall use fund monies to pay administrative and program costs associated with the operation of the program established by this article. B. Separate accounting shall be made […]
36-2998. Qualifying plans A. A qualifying plan, as defined in section 36-2981, may elect to participate in the children’s health insurance program established pursuant to this article, subject to all requirements established in this article and in accordance with section 36-2989. B. The director of the Arizona health care cost containment system shall establish the […]
