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.

Terms Used In Arizona Laws 36-2947

  • Administration: means the Arizona health care cost containment system administration. See Arizona Laws 36-2931
  • Department: means the department of economic security. See Arizona Laws 36-2931
  • Director: means the director of the Arizona health care cost containment system administration. See Arizona Laws 36-2931
  • Member: means an eligible person who is enrolled in the system. See Arizona Laws 36-2931
  • Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
  • Program contractor: means the department or any other entity that contracts with the administration pursuant to section 36-2940 or 36-2944 to provide services to members pursuant to this article. See Arizona Laws 36-2931
  • Provider: means a person who subcontracts with a program contractor for the delivery of services to members pursuant to this article. See Arizona Laws 36-2931
  • System: means the Arizona long-term care system. See Arizona Laws 36-2931

B. If a member is no longer eligible for the system, the program contractor and the department shall notify the administration in accordance with rules adopted pursuant to section 36-2932, subsection G. If that member may be eligible for services under article 1 of this chapter, the program contractor shall refer the person to the administration and arrange for the transfer of records to the appropriate provider as defined in section 36-2901 on notice by the administration.

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