Arizona Laws 36-2974. Dual eligibles; qualifications for coverage; enrollment
A. For purposes of this section all contractors and program contractors are required to provide services to members.
Terms Used In Arizona Laws 36-2974
- Administration: means the Arizona health care cost containment system administration. See Arizona Laws 36-2971
- Contractor: means a person or entity that has a prepaid capitated contract with the administration pursuant to section 36-2904 to provide health care to members under this article either directly or through subcontracts with providers. See Arizona Laws 36-2971
- Department: means the department of economic security. See Arizona Laws 36-2971
- Director: means the director of the Arizona health care cost containment system administration. See Arizona Laws 36-2971
- Member: means an eligible person who enrolls in the system and who is defined as a qualified medicare beneficiary pursuant to section 1905(p) of title XIX of the social security act and whose income does not exceed one hundred per cent of the federal poverty guidelines. See Arizona Laws 36-2971
- Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
- Primary care physician: means a physician who is a family practitioner, general practitioner, pediatrician, general internist, or obstetrician or gynecologist. See Arizona Laws 36-2971
- Primary care practitioner: means a nurse practitioner certified pursuant to Title 32, Chapter 15 or a physician assistant certified pursuant to Title 32, Chapter 25. See Arizona Laws 36-2971
- Program contractor: means the department or any other entity that contracts with the administration pursuant to section 36-2940 or 36-2944. See Arizona Laws 36-2971
B. For a member who is dually eligible the director may implement a policy permitting a choice of contractors or program contractors to the extent the director deems feasible consistent with the section 1115 waiver and federal law. If the director does not implement a choice of contractor policy, the director may enroll the member, at the time eligibility is determined, with an available contractor or program contractor located in the geographic area of the member’s residence.
C. The department shall assist the administration in the screening of all persons who are applying to become eligible pursuant to section 36-2901, paragraph 6, subdivision (a) and who are entitled to services under title XVIII but not title XVI of the social security act to determine if the person meets the eligibility criteria of this section. If a person is determined to be eligible pursuant to section 36-2901, paragraph 6, subdivision (a) and this article, the administration shall make the person dually eligible. On determination of dual eligibility the administration shall enroll the person pursuant to this article and notify the person of the dual eligibility.
D. The administration shall screen all persons who are entitled to services under title XVIII of the social security act and who are applying to become eligible pursuant to section 36-2901, paragraph 6, subdivision (a), as prescribed by title XVI of the social security act or section 36-2931, paragraph 5, to determine if the person meets the eligibility criteria of this section. If a person is determined to be eligible pursuant to section 36-2901, paragraph 6, subdivision (a) or section 36-2931, paragraph 5 and this article, the administration shall make the person dually eligible. On determination of dual eligibility by the administration, the administration shall enroll the person pursuant to this article and notify the person of the dual eligibility.
E. Calculation of income and resource eligibility requirements by the department and the administration pursuant to this section shall be in accordance with title XIX of the social security act, as amended.
F. Program contractors and contractors shall pay medicare deductibles, coinsurance and copayment amounts for services provided to dual eligibles pursuant to this article and as required by the administration for services that are provided by or under referral from a primary care physician or primary care practitioner.