Ariz. Admin. Code § 21-1-203

Current through Register Vol. 30, No. 25, June 21, 2024

Section R21-1-203 - Exceptions, Limitations, and Exclusions

A. DCS CHP shall not pay for:

1. Non-medically necessary health services.

2. Any health service that is not eligible for reimbursement by AHCCCS in 9 A.A.C. Chapter 22, Article 2, including cosmetic procedures, experimental treatment, and personal care items.

3. The cost of care and services payable through any federal, state, county, or municipal program to which a DCS CHP Member may be entitled, except for the cost of care and services in excess of any such program.

4. The cost of care and services payable through an insurance carrier that provides coverage for the DCS CHP Member under A.R.S. § 8-512, except for the cost of care and services in excess of any such insurance benefits.

5. Any admission, service, item, or otherwise uncovered service identified in A.R.S. Title 36, Chapter 29, Article 1, or the approved Medicaid State Plan.

B. A health provider shall not submit a bill to or seek payment from the following for any covered services:

1. DCS CHP Member; or

2. DCS CHP Member's:

a. Guardian,

b. Custodian,

c. Estate,

d. Foster parent, or

e. Birth parent.

Ariz. Admin. Code § R21-1-203

Adopted by exempt rulemaking at 21 A.A.R. 2554, effective 11/30/2015. Amended by final rulemaking at 27 A.A.R. 2518, effective 10/5/2021.