Ariz. Admin. Code § 9-11-305

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-11-305 - Outpatient Treatment Center Rates and Charges Schedule

A. Before an outpatient treatment center provides services to patients, an outpatient treatment center administrator or designee shall submit to the Department a rates and charges package that contains:

1. A cover letter that includes:

a. The name, physical address, mailing address, county, and telephone number of the outpatient treatment center;

b. The identification number assigned to the outpatient treatment center:

i. By the Department;

ii. By AHCCCS, if applicable;

iii. By Medicare, if applicable; and

iv. As the outpatient treatment center's national provider identifier;

c. The name, telephone number, and e-mail address of:

i. The outpatient treatment center administrator,

ii. The outpatient treatment center chief financial officer, and

iii. Another individual involved in the preparation of the rates and charges package whom the Department may contact regarding the rates and charges package; and

d. The planned implementation date for the rates and charges;

2. Either:

a. A rates and charges schedule, in a format specified by the Department, containing:

i. A table of contents;

ii. For each unit of service offered for which a separate rate or charge is billed:

(1) The unit of service code,

(2) A description of the unit of service, and

(3) The rate or charge for the unit of service; and

iii. A copy of any outpatient treatment center rules or formulae which may affect the rate or charge for a unit of service; or

b. Current cost reports and financial information that the outpatient treatment center files for other government reporting purposes if the current cost reports and financial information submitted to the Department contain the information required in subsections (A)(2)(a)(ii) and (A)(2)(a)(iii); and

3. A form provided by the Department, on which the outpatient treatment center administrator or designee:

a. Attests that, to the best of the knowledge and belief of the outpatient treatment center administrator or designee, the information submitted according to subsections (A)(1) and (A)(2) is accurate and complete; or

b. If the outpatient treatment center administrator or designee has personal knowledge that the information submitted according to subsections (A)(1) and (A)(2) is not accurate or not complete:

i. Identifies the information that is not accurate or not complete;

ii. Describes the circumstances that make the information not accurate or not complete;

iii. States what actions the outpatient treatment center is taking to correct the inaccurate information or make the information complete; and

iv. Attests that, to the best of the knowledge and belief of the outpatient treatment center administrator or designee, the information submitted according to subsections (A)(1) and (A)(2), except the information identified in subsection (A)(3)(b)(i), is accurate and complete.

B. To change an outpatient treatment center's current rates and charges information, an outpatient treatment center administrator or designee shall submit to the Department:

1. A cover letter:

a. Containing the information specified in subsection (A)(1), and

b. Stating that the accompanying information is changing the outpatient treatment center's current rates and charges information;

2. Either:

a. The rates and charges schedule specified in subsection (A)(2)(a) or the current cost reports and financial information specified in subsection (A)(2)(b); or

b. The following information:

i. A description of:

(1) The current and new rate or charge for each unit of service undergoing a change, and

(2) The current and new rules and formulae for each change to the outpatient treatment center rules or formulae which may affect the rate or charge for a unit of service;

ii. The line number or page number in the outpatient treatment center's current rates and charges information for each change listed in subsection (B)(2)(b)(i); and

iii. A list of each previous change:

(1) To a rate, charge, rule, or formula being changed;

(2) That was submitted since the last submission made according to subsection (A)(2) or (B)(2)(a); and

(3) Including:

(a) The date the rate, charge, rule, or formula was previously changed; and

(b) A description of how the rate, charge, rule, or formula was previously changed; and

3. A form provided by the Department, on which the outpatient treatment center administrator or designee:

a. Attests that, to the best of the knowledge and belief of the outpatient treatment center administrator or designee, the information submitted according to subsections (B)(1) and (B)(2) is accurate and complete; or

b. If the outpatient treatment center administrator or designee has personal knowledge that the information submitted according to subsections (B)(1) and (B)(2) is not accurate or not complete:

i. Identifies the information that is not accurate or not complete;

ii. Describes the circumstances that make the information not accurate or not complete;

iii. States what actions the outpatient treatment center is taking to correct the inaccurate information or make the information complete; and

iv. Attests that, to the best of the knowledge and belief of the outpatient treatment center administrator or designee, the information submitted according to subsections (B)(1) and (B)(2), except the information identified in subsection (B)(3)(b)(i), is accurate and complete.

C. An outpatient treatment center administrator shall implement rates and charges for a rates and charges schedule submitted as specified in subsection (A) or for a change in the outpatient treatment center's current rates and charges information submitted as specified in subsection (B) on a date determined by the outpatient treatment center but not earlier than the date the Department notifies the outpatient treatment center that the Department received the rates and charges information.

D. When the Department receives from an outpatient treatment center a rates and charges schedule submitted as specified in subsection (A) or a change in the outpatient treatment center's rates and charges information submitted as specified in subsection (B), the Department shall provide written notice to the outpatient treatment center within five business days of receipt of the rates and charges information.

E. An outpatient treatment center administrator, who receives a request from the Department for a revision of a rates and charges schedule not prepared as specified in subsection (A) or for a revision of a change in the outpatient treatment center's current rates and charges information not prepared as specified in subsection (B), shall ensure that the revised rates and charges schedule or the revised information changing the current rates and charges information is submitted to the Department:

1. Within 21 calendar days after the date on the Department's letter requesting an initial revision, and

2. Within seven calendar days after the date on the Department's letter requesting a second revision.

F. If an outpatient treatment center administrator or designee does not submit a rates and charges schedule or information about changes to the outpatient treatment center's rates and charges according to this Section, the Department may assess civil penalties as specified in A.R.S. § 36-431.01.

Ariz. Admin. Code § R9-11-305

Section recodified from R9-11-107 at 10 A.A.R. 3835, effective August 24, 2004 (Supp. 04-3). Section repealed; new Section made by final rulemaking at 13 A.A.R. 3648, effective December 1, 2007 (Supp. 07-4).