Ariz. Admin. Code § 9-15-201

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-15-201 - Primary Care Provider and Service Site Requirements

A. A primary care provider may request to participate in the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program:

1. If the primary care provider:

a. Meets the requirements in A.R.S. § 41-1080 or is a U.S. National according to U.S.C. Title 8, Chapter 12;

b. Has completed the final year of a course of study or program approved by an accrediting agency recognized by the U.S. Department of Education or the Council for Higher Education Accreditation for higher education in a health profession licensed under A.R.S. Title 32;

c. Holds a current Arizona license or certificate in a health profession licensed under A.R.S. Title 32;

d. If a physician, has completed a professional residency program and is board certified or board eligible in:

i. Family medicine,

ii. Internal medicine,

iii. Pediatrics,

iv. Geriatrics,

v. Obstetrics-gynecology, or

vi. Psychiatry;

e. Except for a pharmacist or a behavioral health care provider providing primary care services at a free-clinic, Indian Health Service or tribal facility, or a federal prison or state prison, agrees to comply with the requirements for a sliding-fee schedule according to 9 A.A.C. 1, Article 5;

f. Except for a primary care provider providing primary care services at a free-clinic, Indian Health Service or tribal facility, or a federal prison or state prison, agrees to charge for primary care services at the usual and customary fees prevailing in the primary care area, except that:

i. A patient unable to pay the usual and customary fees is not charged or is charged a reduced fee, according to the service site's or employer's sliding-fee schedule required in subsection (A)(2)(d), or a fee less than the sliding-fee schedule;and

ii. A medically uninsured individual from a family unit with an annual income at or below 200% of the poverty level is charged according to a sliding-fee schedule required in subsection (A)(2)(d) or not charged;

g. Who provides services at a critical access hospital with a separate qualifying service site, agrees to provide:

i. At least 16 hours of service per week at the critical access hospital, and

ii. At least 24 hours of primary care services per week at the qualifying service site;

h. Agrees not to discriminate on the basis of a patient's ability to pay or a payment source, including Medicare, AHCCCS, or a qualifying health plan;

i. Agrees to accept assignment for payment under:

i. Medicare, if providing primary care services to adults;

ii. Children's Health Insurance Program (KidsCare), established under A.R.S. § 36-2982, if providing primary care services to children;

iii. AHCCCS; and

iv. A qualifying health plan; and

j. Has satisfied any other health professional service obligation owed under a contract with a federal, state, or local government before beginning a period of service under the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program, as applicable; and

2. If the primary care provider's service site:

a. Is either a:

i. Service site that meets the requirements in A.R.S. § 36-2172(B)(2), or

ii. Private practice service site as allowed in A.R.S. § 36-2174;

b. Except for a free-clinic or Indian Health Service or tribal facility, accepts assignment for payment under:

i. Medicare, if providing primary care services to adults;

ii. Children's Health Insurance Program (KidsCare), established under A.R.S. § 36-2982, if providing primary care services to children;

iii. AHCCCS; and

iv. A qualifying health plan;

c. Except for a free-clinic or Indian Health Service or tribal facility, is an AHCCCS provider;

d. Except for a free-clinic, Indian Health Service or tribal facility, or a federal prison or state prison:

i. Submits a sliding-fee schedule according to 9 A.A.C. 1, Article 5, to the Department for approval;

ii. Develops and implements a policy for the service site's sliding-fee schedule; and

iii. Ensures that signage, informing individuals that the service site has a sliding-fee schedule, is conspicuously posted in the service site's reception area;

e. Except for a free-clinic, Indian Health Service or tribal facility, or a federal prison or state prison, charges for primary care services at the usual and customary fees prevailing in the primary care area, and has a policy providing that:

i. A patient who is unable to pay the usual and customary fee is:

(1) Charged a reduced fee according to the service site's sliding-fee schedule in subsection (A)(2)(d),

(2) Charged a fee less than the sliding-fee schedule, or

(3) Not charged; and

ii. A medically uninsured individual from a family unit with an annual income at or below 200% of the poverty level is charged according to the service site's sliding-fee schedule in subsection (A)(2)(d) or not charged;

f. Is a free-clinic, develops and implements a policy that the free-clinic provides primary care services to individuals at no charge;

g. Does not discriminate on the basis of a patient's ability to pay or a payment source, including Medicare, AHCCCS, or a qualifying health plan; and

h. Agrees to notify the Department when the employment status of the primary care provider changes.

B. A primary care provider may not participate in the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program, as applicable, if the primary care provider:

1. Has a judgment lien against the primary care provider's property for a debt owed to a federal agency;

2. Is applying to participate in the Primary Care Provider Loan Repayment Program and:

a. Has defaulted on:

i. A Federal income tax liability,

ii. Any federally-guaranteed or insured student loan or home mortgage loan,

iii. A Federal Health Education Assistance Loan,

iv. A Federal Nursing Student Loan, or

v. A Federal Housing Authority Loan; or

b. Is delinquent on payment for:

i. Court-ordered child support, or

ii. State taxes; or

3. Is applying to participate in the Rural Private Primary Care Provider Loan Repayment Program and is delinquent on payment for:

a. State taxes, or

b. Court-ordered child support.

Ariz. Admin. Code § R9-15-201

New Section made by final rulemaking at 7 A.A.R. 2823, effective August 9, 2001 (Supp. 01-2). Adopted by exempt rulemaking at 22 A.A.R. 851, effective 4/1/2016. Renumbered from R9-15-202 and amended by emergency rulemaking at 28 A.A.R. 1481, effective 11/15/2022. Amended by emergency rulemaking at 29 A.A.R. 1274, effective 5/14/2023. Renumbered from R9-15-202 and amended by final rulemaking at 29 A.A.R. 3837, effective 12/6/2023.