Ariz. Admin. Code § 9-22-216

Current through Register Vol. 30, No. 24, June 14, 2024

Section R9-22-216 - NF, Alternative HCBS Setting, or HCBS

A. Services provided in a NF, including room and board, an alternative HCBS setting as defined in R9-28-101, or a HCBS as defined in A.R.S. § 36-2939 are covered for a maximum of 90 days per contract year if the member's medical condition would otherwise require hospitalization.

B. Except as otherwise provided in 9 A.A.C. 28, the following services are not itemized for separate billing if provided in a NF, alternative HCBS setting, or HCBS:

1. Nursing services, including:

a. Administering medication;

b. Tube feedings;

c. Personal care services, including but not limited to assistance with bathing and grooming;

d. Routine testing of vital signs; and

e. Maintenance of a catheter;

2. Basic patient care equipment and sickroom supplies, including:

a. First aid supplies such as bandages, tape, ointments, peroxide, alcohol, and over-the-counter remedies;

b. Bathing and grooming supplies;

c. Identification device;

d. Skin lotion;

e. Medication cup;

f. Alcohol wipes, cotton balls, and cotton rolls;

g. Rubber gloves (non-sterile);

h. Laxatives;

i. Bed and accessories;

j. Thermometer;

k. Ice bags;

l. Rubber sheeting;

m. Passive restraints;

n. Glycerin swabs;

o. Facial tissue;

p. Enemas;

q. Heating pad; and

r. Incontinence briefs.

3. Dietary services including preparation and administration of special diets, and adaptive tools for eating;

4. Any service that is included in a NF's room and board charge or a service that is required of the NF to meet a federal or state licensure standard or county certification requirement;

5. Physician visits made solely for the purpose of meeting state licensure standards or county certification requirements;

6. Physical therapy prescribed only as a maintenance regimen; and

7. Assistive devices and non-customized durable medical equipment.

C. A provider shall obtain prior authorization from the Administration for a NF admission for a FFS member.

Ariz. Admin. Code § R9-22-216

Adopted effective October 1, 1985 (Supp. 85-5). Section repealed, new Section adopted effective September 22, 1997 (Supp. 97-3). Amended by final rulemaking at 6 A.A.R. 2435, effective June 9, 2000 (Supp. 00-2). Subsection (C) amended to correct a typographical error (Supp. 00-4). Amended by final rulemaking at 8 A.A.R. 2325, effective May 9, 2002 (Supp. 02-2). Amended by final rulemaking at 13 A.A.R. 3272, effective September 11, 2007 (Supp. 07-3). Amended by final rulemaking at 13 A.A.R. 4122, effective November 6, 2007 (Supp. 07-4).

The following Section was adopted and amended under an exemption from the provisions of the Administrative Procedure Act which means that this rule was not reviewed by the Governor's Regulatory Review Council; the agency did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; the agency was not required to hold public hearings on the rules; and the Attorney General has not certified this rule. This Section was subsequently repealed and a new Section adopted under the regular rulemaking process.