Ariz. Admin. Code § 9-6-407

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

Section R9-6-407 - Continuing Enrollment

A. To continue enrollment in ADAP, an enrolled individual or the enrolled individual's representative shall:

1. When the enrolled individual's residential address changes, comply with subsection (B);

2. When the enrolled individual's annual household income changes, comply with subsection (C);

3. When the enrolled individual becomes eligible for Medicare or other health insurance coverage, comply with subsection (D);

4. Before the end of the month that is six months after the enrolled individual's month of birth, comply with subsection (E); and

5. Before the end of the enrolled individual's month of birth each year after an individual's initial enrollment, comply with subsection (F).

B. When an enrolled individual's residential address changes, the enrolled individual or the enrolled individual's representative shall submit to the Department:

1. The following information for the enrolled individual in a Department-provided format:

a. The enrolled individual's name and date of birth;

b. The new residential address and mailing address for the enrolled individual;

c. If the enrolled individual is in non-permanent housing, the address of a person that has agreed to receive written communications for the enrolled individual; and

d. If applicable, the address in Arizona to which the enrolled individual would want drugs to be shipped; and

2. Proof of Arizona residency, as specified in R9-6-404(A)(8), showing the new Arizona residential address specified in subsection (B)(1)(b).

C. When an enrolled individual's annual household income changes, the enrolled individual or the enrolled individual's representative shall:

1. Submit to the Department, within 30 calendar days after the change, documentation of the enrolled individual's annual household income, as specified in R9-6-404(A)(6) or (7); and

2. If the enrolled individual's annual household income has decreased to an amount that may make the individual eligible for enrollment in AHCCCS:

a. Apply for enrollment in AHCCCS within 30 calendar days after the change in annual household income; and

b. Submit to the Department, within 30 calendar days after the change, documentation that states the status of the enrolled individual's enrollment in AHCCCS.

D. When an enrolled individual becomes eligible for Medicare or other health insurance coverage, the enrolled individual or the enrolled individual's representative shall, within 30 calendar days after the enrolled individual becomes eligible for Medicare or other health insurance coverage:

1. If eligible for Medicare:

a. Enroll in a Medicare drug plan; and

b. If the enrolled individual's annual household income is at or below 175% of the poverty level, apply for a low-income subsidy; and

c. Submit to the Department a copy of valid documentation stating:

i. The enrolled individual's enrollment in a Medicare drug plan; and

ii. If the enrolled individual's annual household income is at or below 175% of the poverty level, the status of the enrolled individual's eligibility for a low-income subsidy; and

2. If eligible for other health insurance coverage, submit to the Department information about the health insurance coverage to enable the Department to determine if the health insurance coverage is inadequate, according to R9-6-403(4)(b), or unaffordable, according to R9-6-403(4)(c).

E. Before the end of the month that is six months after the enrolled individual's month of birth, the enrolled individual or the enrolled individual's representative shall:

1. Either:

a. Submit to the Department an attestation, in a Department-provided format, that there have been no changes specified in subsection (A)(1), (2), or (3); or

b. Comply with subsections (B), (C), and (D), as applicable; and

2. Obtain from the enrolled individual's HIV-care provider and submit to the Department a copy of the most recent laboratory report of a test for viral load, and, if available, CD4-T-lymphocyte count conducted for the applicant

.

F. Before the end of an enrolled individual's month of birth each year, an enrolled individual or the enrolled individual's representative shall submit to the Department the application packet required in R9-6-404(A).

G . The Department shall:

1. Review information about an enrolled individual and determine eligibility for continuing enrollment for the enrolled individual:

a. At the end of the enrolled individual's month of birth each year,

b. At the end of the month that is six months after the enrolled individual's month of birth each year,

c. When the Department receives information from the enrolled individual or the enrolled individual's representative under subsection (A), or

d. When the Department no longer has sufficient funds to provide continuing enrollment to all enrolled individuals;

2. Grant continuing enrollment to an enrolled individual, subject to the availability of funds, when:

a. The enrolled individual or the enrolled individual's representative complies with subsection (A); and

b. The Department determines that:

i. The information in the documents submitted to the Department is accurate and complete, and

ii. The enrolled individual is eligible under R9-6-403; and

3. Notify the enrolled individual or the enrolled individual's representative of the Department's decision within five working days after receipt of the documents required in subsection (A).

H. The Department may grant pre-approved enrollment status in ADAP, according to R9-6-405(D) or (E) and ending according to R9-6-405(G), to an enrolled individual who is missing documentation to establish eligibility under R9-6-403.

I. If the Department denies continuing enrollment to an enrolled individual, the Department shall send to the enrolled individual or the enrolled individual's representative a written notice of denial setting forth the information required under A.R.S. § 41-1092.03.

Ariz. Admin. Code § R9-6-407

Adopted as an emergency effective January 12, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-1). Emergency expired. Readopted without change as an emergency effective May 9, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-2). Emergency not renewed. Former Section R9-6-808 renumbered as Section R9-6-807, amended, and readopted as an emergency effective August 8, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-3). Emergency expired. Readopted as an emergency and subsection (C) corrected effective November 16, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Adopted without change as a permanent rule effective May 22, 1989 (Supp. 89-2). Renumbered from R9-6-807 effective October 19, 1993 (Supp. 93-4). Former Section R9-6-407 repealed; new Section R9-6-407 renumbered from R9-6-406 and amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Former R9-6-407 renumbered to R9-6-409; new R9-6-407 renumbered from R9-6-406and amended by final rulemaking at 13 A.A.R. 3329, effective November 10, 2007 (Supp. 07-3). Amended by final rulemaking at 25 A.A.R. 3614, effective 12/3/2019.