Sec. R9-28-101 - General Definitions

§ R9-28-101. General Definitions

A. Location of definitions. Definitions applicable to Chapter 28 are found in the following:

Definition Section or Citation

"210" 42 CFR 435.211

"217" 42 CFR 435.217

"236" 42 CFR 435.236

"Acute" R9-28-301

"ADHS" R9-22-101

"ADL" R9-28-101

"Administration" A.R.S. § 36-2931

"Advance notice" R9-28-411

"Aged" R9-28-402

"Aggregate" R9-22-701

"Aggression" R9-28-301

"AHCCCS" R9-22-101

"AHCCCS registered provider" R9-22-101

"ALTCS" R9-28-101

"ALTCS acute care services" R9-28-401

"Alternative HCBS setting" R9-28-101

"Ambulance" A.R.S. § 36-2201

"Ambulation" R9-28-301

"Applicant" R9-22-101

"Assessor" R9-28-301

"Auto-assignment algorithm" or "Algorithm" R9-22-1701

"Bathing" R9-28-301

"Bathing or showering" R9-28-301

"Bed hold" R9-28-102

"Behavior intervention" R9-28-102

"Behavior management services" R9-22-1201

"Behavioral health evaluation" R9-22-1201

"Behavioral health medical practitioner" R9-22-1201

"Behavioral health professional" R9-20-101

"Behavioral health service" R9-20-101

"Behavioral health technician" R9-20-101

"Billed charges" R9-22-701

"Blind" 42 U.S.C. 1382 c(a)(2)

"Capped fee-for-service" R9-22-101

"Case management plan" R9-28-101

"Case management" R9-28-1101

"Case manager" R9-28-101

"Case record" R9-22-101

"Categorically-eligible" R9-22-101

"Certification" R9-28-501

"Certified psychiatric nurse practitioner" R9-22-1201

"CFR" R9-28-101

"Child" R9-22-1503

"Clarity of communication" R9-28-301

"Clean claim" A.R.S. § 36-2904

"Clinical supervision" R9-22-201

"CMS" R9-22-101

"Community mobility" R9-28-301

"Community spouse" R9-28-401

"Consecutive days" R9-28-801

"Continence" R9-28-301

"Contract" R9-22-101

"Contract year" R9-22-101

"Contractor" A.R.S. § 36-2901

"Cost avoid" R9-22-1201 or R9-22-1001

"County of fiscal responsibility" R9-28-701

"Covered services" R9-28-101

"CPT" R9-22-701

"Crawling and standing" R9-28-301

"CSRD" R9-28-401

"Current" R9-28-301

"Day" R9-22-101 or R9-22-1101

"De novo hearing" 42 CFR 431.201

"Department" A.R.S. § 36-2901

"Developmental disability" or "DD" A.R.S. § 36-551

"Diagnostic services" R9-22-101

"Director" R9-22-101

"Disabled" R9-28-402

"Disenrollment" R9-22-1701

"Disruptive behavior" R9-28-301

"DME" R9-22-101

"Dressing" R9-28-301

"Eating" R9-28-301

"Eating or drinking" R9-28-301

"Emergency medical services for the non-FES member" R9-22-201

"Emotional and cognitive functioning" R9-28-301

"Employed" R9-28-1320

"Encounter" R9-22-701

"Enrollment" R9-22-1701

"EPD" R9-28-301

"E.P.S.D.T. services" 42 CFR 440.40(b)

"Estate" A.R.S. § 14-1201

"Experimental services" R9-22-203

"Expressive verbal communication" R9-28-301

"Facility" R9-22-101

"Factor" 42 CFR 447.10

"Fair consideration" R9-28-401

"FBR" R9-22-101

"Federal financial participation" or "FFP" 42 CFR 400.203

"Fee-For-Service" or "FFS" R9-22-101

"File" R9-28-801 "First continuous period of institutionalization" R9-28-401

"Food preparation" R9-28-301

"Frequency" R9-28-301

"Functional assessment" R9-28-301

"Grievance" R9-34-202

"Grooming" R9-28-301

"GSA" R9-22-101

"Guardian" A.R.S. § 14-5311

"Hand use" R9-28-301

"HCBS" or "Home and community based services" A.R.S. § 36-2931

"Health care practitioner" R9-22-1201

"History" R9-28-301

"Home" R9-28-101 and R9-28-801

"Home health services" R9-22-201

"Hospice" A.R.S. § 36-401

"Hospital" R9-22-101

"ICF-MR" or "Intermediate care facility for the

mentally retarded" 42 U.S.C. 1396 d(d)

"IADL" R9-28-101

"IHS" R9-22-101

"IMD" or "Institution for mental

diseases" 42 CFR 435.1010

"Immediate risk of institutionalization" R9-28-301

"Individual Representative" R9-28-509

"Institutionalized" R9-28-401

"Institutionalized spouse" R9-28-101

"Interested Party" R9-28-106

"Intergovernmental agreement" or "IGA" R9-28-1101

"Intervention" R9-28-301

"JCAHO" R9-28-101

"License" or "licensure" R9-22-101

"Medical assessment" R9-28-301

"Medical or nursing services and treatments" or "services and treatments" R9-28-301

"Medical record" R9-22-101

"Medical services" A.R.S. § 36-401

"Medically eligible" R9-28-401

"Medically necessary" R9-22-101

"Member" A.R.S. § 36-2931 and R9-28-901

"Mental disorder" A.R.S. § 36-501

"MMMNA" R9-28-401

"Mobility" R9-28-301

"Natural Support Services" R9-28-101

"Noncontracting provider" A.R.S. § 36-2931

"Nursing facility" or "NF" 42 U.S.C. 1396 r(a)

"Occupational therapy" R9-22-201

"Orientation" R9-28-301

"Partial care" R9-22-1201

"PAS" R9-28-103

"Personal hygiene" R9-28-301

"Pharmaceutical service" R9-22-201

"Physical therapy" R9-22-201

"Physically disabled" R9-28-301

"Physician" R9-22-101

"Physician consultant" R9-28-301

"Post-stabilization care services" 42 CFR 438.114

"Practitioner" R9-22-101

"Primary care provider" or "(PCP)" R9-22-101

"Primary care provider services" R9-22-201

"Prior authorization" R9-22-101

"Prior period coverage" or "PPC" R9-22-101

"Program contractor" A.R.S. § 36-2931

"Provider" A.R.S. § 36-2931

"Psychiatrist" R9-22-1201

"Psychologist" R9-22-1201

"Psychosocial rehabilitation services" R9-22-201

"Qualified behavioral health service provider" R9-28-1101

"Quality management" R9-22-501

"Radiology" R9-22-101

"Reassessment" R9-28-103

"Recover" R9-28-901

"Redetermination" R9-28-401

"Referral" R9-22-101

"Regional behavioral health authority" or "RBHA" A.R.S. § 36-3401

"Reinsurance" R9-22-701

"Representative" R9-28-401

"Resistiveness" R9-28-301

"Respiratory therapy" R9-22-201

"Respite care" R9-28-102

"RFP" R9-22-101

"Room and board" R9-28-102

"Rolling and sitting" R9-28-301

"Running or wandering away" R9-28-301

"Scope of services" R9-28-102

"Section 1115 Waiver" A.R.S. § 36-2901

"Self-injurious behavior" R9-28-301

"Sensory" R9-28-301

"Seriously mentally ill" or "SMI" A.R.S. § 36-550

"Social worker" R9-28-301

"Special diet" R9-28-301

"Speech therapy" R9-22-201

"Spouse" R9-28-401

"SSA" 42 CFR 1000.10

"SSI" 42 CFR 435.4

"Subcontract" R9-22-101

"TEFRA lien" R9-28-801

"Therapeutic leave" R9-28-501

"Toileting" R9-28-301

"Transferring" R9-28-301

"TRBHA" R9-22-1201

"Tribal contractor" R9-28-1101

"Tribal facility" A.R.S. § 36-2981

"Utilization management/review" R9-22-501

"Ventilator dependent" R9-28-102

"Verbal or physical threatening" R9-28-301

"Vision" R9-28-301

"Wandering" R9-28-301

"Wheelchair mobility" R9-28-301

B. General definitions. In addition to definitions contained in A.R.S. §§ 36-551, 36-2901, 36-2931, and 9 A.A.C. 22, Article 1, the following words and phrases have the following meanings unless the context of the Chapter explicitly requires another meaning:

"ADL" or "Activities of Daily Living" mean activities a member must perform daily for the member's regular day-to-day necessities, including but not limited to mobility, transferring, bathing, dressing, grooming, eating, and toileting.

"ALTCS" means the Arizona Long-term Care System as authorized by A.R.S. § 36-2932.

"Alternative HCBS setting" means a living arrangement approved by the Director and licensed or certified by a regulatory agency of the state, where a member may reside and receive HCBS, including:

For a person with a developmental disability specified in A.R.S. § 36-551:

Community residential setting defined in A.R.S. § 36-551;

Group home defined in A.R.S. § 36-551;

State-operated group home under A.R.S. § 36-591;

Group foster home under R6-5-5903;

Licensed residential facility for a person with traumatic brain injury under A.R.S. § 36-2939;

Behavioral health adult therapeutic home under 9 A.A.C 20, Articles 1 and 15;

Level 2 and Level 3 behavioral health residential agencies under 9 A.A.C. 20, Articles 1, 4, 5, and 6; and

Rural substance abuse transitional centers under 9 A.A.C. 20, Articles 1 and 14; and

For a person who is Elderly and Physically Disabled (EPD) under R9-28-301, and the facility, setting, or institution is registered with AHCCCS:

Adult foster care defined in A.R.S. § 36-401 and as authorized in A.R.S. § 36-2939;

Assisted living home or assisted living center, units only, under A.R.S. § 36-401, and as authorized in A.R.S. § 36-2939;

Licensed residential facility for a person with a traumatic brain injury specified in A.R.S. § 36-2939;

Behavioral health adult therapeutic home under 9 A.A.C. 20, Articles 1 and 15;

Level 2 and Level 3 behavioral health residential agencies under 9 A.A.C. 20, Articles 1, 4, 5, and 6; and

Rural substance abuse transitional centers under 9 A.A.C. 20, Articles 1 and 14.

"Case management plan" means a service plan developed by a case manager that involves the overall management of a member's care, and the continued monitoring and reassessment of the member's need for services.

"Case manager" means a person who is either a degreed social worker, a licensed registered nurse, or has a minimum of two years of experience in providing case management services to a person who is EPD.

"CFR" means Code of Federal Regulations, unless otherwise specified in this Chapter.

"Covered services" means the health and medical services described in Articles 2 and 11 of this Chapter as being eligible for reimbursement by AHCCCS.

"Home" means a residential dwelling that is owned, rented, leased, or occupied by a member, at no cost to the member, including a house, a mobile home, an apartment, or other similar shelter. A home is not a facility, a setting, or an institution, or a portion of any of these that is licensed or certified by a regulatory agency of the state as a:

Health care institution under A.R.S. § 36-401;

Residential care institution under A.R.S. § 36-401;

Community residential setting under A.R.S. § 36-551; or

Behavioral health facility under 9 A.A.C. 20, Articles 1, 4, 5, and 6.

"IADL" or "Instrumental Activities of Daily Living" mean activities related to independent living that a member must perform, including but not limited to:

Preparing meals,

Managing money,

Shopping for groceries or personal items,

Performing light or heavy housework, and

Use of the telephone.

"IHS" means the Indian Health Service.

"Institutionalized spouse" means the same as defined in 42 U.S.C. 1396r-5.

"JCAHO" means the Joint Commission on Accreditation of Healthcare Organizations.

"Natural Support Services" are services provided voluntarily by a person not legally obligated to provide those services. The services are specified in the service plan as described under R9-28-510 and cannot supplant other covered services.

(Adopted effective October 1, 1988, filed September 1, 1988 (Supp. 88-3). Amended effective June 6, 1989 (Supp. 89-2). Amended effective July 13, 1992 (Supp. 92-3). Amended effective November 5, 1993 (Supp. 93-4). Section repealed; new Section adopted effective December 8, 1997 (Supp. 97-4). Amended by final rulemaking at 5 A.A.R. 369, effective January 6, 1999 (Supp. 99-1). Amended by final rulemaking at 5 A.A.R. 874, effective March 4, 1999 (Supp. 99-1). Subsection (A)(69) amended to correct a printing error, filed in the Office of the Secretary of State August 13, 1999 (Supp. 99-3). Amended by final rulemaking at 6 A.A.R. 200, effective December 13, 1999 (Supp. 99-4). Amended by final rulemaking at 6 A.A.R. 2461, effective June 9, 2000 (Supp. 00-2). Amended by final rulemaking at 6 A.A.R. 3365, effective August 7, 2000 (Supp. 00-3). Amended by exempt rulemaking at 7 A.A.R. 4691, effective October 1, 2001 (Supp. 01-3). Amended by final rulemaking at 8 A.A.R. 444, effective January 10, 2002 (Supp. 02-1). Amended by final rulemaking at 8 A.A.R. 2356, effective May 9, 2002 (Supp. 02-2). Amended by final rulemaking at 8 A.A.R. 3340, effective July 15, 2002 (Supp. 02-3). Amended by final rulemaking at 9 A.A.R. 3810, effective October 4, 2003 (Supp. 03-3). Amended by final rulemaking at 10 A.A.R. 1312, effective May 1, 2004 (Supp. 04-1). Amended by final rulemaking at 11 A.A.R. 3165, effective October 1, 2005 (Supp. 05-3). Amended by final rulemaking at 11 A.A.R. 4286, effective December 5, 2005 (Supp. 05-4). Amended by final rulemaking at 13 A.A.R. 1090, effective May 5, 2007 (Supp. 07-1). Amended by final rulemaking at 14 A.A.R. 2090, effective July 5, 2008 (Supp. 08-2). Amended by final rulemaking at 18 A.A.R. 3380, effective January 1, 2013 (Supp. 12-4).)

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