Sec. R9-31-101 - Location of Definitions

§ R9-31-101. Location of Definitions

A. Location of definitions. Definitions applicable to 9 A.A.C. 31 are found in the following.

Definition Section or Citation

"ADHS" R9-22-102

"Administration" A.R.S. § 36-2901

"Adverse action" R9-34-102

"Aggregate" R9-22-701

"AHCCCS" R9-31-101

"AHCCCS registered provider" R9-22-101

"Ambulance" A.R.S. § 36-2201

"Applicant" R9-31-101

"Application" R9-31-101

"Behavior management service" R9-31-1201

"Behavioral health evaluation" R9-31-1201

"Behavioral health medical practitioner" R9-31-1201

"Behavioral health professional" R9-31-1201

"Behavioral health service" R9-31-1201

"Behavioral health technician" R9-31-1201

"Billed charges" R9-22-701

"Capital costs" R9-22-701

"Certified nurse practitioner" R9-31-102

"Certified psychiatric nurse practitioner" R9-31-1201

"Child" 42 U.S.C. 1397 jj

"Chronically ill" A.R.S. § 36-2983

"Clean claim" A.R.S. § 36-2904

"Clinical supervision" R9-22-102

"CMDP" R9-31-103

"Continuous stay" R9-22-101

"Contract" R9-22-101

"Contractor" A.R.S. § 36-2901

"Contract year" R9-31-101

"Cost avoid" R9-22-1201

"Cost-to-Charge" R9-22-701

"Covered charges" R9-31-107

"Covered services" R9-22-102

"CPT" R9-22-701

"CRS" R9-31-103

"Date of eligibility posting" R9-22-701

"Day" R9-22-101

"De novo hearing" 42 CFR 431.201

"Dentures" and "Denture services" R9-22-102

"DES" R9-31-103

"Determination" R9-31-103

"Diagnostic services" R9-22-102

"Director" A.R.S. § 36-2981

"DME" R9-22-102

"DRI inflation factor" R9-22-701

"Emergency medical condition" 42 U.S.C. 1396 b(v)

"Emergency medical services for the non-FES" member R9-22-102

"Encounter" R9-22-701

"Enrollment" R9-31-103

"Experimental services" R9-22-101

"Facility" R9-22-101

"Factor" R9-22-101

"Federal Poverty Level" or "FPL" A.R.S. § 36-2981

"First-party liability" R9-22-1001

"Grievance" R9-34-202

"Group Health Plan" 42 U.S.C. 1397 jj

"GSA" R9-22-101

"Head of Household" R9-31-103

"Health care practitioner" R9-31-1201

"Hearing aid" R9-22-102

"Home health services" R9-22-102

"Hospital" R9-22-101

"Household income" R9-31-103

"ICU" R9-22-701

"IGA" R9-31-116

"IHS" R9-31-116

"IHS" or "Tribal Facility Provider" R9-31-116

"Information" R9-31-103

"Institution for Mental Diseases" or "IMD" 42 CFR 435.1010 and R9-22-102

"Inmate of a public institution" 42 CFR 435.1010

"Inpatient hospital services" R9-31-101

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

"Medical record" R9-22-101

"Medical review" R9-31-107

"Medical services" R9-22-101

"Medical supplies" R9-22-102

"Member" A.R.S. § 36-2981

"Mental disorder" A.R.S. § 36-501

"Native American" R9-31-101

"New hospital" R9-22-701

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

"NICU" R9-22-701

"Noncontracting provider" A.R.S. § 36-2981

"Occupational therapy" R9-22-102

"Offeror" R9-31-106

"Operating costs" R9-22-701

"Outlier" R9-31-107

"Outpatient hospital service" R9-22-701

"Ownership change" R9-22-701

"Partial care" R9-22-1201

"Peer group" R9-22-701

"Pharmaceutical service" R9-22-102

"Physical therapy" R9-22-102

"Physician" A.R.S. § 36-2981

"Post stabilization care services" 42 CFR 438.114

"Practitioner" R9-22-102

"Pre-existing condition" R9-31-501

"Prepaid capitated" A.R.S. § 36-2981

"Prescription" R9-22-102

"Primary care physician" A.R.S. § 36-2981

"Primary care practitioner" A.R.S. § 36-2981

"Primary care provider (PCP)" R9-22-102

"Primary care provider services" R9-22-102

"Prior authorization" R9-22-102

"Program" A.R.S. § 36-2981

"Proposal" R9-31-106

"Prospective rates" R9-22-701

"Provider" A.R.S. § 36-2931

"Psychiatrist" A.R.S. § 36-501

"Psychologist" A.R.S. § 36-501

"Psychosocial rehabilitation" R9-22-102

"Qualified alien" A.R.S. § 36-2903.03

"Qualifying plan" A.R.S. § 36-2981

"Quality management" R9-22-501

"Radiology" R9-22-102

"Rebase" R9-22-701

"Redetermination" R9-31-103

"Referral" R9-22-101

"Regional Behavioral Health Authority" or "RBHA" A.R.S. § 36-3401

"Rehabilitation services" R9-22-102

"Reinsurance" R9-22-701

"Remittance advice" R9-22-701

"RFP" R9-31-106

"Respiratory therapy" R9-22-102

"Scope of services" R9-22-102

"Seriously ill" R9-31-101

"Service location" R9-22-101

"Service site" R9-22-101

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

"Specialist" R9-22-102

"Speech therapy" R9-22-102

"Spouse" R9-31-103

"SSI-MAO" R9-31-103

"Stabilize" 42 U.S.C. 1395 dd

"Standard of care" R9-22-101

"Sterilization" R9-22-102

"Subcontract" R9-22-101

"Subcontractor" R9-31-101

"Third-party" R9-22-1001

"Third-party liability" R9-22-1001

"Tier" R9-22-701

"Tiered per diem" R9-31-107

"TRBHA" or "Tribal Regional Behavioral Health Authority" R9-31-1201

"Tribal facility" A.R.S. § 36-2981

"Utilization management" R9-22-501

B. General definitions. The words and phrases in this Chapter have the following meanings unless the context explicitly requires another meaning:

"ADHS" has the same meaning as in A.A.C. R9-22-102.

"AHCCCS" means the Arizona Health Care Cost Containment System, which is composed of the Administration, contractors, and other arrangements through which health care services are provided to a member.

"Applicant" means a person who submits, or whose representative submits, a written, signed, and dated application for Title XXI medical coverage.

"Application" means an official request for Title XXI medical coverage made under this Chapter.

"Contract year" means the period beginning on October 1 and continuing until September 30 of the following year.

"Inpatient hospital services" means medically necessary services that require an inpatient stay in an acute care hospital and that are provided by or under the direction of a physician or other health care practitioner upon referral from a member's primary care provider.

"Native American" means Indian as specified in 42 CFR 137.10.

"Seriously ill" means a medical or psychiatric condition manifesting itself by acute symptoms that left untreated may result in:

Death,

Disability,

Disfigurement, or

Dysfunction.

"Subcontractor" means a person, agency, or organization that enters into an agreement with a contractor or subcontractor to provide services.

(Adopted under an exemption from A.R.S. Title 41, Chapter 6, pursuant to Laws 1998, Ch. 4, § 11, 4th Special Session, effective October 23, 1998 (Supp. 98-4). Amended by exempt rulemaking at 5 A.A.R. 3670, effective September 10, 1999 (Supp. 99-3). Amended by exempt rulemaking at 6 A.A.R. 282, effective December 16, 1999 (Supp. 99-4). Amended by exempt rulemaking at 6 A.A.R. 3205, effective August 4, 2000 (Supp. 00-3). Amended by exempt rulemaking at 7 A.A.R. 4740, effective October 1, 2001 (Supp. 01-3). Amended by final rulemaking at 7 A.A.R. 5846, effective December 7, 2001 (Supp. 01-4). Amended by final rulemaking at 8 A.A.R. 2365, effective May 9, 2002 (Supp. 02-2). Amended by final rulemaking at 8 A.A.R. 3350, effective July 15, 2002 (Supp. 02-3). Amended by final rulemaking at 11 A.A.R. 4295, effective December 5, 2005 (Supp. 05-4). Amended by final rulemaking at 13 A.A.R. 1103, effective May 5, 2007 (Supp. 07-1).)

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