Ariz. Admin. Code § R9-15-209 - Supplemental Verification Requirements of Primary Care Services

A. In addition to the requirements in R9-15-105, if primary care services are provided :

1. By means of telemedicine, a primary care provider shall

1. Report the number of telemedicine hours worked, and

2. attest that the originating site where the telemedicine patient is located and the distant site where the primary care provider is located are both in a HPSA or, if applicable, both in an AzMUA; and

B. If a primary care provider provides primary care services

2. At a critical access hospital with a separate qualifying service site, the primary care provider shall report the:

1.

a. Total number of hours the primary care provider provided primary care services at the qualifying service site separate from the critical access hospital, and

2. b. Total number of hours worked at the critical access hospital.

C. A primary care provider shall submit verification of primary care service hours worked at the primary care provider's approved service site on a Department-provided format containing:

1. The primary care provider's name;

2. The beginning and ending dates during which the primary care services were provided;

3. Whether the primary care provider is providing primary care services full-time or half-time;

4. The primary care provider's notarized signature and date of signature; and

5. The primary care provider's approved service site's licensee, tribal authority, or employer's notarized signature and date of signature.

D. A primary care provider shall submit documentation of primary care service encounters provided at the primary care provider's approved service site in a Department-provided form containing:

1. The primary care provider's name;

2. The beginning and ending dates during which the primary care services were provided;

3. The number of total encounters the primary care provider provided during the time reported in subsection (D)(2);

4. The number of total encounters used the sliding-fee scale the primary care provider provided during the time reported in subsection (D)(2);

5. The primary care provider's notarized signature and date of signature; and

6. The primary care provider's approved service site's licensee, tribal authority, or employer's notarized signature and date of signature.

E. Upon receipt of the verification in subsection (C) and the documentation in subsection (D), the Department shall disburse loan payment funds to the primary care provider's lender or lenders.

F. Primary care services performed before the effective date of a loan repayment contract do not satisfy the contracted primary care health professional service obligation and are not eligible for loan repayment funds.

G. The Department shall disburse loan repayment funds for primary care services provided during a loan repayment contract period according to the allocations in R9-15-209 .

H. The Department may delay disbursing loan repayment funds to a primary care provider's lender or lenders if the primary care provider fails to submit complete or timely service verification and encounter report forms.

I. The Department shall not disburse loan repayment funds to a primary care provider's lender or lenders if the primary care provider fails to submit complete and accurate information required in the service verification and the encounter report forms.

Notes

Ariz. Admin. Code § R9-15-209

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 R9-15-210 and amended by emergency rulemaking at 28 A.A.R. 3684, effective 11/15/2022. Amended by emergency rulemaking at 29 A.A.R. 1274, effective 5/14/2023. Renumbered from R9-15-210 and amended by final rulemaking at 29 A.A.R. 3837, effective 12/6/2023.