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.
Notes
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 Section repealed, new Section adopted effective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.
