Ariz. Admin. Code § R9-31-306 - Enrollment

A. Enrollment requirements applicable to the KidsCare program are described under Chapter 22, Article 17.

1. Except as provided in subsections (A)(3), (4), and (5), at the time of application, an applicant shall select from the following enrollment choices:

a. A contractor which includes a contractor or a qualifying plan as defined in A.R.S. § 36-2981, or

b. The IHS as specified in A.R.S. § 36-2982 . If a member is enrolled with the IHS, a member may elect to receive covered services from a participating Tribal Facility.

2. Except as provided in subsections (A)(3), (4), and (5), coverage shall not begin until a Title XXI enrollment choice is made.

3. The Administration shall enroll a member with CMDP when a member is a foster care child according to A.R.S. § 8-512 .

4. When a Title XIX member becomes ineligible for Title XIX and DES determines the member eligible for Title XXI with no break in coverage,

a. The Title XXI member shall remain enrolled with the Title XIX contractor; and

b. The Administration shall send the Title XXI member a notice explaining the member's right to choose as specified in subsection (A)(1).

5. When an applicant applies for Title XIX through DES and DES determines the applicant ineligible for Title XIX but eligible for Title XXI, the Administration shall enroll the applicant for Title XXI as follows:

a. If a Title XIX contractor pre-enrollment choice is pending at the time the Administration receives the Title XXI approval from DES, the Administration may:

i. Enroll member with the Title XIX contractor, and

ii. Notify the member of the member's enrollment and provide the member an opportunity to select an enrollment choice as specified in subsection (A)(1).

b. If there is no pending Title XIX choice at the time the Administration receives the Title XXI approval from DES, the Administration shall pend the Title XXI decision and obtain a choice from the member as specified in subsection (A)(1).

B. Effective date of initial enrollment.

1. For an eligibility determination completed by the 25th day of the month, enrollment shall begin on the first day of the month following the determination of eligibility.

2. For an eligibility determination completed after the 25th day of the month, enrollment shall begin on the first day of the second month following the determination of eligibility.

C. Enrollment changes.

1. If a member moves from one GSA to another GSA during the period of enrollment, enrollment changes shall occur as follows:

a. If a member's current enrollment choice is available in a member's new GSA, a member shall remain enrolled with the member's current enrollment choice.

b. If a member's current enrollment choice is not available in the new GSA, a member shall:

i. Remain enrolled with the current enrollment choice. The current enrollment choice may limit services to emergency services outside the GSA as specified in R9-31-201 .

ii. Select from the enrollment choices provided in R9-31-306(A)(1) that are available in the new GSA. Once a new choice is made, a member shall be enrolled with the new choice effective with the date the Administration processes the member's enrollment choice. Covered services shall be available on the date of the enrollment change.

2. A member may change a member's enrollment choice:

a. During a member's annual enrollment choice period,

b. At any time from:

i. IHS to a contractor as specified in subsection (A)(1) of this Section; or

ii. A contractor to IHS.

c. When a member is no longer a foster care child as specified in subsection (A)(3) of this Section.

3. Except for subsection (C)(2)(c) of this Section, the effective date of the new enrollment choice is the date the Administration processes the enrollment choice. The effective date of the enrollment change from CMDP to a Title XXI choice as specified in subsection (A)(1) of this Section, shall be the first of the following month.

D. Annual enrollment choice period. A member shall have the opportunity to change enrollment no later than 12 months following the last time a member made an enrollment choice or had the opportunity to make an enrollment choice.

E. Health Insurance Portability and Accountability Act of 1996. As specified in A.R.S. § 36-2982, a Title XXI member who has been disenrolled shall be allowed to use enrollment in the Title XXI program as creditable coverage as defined in A.R.S. § 36-2984.

Notes

Ariz. Admin. Code § R9-31-306

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 final rulemaking at 7 A.A.R. 5846, effective December 7, 2001 (Supp. 01-4). Amended by final rulemaking at 20 A.A.R. 193, effective 1/7/2014.