Ariz. Admin. Code § R9-6-401 - Definitions

In this Article, unless otherwise specified:

1. "ADAP" means the AIDS Drug Assistance Program.

2. "Adult" means an individual who is:

a. Eighteen or more years old;

b. Married; or

c. Emancipated, as specified in A.R.S. Title 12, Chapter 15.

3. "Advocacy" means the act of supporting, recommending, or arguing in favor of a cause or course of action for the benefit of an individual or group of individuals.

4. 3. "AHCCCS" means the Arizona Health Care Cost Containment System.

5. "Annual family income" means combined yearly gross earned income and unearned income of all adult individuals within a family unit.

4. "Annual household income" means the adjusted gross income of all adult individuals within a household, as would be reported on the federal income tax return for an individual in the household, modified to include:

a. Federal taxable wages,

b. Tips,

c. Unemployment compensation,

d. Social security income,

e. Self-employment income,

f. Social security disability income,

g. Retirement or pension income,

h. Capital gains,

i. Investment income,

j. Rental and royalty income,

k. Excluded (untaxed) foreign income, and

l. Alimony.

6. 5. "Applicant" means an individual for whom a request for initial enrollment in ADAP is submitted to the Department, as specified in R9-6-404.

7. 6. "Applying for a low-income subsidy" means submitting forms and supporting documentation to the Social Security Administration for determining eligibility for receiving a low-income subsidy.

8. "Biological substance" means a compound made by or derived from a plant or animal source.

9. "Business day" means any day of the week other than a Saturday, Sunday, legal holiday, or day on which the Department is authorized or obligated by law or executive order to close.

10. 7. "Calendar day" means any day of the week, including a Saturday, Sunday, or legal holiday.

11. "Case management services" means the activities performed by a case manager for an HIV-infected individual or the individuals in the HIV-infected individual's family unit.

12. 8. "Case manager" means an individual who:

a. Assesses the needs of a person living with HIV for:

i. Medical services, nursing services, or health-related services, as defined in A.R.S. § 36-401;

ii. Services not related to the treatment of HIV infection, intended to maintain or improve the physical, mental, or psy-chosocial capabilities of a person living with HIV or an individual in the person living with HIV's household;

iii. Housing; or

iv. Financial assistance;

b. If applicable, assists the person living with HIV with obtaining housing, financial assistance, or the services specified in subsection (8)(a)(i) and (ii);

c. Coordinates the interaction of the person living with HIV with individuals providing the services specified in subsection (8)(a)(i) and (ii); and

d. Monitors the interaction of the person living with HIV with individuals providing the services specified in subsection (8)(a)(i) and (ii) to:

i. Determine the effects of the activities of individuals providing the services specified in subsection (8)(a)(i) and (ii) on the needs of the person living with HIV, and

ii. Develop strategies to reduce unmet needs.

13. 9. "CD4-T-lymphocyte count" means the number of a specific type of white blood cell in a cubic millimeter of blood.

14. "Community service organization" means a nonprofit entity that assists an individual who is infected with HIV or affected by another individual's infection with HIV by providing the services listed below or coordinating the interaction of the individual with service providers to obtain or retain:

a. Rehabilitation services,

b. Case management services,

c. Support services,

d. Advocacy,

e. Financial assistance, or

f. Housing.

15. "Confirmatory test" means a laboratory analysis, such as a Western blot analysis, approved by the U.S. Food and Drug Administration to be used after a screening test to diagnose or monitor the progression of HIV infection.

10. "Contract pharmacy" means an entity that has a legally binding agreement with the Department to dispense drugs through ADAP to enrolled individuals.

16. 11. "Current" means within the six months before the date on which an:

a. Individual submits the documents specified in R9-6-404 to the Department as an application for initial enrollment in ADAP, or

b. Enrolled individual submits to the Department the documents required in R9-6-407 for continuing enrollment.

17. 12. "Date of application" means the month, day, and year that the Department receives the documents specified in R9-6-404 for enrollment in ADAP.

18. "Diagnosis" means an identification of a communicable disease by an individual authorized by law to make the identification.

19. 13. "Drug" means a chemical substance or a compound made by or derived from a plant or animal source that:

a. Has been determined by the U.S. Food and Drug Administration to be useful in the treatment of individuals with HIV infection, and

b. Is available through a prescription order.

20. "Earned income" means monetary payments received by an individual as a result of work performed or rental of property owned or leased by the individual, including:

a. Wages,

b. Commissions and fees,

c. Salaries and tips,

d. Profit from self-employment,

e. Profit from rent received from a tenant or boarder, and

f. Any other monetary payments received by an individual for work performed or rental of property.

21. "Employed" means working for a person for money in the form of wages or a salary.

22. "Enrolling in a Medicare drug plan" means submitting information to the Centers for Medicare and Medicaid Services during an initial enrollment period or general enrollment period and selecting a Medicare drug plan.

23. "Family unit" means:

a. A group of individuals residing together who are related by birth, marriage, or adoption; or

b. An individual who:

i. Does not reside with another individual; or

ii. Resides only with another individual or group of individuals to whom the individual is unrelated by birth, marriage, or adoption. 24.

14. "Formulary" means a list of drugs that are available to an individual through the individual's health insurance or ADAP.

25. "General enrollment period" means the interval of time between November 15 and December 31 of each calendar year during which an individual:

a. May enroll in a Medicare drug plan if the individual, before May 15, 2006:

i. Was enrolled in Medicare,

ii. Was eligible to enroll in a Medicare drug plan, and iii. Did not enroll in a Medicare drug plan; or

b. Currently enrolled in a Medicare drug plan may select a different Medicare drug plan.

26. "Gift" means something given voluntarily by an individual to another individual without payment in return.

27. "Guardian" means an individual appointed as a legal guardian by a court of competent jurisdiction.

15. "Health insurance enrollment period" means an interval of time during which an individual may apply for health insurance coverage, including:

a. An annual interval of time, and

b. Any additional intervals of time due to a change in the individual's situation or circumstances.

28. "Health-related services" means the same as in A.R.S. § 36-401.

29. "Health services" means medical services, nursing services, or health-related services, as provided to an individual. 30.

16. "HIV infection" means the same as in A.R.S. § 36-661.

17. "HIV-care provider" means the physician, registered nurse practitioner, or physician assistant who is treating an applicant or enrolled individual for HIV infection.

31. "Homeless" means having a primary nighttime sleeping place that is not:

a. Designed to be a sleeping place for human beings, or

b. Ordinarily used as a primary nighttime sleeping place for human beings.

18. "Household" means an applicant or enrolled individual and any of the following individuals, as applicable, residing with the applicant or enrolled individual:

a. The applicant's or enrolled individual's spouse;

b. A dependent parent;

c. A parent of a child who is:

i. The applicant or enrolled individual, and

ii. Claimed as a dependent by the parent;

d. A dependent sibling or other relative;

e. A dependent child of the applicant or enrolled individual, regardless of age and including an adopted child or a foster child;

f. A non-dependent child or other relative if claimed or could be claimed as a dependent on the applicant's or enrolled individual's taxes; and

g. A child who is a part of a shared custody agreement of the applicant or enrolled individual, in years for which the child is claimed or could be claimed as a dependent on the applicant's or enrolled individual's taxes.

32. "Initial enrollment period" means the interval of time during which an individual may first enroll in a Medicare drug plan.

33. 19. "Job" means a position in which an individual is employed.

34. 20. "Low-income subsidy" means Medicare-provided assistance that may partially or fully cover the costs of drugs and is based on the annual household income for an individual

35. "Medical services" means the same as in A.R.S. § 36-401.

36. 21. "Medicare" means a federal health insurance program established under Title XVIII of the Social Security Act.

37. 22. "Medicare drug plan" means insurance approved by Medicare to cover some of the costs of drugs for individuals enrolled in Medicare.

38. 23. "Non-permanent housing" means a situation in which an individual is:

a. Living in a place that is not designed to be a sleeping place for human beings or ordinarily used as a primary nighttime sleeping place for human beings, or

b. Living in a shelter or other temporary living arrangement.

39. "Nonprofit" means owned and operated under the direction of an entity that is recognized as exempt under § 501 of the U.S. Internal Revenue Code.

40. "Nursing services" means the same as in A.R.S. § 36-401.

24. "Person living with HIV" means an individual who is HIV-infected.

41. 25. "Physician" means an individual licensed as a:

a. Doctor of allopathic medicine under A.R.S. Title 32, Chapter 13, or through a similar licensing board in another state; or

b. Doctor of osteopathic medicine under A.R.S. Title 32, Chapter 17, or through a similar licensing board in another state.

42. 26. "Physician assistant" means an individual licensed under A.R.S. Title 32, Chapter 25, or through a similar licensing board in another state.

43.27. "Poverty level" means the annual household income for a household of a particular size, as specified in the poverty guidelines updated annually in the Federal Register by the U.S. Department of Health and Human Services.

28. "Pre-approved enrollment status" means that an applicant may receive drugs or other services through ADAP on a temporary basis.

44.29. "Prescription order" means the same as in A.R.S. § 32-1901.

45. "Primary care provider" means the physician, registered nurse practitioner, or physician assistant who is treating an applicant or enrolled individual for HIV infection.

46. "Provisional enrollment" means an interval of time, determined by the Department, during which an individual who meets the eligibility criteria specified in R9-6-403(1) through (4) may receive drugs on the ADAP formulary through the vendor pharmacy while the individual is waiting for:

a. An eligibility determination for AHCCCS enrollment or a low-income subsidy; or

b. Enrollment in a Medicare drug plan.

47. "Public assistance" means a government program that provides a monetary payment, or that supplies goods or services that have a monetary value, to individuals, based on need, such as Supplemental Security Income, Temporary Aid to Needy Families, Food Stamps, or non-federally funded General Assistance.

48. 30. "Registered nurse practitioner" means an individual who meets the definition of registered nurse practitioner in A.R.S. § 32-1601 and is licensed under A.R.S. Title 32, Chapter 15, or through a similar licensing board in another state.

49. 31. "Regular" means recurring at fixed intervals.

50. "Rehabilitation services" means the same as in A.A.C. R9-10-201.

51. 32. "Representative" means the:

a. Guardian of an individual;

b. Parent of an individual who is not an adult; or

c. Person designated as an agent for an individual through a power of attorney, as specified in A.R.S. Title 14, Chapter 5, Article 5.

52. "Reservist" means a member of the Reserves of the U.S. Army, Air Force, Navy, Marine Corps, or Coast Guard.

53. 33. "Resident" means an individual who has a place of habitation in Arizona and is living in Arizona .

54. "Restricted drug" means a drug on the ADAP formulary that is approved by the Department on a case-by-case basis for enrolled individuals who meet medical indications for the use of the drug.

55. "Routine training" means military education and related hands-on activities designed to make an individual ready for the tasks the individual would be expected to perform as a member of the U.S. Air Force, Army, Coast Guard, Marine Corps, or Navy.

56. "Screening test" means a laboratory analysis approved by the U.S. Food and Drug Administration as an initial test to indicate the possibility that an individual is HIV infected.

57. 34. "Self-employed" means receiving money as a direct result of the work performed by an individual rather than from wages or a salary paid to the individual.

58. "Service provider" means an individual who provides medical services, nursing services, health-related services, or support services for an HIV-infected individual.

59. "Shelter" means a facility that provides individuals with a temporary place to sleep at night with the expectation that the individual will go elsewhere during the daylight hours.

60. "Support services" means activities, not related to the treatment of HIV infection, intended to maintain or improve the physical, mental, or psychosocial capabilities of an HIV-infected individual or the individual's family unit and that may include:

a. Providing opportunities for social interactions for HIV-infected individuals;

b. Taking care of a child of an HIV-infected individual while the HIV-infected individual receives medical services;

c. Providing food or meals to an HIV-infected individual in the residence; or

d. Providing information about available support services or materials about how to reduce the risk of spreading HIV.

61. "Temporary" means transient, with no expectation of permanence.

62. "Third-party payor" means a person other than an HIV-infected individual, such as health insurance or an employer, that is responsible for paying a portion of the costs of drugs for the HIV-infected individual.

63. "Tourist" means an individual who is living in Arizona but maintains a place of habitation outside of Arizona and lives outside of Arizona for more than six months during a calendar year.

64. "Treatment" means the administration to an individual of health services intended to relieve illness or injury.

65. "Unearned income" means monetary payments received by an individual that are not compensation for work performed or rental of property owned or leased by the individual, including:

a. Unemployment insurance;

b. Workers' compensation;

c. Disability payments;

d. Payments from the Social Security Administration;

e. Payments from public assistance;

f. Periodic insurance or annuity payments;

g. Retirement or pension payments;

h. Strike benefits from union funds;

i. Training stipends;

j. Child support payments;

k. Alimony payments;

l. Military family allotments;

m. Regular support payments from a relative or other individual not residing in the household;

n. Investment income;

o. Royalty payments;

p. Periodic payments from estates or trusts; and

q. Any other monetary payments received by an individual that are not:

i. As a result of work performed or rental of property owned by the individual,

ii. Gifts,

iii. Lump-sum capital gains payments,

iv. Lump-sum inheritance payments,

v. Lump-sum insurance payments, or

vi. Payments made to compensate for personal injury.

35. "Valid" means still in effect or having legal force.

66. "Vendor pharmacy" means an entity that contracts with the Department to perform the activities specified in R9-6-409(C).

67. "Veteran" means an individual who has served in the United States Armed Forces.

36. "Viral load" means the amount of HIV circulating in the body of an individual.

68. "Viral load test" means a laboratory analysis to determine the amount of HIV circulating in the body of an individual.

Notes

Ariz. Admin. Code § R9-6-401

Adopted as an emergency effective January 12, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-1). Emergency expired. Readopted without change as an emergency effective May 9, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-2). Amended and readopted as an emergency effective August 8, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-3). Emergency expired. Readopted without change as an emergency effective November 16, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Adopted without change as a permanent rule effective May 22, 1989. Amended as an emergency effective June 26, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Emergency amendment readopted without change effective October 17, 1989 (Supp. 89-4). Amended effective September 19, 1990 (Supp. 90-3). Renumbered from R9-6-801 effective October 19, 1993 (Supp. 93-4). Former Section R9-6-401 renumbered to R9-6-402; new Section R9-6-401made by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Amended by final rulemaking at 13 A.A.R. 3329, effective November 10, 2007 (Supp. 07-3). Amended by final rulemaking at 25 A.A.R. 3614, effective 12/3/2019.