A. To
continue enrollment in ADAP, an enrolled individual or the enrolled
individual's representative shall:
1. When the
enrolled individual's residential address changes, comply with subsection (B);
2.
When the enrolled individual's primary care provider
changes, comply with subsection (C);
3.
2.
When the enrolled individual's annual household income changes, comply with
subsection (C);
4.3. When the enrolled
individual becomes eligible for Medicare or other health insurance coverage,
comply with subsection (D);
5. 4. Before the end of
the month that is six months after the enrolled individual's month of birth,
comply with subsection (E); and
6. 5. Before the end of
the enrolled individual's month of birth each year after an individual's
initial enrollment, comply with subsection (F).
B. When an enrolled individual's residential
address changes, the enrolled individual or the enrolled individual's
representative shall submit to the Department:
1.
Complete a Department-provided form containing for
the enrolled individual the information specified in
R9-6-404(A)(1)(a)
through
R9-6-404(A)(1)(h)
and
R9-6-404(A)(1)(j),
(k), (m), (n), and (o);
2.
Attest on the form specified in subsection (B)(1)
that:
a.
To the best of the knowledge and belief of the
enrolled individual or the enrolled individual's representative, the
information submitted in the form and the documents submitted with the form are
accurate and complete;
b.
The enrolled individual meets the eligibility
criteria specified in
R9-6-403;
and
c.
The enrolled individual or the enrolled individual's
representative understands that eligibility does not guarantee that the
Department will be able to provide drugs and that an individual's enrollment in
ADAP may be terminated as specified in
R9-6-408;
3.
Grant permission on the form specified in subsection
(B)(1) for the Department to discuss the enrolled individual's enrollment
with:
a.
AHCCCS, for the purpose of determining AHCCCS
eligibility;
b.
Medicare and the Social Security Administration, for
the purpose of determining eligibility for a low-income subsidy and enrollment
in a Medicare drug plan;
c.
The applicant's primary care provider or
designee;
d.
The vendor pharmacy, to assist with drug
distribution; and
e.
Any other entity as necessary to establish
eligibility for enrollment in ADAP or assist with drug
distribution;
4.
Sign and date the form specified in subsection
(B)(1); and
5.
Submit to the Department within 30 calendar days of
the change:
a.
The form specified in subsection (B)(1);
and
1. The following
information for the enrolled individual in a Department-provided format:
a. The enrolled individual's name and date of
birth;
b. The new residential
address and mailing address for the enrolled individual;
c. If the enrolled individual is in
non-permanent housing, the address of a person that has agreed to receive
written communications for the enrolled individual; and
d. If applicable, the address in Arizona to
which the enrolled individual would want drugs to be shipped; and
b.
2. Proof of Arizona residency, as specified in
R9-6-404(A)(8), showing the new Arizona residential address specified in
subsection (B)(1)(b).
C.
When an enrolled individual's primary care provider
changes, the enrolled individual or the enrolled individual's representative
shall:
1.
Comply with subsections (B)(1) through
(4);
2.
Obtain from the new primary care provider the
Department-provided form specified in subsection (D), completed by the new
primary care provider; and
3.
Submit the form specified in subsection (B)(1) and
the form specified in subsection (C)(2) to the Department within 30 calendar
days after the change.
D.
The primary care provider of an enrolled individual
shall complete for the enrolled individual a Department-provided form
containing:
1.
The information required under
R9-6-404(B)(1),
(2), and (5) through (8); and
2.
The dates of and results for the most recent
CD4-T-lymphocyte count and, if available, viral load test conducted for the
enrolled individual.
E.
C. When an enrolled
individual's annual household income changes, the enrolled individual or the
enrolled individual's representative shall:
1.
Submit to the Department, within 30 calendar days after the change,
documentation of the enrolled individual's annual household income, as
specified in
R9-6-404(A)(6) or
(7); and
2. If the enrolled individual's annual
household income has decreased to an amount that may make the individual
eligible for enrollment in AHCCCS:
1.a. Apply for enrollment
in AHCCCS within 30 calendar days after the change in annual household income;
and
2.
b. Submit to the Department, within 30 calendar days
after the change, documentation that states the status of the enrolled
individual's enrollment in AHCCCS.
F.
D.
When an enrolled individual becomes eligible for Medicare or other health
insurance coverage, the enrolled individual or the enrolled individual's
representative shall, within 30 calendar days after the enrolled individual
becomes eligible for Medicare or other health insurance coverage:
1.
Apply for a low-income subsidy and for a Medicare
drug plan, and
2.
If the enrolled individual is determined to be
ineligible for a low-income subsidy, submit to the Department documentation
that complies with
R9-6-403(6).
1. If eligible for Medicare:
a. Enroll in a Medicare drug plan;
and
b. If the enrolled individual's
annual household income is at or below 175% of the poverty level, apply for a
low-income subsidy; and
c. Submit
to the Department a copy of valid documentation stating:
i. The enrolled individual's enrollment in a
Medicare drug plan; and
ii. If the
enrolled individual's annual household income is at or below 175% of the
poverty level, the status of the enrolled individual's eligibility for a
low-income subsidy; and
2. If eligible for other health insurance
coverage, submit to the Department information about the health insurance
coverage to enable the Department to determine if the health insurance coverage
is inadequate, according to
R9-6-403(4)(b),
or unaffordable, according to R9-6-403(4)(c).
G.
Before the expiration of each six-month period after
an individual's initial enrollment, the enrolled individual or the enrolled
individual's representative shall submit to the Department:
1.
Proof of annual family income, as specified in
R9-6-404(A)(7) or
(8); and
2.
Proof that the enrolled individual is a resident of
Arizona, as specified in
R9-6-404(A)(9).
H.
E. Before the end of the month that is six months
after the enrolled individual's month of birth, the enrolled individual or the
enrolled individual's representative shall:
1.
Either:
a. Submit to the Department an
attestation, in a Department-provided format, that there have been no changes
specified in subsection (A)(1), (2), or (3); or
b. Comply with subsections (B), (C), and (D),
as applicable; and
2.
Obtain from the enrolled individual's HIV-care provider and submit to the
Department a copy of the most recent laboratory report of a test for viral
load, and, if available, CD4-T-lymphocyte count conducted for the applicant
3.
Submit to the Department:
a.
The form specified in subsection
(H)(1),
b.
The form specified in subsection
(H)(2),
c.
Proof of annual family income, as specified in
R9-6-404(A)(7) or
(8), and
d.
Proof that the enrolled individual is a resident of
Arizona, as specified in
R9-6-404(A)(9)
.
F.
Before the end of an enrolled individual's month of birth each year, an
enrolled individual or the enrolled individual's representative shall submit to
the Department the application packet required in
R9-6-404(A).
I.
G
. The Department shall:
1.
Review information about an enrolled individual and determine eligibility for
continuing enrollment for the enrolled individual:
a. At the end of the enrolled individual's
month of birth each year,
b. At the
end of the month that is six months after the enrolled individual's month of
birth each year,
b.
c. When the Department receives information from the
enrolled individual or the enrolled individual's representative under
subsection (A), or
c.
d. When the Department no longer has sufficient funds
to provide continuing enrollment to all enrolled individuals;
2. Grant continuing enrollment to
an enrolled individual, subject to the availability of funds, when:
a. The enrolled individual or the enrolled
individual's representative complies with subsection (A); and
b. The Department determines that:
i. The information in the documents submitted
to the Department is accurate and complete, and
ii. The enrolled individual is eligible under
R9-6-403;
and
3. Notify
the enrolled individual or the enrolled individual's representative of the
Department's decision within five working days after receipt of the documents
required in subsection (A).
H. The Department may grant pre-approved
enrollment status in ADAP, according to R9-6-405(D) or (E) and ending according
to
R9-6-405(G),
to an enrolled individual who is missing documentation to establish eligibility
under
R9-6-403.
J.
I. If
the Department denies continuing enrollment to an enrolled individual, the
Department shall send to the enrolled individual or the enrolled individual's
representative a written notice of denial setting forth the information
required under A.R.S. §
41-1092.03.
