Ariz. Admin. Code § 9-28-201

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-28-201 - General Requirements

In addition to the exclusions and limitations specified in this Article, services provided to a member are covered services if:

1. Medically necessary, cost effective, and federally reimbursable;

2. Coordinated by a case manager in accordance with requirements specified in R9-28-510;

3. The provider obtains prior authorization as required by a member's program contractor or by the Administration:

a. Failure of the provider to obtain prior authorization is cause for denial.

b. Services provided during prior period coverage are exempt from prior authorization requirements;

4. Provided in facilities or areas of facilities that are licensed or certified under Article 5 of this Chapter, or meet other requirements described in Article 5 of this Chapter;

5. Rendered by AHCCCS registered providers as permitted under this Chapter and within their scope of practice; and

6. Provided at an appropriate level of care, as determined by the case manager or the primary care provider.

Ariz. Admin. Code § R9-28-201

Adopted effective October 1, 1988, filed September 1, 1988 (Supp. 88-3). Section repealed; new Section adopted effective September 22, 1997 (Supp. 97-3). Amended by final rulemaking at 8 A.A.R. 2356, effective May 9, 2002 (Supp. 02-2).