Section R9-22-216. NF, Alternative HCBS Setting, or HCBS

A.      Services provided in a NF, including room and board, an alter- native 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

Arizona Health Care Cost Containment System - Administration

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 require- ments;

6.        Physical therapy prescribed only as a maintenance regi- men; and

7.        Assistive devices and non-customized durable medical equipment.

C.      A provider shall obtain prior authorization from the Adminis- tration for a NF admission for a FFS member.

Historical Note

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 Section repealed, new Section adopted effective September 22, 1997 (Supp. 97-3).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). Sub- section (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).