Section R9-22-504. Marketing; Prohibition Against Inducements; Misrepresentations; Discrimination; Sanctions

A.      A contractor or the contractor’s marketing representative shall not offer or give any form of compensation or reward, or engage in any behavior or activity that may be reasonably con- strued as coercive, to induce or procure AHCCCS enrollment with the contractor. Any marketing solicitation offering a ben-

efit, good, or service in excess of the covered services in Arti- cle 2 is deemed an inducement.

B.       A marketing representative shall not misrepresent itself, the contracting health plan represented, or the AHCCCS program, through false advertising, false statements, or in any other manner to induce a member of another contractor to enroll in the represented health plan. Violations of this subsection include, but are not limited to, false or misleading claims, inferences, or representations such as:

1.        A member will lose benefits under the AHCCCS program or lose any other health or welfare benefits to which a member is legally entitled, if the member does not enroll in the represented contracting health plan;

2.        Marketing representatives are employees of the state or representatives of the Administration, a county, or any health plan other than the health plan by which they are employed, or by which they are reimbursed; and

3.        The represented health plan is recommended or endorsed as superior to its competition by any state or county agency, or any organization, unless the organization has certified its endorsement in writing to the health plan and the Administration.

C.      A marketing representative shall not engage in any marketing or pre-enrollment practice that discriminates against a member because of race, creed, age, color, sex, religion, national ori- gin, ancestry, marital status, sexual preference, physical or mental disability, or health status.

D.      The Administration shall hold a contractor responsible for a violation of this Section resulting from the performance of any marketing representative, subcontractor, agent, program, or process under the contractor’s employ or direction and shall impose contract sanctions on the contractor as specified in contract.

E.       A contractor shall produce and distribute informational materi- als that are approved by the Administration to each enrolled member or designated representative after the contractor receives notification of enrollment from the Administration. The contractor shall ensure that the informational materials include, at a minimum:

1.        A description of all covered services as specified in con- tract;

2.        An explanation of service limitations and exclusions;

3.        An explanation of the procedure for obtaining services;

4.        An explanation of the procedure for obtaining emergency services;

5.        An explanation of the procedure for filing a grievance and appeal; and

6.        An explanation of when plan changes may occur as spec- ified in contract.

Historical Note

Adopted as an emergency effective May 20, 1982, pursu- ant to A.R.S. § 41-1003, valid for only 90 days (Supp. 82- 3). Former Section R9-22-504 adopted as an emergency now adopted and amended as a permanent rule effective August 30, 1982 (Supp. 82-4). Former Section R9-22- 504 repealed, former Section R9-22-505 renumbered and adopted without change as Section R9-22-504 effective October 1, 1983 (Supp. 83-5). Former Section R9-22-504 repealed, former Section R9-22-528 renumbered and amended as Section R9-22-504 effective October 1, 1985 (Supp. 85-5). Amended effective December 8, 1997 (Supp. 97-4). Amended by final rulemaking at 11 A.A.R.

4277, effective December 5, 2005 (Supp. 05-4).

Amended by final rulemaking at 14 A.A.R. 4330, effec- tive January 3, 2009 (Supp. 08-4).