Section R9-22-509. Transition and Coordination of Member Care

A.      A contractor shall assist in the transition of members to and from other AHCCCS contractors.

1.        Both the receiving and relinquishing contractor shall:

a.         Coordinate with the other contractor to facilitate and schedule appointments for medically necessary ser- vices for the transitioned member within the Admin- istration’s timelines specified in the contract. If requested by the Administration, a contractor shall submit the policies and procedures regarding transi- tion of members to the Administration for review and approval;

b.        Assist in the referral  of transitioned members to other community health agencies or county medical assistance programs for medically necessary ser- vices not covered by the Administration, as appro- priate; and

c.         Develop policies and procedures to be followed when transitioning members who have significant medical conditions; are receiving ongoing services; or have, at the time of the transition, received prior authorization or approval for undelivered, specific services.

2.        The relinquishing contractor shall notify the receiving contractor of relevant information about the member’s medical condition and current treatment regimens within the timelines defined in contract;

3.        The relinquishing contractor shall forward medical records and other relevant materials to the receiving con- tractor. The relinquishing contractor shall bear the cost of reproducing and forwarding medical records and other relevant materials;

4.        Within the timelines specified in contract, the receiving contractor shall ensure that the member selects or is assigned to a primary care provider, and provide the member with:

a.         Information regarding the contractor’s providers,

b.        Emergency numbers, and

c.         Instructions about how to obtain services.

B.       A contractor shall not use a county or noncontracting provider health resource alternative to diminish the contractor’s con- tractual responsibility or accountability for providing the full scope of covered services. The Administration may impose sanctions as described in contract if a contractor makes refer- rals to other agencies or programs to reduce expenses incurred by the contractor on behalf of its members.

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-

Arizona Health Care Cost Containment System - Administration

3). Former Section R9-22-509 adopted as an emergency adopted, amended and renumbered as Section R9-22-508, former Section R9-22-510 adopted as an emergency now adopted and renumbered as Section R9-22-509 as a per- manent rule effective August 30, 1982 (Supp. 82-4). For- mer Section R9-22-509 repealed, former Section R9-22- 505 renumbered and amended as Section R9-22-509 effective October 1, 1985 (Supp. 85-5). Amended effec-

tive 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, effective January 3, 2009 (Supp. 08-4).