Section R9-31-213. Health Risk Assessment and Screening Services

A.      As authorized by A.R.S. § 36-2989, the following services shall be covered for a member:

1.        Screening services, including:

a.         Comprehensive health, behavioral health and devel- opmental histories;

b.        Comprehensive unclothed physical examination;

c.         Appropriate  immunizations  according  to  age  and health history; and

d.        Health education, including anticipatory guidance.

2.        Vision services including:

a.         Diagnosis and treatment for defects in vision,

b.        Eye examinations for the provision of prescriptive lenses, and

c.         Provision of prescriptive lenses.

3.        Hearing services, including:

a.         Diagnosis and treatment for defects in hearing,

b.        Testing to determine hearing impairment, and

c.         Provision of hearing aids.

B.       All providers of services shall meet the following standards:

1.        Provide services by or under the direction of, the mem- ber’s primary care provider or dentist.

2.        Perform tests and examinations as specified in contract and under 42 CFR 441, Subpart B, January 29, 1985, which is incorporated by reference and on file with the Office of the Secretary of State and the Administration. This incorporation by reference contains no future edi- tions or amendments.

3.        Refer members as necessary for dental diagnosis and treatment, and necessary specialty care.

4.        Refer members as necessary for behavioral health evalua- tion and treatment services as specified in 9 A.A.C. 31, Article 12.

C.      A contractor shall meet the following additional conditions for members:

1.        Provide information to members and their parents or guardians concerning services; and

2.        Notify members and their parents or guardians regarding the initiation of screening and subsequent appointments according to  the AHCCCS Administration Periodicity Schedule.

D.      A contractor, primary care provider, attending physician, or practitioner shall refer a member with special health  care needs under A.A.C. R9-7-301 to CRS.

Historical Note

Adopted under an exemption from A.R.S. Title 41, Chap- ter 6, pursuant to Laws 1998, Ch. 4, § 11, 4th Special Ses-

sion, effective October 23, 1998 (Supp. 98-4). Amended by exempt rulemaking at 5 A.A.R. 3670, effective Sep- tember 10, 1999 (Supp. 99-3). Amended by final

rulemaking at 7 A.A.R. 5846, effective December 7, 2001

(Supp. 01-4).