Section R9-6-401. Definitions

In this Article, unless otherwise specified:

1.        “ADAP” means the AIDS Drug Assistance Program.

2.        “Adult” means an individual who is:

a.        Eighteen or more years old;

b.        Married; or

c.        Emancipated, as specified in A.R.S. Title 12, Chap- ter 15.

3.        “Advocacy” means the act of supporting, recommending, or arguing in favor of a cause or course of action for the benefit of an individual or group of individuals.

4.        “AHCCCS” means the Arizona Health Care Cost Con- tainment System.

5.        “Annual family income” means the combined yearly gross earned income and unearned income of all adult individuals within a family unit.

6.        “Applicant” means an individual for whom a request for initial enrollment in ADAP is submitted to the Depart- ment, as specified in R9-6-404.

7.        “Applying for a low-income subsidy” means submitting forms and supporting documentation to the Social Secu- rity Administration for determining eligibility for receiv- ing a low-income subsidy.

8.        “Biological substance” means a compound made by or derived from a plant or animal source.

9.        “Business day” means any day of the week other than a Saturday, Sunday, legal holiday, or day on which the Department is authorized or obligated by law or execu- tive order to close.

10.     “Calendar day” means any day of the week, including a Saturday, Sunday, or legal holiday.

11.     “Case management services” means the activities per- formed by a case manager for an HIV-infected individual or the individuals in the HIV-infected individual’s family unit.

12.     “Case manager” means an individual who:

a.        Assesses the needs of an HIV-infected individual for health services, housing, support services, and finan- cial assistance;

b.        Assists the HIV-infected individual with obtaining health services, housing, support services, or finan- cial assistance, as applicable;

c.        Coordinates the interaction of the HIV-infected indi- vidual with service providers; and

d.        Monitors the interaction of the HIV-infected individ- ual with service providers to:

i.         Determine the effects of each service pro- vider’s activities on the needs of the HIV- infected individual, and

ii.        Develop strategies to reduce unmet needs.

13.     “CD4-T-lymphocyte count” means the number of a spe- cific type of white blood cell in a cubic millimeter of blood.

14.     “Community service organization” means a nonprofit entity that assists an individual who is infected with HIV or affected by another individual’s infection with HIV by providing the services listed below or coordinating the interaction of the individual with service providers to obtain or retain:

a.        Rehabilitation services,

b.        Case management services,

c.        Support services,

d.        Advocacy,

e.        Financial assistance, or

f.         Housing.

15.     “Confirmatory test” means a laboratory analysis, such as a Western blot analysis, approved by the U.S. Food and Drug Administration to be used after a screening test to diagnose or monitor the progression of HIV infection.

16.     “Current” means within the six months before the:

a.        Date of application, or

b.        Date on which an enrolled individual submits to the Department the documents required in R9-6-407 for continuing enrollment.

17.     “Date of application” means the month, day, and year that an individual submits the documents specified in R9-6- 404 to the Department as an application for initial enroll- ment in ADAP.

18.     “Diagnosis” means an identification of a communicable disease by an individual authorized by law to make the identification.

19.     “Drug” means a chemical or biological substance deter- mined by the U.S. Food and Drug Administration to be useful in the treatment of individuals with HIV infection and available only through a prescription order.

20.  “Earned income” means monetary payments received by an individual as a result of work performed or rental of property owned or leased by the individual, including:

a.        Wages,

b.        Commissions and fees,

c.        Salaries and tips,

d.        Profit from self-employment,

e.        Profit from rent received from a tenant or boarder, and

f.         Any other monetary payments received by an indi- vidual for work performed or rental of property.

21.     “Employed” means working for a person for money in the form of wages or a salary.

22.     “Enrolling in a Medicare drug plan” means submitting information to the Centers for Medicare and Medicaid Services during an initial enrollment period or general enrollment period and selecting a Medicare drug plan.

23.  “Family unit” means:

a.        A group of individuals residing together who are related by birth, marriage, or adoption; or

b.        An individual who:

i.         Does not reside with another individual; or

ii   Resides only with another individual or group of individuals to whom the individual is unre- lated by birth, marriage, or adoption.

24.     “Formulary” means a list of drugs that are available to an individual through the individual’s health insurance or ADAP.

25.     “General enrollment period” means the interval of time between November 15 and December 31 of each calendar year during which an individual:

a.        May enroll in a Medicare drug plan if the individual, before May 15, 2006:

i.         Was enrolled in Medicare,

ii.        Was eligible to enroll in a Medicare drug plan, and

iii.      Did not enroll in a Medicare drug plan; or

b.        Currently  enrolled   in  a  Medicare  drug   plan  may select a different Medicare drug plan.

26.     “Gift” means something given voluntarily by an individ- ual to another individual without payment in return.

27.     “Guardian” means an individual appointed as a legal guardian by a court of competent jurisdiction.

28.     “Health-related services” means the same as in A.R.S. § 36-401.

29.     “Health services” means medical services, nursing ser- vices, or health-related services provided to an individual.

30.     “HIV infection” means the same as in A.R.S. § 36-661.

31.     “Homeless” means having a primary nighttime sleeping place that is not:

a.        Designed to be a sleeping place for human beings, or

b.        Ordinarily  used  as  a  primary  nighttime   sleeping place for human beings.

32.     “Initial enrollment period” means the interval of time during which an individual may first enroll in a Medicare drug plan.

33.     “Job” means a position in which an individual is employed.

34.     “Low-income subsidy” means Medicare-provided assis- tance that may partially or fully cover the costs of drugs and is based on the income of an individual and, if appli- cable, the individual’s spouse.

35.     “Medical services” means the same as in A.R.S. § 36- 401.

36.     “Medicare” means a federal health insurance program established under Title XVIII of the Social Security Act.

37.     “Medicare drug plan” means insurance approved by Medicare to cover some of the costs of drugs for individ- uals enrolled in Medicare.

38.     “Non-permanent housing” means a living situation in which an individual is:

a.        Homeless, or

b.        Living in a shelter or other temporary living arrange- ment.

39.     “Nonprofit” means owned and operated under the direc- tion of an entity that is recognized as exempt under § 501 of the U.S. Internal Revenue Code.

40.     “Nursing services” means the same as in A.R.S. § 36- 401.

41.     “Physician” means an individual licensed as a doctor of allopathic medicine under A.R.S. Title 32, Chapter 13, or as a doctor of osteopathic medicine under A.R.S. Title 32, Chapter 17.

42.     “Physician assistant” means an individual licensed under

A.R.S. Title 32, Chapter 25.

43.     “Poverty level” means the annual family income for a family unit of a particular size, as specified in the poverty guidelines updated annually in the Federal Register by the U.S. Department of Health and Human Services.

44.     “Prescription order” means the same as in A.R.S. § 32- 1901.

45.     “Primary care provider” means the physician, registered nurse practitioner, or physician assistant who is treating an applicant or enrolled individual for HIV infection.

46.     “Provisional enrollment” means an interval of time, determined by the Department, during which an individ- ual who meets the eligibility criteria specified in R9-6- 403(1) through (4) may receive drugs on the ADAP for- mulary through the vendor pharmacy while the individual is waiting for:

a.        An  eligibility determination  for   AHCCCS  enroll- ment or a low-income subsidy; or

b.        Enrollment in a Medicare drug plan.

47.  “Public assistance” means a government program that pro- vides a monetary payment, or that supplies goods or ser- vices that have a monetary value, to individuals, based on need, such as Supplemental Security Income, Temporary Aid to Needy Families, Food Stamps, or non-federally funded General Assistance.

48.     “Registered nurse practitioner” means an individual who meets the definition of registered nurse practitioner in

A.R.S. § 32-1601 and is licensed under A.R.S. Title 32, Chapter 15.

49.     “Regular” means recurring at fixed intervals.

50.     “Rehabilitation services” means the same as in A.A.C. R9-10-201.

51.     “Representative” means the:

a.        Guardian of an individual;

b.        Parent of an individual who is not an adult; or

c.        Person designated as an agent for an individual through a power of attorney, as specified in A.R.S. Title 14, Chapter 5, Article 5.

52.     “Reservist” means a member of the Reserves of the U.S. Army, Air Force, Navy, Marine Corps, or Coast Guard.

53.     “Resident” means an individual who has a place of habi- tation in Arizona and lives in Arizona as other than a tourist.

54.     “Restricted drug” means a drug on the ADAP formulary that is approved by the Department on a case-by-case basis for enrolled individuals who meet medical indica- tions for the use of the drug.

55.     “Routine training” means military education and related hands-on activities designed to make an individual ready for the tasks the individual would be expected to perform

as a member of the U.S. Air Force, Army, Coast Guard, Marine Corps, or Navy.

56.     “Screening test” means a laboratory analysis approved by the U.S. Food and Drug Administration as an initial test to indicate the possibility that an individual is HIV infected.

57.     “Self-employed” means receiving money as a direct result of the work performed by an individual rather than from wages or a salary paid to the individual.

58.     “Service provider” means an individual who provides medical services, nursing services, health-related ser- vices, or support services for an HIV-infected individual.

59.     “Shelter” means a facility that provides individuals with a temporary place to sleep at night with the expectation that the individual will go elsewhere during the daylight hours.

60.     “Support services” means activities, not related to the treatment of HIV infection, intended to maintain or improve the physical, mental, or psychosocial capabilities of an HIV-infected individual or the individual’s family unit and that may include:

a.        Providing opportunities for social interactions for HIV-infected individuals;

b.        Taking care of a child of an HIV-infected individual while the HIV-infected individual receives medical services;

c.        Providing food or meals to an HIV-infected individ- ual in the HIV-infected individual’s residence; or

d.        Providing information about available support ser- vices or materials about how to reduce the risk of spreading HIV.

61.     “Temporary” means transient, with no expectation of per- manence.

62.     “Third-party payor” means a person other than an HIV- infected individual, such as health insurance or an employer, that is responsible for paying a portion of the costs of drugs for the HIV-infected individual.

63.     “Tourist” means an individual who is living in Arizona but maintains a place of habitation outside of Arizona and lives outside of Arizona for more than six months during a calendar year.

64.     “Treatment” means the administration to an individual of health services intended to relieve illness or injury.

65.     “Unearned income” means monetary payments received by an individual that are not compensation for work per- formed or rental of property owned or leased by the indi- vidual, including:

a.        Unemployment insurance;

b.        Workers’ compensation;

c.        Disability payments;

d.        Payments from the Social Security Administration;

e.        Payments from public assistance;

f.         Periodic insurance or annuity payments;

g.        Retirement or pension payments;

h.        Strike benefits from union funds;

i.         Training stipends;

j.         Child support payments;

k.        Alimony payments;

l.         Military family allotments;

m.      Regular support payments from a relative or other individual not residing in the household;

n.        Investment income;

o.        Royalty payments;

p.        Periodic payments from estates or trusts; and

q.        Any other monetary payments received by an indi- vidual that are not:

i.         As a result of work performed or rental of prop- erty owned by the individual,

ii      Gifts,

iii.      Lump-sum capital gains payments,

iv.      Lump-sum inheritance payments,

v.        Lump-sum insurance payments, or

vi.      Payments  made  to  compensate  for  personal injury.

66.     “Vendor pharmacy” means an entity that contracts with the Department to perform the activities specified in R9- 6-409(C).

67.     “Veteran” means an individual who has served in the United States Armed Forces.

68.     “Viral load test” means a laboratory analysis to determine the amount of HIV circulating in the body of an individ- ual.

Historical Note

Adopted as an emergency effective January 12, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-1). Emergency expired. Readopted without change as an emergency effective May 9, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-2).

Amended and readopted as an emergency effective August 8, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-3). Emergency expired.

Readopted without change as an emergency effective November 16, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired.

Adopted without change as a permanent rule effective May 22, 1989. Amended as an emergency effective June 26, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Emergency amendment readopted without change effective October 17, 1989 (Supp. 89-4). Amended effective September 19, 1990 (Supp. 90-3). Renumbered from R9-6-801 effective October 19, 1993 (Supp. 93-4). Former Section R9-6-401 renumbered to R9-6-402; new Section R9-6-401 made by final rulemaking at 8 A.A.R. 1953, effective April 3,

2002 (Supp. 02-2). Amended by final rulemaking at 13

A.A.R. 3329, effective November 10, 2007 (Supp. 07-3).