Section R9-6-405. Enrollment Process; Provisional Enrollment

A.      The Department shall:

1.        Review the documents submitted by an applicant as required in R9-6-404(A);

2.        Determine whether the applicant is eligible under R9-6- 403;

3.        Grant or deny enrollment based on applicant eligibility, the date of application, and the availability of funds; and

4.        Notify the applicant or the applicant’s representative of the Department’s decision within five business days after receiving the documents specified in R9-6-404(A).

B.       An applicant or the applicant’s representative shall execute any consent forms or releases of information necessary for the Department to verify eligibility.

C.      The Department shall send an applicant or the applicant’s rep- resentative a written notice of denial, setting forth the informa- tion required under A.R.S. § 41-1092.03, if:

1.        The applicant or the applicant’s representative fails to provide documentation establishing eligibility for enroll- ment in ADAP,

2.        The documentation submitted to the Department under R9-6-404 is found to contain false information, or

3.        The Department does not have funds available to enroll the applicant in ADAP.

D.      The Department shall grant a 30-day provisional enrollment in ADAP to an applicant if:

1.        The Department determines that the applicant meets the requirements of R9-6-403(1) through (4); and

2.        The applicant or the applicant’s representative attests in writing that the applicant has applied for AHCCCS enrollment and, if eligible for Medicare, a low-income subsidy and a Medicare drug plan, but is unable to pro- vide documentation that complies with R9-6-403(5) or

(6) or both.

E.       The Department shall provide an applicant to whom the Department has granted provisional enrollment in ADAP with the drugs on the list specified in R9-6-404(B)(5) during the provisional enrollment period.

F.       Except as specified in subsection (H), to continue ADAP enrollment beyond a 30-day provisional enrollment period, an applicant or the applicant’s representative shall provide to the Department, before the end of the 30-day provisional enroll- ment period, documentation that complies with R9-6-403(5) and, if applicable, R9-6-403(6).

G.      Except as specified in subsection (H), if an applicant with pro- visional enrollment or the applicant’s representative fails to provide documentation as required in subsection (F) to the Department before end of a 30-day provisional enrollment period, the Department shall send the applicant or the appli- cant’s representative a written notice of denial, setting forth the information required under A.R.S. § 41-1092.03.

H.      The Department may grant an extension of provisional enroll- ment to an applicant beyond a 30-day provisional enrollment period if the applicant or the applicant’s representative pro- vides documentation to the Department that the applicant has applied for AHCCCS enrollment and, if eligible for Medicare, a low-income subsidy and Medicare drug plan and:

1.        AHCCCS has not yet determined whether the applicant is eligible for AHCCCS enrollment; or

2.        If the applicant is eligible for Medicare:

a.        The Social Security Administration has not yet determined whether the applicant is eligible for a low-income subsidy, or

b.        The applicant cannot enroll in a Medicare drug plan until the next general enrollment period.

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 as an emergency and subsection (B), Para- graph (2) corrected effective November 16, 1988, pursu- ant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88- 4). Emergency expired. Adopted without change as a per- manent rule effective May 22, 1989 (Supp. 89-2).

Renumbered from R9-6-805 and amended effective October 19, 1993 (Supp. 93-4). Former Section R9-6-405 renumbered to R9-6-406; new Section R9-6-405 renum- bered from R9-6-404 and amended 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, effec- tive November 10, 2007 (Supp. 07-3).