Section R9-6-407. Continuing Enrollment

A.      To continue enrollment in ADAP, an enrolled individual or the enrolled individual’s representative shall:

1.        When the enrolled individual’s residential or mailing address changes, comply with subsection (B);

2.        When the enrolled individual’s primary care provider changes, comply with subsection (C);

3.        When the enrolled individual’s annual family income decreases to an amount that may make the individual eli- gible for enrollment in AHCCCS, comply with subsec- tion (E);

4.        When the enrolled individual becomes eligible for Medi- care, comply with subsection (F);

5.        Before the expiration of each six-month period after an individual’s initial enrollment, comply with subsection (G); and

6.        Before the expiration of each 24-month period after an individual’s initial enrollment, comply with subsection (H).

B.       When an enrolled individual’s residential or mailing address changes, the enrolled individual or the enrolled individual’s representative shall:

1.        Complete a Department-provided form containing for the enrolled individual the information specified in R9-6- 404(A)(1)(a) through R9-6-404(A)(1)(h) and R9-6- 404(A)(1)(j), (k), (m), (n), and (o);

2.        Attest on the form specified in subsection (B)(1) that:

a.        To the best of the knowledge and belief of the enrolled individual or the enrolled individual’s rep- resentative, the information submitted in the form and the documents submitted with the form are accurate and complete;

b.        The enrolled individual meets the eligibility criteria specified in R9-6-403; and

c.        The enrolled individual or the enrolled individual’s representative understands that eligibility does not guarantee that the Department will be able to pro- vide drugs and that an individual’s enrollment in ADAP may be terminated as specified in R9-6-408;

3.        Grant permission on the form specified in subsection (B)(1) for the Department to discuss the enrolled individ- ual’s enrollment with:

a.        AHCCCS, for the purpose of determining AHCCCS eligibility;

b.        Medicare and the Social Security Administration, for the purpose of determining eligibility for a low- income subsidy and enrollment in a Medicare drug plan;

c.        The applicant’s primary care provider or designee;

d.        The vendor pharmacy, to assist with drug distribu- tion; and

e.        Any other entity as necessary to establish eligibility for enrollment in ADAP or assist with drug distribu- tion;

4.        Sign and date the form specified in subsection (B)(1); and

5.        Submit to the Department within 30 calendar days of the change:

a.        The form specified in subsection (B)(1); and

b.        Proof of Arizona residency, as specified in R9-6- 404(A)(9), showing the new Arizona residential address included on the form specified in subsection (B)(1).

C.      When an enrolled individual’s primary care provider changes, the enrolled individual or the enrolled individual’s representa- tive shall:

1.        Comply with subsections (B)(1) through (4);

2.        Obtain from the new primary care provider the Depart- ment-provided form specified in subsection (D), com- pleted by the new primary care provider; and

3.        Submit the form specified in subsection (B)(1) and the form specified in subsection (C)(2) to the Department within 30 calendar days after the change.

D.      The primary care provider of an enrolled individual shall com- plete for the enrolled individual a Department-provided form containing:

1.        The information required under R9-6-404(B)(1), (2), and

(5) through (8); and

2.        The dates of and results for the most recent CD4-T-lym- phocyte count and, if available, viral load test conducted for the enrolled individual.

E.       When an enrolled individual’s annual family income decreases to an amount that may make the individual eligible for enroll- ment in AHCCCS, the enrolled individual or the enrolled indi- vidual’s representative shall:

1.        Apply for enrollment in AHCCCS within 30 calendar days after the change in annual family income; and

2.        If the enrolled individual is determined to be ineligible for AHCCCS enrollment, submit to the Department within 30 calendar days after the change, documentation that complies with R9-6-403(5).

F.       When an enrolled individual becomes eligible for Medicare, the enrolled individual or the enrolled individual’s representa- tive shall, within 30 calendar days after the enrolled individual becomes eligible for Medicare:

1.        Apply for a low-income subsidy and for a Medicare drug plan, and

2.        If the enrolled individual is determined to be ineligible for a low-income subsidy, submit to the Department doc- umentation that complies with R9-6-403(6).

G.      Before the expiration of each six-month period after an indi- vidual’s initial enrollment, the enrolled individual or the enrolled individual’s representative shall submit to the Depart- ment:

1.        Proof of annual family income, as specified in R9-6- 404(A)(7) or (8); and

2.        Proof that the enrolled individual is a resident of Arizona, as specified in R9-6-404(A)(9).

H.      Before the expiration of each 24-month period after an indi- vidual’s initial enrollment, the enrolled individual or the enrolled individual’s representative shall:

1.        Comply with subsections (B)(1) through (4);

2.        Obtain from the enrolled individual’s primary care pro- vider the Department-provided form completed as speci- fied in subsection (D); and

3.        Submit to the Department:

a.        The form specified in subsection (H)(1),

b.        The form specified in subsection (H)(2),

c.        Proof of annual family income, as specified in R9-6- 404(A)(7) or (8), and

d.        Proof that the enrolled individual is a resident of Arizona, as specified in R9-6-404(A)(9).

I.        The Department shall:

1.        Review information about an enrolled individual and determine eligibility for continuing enrollment for the enrolled individual:

a.        Every six months after the individual’s initial enroll- ment;

b.        When the Department receives information from the enrolled individual or the enrolled individual’s rep- resentative under subsection (A); or

c.        When the Department no longer has sufficient funds to provide continuing enrollment to all enrolled indi- viduals;

2.        Grant continuing enrollment to an enrolled individual, subject to the availability of funds, when:

a.        The enrolled individual or the enrolled individual’s representative complies with subsection (A); and

b.        The Department determines that:

i.         The information in the documents submitted to the Department is accurate and complete, and

ii.        The enrolled individual is eligible under R9-6- 403; and

3.        Notify the enrolled individual or the enrolled individual’s representative of the Department’s decision within five business days after receipt of the documents required in subsection (A).

J.        If the Department denies continuing enrollment to an enrolled individual, the Department shall send to the enrolled individ- ual or the enrolled individual’s representative a written notice of denial setting forth the information required under A.R.S. § 41-1092.03.

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).

Emergency not renewed. Former Section R9-6-808 renumbered as Section R9-6-807, amended, and readopted as an emergency effective August 8, 1988, pur- suant to A.R.S. § 41-1026, valid for only 90 days (Supp.

88-3). Emergency expired. Readopted as an emergency and subsection (C) corrected 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 (Supp. 89-2). Renumbered from R9-6-807 effective October 19, 1993 (Supp. 93-4). Former Section R9-6-407 repealed; new Section R9-6-407 renumbered from R9-6- 406 and amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Former R9-6-407 renumbered to R9-6-409; new R9-6-407 renumbered from R9-6-406 and amended by final rulemaking at 13

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