1. A. A service provider shall request an amendment to the HCBS certificate when any of the following information or circumstances change:

   1. 1. Name, address, or telephone number;
   2. 2. Addition of a service to the Division’s service contract;
   3. 3. Deletion of a service to the Division’s service contract;
   4. 4. Change in the Tax ID#; or
   5. 5. Change in AHCCCS provider type.
2. B. The service provider shall file a request for amendment not more than 30 days after the change by sending a written request to the Division.
3. C. The Division shall mail the service provider written notice of amendment approval or denial within 30 days of receipt of the written request.

Historical Note

Adopted effective February 1, 1996; filed in the Office of the Secretary of State December 26, 1995 (Supp. 95-4).