1. A. Services provided in a NF, including room and board, an alternative HCBS setting as defined in R9-28-101, or a HCBS as defined in A.R.S. § 36-2939 are covered for a maximum of 90 days per contract year if the member’s medical condition would otherwise require hospitalization.

2. B. Except as otherwise provided in 9 A.A.C. 28, the following services are not itemized for separate billing if provided in a NF, alternative HCBS setting, or HCBS:

   1. 1. Nursing services, including:

      1. a. Administering medication;
      2. b. Tube feedings;
      3. c. Personal care services, including but not limited to assistance with bathing and grooming;
      4. d. Routine testing of vital signs; and
      5. e. Maintenance of a catheter;

   2. 2. Basic patient care equipment and sickroom supplies, including:

      1. a. First aid supplies such as bandages, tape, ointments, peroxide, alcohol, and over-the-counter remedies;
      2. b. Bathing and grooming supplies;
      3. c. Identification device;
      4. d. Skin lotion;
      5. e. Medication cup;
      6. f. Alcohol wipes, cotton balls, and cotton rolls;
      7. g. Rubber gloves (non-sterile);
      8. h. Laxatives;
      9. i. Bed and accessories;
      10. j. Thermometer;
      11. k. Ice bags;
      12. l. Rubber sheeting;
      13. m. Passive restraints;
      14. n. Glycerin swabs;
      15. o. Facial tissue;
      16. p. Enemas;
      17. q. Heating pad; and
      18. r. Incontinence briefs.
   3. 3. Dietary services including preparation and administration of special diets, and adaptive tools for eating;
   4. 4. Any service that is included in a NF’s room and board charge or a service that is required of the NF to meet a federal or state licensure standard or county certification requirement;
   5. 5. Physician visits made solely for the purpose of meeting state licensure standards or county certification requirements;
   6. 6. Physical therapy prescribed only as a maintenance regimen; and
   7. 7. Assistive devices and non-customized durable medical equipment.
3. C. A provider shall obtain prior authorization from the Administration for a NF admission for a FFS member.

Historical Note

Adopted effective October 1, 1985 (Supp. 85-5). Section repealed, new Section adopted effective September 22, 1997 (Supp. 97-3). Amended by final rulemaking at 6 A.A.R. 2435, effective June 9, 2000 (Supp. 00-2). Subsection (C) amended to correct a typographical error (Supp. 00-4). Amended by final rulemaking at 8 A.A.R. 2325, effective May 9, 2002 (Supp. 02-2). Amended by final rulemaking at 13 A.A.R. 3272, effective September 11, 2007 (Supp. 07-3). Amended by final rulemaking at 13 A.A.R. 4122, effective November 6, 2007 (Supp. 07-4).