1. 1. Medically necessary, cost effective, and federally reimbursable;
2. 2. Coordinated by a case manager in accordance with requirements specified in R9-28-510;

3. 3. The provider obtains prior authorization as required by a member’s program contractor or by the Administration:

   1. a. Failure of the provider to obtain prior authorization is cause for denial.
   2. b. Services provided during prior period coverage are exempt from prior authorization requirements;
4. 4. Provided in facilities or areas of facilities that are licensed or certified under Article 5 of this Chapter, or meet other requirements described in Article 5 of this Chapter;
5. 5. Rendered by AHCCCS registered providers as permitted under this Chapter and within their scope of practice; and
6. 6. Provided at an appropriate level of care, as determined by the case manager or the primary care provider.

In addition to the exclusions and limitations specified in this Article, services provided to a member are covered services if:

Historical Note

Adopted effective October 1, 1988, filed September 1, 1988 (Supp. 88-3). Section repealed; new Section adopted effective September 22, 1997 (Supp. 97-3). Amended by final rulemaking at 8 A.A.R. 2356, effective May 9, 2002 (Supp. 02-2).