Arizona Secretary of State - Ken Bennett


 
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TITLE 9. HEALTH SERVICES

CHAPTER 24. DEPARTMENT OF HEALTH SERVICES
ARIZONA MEDICALLY UNDERSERVED AREA HEALTH SERVICES


Supp. 06-3

ARTICLE 1. REPEALED

Section

R9-24-101. Repealed

R9-24-102. Repealed

R9-24-103. Reserved

R9-24-104. Reserved

R9-24-105. Reserved

R9-24-106. Reserved

R9-24-107. Reserved

R9-24-108. Reserved

R9-24-109. Reserved

R9-24-110. Reserved

R9-24-111. Repealed

R9-24-112. Repealed

R9-24-113. Repealed

ARTICLE 2. ARIZONA MEDICALLY UNDERSERVED AREAS

Article 2 consisting of Sections R9-24-201 through R9-24-205 recodified from R9-24-121 through R9-24-130 (Supp. 95-2).

Section

R9-24-201. Definitions

R9-24-202. Arizona Medically Underserved Area Designation

R9-24-203. Primary Care Index

Table 1. Primary Care Index Scoring

R9-24-204. Primary Care Area Boundaries Determination

R9-24-205. Time-frames

ARTICLE 3. COORDINATING MEDICAL PROVIDERS

Article 3 consisting of Section R9-24-301 recodified from Sections R9-24-131 through R9-24-140 (Supp. 95-2).

Section

R9-24-301. Definitions

R9-24-302. CMP Functions

ARTICLE 4. REPEALED

Article 4, consisting of Sections R9-24-401 through R9-24-412 and Exhibits A, B, C, and D, repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

Article 4, consisting of Sections R9-24-401 through R9-24-412, adopted effective March 17, 1995 (Supp. 95-2).

Section

R9-24-401. Repealed

R9-24-402. Repealed

R9-24-403. Repealed

R9-24-404. Repealed

R9-24-405. Repealed

Exhibit A. Repealed

R9-24-406. Repealed

R9-24-407. Repealed

R9-24-408. Repealed

Exhibit B. Repealed

R9-24-409. Repealed

R9-24-410. Repealed

R9-24-411. Repealed

Exhibit C. Repealed

R9-24-412. Repealed

Exhibit D. Repealed

ARTICLE 1. REPEALED

R9-24-101. Repealed

Historical Note

New Section adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Section repealed by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

R9-24-102. Repealed

Historical Note

New Section adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Section repealed by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

R9-24-103. Reserved

R9-24-104. Reserved

R9-24-105. Reserved

R9-24-106. Reserved

R9-24-107. Reserved

R9-24-108. Reserved

R9-24-109. Reserved

R9-24-110. Reserved

R9-24-111. Repealed

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). Section repealed by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1).

R9-24-112. Repealed

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). Section repealed by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1).

R9-24-113. Repealed

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). Section repealed by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1).

ARTICLE 2. ARIZONA MEDICALLY UNDERSERVED AREAS

R9-24-201. Definitions

In addition to the definitions in A.R.S. § 36-2351, the following definitions apply in this Article, unless otherwise specified:

1. "Act, event, or default" means an occurrence or the failure of something to occur.

2. "Agency" has the same meaning as in A.R.S. § 41-1001.

3. "Ambulatory care sensitive conditions" means the illnesses listed in the first table of Appendix B (entitled "Ambulatory Care Sensitive Conditions") to "Using Administrative Data to Monitor Access, Identify Disparities, and Assess Performance of the Safety Net," in Tools for Monitoring the Health Care Safety Net, AHRQ Publication No. 03-0027, September 2003, Agency for Healthcare Research and Quality, Rockville, MD, and available on the web site of the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, at http://www.ahrq.gov/data/safetynet/billappb.htm.

4. "Arizona Medical Board" means the agency established by A.R.S. § 32-1402 to regulate physicians licensed under A.R.S. Title 32, Chapter 13.

5. "Arizona medically underserved area" means:

a. A primary care area or part of a primary care area with the designation described in R9-24-202(1), or

b. A primary care area with the designation described in R9-24-202(2).

6. "Arizona Regulatory Board of Physician Assistants" means the agency established by A.R.S. § 32-2502 to regulate physician assistants.

7. "Arizona State Board of Nursing" means the agency established by A.R.S. § 32-1602 to regulate nurses and nursing assistants.

8. "Birth life expectancy" means the average life span at the time of birth according to the most recent U.S. life expectancy data in the National Vital Statistics Reports of the National Vital Statistics System, available on the web site of the National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, at http://www.cdc.gov/nchs/fastats/lifexpec.htm.

9. "Board of Osteopathic Examiners in Medicine and Surgery" means the agency established by A.R.S. § 32-1801 to regulate physicians licensed under A.R.S. Title 32, Chapter 17.

10. "Boundary change" means a re-determination of the geographic limits of a primary care area.

11. "Census block" means a geographic unit that is:

a. The smallest unit of census geography established by the U.S. Census Bureau, and

b. One of approximately 8 million similar units covering the entire nation.

12. "Day" means calendar day:

a. Excluding the day of the act, event, or default that triggers the running of a time-frame;

b. Excluding the last day of a time-frame if it is a Saturday, Sunday, or legal holiday; and

c. If the last day of a time-frame is excluded under subsection (12)(b), including the next day that is not a Saturday, Sunday, or legal holiday.

13. "Family unit" means:

a. Two or more individuals related by birth, marriage, or adoption who live at the same residence; or

b. One individual who does not live at the same residence with anyone related by birth, marriage, or adoption.

14. "First health care contact" means the initial telephone call or visit to a health care provider as defined in 45 CFR 160.103 for an individual's health issue.

15. "Full-time" means providing primary care services for at least 40 hours between a Sunday at 12:00 midnight and the next Sunday at 12:00 midnight.

16. "Health organization" means:

a. A person or entity that provides medical services;

b. A third party payor defined in A.R.S. § 36-125.07(C); or

c. A trade or professional association described in 501(c)(3), (4), (5), or (6) of the Internal Revenue Code, 26 U.S.C. 501(c), that is exempt from federal income taxes.

17. "Indian reservation" has the same meaning as in A.R.S. § 11-801.

18. "Legal holiday" means a state service holiday listed in A.A.C. R2-5-402.

19. "Local planning personnel" means individuals who develop programs related to the delivery of and access to medical services for places or areas:

a. Under the jurisdiction of an Arizona city or county, or

b. In an Arizona Indian reservation or less than 50 miles outside the boundaries of an Indian reservation.

20. "Low-weight birth" means the live birth of an infant weighing less than 2500 grams or 5 pounds, 8 ounces.

21. "Medical services" has the same meaning as in A.R.S. § 36-401.

22. "Mobility limitation" means an individual's physical or mental condition that:

a. Has lasted for at least six months,

b. Impairs the individual's ability to go outside the individual's residence alone, and

c. Is not a temporary health problem such as a broken bone that is expected to heal normally.

23. "Motor vehicle" has the same meaning as in A.R.S. § 28-101.

24. "Nonresidential" means not primarily used for living and sleeping.

25. "Person" has the same meaning as in A.R.S. § 41-1001.

26. "Physician assistant" has the same meaning as in A.R.S. § 32-2501.

27. "Political subdivision" means a county, city, town, district, association, or authority created by state law.

28. "Population" means the number of residents of a place or an area, according to:

a. The most recent decennial census prepared by the U.S. Census Bureau and available at http://www.census.gov; or

b. The most recent Population Estimates for Arizona's Counties, Incorporated Places and Balance of County prepared by the Department of Economic Security and available at http://www.workforce.az.gov/?PAGED=67&SUBID=137.

29. "Poverty threshold" means calendar year income relative to family unit size that:

a. Determines an individual's poverty status,

b. Is defined annually by the U.S. Census Bureau, and

c. Is available for the most recently completed calendar year at http://www.census.gov/hhes/poverty/threshld.html.

30. "Primary care area" means a geographic region determined by the Department under R9-24-204.

31. "Primary care HPSA" means primary care health professional shortage area designated by the U.S. Department of Health and Human Services under 42 U.S.C. 254e, 42 CFR 5.1 through 5.4, and 42 CFR Part 5, Appendix A.

32. "Primary care index" means the document in which the Department designates primary care areas as medically underserved according to R9-24-203 and Table 1.

33. "Primary care provider" means a physician, physician assistant, or registered nurse practitioner who:

a. Except for emergencies, is an individual's first health care contact; and

b. Provides primary care services in general or family practice, general internal medicine, pediatrics, or obstetrics and gynecology.

34. "Primary care services" means health care provided by a primary care provider, including:

a. Illness and injury prevention,

b. Health promotion and education,

c. Identification of individuals at special risk for illness,

d. Early detection of illness,

e. Treatment of illness and injury, and

f. Referral to specialists.

35. "Primary care services utilization pattern" means a distribution of the use of primary care services resulting from the factors listed in R9-24-204(A)(3)(a).

36. "Registered nurse practitioner" has the same meaning as in A.R.S. § 32-1601.

37. "Residence" means a structure or part of a structure where an individual lives and sleeps.

38. "Resident" means an individual who lives and sleeps in a place or an area more than one-half of the time.

39. "Residential" means primarily used for living and sleeping.

40. "Self-care limitation" means an individual's physical or mental condition that:

a. Has lasted for at least six months;

b. Impairs the individual's ability to perform activities such as dressing, bathing, or moving around inside the individual's residence; and

c. Is not a temporary health problem such as a broken bone that is expected to heal normally.

41. "Specialist" means an individual who:

a. Is regulated under:

i. A.R.S. Title 32, Chapters 7, 8, 11, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 25, 28, 29, 33, 34, 35, 39, or 41;

ii. A.R.S. Title 36, Chapter 6, Article 7; or

iii. A.R.S. Title 36, Chapter 17; and

b. Meets the education, knowledge, and skill requirements generally recognized in the profession related to a specific service or procedure, patient category, body part or system, or type of disease.

42. "Street route" means a course of travel by road.

43. "Temporary" means lasting for a limited time.

44. "Topography" means the surface configuration of a place or region, including elevations and positions of the physical features.

45. "Travel pattern" means a prevalent flow of motor vehicles resulting from:

a. The configuration of streets, and

b. The location of residential and nonresidential areas.

46. "Value" means a number within a value range.

47. "Value range" means, for a criterion listed in R9-24-203(B) and Table 1, a measurement:

a. Consisting of a scale between upper and lower limits, except for the supplementary criteria score under R9-24-203(B)(12); and

b. To which Table 1 assigns points or 0 points.

48. "Work disability" means an individual's physical or mental condition that:

a. Has lasted for at least six months,

b. Limits the individual's choice of jobs or prevents the individual from working for more than 34 hours per week, and

c. Is not a temporary health problem such as a broken bone that is expected to heal normally.

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). R9-24-201 recodified from R9-24-121 (Supp. 95-2). Section repealed; new Section adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

R9-24-202. Arizona Medically Underserved Area Designation

The Department shall designate as Arizona medically underserved areas:

1. The primary care areas or parts of primary care areas designated as primary care HPSAs by the U.S. Department of Health and Human Services, and

2. The primary care areas designated as medically underserved by the Department under R9-24-203 and Table 1.

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). R9-24-202 recodified from R9-24-122 (Supp. 95-2). Section repealed; new Section adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

R9-24-203. Primary Care Index

A. Every 12 months, the Department shall prepare, according to this Section, a primary care index for designating primary care areas determined under R9-24-204 as Arizona medically underserved areas.

1. For each primary care area determined under R9-24-204, the Department shall calculate the value for each criterion in subsection (B).

a. After calculating the value for each criterion in subsection (B), the Department shall assign points to each value according to Table 1.

b. A primary care area's score is the sum of the points received by the primary care area for each criterion in subsection (B).

2. The Department shall designate as Arizona medically underserved:

a. The primary care areas that, according to subsection (B) and Table 1, score within the top 25 percent on the primary care index or that obtain more than 55 points, whichever results in the designation of more Arizona medically underserved areas; and

b. The primary care areas or parts of primary care areas with the designation described in R9-24-202(1).

B. For each primary care area determined by the Department under R9-24-204, the primary care index shall include a score for each of the following:

1. Population-to-primary-care-provider ratio, determined by dividing the population of the primary care area by the number of primary care providers in the primary care area:

a. Using primary care provider data from the Arizona Medical Board, the Board of Osteopathic Examiners in Medicine and Surgery, the Arizona State Board of Nursing, and the Arizona Regulatory Board of Physician Assistants;

b. Counting a full-time physician as 1.0, a full-time physician assistant as 0.8, and a full-time registered nurse practitioner as 0.8; and

c. If the Department determines that a physician, physician assistant, or registered nurse practitioner practices less than full-time in the primary care area, lowering the number obtained under subsection (B)(1)(b) as follows:

i. Creating a fraction with a numerator that represents the number of hours per week the physician, physician assistant, or registered nurse practitioner practices in the primary care area and with a denominator of 40;

ii. Multiplying 1.0 or 0.8, whichever is appropriate, by the fraction obtained under subsection (B)(1)(c)(i);

iii. Subtracting the result obtained under subsection (B)(1)(c)(ii) from 1.0 or 0.8, whichever is appropriate; and

iv. Subtracting the result obtained under subsection (B)(1)(c)(iii) from the number obtained under subsection (B)(1)(b);

2. Travel distance to the nearest primary care provider, determined by:

a. Estimating the distance in miles:

i. From the center of the most densely populated area in the primary care area determined from the most recent Population Estimates for Arizona's Counties, Incorporated Places and Balance of County identified in R9-24-201(28)(b) or, for the year in which the most recent decennial census is published, from the most recent decennial census prepared by the U.S. Census Bureau; and

ii. To the nearest primary care provider determined from the data described in subsection (B)(1)(a); and

b. Using the most direct street route;

3. Composite transportation score, determined by:

a. Compiling data on the following six indicators from the most recent decennial census prepared by the U.S. Census Bureau:

i. Percentage of population with calendar year income less than 100 percent of the poverty threshold;

ii. Percentage of population older than age 65;

iii. Percentage of population younger than age 14;

iv. Percentage of population with a work disability, mobility limitation, or self-care limitation;

v. Percentage of population without a motor vehicle; and

vi. The motor-vehicle-to-population ratio;

b. Calculating the statewide average value for each of the six indicators in subsection (B)(3)(a);

c. Dividing the value of each indicator for each primary care area by the statewide average value for that indicator;

d. Multiplying the figure calculated under subsection (B)(3)(c) for each indicator by 100; and

e. Averaging the six indicator values obtained under subsection (B)(3)(d) for each primary care area;

4. Percentage of population with calendar year income less than 200% of the poverty threshold, determined from data in the most recent decennial census prepared by the U.S. Census Bureau;

5. Percentage of population with annual income between 100% and 200% of the poverty threshold, determined from data in the most recent decennial census prepared by the U.S. Census Bureau;

6. Percentage of uninsured births, determined from Department birth records reporting payment source as "self-pay" or "unknown;"

7. Ambulatory care sensitive condition hospital admissions:

a. Based on the number of hospital admissions for ambulatory care sensitive conditions per 1000 individuals living in the primary care area who are under age 65, and

b. Determined from hospital inpatient and emergency department services data provided by the Department;

8. Percentage of low-weight births, determined from data provided by the Department;

9. From data provided by the Department, the sum of the percentage of births for which the mothers reported:

a. No prenatal care,

b. Prenatal care that began in the second or third trimester, and

c. Four or fewer prenatal care visits;

10. Percentage of deaths at ages younger than the birth life expectancy, determined from the most recent U.S. life expectancy data and data provided by the Department;

11. Number of infant deaths per 1000 live births, determined from data provided by the Department;

12. Supplementary criteria score, based on the presence or absence in a primary care area of the following:

a. Percentage of minority population greater than the statewide average for all counties, determined from data in the most recent Population Estimates for Arizona's Counties, Incorporated Places and Balance of County identified in R9-24-201(28)(b) and from data in the most recent decennial census;

b. Percentage of elderly population greater than the statewide average for all counties, determined from data in the most recent Population Estimates for Arizona's Counties, Incorporated Places and Balance of County identified in R9-24-201(28)(b) and from data in the most recent decennial census prepared by the U.S. Census Bureau; and

c. Average annual unemployment rate greater than the average annual statewide rate, from data in the most recent Arizona Unemployment Statistics Program Special Unemployment Report, prepared by the Arizona Department of Economic Security; Research Administration, in cooperation with the U.S. Department of Labor, Bureau of Labor Statistics, and available at http://www.workforce.az.gov; and

13. Sole provider or no provider score:

a. Based on whether a primary care area has only 1.0 or less than 1.0 primary care provider;

b. Counting a full-time physician as 1.0, a full-time physician assistant as 0.8, and a full-time registered nurse practitioner as 0.8; and

c. If the Department determines that a physician, physician assistant, or registered nurse practitioner practices less than full-time in the primary care area, lowering the number obtained under subsection (B)(13)(b) as follows:

i. Creating a fraction with a numerator that represents the number of hours per week the physician, physician assistant, or registered nurse practitioner practices in the primary care area and with a denominator of 40;

ii. Multiplying 1.0 or 0.8, whichever is appropriate, by the fraction obtained under subsection (B)(13)(c)(i);

iii. Subtracting the result obtained under subsection (B)(13)(c)(ii) from 1.0 or 0.8, whichever is appropriate; and

iv. Subtracting the result obtained under subsection (B)(13)(c)(iii) from the number obtained under subsection (B)(13)(b).

C. Every 12 months, according to subsections (A) and (B) and Table 1, the Department shall:

1. Withdraw an Arizona medically underserved area designation,

2. Continue an Arizona medically underserved area designation, or

3. Designate a new Arizona medically underserved area.

D. A list of current Arizona medically underserved areas is available in the Department's annual Arizona Medically Underserved Areas (AzMUA) Report at http://www.azdhs.gov/hsd/.

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). R9-24-203 recodified from R9-24-123 (Supp. 95-2). Section repealed; new Section adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

Table 1. Primary Care Index Scoring

 

CRITERIA

VALUE RANGE

POINTS

Population-to-primary-care-provider ratio

≤ 2000:1

2001:1 to 2500:1

2501:1 to 3000:1

3001:1 to 3500:1

3501:1 to 4000:1

> 4000:1 or no provider

0

2

4

6

8

10

Travel distance to nearest primary care provider

≤ 15.0 miles

15.1-25.0 miles

25.1-35.0 miles

35.1-45.0 miles

45.1-55.0 miles

> 55.0 miles

0

2

4

6

8

10

Composite transportation score

51st highest score and below

41st-50th highest scores

31st-40th highest scores

21st-30th highest scores

11th-20th highest scores

10 highest scores

0

2

4

6

8

10

Percentage of population with annual income less than 200% of poverty threshold

≤ 15.0%

15.1-25.0%

25.1-35.0%

35.1-45.0%

45.1-55.0%

>55.0%

0

2

4

6

8

10

Percentage of population with annual income between 100% and 200% of poverty threshold

≤ 10.0%

10.1-15.0%

15.1-20.0%

20.1-25.0%

25.1-30.0%

> 30.0%

0

2

4

6

8

10

Percentage of uninsured births

≤ 6.0%

6.1-10.0%

10.1-14.0%

14.1-18.0%

18.1-22.0%

>22.0%

0

2

4

6

8

10

Ambulatory care sensitive condition hospital admissions

≤ 8.0

8.1-12.0

12.1-16.0

16.1-20.0

20.1-24.0

> 24.0

0

2

4

6

8

10

Percentage of low-weight births

≤ 6.0%

6.1-8.0%

8.1-10.0%

10.1-12.0%

12.1-14.0%

>14.0%

0

2

4

6

8

10

Sum of the percentage of births with:

a. No prenatal care,

b. Prenatal care begun in second or third trimester, and

c. Prenatal care visits ≤ 4

≤ 15.0%

15.1-25.0%

25.1-35.0%

35.1-45.0%

45.1-55.0%

>55.0%

0

2

4

6

8

10

Percentage of deaths at ages younger than birth life expectancy

≤ 40.0%

40.1-50.0%

50.1-60.0%

60.1-70.0%

70.1-80.0%

>80.0%

0

2

4

6

8

10

Number of infant deaths per 1000 live births

≤ 4.0

4.1-6.0

6.1-8.0

8.1-10.0

10.1-12.0

>12.0

0

2

4

6

8

10

Supplementary criteria score

1 Criterion

2 Criteria

3 Criteria

2

4

6

Sole provider or no provider score

Primary care provider ≤ 1.0

Primary care providers > 1.0

5

0

Key to Symbols

≤ represents "less than or equal to"

> represents "more than"

Historical Note

New Table adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

R9-24-204. Primary Care Area Boundaries Determination

A. The Department shall determine the boundaries of primary care areas for the entire state. A primary care area's boundaries shall meet the following requirements:

1. The geographic area within the boundaries corresponds to or is larger than a census block identified for the geographic area in the most recent decennial census;

2. The boundaries are consistent with the population's primary care services utilization patterns; and

3. The primary care utilization patterns are determined by considering:

a. The geographic area's:

i. Topography,

ii. Social and cultural relationships of the people living within the geographic area,

iii. Political subdivision boundaries, and

iv. Travel patterns; and

b. Data about the type, amount, and location of primary care services used by the geographic area's population, obtained from local planning personnel, government officials, health organizations, primary care providers, and residents of the geographic area.

B. In addition to the requirements for primary care area boundaries in subsection (A), the Department shall consider:

1. Indian reservation boundaries, and

2. Primary care HPSA boundaries.

C. Without receiving a primary care area boundary change request under subsection (D), the Department may redetermine the boundaries of one or more primary care areas according to the requirements and considerations in subsections (A) and (B).

D. A primary care area's local planning personnel, government officials, health organizations, primary care providers, or residents may submit to the Department a primary care area boundary change request.

1. A person requesting a boundary change shall:

a. Make the request in writing,

b. Include documentation supporting the boundary change, and

c. Submit the request by October 1 to be considered for inclusion in the next calendar year's Arizona medically underserved area designation process.

2. The Department shall review a primary care area boundary change request according to the time-frames in R9-24-205.

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). R9-24-204 recodified from R9-24-124 (Supp. 95-2). Section repealed; new Section adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

R9-24-205. Time-frames

A. The overall time-frame described in A.R.S. § 41-1072 for a primary care area boundary change request under R9-24-204(C) is 90 days.

1. A person requesting a boundary change and the Department may agree in writing to extend the substantive review time-frame and the overall time-frame.

2. An extension of the substantive review time-frame and the overall time-frame may not exceed 25 percent of the overall time-frame.

B. The administrative completeness review time-frame described in A.R.S. § 41-1072 for a primary care area boundary change request under R9-24-204(C) is 30 days and begins on the date the Department receives a boundary change request.

1. Within the administrative completeness review time-frame, the Department shall mail a notice of administrative completeness or a notice of deficiencies to the person requesting a boundary change.

a. A notice of deficiencies shall list each deficiency and the information or documents needed to complete the boundary change request.

b. A notice of deficiencies suspends the administrative completeness review time-frame and the overall time-frame from the date the Department mails the notice until the date the Department receives the missing information or documents.

c. If the person requesting a boundary change does not submit to the Department all the information and documents listed in the notice of deficiencies within 60 days after the date the Department mails the notice of deficiencies, the Department considers the boundary change request withdrawn.

2. If the Department approves a boundary change request during the administrative completeness review time-frame, the Department does not issue a separate written notice of administrative completeness.

C. The substantive review time-frame described in A.R.S. § 41-1072 for a primary care area boundary change request under R9-24-204(C) is 60 days and begins on the date the Department mails the notice of administrative completeness.

1. Within the substantive review time-frame, the Department shall mail written notification of approval or denial of the boundary change request to the person requesting a boundary change.

2. During the substantive review time-frame:

a. The Department may make one comprehensive written request for additional information; and

b. If the Department and the person requesting a boundary change agree in writing to allow one or more supplemental requests for information, the Department may make the number of supplemental requests for information agreed to.

3. A comprehensive written request for additional information or a supplemental request for information suspends the substantive review time-frame and the overall time-frame from the date the Department mails the request until the date the Department receives all the information and documents requested.

4. If the person requesting a boundary change does not submit to the Department all the information and documents listed in a comprehensive written request for additional information or a supplemental request for information within 60 days after the date the Department mails the request, the Department shall deny the boundary change request.

D. The Department shall approve a primary care area boundary change request under R9-24-204(C) unless:

1. The requested boundaries do not meet the requirements in R9-24-204(A),

2. The considerations required in R9-24-204(B) support the current boundaries and outweigh the information and documents submitted with the boundary change request, or

3. The person requesting the boundary change does not submit information and documents as stated in subsection (B)(1)(c) or subsection (C)(4).

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). R9-24-205 recodified from R9-24-125 (Supp. 95-2). Section repealed by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). New Section made by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

ARTICLE 3. COORDINATING MEDICAL PROVIDERS

R9-24-301. Definitions

In addition to the definitions in A.R.S. § 36-2351 and 9 A.A.C. 24, Article 2, the following definitions apply in this Article, unless otherwise specified:

1. "CMP" means coordinating medical provider.

2. "Continuing medical education" means instruction that meets the requirements in:

a. A.A.C. R4-16-102 for a physician licensed under A.R.S. Title 32, Chapter 13;

b. A.A.C. R4-17-205 for a physician assistant licensed under A.R.S. Title 32, Chapter 25; and

c. A.R.S. § 32-1825 and A.A.C. R4-22-109 for a physician licensed under A.R.S. Title 32, Chapter 17.

3. "Continuing nursing education" means instruction that:

a. Is required by A.A.C. R4-19-511 for authorization from the Arizona State Board of Nursing for a registered nurse practitioner to prescribe and dispense drugs and devices;

b. Meets requirements for continuing education established by a nurse credentialing organization, such as the American Nurses Credentialing Center; or

c. Provides training related to the performance of a nurse's job duties.

4. "Drug prescription services" means providing medication that requires an order by medical personnel authorized by law to order the medication.

5. "Durable medical equipment" means an item that:

a. Can withstand repeated use;

b. Is designed to serve a medical purpose; and

c. Generally is not useful to an individual in the absence of a medical condition, illness, or injury.

6. "Governing authority" has the same meaning as in A.R.S. § 36-401.

7. "Independent decision" means a registered nurse practitioner's action without a physician's order according to A.A.C. R4-19-508 and A.A.C. R4-19-511.

8. "Medical direction" means guidance, advice, or consultation provided by a CMP to a registered nurse practitioner.

9. "Medical personnel" means a medical clinic's physicians, physician assistants, registered nurse practitioners, and nurses.

10. "Nurse" means an individual licensed as a graduate, professional, or registered nurse or as a practical nurse under A.R.S. Title 32, Chapter 15.

11. "Order" means a written directive.

12. "Practice requirements" means the standards for physicians established in:

a. A.R.S. Title 32, Chapter 13 and 4 A.A.C. 16; or

b. A.R.S. Title 32, Chapter 17 and 4 A.A.C. 22.

13. "Referral source" means a person who sends an individual to a third person for medical services.

14. "Social services" means assistance, other than medical services, provided to maintain or improve an individual's physical, mental, and social participation capabilities.

15. "Supervision" has the same meaning as in A.R.S. § 32-2501.

16. "Support services" means drug prescription services, social services, and provision of durable medical equipment.

17. "Work schedule coverage" means a medical clinic's system for ensuring that a sufficient number of medical personnel are present at the medical clinic.

18. "Written protocol" means an agreement that identifies and is signed by a CMP and a registered nurse practitioner or a physician assistant.

Historical Note

Adopted effective July 27, 1978 (Supp. 78-4). R9-24-301 recodified from R9-24-131 (Supp. 95-2). Former Section R9-24-301 renumbered to R9-24-302; new Section R9-24-301 adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3).

R9-24-302. CMP Functions

A. A CMP shall:

1. Participate in planning for the delivery of medical services and support services within the Arizona medically underserved area that includes ways to increase access to medical services and support services for the Arizona medically underserved area's residents;

2. Develop written protocols that:

a. Describe the manner and frequency that a registered nurse practitioner or a physician assistant at a medical clinic will communicate with the CMP, in addition to the face-to-face meeting required in subsection (A)(5);

b. Specify the criteria used by a registered nurse practitioner at the medical clinic in making an independent decision to refer an individual to a physician; and

c. Specify procedures to be followed by a physician assistant at the medical clinic when the CMP's supervision of the physician assistant is by a means other than physical presence;

3. Approve or disapprove the selection of registered nurse practitioners and physician assistants who will work at the medical clinic;

4. Provide:

a. Medical direction to the registered nurse practitioners at the medical clinic, and

b. Supervision to the physician assistants at the medical clinic;

5. At least weekly, conduct a face-to-face meeting with each registered nurse practitioner and each physician assistant at the medical clinic to evaluate the medical services provided by the registered nurse practitioner or physician assistant;

6. For continuing medical education or continuing nursing education of a medical clinic's medical personnel:

a. Recommend specific areas of instruction, including instruction in referral sources; and

b. Develop a written plan for work schedule coverage to accommodate continuing medical education or continuing nursing education; and

7. At least annually, meet with the medical clinic's governing authority to evaluate the medical clinic's program and the medical care provided by the medical clinic's medical personnel.

B. The requirements in subsection (A) do not replace the practice requirements applicable to a CMP.

Historical Note

New Section renumbered from R9-24-301 and amended by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006
(Supp. 06-3).

ARTICLE 4. REPEALED

R9-24-401. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-402. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-403. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-404. Repealed

Historical Note

Adopted effective March 17, 1995. Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-405. Repealed

Historical Note

Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

Exhibit A. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-406. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-407. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-408. Repealed

Historical Note

Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

Exhibit B. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-409. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-410. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-411. Repealed

Historical Note

Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

Exhibit C. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

R9-24-412. Repealed

Historical Note

Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

Exhibit D. Repealed

Historical Note

Adopted effective March 17, 1995 (Supp. 95-1). Section repealed by final rulemaking at 7 A.A.R. 2849, effective August 9, 2001 (Supp. 01-2).

 


Scott Cancelosi
Director
Public Services Division

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Arizona Administrative Code