36-2937. Effective date of program contractor's responsibility

A. If a person is eligible for services under article 1 of this chapter, the provider with whom the member is enrolled under article 1 of this chapter is responsible for providing services covered under article 1 of this chapter until the date of eligibility for the system specified in contract or until the eligible person or member is no longer eligible under article 1 of this chapter, whichever occurs first.

B. For a person who is not a member or eligible person under article 1 of this chapter on the date of eligibility for the system, the program contractor is responsible beginning on the date specified in contract for providing services pursuant to this article. If the person is retroactively eligible pursuant to federal law prior to the date that the program contractor assumes responsibility, the administration shall reimburse noncontracting providers from the Arizona long-term care fund for services which are covered under this article and which are provided to an eligible person during the period of retroactive eligibility. No reimbursement may be made for a service provided during the period of retroactive eligibility that does not qualify for monies under title XIX of the social security act. The director shall adopt rules prescribing reimbursement levels for services provided during the period of retroactive eligibility which are consistent with federal law. Covered inpatient hospital services provided during the period of retroactive eligibility shall not be reimbursed at a level higher than prescribed in section 36-2903.01.