36-2999.01. Definitions

In this article, unless the context otherwise requires:

1. " Administration" means the Arizona health care cost containment system administration.

2. " Arizona long-term care system" means the system established pursuant to article 2 of this chapter.

3. " Center" means a facility operated by a comprehensive care for the elderly organization where primary care and other services are furnished to participants.

4. " Comprehensive care for the elderly program" means a provider directed program of comprehensive care for the elderly that delivers comprehensive medical and social services directly to eligible members.

5. " Director" means the director of the Arizona health care cost containment system administration.

6. " Eligible participant" means a member who:

(a) Is a resident of this state and a United States citizen or a person who meets the requirements for qualified alien status as determined pursuant to section 36-2903.03, who entered the United States on or before August 21, 1996 or who entered the United States on or after August 22, 1996 and who is a member of an exception group under Public Law 104-193, section 412.

(b) Meets the eligibility criteria pursuant to section 36-2934.

(c) Needs institutional services as determined pursuant to section 36-2936.

(d) Is defined as eligible pursuant to section 1902(a)(10)(A)(ii)(XV) and (XVI) of title XIX of the social security act and who meets the income requirements of section 36-2950.

(e) Resides in the comprehensive care for the elderly organization s service area.

(f) Is willing to abide by the requirement that eligible participants receive all health and long-term care services exclusively from the comprehensive care for the elderly organization and its contracted or referred providers unless it is an emergency service.

(g) Has selected the program as that person's provider of services.

(h) Is able to be maintained in a community based setting at the time of enrollment without jeopardizing the eligible participant's health or safety.

7. " Interdisciplinary team" means center staff and comprehensive care for the elderly subcontractors who have current and appropriate licensure, certification or accreditation and who are responsible for assessment and development of the comprehensive care for the elderly participant s care plan and may conduct assessments of the participants and provide services to participants within the team member's scope of practice. The interdisciplinary team may include a:

(a) Primary care provider.

(b) Registered nurse.

(c) Social worker.

(d) Occupational therapist.

(e) Physical therapist.

(f) Recreational therapist or activity coordinator.

(g) Dietician.

(h) Center manager.

(i) Home care coordinator.

(j) Personal care attendant or representative.

(k) Van driver or the van driver's representative.

8. " Member" means an eligible person who is enrolled in the Arizona long-term care system pursuant to article 2 of this chapter.

9. " Organization" means an organization that provides all medical and long-term care services under a comprehensive care for the elderly program and shall be capitated by a program contractor for medicaid services and may be capitated by a program contractor for medicare services.

10. " Program agreement" means an agreement between the organization and a program contractor.

11. " Program contractor" means the entity that contracts with the administration pursuant to sections 36-2940 and 36-2944 to provide services to members pursuant to article 2 of this chapter.

12. " Service area" means the geographic area in which the comprehensive care for the elderly organization has agreed to provide services under the comprehensive care for the elderly program agreement.