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.
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