36-2981. Definitions


In this article, unless the context otherwise requires:


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


2. "Contractor" means a health plan that contracts with the administration for the
provision of hospitalization and medical care to members according to the provisions of
this article or a qualifying plan.


3. "Director" means the director of the administration.


4. "Federal poverty level" means the federal poverty level guidelines published
annually by the United States department of health and human services.


5. "Health plan" means an entity that contracts with the administration for
services provided pursuant to article 1 of this chapter.


6. "Member" means a person who is eligible for and enrolled in the program, who is
under nineteen years of age and whose gross household income meets the following
requirements:


(a) Beginning on November 1, 1998 through September 30, 1999, has income at or
below one hundred fifty per cent of the federal poverty level.


(b) Beginning on October 1, 1999 and for each fiscal year thereafter, has income at
or below two hundred per cent of the federal poverty level.


7. "Noncontracting provider" means an entity that provides hospital or medical care
but does not have a contract or subcontract with the administration.


8. "Physician" means a person licensed pursuant to title 32, chapter 13 or 17.


9. "Prepaid capitated" means a method of payment by which a contractor delivers
health care services for the duration of a contract to a specified number of members
based on a fixed rate per member, per month without regard to the number of members who
receive care or the amount of health care services provided to a member.


10. "Primary care physician" means a physician who is a family practitioner, general
practitioner, pediatrician, general internist, obstetrician or gynecologist.


11. "Primary care practitioner" means a nurse practitioner who is certified pursuant
to title 32, chapter 15 or a physician assistant who is licensed pursuant to title 32,
chapter 25 and who is acting within the respective scope of practice of those chapters.


12. "Program" means the children's health insurance program.


13. "Qualifying plan" means a contractor that contracts with the state pursuant to
section 38-651 to provide health and accident insurance for state employees and that
provides services to members pursuant to section 36-2989, subsection A.


14. "Special health care district" means a special health care district organized
pursuant to title 48, chapter 31.


15. "Tribal facility" means a facility that is operated by an Indian tribe and that
is authorized to provide services pursuant to Public Law 93-638, as amended.