8-512

8-512. Comprehensive medical and dental care;
guidelines

A. The department shall provide comprehensive medical and dental care, as
prescribed by rules of the department, for each child:

1. Placed in a foster home.

2. In the custody of the department and placed with a relative.

3. In the custody of the department and placed in a certified adoptive home before
the entry of the final order of adoption.

4. In the custody of the department and in an independent living program as
provided in section 8-521.

5. In the custody of a probation department and placed in foster care. The
department shall not provide this care if the cost exceeds funds currently appropriated
and available for that purpose.

B. The care may include, but is not limited to:

1. A program of regular health examinations and immunizations including as
minimums:

(a) Vaccinations to prevent mumps, rubella, smallpox and polio.

(b) Tests for anemia, coccidioidomycosis and tuberculosis.

(d) Regular examinations for general health, hearing and vision, including
providing corrective devices when needed.

2. Inpatient and outpatient hospital care.

3. Necessary services of physicians, surgeons, psychologists and psychiatrists.

4. Dental care consisting of at least oral examinations including diagnostic
radiographs, oral prophylaxis and topical fluoride applications, restoration of permanent
and primary teeth, pulp therapy, extraction when necessary, fixed space maintainers where
needed and other services for relief of pain and infection.

5. Drug prescription service.

C. The facilities of any hospital or other institution within the state, public or
private, may be employed by the foster parent, relative, certified adoptive parent,
agency or division having responsibility for the care of the child.

D. For inpatient hospital admissions and outpatient hospital services on or after
March 1, 1993, the department shall reimburse a hospital according to the tiered per diem
rates and outpatient cost-to-charge ratios established by the Arizona health care cost
containment system pursuant to section 36-2903.01, subsection H.

E. The department shall use the Arizona health care cost containment system rates
as identified in subsection D of this section for any child eligible for services under
this section.

F. A hospital bill is considered received for purposes of subsection H of this
section upon initial receipt of the legible, error-free claim form by the department if
the claim includes the following error-free documentation in legible form:

1. An admission face sheet.

2. An itemized statement.

3. An admission history and physical.

4. A discharge summary or an interim summary if the claim is split.

5. An emergency record, if admission was through the emergency room.

6. Operative reports, if applicable.

7. A labor and delivery room report, if applicable.

G. The department shall require that the hospital pursue other third party payors
before submitting a claim to the department. Payment received by a hospital from the
department is considered payment by the department of the department's liability for the
hospital bill. A hospital may collect any unpaid portion of its bill from other third
party payors or in situations covered by title 33, chapter 7, article 3.

H. For inpatient hospital admissions and outpatient hospital services rendered on
and after October 1, 1997, the department shall pay a hospital's rate established
according to this section subject to the following:

1. If the hospital's bill is paid within thirty days of the date the bill was
received, the department shall pay ninety-nine per cent of the rate.

2. If the hospital's bill is paid after thirty days but within sixty days of the
date the bill was received, the department shall pay one hundred per cent of the rate.

3. If the hospital's bill is paid any time after sixty days of the date the bill
was received, the department shall pay one hundred per cent of the rate plus a fee of one
per cent per month for each month or portion of a month following the sixtieth day of
receipt of the bill until the date of payment.

I. For medical services other than those for which a rate has been established
pursuant to section 36-2903.01, subsection H, the department shall pay according to the
Arizona health care cost containment system capped fee-for-service schedule adopted
pursuant to section 36-2904, subsection K.

J. For any hospital or medical claims not covered under subsection D or I of this
section, the department shall establish and adopt a schedule setting out maximum
allowable fees that the department deems reasonable for such services after appropriate
study and analysis of usual and customary fees charged by providers. The department shall
not pay to any plan or intermediary that portion of the cost of any service provided that
exceeds allowable charges prescribed by the department pursuant to this subsection.

K. The department shall not pay claims for services pursuant to this section that
are submitted more than one hundred eighty days after the date of the service for which
the payment is claimed.

L. The department may provide for payment through an insurance plan, hospital
service plan, medical service plan, or any other health service plan authorized to do
business in this state, fiscal intermediary or a combination of such plans or
methods. The state shall not be liable for and the department shall not pay to any plan
or intermediary any portion of the cost of comprehensive medical and dental care in
excess of funds appropriated and available for such purpose at the time the plan or
intermediary incurs the expense for such care.

M. The total amount of state monies that may be spent in any fiscal year by the
department for comprehensive medical and dental care shall not exceed the amount
appropriated or authorized by section 35-173 for that purpose. This section shall not be
construed to impose a duty on an officer, agent or employee of this state to discharge a
responsibility or to create any right in a person or group if the discharge or right
would require an expenditure of state monies in excess of the expenditure authorized by
legislative appropriation for that specific purpose.