Arizona § 36-2971 - Definitions

§ 36-2971. Definitions

In this article, unless the context otherwise requires:

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

2. "Contractor" means a person or entity that has a prepaid capitated contract with the administration pursuant to section 36-2904 to provide health care to members under this article either directly or through subcontracts with providers.

3. "Department" means the department of economic security.

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

5. "Dual eligible" means a person who is determined eligible pursuant to this article and who is also determined eligible pursuant to section 36-2901, paragraph 6, subdivision (a) or section 36-2931, paragraph 5.

6. "Member" means an eligible person who enrolls in the system and who is defined as a qualified medicare beneficiary pursuant to section 1905(p) of title XIX of the social security act and whose income does not exceed one hundred per cent of the federal poverty guidelines.

7. "Noncontracting provider" means a person who provides services and who does not have a subcontract with a contractor or program contractor.

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

9. "Primary care practitioner" means a nurse practitioner certified pursuant to title 32, chapter 15 or a physician assistant certified pursuant to title 32, chapter 25.  This paragraph does not expand the scope of practice for nurse practitioners as defined pursuant to title 32, chapter 15, or for physician assistants as defined pursuant to title 32, chapter 25.

10. "Program contractor" means the department or any other entity that contracts with the administration pursuant to section 36-2940 or 36-2944.

11. "Qualified medicare beneficiary only" means an eligible person who is determined eligible pursuant to this article and who is not enrolled as a member under either article 1 or 2 of this chapter.

12. "Qualifying individual 1" means a person who would be defined as eligible pursuant to this article except for the fact that the person's income is at least one hundred twenty per cent of the federal poverty guidelines but is less than one hundred thirty-five per cent of the federal poverty guidelines.

13. "Qualifying individual 2" means a person who would be defined as eligible pursuant to this article except for the fact that the person's income is at least one hundred thirty-five per cent of the federal poverty guidelines but is less than one hundred seventy-five per cent of the federal poverty guidelines.

14. "Section 1115 waiver" means the research and demonstration waiver granted by the United States department of health and human services.

15. "Specified low income medicare beneficiary" means a person who would be defined as an eligible person pursuant to this article except for the fact that the person's income is above one hundred per cent of the federal poverty guidelines but is less than one hundred twenty per cent of the federal poverty guidelines.

16. "System" means the Arizona health care cost containment system established by article 1 of this chapter and the Arizona long-term care system established by article 2 of this chapter.