AHCCCS Laws, Regulations, and Agreements

Overview

The AHCCCS program is governed by Federal statutes and rules, Arizona statutes and rules and Written Agreements with the federal government called the Waiver and State Plan.

Federal Statutes and Rules

• United States Code ("U.S.C.") provisions that apply to the Medicaid program can be found at Title 42, Chapter 7:
  • Subchapter XIX (Medical Assistance)
  • Subchapter XXI (State Children's Health Insurance Program or "KidsCare" as called in Arizona)

• Code of Federal Regulations ("C.F.R.") is the collection of formal regulations that federal agencies publish regarding the programs they run. The federal regulations about AHCCCS Medicaid are found at Title 42 Part 430 through 456.
  • Medical Assistance
  • The federal regulations about the KidsCare program are found at Title 42 Part 457. SCHIP (KidsCare)

• The Federal Register is the official daily publication for rules, proposed rules, and notices of Federal agencies and organizations, as well as executive orders and other presidential documents.
  • Proposed Federal Rules
• Regulations.gov is your one-stop web site to find, view, and comment on Federal regulations and other Federal actions.
  • Regulations.gov

Arizona Statutes and Rules

• Arizona Revised Statutes ("A.R.S.") that apply to the AHCCCS program can be found at Title 36, Chapters 29 and 34 (Effective Date for Chapter 34: July 1, 2016).
  • Arizona Revised Statutes

• Arizona Administrative Code ("A.A.C.") is the collection of formal rules that Arizona State agencies publish about the programs that they run. The state rules about AHCCCS are found in Title 9 of the Arizona Administrative Code, Chapters 21 (Effective Date: July 1, 2016), 22, 28, 29, 30, 31, and 34.
  • Arizona Administrative Code
    • For rules that have been finalized but not yet published in the A.A.C.:
      • Final Rules
    • For rule changes that are in process:
      • Regulatory Agenda and the Proposed Rules
  • The AHCCCS Directory lists the agency's rules, substantive policy statements, and any materials incorporated by reference as required by A.R.S. § 41-1091.
    • AHCCCS Directory

Petition for Review

Any person may petition the Governor’s Regulatory Review Council to request a review of a final rule based on the person’s belief that the final rule does not meet the requirements of Arizona Revised Statute (A.R.S.) § 41-1030.

A.R.S. § 41-1030 states that:

• A rule is invalid unless it is made and approved in substantial compliance with §§ 41-1021 through 41-1029 and articles 4, 4.1 and 5 of this chapter, unless otherwise provided by law.
• An agency shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule or state tribal gaming compact. A general grant of authority in statute does not constitute a basis for imposing a licensing requirement or condition unless a rule is made pursuant to that general grant of authority that specifically authorizes the requirement or condition.
• An agency shall not make a rule under a specific grant of rulemaking authority that exceeds the subject matter areas listed in the specific statute authorizing the rule.
• An agency shall not make a rule under a general grant of rulemaking authority to supplement a more specific grant of rulemaking authority.
• Submit a Petition for Review

Written Agreements with the Federal Government

• The 1115 Waiver is granted by the federal government. As a result, AHCCCS does not have to follow certain federal statutes and regulations. However, AHCCCS must run its program under Special Terms and Conditions required by the federal government.
  • Arizona’s 1115 Waiver page
• The Arizona State Plans are comprehensive written contracts between AHCCCS and the Centers for Medicare and Medicaid Services (CMS) that describes the nature and scope of its Medicaid and CHIP programs.
  • Arizona State Plan for the Federal Medicaid program
  • Arizona State Plan for the Children's Health Insurance Program (KidsCare)

AHCCCS Emergency Protocols

Under A.R.S. § 41-5202 and the Americans with Disabilities Act of 1990, AHCCCS has a process for communicating with its members during a state of emergency. AHCCCS has protocols in place to communicate with local state, county, city and tribal personnel, and additional protocols for notifications to members when they could be threatened by a state of emergency. It is AHCCCS’s priority that all members receive effective communication regardless of language of origin or ability.