R9-15-201. Primary Care Provider and Service Site Requirements

A. A primary care provider may request to participate in the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program: 1. If the primary care provider: a. Meets the requirements in A.R.S. § 41-1080 or is a U.S. National according to U.S.C. Title 8, Chapter 12; b. Has completed the final year of a course of study or program approved by an accrediting agency recognized by the U.S. Department of Education or the Council for Higher Education Accreditation for higher education in a health profession licensed under A.R.S. Title 32; c. Holds a current Arizona license or certificate in a health profession licensed under A.R.S. Title 32; d. If a physician, has completed a professional residency program and is board certified or board eligible in: i. Family medicine, ii. Internal medicine, iii. Pediatrics, iv. Geriatrics, v. Obstetrics-gynecology, or vi. Psychiatry; e. Except for a pharmacist or a behavioral health care provider providing primary care services at a free-clinic, Indian Health Service or tribal facility, or a federal prison or state prison, agrees to comply with the requirements for a sliding-fee schedule according to 9 A.A.C. 1, Article 5; f. Except for a primary care provider providing primary care services at a free-clinic, Indian Health Service or tribal facility, or a federal prison or state prison, agrees to charge for primary care services at the usual and customary fees prevailing in the primary care area, except that: i. A patient unable to pay the usual and customary fees is not charged or is charged a reduced fee, according to the service site’s or employer’s sliding-fee schedule required in subsection (A)(2)(d), or a fee less than the sliding-fee schedule; and ii. A medically uninsured individual from a family unit with an annual income at or below 200% of the poverty level is charged according to a sliding-fee schedule required in subsection (A)(2)(d) or not charged; g. Who provides services at a critical access hospital with a separate qualifying service site, agrees to provide: i. At least 16 hours of service per week at the critical access hospital, and ii. At least 24 hours of primary care services per week at the qualifying service site; h. Agrees not to discriminate on the basis of a patient’s ability to pay or a payment source, including Medicare, AHCCCS, or a qualifying health plan; i. Agrees to accept assignment for payment under: i. Medicare, if providing primary care services to adults; ii. Children’s Health Insurance Program (KidsCare), established under A.R.S. § 36-2982, if providing primary care services to children; iii. AHCCCS; and iv. A qualifying health plan; and j. Has satisfied any other health professional service obligation owed under a contract with a federal, state, or local government before beginning a period of service under the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program, as applicable; and 2. If the primary care provider’s service site: a. Is either a: i. Service site that meets the requirements in A.R.S. § 36-2172(B)(2), or ii. Private practice service site as allowed in A.R.S. § 36-2174; b. Except for a free-clinic or Indian Health Service or tribal facility, accepts assignment for payment under: i. Medicare, if providing primary care services to adults; ii. Children’s Health Insurance Program (KidsCare), established under A.R.S. § 36-2982, if providing primary care services to children; iii. AHCCCS; and iv. A qualifying health plan; c. Except for a free-clinic or Indian Health Service or tribal facility, is an AHCCCS provider; d. Except for a free-clinic, Indian Health Service or tribal facility, or a federal prison or state prison: i. Submits a sliding-fee schedule according to 9 A.A.C. 1, Article 5, to the Department for approval; ii. Develops and implements a policy for the service site’s sliding-fee schedule; and iii. Ensures that signage, informing individuals that the service site has a sliding-fee schedule, is conspicuously posted in the service site’s reception area; e. Except for a free-clinic, Indian Health Service or tribal facility, or a federal prison or state prison, charges for primary care services at the usual and customary fees prevailing in the primary care area, and has a policy providing that: i. A patient who is unable to pay the usual and customary fee is: (1) Charged a reduced fee according to the service site’s sliding-fee schedule in subsection (A)(2)(d), (2) Charged a fee less than the sliding-fee schedule, or (3) Not charged; and ii. A medically uninsured individual from a family unit with an annual income at or below 200% of the poverty level is charged according to the service site’s sliding-fee schedule in subsection (A)(2)(d) or not charged; f. Is a free-clinic, develops and implements a policy that the free-clinic provides primary care services to individuals at no charge; g. Does not discriminate on the basis of a patient’s ability to pay or a payment source, including Medicare, AHCCCS, or a qualifying health plan; and h. Agrees to notify the Department when the employment status of the primary care provider changes. B. A primary care provider may not participate in the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program, as applicable, if the primary care provider: 1. Has a judgment lien against the primary care provider’s property for a debt owed to a federal agency; 2. Is applying to participate in the Primary Care Provider Loan Repayment Program and: a. Has defaulted on: i. A Federal income tax liability, ii. Any federally-guaranteed or insured student loan or home mortgage loan, iii. A Federal Health Education Assistance Loan, iv. A Federal Nursing Student Loan, or v. A Federal Housing Authority Loan; or b. Is delinquent on payment for: i. Court-ordered child support, or ii. State taxes; or 3. Is applying to participate in the Rural Private Primary Care Provider Loan Repayment Program and is delinquent on payment for: a. State taxes, or b. Court-ordered child support.