R9-22-216. NF, Alternative HCBS Setting, or HCBS

A. Services provided in a NF, including room and board, an alternative HCBS setting as defined in R9-28-101, or a HCBS as defined in A.R.S. § 36-2939 are covered for a maximum of 90 days per contract year if the member’s medical condition would otherwise require hospitalization. B. Except as otherwise provided in 9 A.A.C. 28, the following services are not itemized for separate billing if provided in a NF, alternative HCBS setting, or HCBS: 1. Nursing services, including: a. Administering medication; b. Tube feedings; c. Personal care services, including but not limited to assistance with bathing and grooming; d. Routine testing of vital signs; and e. Maintenance of a catheter; 2. Basic patient care equipment and sickroom supplies, including: a. First aid supplies such as bandages, tape, ointments, peroxide, alcohol, and over-the-counter remedies; b. Bathing and grooming supplies; c. Identification device; d. Skin lotion; e. Medication cup; f. Alcohol wipes, cotton balls, and cotton rolls; g. Rubber gloves (non-sterile); h. Laxatives; i. Bed and accessories; j. Thermometer; k. Ice bags; l. Rubber sheeting; m. Passive restraints; n. Glycerin swabs; o. Facial tissue; p. Enemas; q. Heating pad; and r. Incontinence briefs. 3. Dietary services including preparation and administration of special diets, and adaptive tools for eating; 4. Any service that is included in a NF’s room and board charge or a service that is required of the NF to meet a federal or state licensure standard or county certification requirement; 5. Physician visits made solely for the purpose of meeting state licensure standards or county certification requirements; 6. Physical therapy prescribed only as a maintenance regimen; and 7. Assistive devices and non-customized durable medical equipment. C. A provider shall obtain prior authorization from the Administration for a NF admission for a FFS member.