Ariz. Admin. Code § 21-5-508

Current through Register Vol. 30, No. 45, November 8, 2024

Section R21-5-508 - Special Services Subsidy

A. Special services subsidy shall be:

1. Related to a special needs condition listed in the adoption subsidy agreement; and

2. Necessary to improve or maintain the adopted child's functioning as documented by an appropriate qualified professional. The Adoption Subsidy Program shall review the documentation at least annually.

B. Services approved for the payment of special services subsidy shall be:

1. Provided by a qualified professional;

2. Provided in the least restrictive environment and as close as possible to the adoptive parent's residence;

3. In accordance with the "Standard of Care"; and

4. Not otherwise covered by or provided through maintenance subsidy, medical subsidy, dental subsidy, mental health subsidy, or other resources for which the adopted child is eligible.

C. The adoptive parent shall submit the special services request to the Adoption Subsidy Program and receive approval from the Adoption Subsidy Program prior to the adoptive parent's incurring the specified expense. The request shall include:

1. Documentation from a qualified professional that the service is necessary; and

2. Documentation that the adoptive parent had requested the service and the service provider had denied the request or documentation that the service is not available from other potential funding sources, such as AHCCCS/Medicaid, private insurance, school district, or other community resources.

D. Special services subsidy shall not include:

1. Payment for services to meet needs other than the pre-existing special needs conditions specifically listed in the adoption subsidy agreement;

2. Payment for medical or dental services usually considered to be routine, such as well-child checkups, immunizations, and other services not related to the child's special needs conditions in the adoption subsidy agreement;

3. Payment for health-related services that are not medically necessary, as determined by a qualified professional;

4. Payment for social or recreational services such as routine child care, dance lessons, sports fees, camps, and similar services; and

5. Payment for educational services that are not necessary to meet the special needs conditions specifically listed in the adoption subsidy agreement, or the services for which the school district is responsible.

E. The Department may request an independent review by a qualified professional of a special services request to determine the necessity for medical, dental, psychological, or psychiatric testing or services, or to evaluate the appropriateness of the treatment plan or placement.

F. The Department may issue reimbursements to the adoptive parent for approved special services, or the Department may pay the service provider directly.

G. Special services subsidy reimbursement is limited as follows:

1. The Department shall reimburse in-state and out-of-state inpatient and outpatient hospital services according to the AHCCCS hospital reimbursement system, as required by A.R.S. § 8-142.01(A), if the adoptive parent has obtained prior approval for the service from the Department. Prior approval is not required in an emergency situation.

2. The Department shall not reimburse special services subsidy amounts in excess of the rates allowed by the Department or AHCCCS. The Department shall use the lowest applicable rates as established by AHCCCS, the Department's Comprehensive Medical and Dental Program (CMDP), or rates established by the Adoption Subsidy Program to be customary and reasonable.

3. The Department shall not pay for requests that the adoptive parent or provider submits more than nine months after the date of service for which the adoptive parent or provider requests payment.

Ariz. Admin. Code § R21-5-508

New section made by exempt rulemaking at 21 A.A.R. 3256, effective 1/24/2016.