Ariz. Admin. Code § 9-11-302

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

Section R9-11-302 - Hospital Rates and Charges Schedule

A. Before a hospital provides services to patients, a hospital administrator or designee shall submit to the Department a rates and charges package that contains:

1. A cover letter that includes:

a. The name, physical address, mailing address, county, and telephone number of the hospital;

b. The identification number assigned to the hospital:

i. By the Department;

ii. By AHCCCS, if applicable;

iii. By Medicare, if applicable; and

iv. As the hospital's national provider identifier;

c. The name, telephone number, and e-mail address of:

i. The hospital administrator,

ii. The hospital chief financial officer, and

iii. Another individual involved in the preparation of the rates and charges package whom the Department may contact regarding the rates and charges package; and

d. The planned implementation date for the rates and charges;

2. A rates and charges schedule prepared as specified in subsection (B); and

3. A form provided by the Department, on which the hospital administrator or designee:

a. Attests that, to the best of the knowledge and belief of the hospital administrator or designee, the information submitted according to subsections (A)(1) and (B) is accurate and complete; or

b. If the hospital administrator or designee has personal knowledge that the information submitted according to subsections (A)(1) and (B) is not accurate or not complete:

i. Identifies the information that is not accurate or not complete;

ii. Describes the circumstances that make the information not accurate or not complete;

iii. States what actions the hospital is taking to correct the inaccurate information or make the information complete; and

iv. Attests that, to the best of the knowledge and belief of the hospital administrator or designee, the information submitted according to subsections (A)(1) and (B), except the information identified in subsection (A)(3)(b)(i), is accurate and complete.

B. A hospital administrator shall ensure that a rates and charges schedule:

1. Contains a table of contents for the rates and charges schedule that lists:

a. The beginning line number or page number for the hospital rates and charges overview form required in subsection (B)(2);

b. For each hospital department:

i. The hospital department's name and identification number,

ii. The beginning line number or page number of the rates and charges schedule for the hospital department, and

iii. The charge source's name and identification number for each charge source within the hospital department;

c. The beginning line number or page number for the list required in subsection (B)(4) that matches the name of each charge source with its charge source identification number;

d. The beginning line number or page number for the formula section for formulary, commodity, and contracted services mark-ups required in subsection (B)(5); and

e. The beginning line number or page number for the copy of the hospital's allowance rules and formulae required in subsection (B)(6);

2. Contains an overview form, in a format specified by the Department, that includes:

a. The hospital's name, city, and county;

b. The identification number assigned to the hospital by the Department;

c. The name, telephone number, and e-mail of the individual who prepared the overview form;

d. The date the overview form was submitted to the Department;

e. The hospital's licensed capacity;

f. Whether the entity that is the owner of the hospital is:

i. Not for profit;

ii. For profit; or

iii. A federal, state, or local government agency;

g. The hospital's classification;

h. The planned implementation date for the rates and charges in the overview form;

i. The total percent increase of the rates and charges listed in the overview form compared with the rates and charges from the last overview form, if applicable;

j. The date the overview form was last changed, if applicable;

k. The daily charge for a private room;

l. The daily charge for a semi-private room;

m. The daily charge for a pediatric bed;

n. The daily charge for a nursery bed;

o. The daily charge for a pediatric intensive care bed;

p. The daily charge for a neonatal intensive care bed;

q. The daily charge for a cardiovascular intensive care bed;

r. The daily charge for a swing bed;

s. The daily charge for a rehabilitation bed;

t. The daily charge for a skilled nursing bed;

u. The minimum charges for labor and delivery;

v. The minimum charge for trauma team activation;

w. The minimum charge for an EEG;

x. The minimum charge for an EKG;

y. The minimum charge for a complete blood count with differential;

z. The minimum charge for a blood bank crossmatch;

aa. The minimum charge for a lithotripsy;

bb. The minimum charge for an x-ray;

cc. The minimum charge for an IVP;

dd. The minimum charge for a respiratory therapy session with a small volume nebulizer;

ee. The minimum charge for a CT scan of a head without contrast medium;

ff. The minimum charge for a CT scan of an abdomen with contrast medium;

gg. The minimum charge for an abdomen ultrasound;

hh. The minimum charge for a brain MRI without contrast medium;

ii. The minimum charge for 15 minutes of physical therapy;

jj. The daily rate for behavioral health services for:

i. An adult patient,

ii. An adolescent patient, and

iii. A pediatric patient; and

kk. The code, if applicable, for the units of service specified in subsections (B)(2)(k) through (B)(2)(jj);

3. Lists for each hospital department, in a format specified by the Department:

a. The hospital department name and identification number;

b. The charge source name and identification number for each charge source within the hospital department; and

c. For each unit of service offered by the hospital for which a separate rate or charge is billed from the charge source:

i. The unit of service code;

ii. A description of the unit of service;

iii. The rate or charge for the unit of service; and

iv. The number of times a separate charge was billed for the unit of service during the previous 12 months, if applicable;

4. Contains a list that matches the name of each charge source with its charge source identification number;

5. Contains a formula section for formulary, commodity, and contracted services mark-ups; and

6. Contains a copy of the hospital's allowance rules and formulae, if applicable.

C. To change a hospital's current rates and charges information, a hospital administrator or designee shall submit to the Department:

1. A cover letter:

a. Containing the information specified in subsection (A)(1), and

b. Stating that the accompanying information is changing the hospital's current rates and charges information;

2. Either:

a. The rates and charges schedule specified in subsection (A)(2); or

b. The following information:

i. A description of:

(1) The current and new rate or charge for each unit of service undergoing a change;

(2) The name of each charge source undergoing a change and its charge source identification number;

(3) The current and new formulary, commodity, and contracted services formulae for each change in the hospital's mark-up;

(4) The current and new allowance rules and formulae for each change in the hospital's allowance rules and formulae; and

(5) How the hospital rates and charges overview form required in subsection (B)(2) is affected by the changes specified in subsections (C)(2)(b)(i)(1) through (C)(2)(b)(i)(4);

ii. The line number or page number in the hospital's current rates and charges information for each change listed in subsection (C)(2)(b)(i); and

iii. A list of each previous change:

(1) To a rate; charge; charge source; formulary, commodity, or contracted services formula; or allowance rule or formula being changed;

(2) That was submitted since the last rates and charges schedule submitted according to subsection (A)(2) or (C)(2)(a); and

(3) Including:

(a) The date the rate; charge; charge source; formulary, commodity, or contracted services formula; or allowance rule or formula was previously changed; and

(b) A description of how the rate; charge; charge source; formulary, commodity, or contracted services formula; or allowance rule or formula was previously changed; and

3. A form provided by the Department, on which the hospital administrator or designee:

a. Attests that, to the best of the knowledge and belief of the hospital administrator or designee, the information submitted according to subsections (C)(1) and (C)(2) is accurate and complete; or

b. If the hospital administrator or designee has personal knowledge that the information submitted according to subsections (C)(1) and (C)(2) is not accurate or not complete:

i. Identifies the information that is not accurate or not complete;

ii. Describes the circumstances that make the information not accurate or not complete;

iii. States what actions the hospital is taking to correct the inaccurate information or make the information complete; and

iv. Attests that, to the best of the knowledge and belief of the hospital administrator or designee, the information submitted according to subsections (C)(1) and (C)(2), except the information identified in subsection (C)(3)(b)(i), is accurate and complete.

D. A hospital administrator shall implement rates and charges for a rates and charges schedule, submitted as specified in subsection (A), on a date determined by the hospital but not earlier than:

1. The date the Department notifies the hospital that the Department has completed a review of the rates and charges schedule, or

2. Sixty calendar days after the Department notifies the hospital that the Department received the rates and charges schedule.

E. A hospital administrator shall implement a change in the hospital's current rates and charges information submitted as specified in subsection (C):

1. That is:

a. A new rate; charge; charge source; formulary, commodity, or contracted services formula; or allowance rule or formula;

b. An increase in a rate or charge;

c. A change to a formulary, commodity, or contracted services formula, which results in an increase in a rate or charge; or

d. A change to an allowance rule or formula, which results in an increase in a rate or charge; and

2. On a date determined by the hospital, but not earlier than:

a. The date the Department notifies the hospital that the Department has completed a review of the information submitted as specified in subsection (C), or

b. Sixty calendar days after the Department notifies the hospital that the Department received the information submitted as specified in subsection (C).

F. A hospital administrator shall implement a change in the hospital's current rates and charges information submitted as specified in subsection (C):

1. That is:

a. A deletion of a rate; charge; charge source; formulary, commodity, or contracted services formula; or allowance rule or formula;

b. A reduction in a rate or charge;

c. A change to a formulary, commodity, or contracted services formula, which results in a reduction in a rate or charge; or

d. A change to an allowance rule or formula, which results in a reduction in a rate or charge; and

2. On a date:

a. Determined by the hospital, and

b. Not earlier than the date the Department notifies the hospital that the Department received the information submitted as specified in subsection (C).

G. When the Department receives from a hospital a rates and charges schedule submitted as specified in subsection (A), or a change in the hospital's current rates and charges information submitted as specified in subsection (C), the Department shall:

1. Provide written notice to the hospital within five business days of receipt of the rates and charges information, and

2. Provide written notice to the hospital within 60 calendar days that the Department has reviewed the rates and charges information.

H. A hospital administrator, who receives a request from the Department for a revision of a rates and charges schedule not prepared as specified in subsection (A) or for a revision of a change in the hospital's current rates and charges information not prepared as specified in subsection (C), shall ensure that the revised rates and charges schedule or the revised information changing the current rates and charges information is submitted to the Department:

1. Within 21 calendar days after the date on the Department's letter requesting an initial revision, and

2. Within seven calendar days after the date on the Department's letter requesting a second revision.

I. If a hospital administrator or designee does not submit a rates and charges schedule or information about changes to the hospital's rates or charges according to this Section, the Department may assess civil penalties as specified in A.R.S. § 36-431.01.

Ariz. Admin. Code § R9-11-302

Section adopted effective February 22, 1995, through an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1994, Ch. 115, § 9 (Supp. 95-1). Former R9-11-302 recodified to R9-11-402; new R9-11-302 recodified from R9-11-104 at 10 A.A.R. 3835, effective August 24, 2004 (Supp. 04-3). Section expired under A.R.S. § 41-1056(E) at 12 A.A.R. 1784, effective January 31, 2006 (Supp. 06-2). New Section made by final rulemaking at 13 A.A.R. 3648, effective December 1, 2007 (Supp. 07-4).