Ariz. Admin. Code § 9-15-206

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-15-206 - Primary Care Provider Health Service Priority

A. For a primary care provider providing primary care services at multiple service sites, the Department shall determine the health service priority points in subsection (B)(1) through (6) for each service site and:

1. If the number of primary care service hours worked at one service site is more than 50 percent of the primary care provider's total number of primary care service hours worked, the Department shall use that service site's points to determine an initial application or a renewal application health service priority; or

2. If the number of primary care service hours worked at one service site is not more than 50 percent of the primary care provider's total number of primary care service hours worked, the Department shall use the average of all service sites' points to determine an initial application or a renewal application health service priority.

B. The Department shall review an initial application or a renewal application and assign points based on the following factors to determine the initial application or renewal application health service priority:

1. The service site is located in a rural area:

a. Yes = 10 points, or

b. No = 0 points;

2. The service site's highest geographic, facility, or population HPSA score, consistent with subsection (A), assigned by the U.S. Secretary of Health and Human Services for the area in which the service site is located according to the documentation provided by the primary care provider;

3. The service site's percentage of the total encounters reported according to R9-15-202(B)(15)(l) or R9-15-203(C)(15)(e) that are AHCCCS, Medicare, approved sliding-fee schedule, and free-of-charge encounters:

Percentage	Points
Greater than 50%	10,
35-50%	8,
26-34%	6,
11-25%	4, or
Less than 10%	2;

4. Except for a service site at a federal prison or state prison, if:

a. A medical primary care provider, including a pharmacist, and the distance from the primary care provider's service site to the next service site that provides medical services and offers reduced primary care services fees according to an approved sliding-fee schedule is:

Miles	Points
Greater than 25	4, or
Less than 25	0;

b. A dental primary care provider and the distance from the primary care provider's service site to the next service site that provides dental services and offers reduced primary care services fees according to an approved sliding-fee schedule is:

Miles	Points
Greater than 25	4, or
Less than 25	0; and

c. A behavioral health primary care provider and the distance from the primary care provider's service site to the next service site that provides behavioral health services and offers reduced primary care services fees according to an approved slidingfee schedule is:

Miles	Points
Greater than 25	4, or
Less than 25	0;

5. For an initial application only, the primary care provider is newly employed at the service site or by the employer:

a. Yes = 2 points, or

b. No = 0 points;

6. The primary care provider only provides primary care services when the primary care provider and the patient are physically present at the same location:

a. Yes = 4 points, or

b. No = 0 points;

7. The primary care provider is a resident of Arizona according to A.R.S. § 15-1802:

a. Yes = 4 points, or

b. No = 0 point;

8. The primary care provider is a graduate of an Arizona graduate educational institution:

a. Yes = 4 points, or

b. No = 0 point;

9. For an initial application only, the primary care provider has experience providing primary care services to a medically underserved population:

a. Yes = 4 points, or

b. No = 0 point; and

10. The primary care provider is providing or agrees to provide primary care services full-time:

a. Yes = 3 points, or

b. No = 0 points.

C. To determine a service site's highest HPSA score, the Department shall apply the following HPSA designations:

1. A Primary Medical Care HPSA score if a primary care provider provides medical or pharmaceutical primary care services,

2. A Dental HPSA score if a primary care provider provides dental primary care services, and

3. A Mental Health HPSA score if a primary care provider provides behavioral health primary care services.

D. For the purpose of determining a health service priority and allocating loan repayment funds, the Department shall consider a primary care provider who provides services at a critical access hospital, in addition to primary care services at a service site according to R9-15-201(A)(1)(g), to be providing services full-time.

E. The Department shall determine a primary care provider's initial or renewal application health service priority by calculating the sum of the assigned points for the factors described in subsection (B).

F. The Department shall apply the factors in subsection (G) if the Department determines there are:

1. More than one initial application or renewal application that have the same health service priority and there are funds available for only one initial or renewal application; or

2. Two or more initial applications that have the same health service priority for:

a. A service site and there is one health care provider with a higher health service priority approved to participate in the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program during the same June allocation process, or

b. An employer and there are three primary care providers with a higher health service priority approved to participate in the Primary Care Provider Loan Repayment Program or Rural Private Primary Care Provider Loan Repayment Program during the same June allocation process.

G. To determine participation in the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program for a primary care provider in subsection (F), the Department shall apply the following to each primary care provider's application:

1. If only one application is for a primary care provider who is a resident of Arizona, the Department shall approve the primary care provider for participation;

2. If more than one application is for a primary care provider who is a resident of Arizona, the Department shall apply each of the following factors in descending order until no two applications are the same and all available loan repayment funds have been allocated:

a. Whether a primary care provider will provide primary care services full-time;

b. Whether the primary care provider's service site is located in a rural area;

c. The service site's highest HPSA score reported in subsection (B)(2);

d. Whether the primary care provider provides primary care services when the primary care provider and a patient are at the same location;

e. Whether the primary care provider has experience providing primary care services to a medically underserved population;

f. The number of total hours the primary care provider has experience providing primary care services in a medically underserved population if reported in subsection (G)(2)(e); and

g. Whether the primary care provider's practice or specialty is identified as the greatest unmet healthcare discipline or specialty area in Arizona, as determined by the U. S. Department of Health & Human Services, Health Resources and Services Administration.

H. If more than one initial application or renewal application for a primary care provider in subsection (F) remains after the Department's determinations in subsection (G) and there are limited loan repayment funds available, the Department shall randomly select one primary care provider's initial application or renewal application and approve the primary care provider for participation in the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program.

I. When the Department holds a random selection to determine one initial application or renewal application identified in subsection (H), the Department shall:

1. Assign an Assistant Director from a division within the Department, other than the division responsible for the Primary Care Provider Loan Repayment Program or Rural Health Care Provider Loan Repayment Program, to be responsible for the random selection, and

2. Invite all the primary care providers whose initial applications or renewal applications are identified to participate in the random selection.

J. The Department shall notify a primary care provider of the Department's decision according to R9-15-205.

Ariz. Admin. Code § R9-15-206

New Section made by final rulemaking at 7 A.A.R. 2823, effective August 9, 2001 (Supp. 01-2). Adopted by exempt rulemaking at 22 A.A.R. 851, effective 4/1/2016. Renumbered from R9-15-207 and amended by emergency rulemaking at 28 A.A.R. 3684, effective 11/15/2022. Amended by emergency rulemaking at 29 A.A.R. 1274, effective 5/14/2023. Renumbered from R9-15-207 and amended from R9-15-207 by final rulemaking at 29 A.A.R. 3837, effective 12/6/2023.