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AHCCCS develops the policy contained in this manual using the following authorities:
Federal and State laws and regulations;
Waivers; and
The Medicaid and Children’s Health Insurance Program (CHIP) State Plans.
The federal authorities are the major framework for Medicaid and CHIP programs. The CHIP program in Arizona is called KidsCare.
Federal laws provide for mandatory programs and requirements, but also include options that states may choose in administering these programs. States use these options to individualize the programs for each state.
Federal authorities used to develop eligibility policy for the Medicaid and KidsCare programs include:
Public Laws;
Social Security Act (the Act);
United States Code (USC);
Code of Federal Regulations (CFR);
Federal Register;
State Medicaid Manual (SMM);
SSA's Program Operations Manual System (POMS); and
CMS guidance and letters to State Medicaid Directors (SMDL).
State laws are developed based on the Federal laws and regulations made by Congress and the Federal government. State authorities include:
Arizona Revised Statutes (ARS);
Arizona Administrative Code (AAC);
Arizona Administrative Register (AAR); and
Eligibility Policy and Procedure Manual (EPM).
Medicaid and CHIP programs must comply with Title XIX and Title XXI of the Social Security Act. Since AHCCCS began on October 1, 1982, the agency has been exempt from specific provisions of the SSA under an 1115 Research and Demonstration Waiver. The number 1115 refers to section 1115 of the Act.
The AHCCCS 1115 Waiver contains:
Provisions in the Act from which AHCCCS is waived;
Expenditure authority for certain items under section 1903 of the Act;
Terms and conditions that AHCCCS must fulfill, which includes documents and reports that must be submitted during the year;
Approved federal budget amounts; and
Attachments that outline financial, legislative, and budget neutrality requirements.
See http://www.azahcccs.gov/reporting/federal/waiver.aspx for Arizona’s 1115 Waiver.
Arizona has a Medicaid State Plan and a KidsCare State Plan. The State Plans assure that Arizona will administer the Medicaid and KidsCare programs according to federal requirements, and include any federal options the state has chosen.
AHCCCS is Arizona’s state agency with the responsibility for the State Plans. AHCCCS submits amendments to reflect changes in federal law, regulation, policy, or court decisions.
Term |
Definition |
Arizona Administrative Code (AAC) |
The AAC is commonly referred to as the Rules. The AAC is developed by the responsible state agency and approved by the Governor’s Regulatory Review Council (GRRC). The AAC provides more detail than the ARS. The AHCCCS-related rules are located in Title 9:
See http://www.azsos.gov/rules/arizona-administrative-code to view the AAC. |
Arizona Administrative Register (AAR) |
The AAR is the official publication of the State of Arizona. The AAR contains rules approved by the GRRC but not yet published in the AAC. See http://www.azsos.gov/rules/arizona-administrative-register to view the AAR. |
Arizona Revised Statutes (ARS) |
The ARS are made by the Arizona legislature. The following AHCCCS-related statutes are located in Title 36, Chapter 29:
See https://www.azleg.gov/arstitle to view the ARS. |
Centers for Medicare and Medicaid Services (CMS) Guidance |
Guidance and directives issued as:
See http://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html to search and view SMDL and SHO guidance by type and topic. See http://cms.hhs.gov/rulings/ to view CMS Rulings. |
Code of Federal Regulations (CFR) |
A collection of general and permanent rules (regulations) that have been previously published in the Federal Register. The CFR provides more detail about conditions of eligibility than the USC. Medicaid and CHIP programs are covered in:
See http://www.ecfr.gov/cgi-bin/ECFR?page=browse to view the CFR. |
Federal Register |
The Federal Register is the official daily publication of the U.S. government. It contains:
See https://www.federalregister.gov/ to view the Federal Register. |
Public Law |
A printing of the full text of a new law or an amendment to an existing law after it has been enacted by Congress and signed by the President. Public laws are later codified (collected and arranged) in the US Code (USC) along with all other Federal Laws. See http://www.gpo.gov/fdsys/browse/collection.action?collectionCode=PLAW to view Public Laws. |
Social Security Act (SSA) |
A collection of federal laws that cover all areas of Social Security. The laws authorizing and governing the Medicaid and CHIP programs are contained in three titles of the Act:
See http://www.ssa.gov/OP_Home/ssact/ssact-toc.htm to view the Social Security Act. |
SSA's Program Operations Manual System (POMS) |
Policy Manual for programs administered by the Social Security Administration. Some legal rules dictate that the agency use similar or less restrictive rules than the policies used by the Social Security Administration. See https://secure.ssa.gov/apps10/ to view Social Security’s Policy Manual. |
State Medicaid Manual (SMM) |
Policy guidance for the Medicaid requirements contained in the CFR developed by the Centers for Medicare and Medicaid Services (CMS). See https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021927.html to view the State Medicaid Manual. |
State Plan |
A written contract between AHCCCS and the Centers for Medicare and Medicaid Services (CMS). The State Plan describes the nature and scope of the Medicaid or KidsCare program. See https://azahcccs.gov/Resources/StatePlans/ to view Arizona’s Medicaid and CHIP State Plans. |
United States Code (USC) |
A collection of the federal laws made by Congress sorted by subject matter. See https://uscode.house.gov/ to view the USC. |