Laws & Regulations

The AHCCCS program is governed by Arizona statutes and rules, federal statutes and rules, and two written agreements with the federal government called the State Plan and the Waiver.

Arizona Revised Statutes (“A.R.S.”) that apply to the AHCCCS program can be found at Title 36, Chapter 29. Click on this link to go to an on-line version of the Arizona Revised Statutes.

The Arizona Administrative Code (“A.A.C.”) is the collection of formal rules that Arizona State agencies publish about the programs that they run. The state rules about AHCCCS are found in Title 9 of the Arizona Administrative Code, Chapters 22, 28, 29, 30, 31, and 34. Click on this link to go to an on-line version of the Arizona Administrative Code.

For rules that have been finalized but not yet published in the A.A.C., please refer to the Final Rules page.

The United States Code (“U.S.C.”) that apply to the Medicaid program can be found at Title 42, Chapter 7, Subchapter XIX (Medical Assistance) and Subchapter XXI (State Children’s Health Insurance Program or “KidsCare” as called in Arizona). Click on one of the links to go to an on-line version of these parts of the United States Code.

The Code of Federal Regulations (“C.F.R.”) is the collection of formal regulations that federal agencies publish regarding the programs they run. The federal regulations about the Medical Assistance (Medicaid) program are found at Title 42 Part 430 through 456. The federal regulations about the SCHIP (KidsCare) program are found at Title 42 Part 457. Click on one of the links to go to an on-line version of these parts of the United States Code.

Arizona has a Waiver granted by the federal government. As a result, it does not have to follow certain federal statutes and regulations. However, AHCCCS must run its program under Special Terms and Conditions required by the federal government. A list of those federal statutes and regulations and the Special Terms and Conditions can be found by clicking on this site.

The Arizona State Plan for the Federal Medicaid program can be viewed on this site. The federal government has approved a number of amendments to the State Plan, and they can be viewed on this site. The Arizona State Plan for the State Children's Health Insurance Program (KidsCare) can be viewed on this site. All of these documents are in Portable Document Format (PDF).

The Arizona Health Care Cost Containment System (AHCCCS) Medical Policy Manual (AMPM) documents the medical and program policies and requirements implemented by the AHCCCS Administration for Contractors and fee-for-service providers of these covered services. The manual provides information regarding covered health care services for Arizona residents who are eligible for AHCCCS services. Members who are eligible for emergency services only receive those services through the Federal Emergency Services Program. This manual also provides information regarding behavioral health services.

The Notice of Action Policy and Guide is provided to the AHCCCS Health Plans to help them write Notice of Action letters to members. Notice of Action letters are written when a Health Plan does not approve a service or stops a service that a member has been getting. The guide explains when a letter should be written and what should be in it.

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AHCCCS Directory

(Posted: June 16, 2008)
AHCCCS Directory of the agency's rules, substantive policy statements, and any materials incorporated by reference as required by A.R.S. § 41-1091.[..Details..]

AHCCCS Regulatory Agenda

The AHCCCS Regulatory Agenda identifies the activities, timeframes and progress for rule packages and 5 year reviews as required under A.R.S. 41-1021.02. The schedule also lists all related activities completed by AHCCCS within the last two years.

CMS Rules Overview (Proposed/Issued)

Published in the Federal Register, CY 2007

Over the last several months, the Centers for Medicare and Medicaid Services (CMS) has issued several proposed regulations and guidance impacting Medicaid and the State Children's Health Insurance Program. Congress has also taken steps, in the form of moratoriums, to delay the effective date of a number of these proposals. A summary of proposed regulations can be found here along with links to the rules and comments that have been submitted by AHCCCS to date. [..Details..]

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