Ariz. Admin. Code § 6-6-2110

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

Section R6-6-2110 - Authorization to Provide Services

A. The Division shall issue authorizations to the Qualified Vendors selected by the consumer, the consumer's representative or the Division to provide the needed services.

B. The Division shall pay a Qualified Vendor based on the rates established in the Qualified Vendor Agreement and the units of service documented on the invoices submitted for valid authorizations issued for individual consumers.

C. The Division shall modify authorizations based on changes in the needs of consumers as documented in the ISP by the ISP Team and as applicable, approved by the Division.

D. The Division shall not provide reimbursement for services that have not been authorized except in an emergency situation, as determined by the Division.

E. A Qualified Vendor may provide short-term emergency services and, if the services are approved by the Division, the Division shall pay for the short-term emergency services.

1. The Qualified Vendor shall notify the Division of the emergency situation within one working day of implementing the emergency services.

2. The Division shall approve payment for emergency services for up to five days. Upon verbal or written request from the Qualified Vendor, the District Program Manager may approve an additional emergency period for up to 15 days. The District Program Manager shall approve any extension of the emergency period in writing.

3. The Division shall review the consumer's needs through the ISP process and document as appropriate the revised authorization level.

F. A Qualified Vendors providing service may request an informal review by the Division of the number of units of service or type of services authorized for a specific consumer by submitting a written request for review to the Division District Program Manager.

1. The District Program Manager:

a. Shall conduct a review of the authorized units of service and issue a determination within 10 days of receipt of the request for review; or

b. May, at the sole discretion of the Division, arrange for an independent assessment of the service authorization by an external party selected from a list of independent assessors approved by the Division. The independent assessor shall review the service authorization and provide a written assessment to the District Program Manager within 30 days of the request for an assessment.

2. The District Program Manager shall issue a decision including the reasons for the decision within 10 days of receiving the independent assessment.

Ariz. Admin. Code § R6-6-2110

New Section made by exempt rulemaking at 9 A.A.R. 170, effective February 1, 2003 (Supp. 03-1). Amended by exempt rulemaking at 9 A.A.R. 4656, effective October 9, 2003 (Supp. 03-4).