Ariz. Admin. Code § 9-34-311

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

Section R9-34-311 - Special Requirements for the Appeal Process

A. AHCCCS shall provide that an oral inquiry seeking to appeal an action is treated as an appeal.

B. A resolution of an appeal by AHCCCS before a State Fair Hearing is an informal resolution under A.R.S. § 36-2903.01(B)(4).

C. AHCCCS shall provide a reasonable opportunity for the FFS member to present evidence and allegations of fact or law prior to issuance of an appeal resolution.

D. AHCCCS shall provide the enrollee and representative the opportunity, before and during the appeals process, to examine the enrollee's case file, including medical records, documents not protected from disclosure by law, and records considered during the appeal process.

E. AHCCCS shall schedule a hearing and mail a Notice of State Fair Hearing under A.R.S. § 41-1092.05 if AHCCCS receives a timely appeal and:

1. The prior authorization request, as defined in 9 A.A.C. 22, Article 1, was reviewed by two independent medical professionals prior to mailing the Notice of Action; or

2. The FFS member requests a State Fair Hearing for expedited resolution that meets the criteria in R9-34-316.

Ariz. Admin. Code § R9-34-311

New Section made by final rulemaking at 10 A.A.R. 828, effective April 3, 2004 (Supp. 04-1).