reglab/statecodes huggingface dataset:
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-222 - Denial of a Request for a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall deny a request for a State Fair Hearing under
				  A.R.S. §
									41-1092,
				  et seq., upon written determination that:
1. The request for hearing is
				untimely;
2. The request for
				hearing is not for an action permitted under this Article;
3. The request for hearing is moot, as
				determined by AHCCCS, based on the factual circumstances of each case;
				or
4. The sole issue presented is a
				federal or state law requiring an automatic change adversely affecting some or
				all enrollees.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-223 - Motion for Rehearing or Review

Current through Register Vol. 30, No. 28, July 12, 2024
Under A.R.S. §
									41-1092.09,
				  the Director shall grant a rehearing or review for any of the following reasons
				  materially affecting an enrollee's rights:
1. Irregularity in the proceedings of a
				hearing that deprived an enrollee of a fair hearing;
2. Misconduct of AHCCCS, OAH, or a
				party;
3. Newly discovered material
				evidence that could not, with reasonable diligence, have been discovered and
				produced at the hearing;
4. The
				decision is the result of passion or prejudice;
5. The decision is not justified by the
				evidence or is contrary to law; or
6. Good cause is established for the
				nonappearance of the enrollee at the State Fair Hearing.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-224 - Continuation of Services While the Contractor Appeal and the State Fair Hearing Are Pending

Current through Register Vol. 30, No. 28, July 12, 2024
A. For the
				purposes of this Section, timely filing means filing on or before the later of
				the following:
1. Within 10 days after the
				date that the contractor mails the Notice of Action, or
2. The effective date of the action as
				indicated in the Notice of Action.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-225 - Reversed Appeal Resolutions

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				If the contractor or the Director's Decision reverses a decision to deny,
				limit, or delay services that were not furnished while the appeal was pending,
				the contractor shall authorize or provide the disputed services promptly, and
				as expeditiously as the enrollee's health condition requires.
B. If the contractor or the Director's
				Decision reverses a decision to deny authorization of services, and the
				enrollee received the disputed services while the appeal was pending, the
				contractor shall pay the provider for those services.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-301 - Purpose

Current through Register Vol. 30, No. 28, July 12, 2024
This Article establishes the appeal and State Fair Hearing
				  requirements for an AHCCCS fee-for-service (FFS) member.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-302 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
A. "Action" by AHCCCS or a tribal contractor means:
1. The denial or limited authorization of a requested
				  service, including the type or level of service;
2. The reduction, suspension, or termination of a previously
				  authorized service;
3. The failure to provide services in a timely manner as set
				  forth in contract; or
4. The failure of AHCCCS to act within the time-frames
				  specified in this Article.
B. "AHCCCS" means the AHCCCS Administration as defined in
				  A.R.S. §
									36-2901.
C. "Appeal" means a request for review of an action.
D. "Day" means calendar day unless otherwise
				  specified.
E. "Director" means the Director of the Arizona Health Care
				  Cost Containment System Administration or designee.
F. "Director's Decision" means the final administrative
				  decision under A.R.S. §
									41-1092(5).
G. "FFS member" means an FFS member eligible for AHCCCS under
				  A.R.S. Title 36, Chapter 29, and who is enrolled with AHCCCS on an FFS
				  basis.
H. "Filed" means the date that AHCCCS receives a request as
				  established by a date stamp on the request or other record of receipt.
I. "Institution for Mental Disease" means an institution
				  defined in
				  42 CFR
				  435.1009 and licensed by the Arizona
				  Department of Health Services.
J. "State Fair Hearing" means an administrative hearing under
				  A.R.S. Title 41, Chapter 6, Article 10.
K. "Working day" means a Monday, Tuesday, Wednesday,
				  Thursday, or Friday unless:
1. A legal holiday falls on Monday, Tuesday, Wednesday,
				  Thursday, or Friday; or
2. A legal holiday falls on Saturday or Sunday and a
				  contractor is closed for business the prior Friday or following Monday.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-303 - Computation of Time

Current through Register Vol. 30, No. 28, July 12, 2024
A. Computation
				of time in calendar days begins the day after the act, event, or decision and
				includes all calendar days and the final day of the period. If the final day of
				the period is a weekend or legal holiday, the period is extended until the end
				of the next day that is not a weekend or a legal holiday.
B. Computation of time for working day begins
				the day after the act, event, or decision and includes all working days.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-304 - Language and Format of the Notice of Action

Current through Register Vol. 30, No. 28, July 12, 2024
The Notice of Action shall be in writing and meet the
				  following language and format requirements:
1. The Notice of Action is available in each
				non-English language spoken by a significant number or percentage of FFS
				members as established by contract.
2. The Notice of Action shall explain that
				free oral interpretation services are available to explain the Notice of Action
				for all non-English languages.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-305 - Content of the Notice of Action

Current through Register Vol. 30, No. 28, July 12, 2024
The Notice of Action explains the following:
1. The action AHCCCS has taken or intends to
				take;
2. The reasons for the
				action;
3. The factual and legal
				basis for the decision;
4. The FFS
				member's right to file an appeal with AHCCCS;
5. The procedures for exercising the rights
				specified in this Section;
6. The
				circumstances under which an expedited resolution is available and how to
				request it; and
7. The
				circumstances under which an FFS member has a right to have services continue
				pending resolution of the appeal, how to request that services be continued,
				and the circumstances under which the FFS member shall be liable for the costs
				of these services.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-306 - Time-frame for Notice of Action for Service Authorization Requests

Current through Register Vol. 30, No. 28, July 12, 2024
A. For an
				authorization decision, not covered in subsection (B), for a service requested
				on behalf of the FFS member, AHCCCS shall mail a Notice of Action within 14
				calendar days following receipt of the FFS member's request.
B. For authorization requests in which the
				provider indicates or AHCCCS determines that following the time-frame in
				subsection (A) could seriously jeopardize the FFS member's life or health, or
				ability to attain, maintain, or regain maximum function, AHCCCS shall make an
				expedited authorization decision and provide notice as expeditiously as the FFS
				member's health condition requires, but not later than three working days after
				receipt of the request for service.
C. If the FFS member requests an extension of
				the time-frame in subsection (A) or (B), AHCCCS shall extend the time-frame up
				to an additional 14 days as requested by the FFS member.
D. If AHCCCS needs additional information and
				the extension is in the best interest of the FFS member, AHCCCS shall extend
				the time-frame in subsection (A) or (B) up to an additional 14 days. If AHCCCS
				extends the time-frame, AHCCCS shall:
1. Give
				the FFS member written notice of the reason for the decision to extend the
				time-frame; and
2. Mail and carry
				out the determination as expeditiously as the FFS member's health condition
				requires and no later than the date the extension expires.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-307 - Time-frame for Notice of Action for Service Termination, Suspension, or Reduction

Current through Register Vol. 30, No. 28, July 12, 2024
A. For
				termination, suspension, or reduction of previously authorized AHCCCS covered
				service, AHCCCS shall send the Notice of Action at least 10 days before the
				date of the action except as provided in subsection (B) or (C).
B. AHCCCS may mail the Notice of Action no
				later than the date of action if:
1. AHCCCS
				has factual information confirming the death of an FFS member;
2. AHCCCS receives a clear written statement
				signed by the FFS member that the FFS member no longer wishes services or the
				FFS member gives information that requires termination or reduction of services
				and indicates that the FFS member understands that this shall be the result of
				supplying that information;
3. The
				FFS member is age 21 through 64 and has resided in an Institution for Mental
				Disease for more than 30 days;
4.
				The FFS member is an inmate of a public institution that does not receive
				federal financial participation;
5.
				The FFS member's whereabouts are unknown and the post office returns mail,
				directed to the FFS member, to the contractor indicating no forwarding address;
				or
6. AHCCCS establishes the fact
				that the FFS member has been accepted for Medicaid by another state.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-308 - Who May File

Current through Register Vol. 30, No. 28, July 12, 2024
A. An FFS member
				shall file an appeal or request a State Fair Hearing according to this
				Article.
B. An authorized
				representative, including a provider acting on behalf of the FFS member with
				the FFS member's written consent, shall file an appeal or request a State Fair
				Hearing on behalf of an FFS member.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-309 - Time-frame for Filing an Appeal

Current through Register Vol. 30, No. 28, July 12, 2024
An FFS member shall file an appeal either orally or in
				  writing with AHCCCS within 60 days after the date the FFS member receives the
				  Notice of Action.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-310 - General Requirements for the Appeal Process

Current through Register Vol. 30, No. 28, July 12, 2024
A. AHCCCS shall provide reasonable assistance
				to an FFS member in completing forms and taking other procedural steps.
				Reasonable assistance includes, but is not limited to, providing interpreter
				services and toll-free numbers that have adequate TTY/TTD
				(teletypewriter/telecommunications device for the deaf and text telephone) and
				interpreter capability.
B. AHCCCS
				shall acknowledge receipt of each appeal in writing.
C. AHCCCS shall ensure that the individual
				who makes a decision on an appeal was not involved in any previous level of
				review or decision-making.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-311 - Special Requirements for the Appeal Process

Current through Register Vol. 30, No. 28, July 12, 2024
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.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-312 - Time-frame for Standard Resolution of an Appeal

Current through Register Vol. 30, No. 28, July 12, 2024
A. For standard resolution of an appeal,
				AHCCCS shall resolve the appeal and mail written Notice of Appeal Resolution to
				the FFS member within 30 days after the day AHCCCS receives the
				appeal.
B. If the FFS member
				requests an extension of the 30 day time-frame in subsection (A), AHCCCS shall
				extend the time-frame up to an additional 14 days if requested by the FFS
				member.
C. If additional
				information is needed by AHCCCS and the extension is in the best interest of
				the FFS member, AHCCCCS shall extend the time-frame in subsection (A) up to an
				additional 14 days. If AHCCCS extends the time-frame, AHCCCS shall:
1. Give the FFS member written notice of the
				reason for the decision to extend the time-frame, and
2. Mail and carry out the resolution as
				expeditiously as the FFS member's health condition requires and no later than
				the date the extension expires.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-313 - Content of the Notice of Appeal Resolution

Current through Register Vol. 30, No. 28, July 12, 2024
A. The written Notice of Appeal Resolution
				shall include the results of the resolution process and the date it was
				completed.
B. For appeals not
				resolved wholly in favor of the FFS member, the Notice of Appeal Resolution
				shall contain,
1. The right to request a State
				Fair Hearing, and how to do so,
2.
				The right to request to receive services while the State Fair Hearing is
				pending, and how to make the request,
3. The factual and legal basis for the
				decision; and
4. That the FFS
				member shall be liable for the cost of continued services if the Director's
				Decision upholds AHCCCS' decision.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-314 - Request for a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				An FFS member may request a State Fair Hearing on AHCCCS' standard resolution
				of an appeal. The request shall be in writing, submitted to and received by
				AHCCCS, no later than 30 days after the FFS member receives the AHCCCS Notice
				of Appeal Resolution.
B. If an FFS
				member wants services to be continued pending a State Fair Hearing, the request
				to continue services shall be in writing and comply with R9-34-321.
C. AHCCCS shall mail a Notice of State Fair
				Hearing under A.R.S. §
									41-1092.05
				if AHCCCS receives a timely request for a State Fair Hearing under the
				requirements of this Article.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-315 - Time-frame for Resolution of State Fair Hearing for a Standard Resolution of an Appeal

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall mail a Notice of Final Decision to the FFS
				  member no later than 30 days after the date the Administrative Law Judge sends
				  the recommended decision to AHCCCS, and within 90 days after the date that the
				  FFS member filed the appeal with AHCCCS, not including the days for
				  continuances granted at the enrollee's request.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-316 - Request for Expedited Resolution of an Appeal

Current through Register Vol. 30, No. 28, July 12, 2024
A. AHCCCS shall mail a Notice of State Fair
				Hearing under A.R.S. §
									41-1092.05
				when AHCCCS receives an appeal request from an FFS member no later than 30 days
				after the FFS member receives the AHCCCS Notice of Action and:
1. AHCCCS determines that taking the time for
				a standard resolution could seriously jeopardize the FFS member's life, health,
				or ability to attain, maintain, or regain maximum function;
2. The expedited appeal request is supported
				with documentation by the provider supporting that taking the time for a
				standard resolution could seriously jeopardize the FFS member's life or health,
				or ability to attain, maintain, or regain maximum function; or
3. AHCCCS receives an expedited appeal
				request directly from the provider who indicates that taking the time for a
				standard resolution could seriously jeopardize the FFS member's life or health,
				or ability to attain, maintain, or regain maximum function.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-317 - Time-frame for Resolution of Expedited State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall mail a written Hearing Decision to the FFS
				  member within three working days after the date that the hearing has concluded.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-318 - Withdrawal of a Request for a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A. AHCCCS shall accept a written request for
				withdrawal if the written request for withdrawal is received from the FFS
				member before AHCCCS mails a notice of hearing under A.R.S. §
									41-1092 et
				seq.
B. If AHCCCS mailed a notice
				of hearing under A.R.S. §
									41-1092 et
				seq., an FFS member shall send a written request for withdrawal to OAH.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-319 - Denial of a Request for a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall deny a request for hearing under A.R.S. §
									41-1092 et
				  seq., upon written determination that:
1. The request for hearing is
				untimely;
2. The request for
				hearing is not for an action permitted under this Article;
3. The request for State Fair Hearing is
				moot, as determined by AHCCCS, based on the factual circumstances of the case;
				or
4. The sole issue presented is a
				federal or state law requiring an automatic change adversely affecting some or
				all enrollees.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-320 - Motion for Rehearing or Review

Current through Register Vol. 30, No. 28, July 12, 2024
Under A.R.S. §
									41-1092.09,
				  the Director shall grant a rehearing or review for any of the following reasons
				  materially affecting an enrollee's rights:
1. Irregularity in the proceedings of a
				hearing that deprived an FFS member of a State Fair Hearing;
2. Misconduct of AHCCCS, OAH, or a
				party;
3. Newly discovered material
				evidence that could not, with reasonable diligence, have been discovered and
				produced at the hearing;
4. The
				decision is the result of passion or prejudice;
5. The decision is not justified by the
				evidence or is contrary to law; or
6. Good cause is established for the
				nonappearance of a party at the hearing.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-321 - Continuation of Services While the Appeal and the State Fair Hearing Are Pending

Current through Register Vol. 30, No. 28, July 12, 2024
A. For the
				purposes of this Section, timely filing means filing on or before the later of
				the following:
1. Within 10 days from the date
				that AHCCCS mails the Notice of Action, or
2. The intended effective date of AHCCCS'
				proposed action.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 3 - APPEAL AND HEARING FOR AN FFS MEMBER › Section R9-34-322 - Reversed Appeal Resolutions

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				If the Director's Decision reverses a decision to deny, limit, or delay
				services that were not furnished while the appeal was pending, AHCCCS shall
				authorize or provide the disputed services promptly, and as expeditiously as
				the FFS member's health condition requires.
B. If the Director's Decision reverses a
				decision to deny authorization of services, and the FFS member received the
				disputed services while the appeal was pending, AHCCCS shall pay the provider
				for those services.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-401 - Purpose

Current through Register Vol. 30, No. 28, July 12, 2024
This Article establishes process and requirements for a
				  provider or contractor to resolve a claim dispute or request a State Fair
				  Hearing. A contractor is responsible for any functions or responsibilities
				  delegated under a subcontract. It is the contractor's responsibility to ensure
				  that the subcontractor has the ability to perform the delegated
				  activities.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-402 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
A. "AHCCCS" means the AHCCCS Administration as defined in
				  A.R.S. §
									36-2901.
B. "Claim dispute" means a dispute involving a payment of a
				  claim, denial of a claim, imposition of a sanction or reinsurance.
C. "Contractor" means contractor or program contractor as
				  defined in A.R.S. Title 36, Chapter 29; the Comprehensive Medical Dental
				  Program in the Department of Economic Security; and the Children's
				  Rehabilitation Services and Behavioral Health Services in the Arizona
				  Department of Health Services.
D. "Day" means calendar day unless otherwise
				  specified.
E. "Director" means the Director of the Arizona Health Care
				  Cost Containment System Administration or designee.
F. "Director's Decision" means the final administrative
				  decision under A.R.S. §
									41-1092(5).
G. "FFS member" means an FFS member eligible for AHCCCS under
				  A.R.S. Title 36, Chapter 29, and who is enrolled with AHCCCS on an FFS basis
				  and not enrolled with an AHCCCS contractor.
H. "Filed" means the date that AHCCCS receives a request as
				  established by a date stamp on the request or other record of receipt.
I. "State Fair Hearing" means an administrative hearing under
				  A.R.S. Title 41, Chapter 6, Article 10.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-403 - Computation of Time

Current through Register Vol. 30, No. 28, July 12, 2024
Computation of time for calendar day begins the day after the
				  act, event, or decision and includes all calendar days and the final day of the
				  period. If the final day of the period is a weekend or legal holiday, the
				  period is extended until the end of the next day that is not a weekend or a
				  legal holiday.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-404 - Content of Claim Dispute

Current through Register Vol. 30, No. 28, July 12, 2024
A claim dispute shall specify in detail the factual and legal
				  basis for the claim dispute and the relief requested. AHCCCS shall deny a claim
				  dispute if the factual or legal basis is not detailed.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-405 - Filing a Claim Dispute for a Claim Involving a Member Enrolled with a Contractor

Current through Register Vol. 30, No. 28, July 12, 2024
A. For a
				claim for services rendered to a member enrolled with a contractor, the
				provider shall file a written claim dispute with the contractor under the
				timelines in A.R.S. §
									36-2903.01(B)(4).
B. The contractor shall mail a written Notice
				of Decision of the claim dispute to the provider no later than 30 days after
				the provider files the claim dispute with the contractor, unless the provider
				and contractor agree to a longer period.
C. The contractor's written Notice of
				Decision shall include:
1. The date of the
				decision,
2. The factual and legal
				basis for the decision,
3. The
				provider's right to request a State Fair Hearing under A.R.S. §
										41-1092,
				et seq., and
4. The manner in which
				a request for a State Fair Hearing is filed under A.R.S. §
										41-1092,
				et seq.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-406 - Filing a Claim Dispute from a Contractor for Reinsurance

Current through Register Vol. 30, No. 28, July 12, 2024
A. A contractor
				shall file a written reinsurance claim dispute with AHCCCS under the timelines
				in A.R.S. §
									36-2903.01(B)(4).
B. AHCCCS shall mail a written Notice of
				Decision of the claim dispute for reinsurance to the contractor no later than
				30 days after the contractor files the claim dispute with AHCCCS, unless AHCCCS
				and contractor agree to a longer period.
C. AHCCCS' written Notice of Decision shall
				include:
1. The date of the
				decision,
2. The factual and legal
				basis for the decision,
3. The
				contractor's right to request a State Fair Hearing under A.R.S. §
										41-1092,
				et seq., and
4. The manner in which
				a contractor is to file a State Fair Hearing request under A.R.S. §
										41-1092 et
				seq.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-407 - Filing a Claim Dispute for a Claim Involving an FFS Member

Current through Register Vol. 30, No. 28, July 12, 2024
A. For a claim for
				an FFS member, the provider shall file a written claim dispute with AHCCCS
				under the timelines in A.R.S. §
									36-2903.01(B)(4).
B. AHCCCS shall mail a written Notice of
				Decision of the claim dispute to the provider no later than 30 days after the
				provider files the claim dispute with AHCCCS, unless AHCCCS and the provider
				agree to a longer period.
C.
				AHCCCS' written Notice of Decision shall include:
1. The date of the decision,
2. The factual and legal basis for the
				decision,
3. The provider's right
				to request a State Fair Hearing under A.R.S. §
										41-1092,
				et seq., and
4. The manner in which
				a provider is to file a State Fair Hearing request under A.R.S. §
										41-1092 et
				seq.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-408 - Denial of a Request for a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall deny a request for hearing under A.R.S. §
									41-1092,
				  et seq., upon written determination that:
1. The request for hearing is
				untimely;
2. The request for
				hearing is not for an action permitted under this Article;
3. The provider or contractor waives the
				right to a hearing; or
4. The
				request for hearing is moot, as determined by AHCCCS, based on the factual
				circumstances of the case.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 4 - CLAIM DISPUTE › Section R9-34-409 - Motion for Rehearing or Review

Current through Register Vol. 30, No. 28, July 12, 2024
Under A.R.S. §
									41-1092.09,
				  the Director shall grant a rehearing or review for any of the following reasons
				  materially affecting a provider's rights:
1. Irregularity in the proceedings of a
				hearing that deprived a provider of a fair hearing;
2. Misconduct of AHCCCS, OAH, or a
				party;
3. Newly discovered material
				evidence that could not, with reasonable diligence, have been discovered and
				produced at the hearing;
4. The
				decision is the result of passion or prejudice;
5. The decision is not justified by the
				evidence or is contrary to law; or
6. Good cause is established for the
				nonappearance of a party at the hearing.
Arizona Administrative Code › Title 10 - LAW › Chapter 1 - DEPARTMENT OF LAW - ATTORNEY GENERAL'S OFFICE › Article 1 - DISMISSAL › Section R10-1-101 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
In this Article, unless the context otherwise
				  requires:
1. "Appellant" means any Assistant Attorney General who has
				  filed an appeal from a dismissal by the Attorney General.
2. "Assistant Attorney General" means any attorney who has
				  not been assigned permanent responsibility for directly supervising other
				  attorneys.
3. "Personnel Review Committee" means a three-member
				  committee which shall review an appeal by an Assistant Attorney General of his
				  or her dismissal and render a decision on such appeal.
4. "Personnel Review Panel" means a panel of five members of
				  the State Bar of Arizona appointed by the Attorney General not later than the
				  15th of January of each year from which the Personnel Review Committee is
				  selected.
Arizona Administrative Code › Title 10 - LAW › Chapter 1 - DEPARTMENT OF LAW - ATTORNEY GENERAL'S OFFICE › Article 1 - DISMISSAL › Section R10-1-102 - Application

Current through Register Vol. 30, No. 28, July 12, 2024
A. This Article
				shall apply to all Assistant Attorneys General hired or transferred into any
				vacant position by the Department of Law Attorney General on or after July 27,
				1983, and to all Assistant Attorneys General employed before July 27, 1983, who
				have waived their rights under the State Merit System, but before October 1,
				1984, and shall not apply to any Assistant Attorney General so hired or
				transferred after October 1, 1984.
B. The Attorney General may, in his
				discretion, extend the application of this Article to any Assistant Attorney
				General hired or transferred into any vacant position on or after October 1,
				1984, and who either has been employed by the Attorney General for more than
				five years or whose responsibilities, experience, and performance, in the
				opinion of the Attorney General, justify its application.
Arizona Administrative Code › Title 10 - LAW › Chapter 1 - DEPARTMENT OF LAW - ATTORNEY GENERAL'S OFFICE › Article 1 - DISMISSAL › Section R10-1-103 - Probationary period for Assistant Attorneys General

Current through Register Vol. 30, No. 28, July 12, 2024
All Assistant Attorneys General shall serve a probationary
				  period of two years. An Assistant Attorney General may be dismissed by the
				  Attorney General without cause and without the right to a hearing at any time
				  during his or her two-year probationary period.
Arizona Administrative Code › Title 10 - LAW › Chapter 1 - DEPARTMENT OF LAW - ATTORNEY GENERAL'S OFFICE › Article 1 - DISMISSAL › Section R10-1-104 - Dismissal of Assistant Attorneys General for cause

Current through Register Vol. 30, No. 28, July 12, 2024
A. After serving his or her two-year
				probationary period, an Assistant Attorney General may be dismissed only for
				cause.
B. Cause for dismissal shall
				include the following:
1. Fraud or
				misrepresentation in securing appointment.
2. Incompetency -- meaning the lack of
				ability or fitness to discharge the required duties.
3. Inefficiency -- meaning performance below
				the level of others performing like duties under similar conditions; or the
				incapacity or indisposition to perform one's duties.
4. Neglect of duty.
5. Insubordination -- meaning disrespectful
				or contumacious conduct toward a supervisor; or a knowing disregard of express
				or implied directions; or a refusal to obey a lawful and ethical order issued
				by a person authorized to issue such order.
6. Dishonesty.
7. Drunkenness on duty.
8. Any unlawful use of narcotics or
				habit-forming drugs, or any use of or addiction to narcotics or habit-forming
				drugs which impairs job performance.
9. Conviction of a felony, or conviction of a
				misdemeanor an element of which is intentional, knowing or reckless conduct. A
				plea or verdict of guilty to a charge of a felony, or any misdemeanor an
				element of which is intentional, knowing or reckless conduct is deemed to be a
				conviction for purposes of this Section.
10. Discourteous treatment of the public or
				other public employees.
11.
				Improper political activity.
12.
				Misuse or unauthorized use of state property.
13. Conduct either during or outside duty
				hours which is of such a nature that it causes discredit to the Attorney
				General's Office.
14. Any conduct
				which is inconsistent, incompatible or in conflict with one's official duties
				as an Assistant Attorney General.
15. Failure to discharge one's
				responsibilities as an Assistant Attorney General in a timely manner as
				directed by supervisors.
16.
				Failure or refusal to comply with office policies established by the Attorney
				General.
17. Use or attempted use
				of one's official position for private advantage.
18. Any other action or pattern of activity
				that constitutes cause as a matter of law.
Arizona Administrative Code › Title 10 - LAW › Chapter 1 - DEPARTMENT OF LAW - ATTORNEY GENERAL'S OFFICE › Article 1 - DISMISSAL › Section R10-1-105 - Dismissal procedure of Assistant Attorneys General

Current through Register Vol. 30, No. 28, July 12, 2024
The Attorney General may dismiss any Assistant Attorney
				  General pursuant to A.A.C.
				  R10-1-104,
				  provided that:
1. On or before the
				effective date of any dismissal of an Assistant Attorney General, the attorney
				to be dismissed shall be provided with a written statement setting forth the
				basis for the dismissal in sufficient detail so as to inform him or her of the
				specific reason or reasons for such action.
2. In the event of an appeal by any Assistant
				Attorney General of a dismissal, the Attorney General shall provide a copy of
				the statement setting forth the basis for such dismissal and a copy of the
				written appeal by the Appellant to the Personnel Review Committee appointed to
				review such dismissal.
Arizona Administrative Code › Title 10 - LAW › Chapter 1 - DEPARTMENT OF LAW - ATTORNEY GENERAL'S OFFICE › Article 1 - DISMISSAL › Section R10-1-107 - Rehearing

Current through Register Vol. 30, No. 28, July 12, 2024
A. Either party to
				an appeal by an Assistant Attorney General from his or her dismissal who is
				aggrieved by a decision rendered in such appeal may file with the Personnel
				Review Committee, not later than ten days after service of the decision, a
				written motion for rehearing or review of the decision specifying the
				particular grounds therefor.
B. A
				motion for rehearing under this rule may be amended at any time before it is
				ruled upon by the Personnel Review Committee. A response may be filed within
				ten days after service of such motion or amended motion by any other party. The
				Personnel Review Committee may require the filing of written briefs upon the
				issues raised in the motion and may provide for oral argument.
C. A rehearing of the decision may be granted
				on any of the following grounds materially affecting the moving party's rights:
1. Irregularity in the proceedings before the
				Personnel Review Committee or any order or abuse of discretion, whereby the
				moving party was deprived of a fair hearing;
2. Misconduct of the Personnel Review
				Committee or the prevailing party;
3. Accident or surprise which could not have
				been prevented by ordinary prudence;
4. Newly discovered material evidence which
				could not with reasonable diligence have been discovered and produced at the
				original hearing;
5. Excessive or
				insufficient penalties;
6. Error in
				the admission or rejection of evidence or other errors of law occurring at the
				hearing;
7. A decision not
				justified by the evidence or contrary to law.
Arizona Administrative Code › Title 10 - LAW › Chapter 2 - ATTORNEY GENERAL - FAIR HOUSING › Article 1 - FAIR HOUSING › Section R10-2-102 - Fifty-five or Over Housing

Current through Register Vol. 30, No. 28, July 12, 2024
A. A
				housing facility shall be recognized as meeting the definition of "housing for
				older persons", and thus achieving exemption status, if it meets the standards
				set forth in A.R.S. §
									41-1491.04
				and this Section.
B. "Significant
				facilities and services specifically designed to meet the physical or social
				needs of older persons", as used in A.R.S. §
									41-1491.04(C),
				include, among others, social and recreational programs, continuing education,
				information and counseling, recreational, homemaker, outside maintenance and
				referral services, an accessible physical environment, emergency and preventive
				health care programs, congregate dining facilities, transportation to
				facilitate access to social services, and services designed to encourage and
				assist residents to use the services and facilities available to them. The
				housing facility does not need to have all of these features to qualify for the
				exemption under this subsection; or
C. The housing facility can still meet the
				requirements of A.R.S. §
									41-1491.04,
				even if it is not practicable to provide significant services and facilities
				designed to meet the physical or social needs of older persons, as long as the
				owner or manager of the housing facility demonstrates through credible and
				objective evidence that the provision of significant facilities and services
				designed to meet the physical or social needs of older persons would result in
				depriving older persons in the relevant geographic area of needed and desired
				housing. The following factors, among others, are relevant in meeting the
				requirements:
1. Whether the owner or manager
				of the housing facility has endeavored to provide significant facilities and
				services designed to meet the physical or social needs of older persons either
				by the owner or by some other entity. Demonstrating that the services and
				facilities are expensive to provide is not alone sufficient to demonstrate that
				the provision of such services is impractical;
2. The amount of rent charged, if the
				dwelling is rented, or the price of the dwelling, if it is offered for
				sale;
3. The income range of the
				residents of the housing facility;
4. The demand for housing for older persons
				in the relevant geographic area;
5.
				The range of housing choices for older persons within the relevant geographic
				area;
6. The availability of other
				similarly priced housing for older persons in the relevant geographic area. If
				similarly priced housing for older persons with significant facilities and
				services is reasonably available in the relevant geographic area, then the
				housing facility does not meet the requirements of this paragraph;
				and
7. The vacancy rate of the
				housing facility.
Arizona Administrative Code › Title 10 - LAW › Chapter 2 - ATTORNEY GENERAL - FAIR HOUSING › Article 1 - FAIR HOUSING › Section R10-2-103 - Discrimination in Terms, Conditions, or Privileges in Services or Facilities

Current through Register Vol. 30, No. 28, July 12, 2024
A. Conduct
				prohibited by A.R.S. §§
									41-1491.14(A)
				 and
				41-1491.19(A)
				 includes:
1. Failing to accept or consider a bona fide
				offer because of race, color, religion, sex, handicap, familial status, or
				national origin.
2. Refusing to
				sell or rent a dwelling to, or to negotiate for the sale or rental of a
				dwelling with, any person because of race, color, religion, sex, handicap,
				familial status, or national origin.
3. Imposing different sales prices or rental
				charges for the sale or rental of a dwelling upon any person because of race,
				color, religion, sex, handicap, familial status, or national origin.
4. Using different qualification criteria or
				applications, sale or rental standards or procedures, such as income standards,
				application requirements, application fees, credit analysis, or sale or rental
				approval procedures or other requirements because of race, color, religion,
				sex, handicap, familial status, or national origin.
5. Evicting tenants because of their race,
				color, religion, sex, handicap, familial status, or national origin or because
				of the race, color, religion, sex, handicap, familial status, or national
				origin of a tenant's guest.
Arizona Administrative Code › Title 10 - LAW › Chapter 2 - ATTORNEY GENERAL - FAIR HOUSING › Article 1 - FAIR HOUSING › Section R10-2-104 - Other Prohibited Sale and Rental Conduct

Current through Register Vol. 30, No. 28, July 12, 2024
A. It is unlawful, because of race, color,
				religion, sex, handicap, familial status, or national origin, to restrict or
				attempt to restrict the choices of a person by word or conduct in connection
				with seeking, negotiating for, buying, or renting a dwelling so as to
				perpetuate, or tend to perpetuate, segregated housing patterns, or to
				discourage or obstruct choices in a community, neighborhood, or
				development.
B. It is unlawful,
				because of race, color, religion, sex, handicap, familial status, or national
				origin to engage in any conduct relating to the provision of housing or of
				services and facilities in connection therewith that otherwise makes
				unavailable or denies dwellings to persons. This prohibition includes:
1. Discharging or taking other adverse action
				against an employee, broker, or agent because the person refused to participate
				in a discriminatory housing practice;
2. Employing codes or other devices to
				segregate or reject applicants, purchasers, or renters; refusing to take or to
				show listings of dwellings in certain areas because of race, color, religion,
				sex, handicap, familial status, or national origin; or refusing to deal with
				certain brokers or agents because they or one or more of their clients are of a
				particular race, color, religion, sex, handicap, familial status, or national
				origin;
3. Denying or delaying the
				processing of an application made by a purchaser or renter or refusing to
				approve such a person for occupancy in a cooperative or condominium dwelling
				because of race, color, religion, sex, handicap, familial status, or national
				origin; and
4. Refusing to provide
				municipal services or property or hazard insurance for dwellings or providing
				such services or insurance differently because of race, color, religion, sex,
				handicap, familial status, or national origin.
Arizona Administrative Code › Title 10 - LAW › Chapter 2 - ATTORNEY GENERAL - FAIR HOUSING › Article 1 - FAIR HOUSING › Section R10-2-105 - Blockbusting

Current through Register Vol. 30, No. 28, July 12, 2024
A. Conduct
				prohibited by A.R.S. §
									41-1491.17
				includes:
1. Engaging, for profit, in conduct
				(including uninvited solicitations for listings) which conveys to a person that
				a neighborhood is undergoing or is about to undergo a change in the race,
				color, religion, sex, handicap, familial status, or national origin of persons
				residing in it, in order to encourage the person to offer a dwelling for sale
				or rental; and
2. Encouraging, for
				profit, any person to sell or rent a dwelling through assertions that the entry
				or prospective entry of persons of a particular race, color, religion, sex,
				handicap, familial status, or national origin, can or will result in
				undesirable consequences for the project, neighborhood, or community such as
				lowering of property values, an increase in criminal or antisocial behavior, or
				a decline in the quality of schools or other services or facilities.