reglab/statecodes huggingface dataset:
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-108 - Time-frames

Current through Register Vol. 30, No. 28, July 12, 2024
A. The overall time-frame pursuant to A.R.S.
				§
									41-1075(B)  for the applicant or licensee, granted by the Department
				under this Chapter is set forth in Table 1.1. The applicant or licensee and the
				Department may agree in writing to extend the substantive review time-frame and
				the overall time-frame. An extension of the substantive review time-frame and
				the overall time-frame may not exceed 25% of the overall time-frame.
B. The administrative completeness review
				time-frame described in A.R.S. §
									41-1072 for a license or renewal granted
				by the Department under this Chapter is set forth in Table 1.1 and begins on
				the date that the Department receives an application packet.
1. The Department shall send a notice of
				administrative completeness or deficiencies to the applicant or licensee within
				the administrative completeness review time-frame.
a. A notice of deficiencies shall list each
				deficiency and the information or items needed to complete the
				application.
b. The administrative
				completeness review time-frame and the overall time-frame are suspended from
				the date that the notice of deficiencies is sent until the date that the
				Department receives all of the missing information or items from the applicant
				or licensee.
c. If an applicant or
				licensee fails to submit to the Department all of the information or items
				listed in the notice of deficiencies within 120 days after the date that the
				Department sent the notice of deficiencies or within a time period the
				applicant or licensee and the Department agree upon in writing, the Department
				shall consider the application withdrawn.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Section R9-33-109 - Denial, Revocation, or Suspension of a License

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				Department may deny an application or suspend or revoke a license to operate a
				group home or behavioral-supported group home if:
1. An applicant or licensee does not meet the
				application requirements contained in R9-33-104 or R9-33-105(A);
2. A licensee is not a service provider for
				the duration of one licensure period;
3. A licensee does not correct the
				deficiencies according to the plan of correction contained in R9-33-107 by the
				time stated in the plan of correction; or
4. The nature or number of violations
				revealed by any type of inspection or investigation of a group home or
				behavioral-supported group home poses a direct risk to the life, health, or
				safety of a resident.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 1 - LICENSURE REQUIREMENTS › Table 1.1 - Time-frames (in days)

Current through Register Vol. 30, No. 28, July 12, 2024
Type of approval
Statutory authority
Overall time-frame
Administrative completeness
						  review time-frame
Substantive review time-frame
Application for a license under
						  R9-33-104
A.R.S. §
												36-132(A)(21)
120
60
60
Renewal of a license under
						  R9-33-105
A.R.S. §
												36-132(A)(21)
60
30
30
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 2 - GROUP HOME OR BEHAVIORAL-SUPPORTED GROUP HOME REQUIREMENTS › Section R9-33-201 - Emergency Procedures and Evacuation Drills

Current through Register Vol. 30, No. 28, July 12, 2024
A. A licensee
				shall ensure that a written plan for emergencies:
1. Is developed and implemented;
2. Is available and accessible to staff and
				each resident at the facility;
3.
				Contains procedures for responding to fire, emergency, severe weather
				conditions, and other disasters, including:
a.
				Routes of evacuation, location of firefighting equipment, and evacuation
				devices identified on a floor plan of the facility;
b. Instructions on the use of fire alarm
				systems, firefighting equipment, and evacuation devices;
c. Procedures for evacuating each resident,
				including a resident who is not capable of self-preservation or who has a
				mobility, sensory, or other physical impairment; and
d. Procedures for notifying an emergency
				response team, law enforcement, and the licensee or the licensee's designee;
				and
4. Includes
				procedures for when a resident is missing from the premises.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 2 - GROUP HOME OR BEHAVIORAL-SUPPORTED GROUP HOME REQUIREMENTS › Section R9-33-202 - Fire Safety Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. The Department
				shall issue to an applicant or licensee:
1. A
				fire risk prevention level 1 group home or behavioral-supported group home
				license if the group home or behavioral-supported group home meets the
				requirements in subsections (B) through (G); and
2. A fire risk prevention level 2 group home
				or behavioral-supported group home license if the group home or
				behavioral-supported group home meets the requirements in subsections (B)
				through (H).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 2 - GROUP HOME OR BEHAVIORAL-SUPPORTED GROUP HOME REQUIREMENTS › Section R9-33-203 - Physical Plant Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. A licensee shall
				ensure that:
1. A group home or
				behavioral-supported group home is in compliance with applicable federal and
				state disability laws;
2. If a
				group home or behavioral-supported group home has a resident with a mobility,
				sensory, or other physical impairment, documentation is available for review at
				the group home or behavioral-supported group home that:
a. Is provided by the Division; and
b. Identifies modifications, if any, needed
				to the premises to ensure that the premises are accessible to and usable by the
				resident;
3. The premises
				have been modified as identified by the Division in subsection
				(A)(2)(b);
4. Ramps, stairs, or
				steps on the premises are secured firmly to the ground or a permanent structure
				and have slip-resistant surfaces;
5. If handrails and grab bars are installed
				in a facility, handrails and grab bars are securely attached and
				stationary;
6. For
				behavioral-supported group homes, modifications to the room and closet are
				based on the behavioral-supported group home's assessment of the individual
				needs of each resident designed to minimize the opportunity for a resident to
				cause selfinjury or injury towards others;
7. For behavioral-supported group homes,
				there is a split floor plan and layout that allows for multiple ways to exit an
				area within the home and exit the home itself;
8. For behavioral-supported group homes,
				furniture that is a tipping hazard or could be used as a weapon must be fixed
				to the wall or floor;
9. For
				behavioral-supported group homes, wall hangings that have protective film when
				appropriate;
10. For
				behavioral-supported group homes, windows have an alarm and a film installed to
				prevent injury;
11. For
				behavioral-supported group homes, there is a designated area to keep all sharps
				locked at all times when not in use;
12. For behavioral-supported group homes, all
				toilets are commercial grade and have a locking toilet tank;
13. For behavioral-supported group homes, all
				doors have no slam features;
14.
				For behavioral-supported group homes, the backyard is completely enclosed by a
				fence or block wall with a gate that latches for egress; and
15. For behavioral-supported group homes,
				controls or alerts employees of the egress of a resident from the
				facility.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 2 - GROUP HOME OR BEHAVIORAL-SUPPORTED GROUP HOME REQUIREMENTS › Section R9-33-204 - Environmental Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. A
				licensee shall ensure that:
1. The premises
				are free of accumulations of garbage or refuse;
2. Garbage and refuse in the facility are:
a. Stored in cleanable containers or in
				sealable plastic bags; and
b.
				Removed from the facility at least once every seven days;
3. Cleaning compounds and toxic substances
				are maintained in labeled containers that:
a.
				Are stored to prevent a hazard;
b.
				Are appropriate to the contents of each container;
c. If appropriate based on a resident's
				disability, are locked; and
d. Are
				stored in a separate location from food or medicine;
4. Unused furniture, equipment, fabrics, or
				devices are removed from the facility or maintained in a covered area on the
				premises that is designated by the licensee for storage in a manner that does
				not create a hazard; and
5. There
				are no firearms or ammunition on the premises;
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 2 - GROUP HOME OR BEHAVIORAL-SUPPORTED GROUP HOME REQUIREMENTS › Section R9-33-205 - Vehicle Safety Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				A licensee shall ensure that a vehicle used to transport a resident:
1. Is maintained in safe and working order;
				and
2. Is equipped with:
a. A working heating and air conditioning
				system;
b. A first aid kit that
				meets the requirements in R9-33-201(E)(1);
c. Working seat belts for the driver and each
				passenger; and
d. Floor mounted
				seat belts and wheel chair lock-down devices for each wheel chair passenger
				transported, if the vehicle is used to transport a passenger in a
				wheelchair.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 33 - DEPARTMENT OF HEALTH SERVICES - GROUP HOMES FOR INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY › Article 2 - GROUP HOME OR BEHAVIORAL-SUPPORTED GROUP HOME REQUIREMENTS › Section R9-33-206 - Swimming Pool Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. Except as
				provided in subsection (B), a licensee shall ensure that a private residential
				swimming pool on the premises:
1. If filled
				with water, is surrounded by a fence or enclosure constructed of material that:
a. Is at least 5 feet high;
b. Has no vertical openings greater than 4
				inches across;
c. Is free of
				openings for handholds or footholds on the exterior of the fence or
				enclosure;
d. Is at least 20 inches
				from the edge of the private residential swimming pool;
e. Is clear of objects out to a distance of
				30 inches on either side of the fence or enclosure from the level of the ground
				to a height of 5 feet above the fence or enclosure;
f. Has at least one gate that:
i. Opens outward from the private residential
				swimming pool,
ii. Has a
				self-closing latch attached no less than 54 inches above ground level as
				measured from the exterior side of the fence or enclosure, and
iii. Is locked when the private residential
				swimming pool is not in use;
g. Is secured perpendicular to level ground;
				and
h. Is located at least 54
				inches from the exterior wall of the facility to allow evacuation without
				entering the private residential swimming pool area;
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-101 - Application of Chapter

Current through Register Vol. 30, No. 28, July 12, 2024
A. This
				Article establishes the requirements and process for a petitioner to request a
				State Fair Hearing regarding an adverse action affecting AHCCCS eligibility.
B. This Article applies to appeals
				of eligibility determinations made by AHCCCS including determinations for the
				aged, blind, or disabled (A.A.C. Chapter 22, Article 15), the Arizona Long Term
				Care System (Chapter 28), the Medicare Cost Sharing Program (Chapter 29), the
				Medicare Part D Program (Chapter 30), and adverse actions regarding premiums
				and copayments described in
				R9-34-102(A)(5).
				Hearings on these appeals are conducted as described in this Article, A.R.S.
				§
									36-2903.01(B)(4)
				 and the Arizona Administrative Procedures
				Act in A.R.S. Title 41, Chapter 6.
C. The Arizona Department of Economic
				Security conducts appeals of eligibility under the procedures in A.R.S. Title
				6, Chapter 9 for those eligibility determinations made by the Department
				including:
1. When the request for a State
				Fair Hearing is made for an individual whose eligibility is determined using
				MAGI-based income,
2. When the
				request for a State Fair Hearing is made on behalf of more than one person in
				the same household where at least one person's eligibility is based on
				MAGI-based income,
3. When the
				request for State Fair Hearing of AHCCCS eligibility is made at or near the
				same time as a request for the administrative review of an eligibility
				determination arising from the same facts and circumstances for any other
				public assistance program administered by the Department of Economic
				Security.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-102 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
A. "Adverse action" by AHCCCS means:
1. Denial of eligibility,
2. Discontinuance of eligibility,
3. The imposition of or increase in Arizona Long Term Care
				  System (ALTCS) share of cost determined under A.A.C.
				  R9-28-408
				  or
				  R9-28-410,
4. An eligibility determination that the petitioner claims is
				  beyond the established time-frame, or
5. The imposition of or increase in a premium or
				  copayment.
B. "AHCCCS" means the AHCCCS Administration as defined in
				  A.R.S. §
									36-2901.
C. "Day" means calendar day unless otherwise
				  specified.
D. "Director" means the Director of the Arizona Health Care
				  Cost Containment System Administration or designee.
E. "Director's Decision" means the final administrative
				  decision under A.R.S. §
									41-1092(5).
F. "Filed" means the date that AHCCCS receives a request for
				  a State Fair Hearing as established by a date stamp on the request or other
				  record of receipt.
G. "Petitioner" means applicant, member, or other
				  representative who is described and discussed in A.A.C.
				  R9-22-1501,
				  R9-22-1704,
				  R9-22-1903,
				  R9-22-2004,
				  R9-27-302,
				  R9-28-401,
				  R9-28-1303,
				  R9-29-203,
				  R9-31-302,
				  R9-31-1702, or for an
				  adverse action under subsection (A)(5), an applicant, member, or other
				  representative under 9 A.A.C. 22, Article 14.
H. "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 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-103 - Computation of Time

Current through Register Vol. 30, No. 28, July 12, 2024
A. Computation
				of time begins the day after the date on the Notice of Adverse Action 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. The 30-day time-frame for filing a request
				for a State Fair Hearing begins with the date the petitioner receives the
				Notice of Adverse Action.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-104 - Petitioner's Rights

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall allow a petitioner the right to:
1. A State Fair Hearing; and
2. Copies, at the petitioner's expense, of
				any relevant document not protected from disclosure by law.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-105 - Who May File

Current through Register Vol. 30, No. 28, July 12, 2024
A petitioner who requests a State Fair Hearing shall make the
				  request according to this Article.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-106 - Requesting a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A petitioner may request a State Fair Hearing under this
				  Article only for an adverse action.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-107 - Time-frame for Requesting a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A petitioner shall request a State Fair Hearing in writing
				  with AHCCCS within 30 days after the petitioner receives the Notice of Adverse
				  Action.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-108 - Format and Contents of the Request for a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A petitioner shall submit a written request for a State Fair
				  Hearing to AHCCCS. The request shall contain the case name, the adverse action
				  taken by AHCCCS, and the reason for the State Fair Hearing.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-109 - Notice of Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall mail a Notice of Hearing under A.R.S. §
									41-1092.05
				  if AHCCCS receives a request for a State Fair Hearing that is timely and
				  contains the information listed in
				  R9-34-108.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-110 - 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 upon
				  written determination by AHCCCS that:
1. The request for a State Fair Hearing is
				untimely;
2. The request for a
				State Fair Hearing is not for an adverse action permitted under this
				Article;
3. The request for a 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 applicants or members.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-111 - AHCCCS Time-frame for Resolution of a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall mail a Director's Decision to the petitioner no
				  later than 30 days after the date of the Administrative Law Judge's recommended
				  decision and within 90 days after the date that the petitioner filed the
				  request for a State Fair Hearing not including days for continuances granted at
				  the petitioner's request.
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-112 - 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
				petitioner before AHCCCS mails a Notice of Hearing under R9-34-109.
B. If AHCCCS mailed a Notice of Hearing under
				R9-34-109, the petitioner shall send a written request for withdrawal to the
				Office of Administrative Hearings (OAH).
Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-113 - 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 petitioner's rights:
1. Irregularity in the proceedings of a State
				Fair Hearing that deprived a petitioner 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 9 - HEALTH SERVICES › Chapter 34 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - GRIEVANCE SYSTEM › Article 1 - REQUEST FOR ELIGIBILITY HEARING › Section R9-34-114 - AHCCCS Coverage during the State Fair Hearing Process

Current through Register Vol. 30, No. 28, July 12, 2024
A. If a petitioner requests a State Fair
				Hearing because of an increase in the share-of-cost, premium, or copayment and
				the request is filed before the effective date of the increase, AHCCCS shall
				not enforce the increase until a Director's Decision is rendered that supports
				the increase.
B. If a petitioner
				files a request for a State Fair Hearing for a discontinuance action before the
				effective date of the discontinuance, the petitioner shall continue to receive
				AHCCCS coverage until a Director's Decision is rendered. A petitioner may waive
				coverage while the Director's Decision is pending.
C. A petitioner, eligible under 9 A.A.C. 22,
				Article 31, who requests AHCCCS coverage during the State Fair Hearing process,
				shall comply with the premium payment requirements under A.A.C.
				R9-31-1419.
D. A petitioner whose
				benefits are continued shall be financially liable for all fee-for-service and
				capitation payments made by AHCCCS during a period of ineligibility, if a
				discontinuance decision is upheld under A.R.S. §
									41-1092.08.
E. If a petitioner requests a hearing
				regarding the termination of family planning services under A.A.C. R9-22-1424
				or the guaranteed enrollment period under 9 A.A.C. 22, Article 17, the
				petitioner shall not continue to be AHCCCS eligible after the end of the
				designated time period under A.R.S. § 36-2907.04 and
				42 U.S.C.
				1396 a(e)(2). If the termination of family
				planning services is overturned, the applicable effective date of AHCCCS
				coverage shall be set forth in the Director's Decision.
F. If a denial of eligibility is overturned,
				the effective date of AHCCCS eligibility shall be set forth in the Director's
				Decision.
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 R9-34-201 - Purpose

Current through Register Vol. 30, No. 28, July 12, 2024
This Article establishes the grievance, appeal, and State
				  Fair Hearing requirements for a person enrolled with an AHCCCS contractor. 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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-202 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
The following definitions apply for purposes of this
				  Article:
1. "AHCCCS" means the AHCCCS Administration as defined in
				  A.R.S. §
									36-2901.
2. "Action" by a contractor means:
a. The denial or limited authorization of a requested
				  service, including the type or level of service;
b. The reduction, suspension, or termination of a previously
				  authorized service;
c. The denial, in whole or in part, of payment for a
				  service;
d. The failure to provide a service in a timely manner as set
				  forth in contract;
e. The failure of a contractor to act within the time-frames
				  specified in this Article; or
f. For an enrollee residing in a rural area with only one
				  contractor, the denial of an enrollee's request to exercise the enrollee's
				  right to obtain services outside the contractor's network.
3. "Appeal" means a request for review of an action.
4. "Contractor" means contractor or program contractor as
				  defined in A.R.S. §
									36-2901,
				  36-2931,
				  36-2971
				  and
				  36-2981;
				  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.
5. "Day" means calendar day unless otherwise
				  specified.
6. "Director" means the Director of the Arizona Health Care
				  Cost Containment System Administration or designee.
7. "Director's Decision" means the final administrative
				  decision under A.R.S. §
									41-1092(5).
8. "Enrollee" means a person eligible for AHCCCS under A.R.S.
				  Title 36, Chapter 29 and who is enrolled with an AHCCCS contractor.
9. "Filed" means the date that the contractor or AHCCCS,
				  whichever is applicable, receives the request as established by a date stamp on
				  the request or other record of receipt.
10. "Grievance" means an expression of dissatisfaction about
				  any matter other than an action. Possible subjects for grievances include, but
				  are not limited to, the quality of care or services provided, and aspects of
				  interpersonal relationships such as rudeness of a provider or employee or
				  failure to respect the enrollee's rights.
11. "Institution for Mental Disease" means an institution
				  defined in
				  42 CFR
				  435.1009 and licensed by the Arizona
				  Department of Health Services.
12. "Rural" has the same meaning as in A.R.S. §
									36-2171.
13. "State Fair Hearing" means an administrative hearing
				  under A.R.S. Title 41, Chapter 6, Article 10.
14. "Working day" means a Monday, Tuesday, Wednesday,
				  Thursday, or Friday unless:
a. A legal holiday falls on Monday, Tuesday, Wednesday,
				  Thursday, or Friday; or
b. 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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-203 - 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 in working days,
				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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-204 - Language and Format of the Notice of Action

Current through Register Vol. 30, No. 28, July 12, 2024
A contractor shall ensure that the Notice of Action is in
				  writing and meets the following language and format requirements:
1. The Notice of Action shall be available in
				each non-English language spoken by a significant number or percentage of
				enrollees or potential enrollees in the contractor's geographic service area 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.
3. The format of the
				Notice of Action is easily understood and available in alternative formats,
				such as braille, large font, or enhanced audio, and in an appropriate manner
				that takes into consideration the special needs of an enrollee.
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 R9-34-205 - Content of the Notice of Action

Current through Register Vol. 30, No. 28, July 12, 2024
A contractor shall ensure that the Notice of Action explains
				  the following:
1. The action the
				contractor has taken or intends to take;
2. The reasons for the action;
3. The enrollee's right to file an appeal
				with the contractor;
4. The
				procedures for exercising the rights specified in this Article;
5. The circumstances under which an expedited
				resolution is available and how to request it; and
6. The circumstances under which an enrollee
				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
				enrollee is liable for the costs of services.
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 R9-34-206 - Contractor Notice of Action Time-frame for Service Authorization Requests

Current through Register Vol. 30, No. 28, July 12, 2024
A. For an
				authorization decision, not covered under subsection (B), for a service
				requested on behalf of an enrollee, the contractor shall mail a Notice of
				Action within 14 calendar days following the receipt of the enrollee's
				request.
B. For an authorization
				request in which the provider indicates or the contractor determines that
				following the time-frame in subsection (A) could seriously jeopardize the
				enrollee's life or health or ability to attain, maintain, or regain maximum
				function, the contractor shall make an expedited authorization decision and
				mail the Notice of Action as expeditiously as the enrollee's health condition
				requires, but not later than three working days after receipt of the request
				for service.
C. If the enrollee
				requests an extension of the time-frame in subsection (A) or (B), the
				contractor shall extend the time-frame up to an additional 14 days as requested
				by the enrollee.
D. If the
				contractor needs additional information and the extension is in the best
				interest of the enrollee, the contractor shall extend the time-frame in
				subsection (A) or (B) up to an additional 14 days. If the contractor extends
				the time-frame, the contractor shall:
1. Give
				the enrollee written notice of the reason for the decision to extend the
				time-frame and inform the enrollee of the right to file a grievance if the
				enrollee disagrees with the decision, and
2. Issue and carry out the determination as
				expeditiously as the enrollee'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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-207 - Contractor Notice of Action Time-frame 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, a contractor 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. The contractor may mail the Notice of
				Action no later than the date of action if:
1. The contractor has factual information
				confirming the death of an enrollee;
2. The contractor receives a clear written
				statement signed by the enrollee that the enrollee no longer wishes services or
				the enrollee gives information to the contractor that requires termination or
				reduction of services and indicates that the enrollee understands that this
				shall be the result of supplying that information;
3. The enrollee is age 21 through 64 and has
				resided in an Institution for Mental Disease for more than 30 days;
4. The enrollee is an inmate of a public
				institution that does not receive federal financial participation;
5. The enrollee's whereabouts are unknown and
				the post office returns mail, directed to the enrollee, to the contractor
				indicating no forwarding address; or
6. The contractor establishes the fact that
				the enrollee 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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-208 - Who May File

Current through Register Vol. 30, No. 28, July 12, 2024
A. An enrollee
				shall file a grievance, an appeal, or request a State Fair Hearing according to
				this Article.
B. An authorized
				representative, including a provider, acting on behalf of the enrollee, with
				the enrollee's written consent, may file an appeal or request a State Fair
				Hearing on behalf of an enrollee. A provider is permitted to file a grievance
				with a contractor at the contractor's discretion.
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 R9-34-209 - Enrollee Time-frame for Filing an Appeal or Grievance with the Contractor

Current through Register Vol. 30, No. 28, July 12, 2024
A. An
				enrollee shall file an appeal either orally or in writing with the contractor
				within 60 days after the date of the Notice of Action.
B. The enrollee shall file a grievance either
				orally or in writing with the contractor.
C. The enrollee shall file a grievance
				directly with the contractor. AHCCCS shall refer to the contractor any
				grievance filed with AHCCCS. An enrollee is not entitled to a State Fair
				Hearing on a grievance.
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 R9-34-210 - Contractor General Requirements for Grievance or Appeal Process

Current through Register Vol. 30, No. 28, July 12, 2024
A. A contractor
				shall provide reasonable assistance to enrollees 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. The
				contractor shall acknowledge receipt of each grievance orally or in writing.
				The contractor shall acknowledge receipt of each appeal in writing.
C. The contractor shall ensure that the
				individual who makes a decision on a grievance or an appeal was not involved in
				any previous level of review or decision-making.
D. The contractor shall ensure that a health
				care professional who makes decisions on any of the following appeals or
				grievances has the appropriate clinical expertise in treating the enrollee's
				condition or disease:
1. An appeal of a denial
				that is based on lack of medical necessity,
2. A grievance regarding denial of expedited
				resolution of an appeal, or
3. A
				grievance or appeal that involves clinical issues.
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 R9-34-211 - Contractor Special Requirements for the Appeal Process

Current through Register Vol. 30, No. 28, July 12, 2024
A. A contractor shall treat an oral inquiry
				seeking to appeal an action as an appeal.
B. A resolution of an appeal by the
				contractor before a State Fair Hearing is an informal resolution under A.R.S.
				§
									36-2903.01(B)(4).
C. The contractor shall provide a reasonable
				opportunity for an enrollee to present evidence, and allegations of fact or
				law, in person and in writing. The contractor shall inform the enrollee of the
				limited time available for this in the case of an expedited
				resolution.
D. The contractor shall
				provide the enrollee and representative the opportunity, before and during the
				appeal process, to examine the enrollee's case file, including medical records,
				documents, and records considered during the appeal process, not protected from
				disclosure by law.
E. The
				contractor shall include, as a party to the appeal, the enrollee or the legal
				representative of a deceased enrollee's estate.
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 R9-34-212 - Contractor Time-frame for Standard Disposition of a Grievance

Current through Register Vol. 30, No. 28, July 12, 2024
For disposition of a grievance, a contractor shall complete
				  disposition and provide oral or written notice to the enrollee of the
				  contractor's decision within 90 days after the day the contractor receives the
				  grievance.
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 R9-34-213 - Contractor 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, a contractor shall resolve the appeal and mail the
				written Notice of Appeal Resolution to the enrollee within 30 days after the
				day the contractor receives the appeal.
B. If the enrollee requests an extension of
				the 30-day time-frame in subsection (A), the contractor shall extend the
				time-frame up to an additional 14 days.
C. If the contractor needs additional
				information and the extension is in the best interest of the enrollee, the
				contractor shall extend the time-frame in subsection (A) up to an additional 14
				days. If the contractor extends the time-frame, the contractor shall:
1. Give the enrollee written notice of the
				reason for the decision to extend the time-frame, and
2. Issue and carry out the resolution as
				expeditiously as the enrollee'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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-214 - Contractor Process for an Expedited Resolution of an Appeal

Current through Register Vol. 30, No. 28, July 12, 2024
A. A contractor
				shall establish and maintain a review process for an expedited appeal. The
				contractor shall conduct an expedited appeal if:
1. The contractor receives a request for an
				appeal from an enrollee and the contractor determines that taking the time for
				a standard resolution could seriously jeopardize the enrollee's life or health,
				or ability to attain, maintain, or regain maximum function;
2. The contractor receives a request for an
				expedited appeal from an enrollee supported with documentation from the
				provider that taking the time for a standard resolution could seriously
				jeopardize the enrollee's life or health, or ability to attain, maintain, or
				regain maximum function; or
3. The
				contractor receives a request for an expedited appeal directly from a provider,
				with the enrollee's written consent, and the provider indicates that taking the
				time for a standard resolution could seriously jeopardize the enrollee'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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-215 - Contractor Time-frame for an Expedited Appeal Resolution

Current through Register Vol. 30, No. 28, July 12, 2024
A. For expedited resolution of an appeal, a
				contractor shall resolve the appeal and mail a written Notice of Appeal
				Resolution to the enrollee within three working days after the day the
				contractor receives the appeal. The contractor shall make reasonable efforts to
				provide prompt oral notice.
B. If
				the enrollee requests an extension of the three working day time-frame in
				subsection (A), the contractor shall extend the time-frame up to an additional
				14 days.
C. If the contractor needs
				additional information and the extension is in the best interest of the
				enrollee, the contractor shall extend the time-frame in subsection (A) up to an
				additional 14 days. If the contractor extends the time-frame, the contractor
				shall:
1. Give the enrollee written notice of
				the reason for the decision to extend the time-frame, and
2. Issue and carry out the determination as
				expeditiously as the enrollee'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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-216 - Content of Contractor Notice of Appeal Resolution

Current through Register Vol. 30, No. 28, July 12, 2024
A. A contractor shall ensure that the written
				Notice of Appeal Resolution includes the results of the resolution process and
				the date it was completed.
B. For
				an appeal not resolved wholly in favor of the enrollee, 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 enrollee
				shall be liable for the cost of continued services if the Director's Decision
				upholds the contractor's decision.
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 R9-34-217 - Enrollee Request for a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
A. An enrollee may request a State Fair
				Hearing on the contractor's resolution of an appeal. The request shall be in
				writing, submitted to and received by the contractor, no later than 30 days
				after the date the enrollee receives the Notice of Appeal Resolution.
B. If an enrollee wants services to be
				continued pending a State Fair Hearing, the request to continue services shall
				be in writing and comply with R9-34-224.
C. AHCCCS shall mail a Notice of Fair Hearing
				under A.R.S. §
									41-1092.05
				if a timely request for a State Fair Hearing is received.
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 R9-34-218 - AHCCCS Time-frame for Resolution of a State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
AHCCCS shall mail a Director's Decision to the enrollee no
				  later than 30 days after the date of the Administrative Law Judge's recommended
				  decision and within 90 days after the date that the enrollee filed the appeal
				  with the contractor, not including the number of days the enrollee took to file
				  for a State Fair Hearing, and 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 2 - APPEAL, GRIEVANCE, AND HEARING FOR AN ENROLLED PERSON › Section R9-34-219 - Enrollee's Request for an Expedited State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
An enrollee may request an expedited State Fair Hearing on
				  the contractor's resolution of an expedited appeal. The request shall be in
				  writing, submitted to and received by the contractor no later than 30 days
				  after the enrollee receives the contractor's Notice of Appeal Resolution.
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 R9-34-220 - AHCCCS Time-frame for Resolution of an Expedited State Fair Hearing

Current through Register Vol. 30, No. 28, July 12, 2024
Within three working days after the date AHCCCS receives the
				  case file and information from the contractor concerning an expedited appeal
				  resolution, AHCCCS shall mail to the enrollee the AHCCCS Director's Decision
				  which results from the State Fair Hearing and the Administrative Law Judge's
				  Recommended Decision. AHCCCS shall make reasonable efforts to provide oral
				  notice of the Director's Decision.
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 R9-34-221 - 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 enrollee
				before AHCCCS mails a Notice of a State Fair 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 enrollee shall send a written request for withdrawal to the OAH.