ARIZONA STATE SENATE
Phoenix, Arizona
AHCCCS; grievance and
hearings
Purpose
Eliminates conflicts between
time frames for claims payments and grievances regarding claims under the
Arizona Health Care Cost Containment System (AHCCCS). Ensures time frames and procedures for grievances and appeals
under the Arizona long-term care system (ALTCS) are consistent with the rules
under the AHCCCS acute care program.
Background
A.R.S. §36-2903.01 requires
the AHCCCS administration to establish in rule a process and time frame for
grievances. Currently, statute requires
grievances to be filed with and received by the administration within 60 days
of the adverse action, decision or policy implementation. Grievances relating to claims must be filed
within 12 months from the date of service for which the payment is claimed
(A.R.S. §36-2904.)
Another statute allows
providers and health plans to submit clean claims for payment up to 12 months
from the date of service. In the event
a denied claim is filed just before the claim payment deadline, the complainant
would not be able to file a grievance because the time frame for filing
grievances on denied claims has elapsed.
S.B. 1202 attempts to address this issue by allowing grievances relating
to claims to be filed within the later of 12 months after the date of service,
12 months after the date eligibility is posed or 60 days after the date a
timely claim is denied.
In addition, pursuant to
statute, the Director of AHCCCS is required to perform certain duties and
functions. For example, all final
administrative decisions must be issued and signed by the Director. For 2000, the AHCCCS Director signed
approximately 2,400 final administrative decisions. The AHCCCS administration is requesting authority for the
Director to delegate certain responsibilities of the Director to a designated
AHCCCS staff person.
There is no cost to the
state general fund relating to the provisions of this bill.
Provisions
1. Requires grievances related to claims to be filed, in writing, with the AHCCCS administration, health plan or program contractor within the later of 12 months after the date of service, 12 months after the date eligibility is posted or 60 days after the date a timely claim is denied.
2. Authorizes the AHCCCS Director to deputize an employee to perform any statutory act of the Director.
3. Requires the time frames and procedures of grievances and appeals under ALTCS to be consistent with the rules and procedures under the acute care program.
4. Makes clarifying, conforming and technical changes.
5. Provides for a general effective date.
Prepared by Senate Staff
January 26, 2001