Section R9-22-521. Program Compliance Audits

A.      The Administration shall conduct an onsite program compli- ance audit of a contractor at least once every three years during the term of the Administration’s contract with the contractor. The Administration may conduct, without prior notice, inspec- tions of contractor facilities or perform other elements of a program compliance audit.

B.       An audit team may perform any or all of the following proce- dures:

1.        Conduct private interviews and group conferences with members, physicians, other health professionals, and members of the contractor’s administrative staff includ- ing, but not limited to, the contractor’s principal manage- ment persons;

2.        Examine records, books, reports, and papers of the con- tractor and any management company, and all providers or subcontractors providing health care and other ser- vices. The examination may include, but need not be lim- ited to: minutes of medical staff meetings, peer review and quality of care review records, duty rosters of medi- cal personnel, appointment records, written procedures for the internal operation of the health plan, contracts and correspondence with members and with providers of health care services and other services to the plan, and additional documentation deemed necessary by the Administration to review the quality of medical care.

Historical Note

Adopted as an emergency effective May 20, 1982, pursu- ant to A.R.S. § 41-1003, valid for only 90 days (Supp. 82- 3). Former Section R9-22-521 adopted as an emergency adopted, amended and renumbered as Section R9-22-519, former Section R9-22-523 adopted as an emergency now adopted, amended and renumbered as Section R9-22-521 as a permanent rule effective August 30, 1982 (Supp. 82- 4). Former Section R9-22-521 repealed, new Section R9- 22-521 adopted effective October 1, 1985 (Supp. 85-5).

Amended effective December 8, 1997 (Supp. 97-4). Amended by final rulemaking at 11 A.A.R. 4277, effec- tive December 5, 2005 (Supp. 05-4). Amended by final

rulemaking at 14 A.A.R. 4330, effective January 3, 2009

(Supp. 08-4).

Note

Editor’s Note: The following Section was amended under an exemption from the provisions of the Administrative Procedure Act which means that this rule was not reviewed by the Gover- nor’s Regulatory Review Council; the agency did not submit notice of proposed rulemaking to the Secretary of State for publi- cation in the Arizona Administrative Register; the agency was not required to hold public hearings on the rules; and the Attorney General has not certified this rule. This Section was subsequently amended through the regular rulemaking process.