Section R9-34-207. Contractor Notice of Action Time-frame for Ser­ vice Termination, Suspension, or Reduction

A.       For termination, suspension, or reduction of previously autho­ rized 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 indi­ cates 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 con­ tractor indicating no forwarding address; or

6.        The contractor establishes the fact that the enrollee has been accepted for Medicaid by another state.

Administrative Code                                                                 Title      Ch. 34

Arizona Health Care Cost Containment System - Grievance System

C.       The contractor may shorten the period of advance notice to five days before the date of action if the contractor has verified facts indicating probable fraud by the enroliee.

D.       If the contractor denies payment to a provider, the contractor shall send the Notice of Action to the enrollee at the time of the action affecting the claim.

Historical Note

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