Section R9-34-306. Time-frame for Notice of Action for Service Authorization Requests

A.       For an authorization decision, not covered in subsection (B), for a service requested on behalf of the FFS member, AHC­ CCS shall mail a Notice of Action within 14 calendar days fol­ lowing 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 subsec­ tion (A) could seriously jeopardize the FFS member's life or health, or ability to attain, maintain, or regain maximum func­ tion, 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.       Ifthe 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. IfAHCCCS 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.

E.       For service authorization decisions not reached within the time-frames in this Section, the authorization shall be consid­ ered denied on the date that the time-frame expires.

Historical Note

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