Section R9-34-307. Time-frame for Notice of Action for Service Ter­ mination, Suspension, or Reduction

A.       For termination, suspension, or reduction of previously autho­ rized AHCCCS covered service, AHCCCS 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.       AHCCCS may mail the Notice of Action no later than the date of action if:

1.       AHCCCS has factual information confirming the death of an FFS member;

2.        AHCCCS receives a clear written statement signed by the FFS member that the FFS member no longer wishes ser­ vices or the FFS member gives information that requires termination or reduction of services and indicates that the FFS member understands that this shall be the result of supplying that information;

3.       The FFS member is age 21 through 64 and has resided in an Institution for Mental Disease for more than 30 days;

4.        The FFS member is an inmate of a public institution that does not receive federal financial participation;

5.        The FFS member's whereabouts are unknown and the post office returns mail, directed to the FFS member, to the contractor indicating no forwarding address; or

6.        AHCCCS establishes the fact that the FFS member has been accepted for Medicaid by another state.

C. AHCCCS may shorten the period of advance notice to five days before the date of action if AHCCCS has verified facts indicating probable fraud by the FFS member.

Historical Note

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

Arizona Administrative Code                                                                 Title 9, Ch. 34

Arizona Health Care Cost Containment System   Grievance System