Section R9-34-321. Continuation of Services While the Appeal and the State Fair Hearing are Pending

A.       For the purposes of this Section, timely filing means filing on or before the later of the following:

1.       Within 10 days from the date that AHCCCS mails the Notice of Action, or

2.        The intended effective date of AHCCCS' proposed action.

B.       AHCCCS shall continue the FFS member's services if:

1.       The FFS member files the appeal timely;

2.        The appeal involves the termination, suspension, or reduction of a previously authorized course of treatment;

3.        An authorized provider ordered the services;

4.        The original period covered by the original authorization has not expired; and

5.        The FFS member requests continuation of services.

C.       If,at the FFS member's request, AHCCCS continues or rein­ states the FFS member's services while the appeal is pending, AHCCCS shall continue the services until one of following occurs:

1.       The FFS member withdraws the appeal;

2.        Ten days pass after AHCCCS mails the Notice of Appeal Resolution to the FFS member unless the FFS member within the 10-day time-frame has requested a State Fair Hearing in writing with continuation of benefits until a Director's Decision is reached;

3.        AHCCCS mails a hearing decision adverse to the FFS member; or

4.        The time-period or service limits of a previously autho­ rized service have been met.

D.       If the Director's Decision upholds AHCCCS' action, the FFS member shall be liable for the cost of the services furnished to the FFS member while the appeal is pending, to the extent that the services were furnished solely because of the requirements of this Section.

Historical Note

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

Administrative Code                                                                  Title      Ch. 34

Arizona Health Care Cost .Containment System - Grievance System