Ariz. Admin. Code § R20-6-1921 - Enforcement Consideration
In determining the appropriate enforcement action or penalties for failure to comply with these rules, the Department shall consider any documentation the HCSO provides regarding:
1. Whether seasonal shifts in demand affect
access and availability of covered services;
2. Whether the HCSO's demographic information
has changed significantly since the HCSO's most recent report;
3. Whether an enrollee has refused to accept
covered services the HCSO has offered in the time-frames or locations required
of the HCSO by this Article;
4.
Whether an enrollee has requested and obtained covered services from a
contracted provider whose location, or appointment availability, or capacity
result in the HCSO's non-compliance; and
5. Whether market factors indicate that on a
short-term basis, compliance is not possible. Market factors include shortage
of providers, enrollee or provider location, and provider practice or
contracting patterns.
Notes
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