Ariz. Admin. Code § R6-6-1804 - Who May File a Request for Administrative Review

Current through Register Vol. 27, No. 52, December 24, 2021

A. The DD/ALTCS client or ALTCS service provider desiring an Administrative Review shall first attempt to resolve the complaint through informal communication with the appropriate Health Plan representative or the District Program Manager.

B. If the client or service provider is dissatisfied with the informal decision of the Health Plan or District Program Manager, a written request for an Administrative Review shall be filed with the Division's Compliance and Review Unit not later than 35 calendar days after the adverse action.

C. If the Health Plan or District Program Manager takes no action as to the resolution of a disagreement, the grievant may, within 60 calendar days of the adverse action, file a written request for an Administrative Review with the Division's Compliance and Review Unit.

D. The Division's Compliance and Review Unit shall review the written request and render a written decision within the times prescribed under ALTCS (A.A.C. R9-28-802 or R9-28-804 ).

The following persons may request an Administrative Review:

1. A Requestor; or
2. A Representative. If a Representative is acting on behalf of the Member or Applicant, the Representative shall submit a valid Health Information Portability and Accountability Act authorization. The Representative may not charge a fee for the representation unless the Representative is the Member's or Applicant's attorney.

Notes

Ariz. Admin. Code § R6-6-1804
Adopted effective March 8, 1983 (Supp. 83-2). Section repealed, new Section adopted effective August 29, 1991 (Supp. 91-3). Former Section R6-6-1804 renumbered to R6-6-1803, new Section R6-6-1804 renumbered from R6-6-1805effective September, 30, 1993, under an exemption from A.R.S. Title 41, Chapter 6 (Supp. 93-3). Adopted by final rulemaking at 23 A.A.R. 3350, effective 1/27/2018.

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