Ariz. Admin. Code § R9-34-202 - Definitions

Current through Register Vol. 48, No. 14, April 8, 2022

The following definitions apply for purposes of this Article:

1. "AHCCCS" means the AHCCCS Administration as defined in A.R.S. § 36-2901.

2. "Action" by a contractor means:

a. The denial or limited authorization of a requested service, including the type or level of service;

b. The reduction, suspension, or termination of a previously authorized service;

c. The denial, in whole or in part, of payment for a service;

d. The failure to provide a service in a timely manner as set forth in contract;

e. The failure of a contractor to act within the time-frames specified in this Article; or

f. For an enrollee residing in a rural area with only one contractor, the denial of an enrollee's request to exercise the enrollee's right to obtain services outside the contractor's network.

3. "Appeal" means a request for review of an action.

4. "Contractor" means contractor or program contractor as defined in A.R.S. § 36-2901, 36-2931, 36-2971 and 36-2981; the Comprehensive Medical Dental Program in the Department of Economic Security; and the Children's Rehabilitation Services and Behavioral Health Services in the Arizona Department of Health Services.

5. "Day" means calendar day unless otherwise specified.

6. "Director" means the Director of the Arizona Health Care Cost Containment System Administration or designee.

7. "Director's Decision" means the final administrative decision under A.R.S. § 41-1092(5).

8. "Enrollee" means a person eligible for AHCCCS under A.R.S. Title 36, Chapter 29 and who is enrolled with an AHCCCS contractor.

9. "Filed" means the date that the contractor or AHCCCS, whichever is applicable, receives the request as established by a date stamp on the request or other record of receipt.

10. "Grievance" means an expression of dissatisfaction about any matter other than an action. Possible subjects for grievances include, but are not limited to, the quality of care or services provided, and aspects of interpersonal relationships such as rudeness of a provider or employee or failure to respect the enrollee's rights.

11. "Institution for Mental Disease" means an institution defined in 42 CFR 435.1009 and licensed by the Arizona Department of Health Services.

12. "Rural" has the same meaning as in A.R.S. § 36-2171.

13. "State Fair Hearing" means an administrative hearing under A.R.S. Title 41, Chapter 6, Article 10.

14. "Working day" means a Monday, Tuesday, Wednesday, Thursday, or Friday unless:

a. A legal holiday falls on Monday, Tuesday, Wednesday, Thursday, or Friday; or

b. A legal holiday falls on Saturday or Sunday and a contractor is closed for business the prior Friday or following Monday.

Notes

Ariz. Admin. Code § R9-34-202
New Section made by final rulemaking at 10 A.A.R. 828, effective April 3, 2004 (Supp. 04-1).

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