36-3413. Grievance and appeal process
A. The department shall require all regional behavioral health authorities to
establish and implement a grievance and appeal process for use by service providers and
by individuals receiving and requesting services. The department shall stipulate any
required elements of the process in the request for proposal issued to solicit bids from
entities that wish to become a regional behavioral health authority.
B. The process shall be as prescribed in title 41, chapter 6, article 10 for
grievances and appeals filed by regional behavioral health authorities and by service
providers and individuals receiving and requesting services that have already exhausted
the regional behavioral health authority grievance and appeal process. In the case of
individuals receiving behavioral health services by a service provider that has
contracted directly with the department instead of through a regional behavioral health
authority, the department's grievance and appeal process is considered the primary
process.
C. For individuals who are eligible for services pursuant to chapter 29 of this
title or service providers registered with the Arizona health care cost containment
system administration, the department or the regional behavioral health authority shall
provide notice that the individuals or providers may appeal a decision rendered by the
department to the Arizona health care cost containment system administration if the
disputed decision involves services or payments authorized under chapter 29 of this
title.
D. Individuals who are eligible for behavioral health services pursuant to chapter
29 of this title and who are appealing the denial, reduction, termination or suspension
of a title XIX behavioral health service may appeal directly to the Arizona health care
cost containment system for an expedited hearing pursuant to rules adopted by the
director of Arizona health care cost containment system.
|