Sec 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.

(L01, Ch. 60, sec. 2. Eff. until 7/1/16)