The proposed bill would amend sections 20-2535, 20-2536, and 20-2537 of the Arizona Revised Statutes, specifically updating the process for health care appeals. Under the new law, a member who receives an adverse determination and does not qualify for expedited medical review can request an initial appeal within two years. Additionally, the utilization review agent is required to send a written acknowledgment of the appeal request to both the member and their treating provider within five business days.

The bill also modifies the requirements for the utilization review agent regarding the communication of decisions. It removes outdated language and clarifies that the agent must provide a written statement detailing the decision and rationale if a claim is denied. Furthermore, it establishes that the agent must acknowledge voluntary internal appeals in the same timely manner. The bill streamlines the appeal process by allowing the utilization review agent to initiate an external independent review at any time during the voluntary internal appeal process without needing to comply with certain prior notification requirements.

Statutes affected:
Introduced Version: 20-2535, 20-2536, 20-2537, 20-2534, 20-2533, 32-1601