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's communication regarding the appeal process. It removes outdated language and clarifies that the agent must provide a written statement of their decision, including the rationale and options for further appeal, if the initial appeal is denied. Furthermore, it allows the utilization review agent to initiate an external independent review process 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