This bill proposes to amend current statutes by adding a new section to the Arizona Revised Statutes, specifically title 36, chapter 29, article 1. The new section, 36-2903.18, will require that any appeal of a behavioral health claim that falls under the capped fee-for-service schedule be reviewed by an individual with relevant clinical experience. This insertion aims to ensure that appeals are evaluated by qualified professionals, enhancing the review process for behavioral health claims.

The bill does not delete any existing language from current law but introduces this new requirement to improve the oversight of behavioral health claims within the Arizona Health Care Cost Containment System (AHCCCS). The changes are intended to take effect on the general effective date, thereby reinforcing the importance of clinical expertise in the claims review process.

Statutes affected:
Introduced Version: 36-2903.18