If you receive an Adverse Benefit Determination (also known as an NOA by AHCCCS) letter from DDD indicating that your services have been denied, terminated, reduced, or suspended and you would like to request an appeal of this action, you must do so within sixty (60) calendar days from the date of the Adverse Benefit Determination letter.
The request for an appeal of the action may be filed, either orally or in writing, with DDD’s Office of Administrative Review:
Arizona Department of Economic Security
Division of Developmental Disabilities
Office of Administrative Review
4000 N. Central Ave, 3rd Floor, Suite 301
Mail Drop 2HE5
Phoenix, Arizona 85012
(602) 771-8163 or 1 (855) 888-3106
DDD's Office of Administrative Review will:
- Acknowledge receipt of the appeal in writing within five (5) calendar days.
- Assist you with the completion of forms and other procedural steps, upon request.
- Ensure that you are included as a party during the appeal process.
- Respond to the appeal with a written Notice of Appeal Resolution (NOAR) within thirty (30) days from date the appeal was filed.
- Request an expedited appeal.
- Present information to DDD in person or in writing at any time during the appeal process.
- At any time during the appeal process, review records and other documents considered before and during the appeal, as long as the documents are not protected from disclosure by law.
If the appeal is denied, the member may go to the next step of the Appeals Process. The next step is for the member to request a hearing. The hearing is called a state fair hearing. A state fair hearing is the last step in the Appeals Process. When you send a written request to the Office of Administrative Review for a state fair hearing, your appeal will be sent to AHCCCS in five business days. A copy of the request will also be sent to the Attorney General’s Office. AHCCCS will schedule a hearing date to be heard by the Arizona Office of Administrative Hearings. An Administrative law judge will review your appeal and issue a recommendation.
Appeals for Serious Mental Illness (SMI)
A serious mental illness (SMI) is a mental disorder in persons 18-years of age or older that’s severe and persistent. Any qualifying AHCCCS behavioral health intake provider can perform a Serious Mental Illness (SMI) eligibility evaluation. Members seeking a determination of serious mental illness and members who have been determined to have a serious mental illness can appeal the result of the determination.
Your DDD Health Plan will send you a letter by mail to let you know the final decision on your SMI determination. This letter is called a Notice of Decision. The letter will include information about your rights and how to appeal the decision. You can call your DDD Health Plans’ member services department to file an appeal.
Persons who have been determined to have a serious mental illness can also appeal parts of their treatment plan including:
- A decision regarding fees or waivers.
- The assessment report and recommended services in their ISP or individual treatment or discharge plan.
- The denial, reduction, suspension or termination of any service that is a covered service funded through Non-Title XIX/XXI funds. *
- Capacity to make decisions, need for guardianship or other protective services or need for special assistance.
*Persons determined to have a serious mental illness cannot appeal a decision to deny, suspend or terminate services that are no longer available due to a reduction in State funding.
Requesting a State Fair Hearing
If you disagree with this decision, you may request a state fair hearing. AHCCCS will make the final decision about your appeal. You must file a written request for a hearing with the entity that sent you the Notice of Appeal Resolution, the DDD Office of Administrative Review or your DDD Health Plan, within 120 calendar days from receipt of the appeal decision. If it is decided that the decision was correct, you may be responsible for payment of the disputed services you received while your appeal was being reviewed.
If you do not receive a written appeal decision within 30 calendar days, you have the right to file a request for a hearing with AHCCCS. The written request for a hearing must state the issue that is being appealed.
You may ask for a faster review if:
- Your life or health could be in danger.
- You are not able to meet, keep, or get back to how you are able to do things by waiting 30 calendar days for a decision.
If DDD or your DDD Health Plan agree to make a faster decision, a decision will be made in 72-hours. If the request is denied for a faster decision, you will get a phone call with a follow-up letter in two working days. The letter will tell you that you will receive a decision in 30 calendar days.
If you are unhappy with this decision, you may call the DDD Customer Service Center at 1-844-770-9500 ext. 1 or your DDD Health Plans’ customer service department.