If the agency or the customer disagrees with the fair hearing decision, they can appeal the decision. The process varies depending on the agency:
When the customer or the agency Fair Hearing Coordinator disagrees with the Director’s Decision, he or she may ask for a rehearing from the AHCCCS Director. The customer also has the option to appeal the decision with the Superior Court.
NOTE The customer may petition for a rehearing before filing an appeal with the Superior Court, but does not have to do so.
A rehearing or review may be requested for any of the following reasons:
An irregularity in the hearing or appeal proceedings and the party was deprived of a fair hearing;
Misconduct on the part of an involved party, the eligibility office or the agency;
Newly discovered material evidence that could not have been discovered and produced at the hearing;
The decision was prejudiced;
The decision was not justified by the evidence or is contrary to the law; or
One of the parties had good cause for not appearing at the hearing.
The rehearing process involves a review of the hearing file and other written documents submitted by the customer or the agency. Either party may object to the petition, and on rare occasions, more testimony may be requested. After reviewing the information, the Director issues a Final Decision.
When the customer disagrees with the fair hearing decision, he or she may ask for a review of the decision from the Office of Appeals (OOA) Appeals Board.
NOTE The Appeals Board may accept or decline a rehearing or review of a case.
The Appeals Board conducts the review and notifies the customer and the FAA Policy Support Team (PST) of the review results.
If the OOA Appeals Board decision is unfavorable to the appellant, he or she may submit a request for review to the Appeals Board again.
If the Family Assistance Administration (FAA) disagrees with the OOA Appeals Board decision, FAA must submit a request to the Attorney General’s Office. When the Attorney General’s Office is in agreement with FAA, the Attorney General’s Office submits the request for review to the OOA Appeals Board.
|
Term |
Definition |
|
Office of Administrative Hearings (OAH) |
The office that conducts fair hearings on behalf of the AHCCCS Administration. |
|
Office of Appeals (OOA) |
The office that conducts fair hearings on behalf of the Department of Economic Security (DES). |
|
Superior Court |
The Superior Court hears appeals of administration decisions. |
In general a request for rehearing or an appeal of the hearing decision must be filed in writing within 35 days of the date of the hearing decision letter.
Exceptions:
When appealing a DES Fair Hearing decision, the request must be filed in writing to the OOA within 15 calendar days of the mailing date of the decision.
When the agency is appealing an OOA Appeals Board decision, the request must be sent to the Attorney General’s Office within 10 calendar days from the date of the OOA Appeals Board decision.
|
Program |
Legal Authorities |
|
All Programs |
42 CFR 431.232 and 233 42 CFR 431.244 and 245 ARS 41-1092.08 ARS 41-1092.09 AAC R9-34-113 |