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Any person may ask for an appeal. However, when someone other than the customer or the customer’s representative asks for an appeal, AHCCCS must contact the customer to confirm the request.
When a person who is not authorized to represent an incapacitated customer but is acting responsibly on the customer’s behalf, the person requesting the appeal must sign and return an Authorized Representative form (DE-112). A Physician Statement of Incapacity form (DE-217) must also be in the customer’s case file.
The request for an appeal may be submitted:
· By mail;
· In-person;
· By telephone;
· By fax;
· By e-mail; or
· Through Health-e-Arizona Plus (HEAplus).
NOTE At this time, ALTCS customers are not able to request an appeal through HEAplus.
Each decision letter includes a pre-printed “Appeal Request Form”; or “I Am Asking For A Hearing” section. The customer is not required to use the form or letter to request an appeal.
A written appeal request must contain the following information:
o The customer’s name;
o The action or decision the customer is appealing; and
o The reason for the appeal request.
Term |
Definition |
Appeal Request |
A request for a hearing regarding an adverse action or delay in the application process. |
Decision Letter |
A written notice that explains the action that has been taken on a customer’s case. |
Good Cause |
A valid reason for not submitting the appeal request within the 35-day timeframe. Good cause includes: · Illness; · Failure to receive the decision letter; or · Any other reasonable explanation (as determined by the agency). |
Appeal requests must be received by the 35th calendar day after the date on the decision letter. When the 35th calendar day is on a weekend or state holiday, the due date is extended to the end of the next business day. Appeal requests received after the 35th calendar day will be denied.
All appeal requests are date-stamped when they are received. The table below lists the date the request is considered received based on how it is sent to the agency:
When the request for hearing is... |
Then the date of request is... |
Sent by mail |
The date the letter is received. |
Faxed |
The date the fax transmission was received. |
Sent by email |
The date the email was received. |
Completed through HEAplus |
The date the appeal request is submitted. |
Made in person or by telephone |
The date the request is made. |
The agency determines if the appeal request was filed within the 35 calendar day timeframe and notifies the customer when the request is denied because it was received late.
When the agency denies the customer’s appeal request because it was received late, the customer may ask for a good cause hearing.
This requirement applies to the following programs:
Program |
Legal Authorities |
All Programs |
42 CFR 431.220 and 221 9 AAC 34, Article 1 |