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A customer also has the right to file a grievance if unsatisfied with a matter other than an adverse action. Adverse actions are actions that can be appealed (see MA1701).
A grievance may be filed by:
· A customer;
· A representative; or
· A provider acting on behalf of the customer.
A grievance may be filed either verbally or in writing with the Agency.
Term |
Definition |
Grievance |
An expression of dissatisfaction about any matter other than an adverse action. This includes the quality of care received, the services provided or personal treatment (for example, rudeness or conduct of a provider, health plan or agency staff). |
Office of Administrative Hearing (OAH) |
The OAH handles coordinating the hearings on behalf of AHCCCS Administration. |
Office of the General Counsel (OGC) |
Helps OAH with the coordination of the appeals process on behalf of AHCCCS program customers. |
Grievances must be filed with the Office of the General Counsel (OGC) within 60 days of the date the action happened, or notice was sent:
· The filing date for a verbal grievance is the date of the verbal communication.
· The filing date of a written grievance is the date it is received by the agency.
The agency issues a decision within 30 days of the filing date unless the customer agrees to an extension.
This requirement applies to the following programs:
Program |
Legal Authorities |
All Programs |
AAC R9-34-202, 208, 209 and 210 AAC R9-34-301, 302, 308, 309 and 310 |