• Within 60 calendar days from the date of the NOA: You must ask for your appeal in this time frame.

• Within 5 business days: We’ll send you a letter saying we got your appeal. 

• Within 10 business days from the date on your NOA: File your appeal in this time frame if you’re asking for your services to continue while we review it.

• Within 30 calendar days: We’ll resolve your appeal in this time frame, in most cases. 

• Extension of 14 more calendar days: This happens if we need more info to make a decision and it’s in your best interest. 

• Within 90 calendar days from the decision on your appeal: The time frame you have to ask for a State Fair Hearing if you disagree with an appeal denial.

Facts about time extensions 

• If we need an extension, we’ll tell you in writing. If we don’t get the info within 14 calendar days, we may deny the appeal. 

• We’ll also tell you how to file a complaint if you don’t agree with the extension. 

• You can also ask for an extension of 14 calendar days if you need more time to gather info for the appeal.  

Next steps 

Once we complete review of your appeal, we’ll send you a letter that: 

• Tells you our decision 
• Explains how we made it
• Explains what do if you disagree with the decision

You can speed up your appeal if you believe waiting up to 30 calendar days is harmful to your life, health or function. This is an expedited or quicker decision. 

Examples of expedited appeals

You can ask for these appeals in situations that involve: 

• Crisis, urgent or emergency care 

• A new or continued hospital stay 

• Availability of care 

• Any reason with good cause  

Timelines to know for expedited appeals

If your provider sends supporting info for an expedited appeal: 

• Within 72 hours (3 days): We’ll review your expedited appeal. 

• Extension of 14 more calendar days: This happens if we need more info to make a decision and it’s in your best interest. 

Facts about time extensions 

• If we need an extension, we’ll tell you in writing. If we don’t get the info within 14 calendar days, we may deny the appeal. 

• We’ll also tell you how to file a complaint if you don’t agree with the extension. 

• You can also ask for an extension of 14 calendar days if you need more time to gather info for the appeal.  

Next steps 

Once we complete review of your appeal, we’ll send you a letter that: 

• Tells you our decision 

• Explains how we made it

• Explains what do if you disagree with the decision

If we deny your appeal, you can ask for a State Fair Hearing. You can also ask for this hearing when: 

• You’ve done everything you can with our internal appeals process  

• The decision is still adverse (against you) 

• The service is clinical in nature   

You have 90 calendar days from the date on the Notice of Appeal Resolution to ask a State Fair Hearing. This includes both standard and expedited requests for a State Fair Hearing. 

If you decide to ask for this hearing, follow the directions in the Notice of Appeal Resolution letter. Then, Arizona Health Care Cost Containment System (AHCCCS) will send you info about what to do next. We’ll send your appeal file and related info to AHCCCS at the Office of Administrative Legal Services.  

You can have a representative of your choice help you at the State Fair Hearing. Read about choosing someone to act for you later on this page. 

Next steps 

After the State Fair Hearing, AHCCCS will make a decision:

• If they find our decision to deny your appeal was correct: You may have to pay for services you received while your appeal was in review. 

• If they find our decision on your appeal was incorrect: We’ll authorize and provide the services right away.

People with a designation for serious mental illness (SMI) have rights. With an SMI grievance, you’re asking us to find out if someone violated your rights. 

Timelines to know for SMI grievances 

• One year from the event: The time frame you have to file an SMI grievance. 

• Within 5 business days: We’ll send you a letter saying we got your SMI grievance. 

Anyone can file this type of request. You’ll want to provide all the details, like:  

• The facts (what happened)  

• Names of people or agencies involved  

• Dates  

• The resolution you want  

Need help filing your SMI grievance? 

You can get help filing your SMI grievance. Just contact:  

• Your behavioral health provider  

• The AHCCCS Office of Human Rights (OHR) at 602-364-4585 (Phoenix), 520-770-3100 (Tucson) or 928-214-8231 (Flagstaff). 

Next steps     

Once we finish the investigation, we’ll send you written notice of the result. We may extend the time frame to get more info. If we do, we’ll let you know about the delay in writing. 

Administrative appeals 

Don’t agree with the result of the SMI grievance? You can file an administrative appeal with the Arizona Health Care Cost Containment System (AHCCCS). File by: 

Mail 

Write a letter to AHCCCS and explain the reasons you don’t agree with the result. Then, mail it to:  

AHCCCS Office of Grievance and Appeals    
801 E. Jefferson, MD 6200    
Phoenix, AZ 85034    

Phone 

Call the AHCCCS Clinical Resolution Unit at 602-364-4558 (TTY 711 or 1-800-367-8939). 

Get help with the administrative appeal 

Call us at 602-586-1719 or 1-866-386-5794 (TTY 711). We’re here for you 8 a.m. to 5 p.m., Monday to Friday. 

Learn more about SMI grievances 

Check your member handbook on our materials and forms page. 

Here are just a few reasons you can file an SMI appeal:  

• The assessment and recommended services in the service plan or individual treatment or discharge plan 

• The denial, reduction, suspension or termination of services 

Check your member handbook for other decisions you can appeal. 

Timelines to know for SMI appeals

• Within 5 business days of getting your appeal: We’ll send you a letter saying we got your appeal. 

• Within 7 business days of getting your appeal: We’ll schedule a meeting (informal conference) with you, your clinical team and any other support you wish to have present. 

• Within 3 business days of the informal conference: We’ll send you an SMI Appeal Resolution based on the outcome of the informal conference.

Next steps 

If you disagree with the outcome of your informal conference, you can request a second level informal conference with AHCCCS.

You can speed up your serious mental illness (SMI) appeal if you believe waiting up to 2 business days is harmful to your life, health or function. This is an expedited or quicker decision. 

Examples of expedited SMI appeals

An expedited SMI appeal is an appeal that needs urgent review. You can ask for these appeals in situations that involve: 

• Crisis, urgent or emergency care 

• A new or continued hospital stay 

• Availability of care 

• Any reason with good cause 

Timelines to know for expedited SMI appeals

• Within 1 business day of getting your expedited appeal: We’ll write to let you know we got your request. 

• Within 2 business days of getting your expedited appeal: We’ll schedule a meeting (informal conference) with you, your clinical team and any other support you wish to have present.

• Within 1 business day of the informal conference: We'll send you an SMI Appeal Resolution based on the outcome of the informal conference.

Continuing services during the appeal process 

You’ll keep getting services you were already getting unless: 

• A qualified clinician decides that reducing or stopping services is best for you 

• You agree in writing to reduce or end services 

If the appeal isn’t decided in your favor, we may require you to pay for the services you received during the appeal process. 

People with a serious mental illness (SMI) may have other health conditions. These conditions can affect their ability to effectively take part in their treatment and services, such as:

• Individual service planning

• Inpatient treatment and discharge planning

• Grievances and appeals

Along with our providers, we’re required to identify people with an SMI designation who need Special Assistance. These are people who can't communicate or take part effectively due to:

• Cognitive or intellectual impairment

• Other behavioral or medical conditions

Questions?

• Call ${MS_phone_1} or ${MS_phone_2} (TTY 711). We’re here for you ${MS_hours}. 

• Call the AHCCCS Office of Human Rights at 602-364-4585 or 1-800-421-2124 (TTY 711 or 1-800-367-8939).

If you are a person determined to have a chronic or serious mental illness (SMI), you have rights under state and federal law. For example, you have the right to:

• Appropriate mental health services based on your needs 

• Take part in all phases of your mental health treatment, including individual service plan (ISP) meetings

• Consent to or refuse treatment (except in an emergency or by court order)

• File an appeal or grievance when you disagree with the services you receive or your rights are violated  

• Have a case manager to work with you in getting the services you need

This isn’t a complete list of your rights. 

Learn more about your rights

• Read Your legal rights under the Arizona Administrative Code (PDF) from the Office of the Secretary of State.

• Read Your Rights in Arizona as a Person with a Serious Mental Illness (SMI): English (PDF)| Español (PDF) brochure from the Arizona Health Care Cost Containment System (AHCCCS).

• Call the AHCCCS Office of Human Rights at 1-800-421-2124 or at 602-364-4585.  

Has someone violated your rights? Call us at ${MS_phone_1} or ${MS_phone_2} (TTY 711). We’re here for you ${MS_hours}.