A. Upon a denial, termination, or discontinuance of eligibility, the applicant shall have the right to a prompt evidentiary hearing. The applicant shall have fifteen calendar days from the notification of the denial, termination, or discontinuance in which to request an evidentiary hearing. A form shall be provided for that purpose and shall be sent with the notice. The applicant shall fill out the form setting forth a statement of the grounds for the requested hearing. The request for the hearing shall be delivered or mailed to the director of the department of medical assistance.
B. Within ten business days after receipt of a request for a hearing, the director of the department of medical assistance shall appoint a hearing officer. A complete copy of the application together with all relevant documents shall be given to the hearing officer.
C. A hearing shall be scheduled before the hearing officer at the earliest possible date, but in no event later than fifteen business days after appointment of the hearing officer.
D. Notice of the hearing date shall be mailed to the applicant at least five business days prior to the hearing, except that the applicant may waive the time required for the notice of a scheduled hearing.
E. The hearing shall be informal. Technical rules of evidence shall not apply, except that legally privileged communications shall be excluded.
F. The applicant may represent himself or may be represented by an attorney or a representative of his own choosing.
G. All parties may examine witnesses and present evidence.
H. The applicant shall have the right to examine and copy all documents and records to be used by the department staff at a reasonable time before the hearing.
I. Upon completion of review of all pertinent evidence or within five business days of conclusion of the hearing, the hearing officer shall report his/her recommendation and its basis to the director of the department of medical assistance.
J. The director of the department of medical assistance (or a designee) shall make a final determination based on the hearing officer's recommendation.
K. The director of the department of medical assistance shall mail the applicant a copy of the hearing officer's recommendation and notify the applicant, in writing, of the final determination of the department director within ten business days of receipt of the hearing officer's recommendation.
L. The final determination and action taken pursuant thereto shall be final, subject to a possible right of judicial review in the nature of a special action pursuant to Arizona law. Notice of this right shall be given to the applicant with his/her notice of the final determination.
M. Members appealing a discontinuance or denial of county benefits within fifteen days of notice of the discontinuance will remain eligible for county benefits until a decision on the appeal is rendered.
N. Appellants whose benefits continue through the appeal process may be required to reimburse the county for all costs of medical care received during the appeal process if the discontinuance or denial decision is upheld by the county hearing officer and the department director.
(Ord. 1991-2 § 1 (part), 1991)