AHCCCS; claims review; behavioral health

SB 1116 requires that appeals for behavioral health claims under Arizona's Medicaid program (AHCCCS) subject to a capped fee-for-service payment schedule must be reviewed by an individual with relevant clinical experience. This applies specifically to disputes over payments for behavioral health services where providers are paid under a fixed, capped rate system. The bill directly affects behavioral health providers and patients involved in payment appeals within AHCCCS. It mandates clinical expertise in the review process rather than non-clinical review, aiming to improve the accuracy of payment decisions for these services.