Senator raises concerns over freeze of healthcare appeals

(The Center Square) - An Arizona senator has concerns about the fallout from the Arizona Health Care Cost Containment System's request to freeze 30 pending administrative appeals while at the same time litigating the same issues in another lawsuit.

The agency filed a motion with the Arizona Office of Administrative Hearings, requesting an administrative law judge to pause 30 pending appeals pertaining to Prorenata Labs and six AHCCCS-contracted health plans.  

The dispute concerns reimbursement rates for specific COVID-19 tests and whether an out-of-network laboratory can be compensated for nonemergency services without prior authorization.

David Goodspeed, the chief communications officer for AHCCS, said Prorenata Labs has “filed thousands of disputes challenging [these] two primary issues.”

“AHCCCS has requested that administrative hearings be temporarily paused until a superior court judge rules on the two primary challenged issues to reduce duplicative litigation, inconsistent rulings, and unnecessary expenditure of public resources,” Goodspeed told The Center Square in an email.

State Sen. Mark Finchem, R-Prescott, said he fears this request will “open the door to every agency doing the same thing.”

“If this becomes a playbook for state agencies, the consequences will reach far beyond this case,” Finchem told The Center Square.

Finchem said he did not believe Arizonans could have confidence in the administrative appeals process if any state agency could halt proceedings and move the dispute to court.

The senator questioned why the Hobbs administration “wants to halt established proceedings and shift the legal question to a lawsuit it initiated.”

“Without a full and public explanation, this smells like another attempt by the Hobbs administration to cover up agency actions,” he said.

Finchem said the appeals process was “put into place so providers have a venue to plead their case in an inexpensive way.” The administrative hearings office started operating in 1996.

“The whole point of the AHCCCS is to contain costs. [The administration is] not doing that,” Finchem explained.

He noted every appeal needs to “be heard on its merits.”

Because the state Legislature is out of session, there is not much the governing body can do, Finchem said. However, he said as the chair of the Joint Legislative Audit Committee, he will ask the Arizona Auditor General’s Office to look into the matter.

Finchem said he wants to investigate what is going on and determine whether legislation needs to be passed to address the situation.

The purpose of the audit committee is to hold agencies accountable, Finchem said.