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ATTORNEY NAME (BAR #)
ADDRESS
Attorney for Plaintiff
SUPERIOR COURT OF ARIZONA
MARICOPACOUNTY
)
)
Plaintiff, )
)
v. ) No.
)
XXXXXXXXX, DIRECTOR,)
ARIZONA HEALTH CARE COST )
CONTAINMENT SYSTEM, in XXX official capacity;)COMPLAINTFOR
ARIZONA HEALTH CARE COST) JUDICIAL REVIEW OF
CONTAINMENT SYSTEM, a state agency. )ADMINISTRATIVE
)DECISION
Defendants. )
)
Plaintiff files this Complaint for Judicial Review and states the following:
1.Plaintiff was a party to proceedings before the Defendants Arizona Health Care Cost Containment System captioned XXX v. XXXX and numbered XXX. Pursuant to those proceedings Defendant XXXXX, through her designee, as Director of the Arizona Health Care Cost Containment System, rendered a decision dated August 15, 2002, which found that the Plaintiff was not entitled to incontinence briefs.
2.Defendant Arizona Health Care Cost Containment System (AHCCCS) is an agency of the State of Arizona created by law responsible for ensuring that health care is provided to eligible Arizona residents.
3.Defendant XXXXXXXXX is the Director of the Arizona Health Care Cost Containment System (AHCCCS) and in her official capacity is responsible for the administration of AHCCCS, for ensuring the provision of health care to eligible Arizona residents, and for AHCCCS compliance with federal and state laws.
4.This Court has jurisdiction of this action pursuant to A.R.S. § 12-905 (A) because this is an action to review a final administrative action as authorized under A.R.S. §§ 12-901 et seq.
5.Venue for this action is proper in the Superior Court for Maricopa County because the proceeding culminating in the agency decision was held in that county, and the transaction giving rise to this matter occurred in MaricopaCounty.
6.Plaintiff applied for incontinence briefs with XXXXX, a provider under contract with the AHCCCS Administration. Mercy Care Plan denied Plaintiff those services and Plaintiff appealed. An administrative hearing was held in this matter on November 21, 2001 in front of Administrative Law Judge XXX of the Office of Administrative Hearings.
7.On November 26, 2001, Judge XXX issued a Recommended Decision finding that Plaintiff was entitled to incontinence briefs.
8.On December 20, 2001, Defendant XXXXXXX issued a decision rejecting Judge Strickland’s Recommended Decision and denying Plaintiff’s appeal.
9.On January 15, 2002, Plaintiff filed a timely motion for review and reconsideration. In a final decision dated August 15, 2002, Defendant XXXXXX, through her designee, denied Plaintiff’s motion. The final administrative decision is attached as Exhibit “A” to this complaint. The decision found that the incontinence briefs were not “medically necessary” as defined by the state statute and regulations.
10.Plaintiff’s counsel was served with a copy of the final decision on August 19, 2002.
11.The decision of the Arizona Health Care Cost Containment System is contrary to law and invalid in that:
a. Substantial evidence does not support the decision.
b.The decision is arbitrary, irrational, and capricious and an abuse of discretion in that it fails to give proper weight to the Plaintiff’s treating physician.
c.Defendants’ decision is contrary to A.A.C. R9-22-101(B)(35), which requires services that will “prevent ... adverse health conditions or their progression”to be covered as medically necessary services in accordance
with A.R.S. § 36-2907.
12.Plaintiff is harmed by said illegal and invalid decision and interpretation of law in that he is being denied incontinence briefs.
13.Plaintiff’s health and well being continues to be jeopardized by Defendants’ decision.
14.Pursuant to A.R.S. §12-904, Plaintiff designates the complete transcript of the hearing held on November 21, 2001, all exhibits introduced at the hearing, as well as all decisions and pleadings filed and subsequent evidence filed in support of the Motion for Reconsideration in this matter as the record on appeal.
WHEREFORE, Plaintiff prays that this Court:
A. Enter judgment against Defendants reversing said decision that the Plaintiff is not entitled to incontinence briefs;
B. Enter judgment against Defendants and each of them for Plaintiff’s costs and reasonable attorney fees and for interest on the unpaid portion thereof at the rate of 10% per annum from the date of judgment until paid;
C.Grant such other relief as the Court deems proper.
RESPECTFULLY SUBMITTED THIS ______DAY OF SEPTEMBER, 2002.
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ATTORNEY NAME
ADDRESS
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