FAA6 Case Maintenance and Administrative Lists

Revision 11 (01-01-10 through 03-31-10) : FAA6 Case Maintenance and Administrative Lists

FAA6.D04B – Deemed Newborn Automated Process

Removed reference to the Health Insurance for Parents (HP) program since effective 10/01/09 the program is no longer available. (Policy Broadcast 09‑29, effective 08/26/09)

FAA6.D04F – Deemed Newborn Born to an SSI Mother

Archived Policy

Removed reference to the Health Insurance for Parents (HP) program since effective 10/01/09 the program is no longer available. (Policy Broadcast 09‑29, effective 08/26/09)

FAA6.D04F.01 – Newborn Born to an SSI Mother - Others in the Case Have Open MA

Archived Policy

Removed reference to the Health Insurance for Parents (HP) program since effective 10/01/09 the program is no longer available. (Policy Broadcast 09 29, effective 08/26/09)

FAA6.D04F.02 – Newborn Born to an SSI Mother - Not Known to AZTECS

Archived Policy

Removed reference to the Health Insurance for Parents (HP) program since effective 10/01/09 the program is no longer available. (Policy Broadcast 09 29, effective 08/26/09)

FAA6.F07 – AHCCCS Fraud Prevention Unit (AFPU)

Archived Policy

Changed AHCCCS Predetermination Quality Control (PDQC) to AHCCCS Fraud Prevention unit (AFPU). (Reference changed from FAA2.Q03N)

FAA6.F07A – AHCCCS Fraud Prevention (AFPU) Requirements

Archived Policy

Changed AHCCCS Predetermination Quality Control (PDQC) to AHCCCS Fraud Prevention unit (AFPU). Added hospital sites and Santa Cruz county to list of sites involved in AFPU and Ajo and Sells was not included in referral process. (Reference changed from FAA2.Q03N.01)

FAA6.F07B – Office of Special Investigations (OSI) - AHCCCS Office of Program Integrity (AOPI)

Archived Policy

Removed entire subject because the information is already stated in another area of policy.

FAA6.F07B – FAA Staff Responsibilities for AFPU Process

Archived Policy

Clarified when the referral is sent to AFPU. Added links Mandatory AFPU Referrals and Referral Procedures policies. (Reference changed from FAA2.Q03N.02)

FAA6.F07B.01– FAA Staff Responsibilities – Mandatory AFPU Referrals

Archived Policy

Added Warning stating that applications submitted to Designated local offices must contain a SOBRA Woman participant. Revised for clarity. (Reference changed from FAA2.Q03N.02)

FAA6.F07B.02– FAA Staff Responsibilities – Referral Procedures

Archived Policy

Added to document “Potential Contagious Disease” on the top portion of the FAA-1181A when participant has contagious disease. Removed policy regarding Verification Specialist. Revised for clarity. (Reference changed from FAA2.Q03N.02)

FAA6.F07C.01 –AFPU Responsibilities – Hospital Sites

Archived Policy

Split AFPU Responsibilities into Hospital Sites and Designated Local offices. (Reference changed from FAA2.Q03N.03)

FAA6.F07C.02 – AFPU Responsibilities – Designated Local Office

Archived Policy

Split AFPU Responsibilities into Hospital Sites and Designated Local offices. (Reference changed from FAA2.Q03N.03)

FAA6.F07D – AFPU Findings

Archived Policy

Changed the list of findings returned from AFPU to only include Violations NOT Found, Potential Violations Found, Violations Found and Inconclusive. (Reference changed from FAA2.Q03N.04)

FAA6.F07E – FAA Actions After PDQC AFPU Findings

Archived Policy

Revised for clarity. Added actions to take when a AFPU returns a finding of Inconclusive. Added a NOTE stating AFPU may request additional time to complete investigation. Added a WARNING stating not to deny based on AFPU findings alone. (Reference changed from FAA2.Q03N.05)

FAA6.F07F –AFPU Designated Local Office

Added subject identifying the list of designated AFPU offices.

FAA6.F08 – Office of Special Investigations (OSI) – AHCCCS Office of Program Integrity (AOPI)

Archived Policy

Added that OSI conducts pre-approval on CA, NA and MA combo cases throughout state and MA only cases outside of Maricopa and Pima counties. Changed policy to say that AOPI conducts preapproval and post approval investigations. (Reference changed from FAA6.F07)

FAA6.F08B – OSI/AOPI - Potential Fraud Referral Requirements

Archived Policy

Added policy on when to send the OSI-1017A to AOPI for pending, hospitalized applicants, and active MA cases. Revised for clarity. (Reference changed from FAA6.F07C)

FAA6.F08C – OSI/AOPI - Investigation Request Forms

Archived Policy

Revised to say Complete OSI-1017A instead of print OSI-1017A. (Reference changed from FAA6.F07D)

FAA6.F08D – OSI/AOPI - Acting on OSI Reports of Investigation (ROI)

Archived Policy

Revised subject heading to clarify that the policy applied to both OSI and AOPI ROI’s. (Reference changed from FAA6.F07E)

FAA6.F08D.01 – Acting on OSI/AOPI Reports of Investigation – Violations NOT Found

Archived Policy

Added that the OSI-002 form was sent to OSI when investigation was completed by OSI and the FAA-1182 to AOPI when investigation completed by AOPI. Revised for clarity. (Reference changed from FAA6.F07E.01)

FAA6.F08D.02 – Acting on OSI/AOPI Reports of Investigation – Potential Violations Found

Archived Policy

Revised for clarity. (Reference changed from FAA6.F07E.02)

FAA6.F08D.03 – Acting on OSI/AOPI Reports of Investigation – Violations Found

Archived Policy

FAA6.F08D.04 – Acting on OSI/AOPI Reports of Investigation – Inconclusive

Archived Policy

Added a WARNING stating that a CO11 must be sent when AOPI returns an ROI and the conclusion is Inconclusive. (Reference changed from FAA6.F07E.04)

FAA6.F08D.05 – Acting on OSI/AOPI Reports of Investigation – Information Needed

Archived Policy

Added OSI and AOPI to Subject heading. (Reference changed from FAA6.F07E.05)

FAA6.F08D.06 – Acting on OSI/AOPI Reports of Investigation – Failure to Respond

Archived Policy

Added that the OSI-002 form was sent to OSI when investigation was completed by OSI and the FAA-1182 to AOPI when investigation completed by AOPI. When AOPI has not sent the completed ROI by the due date for determining eligibility. (Reference changed from FAA6.F07E.06)