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    OpenPayerPolicy UpdatesAdministrative/Operational PolicyArizona Complete Health Member Info Update | OpenP…
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    CurrentArizona Complete HealthPolicy 404

    Contractor Website and Member Information

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    Establishes requirements for AHCCCS Contractors regarding member information materials, oral and written communications, website content, language access, newsletters, value-added services, and material submission and review processes.

    Policy Summary
    PayerArizona Complete Health
    PolicyContractor Website and Member Information
    Policy CodePolicy 404
    Change TypeNo material change
    Effective DateOct 1, 2026
    Next Review DateN/A
    Key ActionProvide requested paper member information materials at no charge within five business days.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    5 daysPaper materials on request
    30 daysAdvance notice for significant changes
    15 daysMaterial review period
    2Newsletters per contract year
    6th grade

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Readability target
    12 ptMinimum font size

    Member Information and Communication Requirements

    Accessibility, language, and readability

    Member Information Materials must meet all of the following requirements:

    ALL of the following

    • Provide materials to members and potential members in an easily understood and readily accessible manner.
    • Inform members that paper materials are available at no charge upon request and provide requested paper materials within five business days.within 5 business days
    • Include taglines in the prevalent non-English languages in Arizona and conspicuously visible information explaining the availability of written translation and oral interpretation services, including the Contractor’s toll-free and TTY/TDD customer-service numbers.
    • Make all vital materials available in the prevalent non-English language spoken by each applicable Limited English Proficient population in the service area; oral interpretation does not replace written translation of vital materials.
    • Translate all written member materials into Spanish, whether or not the materials are vital.
    • Provide accurate and culturally appropriate translations.
    • Provide oral interpretation at no cost, including interpretation of English documents into the member’s preferred language, American Sign Language, all non-English languages, and auxiliary aids such as TTY/TDD.
    • Use a sixth-grade reading level as a target, measured using the Flesch-Kincaid scale.sixth-grade reading level
    • Use a font size no smaller than 12 points.minimum 12-point font
    • Make materials available in alternative formats and in an appropriate manner that considers the needs of members who are visually limited, have other disabilities, or have limited reading proficiency, including large-print materials.

    Member newsletter requirements

    Member newsletters must meet all of the following requirements:

    ALL of the following

    • Develop and distribute at least two Member Newsletters during each Contract year.at least two newsletters per Contract year
    • If newsletters are provided electronically, provide written notice to members that the newsletter is available.
    • Submit the newsletter as an initial mock-up of what members will receive, together with the individual articles and readability levels; the newsletter is reviewed under the applicable newsletter review requirements rather than the 15-day file-and-use process.
    • Include educational information on chronic illnesses and ways to self-manage care, and reminders about flu shots and other preventive measures at appropriate times.

    Website and material submission controls

    Contractor websites and Member Information Materials must meet all of the following requirements:

    ALL of the following

    • Include all information required by Attachment B on the Contractor’s website and submit Attachment B as specified in the applicable deliverables requirements.
    • Locate website information so members can easily find and navigate to it from the Contractor’s home page, and provide it in a format members can retain and print.
    • Maintain a website specific to the Contractor’s Medicaid program; do not include links or references to private insurance. Medicare links or references are permitted exclusively to promote coordination of care for members enrolled in both Medicare and Medicaid.
    • Submit applicable Member Information Materials before release with a cover letter describing the material’s purpose, dissemination process, and Flesch-Kincaid reading level, together with a copy, transcript, screenshot, or other distribution-ready documentation.

    Value-added services and external materials

    Value-added services and externally developed health materials must meet all of the following requirements:

    ALL of the following

    • Offer value-added services only to promote healthy lifestyles or improve health outcomes among members.
    • Do not use value-added services to influence continued enrollment with the Contractor.
    • Do not exchange value-added services or incentive items for items prohibited by law.
    • Offer value-added services in a culturally sensitive, unbiased, and equitable manner.
    • Do not report the cost of value-added services as allowable medical or administrative costs, and do not receive compensation for those services.

    Operational Timeframes and Standards

    Paper material fulfillment
    Delivery deadlineWithin 5 business days of a member request
    CostPaper member information must be provided without charge
    AvailabilityMembers must be informed that member information is available in paper form upon request
    Provider termination notice
    Notice deadlineBy the later of 30 calendar days before the provider termination effective date or 15 calendar days after receipt or issuance of the provider termination notice
    RecipientsMembers who received primary care from, or are seen regularly by, the terminated provider

    Contractor Responsibilities

    Documentation Required

    Provide accessible member information

    Provide all Member Information Materials to members and potential members in a manner and format that is easily understood and readily accessible. Inform members that paper materials are available without charge upon request and provide requested paper materials within five business days.

    • Make materials accessible when telephonic and mail-based materials are not sufficient or suitable, including for members experiencing homelessness or living in shelters.
    Documentation Required

    Meet language access and interpretation requirements

    Use State-developed member notices and include taglines in Arizona’s prevalent non-English languages, with large-print information explaining the availability of written translation and oral interpretation services and providing toll-free and TTY/TDD customer-service numbers. Translate all written member materials into Spanish, provide vital materials in the prevalent language for each applicable LEP population, and offer interpretation at no cost, including American Sign Language, all non-English languages, and auxiliary aids such as TTY/TDD.

    • Oral interpretation does not substitute for written translation of vital materials.
    Policy Summary
    PayerArizona Complete Health
    PolicyContractor Website and Member Information
    Policy CodePolicy 404
    Change TypeNo material change
    Effective DateOct 1, 2026
    Next Review DateN/A
    Key ActionProvide requested paper member information materials at no charge within five business days.
    SourceLink
    On This Page
    Member Information and Communication RequirementsOperational Timeframes and StandardsContractor Responsibilities
    Include Medicare Part D issues, cultural competency information other than translation services, tobacco cessation information, HIV/AIDS testing for pregnant members, suicide prevention information, opioid or substance use information, and information on Peer and Family Supports.
  1. Include Contractor-specific issues and topics on preventive care and services in each newsletter.
  2. Include the Contractor’s contact information and crisis hotline information, including information on 988, in each newsletter.
  3. Include educational information about how the Contractor is addressing fair health care access and information about resources for support with Health-Related Social Needs, which may include a link to the Contractor’s Community Resource Guide.
  4. Include information on the Housing and Health Opportunities Program, including relevant information supporting care coordination with the H2O Program Administrator, when applicable to Contractors serving individuals with Serious Mental Illness.
  5. Include information on the Contractor’s integration efforts to improve overall member outcomes, such as behavioral and physical health integration, when applicable.
  6. Include information on Non-Title XIX/XXI Services, as appropriate, and any other information required by AHCCCS.
    7. Use the file-and-use review process for applicable materials and observe the 15-day review period unless AHCCCS requires additional review or an expedited review is warranted.15-day review period

    Submissions made outside standard business hours are received the following business day, and state holidays falling on business days are excluded from the review period.

  7. Request expedited review only when the standard notice period is not possible, clearly mark the request as expedited, and state the reason for the shortened timeframe.
  8. Include all draft member notifications in the material-change submission rather than submitting them separately.
  9. Label all materials, including website materials, email messages, and recorded voice or text messages, with the Contractor’s name and/or logo.
  10. Verify that information is accurate, updated regularly, and appropriately reflects changes in benefits, the Contract, policy, or other relevant updates.
  11. Resubmit updated or revised materials for approval and identify the prior approval date, reason for the update, and all content revisions.
  12. Keep an annual distribution log identifying original submission dates, resubmission dates, and any retraction of a submission, and make the log available to AHCCCS upon request.
  13. Do not directly or indirectly refer to private insurance, include inaccurate, misleading, confusing, negative, or fraudulent information about AHCCCS or the Contractor, use the word ‘free’ for covered services, include political implications, or refer to competing plans in retention materials.
  14. Limit Member Information Materials to information directly related to administration of the Medicaid program or the member’s health and welfare.
    15. Review materials developed by external organizations before distribution to confirm that services are covered under the AHCCCS program, the information is accurate, and the content is culturally sensitive.
  15. Do not distribute external materials that reference services that are not medically necessary, are not AHCCCS-covered benefits, or do not align with AHCCCS policy.
  16. When the Contract requires member education, supplement or replace outside-entity brochures with materials developed by the Contractor and customized for the Medicaid population.
    17. Notice type
    Written notice, provided as part of a good-faith effort
    Readability target
    Readability targetSixth grade reading level
    MeasurementMeasured using the Flesch-Kincaid scale
    Format requirementInformation must be written in an easily understood language and format
    Minimum font size
    Minimum font sizeNo smaller than 12 points
    Alternative formatsMember Information Materials must be available in alternative formats for members with visual limitations, other disabilities, or limited reading proficiency
    Large printLarge-print materials must use a conspicuously visible font size
    Member newsletter frequency
    Minimum frequencyAt least two Member Newsletters during each contract year
    Electronic newslettersIf provided electronically, members must receive written notice that the newsletter is available
    Submission formatSubmit an initial mock-up, the individual articles, and readability levels
    Standard file-and-use review period
    Review period15 days
    After the review periodThe Contractor may disseminate the member information as indicated in its request upon expiration of the 15-day period unless AHCCCS notifies the Contractor otherwise
    Business-day handlingMaterials submitted outside standard business hours are considered received the following business day; state holidays falling on business days are excluded from the 15-day review period
    Significant change notice
    Advance notice30 calendar days before the implementation date
    Covered changesSignificant changes include changes to the AHCCCS covered drug list, cost sharing, covered services, prior authorization, or service delivery
    Member communicationAll members must be informed of changes considered significant by AHCCCS
  17. Translations must be accurate and culturally appropriate.
    18. Documentation Required

    Notify members of provider termination

    Make a good-faith effort to provide written notice to members who receive primary care from, or are seen regularly by, a provider terminated from the network. Provide notice by the later of 30 calendar days before the termination effective date or 15 calendar days after receipt or issuance of the termination notice.

    Denial Risk

    Provide advance notice of significant changes

    Inform members of significant changes at least 30 calendar days before implementation. Covered changes include the AHCCCS covered drug list, cost sharing, covered services, prior authorization, and service delivery.

    Prior Authorization

    Submit member materials for review

    Include all draft member notifications in the material-change submission rather than submitting them separately. Before releasing Member Information Materials, submit a cover letter describing the purpose, dissemination process, and Flesch-Kincaid reading level, together with a copy, transcript, screenshot, or other documentation showing the material as intended for distribution.

    • Required translations do not need to be submitted.
    • Submit materials before release.
    Prior Authorization

    Manage material review and resubmission

    Use the file-and-use review process for applicable Member Information Materials and observe the 15-day review period. If 15 days is not possible, request expedited review by clearly marking the request as expedited and stating the reason; AHCCCS determines whether expedited review is warranted.

    • Materials submitted outside standard business hours are considered received the following business day.
    • State holidays that fall on business days are not counted in the 15-day review period.
    • Resubmit updated or revised materials with the prior approval date, reason for the update, and all content revisions clearly identified.
    Documentation Required

    Maintain compliant contractor website content

    Maintain a Medicaid-specific, accessible, printable website containing the required Attachment B information, with content that members can easily find and navigate from the contractor’s home page. Do not include links or references to private insurance; Medicare references are permitted only to coordinate care for members enrolled in both Medicare and Medicaid.

    • Label website member materials with the contractor’s name and/or logo.
    • Keep website information accurate and updated regularly.
    Billing Rule

    Administer value-added services

    Offer value-added services only to promote healthy lifestyles or improve health outcomes, and do not use them to influence continued enrollment with the contractor. Offer them in a culturally sensitive, unbiased, and equitable manner; do not exchange incentive items for prohibited items or report their costs as allowable medical or administrative costs.

    • The contractor will not receive compensation for value-added services.