Access, flow and utilization management

AzHHA advocates for policies that enable patients to receive the appropriate level of care at the right time, ensuring smooth transitions throughout the continuum of care. This includes prehospital entry, ED arrival, inpatient care, interfacility transfers, post-acute placement and safe discharge.

We support transparent, enforceable timelines for prior authorization and medical-necessity decisions, transparent utilization management standards and accountable networks with sufficient bed capacity, specialty coverage and transportation.

We endorse transfer pathways that prioritize clinical need, reduce ambulance offload delays and prevent unnecessary ED boarding. We oppose practices that block or slow transfers, misclassify status (such as observation versus inpatient) to avoid payment, or rely on opaque denials and retroactive audits. We call on payers to report on denial rates, overturns, delays and expedited authorizations for time-sensitive services.

Furthermore, we encourage coordinated solutions to address post-acute bottlenecks involving SNF, LTACH, rehab, behavioral health, home health, DME and hospice. This includes dependable acceptance of interhospital transfers for specialty services, equitable transport coverage and network adequacy that supports rural Arizona.