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Panel finds structural failures at Access; chair proposes contracting AISP management

Arizona Senate Health and Human Services Committee · January 29, 2026

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Summary

Committee heard Access director update on claims-processing steps and an external review but also read Access-supplied data highlighting missing fields, escalating provider disputes and legal recoupments; Chair announced legislation to require Access to contract AIHP management functions to a qualified managed-care entity.

Virginia Rountree, Director of Access, updated the committee on operational steps: daily claims-and-prior-auth huddles, an external claims vendor under contract, project-management support for process improvement and an independent external review of the Division of Fee-for-Service Management (DFSM). "We have engaged an outside entity to look at all of the operations within DFSM," she said, and committed to biweekly updates with the committee chair.

Committee excerpts from Access data showed gaps that members described as structural: inability to reliably separate urgent versus routine prior-authorizations, fragmented incident and demographic fields, missing workgroup minutes, limited historic quality-outcome records and inability to categorize provider terminations by fraud versus quality of care. The committee highlighted steep increases in disputes and appeals: fee-for-service claim disputes rose from 87 in 2024 to 338 in 2025; provider appeals rose from 219 in 2024 to 577 in 2025. Testimony also cited identified overpayments and small collections to date.

TIP funding and provider payments: Committee members pressed Access staff about the Targeted Investments Program (TIP), noting TIP 1 at $300,000,000 and TIP 2 at $250,000,000 and asking when payments would be disbursed; Access staff said TIP distributions are handled in arrears and that some payout work remains. Lawmakers also raised long-running provider payment disputes and a provider example (identified in hearing as "RH") that alleged months-long prepayment review, delayed payment and potential business closure; Director Rountree committed to follow-up and to provide answers early the following week.

Legislative next step: After extensive discussion of data deficiencies and operational dysfunction, Chairwoman Warner said she would introduce legislation to preserve the AISP fee-for-service option while requiring Access to contract administrative and care-management functions for AIHP to a qualified managed-care organization or capable entity. "I am convinced this is the only approach that will restore accountability," she said.