Friday, March 29, 2019

Arizona Long Term Care System (ALTCS) program Basic information

ARIZON HEALTH CARE COST CONTAINMENT SYSTEM FEE-FOR-SERVICE PROVIDER BILLING MANUAL

GENERAL INFORMATION

All Arizona residents can apply for AHCCCS services or the Arizona Long Term Care System (ALTCS) program. There are many programs that individuals may qualify for in order to receive AHCCCS medical or behavioral health services or ALTCS coverage.

The programs have a number of different financial and non-financial requirements that applicants must meet, including, but not limited to:

1. Proof of Arizona residency at the time of application.
2. Proof of U.S. citizenship and identity or proof of qualified alien status.

 If a non-citizen does not meet the qualified alien status requirements for full services, but meets all other requirements for the Caretaker Relative, SOBRA Child, SOBRA Pregnant Woman, Young Adult Transitional Insurance (YATI), Adult, or SSI-MAO category, the individual is eligible to receive Federal Emergency Services (FES) only.

3. An income test that requires applicants to identify all individual and/or family earned and unearned income and to provide documentation if needed.

4. A resource test that requires applicants to identify resources (e.g., homes, other property, liquid assets, vehicles, and any other item of value) and provide documentation of their value.

NOTE: A resource test is only required for the ALTCS program.

5. Other requirements
    * Each program has certain non-financial and/or financial requirements that are unique to the program and are aimed at servicing specific groups of people.


Eligibility

Eligibility determination is not performed under one roof, but by various agencies, depending on the eligibility category.

For example:

* Pregnant women, caretaker relatives, children, and single individuals enter AHCCCS by way of the Department of Economic Security.

* The blind, aged or disabled, who receive Supplemental Security Income, enter through the Social Security Administration.

* Eligibility for categories such as ALTCS, SSI – Medical Assistance Only (Aged, Blind and Disabled, who do not qualify for Supplemental Security Income cash payment),

KidsCare, Freedom to Work, Breast and Cervical Cancer Treatment Program and Medicare Cost Sharing programs are handled directly by the AHCCCS Administration.

Each eligibility category has its own eligibility criteria.

1. Coverage for parents and caretaker relatives is provided under Caretaker Relatives.
2. Coverage for children is provided under the following eligibility categories:
a. ALTCS
b. KidsCare
i. KidsCare is Arizona’s version of the Title XXI State Children’s Health
Insurance Program.
ii. It covers low-income children under age 19, if the family income is less
than 200 percent of the Federal Poverty Level (FPL).
c. Child Group
d. SSI Cash (Title XVI) or SSI MAO
e. Young Adult Transitional Insurance (YATI) for former Foster Care Children
aged 18 to 26
f. Foster Care Children
g. Adoption Subsidy Children
h. Newborns

All babies born to AHCCCS-eligible mothers are also deemed to be AHCCCS eligible and may remain eligible for up to one year, as long as the newborn continues to reside in Arizona.
i. Newborns born to mothers receiving Federal Emergency Services (FES) also are eligible up to one year of age. While the mother will be covered on a Fee-For-Service basis under FESP, the newborn will be enrolled with a health plan.

ii. Newborns born to mothers enrolled in KidsCare will be approved for KidsCare beginning with the newborn’s date of birth, unless the child is Medicaid eligible.

iii. Newborns receive separate AHCCCS ID numbers and services for them must be billed separately using the newborn's ID. Services for a newborn that are included on the mother's claim will be denied.

3. Coverage for single individuals and couples is provided under the following eligibility  categories:

a. ALTCS
b. Breast and Cervical Cancer Treatment Program
c. Family Planning Services (FPS) provides family planning services for up to 24
months to SOBRA pregnant women after a 60-day post partum period.
d. SOBRA Pregnant Women
e. SSI Cash (Title XVI) or SSI MAO
f. Adults
g. Freedom to Work
h. Transplants
i. Medicare Cost Sharing
j. Hospital Presumptive Eligibility (HPE)

Various Medicare Savings Programs help members pay Medicare Part A & B premiums,deductibles, and coinsurance.
1. Qualified Medicare Beneficiary (QMB)
2. Qualified Individual 1 (QI-1)
3. Specified Low Income Medicare Beneficiary (SLMB)

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