A. Chapter Contents

The following topics are covered in this chapter:

Topic

1301.00    General Information for All Applicants

1301.01 Timeframes for Processing

1301.02 System Checks

1301.03 Duplicate Applications

1301.04 Voluntary Withdrawal of Applications

1302.00    Procedures for Certain Applicants

1302.01 Customers Between the Ages of 21 and 64 Who Enter an Institution for Mental Disease (IMD)

1302.02 Deceased Customers

1302.03 Homeless, Comatose, Amnesiacs, or Mentally Impaired Applicants

1302.04 Incapacitated Applicants

1302.05 Reapplication Within 3 Months of Discontinuance

1302.06 Reapplication While a Hearing is Pending

1303.00    SSI MAO Application Process Overview

1303.01 SSI MAO Specialty Groups

1303.02 SSI Non Cash

1303.03 Emergency Services for Certain Non-Citizens

1303.04 Applicants Who Require a DDSA Referral

1303.05 Referral of an Employed Customer Who Has a Disability to the AHCCCS Freedom To Work Unit

1303.06 Applications Referred from the Arizona Department of Corrections

1303.07 Applications Referred from the Arizona Department of Health Services (ADHS)

1303.08 Applicants Referred from a County Jail

1304.00    Medicare Cost Sharing Applications

1304.01 Conditional QMB Applications

1304.02 Qualified Disabled Working Individual (QDWI) Applications

1305.00    ALTCS Application Process Overview

1305.01 Which ALTCS Office Processes the ALTCS Application?

1305.02 Scheduling the Interview

1305.03 Preparing for the Interview

1305.04 Explaining the ALTCS Application Process

1305.05 Screening for Developmental Disabilities

1305.06 Required Forms

1305.07 Estimating the SOC

1305.08 Obtaining Medical Releases

1305.09 Signing the Application

1305.10 Requesting Additional Information

1305.11 Enrollment Choice in Maricopa County

1305.12 PAS Requests

1305.13 Applicants Who Are Not Eligible for ALTCS in One or More Months in the Application Period, but Who May be Eligible for AHCCCS Medical Services

1306.00    AHCCCS Freedom to Work (FTW) Applications

1306.01 Initiating an AHCCCS FTW Application

1306.02 AHCCCS FTW System Checks and Screening

1306.03 AHCCCS FTW Application Process Overview

1307.00    Breast & Cervical Cancer Treatment Program (BCCTP) Overview

1307.01 Role of AZ-NBCCEDP in the BCCTP Application Process

1307.02 AHCCCS' Role in the BCCTP Application Process

1307.03 BCCTP Eligibility Periods

1307.04 BCCTP Screening for Other Medicaid Eligibility

1307.05 Processing BCCTP Applications

1308.00    SSDI - Temporary Medical Coverge (TMC) Program Applications

1308.01 Initiating the SSDI - TMC Application

1308.02 Systems Checks and Screening

1308.03 Processing SSDI - TMC Applications

1309.00    Approval of Applications

1310.00    Denial of Applications

B. Introduction

This chapter contains information for processing applications for the following AHCCCS programs:

• SSI MAO;

• Medicare Cost Sharing;

• ALTCS;

• AHCCCS Freedom to Work; and

• The Breast & Cervical Cancer Treatment Program

A. Information

Make information about the application process available to all customers or their representatives.

B. Valid Applications

A signed application on a form accepted by AHCCCS is an eligibility requirement and must be obtained before approval of any AHCCCS program. MS 533.00 explains the requirements for a valid application, including who can file an application and the signature requirements.

C. Starting an Application

The application process may be started by the customer or someone acting on the customer's behalf (MS 533.00.D) in a variety of ways, depending on the office/unit to which the customer is applying:

If an application is made to. . .

For. . .

Then the application may be initiated by. . .

The SSI MAO Office

• AHCCCS Medical Services

• Medicare Cost Sharing

The customer or representative by:

• Mail;

• Fax; or

• Walk-in

An ALTCS Office

• ALTCS

• AHCCCS Medical Services

• Medicare Cost Sharing

The customer or representative by:

• Mail;

• Fax;

• Telephone;

• Walk-in; or

• Home visit.

The BCCTP Unit

AHCCCS Medical Services

One of the AZ-NBCCEPD programs by:

• Mail

• Fax

The AHCCCS Freedom to Work Unit

• AHCCCS Medical Services

• ALTCS

• Medicare Cost Sharing

The customer or representative by

• Mail;

• Fax;

• Walk-in; or

• May start as an application to the SSI MAO office or an ALTCS office and be referred to AHCCCS FTW.

D. Customer Assistance

Allow customers to have other individuals of their choice accompany, assist, and represent them in the application process.

When possible, help the customer or representative obtain the information needed for the eligibility determination.

E. Cooperation

Customers or their representatives must cooperate in the eligibility determination process. This includes providing information, reporting changes, and taking any action required to meet the conditions of eligibility for the AHCCCS Health Insurance program for which the customer is applying. 

Cooperation requirements are explained in MS 510.00.

F. Eligibility Documentation

Records for the customer must be established and must contain sufficient information to justify the eligibility (or ineligibility) decision. These records may include:

• A case record containing paper documents;

• ACE record; and

• Imaged documentation in Fortis.

G. Decision Notices

All customers must receive a notice of approval or denial (MS 1604.00).

H. Offering Customers Opportunity to Register to Vote

The National Voter Registration Act (NVRA) of 1993 and Arizona Revised Statute require that pubic assistance offices to provide applicants and recipients with an opportunity to register to vote at the time of application.

The NVRA requirements are specified both in Federal and State law. The legal basis are:

• The United States Code - 42 USC 1973gg.
• The Arizona Revised Statutes - ARS 16-140.

The ALTCS and SSI-MAO local offices are considered public assistance offices and must comply with NVRA.

Follow the instructions in Offering Customers the Opportunity to Register to Vote.

A. Timeframes

Processing timeframes vary according to the program:

If the customer is applying for:

And the customer. . .

Then the processing timeframe is. . .

BCCTP

Is referred by one of the AZ-NBCCEDP programs

7 days

• ALTCS

• Medicare Cost Sharing Programs

45 days

• SSI-MAO

• AHCCCS FTW

• Is age 65 or older;

• Has been determined blind according to MS 505.00; or

• Has been determined disabled according to MS 511.00

45 days

• Claims to be disabled or blind; and

• Requires a referral to DDSA (MS 1303.04) to establish disability, including disability based on blindness

90 days

B. Application Date

Determine the application date as follows:

If the application is for:

And the application is received

Then the application date is:

The Breast and Cervical Cancer Treatment Program (BCCTP)

From one of the Arizona programs of the National Breast and Cervical Cancer Early Detection Program (AZ-NBCCEDP) for the BCCTP

The date that the diagnostic procedure was performed that confirmed a diagnosis of breast cancer, cervical cancer or a pre-cancerous cervical lesion. The referring AZ-NBCCEDP worker provides the date of diagnosis on the BCCTP Referral (BC-100)

• ALTCS

• AHCCCS FTW

• Medicare Cost Sharing

• SSI MAO

By mail

The date the application is received by:

• Any AHCCCS or ALTCS office;

• A Financial or Medical Eligibility Specialist in the field;

• Any outreach site designated by AHCCCS to accept applications: DOC (MS 1303.06), ADHS (MS 1303.07) and CRS (MS 1305.00.C).

By fax

The date the faxed application is received by any of the offices listed above, regardless of whether the application is received after-hours, on a weekend, or a holiday. 

The local office must obtain a signed copy of the application. Either the signed original or a signed faxed copy is acceptable. It is not necessary to obtain the original copy of an application received by fax.

• If an ALTCS local office receives an old Part I application by fax, use the Part I to start the application process, but do not approve eligibility until you receive a signed original or signed fax copy of the ACE generated application.

By walk-in

The date the individual delivers an application to AHCCCS or goes to an ALTCS office and asks to apply. 

For ALTCS:

• Register an application in ACE as soon as you have obtained sufficient information from the individual who came into the office to determine that the customer wants to apply for ALTCS; and

• Offer the individual the option of completing the financial interview while he or she is in the ALTCS office if staff is available. Otherwise schedule an interview appointment (MS 1305.02)

• ALTCS

• MCS

By phone

(ALTCS offices only)

The date of the phone inquiry. 

A request for an application may be received during a telephone inquiry to an ALTCS office. Register an application in ACE as soon as you have obtained sufficient information from the caller to determine that the customer wants to apply.

• Register the application in ACE during the phone inquiry, and

• Offer the caller the option of completing the financial interview during the initial phone contact if staff is available. Otherwise, schedule an interview appointment (MS 1305.02).

ALTCS

During a home visit

The date of the home visit. Register the application in ACE and enter the customer's data when you return to the office. 

This situation may occur when an Eligibility Specialist determines during a home visit that the customer's spouse or another household member is in need of ALTCS. The Eligibility Specialist may complete the application interview for the other individual during the home visit. 

C. Processing Period

The processing period begins the day after the application date and ends on the date that the decision notice is mailed. For the application to be timely, the notice must be mailed within the processing time frame. 

The mailing date is the first business day after the ACE disposition. Notices are printed after close of business on the date of disposition and mailed from Central Office the following work day. 

When the processing period ends on a weekend or holiday, the notices must be mailed prior to the weekend or holiday. Follow the schedule for mailing notices located in the DMS Technical Service Center Public Folder.

D. Requests for Additional Information

Make all requests for information, documentation or actions to be taken by the customer or the customer's representative in writing. Give the customer at least 10 days to provide the requested documentation. The due date may be extended if the customer asks for more time to comply with the request.

If the customer is applying for:

Then Use:

ALTCS

SSI MAO

Medicare Cost Sharing

A Request for Information produced through ACE

AHCCCS Freedom to Work

Request for Information (DE-503)

BCCTP

• Request for Information (BC-503)

• Request for Additional Information (BC-513)

E. Processing Extensions

Under the following circumstances the application processing period may be extended beyond the processing time frame:

• When the customer is not financially eligible for the application month and the following month, but there is a reasonable expectation that the customer might meet financial eligibility requirements during the third month, you may hold the application past the 45-days to obtain verification.

• When the applicant appears to be eligible but documentation from a third-party is needed to make the eligibility determination and the third party has not responded. The customer and Eligibility Specialist must continue to take all appropriate steps to secure the information. 

• When the local office is waiting for a Policy Clarification Request (PCR) response from Central Office (e.g., policy issue; trust review; transfer rebuttal) that will affect the eligibility decision;

• When a DDSA decision is pending, or

• For BCCTP, when required documents are not submitted to AHCCCS with the BCCTP application or AHCCCS has evidence that BCCTP eligibility requirements may not be accurately stated on the application.

Failure to process an application within the appropriate timeframe is not a valid reason for denial of the application. Give the customer the opportunity to provide necessary information or documentation and help the customer obtain the required verification.

A. Policy

As early in the application process as possible:

• Investigate the customer's current or previous benefit history with AHCCCS and other agencies; and

• Complete the required systems checks and document the results.

B. Required System Checks

The following systems checks are required:

If the customer is applying for. . .

Then check. . .

• ALTCS

• AHCCCS Freedom to Work for ALTCS services

• ACE

• PMMIS

• ASSIST

• AZTECS

• GUIDE

• WTPY

• SSI MAO

• AHCCCS FTW for AHCCCS Medical Services

• BCCTP

• Medicare Cost Sharing

• ACE

• PMMIS

• AZTECS

• GUIDE

• WTPY

NOTE: Appendix XVII of the ALTCS ACE Procedure Manual provides specific information about system checks. 

Chapter 17 of the ALTCS ACE Procedures Manual and Chapter 19 of the Interim SSI MAO ACE Procedures Manual provides instructions on how to request WTPYs and interpret responses.

C. ACE

AHCCCS Customer Eligibility (ACE) is an AHCCCS database that maintains data and processes eligibility for the following AHCCCS programs:

• SSI MAO, including the SSI MAO specialty groups and federal emergency services;

• Medicare Cost Sharing programs; and

• ALTCS. 

Do not register BCCTP and AHCCCS FTW applications in ACE. The Breast and Cervical Cancer treatment Program (BCCTP) and AHCCCS Freedom to Work (FTW) each have their own databases to maintain eligibility information. 

Before registering an application in ACE, check ACE to determine if the customer is already known to ACE and has been assigned a personal ID. Follow the instructions in Chapter 19 of the ALTCS ACE Procedure Manual or Chapter 12 of the Interim SSI MAO ACE Procedures Manual to determine if an individual is known to ACE and to register an application.

D. ACE/ PMMIS Interface

New eligibility and changes dispositioned in ACE are transmitted to PMMIS every night.

E. PMMIS

The Prepaid Medical Management Information System (PMMIS) maintains eligibility history and related data for the following AHCCCS programs:

• AHCCCS Care;

• AHCCCS Freedom to Work;

• Arizona Long Term Care System (ALTCS);

• Breast & Cervical Cancer Treatment Program (BCCTP);

• Deemed Newborns;

• Families with Children (1931);

• Health Insurance for Parents;

• KidsCare;

• Medical Expense Deduction (MED);

• Pregnant Women;

• Qualified Medicare Beneficiary (QMB Only);

• Six-month Guarantee;

• S.O.B.R.A. Child;

• SSI Cash;

• SSI Medical Assistance Only (SSI MAO);Title IV-E Foster Care and Adoption Subsidy; and

• Young Adults Transitional Insurance (YATI).

PMMIS is updated daily with eligibility and changes from:

• ACE;

• AZTECS; and

• The Social Security Administration (regarding SSI Cash eligible individuals).

The Breast and Cervical Cancer treatment Program (BCCTP) and AHCCCS Freedom to Work (FTW) each have their own databases to maintain eligibility information. These databases do not interface with PMMIS. However, eligibility for these programs is posted manually to PMMIS by AHCCCS staff in the Member File Integrity System. 

Use PMMIS to determine the customer's current or past AHCCCS eligibility. If the customer is currently eligible for an AHCCCS program, follow the instructions in How to Process Cases Showing Open Eligibility in PMMIS. 

The Medicare buy-in status for customers who qualify for Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualified Individual-1 (QI-1) is also available in PMMIS. Follow the instructions in How to Research a Customer's Buy-In Status.

F. DES Systems

The Department of Economic Security (DES) has three automated systems that provide information relevant to AHCCCS eligibility:

• AZTECS;

• Guide; and

• ASSIST.

G. AZTECS

Arizona's Technical Eligibility Computer System (AZTECS) is the DES eligibility determination system that supports Arizona's Temporary Assistance to Needy Families (TANF), Arizona's Food Stamp program, and AHCCCS eligibility determined by DES. 

AZTECS interfaces with PMMIS daily to transmit eligibility and changes in AHCCCS eligibility for the following AHCCCS programs:

• AHCCCS Care

• Deemed Newborn;

• Families with Children (1931);

• Medical Expense Deduction (MED);

• Pregnant Women and

• SOBRA Child.

Use AZTECS as an investigative tool to obtain information about the customer's household composition, income and resources that were reported to DES.

H. GUIDE

The General Unemployment Insurance Development Effort (GUIDE) is a DES computer software system that automates the processing of unemployment insurance claims and benefits payments. Each office has direct on-line access to GUIDE. 

Use GUIDE to:

• Verify receipt of unemployment insurance (income verification - MS 607.87);

• Establish potential eligibility for unemployment insurance (UI) compensation for a referral for potential benefits (MS 524.00); and

• Obtain information about recent employment (employer and date last worked).

GUIDE contains data that individual employers report to Unemployment Insurance (UI) and reflects wages earned in a prior quarter. Therefore, GUIDE cannot be used to verify current wage and employer information and (UI) is not the originator of the data. If wage or employer information does not seem to be consistent with information reported by the customer, the Eligibility Specialist must contact the employer to verify the data. 

CAUTION: Because of a privacy agreement, AHCCCS cannot reveal to the customer that GUIDE/UI was the source of any employment information or any of the details obtained from UI, including employer name, dates or amounts reported.

I. ASSIST

The Arizona Social Services Information and Statistical Tracking System (ASSIST) is a database management system to provide support for the delivery and purchase of social services and placements on an individual basis for clients throughout the State of Arizona.

Use ASSIST to determine an ALTCS applicant's status with the DES Division of Developmental Disabilities.

J. WTPY

The Wire Third-Party Query (WTPY) process is an interface with the Social Security Administration's database in Baltimore. 

Use the WTPY to verify the customer or responsible relative's:

• Social Security number, if the person is receiving Title II or Title XVI;

• Income from Social Security Title II or SSI Cash (Title XVI);

• Medicare eligibility, and

• SSI Cash status (MS 532.00)

A WTPY may also verify:

• Age according to MS 502.00;

• Blind according to MS 505.00 and

• Disabled according to MS 511.00.

Follow the instructions in Chapter 17 of the ALTCS ACE Procedures Manual or Chapter 19 of the Interim SSI MAO ACE Procedures Manual to request WTPYs and interpret the responses.

A. Definition

A duplicate application potentially exists when a new application is received for an individual who is already an AHCCCS customer, or already has a pending application.

B. Avoiding Duplicate Person IDs

Avoid assigning more than one ACE Person ID number to the same person by following the instructions in:

• Chapter 19 of the ALTCS ACE Procedures Manual; or

• The Find Person section of the Interim SSI MAO ACE Procedures Manual.

C. Evaluating a Duplicate Application

Compare the new application with the pending application or active case to determine the following:

• Who initiated the new application and that person's authority to act on behalf of the customer;

• Whether or not the customer is requesting additional benefits; and

• Any inconsistencies in information between the two applications.

Step

Action

1

Determine if the person who initiated the new application has higher authority than the customer or the current representative (MS 533.00.D). Obtain proof of the individual's authority to represent the customer (court documents, POA, Authorized Representative form).

If the person who initiated the duplicate application. . .

Then. . .

Has higher authority

• Update the name, role, relationship and address of the representative in ACE so that all future contacts and correspondence will be with the proper representative.

• Review eligibility criteria with the new representative and gather any additional proof available to assure that the eligibility determination is accurate.

Has lower authority

• Contact the person who initiated the duplicate application and explain that someone else (with higher authority) is already representing the customer.

• Explain the situation and action taken in ACE Comments.

2

Determine if additional services are requested on the new application.

If the new application is requesting. . .

Then. . .

Services the customer is currently receiving or is applying for on the pending application

• Do not register the application in ACE; and

• Explain the situation and action taken in ACE Comments.

Additional services

• Register the application in ACE; and

• Work with the person with the highest authority to complete the application process.

D. Examples

Example 1: The customer submits an application for Medicare Cost Sharing. Before a decision can be made on the Medicare Cost sharing application, the customer enters a nursing home and authorizes her son to apply for ALTCS on her behalf. He submits a new application to AHCCCS. The ACE system check indicates a pending application for Medicare Cost Sharing. The Eligibility Specialist registers the ALTCS application in ACE and adds the son to ACE as the Authorized Representative. The Eligibility Specialist works with the authorized representative to determine the customer's eligibility for both ALTCS and Medicare Cost Sharing programs. 

Example 2: When the customer entered a nursing home, the customer's friend called the ALTCS office and initiated an ALTCS application. A week later the customer's daughter and court appointed guardian comes to Arizona from Indiana and goes to the ALTCS office to initiate an application. After verifying the daughter's status as the legal guardian the Eligibility Specialist enters the daughter in ACE as the legal representative and works with her to complete the application initiated by the customer's friend. The Eligibility Specialist calls the customer's friend to explain that the customer's legal guardian has assumed responsibility for the application.

Example 3: The customer receives AHCCCS Medical Services and QMB. His daughter applied for these benefits for him as his authorized representative and has been completing the annual renewals on his behalf for several years. During a recent visit to the local senior center the customer picked up information about Medicare Cost Sharing Programs and an Application for AHCCCS Health Insurance. Not remembering that he had AHCCCS coverage, the customer completed the application and sent it to the SSI MAO office. The SSI MAO staff completed the ACE system check, discovered that the customer had an active record, called the customer and explained the situation and documented the action in ACE Comments.

A. Who Can Withdraw an Application

Accept a request for withdrawal of the application from the:

• Customer; or

• Customer's representative. 

EXCEPTION: If a legal representative initiated the application, then only the legal representative (or his authorized representative) may request a withdrawal of the application.

B. How Can Withdrawal Be Requested?

An application may be voluntarily withdrawn:

• In writing; or

• Verbally

C. Written Requests

Accept a written, signed request for withdrawal in either of the following formats:

• Voluntary Withdrawal of Application (DE‑130); or

• A signed, written request to withdraw the application.

D. Verbal Requests

When a customer or representative verbally withdraws an application, deny the application based solely on the verbal request and send a notice to deny the application based on the following constraints:

If the customer or representative recants the voluntary withdrawal request. . .

Then. . .

Within 35 days of the date of the denial notice

Reopen the application control date and continue to process the application.

More than 35 days after the date of the denial notice

A new application is required.

E. Notices