A. Chapter Contents

The following topics are covered in this chapter:

1501.00

General Information About Changes

1502.00

Customer's Responsibility to Report Changes

1503.00

Changes Reported or Requested by an Program Contractor

1504.00

Types of Changes

1504.01

Acute Care Health Plan Changes

1504.02

Address Change for the Customer

1504.03

Address Change for the Customer's Spouse

1504.04

Address Change for the Parent(s) of a Customer Who is a Minor Child

1504.05

Address Change for the Customer's Representative

1504.06

Age 19

1504.07

Age 22 for IMD Inpatient Services

1504.08

Age 22 for Working Students

1504.09

Age 65

1504.10

ALTCS Customer Refusing Services

1504.11

Cancer Treatment Ends

1504.12

Citizenship or Non-Citizen Status Change

1504.13

CSMIA Amount Made Available to a Community Spouse

1504.14

Death of Customer

1504.15

Death of Customer's Spouse

1504.16

Death of Customer's Parent or Other Household Member

1504.17

DDD Status Change

1504.18

DDSA Redetermination of Disability of Blindness

1504.19

Demographic Information Corrections

1504.20

Divorce

1504.21

Expenses

1504.22

Federal and State Government Mandated Changes

1504.23

HCBS Provider Not Available

1504.24

Household Composition Change

1504.25

IMD Admission/Discharge

1504.26

Income Amount Changes

1504.27

Long Term Care Living Arrangement

1504.28

Marriage

1504.29

Medical Improvement

1504.30

Medical Insurance Coverage/Premiums

1504.31

Medicare Eligibility Begins

1504.32

Out of Service Area (Within Arizona)

1504.33

Out of State Move - Permanent

1504.34

Out of State Move - Temporary

1504.35

Penal Institution Admission

1504.36

Resource Changes

1504.37

Returned Mail

1504.38

School Attendance Change

1504.39

Separation

1504.40

Share of Cost Adjustments

1504.41

Share of Cost Related Expenses

1504.42

Social Security Number Receipt

1504.43

SSI Cash Eligibility Begins or Ends

1504.44

Work Related Expenses

1505.00

Discontinuance

1506.00

Voluntary Discontinuance Requests

B. Introduction

This chapter explains how to process changes that occur after the initial approval of AHCCCS eligibility.  It provides information about identifying and processing changes related to AHCCCS eligibility for:

•SSI MAO;

•ALTCS;

•Medicare Cost Sharing;

•AHCCCS Freedom to Work;

•The Breast and Cervical Cancer Treatment Program; and

•SSDI-Temporary Medical Coverage Program

NOTE: Enrollment change policy is in Chapter 1100.

A. How do Changes Affect the Customer

Changes in the customer's circumstances could affect:

•The customer's ability to receive correspondence from AHCCCS or from the customer's AHCCCS health plan or program contractor;

•The customer's eligibility for AHCCCS Health Insurance programs;

•The amount the customer is required to pay, or

•The customer's enrollment with an AHCCCS health plan or program contractor.

Most changes affect the customer's eligibility or share of cost/premium for a prospective month.

B. How Does AHCCCS Receive Information About Changes

Anyone who has knowledge of a change in the customer's circumstances may report changes, including:

•The customer;

•The customer's representative;

•The customer's spouse

•Relatives, friends or neighbors;

•AHCCCS health plans;

•AHCCCS program contractors;

•Medical facilities;

•HCBS facilities;

•Attorneys; and

•Trustees.

C. Customer's Responsibility

Customers or their representatives are required to report any events that may affect eligibility, continued eligibility or the amount the customer must pay, within 10 days of the change. (MS 1502.00)

D. Verifying Changes

Information reported by someone other than the customer or the customer's spouse or representative must be verified before any action can be taken.  Confirmation of the change by the customer or the customer's representative is required even if the reported change would not routinely require verification.

Verification requirements for specific types of changes are explained in MS 1504.00.

A. What is the Customer Required to Report?

Customers or their representatives are required to report any events that may affect eligibility, continued eligibility or the amount the customer must pay.

The changes a customer is required to report vary among programs:

Address change of the customer, including a temporary or permanent move out of state

X

X

X

X

X

X

The customer or spouse's admission to or discharge from a medical facility, private institution or public institution

X

X

X

X

X

X

Changes in household composition

X

X

X

X

X

X

Death of the customer or other household member

X

X

X

X

X

X

Marriage, separation or divorce of the customer

X

X

X

X

X

X

Changes in school attendance of dependent children age 18-22 (including the customer)

X

X

X

X

X

Increase or decrease in the income of the customer, the customer's spouse or dependents or a determination of eligibility for additional benefits.

X

X

X

X

X

X

Obtaining or terminating the customer's First or Third Party insurance

X

QMB

ONLY

X

X

X

X

Changes in the customer's medical insurance premiums, non-covered and remedial medical expenses, and shelter expenses

X

Changes in the customer's work related expenses

X

X

X

A change in the amount of the CSMIA made available to the community spouse

X

Changes in the income paid to a trust or disbursements made from a trust

X

X

X

A change in the resources of the customer of the customer's spouse (including the receipt, transfer, sale or gifting of any real or personal property).

X

Medical improvement of the customer

X

X

A change in the citizenship or non-citizen status of the customer

X

X

X

X

X

X

Receipt of a Social Security number for the customer

X

X

X

X

X

X

Any other changes that may affect the customer's eligibility

X

X

X

X

X

X

Any other changes that may affect the customer's premium or share of cost

X

X

X

B. When Should Changes Be Reported?

Changes must be reported in advance, as soon as the future event becomes known.  Unanticipated changes must be reported within 10 days of the date the change occurred.

EXCEPTION: Special reporting requirements apply to trustees of Special Treatment Trusts. Trustee reporting requirements are described in MS 804.09.

C. How Can Changes Be Reported?

Changes can be reported in person, by phone or in writing.

D. How is the Customer Informed?

AHCCCS informs customers about their responsibility to report changes in a variety of ways:

Applies using an Application for AHCCCS Health Insurance (AH-001)

On Page D of the AH-001.

Applies using an Application for AHCCCS Medical Services and Medicare Cost Sharing (DE-103)

On page C of the DE-103.

Applies for ALTCS

•Verbally by the Eligibility Specialist during the interview;

•On the Rights and Responsibilities of Customers (DE-113);

•On the Change Report Form (DE-146); or

•On a Reporting Changes card (DE-146A).

Is approved for AHCCCS Health Insurance

On each written notice of approval or change.

E. Using the Change Report Form (ALTCS Only)

A Change Report Form (DE-146) or Reporting Changes (DE-146A) card is provided to an ALTCS customer at the following times:

•During the application process;

•At each renewal; and

•Upon receipt of a completed DE-146 or DE-146A.

A. Overview

ALTCS program contractors may report or request changes for customers who are receiving ALTCS services under the ALTCS or AHCCCS Freedom to Work programs.

B. Forms Used

The ALTCS program contractor uses the following methods to notify AHCCCS staff of changes:

ALTCS Program Contractor Change Request (DE-621)

The DE-621 is used to notify the AHCCCS Administration when two program contractors have agreed to a change in enrollment for the customer in accordance with MS 1105.02.

Electronic Member Change Report (MCR)

•The ALTCS program contractor enters the changes or requests online via the Internet and submits the change request electronically to a designated ALTCS office, DHCM, or the Medical QC Unit, and;

•AHCCCS replies electronically to the ALTCS program contractor about the outcome of the reported change or request.

C. MCR Changes Processed by ALTCS Local Offices

The program contractor uses the Electronic Member Change Report (MCR) to report the following changes to the ALTCS local office:

•Demographic changes or corrections in the customer's name, address, SSN, sex or date of birth;

•Death of the customer;

•Address, placement or living arrangement changes;

•Medicare or Third Party insurance changes;

•Income and resource changes;

•Voluntary withdrawals related to refusal of HCBS services;

•Voluntary withdrawals for any other reason;

•The customer's temporary absence from Arizona;

•The customer's return to Arizona following a temporary absence; and

•Tribal transfers to another program contractor.

The program contractor uses the Electronic Member Change Report to request the following changes:

•An enrollment change within Maricopa County when the customer claims that one of the situations specified in MS 1106.00 exists,

•PAS Reassessment requests.

D. MCR Changes Processed by DHCM

Most acute to LTC and LTC to acute contract type changes are processed through the Division of Health Care Management (DHCM).  The DHCM contacts the Technical Service Center (TSC) to initiate on-line contract type changes.

E. Verification

Changes reported by the ALTCS program contractor must be verified before any action can be taken.  Follow the verification instructions for the specific change(s) in MS 1504.00.

F. Processing Time Frame

When a change action is appropriate, disposition the change(s) in ACE or complete an automated referral as soon as possible, but no later than five (5) working days after receipt of the Electronic Member Change Report. Document the change reported and the action taken in ACE Comments.

G. Returning the MCR to the Program Contractor

The AHCCCS staff responsible for processing the reported change, either the ALTCS local office, the DHCM, the TSC or the Medical QC Unit, is also responsible for completing the response section of the Electronic Member Change Report and returning it to the program contractor to report the action that was taken.

H. Attachments

The Program Contractor may attach documents to the Electronic Member Change Report to support the change or request. The attachments can be sent electronically with the Electronic Member Change Report or can be sent by mail or fax.

The AHCCCS staff responsible for completing the response section of the Electronic Member Change Report and returning the Electronic Member Change Report to the program contractor is responsible for the following:

NOTE: Do not print or scan the Electronic Member Change Report.

A Introduction

MS 1504.00 provides an alphabetical listing of types of changes.  The following information is provided for each type of change:

•Description: A description of the change and how the change may affect the customer;

•Programs: The AHCCCS programs that may be affected by the change;

•Proof:  The type(s) of verification that may be used to verify the change; and

•General Processing:  A brief description of how to process the change

Additional information is included for some types of changes.

A. Description

The Eligibility Specialist may change a customer's acute care health plan enrollment ONLY if the customer was enrolled in the wrong health plan due to an Eligibility Specialist's error.

MS 1101.04 contains additional information about health plan enrollment changes.

B. Programs

This change affects the following programs:

•BCCTP

•SSI MAO

•AHCCCS FTW receiving AHCCCS Medical Services

•SSDI-Temporary Medical Coverage

C. Proof

Verify that the Eligibility Specialist erroneously enrolled the customer in a different health plan than the one the customer selected.

REMEMBER: If the customer was enrolled with an AHCCCS health plan within the 90 days prior to the current approval date and that health plan serves the customer's current residence, the customer is automatically re-enrolled with the same health plan by the Prepaid Medical Management Information System (PMMIS).

D. General Processing

Call the Technical Services Center (TSC) to report the correct information.

Direct all other requests by the customer for health plan changes to the Communication Center.

•Direct phone requests to (602) 417-7100 or 1-800-962-6690; or

•Send written requests to Mail Drop 3400.

A. Description

An address change refers to a change in a mailing address or physical address of the customer.

If the address change includes one of the Other Considerations in Subsection E, the other factor(s) must be fully verified and processed along with the address change.

Address change policy for other individuals is in the following subsections:

Customer's spouse

MS 1504.03

Parent(s) of a customer who is a minor child

MS 1504.04

Customer's representative

MS 1504.05

B. Programs

Address changes affect the following programs:

•SSI MAO

•Medicare Cost Sharing

•ALTCS

•AHCCCS FTW

•BCCTP

•SSDI-Temporary Medical Coverage

C. Proof

The proof required to process an address change depends on who provides the information:

•The customer; or

•The customer's representative