Eligibility Policy Manual

Transmittal #11

Subject: Chapter 1300 - Applications

Implementation Date: April 1, 2005

The Application Chapter is now available in the Eligibility Policy Manual. This chapter provides information about processing applications for ALTCS, SSI MAO including the SSI MAO specialty groups, AHCCCS Freedom to Work, and the Breast and Cervical Cancer Treatment Program.

We added the following new processes to Chapter 2000 to complement the Application Chapter:

We also updated the following processes in Chapter 2000. The changes are very minor, and include correcting small errors and adding links to the Application Chapter:

We also updated information in the following manual sections:

MS 502.00 - Age: We added clarification that the WTPY may be used to verify the customer's age only when the customer is receiving Title II or Title XVI benefits.

MS 511.00- Disabled: We added a note to subsection F clarifying that a DDSA referral is required for a customer who receives Medicare solely due to a diagnosis of End Stage Renal Disease (ESRD).

MS 517.00 - Insurance Coverage (No Creditable Coverage): Added to Subsection A exceptions to the requirement of no creditable Coverage for the Breast and Cervical Cancer Treatment Program and how to verify the exceptions.

MS 520.00 - Medicaid (Ineligible For): Wording changes in Subsection A, include clarification that AHCCCS Freedom to Work may be approved if the customer is currently eligible for Health Insurance for Parents or for one of the Medicaid coverage groups listed in MS 1306.02.A that only permits temporary eligibility.

MS 529.00 - Resident of Arizona: Under Subsection A, added a note explaining that an individual may apply for ALTCS before becoming an Arizona resident, but must establish Arizona residency before ALTCS can be approved and links to procedures in How to Process an ALTCS Application for a Customer Who Lives Out-of-State.

MS 533.00 - Valid Application:

• We have completely revised Subsection C to include definitions of valid application, legal representative, Guardian, conservator, executor, public fiduciary, authorized representative, responsible party and parent
• Subsection D now specifies the hierarchy of individuals who may apply for the customer.
• We added a paragraph to Subsection E to clarify that an unsigned application containing the customer's name and address is sufficient to start the application process, but the customer or the customer's representative must sign the application before eligibility can be approved.

MS 607.78 - Supplemental Security Income (SSI): We added instructions for entering SSI Cash income in ACE when the customer has established Arizona residency, but is still receiving SSI Cash from another state. The income must be entered as Social Security instead of SSI Cash to avoid a mismatch with PMMIS. After the Social Security Administration processes the customer's address change to Arizona, the income type should be corrected to SSI Cash in ACE.

MS 804.04 - Process for Establishing a Special Treatment Trust: We added a requirement to give the customer the new brochure How to Create and Maintain an Income Only Trust (DE-834) if the customer has created or needs to create an Income Only Special Treatment Trust.

MS 1101.03 - Guaranteed Enrollment Periods: Added Subsection E to clarify that the six-month guarantee applies to a customer who is approved for AHCCCS Medical Services under the Basic Coverage Group of AHCCCS Freedom to Work unless the customer fails to pay the FTW premiums, moves out-of-state, dies, voluntarily withdraw from the AHCCCS program, is an inmate of a public institution, was factually ineligible when initially enrolled with the health plan, or is adopted. However, the six-month guarantee does not apply to a customer who receives ALTCS services under AHCCCS Freedom to Work.

MS1201.00 - Share of Cost (SOC):

• Clarified that an AHCCCS Freedom to Work customer who is eligible for ALTCS services and lives in an HBCS living arrangement has a zero SOC as well as an Alternate SOC of zero; and
• Added information about the SOC policy for a customer in an IMD.

MS 1305.02.G - Rescheduling (ALTCS) Interview Appointments:
We have changed policy to require that when customer or representative fails to keep an ALTCS interview appointment and does not contact the ALTCS Local Office by close of business on the day of the appointment, the ALTCS office staff must make additional attempts to contact the customer or representative by phone during the next few days. Deny the application only when these attempts to contact the customer are unsuccessful.