Nursing Facility Information

AHCCCS covers medically necessary nursing facility services for members in both the acute and long term care programs. For AHCCCS members in the Acute Care program, services in nursing facilities, including room and board, are available for members who require short-term convalescent care up to a maximum of 90 days per contract year. For AHCCCS members in the Arizona Long Term Care System (ALTCS) program, services in nursing facilities, including room and board, are available to members who require these services on a continuous basis but who do not require hospital care or direct daily care from a physician. A nursing facility must be licensed and Medicare/Medicaid certified by ADHS in accordance with federal regulations in 42 CFR Part 483.

A.R.S. § 36-2999.51 et seq. authorize the Administration to administer a provider assessment on health care items and services provided by nursing facilities and to make supplemental payments to nursing facilities for covered Medicaid expenditures. More information can be found at the link below:

Nursing Facility Tax Assessment

The spreadsheet located at the link below provides statistics regarding AHCCCS nursing facility days, by facility by payor, for dates of service from October 1, 2010 through September 30, 2011. Payor information is included for the ALTCS Elderly and Physically Disabled (EPD) Contractors and the AHCCCS Fee-For-Service (FFS) program.

AHCCCS Nursing Facility Days by Payor [23KB, Excel]

Nursing facility assessment funds are matched with Federal Medicaid dollars; the majority of the funds are paid to ALTCS EPD Contractors so that they can make enhanced payments to nursing facilities in accordance with Federal and State laws and regulations and CMS approval. The remaining portion of the funds are used by AHCCCS to make Fee-For-Service supplemental payments to nursing facilities according to those same requirements. The spreadsheet found at the link below details the amount of the funds paid to ALTCS EPD Contractors and the AHCCCS FFS program.

Nursing Facility Enhanced Payment Revenue [11KB, Excel] 

Provider supplemental payments related to Fee-For-Service utilization are made directly to nursing facility providers from the Administration. The spreadsheet in the following link shows the supplemental payments that come directly from AHCCCS to the providers. The first quarterly payments for FFY 2013 will be paid on March 29, 2013.

Nursing Facility Supplemental Payments for FFS Utilization [18KB, Excel]