519.02 Assisted Living Facilities

 

A. Introduction

 

An assisted living facility is a residential care institution that provides or contracts to provide supervisory care services, personal care services, or directed care services on a continuing basis. Both Developmentally Disabled (DD) and Elderly and Physically Disabled (EPD) customers can reside in assisted living facilities.

 

There are three types of assisted living facilities which qualify as ALTCS alternative residential living arrangements when the facility is licensed by the Arizona Department of Health Services (ADHS), or certified as an Adult Foster Care Home by the county, and registered with AHCCCS (has an AHCCCS ID number):

 

 

If the customer is living in an assisted living facility that is..

And is…

Then the customer may be eligible for…

Licensed with ADHS;

 

or

 

Certified by the county as a Adult Foster Care Home

Registered with AHCCCS

 

ALTCS Services

Not registered with AHCCCS

  • ALTCS acute care if the customer’s income is less than 100% of the FBR; or

  • The AHCCCS medical services under the AHCCCS FTW coverage group (MS 402)

 


 

B. Un-contracted facilities

 

The facility must be registered with AHCCCS, but does not need to be contracted with the customer’s program contractor to be considered a setting in which ALTCS Services may be approved.

 

If the facility does not have a contract and the customer is approved, it is the responsibility of the program contractor to either:

 

If a customer or representative contacts the Eligibility Specialist with questions about whether a specific facility has a contract with the program contractor, advise the customer or representative to contact the program contractor.

 


 

C. Proof

 

Take the following steps to determine if a customer resides in an Adult Foster Care Home, Assisted Living Home or Assisted Living Center where ALTCS Services can be approved.

 

Step

Action

1

Contact the facility to verify that the customer is living in an Adult Foster Care Home, Assisted Living Home or Assisted Living Center. Ask for the following information:

  • The facility AHCCCS registration number;

  • If the facility does not have an AHCCCS registration number, ask if the facility is licensed by the ADHS; and

  • If the facility is not licensed by ADHS, ask if the facility has been certified by the county as an Adult Foster Care Home.

2

Verify that the facility is registered with AHCCCS.

 

Log into the PMMIS Provider Sub-system, and enter the provider name or number, if known. If the provider number matches with the appropriate provider ID Type, it is an approvable HCBS alternative setting

 

 

Type of Facility

Provider Type

 

 

 

AHCCCS registered Adult Foster Care Home

50

 

 

 

Licensed and registered Assisted Living Homes

36

 

 

 

Licensed and registered Assisted Living Center

49

 

 

 

3

Determine the customer’s living arrangement based on information from the facility and the Provider Sub-system:

 

 

IF the customer resides in…

THEN…

 

 

 

A facility which is an AHCCCS registered Adult Foster Care Home, Assisted Living Home or Assisted Living Center

The customer is living in an ALTCS alternative residential facility in which ALTCS services may be approved.

 

 

 

A facility which is not registered with AHCCCS, but which is licensed by ADHS or is certified by the county as an Adult Foster Care Home

The customer is not living in a setting where ALTCS can be approved. Determine the customer’s eligibility for Limited ALTCS Services using 100% of the FBR.

 

 

 

A setting that is unregistered, unlicensed and uncertified

Consider the living arrangement to be the customer’s “home”. (MS 519.01).