Arizona Long Term Care (ALTCS) Tribal Case Management
Long Term Care provided for American Indians residing on tribal reservations is known as the Arizona Long Term Care System (ALTCS) Tribal Case Management Program.
Overview of the ALTCS Tribal Case Management Program
The Arizona Long Term Care System (ALTCS) Tribal Case Management Program provides acute care (general medical care services), behavioral health, long term care, and case management services. These services are offered to American Indian ALTCS members at risk of institutionalization (i.e. those who are elderly and/or have physical disabilities) who reside on a tribal reservation.
ALTCS Tribal Contractors
Seven tribes have an Intergovernmental Agreement (IGA) with AHCCCS to provide case management services to their respective tribal members enrolled in ALTCS. The seven tribes and urban Indian health program commonly referred to as "tribal contractors" provide case management services for their enrolled ALTCS members. These tribal contractors are listed in the following table.
|Long Term Care Tribal Contractors||Website||Phone Number|
|Gila River Indian Community||www.gilariver.org||602-528-1200|
|Navajo Nation/Fort Defiance||928-871-7988|
|Navajo Nation/Tuba City||928-283-3250|
|Pascua Yaqui Tribe||www.pascuayaqui-nsn.gov||520-879-6020|
|San Carlos Apache Tribe||928-475-2138|
|Tohono O'Odham Nation||www.tonation-nsn.gov||520-383-6075|
|White Mountain Apache Tribe||www.wmat.nsn.us||928-338-1242|
American Indian ALTCS members residing on reservations other than the seven tribes receive case management services through the Native Health (phone: 602-279-5262).
The tribes served by the Native American Community Health Center include:
- Ak-Chin Indian Community
- Cocopah Tribe
- Colorado River Indian Tribes
- Fort McDowell Yavapai Nation
- Fort Mohave Indian Tribe
- Havasupai Tribe
- Hualapai Tribe
- Kaibab-Paiute Tribe
- Quechan Tribe
- Salt River Pima-Maricopa Indian Community
- Tonto Apache Tribe
- Yavapai Apache Nation
- Yavapai Prescott Tribe
Additional Information About ALTCS
ALTCS provides services and settings for members who are elderly and/or have physical disabilities and/or have developmental disabilities.
Tribal ALTCS Case Management Forms
Tribal ALTCS Programs shall establish a system of record keeping that maintains case file documentation in a secure and organized manner. Case Managers are responsible for maintaining complete and comprehensive case file documentation for each member. Below are forms utilized by Tribal ALTCS Case Managers.
- Exhibit 1620-2, ALTCS Member Change Report
- Exhibit 1620-3, Uniform Assessment Tool and Guidelines
- Exhibit 1620-7, Fee-For-Service (FFS) Out-of-State Nursing Facility Placement Request Form
- Exhibit 1620-8, Contractor Change Request Form
- Exhibit 1620-9, ALTCS Enrollment Transition Information (ETI) Form
- Exhibit 1620-12, Spouse Attendant Care Acknowledgement of Understanding Form
- Exhibit 1620-13, ALTCS Member Service Plan
- Exhibit 1620-14, ALTCS Member Contingency Back-Up Plan
- Exhibit 1620-15, Assisted Living Facility (ALF) Residency Agreement
- Exhibit 1620-16, Assisted Living Facility (ALF) Financial Change Agreement
- Exhibit 1620-17, HCBS Member Needs Assessment
Tribal ALTCS Case Management Forms (Español)
- Exhibit 1620-12-SP, Forma de reconocimiento de entendimiento de atenciones de cónyuge
- Exhibit 1620-13-SP, Plan de servicios para miembros del Programa ALTCS de Arizona Health Care Cost Containment System
- Exhibit 1620-14-SP, Plan para contingencia o imprevistos de miembros de AHCCCS/Arizona Long Term Care System (ALTCS)
- Exhibit 1620-15-SP, Convenio de residencia en instalación con ayuda para vivir (ALF)
- Exhibit 1620-16-SP, Convenio de cambio económico para Instalación con ayuda para vivir (ALF)
Becoming an AHCCCS/ALTCS Provider
Information about becoming an AHCCCS ALTCS Provider can be found in the Provider Registration section of the Plans, Providers, Contractors, and Vendors portal.