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Services are provided on a fee-for-service basis in the following situations:
Service Package |
When the customer... |
AHCCCS Medical Services |
· Is eligible to have medical bills paid during the three months prior to application (Prior Quarter) · Is eligible for Federal Emergency Services (FES); · Enrolls with American Indian Health Program (AIHP); · Is eligible for Hospital Presumptive Eligibility (HPE); · Has less than 30 days of prospective eligibility; or · Is eligible only for a retroactive period of eligibility. |
ALTCS Services |
· The customer is eligible for ALTCS services only during the prior period. Example: The customer dies before ALTCS is approved but is eligible for ALTCS services in the prior period. ALTCS services are paid on a fee-for-service basis. · The customer is enrolled with a tribal contractor, or there is no tribal or EPD program contractor serving the customer’s geographical service area. · The Assistant Director of the Division of Member Services approves (on a case-by-case basis) fee-for-service payment for long term care services during the prior period for a customer who: o Was enrolled with an AHCCCS Complete Care (ACC) plan when ALTCS was approved; and o The AHCCCS Complete Care (ACC) plan’s responsibility for paying for nursing facility services for a 90-day period per contract year ended prior to the date the ALTCS approval was processed. |
Term |
Definition |
AHCCCS American Indian Health Program (AIHP) |
AIHP is responsible for paying fee-for-service claims submitted for Native Americans who have chosen not to enroll in an acute capitated health plan. If the Native American customer does not choose a plan and lives within the bounds of the tribal nation, the customer will be automatically enrolled in AIHP. |
Federal Emergency Services (FES) |
Emergency services provided to immigrants who are eligible for Medicaid except for their immigration status |
Hospital Presumptive Eligibility (HPE) |
Temporary coverage for people who are likely to qualify for AHCCCS Medical Assistance. See MA417 for details. NOTE Eligibility for HPE is determined by qualified hospitals |
Program |
Legal Authorities |
All programs |
AAC R9-22-1702 AAC R9-28-416 AAC R9-22-1601 |