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ALTCS customers who are age 65 or older (elderly) or who have a physically disability (EPD) whose county of fiscal responsibility is Maricopa County, Gila County, Pinal County, or Pima County have a choice of program contractors.
EXCEPTION:
See MA1104D for American Indian customers with on-reservation status.
When the customer or representative is unable or unwilling to make a choice, the applicant will automatically be assigned to a program contractor.
If a customer does not choose a program contractor before the application is approved, AHCCCS automatically assigns a program contractor and enrolls the customer. A Freedom of Choice letter is mailed to customers informing them of the program contractor they were enrolled in and giving them a 90-day period to choose a different program contractor if they wish to change. If the customer does not contact AHCCCS to choose a different program contractor, the customer will remain enrolled with the auto-assigned program contractor.
EXCEPTION:
A customer who is reapplying for ALTCS is reenrolled with the former program contractor when the application is approved within 90 days of disenrollment.
The following policy is used to determine who has the authority to make an enrollment choice:
If... |
Then... |
The customer has a legal representative |
Only the legal representative may choose a program contractor for the customer. |
The customer does not have a legal representative |
The customer, an authorized representative, a family member, a friend, a neighbor, or any other interested party who does not have a conflict of interest may make the enrollment choice |
More than one person indicates a choice |
All parties are contacted to attempt to determine a mutually acceptable choice. If everyone still disagrees, use the following hierarchy to determine which person is given priority in choosing: · Legal representative · Applicant · Spouse · Parent · Authorized representative |
If the customer or representative has not selected a program contractor despite reasonable efforts, and has not requested additional time, the Benefits and Eligibility Specialist will see if a choice can be made for the customer. If the customer’s primary healthcare provider(s) contract with only one of the available program contractors, the worker will choose that program contractor for the customer. Otherwise, the customer will be automatically assigned to a program contractor.
A person with a conflict of interest is not allowed to make an enrollment choice for the applicant.
If the customer is unable to make the enrollment choice and there is no one without a conflict of interest who can make the choice, AHCCCS chooses the program contractor.
A social worker employed by a nursing facility, or a case manager employed by a program contractor (even if acting as an authorized representative) has a conflict of interest because the selection may have a financial impact on the person’s employer.
The ALTCS office is responsible for:
· Providing enrollment choice information;
· Helping the customer make an informed choice; and
· Documenting enrollment choice, unless a choice cannot be made, and the customer is auto-assigned to a program contractor.
The customer will receive an AHCCCS ID card with confirmation of enrollment. The name and telephone number of the program contractor are printed on the customer’s ID card.
The ID card is mailed to the customer after enrollment is processed. The customer should receive the card a few days after application is approved.
Term |
Definition |
Choice County |
A county that has more than one program contractor available to ALTCS customers who are age 65 or older (elderly) or have a physical disability (EPD). Currently, Maricopa, Gila, Pina,l and Pima are choice counties. |
Conflict of Interest |
When a person is employed by or somehow related to a business or entity with a financial interest in the customer’s enrollment or placement. |
This requirement applies to the following program:
Program |
Legal Authorities |
ALTCS |
ARS 36-2932 and 2933 AAC R9-28-413 |