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When agreement of the program contractors is required, both the enrollment change and the effective date must be approved by both the current and requested ALTCS program contractors. Officials representing both program contractors must complete and sign portions of the Program Contractor Change Request (Exhibit 1620-8 in the AHCCCS Medical Policy Manual).
If the requested program contractor does not agree to the change, the current program contractor can ask the Division of Health Care Management (DHCM) to review the case situation. If the Division of Health Care Management (DHCM) determines a change in enrollment would be in the best interest of the customer, DHCM may authorize the enrollment change. If the DHCM determines that a change in enrollment would not be in the best interest of the customer or does not support the choice of the customer, the Division of Health Care Management (DHCM) may deny the enrollment change. The customer may file an appeal with AHCCCS.
Approval of both program contractors is required when:
Who initiated the enrollment change... |
Reason for change... |
Customer or customer’s representative |
· Customer has moved to a medical facility or alternative HCBS living arrangement in a county not served by the current program contractor. · Parent(s) and child customer live in different counties. |
Program Contractor |
· Program contractor is responsible for a customer residing outside of their service area and wishes to enroll customer with program contractor who serves the area. · Customer residing in an institution wishes to move to another institution outside of the area served by the customer’s program contractor. · Customer initiates move to medical facility or alternative residential facility in another county and requests an enrollment change through the current program contractor. |