B Application Processing

 

 

Revised 04/26/2022

 

Policy

The customer, or someone acting on the customer’s behalf, may start the application in a variety of ways as described in the following table:

When the application is made for...

Then the application may be started by...

Arizona Long Term Care System

The customer or representative by:

·        Mail;

·        Telephone;

·        E-mail;

·        Fax;

·        Walk-in to a local ALTCS or AHCCCS office; or

·        Home visit.

Breast and Cervical Cancer Treatment Program

One of the Arizona National Breast and Cervical Cancer Early Detection Programs (AZ-NBCCEDP) programs by:

·        Mail;

·        Email; or

·        Fax.

Any other AHCCCS Medical Assistance program

The customer or representative by:

·        Online through Health-e-Arizona Plus (HEAplus);

·        Telephone;

·        E-mail;

·        Fax;

·        Walk-in to a local AHCCCS or DES-FAA office; or

·        Walk-in to a participating assistor office.

 

See the following links to find the customer’s local office:

·        DES-FAA:    https://des.az.gov/find-your-local-office

·        ALTCS:         https://azahcccs.gov/Members/ALTCSlocations.html

·        AHCCCS:    https://www.azahcccs.gov/shared/AHCCCScontacts.html

 

1)    Application Date

The application date is determined as follows:

When the application is for...

And the signed application is received...

Then the application date is...

Any program

By Health-e-Arizona Plus (HEAplus)

The date the application is submitted in HEAplus.

By mail

The date the application is received by any of the following:

·        AHCCCS local office;

·        ALTCS local office;

·        DES-FAA local office; or

·        Outreach site designated to accept AHCCCS Medical Assistance applications.

By phone

The date the application is received over the phone.

By e-mail

The date the application is received by any of the offices listed above, even when received after-hours, on a weekend, or a holiday.

By fax

The date the application is received by any of the offices listed above, even when received after-hours, on a weekend, or a holiday.

By walk-in

The date the person delivers the application to a local office.

By a Community Assistor

·        The date the application is signed and dated; or

·        The date the application is received when the application is not dated.

From a hospital for a hospitalized customer

·        The date the application is signed and dated; or

·        The date on the admittance or cover sheet when the application is not dated.

BCCTP

From an Arizona National Breast and Cervical Cancer Early Detection Program (AZ-NBCCEDP)

The date the diagnostic procedure was performed that confirmed a diagnosis of breast cancer, cervical cancer, or a pre-cancerous cervical lesion. 

NOTE          This date will be earlier than the date the application is received.

ALTCS

During a home visit

Date of the home visit.

 

NOTE          An application may be accepted without a signature. However, the application must be signed by an authorized person before it can be approved.

 

2)    Processing Period

The processing period begins the day of the application date and ends on the date that the decision has been made and the customer is notified.

The decision letter is available electronically as soon as the decision is processed. The processing period and the system record updates may be expedited when the customer:

·        Has an emergent medical need; and

·        Does not have medical assistance coverage.

3)    Decision Letters

Each person that applies for MA must receive a letter explaining the decision on their application. 

Letters must be sent to the following persons:

·         The customer;

·         The customer’s legal representative; and

·         The customer’s authorized representative when the customer and representative do not live together.

 

4)    Requests for Information

A letter is sent to the customer when more information is needed to make a decision. Customers are given at least 15 days from the date of the letter to provide the requested information.

 

5)    Processing Period Extensions

The application processing period may be extended beyond the processing time frame for any of the following reasons:

·        The customer appears to be eligible, but documentation from a third-party is needed to make the eligibility determination and the third party has not responded. The customer and Benefits and Eligibility Specialist must continue to take all actions needed to get the information;

·        A Policy Clarification Request (PCR) is needed that will affect the eligibility decision;

·        A Disability Determinations Services Administration (DDSA) decision is pending; or

·        The customer requests more time to get documentation or proof needed for the eligibility decision.

NOTE          Failure to process an application within the appropriate timeframe is not a valid reason to deny the application.

 

Definitions

Term

Definition

Calendar Day

Any day in the month. This includes weekends and holidays.

Emergent Medical Need

A medical condition that, in the absence of immediate medical attention or medication, is reasonably likely to result in at least one of the following:

·        Placing the customer’s health in serious jeopardy

·        Serious impairment to bodily functions

·        Serious dysfunction of any bodily organ or part

·        Serious physical harm to another person

Working Day

Any day Monday through Friday, excluding federal and state holidays.

 

Timeframes

When the customer is applying for:

Then the processing period is...

SSI-MAO or FTW based on disability

90 calendar days from the application date

KidsCare

30 calendar days from the application date

BCCTP

7 calendar days from the date a complete application is received by AHCCCS.

All other programs

45 calendar days from the application date

Exceptions:

·        20 calendar days from the application date when the customer is pregnant

·        7 calendar days from the application date ONLY when no proof or other information is needed for the determination

 

Legal Authority

Program

Legal Authorities

All Programs

42 CFR 435.907

42 CFR 435.912

42 CFR 457.340 (KidsCare)

AAC R9-22-1413(A)

AAC R9-22-2006(A)