1303 ALTCS Application Process

Policy

ALTCS applications are different from other AHCCCS Medical Assistance applications in the following ways:

·         A financial interview with the customer or customer’s representative is required;

·         A Pre-Admission Screening (PAS) assessment is required;

·         A Share of Cost (SOC) is estimated and determined; and

·         Customers may still qualify for other AHCCCS Medicaid Assistance categories, when they fail to meet requirements that only apply to ALTCS.

General information about the application process can be found in MA1301 and MA1302.  This section provides information specific to the ALTCS application process.

1)    ALTCS Interview

A financial interview is required for all ALTCS applications.  The interview may be in person or by telephone.

The interview may be with the customer or with a person acting on behalf of the customer such as a representative (MA1301A.3).

2)    PAS Assessment

To qualify for ALTCS a customer must be determined to need the level of care provided in a hospital, skilled nursing facility or intermediate care facility.  This determination is made through the PAS process.

Chapter 1000 contains a complete description of the PAS process.

3)    Estimating the Share of Cost

Most nursing facilities require full payment of all facility expenses prior to ALTCS approval.  However, some nursing facilities will allow a patient who has applied for ALTCS to pay the estimated share of cost during the application process.

A Share of Cost Estimate is completed for customers who:

·         Live in a nursing facility; or

·         Expect placement in a nursing facility during the ALTCS application process.

The most accurate information available is used during the application process to calculate the customer’s estimated SOC.  This estimate may change once proof of income and deductions is received.  The SOC amount can change from month to month based on changes in income, deductions and living arrangements;

The fact that an estimated SOC has been provided is no guarantee that the ALTCS application will be approved.  Approval is subject to the customer meeting all financial and medical eligibility requirements.  If the application is approved, the approval notice will show the actual SOC amount(s);

The nursing facility may require payment in full pending approval of the ALTCS application.  However, if the nursing facility agrees to accept estimated SOC payments pending ALTCS approval, the customer should begin paying the estimated SOC amount to the nursing facility while the ALTCS application is being processed;

If the customer paid the estimated SOC and the actual SOC is lower, the nursing facility will refund the difference for each approved month (MA705J).

4)    Customers Not Eligible for ALTCS

A customer may qualify for other AHCCCS MA categories when the customer does not qualify for ALTCS for one of the following reasons:

·         Failed the PAS;

·         Missed Appointment;

·         Failed to verify resources; or

·         Has excess resources.

Definitions

Programs and Legal Authorities