302 Types of AHCCCS Medical Assistance Service Packages

Revised 04/26/2022

Policy

AHCCCS Medical Assistance coverage is provided through the following service packages:

· AHCCCS Medical Assistance Service Package;

· ALTCS Service Package;

· Emergency Service Package;

· Medicare Savings Programs Service Packages; and

· Transplant Extended Eligibility Program Medical Assistance Service Package.

See Chapter 1200 for information on customer costs.

1) AHCCCS Medical Assistance Service Package

The AHCCCS Medical Assistance Service Package includes:

· Medical services;

· Behavioral health services;

· EPSDT Services for customers under age 21;

· Family Planning Services; and

· Payment of the Part B Medicare premium for most AHCCCS programs.

Most customers receive all medically necessary services from an AHCCCS Complete Care Plan.

Native Americans may choose to receive services by enrolling in an AHCCCS Complete Care Plan or through the American Indian Health Program (AIHP).

2) ALTCS Service Packages

ALTCS customers may be eligible for a:

· Full ALTCS service package; or

· Limited ALTCS service package.

The full ALTCS service package includes the following services:

· Case Management;

· Medical Services;

· Behavioral Health Services;

· Family Planning Services;

· Long Term Care Services;

· EPSDT Services for Medicaid eligible children under age 21; and

· Payment of the Part B Medicare premium, except for some customers that qualify for ALTCS Freedom to Work).

NOTE The limited ALTCS service package includes all the services listed above EXCEPT Long Term Care Services.

See MA521, MA705K, and MA900 for details about what can result in a customer getting only the limited ALTCS service package.

3) Emergency Service Package

The emergency service package is limited to services that are needed to treat an emergency medical condition.

4) Medicare Savings Program Packages

There are three Medicare Savings Plan (MSP) programs and two service packages, one for QMB and one for SLMB or QI-1:

Program

Benefits Paid

QMB

· Medicare Part A premiums;

· Medicare Part B premiums;

· Medicare deductibles; and

· Medicare coinsurance

SLMB or QI-1

Medicare Part B premiums

5) Transplant Extended Eligibility Program – Medical Service Package

Customers eligible for the Transplant Extended Eligibility Program have two options for the extension of coverage. The option chosen determines the amount and duration of services that will be provided:

· Option One – The customer can choose to receive one 12-month extension of full MA services. The period begins the day after the previous AHCCCS program coverage ends. These customers receive the full AHCCCS Medical Assistance Services package listed in section 1) of this policy.

· Option Two – The customer can choose to postpone the AHCCCS coverage extension until the time the transplant is performed. If the customer is found to still be ineligible for any other AHCCCS program due to excess income, the customer will receive the eligibility extension, which covers only transplant-related surgery and services. This includes up to 100 days of post-transplantation care.

Definitions

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 AHCCCS Complete Care plan. If the Native American member does not choose a plan and lives within the bounds of a tribal nation, the member will be automatically enrolled in AIHP.

Emergency Services

Medically necessary services, including labor and delivery, to treat a medical or behavioral health condition that in the absence of immediate medical attention is reasonably likely to result in:

· Placing the individual's health in serious jeopardy;

· Serious impairment to bodily functions;

· Serious dysfunction of any bodily organ or part; or

· Serious physical harm to another person.