B ALTCS Acute Care

Policy

Customers whose living arrangements do not allow them to get long-term care services only get the limited ALTCS service package described in MA301. 

When there is a change to a customer’s living arrangement that allows for long-term care services to be approved, the long term care services start the date of the change.

These changes may include any of the following:

·        The customer moves home;

·        The customer moves to a different facility; or

·        The current facility becomes certified, gets registered with AHCCCS, or contracts with a program contractor.

When the ALTCS customer is only eligible for the limited ALTCS service package, income eligibility is determined using either the:

·        Gross Income Test; or

·        Net Income Test.

1)    Gross Income Test

The Gross Income Test is used when a customer is in any of the following living arrangements for at least one day in the month:

·        Non-certified medical facility;

·        Long term care facility that is not registered with AHCCCS;

·        Long term care bed in a VA hospital; or

·        Medical facility that does not have a contract with the program contractor.

2)    Net Income Test

The Net Income Test is used when the customer meets any of the following for all days in the month:

·        Lives in an HCBS setting that is licensed or certified, but is not registered with AHCCCS;

·        Lives at home or in an HCBS setting and refuses HCBS services; or

·        Refuses to move from a non-contracted HCBS setting to a contracted setting.

Definitions

Proof

Proof that a facility is licensed and registered with AHCCCS is generally obtained through an electronic data match. 

When proof is not available through this match or the facility is not listed in the electronic records, other sources of proof include:

Contact with the facility to determine:

·        The name and address of the facility;

·        Whether the facility is licensed or certified.

Legal Authority