What is ALTCS?
ALTCS stands for Arizona Long Term Care System. ALTCS is part of the Arizona Health Care Cost Containment System (AHCCCS) state health care program for the needy. ALTCS provides long-term care services to eligible persons.
How are ALTCS services provided?
ALTCS services are generally provided by ALTCS Program Contractors. ALTCS Program Contractors provide services through a Health Maintenance Organization (HMO) or managed care program. The ALTCS Program Contractors for each county are listed at the end of this packet.
What happens after I am approved for ALTCS?
You will be enrolled with an ALTCS Program Contractor.
You will be assigned a Case Manager who will meet with you and your family or representative to develop a specific
plan for your care
What services are available through ALTCS?
AHCCCS Acute Care Services, which include: doctors, hospitalization, prescriptions, lab work, x-rays, tests, and
specalist treatments.
Nursing Home Care, provided in a licensed nursing facility, Intermediate Care Facility for the Mentally Retarded (ICF-
MR), a freestanding hospice, a residential treatment facility for persons under 21 or a psychiatric hospital for persons
age 65 or older.
Home and Community-based Services (HCBS) provided in your home. These in-home services are intended to help you
to remain in your own home. HCBS services include, but are not limited to:
Home Health Nursing
Habitation
Adult Day Care
Personal Care
Medical Transportation
Mental Health Services
Homemaker Services
Attendant Care
Respite Care
Home Health Aids
Home Delivered Meals
Hospice
Home and Community-based Services (HCBS) may also be provided in a supervised alternative residential setting, such
as an Adult Foster Care Home, Assisted Living Home, Group Home or a Level I, II, or III Behavioral Health Center.
Who determines what services I need and where I should receive these services?
These decisions are made by your Case Manager and primary care physician with your input and input from your spouse or representative.
Can I choose my own physician?
Your ALTCS Program Contractor will give you an opportunity to pick your own primary care physician from an approved listing, or will pick one for you if you do not make a choice.
Your ALTCS Program Contractor will only pay for services authorized by ALTCS contracting physicians.
If you choose to see a non-contracting physician, you will be responsible for the payment for that medical service.
Will I have to pay anything towards the cost of my care?
If you are living at home or in an alternative residential setting, you are responsible for paying for Home and Community Based Services that you receive before your ALTCS application is approved.
If you are living in an alternative residential setting, such as an Assisted Living Home, you are also responsible for paying room and board charges in the residential setting both before and after ALTCS is approved. ALTCS does not pay for room and board in alternative settings.
Some ALTCS recipients also have to pay a share of cost of their medical care. The amount you may have to pay will depend on your living circumstances and medical needs, your income, and the income and needs of your spouse and children.
Your ALTCS Eligibility Interviewer (El) will notify you with an additional form and a verbal explanation to show you how your share of cost will be determined. You will receive notices from your ALTCS El telling you if you will need to pay a share of cost, and how much that cost will be. Your ALTCS Program Contractor will tell you where to make payment, either to your health care provider or nursing home, or sometimes to the ALTCS Program Contractor so that the contractor can make payment to your service providers.
ALTCS Medical Eligibility Pre-Admission Screening (PAS)
The purpose of the Pre-Admission Screening (PAS) is to identify whether or not applications meet criteria for Title XIX or Medicaid funding long term care services (ALTCS). To receive federal Medicaid funds for an individual, AHCCCS must demonstrate that the applicant has a medical need for these services and is at risk of institutionalization. This means that the applicant is in need of long term care at a level of care comparable to that provided in a nursing facility, but which is below that of an acute care setting (hospitalization or intense rehabilitation) and above that of a supervisory/ personal care setting (intermittent outpatient medical intervention or benevolent oversight.)
An individual who meets ALTCS criteria for Title XIX eligibility will present with a combination of the following needs and impairments:
Requires nursing care by or under supervision of a nurse on a daily basis
Requires regular medical monitoring
Exhibits impaired cognitive functioning
Exhibits impaired self care with activities of daily living
Exhibits impaired continence
Displays psychosocial deficits
The PAS tool is the instrument used to determine whether or not an individual is medically eligible for ALTCS. It is completed by an assessor who may be a social worker or a registered nurse. In certain instances a nurse/social worker team may assess the individual. The assessment is a face-to-face interview with the applicant and other informants.
The PAS consists of several sections:
1. Intake information
2. Demographic information
3. Functional information and assessment
4. Medical information and assessment
In order to be eligible for ALTCS services, an individual must be determined to be at risk of institutionalization. PAS screening is designed to determine whether or not the applicant is at risk by examining the individual's recent functional and medical condition. This may be achieved by asking questions of the applicant and significant others, reviewing available records and observing the applicant's behavior during the PAS interview.
All the functional and medical assessment criteria are taken into account in the development of a numerical score which is determined to meet or not to meet the baseline criteria. A level of care is determined based on the score and individual PAS items. If either the score or the level of care is determined to be questionable or inappropriate by the PAS team, an evaluation can be made by the ALTCS physician consultant. This physician review may override the numerical score if appropriate.
Functional Assesment
The functional portion of the screening focuses on the following areas:
1. Activities of Daily Living (ADLs)
Mobility - purposeful movement within the applicant's residence
Transfer - the ability to move between two surfaces, i.e. bed, wheelchair, chair
Bathing - washing, rinsing, drying body parts, transfer in/out of tub
Grooming - tending to appearance of hair, teeth, face, hands, nails
Dressing - Putting on and removing articles of clothing
Eating - putting food and fluids into system
Toileting - managing elimination of urine and feces/li>
2. Continence
3. Vision
4. Orientation to person, place and time
5. Behavior patterns such as wandering, aggression, self-injurious, suicidal or disruptive
Medical Assesment
The medical portion of the screening focuses on the following areas:
Medical condition - determines an applicant's medical conditions whether acute, chronic
or history; if these conditions impact ADLs; and if medical or nursing treatments are
required
Services and treatment - identifies all services and treatments an applicant receives or
needs
2008 ALTCS Eligibility Effective January 1, 2008
ALTCS Income Eligibility Cap
Resources for Individual
Maximum Community Spouse Resource Allowance
Minimum Community Spouse Resource Allowance
Personal Needs Allowance
$1,911
$2,000
$104,400
$20,880
$95.55
**Eligibility amount changes annually – January of each year.
Before proceeding with the ALTCS application…
Does the applicant need the assistance of an Elder Law Attorney to proceed with the ALTCS application?
If “YES” is checked on any of the questions below, it is recommended that the applicant visit an Elder Law Attorney BEFORE applying for benefits.
Is monthly income over $1,911?
If single, are assets over $2,000?
If married, are assets over $20,880?
Is car value over $4,500?
Is the primary house in a trust?
Do applicant’s assets include a trust?
Have there been transfers of cash or assets within the past 60 months? (i.e. charity, gifts, name changed on property)
Does the primary home have more than $500,000 in equity?
Is there more than one home/property?
Is there more than one car?
If YES has been checked on any of the above questions, it is in the best interest of the applicant to visit an Elder Law attorney BEFORE applying for benefits.
Call Jackson White at 480.464.1111 for your FREE phone consultation.
If you have not checked any of the above boxes, the ALTCS application follows for your convenience in filing. Our Elder Care Coordinators are available should you have any questions.
Where do I send the Application?
Please mail or fax your ALTCS application to the Long Term Care Office listed below that is nearest to your residence.
Arizona Long Term Care Offices
Mesa
460 N. Mesa Dr., Suite 101
Mesa, AZ 85201
Tel. (602) 417-6400
Fax (480) 644-0878
Casa Grande
500 North Florence Street
Casa Grande, AZ 85222
Tel. (520) 421-1500
Fax (520) 836-6828
Cottonwood
One North Main St.
Cottonwood, AZ 86326
Tel. (928) 634-8101
Fax (928) 634-8007
Flagstaff
3480 E. Route 66
Flagstaff, AZ 86004
Tel. (928) 527-4104
Fax (928) 527-1686
Glendale
2830 W. Glendale Ave.
Suite 19, Suite 34 & Suite 8
Phoenix, AZ 85051
Tel. (602) 411-6000
Fax (602) 417-6154
Globe/Miami
Cobre Valle Plaza
2250 Highway 60, Suite H
Miami, AZ 85539-9700
Kingman
519 E. Beale St., Suite 150
Kingman, AZ 86401
Tel. (928) 753-2828
Fax (928) 753-6995
Lake Havasu City
285 S. Lake Havasu Ave.
Lake Havasu City, AZ 86403
Tel. (928) 453-5100
Fax (928) 453-6057
Phoenix South
700 E. Jefferson Street
Phoenix, AZ 85034
Tel. (602) 417-6600
Fax (602) 417-6650
Prescott
1570 Willow Creek Road
Prescott, AZ 86301
Tel. (928)778-3968
Fax (928) 778-1232
Show Low
580 E. Old Linden Rd., Suite 3
Show Low, AZ 85901
Tel. (928) 537-1515
Fax (928) 537-1822
Sierra Vista
484 East Wilcox Drive
Sierra Vista, AZ 85635
Tel. (520) 459-7050
Fax (520) 459-0702
Tucson
Magdalena Building
110 S. Church Ave., Suite 512
Tucson, AZ 85701
Tel. (520)205-8600
Fax (520)205-8709
Yuma
3850 W. 16th St., Suite B
Yuma, AZ 85364
Tel. (928) 782-0776
Fax (928) 782-2894
AHCCCS
Arizona Health Care Cost Containment System Insurance Providers:
Acute Care Health Plans
Please note while this is a complete list for the state, health plans are not broken down by county. Please contact JacksonWhite or your counties long-term care office for your counties specific information.
Long-Term Care Program Contractors
Please note while this is a complete list for the state, health plans are not broken down by county. Please contact JacksonWhite or your counties long-term care office for your counties specific information.
Behavioral Health Plans
Please note while this is a complete list for the state, health plans are not broken down by county. Please contact JacksonWhite or your counties long-term care office for your counties specific information.
This site is informational only and should not be construed as legal advice. Receipt of this information does not create an attorney-client relationship. Please consult a knowledgeable attorney regarding your specific legal needs.
