Every 6 months the ALTCS financial requirements are evaluated. Effective January 1, 2012, there have been a few changes to note.

ALTCS Financial Requirements*:

Monthly Income Limit for an Individual $2,094
Resource Limit for an Individual $2,000
Maximum Community Spouse Resource Allowance $113,640
Minimum Community Spouse Resource Allowance $22,728
Maximum Monthly Maintenance Needs Allowance $2,841
Minimum Monthly Maintenance Needs Allowance $1,839
Personal Needs Allowance $104.70
*Effective Jan. 1, 2012

To have these numbers explained in more detail, call one of our social workers today. If you are interested in any of our free resources such as 2012 rate cards or new ALTCS guides, call an Elder Care Advisor at 1.800.243.1160 or request them on our website: www.ArizonaSeniorLaw.com/resources/

Happy New Year,

Jackson White Elder Law

If an ALTCS recipient is awarded Wartime Pension, plus Aid & Attendance, and as a result is over the $2022 income amount for ALTCS, will their eligibility be jeopardized? It’s a possibility. However, there are two important rules to thoroughly consider before arriving to a conclusion.

1. First, it is important to realize that Wartime Pension plus Aid & Attendance consists of two distinct pension amounts; Wartime pension as a result of your Unreimbursed Medical Expenses, and Aid & Attendance. And as far as ALTCS is concerned, the pension amount attributable to Unreimbursed Medical Expenses and Aid & Attendance IS NOT counted towards income eligibility or share of cost. In order to accurately assess the amount of “countable” pension, an Eligibility worker needs to figure out how much of the awarded pension is countable Wartime Pension and how much of it is Unreimbursed Medical Expenses and Aid & Attendance. In order to do this, a DE 210 form must be completed.
2. Second, if an ALTCS recipient is still over income after the Wartime Pension has been accounted for and the Aid & Attendance has been disregarded; know that an Income Only Trust can be used to keep the ALTCS recipient eligible.

If you have a resident who is applying for both VA and ALTCS benefits, it is advisable to speak with a JacksonWhite representative in order to help coordinate the two benefits and red flag any eligibility issues.

Call and speak with a JacksonWhite Elder Care Advisor today at 1.800.243.1160.

As you can see, this notification letter will raise some questions and concerns for your patients and/or residents. If the recipient is eligible for another AHCCCS program that covers Medicare Part B, then know they will automatically be enrolled and can disregard the notice. However, if they are NOT eligible for any program other than ALTCS, then their Part B premium will no longer be covered by AHCCCS. In which case, unless they opt to terminate their Medicare Part B coverage, they will have the cost of future Medicare Part B premiums deducted from their social security checks. If they do not receive Social Security, they will be billed for their Medicare Part B premiums.

Healthcare facilities should be aware that ALTCS has established a system that will automatically recalculate the Share-of-Cost for all ALTCS participants affected by this change. Therefore, facilities can expect to see minimal impact caused by this upcoming change other than in their day to day billing and accounting operations, due to the need for updating information to reflect the new Share-of-Cost amounts.

Register for ALTCS 101 Training
Are you a healthcare professional in Arizona? Do you have questions about the process of applying for ALTCS and the eligibility requirements? Learn more about the ALTCS program by attending a FREE ALTCS 101 training on August 25, 2011 at the JacksonWhite Mesa Office. Space is limited so hurry and reserve your seat online at arizonaseniorlaw.com/resources.

More questions about coordinating benefits? Contact one of our Elder Care Social Workers at 1-800-243-1160.

The Elder Law Department at JacksonWhite is committed to making sure you stay on top of the latest information regarding ALTCS. This month’s Right to the Point focus is on the recently announced contractual changes to the ALTCS managed care companies/program contractors and what health care providers can do to ensure a smooth transition time.

Changes to the ALTCS Program Contractors and How They Affect Health Care Providers

Last month, AHCCCS awarded ten contracts to four managed care companies/program contractors, allowing those companies to provide long-term care services to Arizonans on ALTCS. The awarded contracts take effect October 1, 2011 and will last up to five years. Contracts were awarded by the following regions of the State:

Maricopa County – Bridgeway Health Solutions, Evercare Select, Mercy Care Plan, and SCAN Long Term Care*

Pima/Santa Cruz Counties – Evercare Select

Cochise/Graham/Greenlee Counties – Bridgeway Health Solutions

Yuma/La Paz Counties – Evercare Select

Mohave/Coconino/Apache/Navajo Counties – Evercare Select

Yavapai County – Evercare Select

Pinal/Gila Counties – Bridgeway Health Solutions

*SCAN was approved to have a “capped” contract meaning they are allowed to keep all members as of October 1, 2011, but after that date SCAN will not be able to secure new members.

What these changes mean for health care providers

Health care providers (i.e. – health care facilities, hospices, group homes, in-home care companies, etc.) are able to establish year-long contracts with the managed care companies/program contractors listed above. After a year, the health care provider has the choice to renew the contract with the managed care company/program contractor under the same terms, renegotiate the terms of the contract, or no longer provide services for that managed care company’s/program contractor’s ALTCS members. Health care providers can have several of these contracts at any given time.

Health care providers should begin to review their current ALTCS contracts now, making special note of details such as the date their contracts are up and the current compensation amounts for services provided. Now is also the time to consider which managed care companies/program contractors it makes sense to have a contract with. If there is a new program contractor in one of the counties where health care services are provided, the health care provider should start looking into establishing a contract with that managed care company/program contractor so services can begin on October 1, 2011.

Currently, more than 25,000 Arizona residents are enrolled in the ALTCS program. ALTCS has been viewed as a national model for its success in supporting over 70 percent of its members in the home or community-based residential facilities. Many of these ALTCS members in several counties will be enrolled in a new health plan. Those affected should have already been notified which managed care company/program contractor has been chosen to serve their region of the state. AHCCCS has a well established track record of coordinating closely with outgoing and incoming program contractors and has a proven process to ensure continuity of care and a safe and successful transition period.

If you have any questions regarding contracts with ALTCS program contractors, ALTCS eligibility regulations and/or the services available through the ALTCS benefit, please contact a JacksonWhite Elder Care Social Worker at 1-800-243-1160. Our Elder Care Social Workers are always there as a resource to the Arizona health care community and are able to provide a complementary benefit screening for those wishing to learn more about their ALTCS eligibility status. Those interested in an ALTCS screening can call toll-free (1-800-243-1160) or fill out the webform on our home page.

To sign-up to receive Senior News via email, visit our resources page.

How to Help With an ALTCS Denial

Chances are pretty good that you have at least one resident, client, or patient that has recently received an ALTCS denial. After all, given that the denial rate for the ALTCS benefit hovers right around 70 percent, applicants actually stand a greater chance of denial than they do of approval, particularly if they did nothing to prepare themselves for the ALTCS application. Nevertheless, even individuals who have been denied ALTCS have options, and as a health care provider, you are uniquely situated to help individuals sort through these options so they may ultimately qualify for the benefit they need.

Option one: Request an eligibility hearing

ALTCS applicants can receive a fair and impartial review of an ALTCS denial by requesting an eligibility hearing within 45 days from the denial. The appeal process begins with a pre-hearing discussion, at which applicants can speak with an eligibility worker about the reason for the denial. If the pre-hearing discussion does not resolve the issue, the next step is the eligibility hearing itself, which takes place at the Office of Administrative Hearings in front of an Administrative Law Judge. ALTCS applicants can arm themselves with every possible advantage by having an attorney represent them at the hearing, although nothing prevents applicants from advocating on their own behalf.

If you determine that a resident, client or patient might have received an ALTCS denial in error, you can suggest the possibility of pursuing an eligibility hearing. Individuals can request a hearing by submitting an official request for a hearing, the form for which is found on the back of the ALTCS Notice of Action. Alternatively, the patient can submit a written request containing his or her name, a specific request for a hearing on the denial, and the reason for which he or she believes the denial was made in error.

One thing to keep in mind as you consider this option with individuals is that the ALTCS program has very strict eligibility requirements. Most denials are not the result of eligibility worker error, but are the result of applicants genuinely not meeting the eligibility requirements. Individuals should probably determine whether the eligibility hearing might in fact bring a favorable outcome before they pursue this option. A benefits screening with JacksonWhite Elder Law can help determine their appeal rights, as well as the validity of the denial issue, before they proceed with the appeal process.

Option two: ALTCS planning

A second option that is available to a person who has recently been denied ALTCS is to consult with an Elder Law attorney about ALTCS planning. As you know, the ALTCS benefit is only available to applicants who meet specific income and resource requirements. Even those who do not presently meet these requirements, however, might well qualify for the benefit after some planning. With a specific plan, the individual could get on track to qualify for the benefit with as little delay as possible.

There is almost always planning that can help an individual prepare for the ALTCS application. Ideally, individuals and families will think about planning before they apply for the benefit the first time, but they can also prepare after they have received an ALTCS denial. Importantly, however, it is not the ALTCS eligibility worker’s role to help your patient qualify for the benefit. Rather, eligibility workers stick to determining eligibility and Elder Law attorneys offer counsel on ALTCS planning that can actually facilitate eligibility. By working with JacksonWhite to prepare for a reapplication, those you serve might be able to overcome an ALTCS denial.

Working together to help those you know qualify for ALTCS

As a health care provider, you want to provide your patients, residents and clients with the highest quality of care, but you also want to ensure compensation for your services. Many times, the only way to obtain compensation for your services is through the ALTCS program. It can be frustrating when your patients do not qualify for a benefit that will afford them the opportunity to receive the care they absolutely need. If a patient at your facility or someone in your care has recently been denied ALTCS, we can help by evaluating their situation and preparing with them a plan to qualify for the benefit.

Because the best way to overcome an ALTCS denial is to avoid the denial to begin with, we also work with many facilities to help their applicants qualify for the ALTCS benefit on the first application. Many ALTCS applicants could establish a seamless transition between payer sources, which brings benefits to patients and health care providers alike, by simply planning in advance. Of course, this seamless transition is best accomplished by exercising foresight, and by relying on experience with ALTCS rules and requirements. By consulting with us early in the process, you can relieve this burden from your social workers, while at the same time help patients at your facility qualify for the ALTCS benefit on their first application.

Whether your resident or patient has recently received a denial for the ALTCS benefit or you are hoping to help them avoid an ALTCS denial in the first place, ALTCS planning is a must. The sooner that you start considering these issues with patients at your facility, the more likely you are to facilitate a smooth transition between payer sources. The Elder Law department at JacksonWhite is available for consultations and as an information source to help in this process however we can.

AHCCCS Announces ALTCS Contracts

On May 5th, the Arizona Health Care Cost Containment System (AHCCCS) announced that nine contracts had been awarded to three successful managed care companies. Those managed care companies will provide services to Arizonans enrolled in the Arizona Long Term Care System (ALTCS) program. The contracts were awarded for up to five years, beginning on October 1, 2011.

Currently, more than twenty-five thousand Arizona residents are enrolled in the ALTCS program, which serves individuals who are low income, at risk of institutionalization and either elderly (age 65 and over), blind, or disabled. ALTCS members also receive medical care under the long term care program, including doctor’s office visits, hospitalization, prescriptions, lab work, and behavioral health services. ALTCS has been viewed as a national model for its success in supporting over 70 percent of its members in the home or in community-based residential facilities rather than placing members in more costly nursing home settings.

A total of nine managed care companies submitted offers to serve either a portion or all of the State’s ALTCS population, resulting in a competitive process that drives down program costs. Contracts were awarded to the identified companies in the following regions of the State:

Maricopa County – Bridgeway Health Solutions, Evercare Select and Mercy Care Plan

Pima/Santa Cruz Counties - Evercare Select

Cochise/Graham/Greenlee Counties – Bridgeway Health Solutions

Yuma/La Paz Counties – Evercare Select

Mohave/Coconino/Apache/Navajo Counties – Evercare Select

Yavapai County – Evercare Select

Pinal/Gila Counties – Bridgeway Health Solutions

Just recently, SCAN was approved to have a “capped” contract, meaning they are allowed to keep all members as of October 1, 2011. After that date SCAN will not be able to secure new members.

Alzheimer’s & the Law: Protecting Yourself and Your Family Now Available in Digital or Hard Copy Versions

The new Alzheimer’s & the Law guides have arrived and are ready to be given as a resource to clients, families, patients and residents. This guide covers a variety of topics from paying for long-term care to advance directives to the types of long-term care facilities. Request digital or hard copy versions of the guide here.

A special thank you to our sponsors: Synergy Homecare, ABRiO Care, Cypress Home Care Solutions, Homewatch Caregivers, Grace Hospice, Home Helpers Direct Link, Aunt Barb’s Home Placement, Palm Valley Rehabilitation and Care Center, Hospice of the Pines, Accent Care, Hospice Inspiris, Canyon Valley Memory Care Residence, Lake View Terrace Memory Care Residence, Heartfelt Care, Geriatric Resources and New Hope Hospice. Without their support, this guide and the moni given to the Alzheimer’s Association wouldn’t be possible!
From the blog…

The Elder Law Department at JacksonWhite is committed to making sure we blog regularly on a broad spectrum of Elder Law related topics. Subscribe to get a weekly email of the most popular topics from that week or join us on Facebook to be notified when a new blog is posted.

Standards for drafting wills and Arizona conservatorships
May 25, 2011 – Guardianship Blog

Arizona state probate laws: Anti-lapse
May 24, 2011 – Probate Blog

Trusts might not help long-term care eligibility
May 24, 2011 – ALTCS Blog

When you might need an Arizona special needs attorney’s help
May 20, 2011 – Special Needs Trust Blog

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Have an event coming up and need help spreading the word? Our site, arizonaseniorlaw.com has a new area devoted to promoting health care industry events and trainings. We’d love to post the details of your event so send all relevant information to Julie Boyster at jboyster@jacksonwhitelaw.com and we’ll get it up there.

We’re proud to be associated with those in the health care industry devoted to providing great care of Arizona seniors and their families.

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What does this mean to the future of Alzheimer’s?  That researchers have found ways to detect Alzheimer’s disease early on, well before symptoms become problematic, is quite promising.  But as it now stands, scientists have yet to take this research to the next logical level, which is preventing the full onset of the disease for those who have been diagnosed early.  Nevertheless, this glimpse of hope has caused many renowned scientists to recommit themselves to the cause of finding a cure for this debilitating disease.

Chelle who said, “I too am biased as a Social Worker. Social Workers have chosen to be in this profession and schooled to learn systems and human psychology. We are able to assist our clients to navigate many complicated personal, socitial, legal systems. All this done with the spirit that each client has their own strengths.”

The winner has been notified via email and will be given the $50 Westcor gift certificate! Congratulations! And thanks again to all the others who commented and those social workers out there making a difference!

Perhaps the most commonly perpetrated annuity fraud is simple misrepresentation, which involves a selling agent who materially misrepresents or fails to disclose key features about the annuity.  Those who are ill informed about the full nature of an annuity are in no position to invest in the product, yet this happens with great frequency, particularly within the senior population.  When selling an annuity, agents must accurately convey its tax benefits and consequences, as well as the surrender charge.  Failure to adequately inform buyers amounts to a dishonest assessment of the product, and agents can be held responsible for this behavior.

While misrepresentation encompasses all types of annuity fraud, one specific practice is by itself worth discussing.  Churning is when a sales agent convinces a client to replace an existing variable rate annuity with a new one, even though the annuity has no clear advantage to the client.  The agent may tout the new annuity’s benefits, without mentioning his expected commission or the buyer’s surrender charge for closing out the old annuity.  All of this is motivated by personal gain and not the buyer’s interest, and agents should not get away with this.

Perhaps more than any other group, seniors are the targets of annuity fraud.  This may be because the concept of a steady income is easily marketable to a demographic that is no longer in the work force.  But what some of these seniors don’t realize is that variable rate annuities do not always provide a steady income.  For instance, certain annuities are without a guaranteed rate of return, such that the annuity income may dwindle significantly if the underlying investments are unsuccessful.  Further, seniors who are not fully informed of surrender penalties and other charges may mistakenly believe that they will retain access to annuitized funds, which is not the case.  And, to make matters worse, it is not entirely uncommon for sales agents to visit assisted living facilities and retirement communities to pitch these products, regardless of their disadvantages to seniors.

Of course, seniors can protect themselves from this type of activity by simply ridding their homes of unneeded or expired medications, particularly of the narcotic variety.  To help facilitate this, the Drug Enforcement Administration has partnered with Arizona law enforcement agencies to implement the National Prescription Drug Take-Back (NDTP) program.

NDTP is a free and anonymous service that collects unwanted prescription drugs from people throughout the state on an annual basis.  Last year, Arizonans turned in well over 6,000 pounds of prescription drugs on NDTP day, and the DEA hopes to collect even more this year.  Collection sites will open up on April 30, from 10 a.m. to 2 p.m., and Arizonans are encouraged to deposit their old prescription medications to a designated site on that day.  Arizona seniors can help further this cause by ridding their homes of unwanted prescription medications.

It is against this backdrop that some people are growing concerned about budget cuts that may come to the National Institute on Aging, the nation’s primary source of grant funding for aging research.  A recent story in the New York Times reported that 2012 might bring significant cuts to the NIA, which could drastically impact the organization’s ability to conduct thorough research on issues relating to aging.  And while this might not seem like anything to lose sleep over, it is actually quite astounding just how many research projects that the NIA supports.

The most cutting edge aging research has actually revealed ways in which the aging process can be reversed in mice.  And while we are yet to see this replicated in humans, aging research continues to demonstrate the tremendous benefits that diet, exercise, and physical activity brings to seniors.  And, of course, without diligent and thorough research we would never get any closer to a cure for Alzheimer’s disease.

While we should not expect to see aging research come to a screeching halt any time soon, budget cuts could very well slow some of this research down.  The director of the NIA expressed concern in the New York Times article that budget cuts could ultimately discourage innovation and new discoveries.  The director also worries that without funding, new scientists would have little incentive to enter the field.  Gratefully, however, we have thus far pushed forward with aging research, and have made many discoveries along the way.