Right to the Point – Changes to the ALTCS Program Contractors and How They Affect Health Care Professionals

Right to the Point is a monthly update for Arizona healthcare professionals. To receive it via email, please send your email address to Shanna Kesler at skesler@jacksonwhitelaw.com

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.