What is a contracted facility and why is this important to ALTCS/Medicaid members?

By January 27, 2011Uncategorized

Everybody who has applied for Arizona Medicaid knows that ALTCS/Medicaid rules can be quite complicated.  Qualifying for Arizona Medicaid many times presents seniors with a variety of obstacles, forcing them to engage in ALTCS planning to meet eligibility requirements.  While it is ordinarily a big relief for seniors to finally obtain ALTCS eligibility, ALTCS rules do not go away upon a member’s approval for the benefit.  In other words, ALTCS/Medicaid may refuse to pay for services when Arizona Medicaid members fail to abide by certain rules.  As such, it is important for those who apply for Arizona Medicaid to have a firm grasp of the services that ALTCS/Medicaid covers.

One important concept for Arizona Medicaid members to understand is that of a contracted facility.  To receive services, an ALTCS member works with a program contractor.  This program contractor provides members with a list of contracted facilities from which they can receive services.  ALTCS members are limited to receiving services at one of these contracted facilities if they want ALTCS to cover the cost.  Of course, ALTCS members are free to obtain services at a non-contracted facility, but they must pay the bill out-of-pocket if they choose to do so.  This concept should be familiar to those who have belonged to HMOs or other managed care systems.