ALTCS Services

One of the first questions asked when contacted about ALTCS is what are the ALTCS services?

Arizona’s Medicaid, called ALTCS, is one of the nation’s most robust Medicaid long-term care programs in the United States. I say this because Arizona is an approved Home and Community-Based Services State or a “Waiver State.”  The state of Arizona offers additional benefits through the Home and Community-Based Services- HCBS Program.

Because Arizona has such a great program, many moves from other states to Arizona to take advantage of our state’s Medicaid Long term care program.

ALTCS, or Arizona’s Medicaid, is funded by Federal, State, and County tax dollars and is regulated under Federal law  42 U.S. Code § 1396a.

Title 42 defines what benefits must be provided by the state. A state cannot offer less than what Federal law dictates, but it can provide more benefits.

ALTCS covered the following essential medical service, per the AHCCCS Medical Policy Manual and AHCCCS Administrative Code A.A.C. § R9-28-201 to § R9-22-206.

ALTCS Services are divided into two categories. These are Institutional Services and Home and Community Based Services.

Institutional Services

Institutional Services under ALTCS covered services are provided in a Nursing Facility and include:

• Nursing care services;
• Rehabilitative services are prescribed as a maintenance regimen;
• Restorative services, such as range of motion;
• Social services;
• Nutritional and dietary services;
• Recreational therapies and activities;
• Medical supplies and non-customized durable medical equipment under 9 A.A.C. 22, Article 2;
• Overall management and evaluation of a member’s care plan;
• Observation and assessment of a member’s changing condition;
• Room and board services, including support services such as food and food preparation, personal laundry, and housekeeping;
• Non-prescription and stock pharmaceuticals; and
• Respite care services are not to exceed 600 hours per benefit year.
• Behavioral health services
• Semi-private room unless the nursing facility only has private room settings or the medical condition requires isolation or the primary care provider or attending physician provides written authorization for a private room

Limited bed hold is provided for short term hospital stays. see A.R.S. § 36-2939(B)(3) for limitations and rules.

Home and Community Based Services

ALTCS Services that are provided under Home and Community Based Services include:

Services in the home and an alternative residential setting, which include assisted living and group care homes.

Home health services on a part-time or intermediate basis and included both in the home or alternative residential setting.

• Nursing Care
• Home health aide
• Doctor’s office visits, including specialists treatment*
• Hospitalization
• X-Ray and Lab fees
• Ambulance
• Medical Supplies, equipment, and appliances
• Prescriptions

*ALTCS does not currently cover chiropractors, and dental up to $1000 per year is covered as emergency dental care.

Per A.A.C. § R9-28-201, they must be medically necessary, cost-effective, and reimbursable by Medicare for services to be provided by ALTCS. I hope you are now understanding about ALTCS covered services.

Read about Arizona Long Term Care Program for Seniors in Arizona.

For instance, under the Home and Community Based program, incontinence briefs, a.k.a. by the brand name “Depends,” are provided, providing they are to treat a medical condition and prevent skin breakdown when ordered by the primary care provider P.C.P. or the attending physician.

Prevention of skin breakdown when a documented medical condition is the cause of incontinence of bowel and or bladder. The amount supplied can not exceed 180 incontinent briefs per month unless the attending physician prescribes more than 180.

Nursing and Assisted living expenses are covered:

Nursing facilities, and through the HBCS program, assisted Living facilities are covered by ALTCS. This includes group assisted living care homes too. Depending on your income and marital status, there may be a “share of cost” or co-pay.

Hospice services: Hospice services are provided for those with a life-limiting illness or in the final stage of an incurable disease. Hospice can add quality of life to those that have a terminal illness.

Not all hospice companies and services are the same so choose the hospice provider carefully.

Speech, physical, and occupational therapies:

Speech therapy:

For seniors, speech therapy can increase cognitive skills, communication, and safe swallowing. It can also include the use of communication devices.

Physical therapy:

Physical therapy is covered by ALTCS. Physical therapy helps to improve strength, mobility, and flexibility.

Falls are the leading cause of death among adults over 65. A physical therapist will teach seniors ways to reduce the risk of falls.

Occupational therapy: 

Occupational therapy is one of the essential rehabilitation programs for adults over 65. Occupational therapy teaches seniors exercise and rehabilitation techniques to help make daily activities of daily living tasks like dressing, eating, bathing, walking, and transferring easier.

Behavioral Health

Behavioral health services: Depression and anxiety are a normal part of aging. ALTCS will provide funding for behavioral health services.

Durable medical equipment and medical supplies

Private duty nursing services

Conclusion:

As you can see, ALTCS services are comprehensive and cover what is medically necessary. It covers room and board in all approved ALTCS approved facilities for a semi-private room unless otherwise prescribed or if only private rooms are offered at the facility.

See your Plan Provider Handbook for more details on coverage and limitations.

Know about Medicaid Spend Down Arizona.