ATTENTION ARIZONA ALTCS PROVIDERS – Part I
On Dec. 23, 2022, Congress passed legislation which will end the Medicaid continuous enrollment requirement related to the COVID-19 pandemic on April 1, 2023. At that time, AHCCCS was required to reverify the eligibility status of all members enrolled in AHCCCS and KidsCare (Arizona’s CHIP program). AHCCCS is the Arizona Health Care Cost Containment System, which is the state agency tasked with administering federal Medicaid benefits to individual recipients and qualifying medical providers who care for those recipients.
According to an earlier Press Release, AHCCCS will complete a full eligibility renewal for all 2.4 million enrolled members over the course of 12 months, beginning April 1, 2023. Members will be notified of their eligibility renewal prior to their month of renewal.
Per federal requirements, the ending of the continuous enrollment requirement will represent the first time in three (3) years that Medicaid and CHIP members will go through this renewal process.
Member Renewals
Persons receiving AHCCCS ALTCS (long-term care) are included in those impacted by the renewal process. Therefore, providers should be aware of changes that will likely be made in the breakdown between what the resident has to pay monthly, and the remainder of the total monthly amount which is payable through the managed care provider on behalf of ALTCS. We are hearing reports that residents are receiving notifications that their out-of-pocket monthly portion of the fee payable to the assisted living facility has increased. This will affect all ALTCS-enrolled providers who receive payments through MercyCare, Banner, or United Healthcare, which are the three managed care organizations (MCO’s) that distribute ALTCS funds on behalf of AHCCCS in Maricopa County.
AHCCCS has prepared a web-based Fact Sheet addressing the re-enrollment certification process, that contains a phone number for ALTCS recipients to call. A link to the Fact Sheet is available here.
Provider Renewals
At the same time, as of February, 2023, AHCCCS has identified 5,288 providers who have not taken the required action to maintain their registered status. (See: https://www.azahcccs.gov/shared/News/GeneralNews/providerterminations.html)
According to the above release, “the process to revalidate registered providers began in November 2022 with letters mailed to the first group of providers. They were asked to revalidate in the AHCCCS Provider Enrollment Portal (APEP) within 90 days. Only 8% took the action requested to maintain their registration.”
AHCCCS advises that “[a]ny provider who has not completed the revalidation process in APEP will receive written notification to submit an application. Providers who do not respond will receive written notification of pending termination and appeal rights.”
“To avoid termination and/or loss of billing privileges, providers must respond and take action, following specific actions outlined in the letter, within the noted time frames. Failure to complete these actions result in termination and claim denials.” Therefore, assisted living providers who wish to continue to serve ALTCS-eligible recipients are advised not to ignore any AHCCCS notifications regarding revalidating through the APEP system and to seek advice from the state agency if they have difficulty following the online re-enrollment steps. If you are uncertain if you have to re-enroll to maintain your ALTCS provider ID number, you can call AHCCCS Provider Assistance at (602) 417-7670, option 5. Have your AHCCCS Provider ID number ready at the time you call. The clerk will be able to look up your record and inform you when your re-enrollment is due.
The information herein is intended to be educational and an introduction to the subject matter presented. Despite any statutory or regulatory references cited in the article above, it is NOT specific legal advice to be relied upon for specific individual circumstances. Contact your own legal professional or reach out to our firm if you would like specific advice on this topic.
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