First, what is ALTCS? Arizona Long Term Care System (“ALTCS”) is part of the Arizona Health Care Cost Containment System (“AHCCCS”). AHCCCS is the state program that implements the Federal Medicaid program which is a health care program for the poor.
ALTCS provides acute and long-term care services for persons who are elderly (over age 65), physically disabled or developmentally disabled. Nationwide, the Medicaid program pays for over half of all nursing home costs.
What does ALTCS pay for? ALTCS offers a complete array of acute medical, skilled nursing, assisted living, home health, behavioral health services, home and community-based services, and case management services to all eligible persons. Services are coordinated and provided by an ALTCS program contractor selected by the applicant.
What is different About Applying for ALTCS right now during the COVID-19 pandemic?
We are all too aware that the current COVID-19 pandemic has changed the way normal business is being conducted. This is also true for ALTCS applications. When an application for ALTCS is submitted, ALTCS conducts a medical assessment. Typically, this is done in person. While ALTCS does not appear to have made any official policy changes, we are being told that medical assessments may be conducted over the phone for safety reasons at this time.
To properly prepare for an over the phone medical assessment, applicants and families should be ready to share accurate information regarding the assistance a person needs with activities of daily living (ADL’s). These include mobility, transferring, toileting, dressing, feeding, bathing and grooming. The applicant’s diagnosis, sensory function, orientation, emotional/cognitive behavior and needed medical services and treatments are also scored. Typically, individuals who meet ALTCS medical criteria frequently present with a combination of the following needs or impairments: require skilled nursing care; require regular medical monitoring, require prompting, supervision, or hands-on assistance for ADL’s due to cognitive impairment (e.g., Alzheimer’s disease and/or dementia) or physical disability, incontinence, and/or psychosocial deficits.
It is of paramount importance that families accurately describe the level of assistance required, as an assessor who is conducting an interview over the phone will not be able to observe anything firsthand. Often times, an applicant may try to minimize the medical assistance they require because it is difficult to admit to or to communicate the gravity of the situation. This can be especially worrisome in an over the phone interview.
The applicant must also be ready for provide a current list of prescription medications and six months of medical and hospital records.
Most importantly, during these times, things are subject to change. We are providing an update on the most recent information we have received so that our clients can be best prepared. Applying for ALTCS requires careful documentation. ALTCS applications can be complex and involve many legal issues. If you or a loved one intend to apply for ALTCS in the near future, contact our office for the most up to date legal advice and assistance.
By Megan Selvey, Esq.