Tribal Arizona Long Term Care System (TRIBAL ALTCS) Program

Overview of the Tribal ALTCS

The Tribal Arizona Long Term Care System (Tribal ALTCS) Program is a Fee-For-Service (FFS) integrated health plan that delivers comprehensive patient care through the coordinated efforts of the assigned Tribal ALTCS Case Manager, various tribal and non-tribal FFS healthcare providers, and AHCCCS Division of Fee-For-Service Management (DFSM). This approach aims to provide user-friendly access to culturally appropriate health care services for improved health outcomes.

Eligible elderly and/or physically disabled American Indians who live on or lived on a reservation prior to admission into an off-reservation facility will be enrolled in a Tribal ALTCS Program. Members will remain eligible for Tribal ALTCS if they continue to meet Medicaid medical and financial requirements.

Tribal ALTCS Programs

AHCCCS (Arizona Health Care Cost Containment System) works in partnership with seven Tribes and one Urban Indian Organization (UIO). The partnership is formed by an Intergovernmental Agreement or Contract to provide long-term care case management services to respective tribal members who are enrolled in an ALTCS health plan.

AHCCCS has an Intergovernmental Agreement (IGA) to provide Long-Term Care case management services to Tribal ALTCS members enrolled with any of the following tribes:

• Gila River Indian Community
• Hopi
• Navajo Nation
• Pascua Yaqui
• San Carlos Apache
• Tohono O’Odham Nation
• White Mountain Apache

Native American Community Health Center has a contract with AHCCCS to provide case management services to tribal members who qualify for ALTCS but are enrolled with a tribe that does not have its own Tribal ALTCS program. Tribal members enrolled with Native American Community Health Center for Tribal ALTCS case management services include members from:

• Ak-Chin Indian Community
• Cocopah Tribe
• Colorado River Indian Tribes
• Fort McDowell Yavapai Nation
• Fort Mohave Indian Tribe
• Havasupai Tribe
• Hualapai Tribe
• Kaibab-Paiute Tribe
• Quechan Tribe
• Salt River Pima-Maricopa Indian Community
• Tonto Apache Tribe
• Yavapai Apache Nation
• Yavapai Prescott Tribe

• Intergovernmental Agreement

Tribal ALTCS Member Handbook

• Member Guide | Word Version

Long Term Services and Supports (LTSS)

AHCCCS and Tribal ALTCS Programs are committed to ensuring that Tribal Arizona Long Term Care System (ALTCS) members receive culturally competent care in environments that prioritize independence and personal choice.

Prior Authorization: Providers must submit and obtain prior authorization for LTSS services by submitting a request to the assigned Tribal ALTCS Case Manager.

Long Term Care Services

• Adult Day Health Care Services
• Assisted Living Facilities
• Assisted Living Home
• Adult Foster Care Home
• Assisted Living Center
• Attendant Care Services
• Community Transition Service
• Habilitation Services
• Home Delivered Meals
• Home Health Services
• Home Modification
• Homemaker Services
• Hospice Services
• Personal Care Services
• Respite Services
• Nursing Facility Services
• DME, Orthotic, Prosthetic Device, and Medical Supplies
• Medically Necessary Non-Emergency Transportation (when mileage exceeds 100 miles)

Occupational (OT) and Physical Therapy (PT)

Inpatient OT and PT are included in the facility's authorization. Outpatient OT and PT do not require prior authorization. To avoid any delays in service care coordination, providers must submit their claim with supporting documentation to AHCCCS using the Provider Portal or via fax after rendering services.

Therapy visits limitations apply as specified in AMPM Policy 310-X regardless of enrollment changes throughout the benefit year.

Acute Medical

Inpatient hospitalizations for non-Medicare covered members and outpatient surgery must be authorized by the AHCCCS DFSM Medical/Utilization Review unit. The Tribal ALTCS Case Managers do not authorize the acute medical services.

Prior Authorization: Providers must obtain prior authorization for acute medical services by submitting requests to the AHCCCS Division of Fee-For-Service Management via fax. See the following for information on how to submit a PA request for acute services:

• PA Submission via fax: (602) 256-6591
• Providers must use the appropriate mandatory FFS Fax Cover Sheet for the services being requested when submitting a PA request and can be found on the Prior Authorization Forms webpage.
• Urgent Prior Authorization Requests:
• Notify the Care Management team at Caremanagers@AZAHCCCS.gov to notify them of the urgent request immediately after submitting the PA via fax.
• FFS Provider Training

For additional guidance and requirements regarding acute prior authorizations, refer to AMPM 820 – Fee-for-Service Authorization Requirements found on the AHCCCS Medical Policy Manual (AMPM) webpage.

Behavioral Health (BH) Services

AHCCCS covers BH services (behavioral health and/or substance use) within certain limits for members. The Tribal ALTCS Case Managers assist with care coordination and monitor outpatient and acute behavioral health admissions at hospitals and designated acute behavioral health facilities. Tribal ALTCS Case Mangers do not authorize these types of behavioral health services.

Prior Authorization: Providers must obtain prior authorization for BH services by submitting requests to the AHCCCS Division of Fee-For-Service Management via fax.

• PA Submission via fax: (602) 253-6695
• PA Request forms: Prior Authorization Forms webpage.

Inpatient behavioral health hospital admissions require submission of the following Fee For Service forms with the initial and subsequent continued stay PA requests: The Inpatient Certification of Need (CON) form is submitted with the initial request for PA. Inpatient Re-certification of Need (RON) is submitted with each continued stay PA request. Admissions to Behavioral Health Residential Facilities and initiation of treatment in an Intensive Outpatient Program also require the submission of IOP BHRF CON (initial request) and IOP BHRF RON (continued stay request) documents.

Vist the Prior Authorization Form webpage for the inpatient and IOP BHRF CON and RON documents.

Refer to Chapter 820 of the AHCCCS Medical Policy Manual (AMPM) for more information on PA requirements for acute medical and behavioral health services.

Dental Services

AHCCCS provides coverage of dental services within the limitations specified for Tribal ALTCS members when they are considered medically necessary and cost effective but may be subject to prior authorization by AHCCCS DFSM’s Medical PA Unit. Tribal ALTCS Case Managers assist with care coordination for dental services. Tribal ALTCS Case Mangers do not authorize dental services.

Prior Authorization: Dental services do not require a PA unless it exceeds the service limitations provided in the following resources.

For additional guidance and requirements regarding acute, behavioral, and dental prior authorizations, refer to AMPM 820 – Fee-for-Service Authorization Requirements.

Services that do not require Prior Authorization

Tribal ALTCS Case Mangers do not authorize the following services. To avoid any delays in service care coordination, providers must submit their claim with supporting documentation to AHCCCS using the Provider Portal or via fax after rendering services.

• Services performed during a Retroactive Eligibility Period
• When other coverage is primary, e.g.: Medicare or Commercial Insurance
• Emergency Medical Hospitalization less than 72 hours
• Diagnostic procedures, e.g., EKG, MRI, CT scans, X-rays, Labs, colonoscopy, EGD, Sleep Studies, cardiac catheterization
• Non–Surgical Procedures, e.g., PICC Line/Central Line removal or placement, PEG removal, Blood Transfusions
• Outpatient Chemotherapy and Non IMRT Radiation
• Emergency Dental and Dental Services for Members under 21 years old (AMPM Ch. 400), Some dental services for members under 21 do require prior authorization – see Ch 431 & Ch 820
• Emergency Dental Services for Members age 21 years and older up to the $1000 limit (AMPM Policy 310-D1)
• Eyeglasses for members under 21 years old
• Family Planning Services
• Physician Consultations and Office Visits
• Prenatal Care
• Emergency Transportation
• Non-Emergency Transportation of less than 100 miles
• Services billed by IHS/638 providers.

Prior Authorization Issues

LTSS: Providers must contact the Tribal ALTCS case manager to resolve prior authorization issues before contacting AHCCCS Customer Support Center or DFSM.

Acute Medical, Behavioral Health, and Dental Services: Providers must submit a service ticket to AHCCCS to resolve claims issues by using the ServiceNow option before contacting AHCCCS Customer Support or DFSM. Prior authorizations related to these services should not be directed to the Tribal ALTCS Programs.

Claim Submission and Status

Providers can use the AHCCCS Online Provider Portal to submit a claim or check the status of a claim.

All paper claims should be mailed, with adequate postage, to:
AHCCCS Claims
P.O. Box 6270
Phoenix, AZ 85005

If you are unable to resolve a claim issue using the Online Provider portal or after reviewing your remittance advice, please contact the AHCCCS Customer Support Center at ServiceNow.

For claim issues or questions, providers are required to submit a service ticket to AHCCCS using the ServiceNow option before contacting AHCCCS Customer Support or the Division of Fee-For-Service Management by phone.