C Changes Requiring Health Plan Agreement

Revised 08/20/2024

Policy

When agreement of the ALTCS Health Plan is required, both the enrollment change and the effective date must be approved by both the current and requested health plan. Officials representing both health plan must complete and sign portions of the Program Contractor Change Request (Exhibit 1620-8 in the AHCCCS Medical Policy Manual).

If the requested health plan does not agree to the change, the current health plan can ask the Division of Managed Care Operations (DMCO) to review the case situation. If the DMCO determines a change in enrollment would be in the best interest of the customer, DMCO may authorize the enrollment change. If the DMCO determines that a change in enrollment would not be in the best interest of the customer or does not support the choice of the customer, the DMCO may deny the enrollment change. The customer may file an appeal with AHCCCS.

Approval of both health plans is required when:

Who initiated the enrollment change...	Reason for change...
Customer or customer’s representative	Customer has moved to a medical facility or alternative HCBS living arrangement in a county not served by the current ALTCS Health Plan. Parent(s) and child customer live in different counties.
ALTCS Health Plan	ALTCS Health Plan is responsible for a customer residing outside of their service area and wishes to enroll customer with the health plan who serves the area. Customer residing in an institution wishes to move to another institution outside of the area served by the customer’s health plan. Customer initiates move to medical facility or alternative residential facility in another county and requests an enrollment change through the current health plan.