When a PAS Assessor witnesses a situation with an applicant or member that calls for immediate intervention, the Assessor shall do one of the following:
For life-threatening situations, call 911.
For other situations, notify Adult Protective Services (APS) or Department of Child Safety (DCS) of the presence of serious physical or medical neglect.
When it appears that a referral to APS or DCS may be appropriate, the Assessor shall discuss the issue with his or her supervisor. In some cases, depending on the severity of the issue, the discussion may occur after the referral has been made. In less urgent situations, the supervisor may contact the AHCCCS Division of Managed Care Operations/Clinical Quality Management (DMCO/CQM) for guidance regarding contacting APS or DCS.
In addition, the Assessor shall notify DMCO/CQM using the online form on the AHCCCS website at https://www.azahcccs.gov/ACMS/default.aspx whenever one of the following is suspected:
A problem with the quality of the care being provided to the member;
The member is being abused or neglected;
The member has unmet medical or dental needs;
Provider fraud has been committed; or
The member is residing in an unlicensed or uncertified room and board home and is receiving direct, personal, or supervisory care services on other than a temporary basis pending ALTCS approval.
When completing the online Quality of Care Received form the Assessor shall indicate the severity status level as follows:
Severity Level 1. Potential quality of care issue with minimal adverse effects (issue may impact the member if not resolved).
Severity Level 2. Potential quality of care issue with moderate adverse effects (issue will impact the member if not resolved).
Severity Level 3. Potential quality of care issue that immediately impacts the member and is life-threatening or dangerous.
N/A
A Customer Issue Referral (CIR) form completed by the Assessor or Benefits and Eligibility Specialist.
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Program |
Legal Authorities |
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ALTCS |
42 CFR 483.430 |