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Each year effective on the customer’s anniversary date, an ALTCS customer whose fiscal county is Maricopa, Gila, Pinal, or Pima has the opportunity to change enrollment to one of the other ALTCS health plans that serves their fiscal county.
Generally, once enrollment occurs a customer cannot change enrollment until their anniversary date. However, an ALTCS customer whose county of fiscal responsibility is Maricopa, Gila, Pinal, or Pima may ask to change to a different ALTCS Health Plan serving that county. In certain circumstances, the customer’s request may be approved to allow an enrollment change prior to the anniversary date.
The ALTCS local offices have the authority to approve the change request when any of the following conditions exist:
Incorrect information or agency error;
Lack of initial enrollment choice;
Lack of annual enrollment choice;
Family continuity of care;
Continuity of institutional or residential setting; and
Failure to correctly apply the 90-day re-enrollment policy.
An enrollment change may also be made based on medical continuity of care, but requires the involvement of both the current and receiving ALTCS Health Plans.
If an enrollment change is requested for another reason, the customer is referred to his or her current ALTCS Health Plan.
The customer or the customer’s representative may contact the ALTCS local office and request an enrollment change.
The current ALTCS Health Plan sends an Electronic Member Change Report to the ALTCS local office when the customer or representative requests an enrollment change through their current ALTCS Health Plan and claims one of the situations in MA1107C.
An enrollment change is effective the first day of the month following the month in which the change is made.
Exception
When the county of fiscal responsibility is changed, the county change and any related enrollment change is effective the day the change is made.
The customer will receive a denial letter informing them of their hearing rights. The customer may file a grievance with AHCCCS if an enrollment change request is denied.
See How to Evaluate a Health Plan Change Request for more information.
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Term |
Definition |
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90 Day Re-enrollment Rule |
If the customer was enrolled with an AHCCCS Health Plan within the 90 days prior to the current approval date, the customer is automatically re-enrolled with the same health plan. |
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Anniversary Date |
The date that coverage first goes into effect becomes its anniversary date each year. |
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Program |
Legal Authorities |
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ALTCS |
ARS 36-2932 and 2933 AAC R9-28-413 |