P1105 ALTCS Program Contractor Choice

MA1105

Enrollment choice may be provided verbally or in writing. When preparing for the financial interview, review the case file. Did the customer provide an enrollment choice?

• If YES, STOP. Enter the enrollment choice on the Enrollment Choice screen in HEAplus.

• If NO, continue to Step 2.

NOTE     Discuss the enrollment choice during the financial interview using the Program Contractor Choice Documentation form (DE-970). Advise the customer or representative they may also call the program contractor for information. To see program contractor choices available in the customer’s county, click here. The DE-970 is for internal use only and should not be mailed to the customer or the person acting on the customer’s behalf.

Complete Section 1 of the DE-970 to determine the customer’s demographics and prior enrollment information.

Ask whether the customer plans to remain in the current living arrangement and wants to keep current service providers.

Using the program contractors’ websites, identify any program contractors that contract with the customer’s current or preferred providers. Document your findings on the DE-970.

Compare the program contractors by completing Section 2 of the DE-970. Discuss the results with the customer or representative.

NOTE     When the customer is already enrolled in an ACUTE health plan, check to see if that health plan serves as an ALTCS program contractor. For example, if the customer’s fiscal county is Maricopa, and they are on UnitedHealthcare for their ACUTE coverage, they may want to use the same company for their program contractor.

After reviewing program contractor options, does the customer or representative make a choice?

• If YES, STOP. Enter the choice on the DE-970 and the Enrollment Choice screen in HEAplus. Document the customer’s choice in the case notes.

• If NO, document in case notes that the customer is not ready to make a choice. Follow up with the customer in 10 days. Continue to Step 8.

Contact the customer or representative after 10 days to see if a choice has been made. Has the customer or representative made a choice?

• If YES, STOP. Enter the choice on the DE-970 and the Enrollment Choice screen in HEAplus. Document the customer’s choice in case notes.

• If NO, continue to Step 9 and document in case notes that the customer is not ready to make a choice.

Has the customer or representative asked for more time to make the decision?

• If YES, check to see if the PAS is complete and continue to Step 10.

• If NO, continue to Step 11.

Is the PAS complete?

• If YES, allow the customer 5 more days, or until the 45th day, whichever comes first, to make a choice.

• If NO, inform the customer they have until the PAS is complete to make a choice.

When the customer is unable or unwilling to make a choice, review Section 2 of the DE-970. Does the customer live in a nursing facility or an HCBS residential facility (assisted living, group home, etc.)?

• If YES, continue to Step 12.

• If NO, continue to Step 13.

When the customer lives in or plans to live in a nursing facility or HCBS facility, assume the customer wishes to remain in the same setting, unless there is conflicting information. Does the facility contract with only one available program contractor?

• If YES, STOP. Enroll the customer with that program contractor.

• If NO, continue to Step 13.

When the customer lives at home OR in a facility that contracts with more than one or none of the available program contractors, does the customer’s primary care physician (PCP) contract with any of the program contractors?

• If YES, continue to Step 14.

• If NO, STOP. Leave the ALTCS Option on the Enrollment Choice screen in HEAplus blank. The customer will be auto assigned in PMMIS.

Does the PCP contract with only one available program contractor?

• If YES, enroll the customer with that program contractor.

• If NO, leave the ALTCS Option on the Enrollment Choice screen in HEAplus blank. The customer will be auto assigned in PMMIS.