P1501 Changes Reported or Requested by an ALTCS Program Contractor

Program	Manual Section
ALTCS	MA1501B

Procedures

ALTCS program contractors may report or request changes for customers using one of the following methods:

Notification Method

Purpose

ALTCS Program Contractor Change Request (DE-621)

Notifies AHCCCS when two program contractors have agreed to a change in enrollment for the customer

Electronic Member Change Report

Used to electronically submit any of the following changes or requests to an AHCCCS:

Demographic changes or corrections;
Death of customer;
Address or living arrangement changes;
Medicare or TPL changes;
Income and resource changes;
Refusal of HCBS services;
Voluntary withdrawals;
Customer’s temporary absence from Arizona;
Customer’s return to Arizona following a temporary absence; or
Tribal transfers to another program contractor.
Enrollment change requests within Maricopa or Pima County when the customer claims that one of the situations in MA1106 exists; or
PAS Reassessment requests.

Changes reported by the ALTCS program contractor must be verified before any action can be taken. Follow the verification instructions for the specific change in MA1502.

When a change action is appropriate, process the change no later than five working days after the Electronic Member Change Report is received. Complete the response section of the Electronic Member Change Report and return it to the program contractor to report the action taken.

Document actions taken in the case notes and place any attachments or supporting documents sent by the program contractor in the case file