MA1109B

Check for current AHCCCS eligibility. Is customer currently eligible?

• If YES, skip to Step 4 

• If NO, continue to Step 2

Instruct the customer to apply for AHCCCS.

NOTE     It is important to explain the difference between an AHCCCS application and a CRS application.

• If the customer did not apply for AHCCCS, STOP. Deny the CRS application and send a denial notice to the customer and any authorized parties.

• If the customer applied, continue to Step 3.

Monitor the AHCCCS application for a decision for14 days. Was the customer approved for full service acute care or ALTCS/DDD?

• If YES, continue to Step 4

• If NO, STOP.  Deny CRS application for the appropriate reason.

The AHCCCS CRS Nurse reviews the CRS application packet and requests more information if needed from the current health plan, the application referral source or the parent or representative to make the CRS designation determination.

When the information is received, the AHCCCS CRS Nurse (and as needed, the CRS Manager) reviews all information provided

• If the documentation does not verify a CRS condition and that active treatment is required within 18 months. STOP. Deny the application for “Not medically eligible for CRS” and send the denial notice.

• If the documentation does verify a CRS condition and active treatment is needed within 18 months, skip to Step 7.

• If unable to determine whether the condition meets CRS criteria according to the CRS rules, continue to Step 6.

Refer the CRS application and supporting documents to the CRS Physician Consultant for a decision. 

• If the CRS Physician Consultant determines the documentation does not verify a CRS condition, STOP. Deny the application for “Not medically eligible for CRS” and send the denial notice to the customer and health plan.

• If the CRS Physician Consultant determines the documentation does verify a CRS condition, continue to Step 7.

Approve the CRS application and send the approval notice to the customer and the health plan.