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AHCCCS covers medically necessary nursing facility services for members in both the acute and long term care programs. For AHCCCS members in the Acute Care program, services in nursing facilities, including room and board, are available for members who require short-term convalescent care up to a maximum of 90 days per contract year (fee-for-service coverage may be available if the stay goes beyond the 90 day per contract year maximum. Such coverage must be requested by the nursing facility and will be assessed on a case by case basis). For AHCCCS members in the Arizona Long Term Care System (ALTCS) program, services in nursing facilities, including room and board, are available to members who require these services on a continuous basis but who do not require hospital care or direct daily care from a physician. A nursing facility must be licensed and Medicare/Medicaid certified by ADHS in accordance with federal regulations in 42 CFR Part 483.
A.R.S. § 36-2999.51 et seq. authorize the Administration to administer a provider assessment on health care items and services
provided by nursing facilities and to make supplemental payments to nursing facilities for covered Medicaid expenditures. More
information can be found at the link below:
Nursing Facility Tax Assessment
The spreadsheet located at the link below provides statistics regarding AHCCCS nursing facility days, by facility, by payor, for dates of service from October 1, 2012 through September 30, 2013. Payor information is included for the ALTCS Elderly and Physically Disabled (EPD) Contractors and the AHCCCS Fee-For-Service (FFS) program.
The spreadsheet located at the link below provides statistics regarding AHCCCS nursing facility days, by facility, by payor, for dates of service from October 1, 2013 through September 30, 2014. Payor information is included for the ALTCS Elderly and Physically Disabled (EPD) Contractors and the AHCCCS Fee-For-Service (FFS) program.
Nursing facility assessment funds are matched with Federal Medicaid dollars; the majority of the funds are paid to ALTCS EPD Contractors so that they can make enhanced payments to nursing facilities in accordance with Federal and State laws and regulations and CMS approval. The remaining portion of the funds are used by AHCCCS to make Fee-For-Service supplemental payments to nursing facilities according to those same requirements. The spreadsheet found at the link below details the amount of the funds paid to ALTCS EPD Contractors and the AHCCCS FFS program.
Provider supplemental payments related to Fee-For-Service utilization are made directly to nursing facility providers from the Administration. The following links show the supplemental payments that come directly from AHCCCS to the providers.