AHCCCS Benefit Changes
2017
Proposed Coverage of Occupational Therapy and Emergency Dental and Extraction Services
Overview
As part of the 2017 Legislative session, the Arizona Legislature passed SB 1527 which added occupational therapy in an outpatient setting and adult emergency dental services and extractions up to $1000 as covered benefits, effective August 9, 2017. AHCCCS must obtain CMS approval to amend its State Plan through a State Plan Amendment to reflect this update. AHCCCS plans to begin coverage of these services beginning October 1, 2017. Below is more information about the proposed coverage of occupational therapy and adult dental services and extractions.
EPSDT Services
AHCCCS assures that access to early and periodic screening, diagnostic and treatment (EPSDT) services are covered by the State for any child under 21 years of age eligible under the State Plan, in compliance with 42 CFR §440.345.
Tribal Consultation
AHCCCS consulted with tribes regarding the coverage of occupational therapy and emergency dental and extraction services on July 27, 2017. Below is a link to more information regarding the 07/27/2017 Tribal Consultation.
Tribal Consultation 07/27/2017
DRAFT State Plan Amendment and Public Comment Period
AHCCCS is accepting public comments on the DRAFT State Plan Amendment to add occupational therapy in an outpatient setting and adult emergency dental services and extractions up to $1000 as covered benefits. The DRAFT SPA can be found on the link below:
Comments are being accepted through September 11, 2017, and can be submitted as follows:
Email: publicinput@azahcccs.gov
OR
Mail: AHCCCS
Attn: Office of Intergovernmental Relations
801 E. Jefferson St., MD 4200
Phoenix, AZ 85034
2016
Proposed Coverage of Podiatry Services Performed by a Licensed Podiatrist
Overview
As part of the 2016 Legislative session, the Arizona Legislature passed HB 2704 to add podiatry services performed by podiatrist who is licensed pursuant to title 32, chapter 7 and ordered by a primary care physician or primary care practitioner as a covered benefit for all AHCCCS members, effective August 6, 2016. AHCCCS must obtain CMS approval to amend its State Plan through a State Plan Amendment to reflect this update. AHCCCS plans to begin coverage of this service beginning October 1, 2016. Below is more information about the proposed coverage of podiatry services performed by a licensed podiatrist.
EPSDT Services
AHCCCS assures that access to early and periodic screening, diagnostic and treatment (EPSDT) services are covered by the State for any child under 21 years of age eligible under the State Plan, in compliance with 42 CFR §440.345.
Tribal Consultation
AHCCCS consulted with tribes regarding the coverage of podiatry services performed by a licensed podiatrist on May 18, 2016. Below is a link to more information regarding the 05/18/2016 Tribal Consultation.
Tribal Consultation 05/18/2016
DRAFT State Plan Amendment and Public Comment Period
AHCCCS is accepting public comments on the DRAFT State Plan Amendment to add podiatry services performed by a licensed podiatrist as a covered benefit. The DRAFT SPA can be found on the link below:
DRAFT SPAComments are being accepted through July 20, 2016, and can be submitted as follows:
Email: LegislativeBenefitChange@azahcccs.gov
OR
Mail: AHCCCS
Attn: Office of Intergovernmental Relations
801 E. Jefferson St., MD 4200
Phoenix, AZ 85034
2014
Proposed Coverage of Insulin Pumps
Overview
As part of the 2014 Legislative session, the Arizona Legislature passed HB 2705 to add insulin pumps as a covered benefit for all AHCCCS members, effective October 1, 2014. Insulin pumps were previously eliminated as a covered adult benefit on October 1, 2010. AHCCCS must obtain CMS approval to amend its State Plan through a State Plan Amendment to reflect this update. Below is more information about the proposed coverage of insulin pumps.
EPSDT Services
AHCCCS assures that access to early and periodic screening, diagnostic and treatment (EPSDT) services are covered by the State for any child under 21 years of age eligible under the State Plan, in compliance with 42 CFR §440.345.
Tribal Consultation
AHCCCS consulted with tribes regarding the coverage of insulin pumps on April 17, 2014, in compliance with Section 5006(e) of the American Recovery and Reinvestment Act of 2009. Below is a link to the summary of the 04/17/2014 Tribal Consultation.
DRAFT State Plan Amendment and Public Comment Period
2011
Overview
On March 15, 2011, Governor Brewer presented her plan to preserve Arizona's Medicaid program with reforms that will drive down costs by an estimated $500 million in the State's General Fund for the partial first year. The plan was approved by the Legislature as part of the FY 2012 budget adoption.
The plan includes changes to the AHCCCS member benefits and will be effective October 1, 2011, unless otherwise indicated. More information is provided below. Continue to check this page for updates as they become available.
Fact Sheets
AHCCCS Memos to Providers
AHCCCS will publish memoranda regarding additional information as it becomes available.
Information for Members
AHCCCS members received the following information from their respective Health Plans.
Regulatory Updates
Proposed changes to the Administrative Code, State Plan, and 1115 Waiver will be posted here as they become available.
Administrative Code (rules)- Adult Inpatient Limits and Member Billing
- Restoration of Transplants (eff. 04/01/2011)
- Respite Reduction
- Emergency Department Limit
FAQs
The Frequently Asked Questions (FAQs) respond to inquiries about the benefit changes. As AHCCCS continues its review, it will update the FAQs. If you do not find a response to your question, please email: LegislativeBenefitChange@azahcccs.gov. Members should contact their health plans for additional information.
Benefit Changes FAQs- 2011 (Updated 03/15/2013) Respite Changes FAQs
2010
Overview
In response to significant fiscal challenges facing the State and substantial recent growth in the Medicaid population, AHCCCS implemented several changes to the adult benefit package, effective October 1, 2010. The benefits eliminated or limited are all considered optional services under federal law and, therefore, AHCCCS is not required to provide them. More information about these changes is provided below. Continue to check this page for updates as they become available. Information available at this time is outlined in the Benefit Fact Sheet below.
Transplant Restoration Update
Governor Brewer’s Medicaid Reform Plan restores the transplants AHCCCS previously covered for adult members age 21 and older effective April 1, 2011. See the links below for additional information:
Legislation
The FY 2010 enacted budget directs AHCCCS to eliminate various medical and health services for adults.
HB 2010 (See page 21 of this PDF file, which is page 20 of the bill.)
AHCCCS Memos to Providers
AHCCCS will publish memoranda regarding additional information as it becomes available.
- Memo, Transplant Restoration - 04/07/2011
- Memo, Well Exams - 10/20/2010
- Memo, Benefit Changes - 08/02/2010
- Memo, Podiatric Services - 04/05/2010
Regulatory Updates
When available, proposed changes to the State Plan and Arizona Administrative Code will be posted here.
Transplant Restoration Proposed Rule
Benefit Changes Exemption Request - pending before CMS
Waiver Amendment (NEMT)
Medicaid State Plan Amendments (SPAs)
Final Rules filed with AZ Secretary of State
- R9-22-101, R9-22-201, R9-22-202, R9-22-203, R9-22-205, R9-22-206, R9-22-207, R9-22-212, R9-22-215: Service Limitations/Exclusions
- R9-28-206: Arizona Long Term Care System (ALTCS)
- R9-22-206: Exclusion of Pancreas-only Transplants
Medical Policy Updates
Transplants (Refer to updated info above)Background information about the changes to the AHCCCS coverage criteria for adult organ transplants is provided in the links below.
- Transplant Changes Summary - 10/06/2010
- Transplant Analysis Details
- Cyrcahealth Reviews
- Liver Transplant Policy Review and Recommendation - 10/06/2010
- Heart Transplant Policy Review and Recommendation - 03/01/2010
- Lung Transplant Policy Review and Recommendation - 11/22/2009
- Heart/Lung Transplant Policy Review and Recommendation - 07/20/2009
- Stem Cell Transplant Policy Review and Recommendation - 06/22/2009
The AHCCCS Medical Policy Manual (AMPM) has been amended to reflect the changes in the adult benefit package, effective 10/01/2010. Conforming changes to other sections of the AMPM have also been posted.
The current version of the AMPM, with all revisions, can be viewed by following the link below:
- AHCCCS Medical Policy Manual (Please note the What's New memo, which includes a summary of significant changes.)
By letter dated December 17, 2010, CMS informed AHCCCS it will not approve the request to waive the requirement to provide Non Emergency Medical Transportation (NEMT) to childless adults below 100 percent of the Federal poverty level and for Medical Expense Deduction (MED) participants in Maricopa and Pima counties. Therefore, AHCCCS will NOT make any changes to the coverage of NEMT.
FAQs
The Frequently Asked Questions (FAQs) respond to inquiries about the benefit changes. As AHCCCS continues its review, it will update the FAQs. If you do not find a response to your question, please email: LegislativeBenefitChange@azahcccs.gov. Members should contact their health plans for additional information.
Benefit Changes FAQs - 09/15/2010
Information about Optional Services AHCCCS covers beyond federal requirements is provided below.