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The Share of Cost (SOC) is a monthly amount a customer must pay toward the cost of long term care services. Customers who qualify for ALTCS or FTW – ALTCS may have a SOC. However, the maximum SOC is limited to the monthly capitation rate for the customer.
Customers who get ALTCS Acute Care only, and FTW – ALTCS customers who live in an HCBS setting do not have a SOC.
The SOC amount is based on the customer’s:
· Counted income;
· Living arrangement; and
· Allowed SOC deductions.
The SOC is recalculated each time there is a change in the customer’s income or amount of the SOC deductions.
The ALTCS program contractor is usually responsible for collecting the SOC from the customer. However, there are exceptions as described in the table below:
If the customer... |
Then... |
Is eligible, but not enrolled during a month |
The program contractor is not responsible for collecting the customer's SOC for that month. |
Changes program contractors during the month |
Each program contractor is entitled to a portion of the monthly SOC based on the number of days the customer is enrolled with that program contractor. The program contractor with whom the customer is first enrolled during the month is responsible for collecting the SOC, figuring each program contractor’s share, and transferring the prorated SOC amount to the receiving program contractor. |
Term |
Definition |
ALTCS Acute Care only |
The customer qualifies for the ALTCS program but cannot receive long-term services. |
Capitation rate |
A fixed rate paid to the health plan or program contractor for the delivery of services to each customer enrolled with that health plan or program contractor, regardless of the amount of medical services the customer receives. |
Program |
Legal Authorities |
ALTCS |
42 USC 1396a(q) and 42 USC 1396r-5(d) 42 CFR 435.725 and 435.726 ARS 36-2932(L) AAC R9-28-408, 410, 411 |
FTW-ALTCS |
42 USC 1396a(q) and 42 USC 1396r-5(d) ARS 36-2950 AAC R9-28-1321 |