Section R9-28-406. ALTCS Living Arrangements

A.      Long-term care living arrangements. A person may be eligible for ALTCS services, under Article 2, while living in one of the following settings:

1.        Institutional settings:

a.         A Nursing Facility (NF) defined in 42 U.S.C. 1396r(a),

b.        An Institution for Mental Diseases (IMD) for a per- son who is either under age 21 or age 65 or older,

c.         An Intermediate Care Facility for the Mentally Retarded (ICF-MR) for a person with developmental disabilities,

d.        A hospice (free-standing, hospital, or nursing facil- ity subcontracted beds) defined in A.R.S. § 36-401; or

2.        Home and community-based services (HCBS) settings:

a.         A person's home defined in R9-28-101(B), or

b.        Alternative HCBS settings defined in R9-28-101(B).

B.       ALTCS acute care living arrangements.

1.        A person applying for and otherwise entitled to receive ALTCS coverage shall receive only ALTCS acute care coverage if residing in one of the following living arrangements, settings, or locations:

a.         A noncertified medical facility, or

b.        A medical facility that is registered with AHCCCS but does not have a contract with an ALTCS pro- gram contractor, or

c.         At home or in an alternative HCBS setting when the person refuses HCBS services, or

d.        A licensed or certified HCBS facility that is not reg- istered with AHCCCS.

2.        Eligibility income limits.

a.         For a person residing in a setting described in sub- section (1)(a) or (1)(b), the gross income limit is 300 percent of the Federal Benefit Rate (FBR).

b.        For a person residing in a setting described in sub- section (1)(c) or (1)(d), the net income limit is 100 percent of the FBR.

C.      Inmate of a public institution. An inmate of a public institution is not eligible for the ALTCS program if federal financial par- ticipation (FFP) is not available as described under R9-22-310.

Historical Note

Adopted effective October 1, 1988, filed September 1, 1988 (Supp. 88-3). Section repealed, new Section adopted by final rulemaking at 5 A.A.R. 369, effective January 6, 1999 (Supp. 99-1). Amended by exempt

rulemaking at 7 A.A.R. 4691, effective October 1, 2001 (Supp. 01-3). Amended by final rulemaking at 20 A.A.R.

234, effective January 7, 2014 (Supp. 14-1).