Arizona Long Term Care System

ALTCS Acute Health Plan Options

Health and Medical Services
This is also known as Acute Care Services. These services help you to maintain or restore good health. These services must be medically necessary and cost effective. These services are provided by your acute health plan. Your doctor is responsible for coordinating your health care through the acute health plan.

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Acute Health Plan Options
Your choices of acute health plans will depend upon the county in which you live. The current acute health plans are:

• United Healthcare (all counties) 1.800.348.4058 www.uhccommunityplan.com
• Mercy Care
• (Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, and Yuma Counties) 602.263.3000 or 1.800.624.3879 www.mercycareplan.com
• Banner Health

American Indians may also choose to get their acute health care services through the American Indian Health Plan (AIHP). American Indian members are able to receive health care services from any Indian Health Service provider or tribally owned and/or operated facility at any time.

If you are not sure which acute health plan you have picked or been assigned, call the Division’s Health Care Services at 602.771.8080 or 1.800.624.4964, if outside Maricopa County.

​You can change your acute health plan once a year. This is called open enrollment. You will be sent a letter with information about what choices are in your county.

If you want to change your acute health plan and it is not time for open enrollment, you may be able to change plans in special cases. You may be able to change your acute health plan if:

• You were not given a choice of acute health plans;
• You were not notified at your annual enrollment choice;
• You lost eligibility for 90 calendar days or less and were not put back on the same acute health plan you had before;
• You have a medical continuity of care issue

You will be notified if there is a change to the Division’s acute health plans. You can choose from the acute health plans available in your county. If you do not make a choice, you will be assigned to an acute health plan.

​If you are unhappy with your acute health plan, first call your acute health plan’s member services. They may be able to help you with any concerns you may have about your acute health 

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Services

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Pharmacy Services
Your acute health plan has a list of covered medications. If you want a copy of the list, call your acute health plan’s member services or go to their website.

All medications must be filled at a pharmacy in your acute health plan’s network. Many pharmacies are open 24 hours, seven days a week. Check your acute health plan’s member handbook for the process to get your medications after hours, holidays, or on weekends. You can get a list of pharmacies from your acute health plan.

Remember to get refills before you run out of medicine.

Medical Care Outside of Health Plan Network
If you decide to get medical care not in your acute health plan, you may have to pay for it. Out of pocket costs may be covered for medical care if you have other insurance. Check with your acute health plan’s member services about possible coverage.

Emergency and urgent care services are covered.
Medicare and Other Health Insurance
If you have other insurance let your doctors know.

If you have other insurance, that insurance will be billed first. Your acute health plan will pay your out of pocket costs to your doctor if it is a covered service within your acute health plan. Do not pay your out of pocket costs yourself. Ask your doctor to bill your acute health plan.

Your acute health plan does not pay for any medications paid by Medicare. It will also not pay for any out of pocket costs for these medications.

If you get a bill for a service that is covered, contact the agency that sent you the bill. You are not responsible to pay out of pocket costs, including AHCCCS co-payments. If you continue getting billed, contact the acute health plan’s member services. The division may also help you with these bills.

Covered Health and Medical Services
There may be health and medical services your acute health plan will not cover. If you receive services that are not covered, you may be billed for them. It is important you review your acute health plan member handbook. It contains more information and limits that may apply. In general, the following health and medical services are covered:

• Ambulatory surgery
• Anti-hemophilic agents and related services
• Audiology
• Behavioral Health
• Chiropractic services
• Dialysis
• Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
• Early detection health risk assessment, screening, treatment and primary prevention
• Emergency services
• Eye examinations/optometry
• Foot and ankle services
• Hospital services
• Immunizations
• Incontinence supplies
• Laboratory
• Maternity services

• Medical foods
• Medical supplies, Durable Medical Equipment (DME), orthotic and prosthetic devices
• Nutrition
• Oral health
• Physician services
• Post-stabilization care services
• Prescription medications
• Primary Care Provider (PCP) services
• Radiology and medical imaging
• Rehabilitation therapy
• Transplantation of organs and tissue and related prescriptions (Limitations apply
• Transportation
• Triage/Screening and evaluation
• Vision Services/Ophthalmology/Optometry
• Well visits (well exams) such as, but not limited to, well woman exams, breast exams and prostate exams are covered.

Transportation
Rides are only for covered health care visits. If you need a ride to an appointment, ask a relative, friend or neighbor first. If you cannot get a ride, call your acute health plan’s member services. They will help you set up transportation.
Here are some general tips if you need a ride:

• Call at least three calendar days before your health care visit.
• If you have an urgent need to see your doctor, try to call member services three hours before your visit.
• If you do not call ahead of time, the acute health plan may not have enough time to arrange transportation.
• If you have an emergency, call 911 or the emergency number in your area. You do not need to give advance notice.
• Let member services know of any special needs you have such as a wheelchair.

• Know the address of your health care provider.
• After your health care visit, call for a ride home.
• Be specific about where you want to be picked up.
• If you cancel your health care visit, call member services  to cancel your ride.
• Transportation is for you and your caregiver, if you need help during your health care visit. Parents should make other care arrangements for other children.

Incontinence Briefs and Incontinence Pads
Incontinence briefs are also called diapers, pull-ups, and incontinence pads. These are covered for members in the ALTCS program when needed to treat a medical condition. The conditions might be a rash, infection, or skin breakdown. Prior approval may be needed.

• You have a medical condition which causes incontinence. This is when your body is not able to control going to the bathroom.
• Your doctor gives you a prescription for the briefs.
• The briefs are from an approved vendor.
• Prior authorization may be needed.

You can get up to 180 incontinence briefs a month. Prior authorization is needed if your doctor says that briefs in a month are needed. You get the briefs from the DDD/ALTCS Health Plan providers.

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