Arizona Health Care Cost Containment System
Arizona Long Term Care System (ALTCS) Performance Measure

Initiation of Home and Community Based Services
For Elderly and Physically Disabled Members

Measurement Period: October 1, 2008, through September 30, 2009
Prepared by the Division of Health Care Management
August 2010

Thomas J. Betlach
Director, AHCCCS

“Our first care is your health care”

Performance Measure Project Summary

Background: More than 10 million Americans require long-term care services, ranging from skilled
nursing care to support services, such as help with activities of daily living (dressing and bathing, for
example). Estimates of total U.S. spending on long-term care services range from $194 billion to $280
billion. Medicaid is the largest financier of long-term care services, with studies estimating the
proportion at 40 percent or more of all long-term care spending.1,4
Home and community-based services (HCBS) have become a growing part of states’ Medicaid
programs, providing a cost-effective alternative to institutional care for the elderly and physically
disabled.5 With the appropriate services, many people who would otherwise live in nursing facilities
are able to live in private homes or in community residential settings. More than 67 percent of elderly
and physically disabled Arizonans enrolled in the Arizona Long Term Care System (ALTCS) reside in
home and community-based settings.
Purpose:
AHCCCS annually measures the percentage of newly placed HCBS ALTCS members
who receive specific services within 30 days of enrollment, as required by AHCCCS medical policy.
This measure assesses Contractor performance in this area.
Goals:
AHCCCS has established a Minimum Performance Standard (MPS) for ALTCScontracted health plans (Contractors) that 92 percent of their members included in this measurement
will have a service within 30 days of enrollment. The AHCCCS goal for this measure is 98 percent.
Methodology: The measurement period for the current study is October 1, 2008, through September
30, 2009. A representative random sample was selected for each Contractor. The sample frame
consists of elderly and physically disabled (E/PD) members who:
•
were enrolled for 30 days or more with an ALTCS Contractor during the measurement period,
•
were newly placed in an HCBS setting, other than an assisted living facility, and
•
were not ventilator-dependent, as Contractors are required to initiate services for those members
within 14 days of enrollment.
Also excluded were members who died, were hospitalized, receiving hospice services, or refused
services when these situations were documented as occurring within 30 days of enrollment.
Data were first collected from AHCCCS encounter data (records of claims paid by Contractors). If
services within 30 days of enrollment were not found in AHCCCS encounter data, Contractors were
asked to provide information from medical or case management records or their claims data. Data
collected by Contractors were validated against documentation, such as copies of the pertinent sections
of case management records, medical/service records from providers, or verification of claims paid by
Contractors for qualifying services.
Results:
In the current measurement, 96.0 percent of members received services within 30 days
of enrollment, a statistically significant increase over the previous rate of 94.4 percent. There was no
significant difference in rates of initiation of services between rural and urban counties, or by
members’ race or ethnicity.
Rates by Contractor ranged from 90.0 percent to 100 percent. Six of the eight Contractors exceeded
the minimum standard and three achieved the AHCCCS goal. Contractors that did not meet the MPS
will be required to implement corrective action plans to bring their rates up to the standard.

Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long Term Care System (ALTCS)
PERFORMANCE MEASURE for INITIATION OF HOME AND
COMMUNITY BASED SERVICES
For the Measurement Period October 1, 2008, through September 30, 2009

consists of a variety of medical and social
services to help meet the health and personal
needs of people with chronic illness or
disability. These services range from skilled
nursing care to support services, such as
help with activities of daily living (dressing
and bathing, for example).

Introduction
It is estimated that roughly two-thirds of
Americans age 65 and older today will
eventually need some type of long-term care
— ranging from personal care assistance for
managing daily activities at home to nursing
home care — for an average of three years. 1

Medicaid is the main source of long-term
At the same time, significant increases in the
care
coverage
and
elderly population are
financing in the U.S.,
occurring.2 In less
accounting for at least
than 20 years, the
Home and community$112
billion
in
number of Arizonans
1,4
expenditures.
More
age 65 and older is
based services provide a
expected to be almost
than
half
of
all
Medicaid
cost-effective
2 million, or about 20
long-term care spending is
alternative to
for institutional care, but a
percent of the state’s
institutional care for the
growing share – 43
population.3
percent in 2007, up from
elderly and physically
30 percent in 2000 – went
While the health of
disabled.
older Americans is
to home and communityimproving
overall,
based services (HCBS). 1
― The Kaiser Commission on
More than $45 billion in
many are disabled and
Medicaid and the Uninsured
Medicaid dollars went to
suffer from chronic
home health, personal
conditions. About 80
care and other home and
percent of seniors
community-based services
have at least one
in federal fiscal year 2008.1
chronic health condition, and 50 percent
have two or more chronic health conditions,
These services provide a cost-effective
such as arthritis, hypertension, heart disease,
alternative to institutional care for the
diabetes and respiratory disorders. 2
elderly and physically disabled (E/PD). In
More than 10 million Americans, including
addition, research has shown a strong
about 6 million elderly and 4 million
connection between receiving services in the
children and working-age adults, need longhome and improved consumer satisfaction
term services and supports. Long-term care
and overall quality of life.4
1

provider (PCP) and other providers,
addresses any problems with service
delivery, and modifies the member’s care
plan based on changes in health status. Case
managers visit new members and, in
conjunction with those members or their
representatives, assess needs to determine
the most appropriate services and placement.
AHCCCS requires that contracted health
plans initiate home and community-based
services within timelines to meet members’
medical needs, but no later than 30 calendar
days from their date of enrollment.

Arizona has developed an HCBS program
that allows long-term care members to
choose this option when appropriate. People
receiving HCBS generally are more likely to
have family caregiver involvement and
assistance and have fewer needs resulting
from cognitive impairments.
The AHCCCS HCBS Program
The Arizona Health Care Cost Containment
System (AHCCCS) has provided home and
community-based services to long-term care
beneficiaries through a waiver from the
Centers for Medicare and Medicaid Services
(CMS) since 1989. Through its Arizona
Long Term Care System (ALTCS),
AHCCCS provides comprehensive coverage
for HCBS members residing in their own
homes or approved alternative residential
settings, such as assisted living facilities or
group homes. Covered services include care
such as home health nursing, attendant or
personal care, and home-delivered meals.
Members may designate a family member or
friend to provide attendant care; after
completion of training, these caregivers can
be paid by AHCCCS.

To ensure that member needs continue to be
met in the most appropriate setting, case
managers reassess members’ physical and
functional status at regular intervals and
monitor the ongoing provision of services.
AHCCCS also monitors service provision
through regular reviews of Contractor
operations.
AHCCCS annually measures the percentage
of newly placed HCBS members who
receive specific services within 30 days of
enrollment. This measurement is conducted
to
determine
individual
Contractor
compliance with performance standards in
contract, as well as to analyze overall rates
of initiation of services for HCBS members.

In September 2009, 67.6 percent of the
25,237 elderly and physically disabled
Arizonans enrolled in ALTCS resided in
home and community-based settings.

It should be noted that this measurement
does not include all covered home and
community-based services. For example,
emergency-alert and home-modification
services are not included because they are
typically provided in conjunction with
nursing, personal care or other supportive
services. This measurement focuses on the
health-related services that primarily allow
ALTCS members to remain in their homes
as long as possible (see Appendix A,
Methodology, for a complete list of services
and service codes included in this
measurement).

By providing a variety of alternative settings
with differing levels of care, ALTCS
members may be able to transfer from
nursing homes to home or other communitybased settings or delay institutionalization
for a longer period of time.
Once eligibility for ALTCS is determined
based on financial and medical criteria,
E/PD members enroll with a contracted
health plan (Contractor). Each member is
assigned a case manager, who coordinates
care with the member’s primary care

2

Contractors show encounter-omission rates
of less than 5 percent for each year.

Methodology
The measurement period for the current
study is October 1, 2008, through September
30, 2009. A representative random sample
was selected for each Contractor. The
sample frame consists of E/PD members
who:
•
were enrolled for 30 days or more with
an ALTCS Contractor during the
measurement period, and
•
were newly placed in an HCBS setting,
other than an assisted living facility.

To validate additional information collected
by
Contractors,
AHCCCS
required
documentation of services provided or
reasons why a member did not receive
services (for example, the member refused
services while waiting for a family member
to become trained to provide attendant care).
Documentation provided by Contractors
included copies of the pertinent sections of
case management records, medical/service
records from providers, or verification of
claims paid by Contractors for qualifying
services. This documentation was reviewed
by AHCCCS staff with expertise in ALTCS
case management.

This study does not include ventilatordependent members, as Contractors are
required to initiate services for those
members within 14 days of enrollment.
Data were first collected from AHCCCS
encounter data (records of claims paid by
Contractors). If services within 30 days of
enrollment were not found in AHCCCS
encounter data, Contractors were asked to
provide information from medical or case
management records or their claims data.

Performance Standards
For this reporting period, AHCCCS set the
Minimum Performance Standard (MPS) that
Contractors must achieve for this measure at
92 percent. Contractors who do not meet the
MPS must develop and implement
corrective action plans, as approved by
AHCCCS. If Contractors are already
achieving the minimum standard, they
should strive for the AHCCCS goal of at
least 98 percent.

In analyzing initiation of services, AHCCCS
did not include members who: died, were
residing in and receiving services from an
assisted living facility or nursing home,
were admitted to a hospital, were receiving
hospice services, or refused services when
these situations were documented as
occurring within 30 days of enrollment. Five
members also were excluded for other
reasons, primarily because another payer,
such as Medicare, was providing a service
for the member during the first 30 days.
Percentages of members who fell into one of
the above categories are reported in Table 1.

Results and Analysis
The original study sample included 861
HCBS members enrolled with eight
Contractors serving ALTCS E/PD members.
Of those, 133 people were excluded because
they were residing in assisted living
facilities or transferred to nursing homes
(27), were admitted to hospitals (15), were
receiving hospice services (21), died (4),
refused services (21) or were waiting for a
family member or friend to complete
training as their paid caregiver and did not
want someone else to provide services (45)
in the first 30 days of enrollment (Table 1).

Data Quality and Reliability
AHCCCS conducts validation studies to
evaluate the completeness of encounter data.
The two most recent annual studies of
encounters submitted by ALTCS E/PD

3

Member exclusions by Contractor were:

Discussion
Given the variety and complexity of
members’ needs and personal situations
when they enroll in the ALTCS program,
Contractors’ case managers face distinct
challenges in ensuring that enrollees have
prompt access to home and community
based services that fit with their individual
choices and needs. Despite these challenges,
the overwhelming majority of new ALTCS
members placed in HCBS settings receive
services within 30 days of enrollment.

Exclusions by Contractor
Bridgeway Health Solutions
Cochise Health Systems
Evercare Select
Mercy Care LTC
Pima Health System LTC
Pinal/Gila LTC
SCAN LTC
Yavapai County LTC
TOTAL

23
8
16
21
31
7
20
7
133

Since much of the data for this measure is
collected from case management records
when claims or encounters for services are
not available, Contractors must ensure that
case managers thoroughly and consistently
document when home and community-based
services are initiated for new members or
when members or authorized representatives
refuse services. Over the past few years,
AHCCCS has worked with Contractors to
improve documentation.

Among the remaining 728 people, 699 or
96.0 percent received services within 30
days of enrollment (Table 2), which was a
statistically significant increase over the
previous rate of 94.4 percent (p= .015).
Initiation of Services <30 Days
Did Not
Receive
Servic es,
4.0%

Quality Improvement Initiatives
ALTCS
Program
Contractors
have
developed numerous initiatives over the
years to enhance the quality of life of HCBS
members, several of which facilitate timely
access to care. These include:
•
Monitoring service provision to HCBS
members within one to two weeks of
enrollment. Reports are run at regular
intervals and provided to case managers.
•
The use of automated case management
systems, which can be used to track
timeliness of service initiation and generate
reminders for case managers to follow up.
•
The development of multi-disciplinary
teams that combine case management,
medical
management
and
quality
management staff to more closely monitor
needs of members in the HCBS program and
develop new ways to facilitate timely access
to care.

Rec eived
Services,
96.0%

There was no significant difference in rates
of initiation of services between rural and
urban counties. There also were no
significant differences in rates for members
who identified themselves as Hispanic,
Native American, Black or “other”,
compared with non-Hispanic White
members.
Rates by Contractor ranged from 90.0
percent to 100 percent. Six of the eight
Contractors exceeded the Minimum
Performance Standard and three achieved
the AHCCCS goal.

4

•

During this measurement period, SCAN
Long Term Care staff identified attendant
care agencies that would come into
members’ homes to train caregivers, in order
to assist members in receiving services more
quickly when they have designated a family
member or friend to help care for them. This
Contractor showed substantial improvement
over the previous year to meet the minimum
performance standard.

Conclusions
AHCCCS raised the minimum performance
level in the previous year in order to
encourage continued improvement. As a
result, Contractors have implemented
interventions that have led to overall
improvement and continued progress toward
the long-range goal for ensuring timely
initiation of services for members in home
and community based settings.

Initiation of HCBS Services Performance Measure Trend
120

100

80

60

40

20

0
CYE 03

CYE 04

CYE05

CYE 06

Overall Rate

5

CYE 07

CYE 08

AHCCCS MPS

CYE 09

References
1

Engquist G, Johnson C, Lind A, Barnette LP.
Policy Brief: Medicaid-Funded Long-Term
Care: Toward More Home- and CommunityBased Options. Center for Health Care
Strategies. Hamilton, NJ. May 2010. Available
at:
http://www.chcs.org/publications3960/publicatio
ns_show.htm?doc_id=1253871. Accessed July
6, 2010.
2
Wan H, Sengupta M, Velkoff VA, DeBarros
KA. 65+ in the United States: 2005. U.S.
Census Bureau, Current Population Reports,
P23-209, U.S. Government Printing Office,
Washington, DC, December 2005. Available at:
http://www.census.gov/population/www/socdem
o/age.html#elderly. Accessed June 12, 2006.
3
The state long-term care health sector 2005:
Characteristics, utilization and government
funding. American Health Care Association.
Washington, DC, August 2006. Available at:
http://www.ahca.org/research/index.html.
Accessed July 5, 2007.
4
Medicaid: A primer. Kaiser Commission on
Medicaid and the Uninsured. Washington DC.
June 2010. Available at:
http://www.kff.org/medicaid/upload/733404.pdf. Accessed July 6, 2010.
5
Appelbaum R, Schneider B, Kunkel S, Davis S.
A guide to quality in consumer directed services.
Scripps Gerentology Center. Miami University.
May 2004. Available at:
http://www.hcbs.org/files/42/2099/Guidefront.p
df. Accessed June 21, 2005.

For questions or comments about this
report, please contact:
Rochelle Tigner,
Quality Improvement Manager
Clinical Quality Management Unit
Division of Health Care Management
MD 6700
701 E. Jefferson St.
Phoenix, AZ 85034
rochelle.tigner@azahcccs.gov

6

Table 1
AHCCCS ALTCS PERFORMANCE MEASURE
INITIATION OF HOME AND COMMUNITY BASED SERVICES
Exclusions from Analysis of Initiation of Services, All Contractors
Measurement Period: October 1, 2008, through September 30, 2009

Reason

n

Percent

Member in Assisted Living Facility/Nursing Facility

27

20.3%

Member Admitted to Hospital

15

11.3%

Member Recieving Hospice Services

21

15.8%

Member Refused Services

21

15.8%

Member Awaiting Designated Caregiver to be Trained

45

33.8%

Died

4

3.0%

133

100.0%

TOTAL

7

Table 2
AHCCCS ALTCS PERFORMANCE MEASURE
INITIATION OF HOME AND COMMUNITY BASED SERVICES
WITHIN 30 DAYS OF ENROLLMENT, BY CONTRACTOR
Measurement Period: Oct. 1, 2008, through Sept. 30, 2009
Minimum Performance Standard: 92%

Number who Percent who
Received
Received
Service Within Service Within
30 Days
30 Days

Contractor

n

Evercare Select

62

61

98.4%

68

68

100.0%

144

140

97.2%

131

129

98.5%

33

33

100.0%

51

50

98.0%

43

41

95.3%

38

37

97.4%

174

173

99.4%

177

172

97.2%

70

63

90.0%

70

68

97.1%

103

97

94.2%

88

76

86.4%

99

91

91.9%

89

72

80.9%

728

699

96.0%

712

672

94.4%

Pima Long Term Care

Cochise Health Systems

Yavapai County LTC

Mercy Care Plan

Pinal/Gila Long Term Care

SCAN Long Term Care
Bridgeway Health Solutions

TOTAL

Notes:
Statistically significant values are shown in bold (p< .05)
Shaded rows show results of previous measurement, Oct. 1, 2007, through Sept. 30, 2008.

8

Relative
Percent
Change

Statistical
Significance

-1.6%

p=.477

-1.3%

p=.686

2.0%

p=1.00

-2.1%

p=1.00

2.3%

p=.215

-7.4%

p=.165

9.0%

p=.066

13.6%

p=.026

1.7%

p=.015

Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long Term Care System (ALTCS)
Performance Measure Methodology

Project Title:

Initiation of Home and Community Based Services (HCBS)

Background:

Health care services and supports should be provided to members in the
Arizona Long Term Care System (ALTCS) who are residing in home and
community-based settings as quickly as possible after enrollment. These
services and supports include, but are not limited to: adult day health care,
attendant care, behavioral health services, habilitation services, homedelivered meals, home health aide services, home health nursing,
homemaker assistance, home infusion therapy and respiratory therapy.
Arizona Health Care Cost Containment System (AHCCCS) medical policy
requires that service be provided within the first 30 days after enrollment to
new ALTCS members who are placed in the Home and Community Base
Services (HCBS) program.

Purpose:

The purpose of this study is to evaluate ALTCS Contractor compliance
with AHCCCS medical policy in initiating services to newly enrolled
elderly and physically disabled (E/PD) members in the HCBS program.

Measurement
Period:

October 1, 2008, through September 30, 2009

Study Questions:

1. What is the number and percentage (overall, by urban and rural
counties, and by individual Contractor) of sample members to whom a
service was provided within 30 calendar days of enrollment?
2. For those members who did not receive services within 30 calendar
days of enrollment, what were the reasons?

Population:

E/PD members

Sample Frame:

The sample frame consists of E/PD members who met the following
criteria:
• Newly placed in an HCBS setting (H placement code) or temporary
setting (Z placement code) during the measurement period,
• Enrolled in ALTCS for 30 or more days during the measurement
period, and
• Not placed in an ALTCS-authorized HCBS setting prior to this
measurement period.

Sample Frame
Exclusions:

This measure did not include members who were enrolled in the Ventilator
Dependent program. AHCCCS requires services for these members to be
implemented within 14 days of enrollment.

i

Members with Prior Period Coverage (PPC) were excluded from the
sample frame. PPC is a retroactive coverage period for which Contractors
are financially responsible for paying for covered services.
Sample Selection:

A statistical software package was used to select a random representative
sample by Contractor from the sample frame. The sample size was
determined using a confidence level of 95 percent and a 5-percent
confidence interval, plus oversampling that was based on the previous
year’s exclusions and missing record count.

Sample Strata:

The random sample was further stratified by urban and rural counties.

Data Sources:

AHCCCS recipient enrollment data was used to identify members who met
the sample frame criteria. AHCCCS encounter data, and member medical
records and/or case management files, and Contractor claims data were
used to identify services received by members in the sample frame.

Data Collection:

Data was first collected from AHCCCS administrative (encounter) data. If
acceptable services were not identified as being provided within 30 days of
enrollment, AHCCCS requested that Contractors use medical records, case
management files or their own claims data to verify whether any of the
services measured in this study were provided to those members within the
first 30 days of enrollment. If services were not provided within 30 days,
Contractors were to provide the reason and supporting documentation for
each case.
Contractors were required to collect data using the AHCCCS standardized
methodology in an electronic format provided by AHCCCS. Each
Contractor was provided an electronic file of its sample members for
whom encounters for services within 30 days of enrollment were not found
in the AHCCCS encounter system. After collection of data, Contractors
were required to return the data to AHCCCS in the predetermined
electronic format.

Confidentiality
Plan:

AHCCCS continues to work in collaboration with Contractors to develop,
implement and maintain compliance with Health Insurance Portability and
Accountability Act (HIPAA) requirements.
The Data Analysis & Research (DAR) Unit maintains the following
security and confidentiality protocols:
• To prevent unauthorized access, the sample member file is maintained
on a secure, password-protected computer, by the DAR project lead,
• Only select Division of Health Care Management (DHCM) employees,
who enter or analyze data, have access to study data.
• Sample files given to Contractors are tracked to ensure that all records
are returned.
• All employees and Contractors are required to sign a confidentiality
agreement.
• Member names are never identified or used in reporting.
ii

•

Data Validation:

Upon completion, all study information is removed from the computer
and placed on a compact disk, and stored in a secure location.

The sample frame was validated to ensure that members met criteria for
inclusion in the study.
Data files received back from Contractors were reviewed to ensure that:
• all members included in the sample were listed in the returned data file,
• services met numerator criteria for this performance measure,
• all requested information was provided.
Service data provided by Contractors must have been accompanied with
documentation of the source data (i.e., copy of the pertinent section of the
medical record or case management file and/or a copy of a paid claim),
including the date(s) of service. Contractor-supplied data was validated by
clinical staff of the AHCCCS ALTCS unit

Indicators:

1. The number and percentage (overall, by urban and rural counties, and
by individual Contractor) of sample members who received at least one
acceptable home and community-based service within 30 days of
enrollment during the measurement periods.
2. The number and percentage of members who did not receive an
acceptable home and community-based service within 30 days of
enrollment, by reason category.

Denominators:

1. The number of members who met the sample frame criteria
2. The number of members who met the sample frame criteria and did not
receive a service within 30 days of enrollment

Numerators:

1. The number of sample members who received an acceptable service
within 30 days of enrollment in ALTCS
2. The number of sample members who did not receive an acceptable
service within 30 days of enrollment for one of the following reasons:
• The number of members who refused all services
• The number of members who refused services while waiting for a
specific person to be trained as an attendant caregiver
• The number of members who died within 30 days of enrollment
• The number of members who were admitted to a hospital or
nursing facility within 30 days of enrollment
• The number of members who were receiving hospice services
within 30 days of enrollment
• The number of members who were in an assisted living facility
within 30 days of enrollment

Analysis Plan:

•
•

The numerator was divided into the corresponding denominator for
each indicator (i.e., study question) to determine the indicator rate.
Data for services received within 30 days was analyzed as a statewide
aggregate, and by urban and rural counties, to determine overall and
urban- and rural- county rates.
iii

•

•
•
•

When calculating rates for initiation of services within 30 days of
enrollment (study question #1), members were excluded from the
denominator for the following reasons:
o refused all applicable services
o refused services while waiting for a designated caregiver to
be trained
o died within 30 days of enrollment
o admitted to a hospital or nursing facility within 30 days of
enrollment
o receiving hospice services within 30 days of enrollment
o residing in an assisted living facility within 30 days of
enrollment
Outliers were identified using standard deviations and patterns of
abnormal distribution of data.
Differences between prior study results were analyzed for statistical
significance and relative change.
The following assumptions were used to determine whether the
indicator criteria was met:
o Members included in the sample sent to Contractors for which
data was not received back from the Contractor were counted as
having no service within 30 days;
o Any service documented by the Contractor that did not include
the date it was first delivered was counted as being provided
outside the 30-day requirement.

Comparative
Analysis:

•
•

Deviations from
HEDIS:

This indicator is based on an AHCCCS contractual requirement and is not
based on any nationally recognized methodology, such as the Health Plan
Employer Data and Information Set (HEDIS).

Deviations from
Previous
Methodology:

There were no deviations from the methodology used for the previous
measurement.

Quality Control:

To ensure consistency and reliability in data abstraction, AHCCCS:
• provided each Contractor with the methodology for this measure,
• provided each Contractor with a data specification sheet, file layout,
and data dictionary for this measure,
•
•

Overall rates for urban and rural counties were compared.
Individual Contractor rates were compared to each other and to the
AHCCCS Minimum Performance Standard and Goal.

provided Contractors with detailed written instructions for data
collection,
provided updates and ongoing technical assistance to Contractors
regarding data collection for this measure.

iv

Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long-Term Care System (ALTCS) Performance Indicator
Initiation of Home and Community (HCB) Services
Instructions for submission of data
The data layout and instructions described must be followed for submission to ensure accuracy of
data translation and acceptance of data elements by AHCCCS.
•

All variable fields must be left justified.

•

All variable fields are to be used exactly as indicated in the proceeding tables.

•

If information does NOT exist for any variable field, leave blank spaces in the columns.

•

Do not add any “new” variables that are not listed in the proceeding table.

•

Do not change variable names.

•

Do not change the order of the variable fields.

•

All dates should be formatted as mm/dd/yyyy. Thus, January 2, 2009, would be reported as
01/02/2009.

•

The format has been designed for accurate importing of the data into AHCCCS software.
Any changes to the format could result in lost information and a request for the Contractor
to resubmit the data.

•

Do not change information provided by AHCCCS. Any discrepancy in provided
information, please provide AHCCCS with separate notation of difference and reason for
change.

•

Submit the data files using the SFTP server.
lucy.valenzuela@azahcccs.gov).

•

Data must be submitted to AHCCCS by close of business May 14th 2010.

Contact Lucy Valenzuela (e-mail:

ANY DEVIATIONS FROM THE INSTRUCTIONS FOR SUBMISSION OF DATA WILL
NOT BE ACCEPTED AND RETURNED TO THE CONTRACTOR.
Contact information:
Technical questions related to the data request: should be directed to Lucy Valenzuela e-mail:
lucy.valenzuela@azahcccs.gov (preferred) or call (602) 417-4753
All other questions related to the project should be directed to Rochelle Tigner at (602) 417-4683
or e-mail: rochelle.tigner@azahcccs.gov
v

LAYOUT OF MEMBER IDENTIFIED FILE

Variable
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Variable Name
AHCCCS ID
Contractor
Last Name
First Name
Placement Code
Placement Begin Date
Placement End Date
ALTCS Enrollment Begin Date
ALTCS Enrollment End Date
Date Of Birth
Date Of Death
Gender
Race
Fiscal County
Residential County
Service Code

Format

Length

Text
Text
Text
Text
Text
Date
Date
Date
Date
Date
Date
Text
Text
Text
Text
Text

17

Service Date

Date

10

140

149

18

Exclusion Begin Date

Date

10

150

159

19

Exclusion End Date

Date

10

160

169

20

Reason For Exclusion

Text

10

170

179

21

Other

Text

50

180

229

9
6
30
20
2
10
10
10
10
10
10
1
2
2
2
5

vi

Start Column
1
10
16
46
66
68
78
88
98
108
118
128
129
131
133
135

End Column
9
15
45
65
67
77
87
97
107
117
127
128
130
132
134
139

Description of Included Elements
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

AHCCCS ID
Contractor
Last Name
First Name
Placement Code
Placement Begin Date
Placement End Date
ALTCS Enrollment Begin Date
ALTCS Enrollment End Date
Date of Birth
Date of Death
Gender
Race
Fiscal County
Residential County
Service Code
Service Date

18
19
20

Exclusion Begin Date
Exclusion End Date
Reason For Exclusion

21

Other

9-digit alpha number assigned to a member upon enrollment into AHCCCS
6-digit number that tells what Contractor the member was enrolled with
Last name of member as listed in AHCCCS system
First name of member as listed in AHCCCS system
ALTCS placement code
Date that member became eligible for Home Community Based Services.
Date that member’s Home Community Based Services ended.
Date (not including prior period coverage) member was enrolled with the Contractor
Date that member’s ALTCS enrollment ended
Date that member was born as listed in AHCCCS system
Date that member expired as listed in AHCCCS system
Male or Female
Race of member as listed in AHCCCS system
County of financial responsibility
County in which the member resides
Five digit code that identifies specific service provided
Date that service was first provided to member (this is not the date that the case
manager authorized the service)
Date that a service began making a member eligible for exclusion
Date that a service ended making a member eligible for exclusion
Reason why service was not provided within 30 days of enrollment. (Drop-Down box
is provided that includes the acceptable exclusions.)
Other reason why service was not provided within 30 days of enrollment

vii

Appendix A: Acceptable Home and Community Based Services
Adult Day Health

Other
S5180 and S5181– applies to following:

S5100 Day Care service; per 15 minutes.
S5101 Day Care service; per ½ day.

S5180 Home health respiratory therapy, initial
evaluation.

S5102 Day Care service; per diem.

S5181 Home health respiratory therapy, NOS; per
diem.

Attendant Care
S5125 Attendant care service; per 15 minutes.

Habilitation Services
T2021 Day habilitation waiver; per 15 minutes

Home-Delivered Meals
S5170 Home-delivered meals; per meal
including preparation.

T2020 Day Habilitation, waiver; per diem.
T2017 Habilitation residential, waiver; per 15
minutes.

Home Health Aide
T1021 Home health aide or Certified Nurse
Assistant (CNA); per visit.

Behavioral Health
T1019 Personal care services; per 15 minutes.

Home Health Nursing
G0154 Nursing Care, in the home; per hour (w
or w/o *Modifier TG)

T1020 Personal care services, not for IP or
residential care facilities; per diem.
H2014 Skills training and development; per 15
minutes. (w or w/o *Modifier HQ)

Home Infusion
S9379 Home Infusion Therapy; per diem. Not
otherwise classified.

H2025 Ongoing support to maintain employment;
per 15 minutes.
T2018 Habilitation, supported employment,
waiver; per diem.

Personal Care

T2019 Habilitation, supported employment,
waiver; per 15 minutes.

T1019 Personal care services; per 15 minutes.

H2019 Therapeutic behavioral services
(Behavioral Health Therapeutic Day Program);
per15 minutes. (w or w/o *Modifier TF)

Respite

S5150 Unskilled, not hospice; per 15 min in
home respite care.

H2020 Therapeutic behavioral services
(Behavioral Health Therapeutic Day Program); per
diem.

viii

S5150 Group, not hospice; per 15 min respite
care. (*Modifier HQ)

H0036 Community psychiatric supportive
treatment, Face to Face (Behavioral Health
Medical Day Program); per 15 minutes.

S5151 Unskilled, not hospice; per diem in home Behavioral Health, cont.
respite care.
H0036 Community psychiatric supportive
treatment, Face to Face (Behavioral Health
Medical Day Program); per 15 minutes. (*Modifier
TF)

Homemaker
S5130 Homemaker services, NOS; per 15 min.

H0037 Community psychiatric supportive
treatment program (Behavioral Health Medical
Day Program); per diem.
*Modifier HQ – Modifier for group setting
*Modifier TF - Modifier for intermediate level of care
*Modifier TG - Modifier for complex/high level of care.

ix