Ariz. Admin. Code § R9-28-411 - Changes, Redeterminations, and Notices
A. Reporting and verifying changes.
1. A person shall report to the ALTCS
eligibility office the following changes for a person, a person's spouse, or a
person's dependent children under
42 CFR
435.916:
a.
A change of address;
b. An
admission to or discharge from a medical facility, public institution, or
private institution;
c. A change in
the household's composition;
d. A
change in income;
e. A change in
resources;
f. A determination of
eligibility for other benefits;
g.
A death;
h. A change in marital
status;
i. An improvement in the
person's medical condition;
j. A
change in school attendance;
k. A
change in Arizona state residency;
l. A change in citizenship or alien
status;
m. Receipt of an SSN under
R9-22-305;
n. A transfer of assets
under
R9-28-409;
o. A change in trust income and disbursements
in accordance with state and federal law;
p. A change in first- or third-party
liability that may be responsible for payment of all or a portion of the
person's medical costs;
q. A change
in first-party medical insurance premiums;
r. A change in the household expenses used to
calculate the community spouse monthly income allowance described in
R9-28-410;
s. A change in the amount of the community
spouse monthly income allowance that is provided to the community spouse by the
institutionalized spouse under
R9-28-410;
and
t. Any other change that may
affect the person's eligibility or share-of-cost.
2. A change shall be reported either orally
or in writing as described under
R9-22-306
a.
The name of the affected person;
b.
The change;
c.
The date the change happened;
d.
The name of the person reporting the change;
and
e.
The person's Social Security or case number, if
known, under A.R.S. §
36-2934 .
3.
A person shall provide verification of changes upon
request, under A.R.S. §
36-2934, if needed to redetermine eligibility or to re-calculate post-eligibility
computation of income.
4.
A person shall report anticipated changes in
advance, as soon as the future event becomes known.
5.
A person shall report other changes events within 10
days of the date the change occurred.
B. Processing of changes and
redeterminations. A person's eligibility shall be redetermined at least one
time every 12 months and when changes occur, under
42 CFR
435.916. A person's share-of-cost, specified
in
R9-28-408,
shall be redetermined whenever a change occurs that may affect the
post-eligibility computation of income.
C. Actions that may result from a
redetermination or change. Processing a redetermination or change shall result
in one of the following findings:
1. No change
in eligibility or the post-eligibility computation of income;
2. Discontinuance of eligibility if a
condition of eligibility is no longer met;
3. Suspension of eligibility if a condition
of eligibility is temporarily not met;
4. A change in the post-eligibility
computation of income and the person's share-of-cost; or
D. Notices.
1. Contents of notice. The Administration
shall issue a notice when an action is taken regarding a person's eligibility
or computation of share-of-cost. The notice shall contain the following
information:
a. A statement of the action
being taken;
b. The effective date
of the action;
c. The specific
reason for the intended action;
d.
The actual figures used in the eligibility determination and specify the amount
by which the person exceeds income standards if eligibility is being
discontinued because either a person's resources exceed the resource limit, or
a person's income exceeds the income limit;
e. The specific law or regulation that
supports the action, or a change in federal or state law that requires an
action;
f. An explanation of a
person's right to request an evidentiary hearing as described under 9 A.A.C.
34; and
g. An explanation of the
date by which a request for hearing must be received so that eligibility or the
current share-of-cost may be continued.
2. Advance notice of changes in eligibility
or share-of-cost. "Advance notice" means a notice that is issued to a person at
least 10 days before the effective date of change. Except as specified in
subsection (D)(3), advance notice shall be issued whenever the following
adverse action is taken:
a. To discontinue or
suspend eligibility if an eligible person no longer meets a condition of
eligibility, either ongoing or temporarily;
b. To affect post-eligibility computation of
income and increase a person's share-of-cost; or
3.
Under
42 CFR
431.213, notice shall be issued to a person
to discontinue eligibility or to increase the share-of-cost, no later than the
effective date of action if: Adverse actions. An applicant or member
may appeal, as described under 9 A.A.C. 34, by requesting a hearing from the
Administration or its designee concerning any of the adverse actions if:
a. A person provides a clear, written
statement, signed by the person, that a person no longer desires
services;
b. A person provides
information that requires termination of eligibility or an increase in the
share-of-cost and the person signs a clear written statement waiving advance
notice;
c. A person cannot be
located and mail sent to that person has been returned as
undeliverable;
d. A person has been
admitted to a public institution where the person is ineligible for ALTCS under
R9-28-406; or
e. A person has been
approved for Medicaid in another state;
f. The Administration has information that
confirms the death of the person;
g. The person's primary care provider has
prescribed a change in the level of medical care; or
h. The notice involves an adverse
determination regarding the PAS, specified in A.R.S. §
36-2936.
E. Transitional. HCBS
services may be provided to a person who is no longer at risk of
institutionalization but who continues to require significant long-term care
services under A.R.S. §
36-2936(D).
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.