7 out of 10 applicants are denied for ALTCS the first time they apply. With non-financial, financial, and medical reasons for denials, there is an obvious need for someone to take those applicants by the hand and help them understand why, work with them on options to prevent a denial, and help them through the process of becoming eligible.
Today’s topic: ALTCS MEDICAL ELIGIBILITY
- ALTCS only needs the following records: the most recent history and physical, physician progress notes for a year, documented list of medical conditions and diagnoses, prescription and over-the-counter (OTC) list, hospital or SNF discharge summaries from the past 6 months, and if residing in assisted living, the most recent monthly or quarterly needs assessment.
- Remember to request records in advance to prevent delays in processing. These can be provided to ALTCS before the actual medical assessment.
- The eligibility is getting tougher. For example, it used to be that a dementia diagnosis in the chart was sufficient. Now, it must be documented by a neurologist. If you have a consumer with dementia, Alzheimer’s disease, or other neurological diseases, make sure you encourage them to schedule and follow through on their visit to a neurologist. This is worth 20 of the 60 points needed to qualify!
- Many of you are providing care to family members. We encourage you to begin journaling the services you are providing (date of service, time started, time ended, what service was performed). This will help show ALTCS how often the care is needed.
- For family or friend caregiving: Consider putting a Caregiver Agreement into place to document the details of the arrangement and create a pattern of documentation to show what is being done, how often, and for how long. We prepare Caregiver Agreements for $200.
- If you are not sure someone will pass the ALTCS medical eligibility, request a Private Request PAS (Pre-Admission Screening). If eligible, this PAS can be used for up to 180 days. If a potential ALTCS applicant is in spend down mode and will run out of funds in about six months, this is a great tool to use to ensure that there can be a successful transition onto ALTCS when the spend down is complete.
Montgomery & Associates, Inc. is an ALTCS planning firm with over 28 years’ experience helping people get approved for ALTCS.
Former ALTCS employees | Former Law Firm ALTCS Paralegal | In business since 2001
Written by Carol Aragon-Montgomery 05/29/19
We are not affiliated/contracted/employed with: AHCCCS / ALTCS / VA / Medicare (CMS) / Federal Government.