Fee For Service Nursing Facility and Home and Community Based Service

Provider Specialty Rate Increase Effective January 01, 2017

AHCCCS has taken action to address the increased labor costs resulting from the Arizona

minimum wage increase and employee benefit provisions of A.R.S. § 23-363 as approved by

voters as Proposition 206 on November 8, 2016, and to assure that payments are consistent with

efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care

and services are available at least to the extent that such care and services are available to the

fee-for-service Specialty Rates for NFs and to specific services billed by HCBS providers. The

specialty rate increase for nursing facilities is 3.5%. The HCBS provider increase for Assisted

Living Facilities (ALFs) is 7% for specific services to include: T2031, and T2033. For additional

rate information please see: //www.azahcccs.gov/PlansProviders/RatesAndBilling/FFS/.

How to Receive the Increase on Claims for Date of Service January 1, 2017 or Later

That Were Reimbursed at the October 1, 2016 Rate

Nursing Facilities

Claims reimbursed for date of service January 1, 2017 and forward that were paid at the 10/01/16

specialty NF rate will need to be replaced by the NF. Replacement claims must be billed at the

For instruction on how to submit a replacement claim to fee-for-service, please view Chapter 4

of the Fee-For-Service Provider Manual at:

//www.azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/FFS_Chap04General

BillingRules.pdf

Assisted Living Facilities

Assisted Living Facilities must work with the Tribal ALTCS member’s Tribal Case Manager to

ensure completion of required January 1, 2017 Residency Agreement revisions. Upon

notification of the revised Residency Agreement from the member’s Tribal Case Manager,

AHCCCS will revise ALF specialty per diem rates, where applicable, for dates of service

January 1, 2017 or later. Claims reimbursed for date of service January 1, 2017 and forward, that

to receive the 7% increase. For instruction on how to submit a replacement claim to fee-for-

service, please view Chapter 4 of the Fee-For-Service Provider Manual at:

//www.azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/FFS_Chap04General

BillingRules.pdf.

Status of fee-for-service authorizations, ALTCS member case plans, and fee-for service claims,

must be verified using the AHCCCS Online system. If you require assistance with:

AIHP member authorizations: call the FFS Prior Authorization area at 602-417-4400, or

800-433-0425 (outside Phoenix).