Home care billing in Arizona

Managed long-term services and supports. CMS's 2024 state tables list AHCCCS (MLTSS) as a statewide 1115(a) program whose participating plans are Banner University Family Care, Mercy Care, UnitedHealthcare and the DES/Division of Developmental Disabilities, alongside the AHCCCS Complete Care acute plans; members who do not choose a plan are auto-enrolled and get 90 days to pick a different one.⁸ The demonstration's special terms and conditions describe ALTCS as a statewide managed care system delivering physical, behavioral and long-term care through contractors AHCCCS calls Program Contractors; EPD enrollees in Maricopa and Pima counties choose a contractor, enrollees elsewhere take the contractor for their geographic service area, and DD members receive their long-term services and supports through DES/DDD (STCs, cited above).

Agency choice of EVV vendor with a state aggregator: EVV has been required since January 1, 2021 for attendant care, personal care, homemaker, habilitation and respite and for in-home skilled nursing, and every agency provider must use an EVV system and send its visit data to the AHCCCS aggregator.¹ Since October 1, 2025 AHCCCS has run its own aggregator in place of Sandata. Providers already on alternate vendors kept their systems, with the vendor redirecting data to AHCCCS after testing; providers who had relied on Sandata's state-funded system had to contract with Sandata directly or switch vendors before that date or face claim payment delays for missing EVV data; and prior authorization data is no longer required in the visit record (Arizona Complete Health EVV 2.0 notice, cited below). The aggregator only tests that the vendor's data arrives in the correct format, so the agency stays responsible for its vendor's compliance with AHCCCS policy, and the health plans audit provider EVV compliance.

Services under EVV¹

• Attendant care, since January 1, 2021
• Personal care, since January 1, 2021
• Homemaker, since January 1, 2021
• Habilitation, since January 1, 2021
• Respite, since January 1, 2021
• In-home skilled nursing, since January 1, 2021

A program contractor pays only for services provided under referral from its case management unit. A.R.S. 36-2938 requires continual case management under the uniform statewide program, a long-term care service plan for each member with a cost benefit analysis of institutional against home and community based services, and case managers who direct members to the most appropriate amount, duration and type of services and continually monitor and reassess need.⁵ Eligibility starts with a preadmission screening by a registered nurse or social worker showing the person needs nursing facility or ICF/IID level of care, completed within eight days, and no one gets home and community based services without it (A.R.S. 36-2936, cited below). The written plan of care must exist before services are furnished, and federal funding is not claimed for services outside it (STCs, cited above). UnitedHealthcare's ALTCS EPD manual, for example, has the case manager reassess members on home and community based services every 90 days or on a change in condition and authorize attendant care, home health aide visits and emergency alert systems, and DES/ALTCS DDD must certify a provider before it renders HCBS to DD members (cited below).

Claims go to the member's Program Contractor. A.R.S. 36-2943 requires a claim for an authorized service from a home and community based provider to be adjudicated within thirty calendar days after the program contractor receives it, and an unpaid claim accrues interest at one percent per month from the date it was submitted.⁷ AHCCCS's own fee-for-service rules give 6 months from the date of service, or from the date eligibility is posted if later, for the initial claim and 12 months to reach clean claim status (fee-for-service billing manual chapter 4, cited below). Plan manuals add their own windows: UnitedHealthcare, for example, requires secondary claims within 180 days of the date of service even before the primary carrier pays, and denies them without the primary EOB. The EVV visit has to be in the AHCCCS aggregator or the plan holds the payment for missing EVV data.

National Government Services, the A/B MAC for Jurisdiction 6, processes Medicare home health and hospice claims for Arizona along with Alaska, California, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Washington, Wisconsin and the Pacific and Caribbean territories.¹³ Arizona counts home health agencies, defined in A.R.S. 36-151 as agencies primarily engaged in skilled nursing and other therapeutic services, whose home health services are furnished under a physician's care and may include part-time or intermittent home health aide services, among the health care institutions regulated by the Department of Health Services under A.R.S. 36-401, which also defines personal care services as help with activities of daily living that needs no professional training. For ALTCS members, A.R.S. 36-2939 lists home health, home health aide, homemaker, personal care, habilitation and respite among the covered home and community based services, with adult day health and home delivered meals added for members without developmental disabilities.