Benefits & Services

Case & Disease Management

Case Management

Case management is a benefit offered at no cost to you. Our goal is to help you be healthy. A case manager is assigned to each B – UFC/ALTCS member. The case manager will help you get the services you need to keep you healthy. They will work with you and your PCP to coordinate your care. Your case manager must authorize all services provided through B – UFC/ALTCS. They will provide you with contact information in case you need information in between visits. For more information, please call our Customer Care Center and ask about Case Management at (833) 318-4146, TTY 711.

Disease Management

Disease Management is another service offered at no cost to B – UFC/ALTCS members. If you have a health problem such as diabetes or asthma or if you are looking for ways to stay healthy, our Disease Managers are here to help you. For more information, please call our Customer Care Center and ask about Disease Management at (833) 318-4146, TTY 711.

Dental Care

If you are 21 years or older, you have covered dental services. Your dental services will have a limit of $1,000 per benefit year. Any unused benefit will not roll over to the next year. You may be billed for any services that are over the limit. Some dental services may have limits and/or prior authorization requirements. Please contact our Case Manager or Customer Care Center if you have any questions.

• All health plan members ages 20 and younger are assigned to a Dental Home, also known as a Primary Dental Provider (PDP). A Dental Home is a dentist’s office that is visited every six months for a check-up.
• All dental health checkups, cleanings and treatments are covered for health plan members ages 20 and younger.
• Children do not need to be referred by his/her PCP to see a dentist.

At 12 months of age children should begin to see a dentist for a checkup every six months. B – UFC/ALTCS sends dental checkup reminders. Dentists can help prevent cavities. They also teach you and your child how to care for teeth.

Look in the Provider Directory to choose a dental clinic near you or call our Customer Care Center for help scheduling a visit.

Use these guidelines for scheduling appointments for your child:

• Emergency dental appointments – same day appointments for extreme pain and dental emergencies.
• Urgent dental appointments – within 3 days for lost fillings, broken tooth.
• Routine dental appointments – within 45 days for routine checkups and dental cleanings.
• Make sure you take your child’s B – UFC/ALTCS Member ID card with you to the dental appointment. 

EPSDT Program

Well-Child Care / Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

B – UFC/ALTCS wants to help your children grow up healthy. EPSDT is a comprehensive child health program of prevention, treatment, correction, and improvement (amelioration) of physical and mental health problems for AHCCCS members under the age of 21.

The purpose of EPSDT is to ensure the availability and accessibility of health care resources, as well as to assist Medicaid members in effectively utilizing these resources.

EPSDT services provide comprehensive health care through primary prevention, early intervention, diagnosis, medically necessary treatment, and follow-up care of physical and behavioral health problems for AHCCCS recipients less than 21 years of age. EPSDT services include screening services, vision services, dental services, hearing services and all other medically necessary mandatory and optional services listed in federal law 42 USC 1396d (a) to correct or ameliorate defects and physical and mental illnesses and conditions identified in an EPSDT screening whether or not the services are covered under the AHCCCS state plan.

Limitations and exclusions, other than the requirement for medical necessity and cost effectiveness do not apply to EPSDT services.

A well-child visit is synonymous with an EPSDT visit and includes all screenings and services described in the AHCCCS EPSDT and dental periodicity schedules.

Amount, Duration, and Scope

The Medicaid Act defines EPSDT services to include screening services, vision services, dental services, hearing services and “such other necessary health care, diagnostic services, treatment and other measures described in federal law subsection 42 USC 1396d(a) to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the AHCCCS state plan.

This means that EPSDT covered services include services that correct or ameliorate physical and mental defects, conditions, and illnesses discovered by the screening process when those services fall within one of the 29 optional and mandatory categories of “medical assistance” as defined in the Medicaid Act. Services covered under EPSDT include all 29 categories of services in the federal law even when they are not listed as covered services in the AHCCCS state plan, AHCCCS statutes, rules, or policies as long as the services are medically necessary and cost effective.

EPSDT includes, but is not limited to, coverage of: inpatient and outpatient hospital services, laboratory and x-ray services, physician services, nurse practitioner services, medications, dental services, therapy services, behavioral health services, medical supplies, prosthetic devices, eyeglasses (with unrestricted repair or replacement), transportation, and family planning services. EPSDT also includes diagnostic, screening, preventive and rehabilitative services. However, EPSDT services do not include services that are solely for cosmetic purposes, or that are not cost effective when compared to other interventions.

Coordination of care with schools and state agencies may occur within the limits of applicable regulations.

EPSDT/Well-Child Visits Include:

• A comprehensive health and developmental history, including growth and development screening which includes physical, nutritional and behavioral assessments
• Nutritional Assessment provided by a PCP
• Behavioral Health Screening and services provided by a PCP
• Developmental Screening Tools used by a PCP
• A comprehensive unclothed physical examination
• Appropriate immunizations according to age and health history
• Laboratory tests including blood lead screening assessment and blood lead testing appropriate to age and risk. Required blood lead screening for children under six years of age is based on the child’s risk as determined by either the member’s residential zip code or presence of other known risk factors
• Health education, counseling, and chronic disease self-management
• Appropriate oral health screening, intended to identify oral pathology, including tooth decay and/or oral lesions, and the application of fluoride varnish conducted by a physician, physician assist or nurse practitioner
• Appropriate vision, hearing and speech screenings
• TB testing as appropriate to age and risk
• Eye examinations and prescriptive lenses (to include unrestricted repair or replacement)
• Ocular photoscreenng for children ages 3-5 is covered when due to challenges with a child’s ability to cooperate with traditional vision screening techniques. Limited to lifetime coverage of 1
• Medicines listed in the B – UFC Drug Formulary
• Special medical foods when medically necessary
• Well-Child* Care will also give you ideas about how to:
  • Keep your child well
  • Protect your child from getting hurt
  • Spot health problems early
  • Apply for services like WIC, Head Start, Children’s Rehabilitative Services (CRS), and the Arizona Early Intervention Program (AzEIP). 

Well-Child Care Will Also Give You Ideas About How To:

• Keep your child well
• Protect your child from getting hurt
• Spot health problems early
• Apply for services like WIC, Head Start, Children's Rehabilitative Services (CRS), and the AzEIP

Tobacco-Free Lifestyle

Tobacco Education and Prevention

The B – UFC/ALTCS Tobacco Cessation Program offers a number of nicotine replacement products. This includes patches, lozenges, gum, and medications to help you quit tobacco. When you and your doctor decide which is best for you, a twelve-week supply is available by prescription every six months as needed. Only one product can be selected at a time. Members also have no cost telephone support from the Arizona Smoker's Hotline (ASHLine). ASHLine is sponsored by the Arizona Department of Health Services and Prevention Program (ADHS-TEPP). ASHLine can help you at no cost by setting a quit date and giving you support. If you would like more information about quitting tobacco, please call the ASHLine at (800) 556-6222. Or visit their website at www.ashline.org.

Freedom From Smoking - American Lung Association. This is a program to help adult smokers quit. Freedom From Smoking® is available as a group clinic, an online program and a self-help book. Talk to a cessation counselor at the Lung HelpLine at 1-800-LUNGUSA (1-800-586-4872).

Tobacco Free Arizona  - Arizona Department of Health Services. Learn more about the risks of tobacco use and find the resources to quit. 

Transition of Care

Transitional Program

The B – UFC/ALTCS Transitional program is for current ALTCS members whose condition has improved. These members do not need care at a Nursing Facility (NF) or Intermediate Care Facility (ICF). These members still need some long-term care services. Members qualify to get other ALTCS services that are medically needed.

ALTCS Transitional members may have a short stay in a NF or ICF if the medical condition gets worse for a short time. The member may have up to 90 straight days of care at any one admission if medically needed.

Transportation

Emergency

Your condition is a medical emergency when your life, body parts or bodily functions are at risk of damage or loss unless immediate care is received. In cases of emergency (in a life-threatening situation) call 911. Taxis will not transport you to the emergency room.

Medically Necessary Non-Emergency Transportation (NEMT)

AHCCCS covers NEMT to or from the closest appropriate AHCCCS registered provider when a member is not able to find his/her own transportation. 

For members living in Maricopa and Pima Counties:

• NEMT services to and from a pharmacy are only covered for trips within 15 miles of the pick-up location, except for trips to (1) compounding or specialty pharmacies and (2) pharmacies in an MSIC or IHS/638 facilities. 
• The 15-miles is calculated from the pick-up location to the drop-off location, for one direction.
• Trips to compounding or specialty pharmacies over 15 miles may be covered if your health plan gives prior authorization for the transportation.
• Trips to a pharmacy in an MSIC or IHS/638 facility, can go over 15 miles without getting a prior authorization from your health plan.
• The 15-mile distance does not apply to members who do not live in Maricopa or Pima County.

If you need a ride to an appointment, ask a friend, family member or neighbor first. If you cannot get a ride we can help you.

Call our Customer Care Center at least 72 hours before your scheduled visit. Same day transports may not always be available due to the number of transportation vehicles in all counties.

On weekends and holidays, you can call our Customer Care Center for taxi rides to urgent care centers when you are sick. Always remember to dial 911 if it is a medical emergency.

Car Seat, Wheelchair, or Stretcher

If you have the need for a wheelchair accessible vehicle or have stretcher needs for your ride to a routine doctor's visit, please be sure to mention that when arranging a ride. You must call our Customer Care Center at least 72 hours before your appointment date

Children, Companions, or Escorts

B – UFC/ALTCS allows the member and one more passenger per transport. More than one more passenger is allowed if that person is a minor under the care and supervision of the Member or has a medical condition. If the member is a single caregiver with more than one minor child in his/her care, B – UFC/ALTCS allows the additional minor children to be transported. Please be sure to call 72 hours or more in advance if car seats are needed for the additional passengers. Not all taxis can accommodate more than 3 passengers.

If you call to get a ride to a medical appointment, please be ready to tell the representative the following:

• Your name, AHCCCS ID number, date of birth, address, phone number (for verification purposes)
• The date, time, and address of your medical visit
• If you need a ride one way or a round trip
• Your travel needs (wheelchair, stretcher, or other)
• Any special needs (oxygen, IVs, someone who needs to travel with you, an extra-wide or electric wheelchair, a high-top vehicle, etc.)
• Children under the age of 5 must have a car seat

Canceling Rides to Your Appointments

If you cancel your doctor or dentist visit, you must also call our Customer Care Center to cancel your ride to your visit.