Elimination of Prior Quarter Coverage


Attn: All Arizona Skilled Nursing Facilities:

Centers for Medicare & Medicaid Services (CMS) has approved Arizona’s requests to amend its section 1115 demonstration project to eliminate the Prior Quarter Coverage for benefits.

“Under this amendment, beginning no sooner than April 1, 2019, Arizona will test whether waiving retroactive coverage for certain groups of Medicaid beneficiaries encourages them to obtain and maintain health coverage, and whether the policy encourages beneficiaries to apply for Medicaid expeditiously when they believe they meet the criteria for eligibility, to ensure primary or secondary coverage through Medicaid in case the need for services arises”. (CMS approval letter, date Jan 18, 2019)

The elimination of the current PRIOR QUARTER COVERAGE rules will mean that ALTCS approval for your residents will be from the month of application forward (or month of eligibility) – you will NOT be able to retroactively bill for the previous three month prior any longer.

Comprehensive Benefit coordination is now more important than ever.

With the approval of the waiver, it will mean that the months prior to date of application are now unrecoverable – making the timing of the application crucial to securing coverage without a gap in payment.

We would encourage a very proactive discussion with one of our Benefit Coaches to make sure you are ready for the implementation of the new policy prior to April 2019.

We are here to help you get ready!-  The Benefit Results Team