Providers, Ball v Betlach Lawsuit

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A recent decision from the Court in the Ball v Betlach (formerly Ball v Biedess) lawsuit required Arizona Health Care Cost Containment System (AHCCCS) to make changes to current contract and policy regarding back-up workers. This has resulted in changes to the Division’s policies and procedures.

The Division will begin verifying that each provider agency contracted to provide attendant care, housekeeping or respite is available after normal business hours, including weekends. This needs to be verified at a minimum quarterly until the Division can demonstrate 100% compliance for two consecutive quarters. The Division will complete a test of all agencies contracted to provide a critical service (attendant care, housekeeping and respite). Your agency is required to return any calls received after hours within 15 minutes from the time a message is left.

Additionally, all providers of attendant care, housekeeping or respite are required to have processes in place to ensure there are back-up caregivers available on-call to substitute for those times when an unforeseeable gap in critical service occurs and to fill those gaps within two hours of being reported. Agencies are required to work with the family to follow the steps in the back-up plan when the scheduled provider becomes unavailable. Agencies must offer a replacement each time a gap occurs, regardless of the consumer/family's preference. When a replacement is offered, consumers/families have the right to decline the replacement. If your agency is unable to offer a replacement you are required to contact the Support Coordinator. The Support Coordinator will work with family to follow the back-up plan and find a replacement, if needed. It is the responsibility of the agency to follow up with the support coordinator to identify how the gap was resolved and report on the monthly Non-Provision of Service report. Continued inability of the agency to offer replacements may result in the family choosing another agency to provide the service on an ongoing basis.

Consumers/Families authorized to receive a critical service will be mailed a letter identifying the steps they should take when a provider is unavailable for a scheduled work time. This letter directs the family to contact the authorized agency when a provider is unavailable or does not show for a scheduled time. Families will also be given a 24-hour phone number to AHCCCS for families to report when a provider is unavailable to work. If AHCCCS, receives a call from a consumer/family reporting the scheduled provider did not show, AHCCCS will contact the authorized agency. Your agency is required to return any call from AHCCCS within 15 minutes. When an agency receives a call from AHCCCS reporting the gap, the agency will be required to call the hotline back to report how the gap was resolved.

Failure to comply with any of the requirements may result in a corrective action.

Arizona Health Care Cost Containment System 24/7 Contact Number
(800) 218-7509