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Planning Meeting and Assessment Changes Including Parents as Paid Caregivers (PPCG)

Mother showing her daughter how to brush her teeth.

The Arizona Health Care Cost Containment System (AHCCCS) received temporary authority from the Centers for Medicare and Medicaid Services (CMS) to allow parents of minor children with disabilities to be paid caregivers during the federal COVID-19 Public Health Emergency (PHE) on April 6, 2020. This ensured children received Attendant Care or Habilitation services during the PHE. AHCCCS sent an 1115 Waiver amendment to CMS requesting to make the Parents as Paid Caregivers (PPCG) service model authority permanent on September 27, 2023.

AHCCCS and the Department of Economic Security Division of Developmental Disabilities (DES/DDD) released the final versions of revised policies and exhibits on September 3, 2025 that were posted for public comment between May and July. Many of the revised policies relate to the Parents as Paid Caregiver (PPCG) service model, which applies specifically to parents who provide paid care to their minor children. “These updates reflect changes required by House Bill 2945, which became law in April 2025, as well as commitments made to the Centers for Medicare & Medicaid Services (CMS) in the Arizona 1115 Waiver proposal and conditions CMS included in the state’s approval to make the PPCG service model permanent.”

AHCCCS Policies and Exhibits

Division Policies

Additionally, some of the revised policies affect how person-centered service plan (PCSP) meetings are conducted and modify supervision requirements for direct care workers employed by service provider agencies. These policy changes also incorporate feedback received from stakeholders during the public comment period from May through July 2025. These revised policies and exhibits have a direct impact on some planning meeting requirements as well as the parents as paid caregivers (PPCG) for their minor children service model.The following is a list of these documents.

Planning Meeting Requirement Updates

Beginning October 1, 2025, members eligible for the Arizona Long Term Care System (ALTCS) will complete one full person-centered service plan (PCSP) with their Support Coordinator and team each year. They will review the member’s PCSP at the three other 90-day Planning Review meetings. Most members can choose to hold the second and fourth review meetings virtually. Virtual meetings must have both audio and visual capabilities.

  1. Support Coordinators will hold a full in-person PCSP meeting once per year in the member’s home.
  2. The member’s PCSP will be reviewed at the first 90-day Planning Meeting Review. Most members can choose to hold this meeting virtually. It can also be held at a service location.
  3. The member’s PCSP will be reviewed at the second 90-day Planning Meeting Review. This meeting will be in person at the member’s home.
  4. The member’s PCSP will be reviewed at the third 90-day Planning Meeting Review. Most members can choose to hold this meeting virtually. It can also be held at a service location.

The member can still request to have their PCSP updated more often if needed.

All PCSPs and PCSP Reviews will continue to be held in person with no virtual option for:

  • Members on a 180-day review cycle.
  • Members using the Parents as Paid Caregiver (PPCG) service model.
  • Members using the Spouses as Paid Caregivers service model.
  • Members living in licensed residential settings.
  • Members using the Independent Provider service model.
  • Members without access to the internet or if it costs minutes on their phones.

Assessment Changes Update October 2025 (Updated 11/3/2025)

On October 1, 2025, Support Coordinators began using the new HCBS Needs Tool (HNT) at member planning meetings. On Thursday, October 16, 2025, the Governor and AHCCCS directed DDD to pause the use of the HNT after hearing concerns from families. AHCCCS plans to make some clinical changes to the HNT. It has outlined these changes through emergency rulemaking. These changes include new tasks that can be assessed for children with complex needs. They will also add a new process called Extraordinary Care Review for children under the age of 18. AHCCCS will post the Extraordinary Care Review policy for public comment on its public comment website before finalizing the changes.

On October 16, 2025, AHCCCS guidance stated that members under age 18:

  • Would not be assessed for Attendant Care and Habilitation until the HNT was revised
  • Would have their hours reinstated to match the last HCBS Needs Assessment tool completed prior to October 1, 2025
  • Would be authorized for any additional assessed hours resulting from the use of the October 1 HNT

An email was sent to members and families with this information on October 16, 2025.

On October 29, 2025, AHCCCS provided updated guidance for all DDD members under age 18. This guidance stated:

  • Assessments completed using the HNT after October 1, 2025, are considered invalid.
  • Additional hours assessed using the October 1, 2025, HNT may not be authorized. DDD must reinstate authorizations. Members will receive the direct care services (attendant care) and habilitation hours they received prior to October 1, 2025.
  • DDD Support Coordinators must complete an assessment using the HNT in place prior to October 1, 2025:
    • When a Health Care Decision Maker has concerns about the reinstatement of hours and prefers the hours/or service assessed from the 10/1 version of the HNT.
    • To reassess members under age 18 who were assessed for the first time using the invalid HNT after October 1, 2025.
    • When they identify members under age 18 who are newly eligible for ALTCS, have had a significant change in their condition, or whose health care decision maker requests an updated assessment.

Your Support Coordinator will explain the Extraordinary Care Review process and how to ask for an exception once AHCCCS publishes its updated policies. Extraordinary Care Review is for minor members who need more direct care or habilitation service hours than the HNT shows, based on the age limits and number of hours documented. The Division will share more information as it becomes available. More information can be found in the AHCCCS Emergency Rule and Policy FAQ.

Resources for Families

Public Town Halls

AHCCCS and DDD hosted public meetings on February 5 and 6, 2025. The PPCG Program Update presentation has more details about the PPCG program update.

AHCCCS and DDD hosted public meetings on May 20 and 21, 2025 to provide a summary of the overall themes in the revised policies as well as the recommended order of review for efficient flow. The presentation used at the May 20 and 21 town halls is available for review in PDF format.

AHCCCS and DES/DDD co-hosted public forums on September 4, 2025, to provide interested stakeholders with an overview of the final policies and exhibits.

AHCCCS and DES/DDD co-hosted public forums on September 24, 2025 at 10:30 a.m. and September 25, 2025 at 6:00 p.m. DDD shared updated information about program growth. AHCCCS addressed frequently asked questions related to policy revisions published on September 3, 2025

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