Quick Reference - Services Out of State
Return to Member and Family Resources
- Download Services While Traveling Out of State (English).
- Download Services While Traveling Out of State (Spanish).
Services While Traveling Out of State
This guide has information about services that may be available when an Arizona Long Term Care Services (ALTCS) eligible Member travels outside Arizona.
Can a Member receive services when traveling outside Arizona?
Yes, this may be possible. First, contact the Member’s Support Coordinator as soon as you know the Member will be traveling out of state. They will complete an assessment to make sure the services are needed. The services must be medically necessary and cost-effective. The Support Coordinator will determine if the current assessed service level is needed while traveling out of state. The Support Coordinator will also assess if additional support that is necessary. This assessment and approval from the Support Coordinator must happen before the Member travels. Services will not be covered otherwise.
The Qualified Vendor must approve the provider to be paid and travel with the Member. Electronic Visit Verification (EVV) is still required by the provider while providing service out of state. The responsible person and the provider need to discuss and agree on who will pay for travel and all related expenses before traveling. This includes who is paying for the providers lodging, food and other expenses. No services are covered if the Member travels outside the United States.
Emergency medical care and emergency behavioral care are available while the Member is temporarily out-of-state.
Will DDD pay for services that were not approved before the Member traveled outside Arizona?
DDD will not pay for services that were not assessed for and approved before the Member traveled outside Arizona.
Are there any services that are not covered when a Member travels out of state?
Licensed Health Aide (LHA) services are not covered when a Member travels out of Arizona.
What can be done if DDD approves services and the preferred provider is unavailable?
DDD cannot require providers to travel out of state. Members should contact their Support Coordinator. They will help find another provider.
What can be done if out-of-state services are denied and there is disagreement with the decision?
The Support Coordinator will mail a Notice of Adverse Benefit Determination to the responsible person. It will explain why the service was denied. It will also explain what can be done if there is disagreement and includes the Member’s appeal rights.
Do DDD Health Plans provide physical and behavioral health services when a Member is traveling out of state?
The DDD Health Plans (Mercy Care, UnitedHealth Care Community Plan, and the DDD Tribal Health Program) only cover emergency medical care for Members when they temporarily travel out of state. Services are not covered when the Member leaves the United States and United States Territories. Members with questions about out-of-state coverage should contact their DDD Health Plan’s Member Services unit. Their phone number is listed on the Member’s insurance card.