MedicaidReimbursementMedium impact
AHCCCS DFSM Claims Clues - FFS Billing Specialty NF & HCBS Rate Increase Effective 1-1-17
Arizona Medicaid - AHCCCS·AZ·Claims & Billing
Effective date
Jan 1, 2017
We identified it
Jun 17, 2026
Summary
AHCCCS increased specialty rates effective January 1, 2017 - 3.5% for nursing facilities and 7% for assisted living facilities providing specific HCBS services (T2031, T2033). Claims paid at old rates must be replaced with new claims at increased rates.
Action Required
For claims with dates of service January 1, 2017 or later that were reimbursed at October 1, 2016 rates: Nursing facilities must submit replacement claims at the new 3.5% increased specialty rate after verifying authorization letter or checking AHCCCS online system. Assisted living facilities must work with Tribal Case Managers to complete required Residency Agreement revisions, then submit replacement claims at 7% increased rates for T2031 and T2033 services. Reference Chapter 4 of the Fee-For-Service Provider Manual for replacement claim instructions.