Member Information

You want to feel your best. And we want to help. Get started by reviewing your member handbook to make sure you understand your health plan. Then, to get the most out of your plan, click on the links below to learn more about all of your benefits.

 

New dental benefits and outpatient occupational therapy benefits for adult members starting October 1, 2017. (English | Español | العربية |Tiếng Việt)

Understanding your benefits
Your health is important to us. That’s why we want to be sure you and your family get the medical care you need. Covered services are listed below. To learn more, please read your Member Handbook.

Covered services
Your PCP and case manager will help you get the health care and long-term care services you need. Below is a list of covered services. You can also view a list of non-covered services and benefit changes. There may be some limitations based on AHCCCS rules and policies. If you have Medicare, read the Medicare handbook called “Other Things You Should Know About Medicare” to find out which services are covered.

Long Term Care services

  • Nursing homes
  • Home- and community-based services
    • Adult day health care
    • Attendant care
    • Spouse attendant care
    • Self-directed attendant care
    • Day treatment and training
    • Emergency alert systems
    • Habilitation
    • Home delivered meals
    • Home health services
    • Homemaker services
    • Home modifications
    • Hospice
    • Personal care
    • Respite and group respite care
  • Alternative residential settings
    • Adult foster care
    • Assisted living home
    • Assisted living center
    • Alzheimer’s treatment assistive living
    • Behavioral health level II and III
    • Rural substance abuse transitional agency
    • Therapeutic Home Care – adult and child
    • Traumatic brain injury homes

Medical services

  • Hospital care
  • Doctor office visits, including specialists
  • Routine physical exams
  • Health risk assessments and screening
  • Nutritional assessments
  • Laboratory and X-ray
  • Durable medical equipment and supplies
  • Medications on Mercy Care Plan’s list of covered medicines. Members with Medicare will receive their medications from Medicare Part D.
  • Emergency care
  • Care to stabilize you after an emergency
  • Rehabilitation services, including occupational, speech, physical and respiratory therapy
  • Routine immunizations
  • Medically necessary organ and tissue transplants and related prescriptions
  • Kidney dialysis
  • Emergency and pre-transplant dental services; medically necessary dentures
  • Medically necessary foot care
  • Maternity care (prenatal, labor and delivery, postpartum)
  • Family planning services
  • Behavioral health services and settings
  • Medically necessary transportation to and from required medical services; emergency transportation
  • Outpatient surgery and anesthesia
  • Audiology services
  • Cataract removal; medically necessary vision services
  • Medical foods, with limitations
  • Urgent care

Additional services for children (under 21)

  • Routine preventive dental services, including oral health screenings, cleanings, fluoride treatments, dental sealants, oral hygiene education, X-rays, fillings, extractions and other medically necessary procedures and therapeutic and emergency dental services
  • Vision services, including exams and prescriptive lenses
  • Regular checkups and immunizations
  • Chiropractic services
  • Children’s rehabilitative services
  • Conscious sedation
  • Incontinence briefs, with limitations

Additional services for Qualified Medicare Beneficiaries (QMBs)
Any service covered by Medicare but not by AHCCCS.

  • Chiropractic services

Your guide to getting the care you need
Trying to learn how to get the care and services you need? Your Member Handbook can help.

Handbook archives:

Here you’ll find:

  • Important phone numbers
  • Your rights and responsibilities as a member
  • Which services are covered and which are not
  • Information on how to get the care you need
  • How to get help with appointments
  • Tips to keep you healthy

You can also call Member Services to get a printed Member Handbook. You can reach Member Services at:

  • 602-263-3000 or 1-800-624-3879, Hearing Impaired (TTY/TDD) 711
  • Click on the "Contact Us" link on the Home Page

Looking for an advance directive or other form? You can download any of the forms below at no cost.

When you become a member of Mercy Care Plan Long Term Care, you are assigned a case manager. You will receive case management services for as long as you stay on the ALTCS program. Your case manager will work with you, your guardian and your doctor to help decide which services will best meet your needs.

Learn more about:

The role of the case manager
Case managers visit members in their homes and assess the member’s needs. Families are encouraged to help with the assessment.

These visits are held based on where the member lives:

  1. If the member lives in a nursing home, the case manager visits every six months.
  2. If the member lives in an assisted-living facility, the case manager visits every three months.
  3. If the member lives in his or her own home, or family home in the community, the case manager visits every three months.
  4. Members who are not using ALTCS services need to have one face-to-face visit each year and a phone call every three months. However, a member can call their case manager any time service is needed. Please call the case manager right away to schedule a face-to-face assessment if needed.

If the case manager is not visiting as often as shown above, please call us immediately and we will help.

Once the assessment is done, the case manager, member and family talk about how to meet the member’s needs. Remember that ALTCS services are to help add to the care that is already being provided. It is never meant to completely take away family involvement.

Case managers will never force a member to move to any setting against their or their families’ wishes*. We will always work with the member and family to have the member live in the setting that will meet their needs. If the family and member are ready to move to an assisted-living or nursing home, the case manager will help. If the member wants to stay at home with support services, we will gladly work to find services to meet their needs.

Based on the service plan created with the member/family, the case manager makes sure the services on the service plan are ordered. Any other service needs, such as medications, provider services and treatments, should always go through the member’s providers.

*Members with mental health diagnoses who are under court ordered treatment are subject to follow the courts’ requirements.

Prevention services
The case manager must help support and educate the member about specific health related topics. These include:

Flu shots
Every year we coordinate more than 8,000 flu shots for Mercy Care Long Term Care members. Getting the flu is serious. It can lead to pneumonia, hospitalization and even death. The flu shot helps to prevent the flu and its complications. The case manager can help schedule the flu shot. Members should talk to their case manager every year about the flu shot. October is the best time to get the shot.

Diabetes improvement
Every year we work to help our members with diabetes get the tests they need to check if their diabetes is under control. You should work with your PCP to come up with a plan if your diabetes is not under control. Tests you need include:

  • A retinal eye exam to see if your eyes are in good health
  • Blood tests to check your blood sugar levels
  • Blood tests to check the levels of the fats in your blood

These tests must be completed every year to help you be healthier. Talk to your PCP to make sure you get the tests you need.

Advance directives
All Mercy Care Long Term Care members should have paperwork completed to help your providers know your health care wishes, if you should ever be unable to make those decisions for yourself. This paperwork is called advance directives. Take the time to complete advance directive forms, which can include a Health Care Power of Attorney and a Living Will. Return a copy of your completed forms to your case manager. If you have not yet completed this paperwork, your case manager will continue to talk about the importance of this form with you during your enrollment with Mercy Care Long Term Care.

Learn more about advance directives.

Seeing your Primary Care Physician (PCP)
It is very important for you to have a “medical home.” This means having a primary provider that you visit routinely. They will review your medicines and make sure you get the preventive services you need to feel as well as possible. We ask that Mercy Care Long Term Care members see their PCP every three months to go over any changes to their health and review all medications.

These visits help the PCP get to know you and your needs. This can also help to keep you out of the long lines at the emergency room. It can also help to keep you from being admitted to the hospital because you were closely monitored while living in your home.

When to contact your case manager
Call your case manager for any of these reasons:

  • Your caregiver did not show-up as scheduled
  • Your caregiver leaves before shift is over
  • Your caregiver is not providing all the care they were assigned to do
  • Your caregiver quit
  • You are having trouble getting an appointment with your PCP every time you call
  • You are having trouble picking up your prescriptions or getting them filled
  • You are having trouble getting your supplies or equipment
  • You were discharged from the hospital and need help re-starting services
  • You want to change your living situation. For example, you want to move home from a nursing home or you want to move from your home to an assisted-living facility.
  • You want to cancel or put services on hold
  • You want to look at having different/more services in your home
  • You want to report an issue at a nursing home or assisted-living home
  • When you have a new address or phone number

If you have one of the following medical conditions:  depression, high blood pressure, diabetes, asthma or congestive heart disease, please contact us so we can help you take care of your disease.

How to contact your case manager
At your first visit, your case manager gave you a welcome letter, a business card, and a refrigerator magnet with the case manager’s name and phone number. If you cannot find these items, please call 602-263-3000 or toll-free 1-800-624-3879. Hearing Impaired call (TTY/TDD) 1-866-602-1982 and ask to speak to your case manager or ask for your case manager’s work phone number to call them directly.

Trouble reaching your case manager?
If you have tried more than once to call your case manager and are still not getting a response, please call 602-263-3000 or toll-free 1-800-624-3879. Hearing Impaired (TTY/TDD) 1-866-602-1982. Ask to speak to your case manager’s supervisor or the case management manager.

As a member of Mercy Care Plan Long Term Care, you have a right to receive quality health care. If you feel you have been treated unfairly, have difficulty seeing your doctor, or have any other health care issues, please call Member Services at 602-263-3000 or toll-free 1-800-624-3879. Hearing Impaired (TTY/TDD) 1-866-602-1982.for assistance.

Help prevent fraud and abuse
Caregivers must complete time sheets that accurately reflect the hours they have worked. Caregivers who fraudulently fill in time and their hiring agencies could be held liable for falsifying information.

You can take the following steps to help stop fraud and abuse.

  1. Never sign a blank time sheet or a time sheet that is not completely filled in.
  2. Never sign a time sheet if you know the caregiver did not work the time listed. This is fraud. If this happens, call the agency or your case manager to report this situation.
  3. Never sign a time sheet if it is for dates you were in the hospital. Caregivers cannot provide you care or care for your house while you are in the hospital. This is fraud. In addition, caregivers cannot “make up” the time once you return from the hospital. This can be considered fraud. For example, if you needed bathing assistance five days a week and were in the hospital for four days, the caregiver cannot visit you on the fifth day and try to make up the time for the first four days.

We understand that during these difficult economic times it may be tempting to help caregivers get a full paycheck even if they haven’t provided all the care that they were assigned to provide. However, this is considered fraud and an abuse of the Medicaid health system.

Report fraud and abuse on our website.

Mercy Care Plan reports our health plan's quality scores and related information, as required by our contract with AHCCCS.

2013 AHCCCS Acute Member Survey Results

2012 AHCCCS Health Plan Report Card

All Survey Information

If you would like a printed copy of the Member Handbook or Provider Directory, call Member Services at:

  • 602-263-3000 or 1-800-624-3879
    Hearing Impaired (TTY/TDD) 711
  • Click on the "Contact Us" link on the Home Page