I recently had a "debate" over attendant care services for my son through DDD/ALTCS. I was requesting attendant care, and they were not really wanting to provide it. They tried to tell me that it was for people that were not ambulatory, but when I challenged them to provide me with the specific written policy that makes that statement, they backed down.
They tried to lead me to believe that Attendant care can only be provided for a lot of physical care tasks only, which is not true. They had a "tool" to figure out how much time that should be allowed to care for my son, which is MISSING a component of Attendant care as it is described in the ALTCS manual which is "General Supervision and Monitoring". Here is an excerpt from the manual:
General supervision which includes:
a. Monitoring and companionship for a member who cannot be safely left alone
b. Assisting with self-administration of medications, and
c. Monitoring the member’s medical condition and ability to perform the activities of daily living.
To their credit, I did get the services requested on appeal, and I did make a point to include a copy of the "tool" as well as point out it was missing this piece from it. The official definintion for Attendant Care (1240-B) and all other services available are in the manual. It is a good resource when you are considering other services as well and it also defines requirements for providers. The link to the ALTCS manual is here:
http://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/Chap1200.pdf
