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Arizona - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

In Arizona, the service that covers one-time set-up costs and coordination to move a person out of an institution and into their own community home is officially called Community Transition Service. It is funded under the Arizona Long Term Care System (ALTCS) and governed by the Arizona Health Care Cost Containment System (AHCCCS) Medical Policy Manual (AMPM) Section 1240-C. The service is available to ALTCS Elderly and Physically Disabled (E/PD) members, Department of Economic Security/Division of Developmental Disabilities (DES/DDD) members, and Fee-For-Service Tribal ALTCS members.

To become an approved Community Transition Service provider, an agency must enroll directly with AHCCCS through the AHCCCS Provider Enrollment Portal (APEP). Arizona does not require a distinct state license for this specific administrative service, but providers must meet AHCCCS enrollment standards and contract with the applicable ALTCS Managed Care Organizations (MCOs) or Tribal ALTCS programs that authorize and pay for the service.

1. Service Definition and Scope

Community Transition Service is a funding source designed to assist ALTCS members in reintegrating into the community by providing goods and services needed to move from an ALTCS Long Term Care (LTC) institutional setting to their own home. A "home" is defined as a residential dwelling owned, rented, leased, or occupied by the member at no cost, and explicitly excludes licensed health care institutions, residential care institutions, community residential settings, or behavioral health facilities.

The service covers allowable, pre-determined goods and services authorized by the member's case manager. It is not intended to supplant items or supports otherwise provided by the Contractor or other community resources, and members moving to an Alternative HCBS Setting (such as a group home or assisted living facility) are not eligible for this service.

2. Regulatory and Oversight Agencies

The primary oversight agency for Medicaid services in Arizona is the Arizona Health Care Cost Containment System (AHCCCS). AHCCCS manages provider enrollment, sets medical policy, and oversees the Managed Care Organizations (MCOs) that administer the ALTCS program.

For members with developmental disabilities, the Department of Economic Security/Division of Developmental Disabilities (DES/DDD) acts as the ALTCS Contractor and provides additional oversight and contracting requirements.

3. Gatekeeping Prerequisites: Who Can Even Apply

Arizona does not impose a Certificate of Need, moratorium, or prior-approval need-review process before accepting an application to become a Community Transition Service provider. However, because this service is administered through the ALTCS managed care delivery system, enrolling with AHCCCS is only the first step.

To actually receive referrals and bill for services, a provider must successfully contract with the specific ALTCS Managed Care Organizations (MCOs), DES/DDD, or Tribal ALTCS programs operating in their geographic service area. MCOs maintain their own network adequacy standards and may close their networks to new providers if they determine they have sufficient capacity.

4. Licensure and Certification Requirements

Arizona does not issue a specific facility or agency license for Community Transition Service providers, as this is primarily an administrative and purchasing coordination function rather than direct medical or personal care. Providers operate as vendors facilitating the purchase of goods.

If a provider also intends to offer direct care services (such as attendant care or nursing), they must obtain the appropriate licenses from the Arizona Department of Health Services (ADHS) and/or HCBS Certification from DES/DDD. However, for Community Transition Services alone, standard business registration and AHCCCS enrollment are the primary requirements.

5. Medicaid Provider Enrollment

All providers must enroll through the AHCCCS Provider Enrollment Portal (APEP). The user who submits the initial application becomes the Domain Administrator and is responsible for maintaining the account and completing revalidations.

Providers must submit a completed W-9 form and set up Electronic Funds Transfer (EFT) by submitting the EFT Authorization Form and a blank voided check or bank letter through the AHCCCS Solutions Center. Failure to complete the EFT requirement will result in the application being denied.

6. Staffing, Training and Background Checks

While Community Transition Service does not involve direct physical care, providers must still meet AHCCCS background check requirements. Personnel must obtain a Fingerprint Clearance Card issued by the Arizona Department of Public Safety (DPS).

If a provider holds a valid DPS Fingerprint Clearance Card, they can upload it along with a valid driver's license or US passport in APEP instead of completing a new Fingerprint-based Criminal Background Check (FCBC). Out-of-state fingerprint cards are not accepted.

7. Documentation, Policies and Records

Providers must maintain detailed records of all purchases and services coordinated under the Community Transition Service. Because funds are strictly limited to a one-time authorization of up to $2,000 per member per five-year period, accurate tracking and invoicing are critical.

Documentation must align with the member's LTC Institutional Setting discharge plan and demonstrate that the goods or services were necessary for community reintegration and not available from other sources.

8. Billing, Rates and Claims

Community Transition Service is funded up to a maximum of $2,000 per member per five-year period. This $2,000 limit includes all applicable administration fees charged by the provider.

Funds become available 30 days prior to the planned discharge date. Providers bill the authorizing ALTCS MCO, DES/DDD, or Tribal ALTCS program, not AHCCCS directly (unless serving a Fee-For-Service member). Specific procedure codes and billing modifiers are established by AHCCCS and detailed in the MCO provider manuals.

9. Approval Sequence and Timeline

The approval process begins with submitting a complete application through APEP, including the W-9 and EFT authorization. AHCCCS reviews the application, and the effective date of enrollment is generally the date the application is approved.

After AHCCCS approval, the provider must initiate contracting and credentialing with the ALTCS MCOs or DES/DDD. The MCO contracting phase can take several months and is dependent on network need.

10. Common Denials and Survey Findings

Applications in APEP are frequently delayed or denied due to incomplete information, such as failing to submit the EFT Authorization Form or providing an out-of-state fingerprint clearance card instead of an Arizona DPS card.

In service delivery, claims may be denied if the provider exceeds the $2,000 per five-year limit, if the member is discharged to an ineligible setting (like an assisted living facility), or if the purchased items were not authorized by the case manager.

11. Key Contacts and Resources

Providers should utilize the AHCCCS website and the APEP portal for enrollment activities. The AHCCCS Solutions Center is the primary mechanism for submitting EFT forms and resolving enrollment inquiries.

For contracting, providers must contact the specific ALTCS MCOs operating in their region or DES/DDD directly.

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