Essential BH and Integrated Care Provider Communication Update 11.14.2018 Page 1 of 14 Essential Behavioral Health and Integrated Care Provider Communication Meeting Agenda Logistics Time: 1:30PM – 3:00PM Date: Wednesday, November 14, 2018 Invitees: BH and Integrated Care Provider Agencies Teleconference Details: https://goto.webcasts.com/starthere.jsp?ei=1221338&tp_key=2ad48af2fc Meeting Purpose: AZ Complete Health-Complete Care Plan Updates Location: Webcast Questions: Feel free to email questions and agenda items to [email protected]Next Meeting: 12/12/2018 Table of Contents Administrative Updates: .......................................................................................................... 2 Dr. Jay Gray (Chief Officer of Integrated Care)........................................................ 2 Updates: ................................................................................................................................... 2 Karin Uhlich (Director, Program Innovations) ......................................................... 2 Leon Lead (Manager of Program Initiatives)............................................................ 3 Debbie Yancer (Grant Writer).................................................................................... 6 Tiffany M. Booth (Director of Provider Development) ............................................. 7 Quality Updates.......................................................................................................................11 Amy Couch (QI Specialist) .......................................................................................11 Peter Picone (Clinical QI Specialist)........................................................................11 Training Updates: ...................................................................................................................13 Rodney Staggers (Senior Manager, Training and Workforce Development)........13
Transcript
Essential BH and Integrated Care Provider Communication Update 11.14.2018 Page 1 of 14
Essential Behavioral Health and Integrated Care Provider
Communication Meeting
Agenda Logistics Time: 1:30PM – 3:00PM Date: Wednesday, November 14, 2018 Invitees: BH and Integrated Care Provider Agencies Teleconference Details:
Essential BH and Integrated Care Provider Communication Update 11.14.2018 Page 2 of 14
Administrative Updates: Dr. Jay Gray (Chief Officer of Integrated Care)
Coordinating Care (Health Home and Specialty) • Reminder: All providers are required to coordinate care among treating providers to best meet
the treatment needs of members. This includes ensuring all treating providers receive regular updates as appropriate to effectively coordinate care.
• Specialty providers are not required to receive approval from Behavioral Health Homes prior to the provision of services, but are required to coordinate care with Health Homes to best meet the treatment needs of members.
• Community Service Agencies (CSAs) are require to have a Comprehensive Assessment on file and an Individualized Service Plan that identifies the services provided by the CSA. The Comprehensive Assessment and Individualized Service Plan must be completed by an Independently Licensed Professional or a Behavioral Health Home in accordance with Licensing and AHCCCS requirements. Behavioral Health Homes are expected to collaborate with CSAs to assist them in obtaining appropriate documentation.
• Please reference the Arizona Complete Health-Complete Care Plan Provider Manual for details.
Updates:
Karin Uhlich (Director, Program Innovations) (Attachments 01-03)
AHCCCS DUGless Portal (Health Home and Specialty) • The DUGless Portal Guide (DPG) serves as a procedures manual that outlines the
requirements, definitions, and values for submission of the identified data elements. Required information is collected by Providers within the Arizona Health Care Cost Containment System (AHCCCS) system and submitted via the DUGless Portal. Data and information are recorded and reported to Managed Care Organizations (MCO’s), Regional Behavioral Health Authorities (RBHA), and Tribal Regional Behavioral Health Authorities (TRBHAs), to assist in monitoring and tracking of the following:
o Access and utilization of services o Community and stakeholder information o Compliance of Federal, State, and grant requirements o Health disparities and inequities o Member summaries and outcomes o Quality and Medical Management activities o Social Determinants of Health
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• The data fields contained within the DUGless portal are required as outlined to support healthcare management practices across the AHCCCS systems. Timeframes for submission are outlined within the following sections; demographic data records must match the Member’s medical records. The DUGless portal will not include any data previously submitted through the former DUG system.
Grant Funded Programs and Services • The Substance Abuse Block Grant (SABG) supports primary prevention services and
treatment services for individuals without health insurance or other resources with Substance Use Disorders (SUDs).
• The Mental Health Block Grant (MHBG) is allocated from SAMHSA to provide behavioral health services to children with Serious Emotional Disturbance (SED). This includes Behavioral Health Services for uninsured/underinsured children with an SED Diagnosis
Grant Funded Non-Medicaid Services for Medicaid Members • Non-Medicaid services available to Medicaid members include:
o Room and Board for children with qualifying SED diagnoses who do not have other pay sources for Room and Board
o Room and Board for priority populations (Pregnant and parenting women and IV Drug Users) receiving BHRF SUD treatment who do not have other pay sources for Room and Board
o Child Care for parents receiving SUD treatment to enable them to receive treatment o Acupuncture for SUD treatment o Mental Health Services NOS--Traditional Healing services for members receiving SUD
treatment
• Provider need to submit the attached form to AzCH for Non-AzCH ACC members (Medicaid members who belong to plans other than AzCH) and who qualify for NT19 SUD services.
• The form is required to obtain an enrollment segment from AHCCCS to allow claims to pay
• Do not submit claims until you have received verification for AzCH that an enrollment segment has been obtained
• More details will be forthcoming as we finalize our process and it is approved by AHCCCS.
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o Four Sections: Community-Based Social Services, Substance Misuse Treatment Support Services, Schools & Family Support Services and School Districts. These are consistent with AHCCCS Targeted Investment Requirements.
o https://www.azcompletehealth.com/providers/resources/community-resources.html
o Target Investment Providers and “Z Code” Reporting o 63% of Provider Organizations with Targeted Investment funding reported at least
1 SDOH “Z code” in October 2018. o Provider Engagement Specialists will be connecting with TI Providers in the near
future to review SDOH reporting, tracking and referring members to community resources.
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Employment Services (Health Home and Specialty) • ADES/RSA-Vocational Rehabilitation program
o ADES/RSA Technical Assistance Document Revised 2018* o FY19 Statewide Collaborative Protocol with ADES/RSA for members determined
SMI* o Training on the ISA Collaborative Protocol will be offered in person at ISA Bi-
Annual Meetings and via webinar an additional 2 times throughout the year. o Annual Membership Plan- AHCCCS is requiring a 7% increase of referrals for
adults determined SMI who are interested in employment for FY19.
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SDOH Resources (Health Home and Specialty)
• November 15th is National Rural Health Day - https://www.hrsa.gov/rural-health/about-us/rural-healthday.html
Debbie Yancer (Grant Writer) (Attachment 06)
Arizona Complete Health-Complete Care Plan Provider Manual (Health Home and
Specialty) • The AzCH-CCP Provider Manual has been updated effective 11/1/2018. Attached is the
Summary of Changes that have been made to the manual. o Provider Manual Section Changes are in the following sections: o Section 1 – Introduction To Arizona Complete Health-Complete Care Plan
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o Section 2 – Covered Services And Related Program Requirements o Section 4 – Medical Management/Utilization Management Requirements o Section 5 – Credentialing And Re-Credentialing Requirements o Section 8 – Grievance And Appeal System o Section 10 – Quality Management Requirements o Section 11 – Specific Physical Health Provider Requirements o Section 12 – Behavioral Health Network Provider Service Delivery Requirements o Section 13 – Health Plan Coordination Of Care Requirements o Section 13 – Health Plan Coordination Of Care Requirements o Section 16 – Deliverable Requirements o Section 18 – Provider Manual Forms And Attachments o Section 19 – Definitions & Acronyms
• The Summary of Changes includes the changes/updates made during this revision period in
lieu of the redline version.
• The new AzCH-CCP Provider Manual has been posted and effective 11/1/2018 to the AzCH website. It can be located under Provider Resources at https://www.azcompletehealth.com/providers/resources/forms-resources.html
Tiffany M. Booth (Director of Provider Development) (Attachments 07-10)
Appointment Availability (Health Home and Specialty) • As a reminder all agencies that provide services to AHCCCS members are required to meet
Appointment Availability Standards per ACOM 417. o Providers will be surveyed every quarter to assess their ability to meet these
standards.
o Providers failing the quarterly survey will receive education and technical assistance from their assigned Provider Engagement Specialist and will be re-surveyed during subsequent quarters.
o Providers unable to meet these standards are subject to reduction in panel size and/or corrective actions.
o Below are the requirements per ACOM 417:
• Primary Care Provider Appointments: o Urgent Care Appointments as expeditiously as the member’s health condition
requires but no later than two business days of request, and
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o Routine care appointments within 21 calendar days of request.
• Specialty Provider Appointments, including Dental Specialty: o Urgent Care Appointments as expeditiously as the member’s health condition
requires, but no later than two business days from the request, and o Routine care appointments within 45 calendar days of referral.
• For Maternity Care Provider Appointments, initial prenatal care appointments for enrolled
pregnant members shall be provided as follows: o First trimester - within 14 calendar days of request, o Second trimester within seven calendar days of request, o Third trimester within three days business of request, and o High risk pregnancies as expeditiously as the member’s health condition requires
and no later than three business days of identification of high risk by the Contractor or maternity care provider, or immediately if an emergency exists.
• For Behavioral Health Provider Appointments:
o Urgent need appointments as expeditiously as the member’s health condition requires but no later than 24 hours from identification of need,
o Routine care appointments: i. Initial assessment within seven calendar days of referral or request for service, ii. The first behavioral health service following the initial assessment as
expeditiously as the member’s health condition requires but no later than 23 calendar days after the initial assessment, and
iii. All subsequent behavioral health services, as expeditiously as the member’s health condition requires but no later than 45 calendar days from identification of need.
• For Psychotropic Medications: o Assess the urgency of the need immediately, and o Provide an appointment, if clinically indicated, with a Behavioral Health Medical
Professional within a timeframe that ensures the member a) does not run out of needed medications, or b) does not decline in his/her behavioral health condition prior to starting medication, but no later than 30 calendar days from the identification of need.
• For Behavioral Health Appointments for persons in legal custody of the Department of Child Safety (DCS) and adopted children in accordance with A.R.S. §8-512.01:
o Rapid response when a child enters out-of-home placement within the timeframe indicated by the behavioral health condition, but no later than 72 hours after notification by DCS that a child has been or will be removed from their home,
o Initial assessment within seven calendar days after referral or request for behavioral health services,
o Initial appointment within timeframes indicated, by clinical need, but no later than 21 calendar days after the initial assessment, and
o Subsequent Behavioral Health Services within the timeframes according to the needs of the person, but no longer than 21 calendar days from the identification of need.
Essential BH and Integrated Care Provider Communication Update 11.14.2018 Page 9 of 14
ACOM Updates (Health Home and Specialty - attachment) • The following ACOM Policies have been revised according to the 10/16/18 ACOM
Revision Memo o Policy 412 Claims Recoupment o Policy 435 Telephone Performance Standards o Policy 439 Material Changes Provider Network and Business Operations highlights
the importance of unexpected changes being reported to AHCCCS within 1 business day in Attachment A. If any elements of Attachment A cannot be completed within the 1 business day they must be completed and sent within 1 week of the initial notification. There have been revisions to Attachment A so be sure to use the most current version located on the AHCCCS Website.
AMPM Updates (Health Home and Specialty - attachment) • The following AMPM Policies have been revised according to the 11/1/18 AMPM Revision
Memo: o Policy 400-2A Maternity and Family Planning Services Plan Checklist o Policy 400-2B EPSDT Annual Plan Checklist o Policy 410 Maternity Care Services
Arizona Complete Health Complete Care Plan Network Communications (Health Home and Specialty – 2 attachments) • Language Assistance – AzCH-CCP offers participating providers and member’s access to
interpreters at no cost. Please review and disseminate the attached communication. • Sonora Quest – As a reminder, Sonora Quest Labs is the preferred outpatient lab for
AzCH-CCP members. Please review and disseminate the attached communication.
Health Current – Arizona Health Information Exchange (HIE) (Health Home and Specialty) • Summit and Trade Show is occurring on December 3-4, 2018, at the Renaissance
Phoenix/Glendale Hotel and Spa. The Summit will focus on how HIE participants are using HIE data to improve care and quality, what the challenges and solutions are in improved data sharing and data quality and will allow participants to meet the Health Current team and other HIE participants.
• To review the agenda, obtain hotel and information and register for the Summit and Trade Show please click the below link: https://healthcurrent.org/2018-summit-trade-show/2017-summit-registration/
The Health Information Exchange (HIE) Onboarding Program (Health Home and Specialty) • Arizona Complete Health Complete Care Plan encourages all provider to consider
Essential BH and Integrated Care Provider Communication Update 11.14.2018 Page 10 of 14
• Through funding available from the Arizona Health Care Cost Containment System (AHCCCS) and Health Current, formerly Arizona Health-e Connection, offers the HIE Onboarding Program to support the participation of eligible AHCCCS providers in bidirectional health information exchange through the HIE.
• The program provides an administrative offset in recognition of the costs the eligible HIE participant has incurred to complete bidirectional connectivity with the HIE. Due to limited funding, this program is available on a first come, first served basis.
• Program Benefits o Improves care coordination o Reduces duplicative treatments o Helps avoid costly mistakes and improves patient safety o Saves time by eliminating calls, faxes to other providers o Reduces costs and improves health outcomes
• To find out more about this program please see the information below. o https://healthcurrent.org/programs/hie-subsidy-program/ o Email [email protected] or telephone 602-688-7200
Health Current Webinars ((Health Home and Specialty) • Electronic Prescribing of Controlled Substances (EPCS)
Date Time Register Here
Tuesday, November 27, 2018 12:00PM - 1:00PM MST Register Here
Wednesday, December 5, 2018 5:00PM - 6:00PM MST Register Here
Thursday, December 13, 2018 12:00PM - 1:00PM MST Register Here
Tuesday, December 18, 2018 7:00AM - 8:00AM MST Register Here
• HIE Portal User Lunch and Learn Webinar Series o November 28: How to Properly Fill Out Opt-Out and ROI Forms o December 12: Care Coordination & Case Management o To register click here: https://healthcurrent.org/news-events/events/
National Imaging Association (NIA) – Portal (Health Home and Specialty) • When utilizing the AzCH-CCP Pre-Auth Check Tool you will be redirected to certain
vendors depending on the services needed. • NIA is one of the vendors utilized by the Health Plan for imaging services. • When accessing NIA, which utilizes RadMD for authorizations, providers will need to click
on Health Net Arizona and then chose the specific line of business, such as Medicaid for the AzCH-CCP line of business.
• The plan selection of Health Net Arizona will change to Arizona Complete Health by 1/1/19.
Essential BH and Integrated Care Provider Communication Update 11.14.2018 Page 11 of 14
Quality Updates
Amy Couch (QI Specialist)
Seclusion and Restraint Updates (Health Home and Specialty) • If you are licensed to provide seclusion and/or restraint please submit your reports to
[email protected] o Each occurrence of seclusion and restraint should be submitted within 5 calendar
days of the occurrence
• If you have questions or need a AzCH Seclusion & Restrain please email [email protected] or contact Loren Masden at 520.809.6529
• Please refer to the AzCH 2018 – 2019 Provider Operations Manual section 10.9 (page 237) for specific information regarding Seclusion and Restraint Reporting
Peter Picone (Clinical QI Specialist)
(Attachments 11-14)
Behavioral Health Home • Please see the attached FY19 AzCH QM Medical Record Audit Tool for Behavioral Health
Homes o AzCH Guide to Medical Records Compliance for Health Home Service Delivery
and Access to Care 10.1.18
• New Indicators(s) o #9.a Members Under Substance Abuse Block Grant Only: Upon admission,
documentation supports that notice was provided to the member regarding their right to receive services from a provider to whose religious character the member does not object
o Please see attached AHCCCS Exhibit 320-T-9 Notice to Individuals Receiving Substance Use Services
• Revised Indicators(s) o #53. There is appropriate outreach and engagement with the member prior to
closure for behavioral health services o AzCH recommends utilizing PM Form 12.4.1 Engagement and Re-engagement
Review or equivalent upon completion of treatment for all members and prior to closure to ensure appropriate outreach has been conducted. A licensed BHP/BHMP designee is required to verify by signature that all engagement and re-
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engagement activities have been exhausted prior to closure from AzCH including treatment completed successfully. The form can be completed prior to or same date of closure and is available in the Forms Section – Section 18.1 of the AzCH Provider Operations Manual
o Please also refer to AzCH PM Section 12.4 Outreach, Engagement, Re-engagement & Closure
• AHCCCS Definition & Responsibilities (AMPM Policy 320-O) Attached o Contracted behavioral health provider that serves as an intake agency, provides
or coordinates the provision of covered behavioral health services, and coordinates care with the primary care provider for adults and/or children with behavioral health needs
o The Behavioral Health Home is responsible for maintaining the comprehensive assessment and conducting periodic assessment updates to meet the changing behavioral health needs for members who continue to receive behavioral health services
o For Acute Care, CRS and RBHA contractors, the behavioral health home provider serves as the case management agency
o The Behavioral Health Home is responsible for maintaining the treatment/service plan and conducting periodic treatment/service plan updates to meet the changing behavioral health needs for members who continue to receive behavioral health services
o Other qualified BHPs, including specialty providers not part of the behavioral health home, may engage in assessment and treatment/service planning activities to support timely access to medically necessary behavioral health services. These providers shall provide completed assessment and treatment/service plan documentation to the Behavioral Health Home for inclusion in the comprehensive Behavioral Health Home clinical record
o The Behavioral Health Home must coordinate with the member’s health plan, PCP, specialty providers and others involved in the care or treatment of the member (e.g. DCS, Probation, etc.), as applicable, regarding assessment and treatment/service planning see AMPM Policy 540
Behavioral Health Home & Specialty • Please see the attached FY19 AzCH QM Medical Record Audit Tool for Behavioral Health
Outpatient Specialty providers
• Revised Indicator(s) o #8. Specialty Agency provides regular treatment updates to the assigned
Behavioral Health Home or assigned PCP for coordination of care and progress towards treatment goals as clinically indicated
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o AzCH recommends utilizing PM Form 12.3.3 Specialty Provider Summary or equivalent to demonstrate coordination of care and is available in the Forms Section – Section 18.1 of the AzCH Provider Operations Manual
o Behavioral Health Specialty Agencies are responsible for determining medical necessity for specialty services and regularly reporting progress to Behavioral Health Homes and PCPs as appropriate and when there are changes to a member’s goals, needs, services or frequency of services
o Please also refer to AzCH PM Section 12.3 Referral and Intake Process
• Please review the attached audit tools effective 10/1/18 for the operational definitions in order to meet compliance
• Please distribute the FY19 AzCH audit tools to appropriate staff at your agency
• If you have any additional questions, please contact me or David Widen, QI Audit Supervisor at [email protected]
Training Updates:
Rodney Staggers (Senior Manager, Training and Workforce Development) Relias Migration • Your site will not be migrated to the new Arizona Association of Health Plans (AzAHP) Relias
site until you have cleaned-up your existing portal. You site is ready for migration when you have done the following
o Deleted all non-AzAHP Job Roles o Deleted all non-AzAHP Facility Types
• Please make sure to read emails coming from Relias. They will have information about the migration
• Clean-up must be done by Tuesday, November 20th.
• Sites that aren’t in compliance will be shut off on Wednesday, November 21st.
Essential BH and Integrated Care Provider Communication Update 11.14.2018 Page 14 of 14
• Motivational Interviewing Overview - CODAC, 1650 E. Fort Lowell, Tucson, AZ, 85719 - 11/14/2018, 1:00pm - 4:30pm
• ASAM LIVE WEBINAR PART TWO - https://attendee.gototraining.com/rt/7190021383301555970 - 11/26/2018, 10:00am - 11:30am
• Cultural Competency 101: Embracing Diversity - Devereux 6141 E Grant Rd. Tucson AZ 85712 - 11/27/2018, 8:30am - 12:30pm
• CASII Training PO-C - AZ Complete Health 1870 W. Rio Salado Pkwy, Tempe AZ 85282 - 11/27/2018, 9:00am - 4:00pm
• Motivational Interviewing Overview - COPE Community Services, 1485 W Commerce Court, Tucson, AZ, 85746 - 11/28/2018, 1:00pm - 4:30pm
• Cultural Competency 101: Embracing Diversity - Pinal Hispanic Council, 107 E. 4th St, Eloy, AZ, 85131 - 11/29/2018, 8:30am - 12:30pm
• Question, Persuade and Refer Suicide Prevention Trainings - COPE Community Services, 1485 W Commerce Court, Tucson, AZ, 85746 - 11/29/2018, 10:30am - 12:00pm
• Question, Persuade and Refer Suicide Prevention Trainings - COPE Community Services, 1485 W Commerce Court, Tucson, AZ, 85746 - 11/29/2018, 1:30pm - 3:00pm
• Cultural Competency 101: Embracing Diversity - Arizona Complete Health -Tucson, AZ 333 E. Wetmore Rd. 6th floor reception area - 12/5/2018, 9:30am - 1:30pm
• Cultural Competency 101: Embracing Diversity - Arizona Complete Health -Tucson, AZ 333 E. Wetmore Rd. 6th floor reception area - 12/7/2018, 9:30am - 1:30pm
• ASAM LIVE WEBINAR PART ONE - https://attendee.gototraining.com/rt/5320486578222290690 - 12/10/2018, 1:00pm - 2:30pm
Douglas A. Ducey, Governor Thomas J. Betlach, Director
801 East Jefferson, Phoenix, AZ 85034 • PO Box 25520, Phoenix, AZ 85002 • 602-417-4000 • www.azahcccs.gov
1
DATE: November 01, 2018
TO: Holders of the AHCCCS Medical Policy Manual
FROM: DHCM Contracts and Policy
SUBJECT: AHCCCS Medical Policy Manual (AMPM)
This memo describes revisions and/or additions to the AMPM. Please direct questions regarding policy updates to the Contracts and Policy Unit at 602-417-4295 or 602-417-4055 or email at [email protected].
UPDATES AND REVISIONS TO THE AHCCCS MEDICAL POLICY MANUAL (AMPM) To view the policies and attachments, please access the following link:
AHCCCS MEDICAL POLICY MANUAL (AMPM)
During the month of September AHCCCS will be transitioning the Policies from the Approved Not Yet Effective section of the AMPM webpage to the AMPM final publishing section. Some Policies may have additional changes since the date they were first posted to the Approved Not Yet Effective section. In the event additional changes were made, those revisions are indicated below. Policies that had no additional changes are then listed after. The transitioned policies have a 10/01/18 effective date.
POLICY 310-Q, RESERVED Policy 310-Q, Non-Physician Surgical First Assistant Services was reserved as the service will be incorporated into AMPM Exhibit 300-1. POLICY 400-2A, MATERNITY AND FAMILY PLANNING SERVICES PLAN CHECKLIST Under Maternity and Family Planning Services Narrative Plan, included ‘Well Women’s Preventative Care’ in checklist item #1.
1. A written description of all planned activities to address the Contractor’s minimum requirements, as specified in the Contractor Requirements for Providing Maternity Care, Family Planning Services and Well Women’s Preventative Care including participation in community and/or quality initiatives within the communities served by the Contractor. The narrative description shall also include Contractor activities to identify member needs, coordination of care, and follow-up activities to ensure appropriate and medically necessary treatment is received in a timely and culturally competent manner.
Under Maternity/Family Planning Services Work Plan, clarified checklist item #3:
3. A work plan that formally documents the Maternity and Family Planning program objectives, strategies and activities directed at achieving optimal birth outcomes, as based on the Contractor Requirements outlined in the Maternity and Family Planning
Douglas A. Ducey, Governor Thomas J. Betlach, Director
801 East Jefferson, Phoenix, AZ 85034 • PO Box 25520, Phoenix, AZ 85002 • 602-417-4000 • www.azahcccs.gov
Page 2 of 4
Services sections of AMPM Chapter 400. The work plan shall be limited to three but no more than five, goals which may or may not include select performance measures from Contract.
POLICY 400-2B, EPSDT ANNUAL PLAN CHECKLIST Under EPSDT Plan and Evaluation Checklist, checklist item #1. k., included ‘mothers’.
k. Process to provide outreach related to dangers of lead poisoning to mothers and all EPSDT age members as specified in policy and implementation of strategies for appropriate follow-up care for members who have abnormal blood lead test results.
Under EPSDT Work Plan, clarified checklist item #3.
3. A work plan that formally documents the EPSDT program objectives, strategies and activities and demonstrates how these activities will improve the quality of services, the continuum of care, and health care outcomes (including processes related to developmental screening tools and childhood obesity). The work plan shall be limited to three, but no more than five goals which may or may not include select performance measures from Contract.
POLICY 410, MATERNITY CARE SERVICES Clarified definition for ‘Postpartum’. For the purposes of this Policy, postpartum is defined as the period beginning the day of parturition and ends the last day of the month in which the 57th day following parturition occurs.
o ATTACHMENT A, SEMIANNUAL REPORT OF NUMBER OF PREGNANT WOMEN WHO ARE HIV/AIDS
POSITIVE No changes.
o ATTACHMENT B, REQUEST FOR STILLBIRTH SUPPLEMENT No changes.
o ATTACHMENT C, AHCCCS CERTIFICATE OF NECESSITY FOR PREGNANCY TERMINATION No changes.
o ATTACHMENT D, AHCCCS VERIFICATION OF DIAGNOSIS BY CONTRACTOR FOR A PREGNANCY
TERMINATION REQUEST No changes.
o ATTACHMENT E, POLICY 410, ATTACHMENT E - MONTHLY PREGNANCY TERMINATION REPORT No changes.
Douglas A. Ducey, Governor Thomas J. Betlach, Director
801 East Jefferson, Phoenix, AZ 85034 • PO Box 25520, Phoenix, AZ 85002 • 602-417-4000 • www.azahcccs.gov
Page 3 of 4
POLICY 411, WOMEN’S PREVENTATIVE CARE SERVICES No Changes. POLICY 1020, MEDICAL MANAGEMENT SCOPE AND COMPONENTS No changes to Policy. ATTACHMENT A, PSYCHIATRIC SECURITY REVIEW BOARD/GEI CONDITIONAL RELEASE MONTHLY REPORT No changes to Attachment A. ATTACHMENT B, ADULT AND CHILD EMERGENCY DEPARTMENT (ED) WAIT TIMES REPORT No changes to Attachment B. ATTACHMENT C, JUSTICE REACH-IN REPORT No changes to Attachment C. ATTACHMENT D, SPECIAL HEALTH CARE NEEDS REPORTING TEMPLATE Replaced ‘Substance Use Disorder’ with ‘Opioid Use Disorder (OUD)’ for all Contractors. ATTACHMENT E, PHARMACY AND PRESCRIBER REPORT TEMPLATE No changes to Attachment E. ATTACHMENT F, EMERGENCY DEPARTMENT (ED) DIVERSION REPORTING SUMMARY No changes to Attachment F. ATTACHMENT G, HIGH NEED/HIGH COST MEMBER LIST No changes to Attachment G.
APPROVED NOT YET EFFECTIVE
To view the policies and attachments, please access the following link:
AMPM APPROVED NOT YET EFFECTIVE
The following Policies are posted for Contactor reference. These Policies are not in effect until the date referenced in each Policy. POLICY 310-A, RESERVED POLICY 310-E, RESERVED POLICY 310-G, RESERVED POLICY 310-H, RESERVED POLICY 310-O, RESERVED POLICY 310-T, RESERVED POLICY 310-W, RESERVED POLICY 310-Y, RESERVED
Douglas A. Ducey, Governor Thomas J. Betlach, Director
801 East Jefferson, Phoenix, AZ 85034 • PO Box 25520, Phoenix, AZ 85002 • 602-417-4000 • www.azahcccs.gov
Page 4 of 4
POLICY 310-CC, RESERVED POLICY 320-A, RESERVED POLICY 320-F, RESERVED POLICY 320-K, RESERVED POLICY 961-C, COMMUNITY SERVICE AGENCIES
AHCCCS MEDICAL POLICY MANUAL
SECTION 320 – SERVICES WITH SPECIAL CIRCUMSTANCES
320-O - Page 1 of 5
320-O BEHAVIORAL HEALTH ASSESSMENTS AND TREATMENT/SERVICE PLANNING
EFFECTIVE DATE: 10/05/17 REVISION DATE: 07/20/17 I. PURPOSE
This Policy applies to Acute Care, ALTCS/EPD, CRS and RBHA Contractors, and Fee-For-Services (FFS) Programs including: Tribal ALTCS and TRBHAs, and FFS Providers as delineated within this Policy. This Policy does not apply to the following FFS populations: Federal Emergency Services (FES). The purpose of this Policy is to describe provisions for behavioral health assessment and treatment/service planning for AHCCCS members.
II. DEFINITIONS
BEHAVIORAL HEALTH HOME Contracted behavioral health provider that serves as an
intake agency, provides or coordinates the provision of covered behavioral health services, and coordinates care with the primary care provider for adults and/or children with behavioral health needs.
BEHAVIORAL HEALTH PROFESSIONAL (BHP)
a. An individual licensed under A.R.S. Title 32, Chapter 33, whose scope of practice allows the individual to: i. Independently engage in the practice of behavioral
health as defined in A.R.S. §32-3251, or ii. Except for a licensed substance abuse technician,
engage in the practice of behavioral health as defined in A.R.S. §32-3251 under direct supervision as defined in AAC. R4-6-101,
b. A psychiatrist as defined in A.R.S. §36-501, c. A psychologist as defined in A.R.S. §32-2061, d. A physician, e. A behavior analyst as defined in A.R.S. §32-2091, f. A registered nurse practitioner licensed as an adult
psychiatric and mental health nurse, or g. A registered nurse.
AHCCCS MEDICAL POLICY MANUAL
SECTION 320 – SERVICES WITH SPECIAL CIRCUMSTANCES
320-O - Page 2 of 5
BEHAVIORAL HEALTH TECHNICIAN (BHT)
As specified in A.A.C. R9-10-101, an individual who is not a BHP who provides behavioral health services at or for a health care institution according to the health care institution’s policies and procedures that:
1. If the behavioral health services were provided in a setting other than a licensed health care institution, the individual would be required to be licensed as a behavioral professional under A.R.S. Title 32, Chapter 33, and
2. Are provided with clinical oversight by a behavioral health professional.
SPECIALTY PROVIDER Behavioral Health service that is not available in the Behavioral Health Home.
TREATMENT/SERVICE PLAN A written description of covered health services and informal supports identified based on an assessment to assist the member in achieving an improved quality of life.
III. POLICY
A. OVERVIEW The model for behavioral health assessment, treatment/service planning, and service delivery shall be strength-based, member-centered, family-friendly, culturally and linguistically appropriate, and clinically supervised. The model is based on four equally important components:
• Input from the member/guardian/designated representative regarding his/her
individual needs, strengths, and preferences,
• Input from other persons involved in the member’s care who have integral relationships with the member,
• Development of a therapeutic alliance between the member/guardian/designated representative and behavioral health provider that promotes an ongoing partnership built on mutual respect and equality, and
• Clinical expertise/qualifications of person(s) conducting the assessment,
treatment/service planning, and service delivery. The model incorporates the concept of a “team,” established for each member receiving behavioral health services.
For children, this team is the Child and Family Team (CFT) and for adults, this team is the Adult Recovery Team (ART). At a minimum, the functions of the CFT and ART include:
AHCCCS MEDICAL POLICY MANUAL
SECTION 320 – SERVICES WITH SPECIAL CIRCUMSTANCES
320-O - Page 3 of 5
1. Ongoing engagement of the member/guardian/designated representative, family and others who are significant in meeting the behavioral health needs of the member, including their active participation in the decision-making process and involvement in treatment.
2. An assessment process that is conducted to: a. Elicit information on the strengths and needs of the individual member and his/her
family, b. Identify the need for further or specialty evaluations, and c. Support the development and updating of the treatment/service plan(s) which
effectively meets the member’s/family’s needs and results in improved health outcomes.
3. Continuous evaluation of the effectiveness of treatment through the CFT or ART
process, the ongoing assessment of the member, and input from the member/ guardian/designated representative resulting in modification to the treatment/service plan(s), as necessary.
4. Provision of all covered services as identified on the treatment/service plan(s), including assistance in accessing community resources as appropriate.
5. For children, services are provided consistent with the Arizona Vision - 12 Principles
as outlined in AMPM Policy 430. For adults, services are provided consistent with the Adult Service Delivery System - 9 Guiding Principles.
6. Ongoing collaboration with other individuals and/or entities with whom delivery and coordination of services is important to achieving positive outcomes (e.g. primary care providers, specialty service providers, school, child welfare, Division of Developmental Disabilities (DDD), justice system and others). This shall include sharing of clinical information as appropriate.
7. Ensure continuity of care by assisting members who are transitioning to a different
treatment program, changing behavioral health providers and/or transferring to another service delivery system (e.g. out-of-area, out-of-state or to an Arizona Long Term Care System (ALTCS) Contractor). For more details, please refer to ACOM Policy 402 and AMPM Policy 520.
B. ASSESSMENT AND SERVICE PLANNING
1. General Requirements for Acute Care, ALTCS/EPD, CRS and RBHA Contractors,
Fee-For-Services (FFS) Programs including: Tribal ALTCS, TRBHAs, and FFS Providers: a. Behavioral health assessments and treatment/service planning must comply with
the Rules set forth in A.A.C. Title 9, Chapters 10 and 21, as applicable.
AHCCCS MEDICAL POLICY MANUAL
SECTION 320 – SERVICES WITH SPECIAL CIRCUMSTANCES
320-O - Page 4 of 5
b. Behavioral health providers, including specialty providers, may engage in assessment and service/treatment planning activities to support timely access to medically necessary behavioral health services.
c. In the event the assessment or treatment/service plan is completed by the BHT the requirements of A.A.C. Title R9-10-1011(B)(3) must be met.
d. At a minimum, the member/guardian/designated representative, and a BHP must be included in the assessment process and development of the treatment/service plan.
e. The assessment and service plan must be included in the clinical record in accordance with AMPM Policy 940.
f. The service plan must be based on the current assessment and identify the specific services and supports to be provided.
g. The behavioral health provider must document whether or not the member/guardian/designated representative is in agreement with the service plan.
h. The member/guardian/designated representative must be provided with a copy of his/her service plan within seven calendar days upon completion of the service plan and/or upon request.
i. Serious Mental Illness (SMI) Determination shall be completed for persons who request an SMI determination in accordance with AMPM Policy 320-P, and
j. For members determined SMI: i. Assessment and treatment/service planning must be conducted in accordance
with A.A.C. Title 9, Chapter 21, Articles 3 and 4, ii. Special Assistance assessment shall be completed in accordance with AMPM
Policy 320-R, iii. The completed treatment/service plan must be signed by the member/
guardian/designated representative in accordance with A.A.C. R9-21-308, and iv. For appeal requirements refer to A.A.C. Title 9, Chapter 21, Article 4 and
ACOM Policy 444.
2. Tribal ALTCS, TRBHAs and FFS Providers: a. Behavioral health providers, including specialty providers, shall provide
completed assessment and treatment/service plan documentation to the TRBHA or to the Tribal ALTCS case manager for inclusion in the member’s medical record,
b. The TRBHA must coordinate with the member’s health plan, Primary Care Provider (PCP), specialty providers and others involved in the care or treatment of the member (e.g. Department of Child Safety (DCS), Probation, DDD), as applicable, regarding assessment and treatment/service planning,
c. Special Circumstances: i. Children Age 11 to 18: The behavioral health provider must complete a
standardized substance use screen and referral for further evaluation when screened positive and this information must be provided to the TRBHA or Tribal ALTCS.
AHCCCS MEDICAL POLICY MANUAL
SECTION 320 – SERVICES WITH SPECIAL CIRCUMSTANCES
320-O - Page 5 of 5
3. Acute Care, ALTCS/EPD, CRS and RBHA Contractors: a. The Behavioral Health Home is responsible for maintaining the comprehensive
assessment and conducting periodic assessment updates to meet the changing behavioral health needs for members who continue to receive behavioral health services,
b. For Acute Care, CRS and RBHA contractors, the behavioral health home provider serves as the case management agency,
c. For ALTCS/EPD contractors, the contractor is responsible for the delivery of case management services for the member,
d. Assessments must be updated at a minimum of once annually, e. Assessments and treatment/service plans must be completed by BHPs or BHTs
under the clinical oversight of a BHP that meets credentialing and training requirements outlined in AMPM Policy 950,
f. The Behavioral Health Home is responsible for maintaining the treatment/service plan and conducting periodic treatment/service plan updates to meet the changing behavioral health needs for members who continue to receive behavioral health services,
g. Other qualified BHPs, including specialty providers not part of the behavioral health home, may engage in assessment and treatment/service planning activities to support timely access to medically necessary behavioral health services. These providers shall provide completed assessment and treatment/service plan documentation to the Behavioral Health Home for inclusion in the comprehensive Behavioral Health Home clinical record. Contractors may incorporate additional requirements, such as Behavioral Health Home referral expectations, as long as they do not prevent timely access to covered behavioral health services,
h. The Behavioral Health Home must coordinate with the member’s health plan, PCP, specialty providers and others involved in the care or treatment of the member (e.g. DCS, Probation, etc.), as applicable, regarding assessment and treatment/service planning see AMPM Policy 540.
i. Special Circumstances: i. Children Age 0 to 5 – Developmental screening must be conducted by the
Behavioral Health Home for children age 0-5 with a referral for further evaluation when developmental concerns are identified,
ii. Children Age 6 to 18 - The Child and Adolescent Service Intensity Instrument (CASII) must be completed by the Behavioral Health Home during the initial assessment and updated at a minimum of once annually,
iii. Children Age 6 to 18 - with CASII Score of four or Higher: Strength, Needs and Culture Discovery Document must be completed by the Behavioral Health Home, and
iv. Children Age 11 to 18 - Standardized substance use screen and referral for further evaluation when screened positive must be completed by the Behavioral Health Home.
Douglas A. Ducey, Governor Thomas J. Betlach, Director
801 East Jefferson, Phoenix, AZ 85034 • PO Box 25520, Phoenix, AZ 85002 • 602-417-4000 • www.azahcccs.gov
Page 1 of 2
DATE: October 16, 2018
TO: Holders of the AHCCCS Contractor Operations Manual
This memo describes revisions and/or additions to the ACOM. Please direct questions regarding policy updates to the Contracts and Policy Unit at 602-417-4295 or 602-417-4055 or email at [email protected].
UPDATES AND REVISIONS TO THE AHCCCS CONTRACTOR OPERATIONS MANUAL (ACOM) To view the policies and attachments, please access the following link:
AHCCCS CONTRACTOR OPERATIONS MANUAL (ACOM) POLICY 412, CLAIMS RECOUPMENT Policy 412 was revised for minor formatting. Policy title was formerly titled, “Claims Reprocessing” and was updated to “Claims Recoupment” for clarity. POLICY 435, TELEPHONE PERFORMANCE STANDARDS AND REPORTING Policy 435 was revised for minor formatting and language clarification on reporting downtime resolution.
o ATTACHMENT A & B, TELEPHONE PERFORMANCE MEASURES TEMPLATE – CENTRALIZED TELEPHONE
LINE DOWN TIME TEMPLATE No changes to Attachment A. Attachment B was revised to include a new column to add a description for resolution.
POLICY 439, MATERIAL CHANGES PROVIDER NETWORK AND BUSINESS OPERATIONS Policy 439 was revised for general formatting and language clarification.
POST TRIBAL CONSULTATION NOTIFICATION/PUBLIC COMMENT CHANGE: Added language to Policy section III., B., 5.,
5. In the event of an unexpected material change to the provider network and/or
business operations, the Contractor shall submit written notification to AHCCCS no
later than one business day of the Contractor becoming aware of the change.
Notification shall be submitted as specified in Contract. The notification shall include
a detailed description of the change, address why it was unexpected and include all of
I. Introduction 3 Field 15 – Dependent Children 19
II. Portal Registration 5 Field 16 – Social Supports of Recovery 20
III. Guidelines for Single Case Data Submissions
9 Field 17 – Military Status 20
IV. Guidelines for File Upload Submissions 10 Field 18 – CASII Intensity Level 21
V. Portal Data Fields 13 Field 19 – CASII Intensity Date 21
Field 1 – Provider ID 13 Field 20 – Substance Use Primary Type 22
Field 2 – AHCCCS ID 13 Field 21 – Substance Use Primary Frequency
22
Field 3 – Date of Birth (DOB) 13 Field 22 – Substance Use Primary Route 23
Field 4 – Referral Date 14 Field 23 – Substance Use Primary Age 23
Field 5 – Referral Source 14 Field 24- Substance Use Secondary Type 24
Field 6 – Treatment Participation 15 Field 25- Substance Use Secondary Frequency
24
Field 7 – Number of Arrests 15 Field 26- Substance Use Secondary Route 25
Field 8 – Arizona Department of Corrections (ADC) or Parole
16 Field 27 – Substance Use Secondary Age 25
Field 9 – Arizona Department of Juvenile Corrections (ADJC)
16 Field 28 – Substance Use Tertiary Type 26
Field 10 – Adult Probation 17 Field 29 – Substance Use Tertiary Frequency
26
Field 11 – Juvenile Probation 17 Field 30 – Substance Use Tertiary Route 27
Field 12 – DES/RSA Involvement 17 Field 31 – Substance Use Tertiary Age 27
Field 13- School Special Education 18 VI. Document Revision History 28
Field 14 – Employment Status 18
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DUGless Portal Guide
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I.
Purpose The DUGless Portal Guide (DPG) serves as a procedures manual which outlines the requirements, definitions, and
values for submission of the identified data elements. Required information is collected by Providers within the Arizona
Health Care Cost Containment System (AHCCCS) system and submitted via the DPG. Data and information are
recorded and reported to Managed Care Organizations (MCO’s), Regional Behavioral Health Authorities (RBHA), and
Tribal Regional Behavioral Health Authorities (TRBHAs), to assist in monitoring and tracking of the following:
Access and utilization of services
Community and stakeholder information
Compliance of Federal, State, and grant requirements
Health disparities and inequities
Member summaries and outcomes
Quality and Medical Management activities
Social Determinants of Health
The data fields contained within the DPG are required as outlined by contacts and to support healthcare management
practices across the AHCCCS systems. Timeframes for submission are outlined within the following sections;
demographic data records must match the Member’s medical records. The DPG will not contain will not include any data
previously submitted through the former DUG system.
Scope of Members to be Reported
The suggestion from AHCCCS on the scope of Member data to be submitted is for those Members for whom the data
applies to and is collected by the Provider. AHCCCS Complete Care Contracts, MCOs, RBHAs, and TRBHAs may
provide additional support and recommendations on information submitted.
Timeframes for Data Submission Data is to be submitted for all new Members and when the Member’s data changes and/or is updated (i.e. a Member’s
employment status changed from full-time to part-time employment).
Data Submission Options
The portal has two options for providers to submit data, by individual Member (single case, page 9) and by multiple
Members in a text file (file upload, page 10). Data may be submitted through either one of these options, not both.
Data Distribution Data submitted through the portal may be shared with AHCCCS Complete Care Contractors, MCOs, RBHAs, and
TRBHAs, as applicable, and if requested from AHCCCS.
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Provider Data Management Vendors
In the event a provider will utilize a vendor to assist with the capture and submission of DUGless data, the vendor will not
be able (at this time) to upload text files or single cases directly and must prepare text files on behalf of providers which
will then be uploaded by the individual provider to the portal.
Contacts
Any questions about the portal or the data fields in the portal should be submitted to DHCM/DAR Information
Management/Data Analytics Unit (IMDAU) Manager, Angela Aguayo at [email protected] and should also
include Lori Petre ([email protected]), Data Analysis and Research Manager for DHCHM/DAR. If there are any
technical issues with the portal contact Customer Support at either [email protected] or 602-417-
4451.
Guide Updates and Revisions
This document serves as a document of reference and will be updated to ensure consistency of changes within the AHCCCS data healthcare system. Revisions to this document are tracked and listed at the end of this document.
Interactive Reference In an effort to support paper-reduction practices this document is developed as an interactive reference Acrobat PDF
(Portable Document Format) document medium. The Table of Contents contains links to the specific data fields and
sections within the DPG for the corresponding data elements/fields. This allows for a quick single-click reference to the
key sections, policies, and supportive documents located throughout AHCCCS’s website. Hyperlinks are displayed with a
blue underlined font.
Portal Data Fields Layout Descriptions All data submitted via the DPG is identified by a field number and a field name. Data fields and names include
subsections: field labels, descriptions, valid values, rules and definitions, updates, and examples to assist in submission
of data elements and consistency of data; further explanation is provided within the following sections.
Sub-Section Description
Field Label Label utilized for data submission within the Demographics Portal.
Description Describes the data field with a brief definition and/or description of the population specifics.
Valid Values A list of all current valid values.
Rules and Definitions
Defines valid values, when applicable; describes how often the information should be updated, and any other applicable rules and/or data validations.
Updates Provides a list of history, updates, and revisions based on manual editions.
Examples Describes one or more situations and the valid value(s) used in the situation(s). Bolded areas are examples of the data submission.
Portal Registration The following information is required in order to register to the portal:
1. National Provider Identifier (NPI) OR AHCCCS Provider ID AND
2. Tax Identification Number (TIN) Master Account vs. Individual Accounts There are two types of accounts that can be created for the DUGless Portal website, Master Accounts and Individual Accounts. A Master Account is the administrator for all accounts created under their Provider ID. This includes activating new accounts, removing accounts for those no longer working for the organization, maintaining site privileges for each user, initiating the password recovery process, and maintaining some of the account information for the Individual accounts. Please contact AHCCCS Provider Registration at 602-417-7670 Option 5 for questions concerning provider group affiliation.
The first account registered for the Provider/Agency will be the Master Account holder. For more detailed information regarding Master Accounts see Appendix A (page 5) – AHCCCS Online Learn More or visit the website.
If the Provider/Agency already has a Master Account, additional user may register for an Individual Account. When an Individual Account is created, the Master Account holder for the Provider/Agency will receive an email to approve the account and they will need to grant individual access to the Supplemental Member Data (DUGless Portal) Step 1: Go to the following website: https://azweb.statemedicaid.us
Click on the ‘Register’ link, under the ‘New Account’ section, on the left hand side of the website
Step 2: To proceed with the registration, please read the User Acceptance Agreement - Terms of Use and accept the agreement by selecting ‘I agree’ and click on ‘Next’
Step 3: Next enter the provider NPI or AHCCCS Provider ID* AND TIN. Make sure ‘Provider’ is selected under the ID, click ‘Next’ NOTE: If your Provider ID is associated to more than one NPI, you must use your NPI
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If your organization does not have a Master Account, you will receive the following message: Either select an address to continue and create a Master Account OR Select Cancel and suspend the registration process
Step 4: Complete the user information, select two security questions, and create a password to create the new account, and then click ‘Create User’ NOTE: The password requirements are located on top of the webpage:
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Password Requirements: Passwords are required to be a minimum of 9 characters in length. Passwords require the use of at least one lower case alpha character, one upper case character, at least one numeric character (1,2,etc), at least 1 special character @!#=$*-/^{}()?_ The password must NOT contain 3 or more of the same consecutive characters (111, aAa, etc.) The password must NOT contain 3 consecutive characters in common with the user name. Step 5: Once you have successfully completed the information requested, you will see the following page:
Step 6: You will receive a letter in the mail, sent to the organization address you selected. The letter will contain an activation code. You will enter this code on the portal logon page to activate your account. Step 7: After receiving the code in the Mail enter user credentials and the activation code to activate Master user account, the next time you log into the portal. Please also refer to ‘Frequently Asked Questions’ on the website for any additional registration and/or account questions and who to contact for any questions regarding the AHCCCS Online accounts. As a reminder, please remember that sharing account logins is prohibited and violates the AHCCCS User Acceptance Agreement. You should NOT share your user name and password with any other individuals. Each user must have their own web account and access to the web site can be terminated if the User Acceptance Agreement is violated.
Single Case Submissions Providers may submit data for individual Members through the AHCCCS Online Main Screen, under ‘Member
Supplemental Data’ and selecting the ‘Single Entry Record’ option in the portal.
The Member’s AHCCCS ID AND Date of Birth are required in order to submit single case data. Once the Member
is identified in the system, the appropriate data fields auto-populated based on the Member’s age and gender.
Once the data fields are completed, Providers must click on the ‘Submit’ button on the bottom on the page. A
message will appear on the screen to indicate the data was successfully recorded. If there are any errors with the
data, an error message will appear. Any data that receives an error message will not be saved in our system and
will need to be re-submitted.
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IV. Guidelines for File Upload Submissions
File Format and Name Providers may submit data on various Members by uploading a file through the AHCCCS Online Main Screen, under ‘Member Supplemental Data’ and selecting the ‘Multiple Records Entry’ option in the portal. The file must be in a plain text format with fixed length values, as detailed in File Layout Table below (page 12), and a file size limit of 10 MB. Providers may submit data on Members from any Provider IDs, as long as ID is active in our system.
The following standards should be used for all file names:
MMDDCCYY of submission
Provider ID the user registered with, regardless of Provider IDs included in the file
3 digit sequence number (in the event of multiple files in a single day)
For example, 10012018111111001.txt
File Submission Results When data is submitted, a summary of the results of the processed file will be displayed. If there are errors, reason of record rejection will be specified next to that line number and AHCCCS ID, in red. To correct errors, a new file will need to be submitted. The error detail list can be uploaded to Excel. Any data that receives an error message will not be saved in our system and will need to be re-submitted.
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Records processed: ### Records accepted: ### Records rejected: ### Rejection Details:
Line: ### AHCCCS ID: ### DOB: ### Provider ID: ### Reason: <reason for record rejection>
Possible Rejection Reasons:
Invalid AHCCCS ID
Invalid Date Format
Member Not Found
Value Not Applicable to the Field
Value Out of Range
Value Not applicable for Member Age
Value Not Applicable for Member Gender
File Upload Example
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File Layout Table for File Upload (Multiple Records Entry)
Field Label Data Type Length Start End PROVIDER_ID varchar 6 1 6
AHCCCS_ID varchar 9 7 15
DOB (YYYYMMDD) datetime 8 16 23
REFERRAL_DATE (YYYYMMDD) datetime 8 24 31
REFERRAL_SOURCE varchar 2 32 33
TREATMENT_PARTICIPATION varchar 1 34 34
NUMBER_OF_ARRESTS tinyint 2 35 36
OA_ADC varchar 1 37 37
OA_ADJC varchar 1 38 38
OA_AOC_ADULT varchar 1 39 39
OA_AOC_JUVENILE varchar 1 40 40
OA_DES_RSA varchar 1 41 41
OA_SCHOOL_SPECIAL_ED varchar 1 42 42
EMPLOYMENT_STATUS varchar 2 43 44
SP_WOMAN_DC varchar 1 45 45
SUPPORT_GROUPS_PARTICIPATION varchar 1 46 46
MILITARY_STATUS varchar 1 47 47
CASII_INTENSITY_LEVEL varchar 2 48 49
CASII_INTENSITY_DATE (YYYYMMDD) datetime 8 50 57
SA_PRIMARY_TYPE varchar 4 58 61
SA_FREQUENCY_1 varchar 1 62 62
SA_ROUTE_1 varchar 1 63 63
SA_AGE_1 tinyint 2 64 65
SA_SECONDARY_TYPE varchar 4 66 69
SA_FREQUENCY_2 varchar 1 70 70
SA_ROUTE_2 varchar 1 71 71
SA_AGE_2 tinyint 2 72 73
SA_TERTIARY_TYPE varchar 4 74 77
SA_FREQUENCY_3 varchar 1 78 78
SA_ROUTE_3 varchar 1 79 79
SA_AGE_3 tinyint 2 80 81
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V. Portal Data Fields
1- Provider ID
Field Label Provider_ID
Description Identifies the provider submitting the file
Valid Values Valid AHCCCS Provider ID (6 characters)
Rules and Definitions
Required on all submissions/transactions
Updates 10/01/2018 Field added.
Examples The Provider submitting the file is 111111. Enter 111111
2- AHCCCS ID
Field Label AHCCCS_ID
Description The unique identifier (ID) assigned by AHCCCS
Valid Values A unique type ‘A’ AHCCCS ID.
Rules and Definitions
AHCCCS ID is required on all submissions/transactions. ID must match ID in 834 enrollment AHCCCS table. Field will be a single text box with a maximum length of 9 characters. Verification will be implemented to ensure that entered values must start with an “A” and have digits for the rest of the field length.
Updates 10/01/2018 Field added.
Examples Enter Member’s unique AHCCCS ‘A’ or ‘S’ type ID assigned. Enter A55555555
3- Date of Birth (DOB)
Field Label DOB
Description The day the Member was born.
Valid Values YYYYMMDD Format
Rules and Definitions
Required on all transactions Must match DOB on 834 enrollment record AHCCCS table.
Updates 10/01/2018 Field added.
Examples Date is recorded as the 4-digit year, 2-digit month and 2-digit day. A Member’s date of birth is March 9, 1943. Enter 19430309
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4- Referral Date
Field Label Referral_Date
Description The date when the provider received a referral for service. A referral includes an oral, written, faxed or electronic request for services made by the Member or on the Member’s behalf.
Valid Values YYYYMMDD Format
Rules and Definitions
The Referral Date should be equal to or less than date of data submission. The Referral Date should be equal to or less than the Member’s first date of service/treatment.
Updates 10/01/2018 Field added.
Examples The Provider receives a call on January 3, 2019, requesting services. Enter 20190103
5- Referral Source
Field Label Referral_Source
Description Identifies the principal source of referral for a Member.
Valid Values
01 - Self/Family/Friend 03 - Other Behavioral Health Provider 05 - RBHA Customer Service 19 - Federal Agency (VA, IHS, Federal Prison, etc.) 35 - AHCCCS Health Plan and/or PCP 36 - DCS Urgent Response (child only)
37 - Community agency other than Behavioral Health Provider (homeless shelter, church, employer)
38 - Arizona Department of Economic Security (ADES) or Tribal Social Services (Adult or other non-urgent DCS referral, DDD, RSA)
39 - Arizona Department of Education (ADE) or Tribal Schools 40 - Criminal justice/correctional (includes AOC-Probation, ADOC,
ADJC, Jail, including Tribal) 41 - Other
Rules and Definitions
Data should only be collected beginning of services/treatment.
Updates 10/01/2018 Field added.
Examples A referral is received from the Arizona Department of Economic Security/Department of Child Safety (ADES/DCS) for an urgent response to provide behavioral health services to a child removed from the home. Enter 36
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6- Treatment Participation
Field Label Treatment_Participation
Description Refers to the presence of a court order or conditions of parole/probation pertaining to the delivery of Behavioral Health services.
Valid Values V - Voluntary C - Involuntary – Criminal; DUI or conditions of parole/probation N - Involuntary – Civil: MH court order, Drug court
Rules and Definitions
Voluntary participation is when a Member (or a parent/guardian, if applicable) is applying for or receiving services voluntarily. Involuntary – Criminal; DUI/ Drug Court /condition of parole/probation is when a Member applies for/receives services as a result of criminal court ordered treatment OR when a Member applies for/receives services as a result of a court ordered DUI screening, education or treatment. Involuntary - Civil/MH Court Order is when a Member applies for/receives services as a result of Title 36 proceedings for a court ordered evaluation (COE) or court ordered treatment (COT)
Updates 10/01/2018 Field added.
Examples The Member walked in and requested services on their own accord. Enter V
7- Number of Arrests
Field Label Number_of_Arrests
Description The number of times the Member has been arrested within the last 30 days.
Valid Values 00 - 31
Rules and Definitions
Entry must be ascertained by a clinical professional. Any arrest that occurred within the last 30 days from the date of service. Field will be single line text box with maximum length of 2 characters.
Updates 10/01/2018 Field added.
Examples The Member has been arrested once during the last 30 days. Enter 01
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8- Arizona Department of Corrections (ADC) or Parole
Field Label OA_ADC
Description Age 18 and Older Only. Refers to other agencies with a current and/or ongoing role with the Member. Is the Member, age 18 and older, involved with the ADC or on parole?
Valid Values Y - Yes N - No X - Not applicable due to age
Rules and Definitions
If Member’s age is 0-17 years old, then ‘X’ is the only accepted value.
Updates 10/01/2018 Field added.
Examples The Adult Member is currently on parole with ADC. Enter Y
9- Arizona Department of Juvenile Corrections (ADJC)
Field Label OA_ADJC
Description Age 0 thru 17 Only. Refers to other agencies with a current and/or ongoing role with the Member. Is the Member, age 0 thru 17, involved with the ADJC?
Valid Values Y - Yes N - No X - Not applicable due to age
Rules and Definitions
If Member’s age is 18 years old or older, then ‘X’ is the only accepted value.
Updates 10/01/2018 Field added.
Examples The Youth Member is currently involved with ADJC. Enter Y
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10- Adult Probation
Field Label OA_AOC_ADULT
Description Age 18 and Older Only. Refers to other agencies with a current and/or ongoing role with the Member. Is the Member, age 18 and older, on adult probation through the Administrative Office of the Courts (AOC)?
Valid Values Y - Yes N - No X - Not applicable due to age
Rules and Definitions
If Member’s age is 0-17 years old, then ‘X’ is the only accepted value.
Updates 10/01/2018 Field added.
Examples The Adult Member is currently on adult probation through AOC. Enter Y
11- Juvenile Probation
Field Label OA_AOC_JUVENILE
Description Age 0 thru 17 Only. Refers to other agencies with a current and/or ongoing role with the Member. Is the Member, age 0 thru 17, on probation through the County Juvenile Probation Department?
Valid Values Y - Yes N - No X - Not applicable due to age
Rules and Definitions
If Member’s age is 18 years old or older, then ‘X’ is the only accepted value.
Updates 10/01/2018 Field added.
Examples The Youth Member is currently on juvenile probation through AOC. Enter Y
12- DES/RSA Involvement
Field Label OA_DES_RSA
Description Refers to other agencies with a current and/or ongoing role with the Member. Is the Member involved with the Department of Economic Security (DES)/ Rehabilitative Services Administration (RSA)?
Valid Values Y - Yes N - No
Rules and Definitions
1 -
Updates 10/01/2018 Field added.
Examples The Member is currently involved with DES/RSA. Enter Y
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13- School Special Education
Field Label OA_SCHOOL_SPECIAL_ED
Description Refers to other agencies with a current and/or ongoing role with the Member. Is the Member receiving special education services through an Individualized Education Program (IEP) or accommodations through a 504 Accommodation Plan at their school?
Valid Values Y - Yes N - No X - Not applicable due to age
Rules and Definitions
Member must be 3 years of age, but not more than 21 years old. Refers to other agencies with a current and/or ongoing role with the Member. The Member is receiving special education services through an IEP at their school.
Updates 10/01/2018 Field added.
Examples The Member is currently receiving special education services. Enter Y The Member is 22 years of age or older. Enter X
14- Employment Status
Field Label EMPLOYMENT_STATUS
Description The Member’s current employment status.
25 - Competitively Employed Part-Time 28 - Other Employment 29 - Inactive in the Community
Rules and Definitions
Competitively Employed Full-Time Refers to competitive employment performed in an integrated community setting on a full-time basis (35 or more hours per week) for which an individual is compensated in accordance with the Fair Labor Standards Act; or the individual is in military service. Criteria for competitive employment must include the following three components: pay at minimum wage or higher; a job located in an integrated community setting; and a job that was not set aside for a particular population. Employment may be with or without interventions, assistance, or supports, typically provided by staff of a vocational or other rehabilitation program. The individual may have obtained the job with the assistance of a vocational program or on their own.
Competitively Employed Part-Time Refers to competitive employment performed in an integrated community setting on a part-time basis (less than 35 hours per week) for which an individual is compensated in accordance with the Fair Labor Standards Act; or the individual is in military service. Criteria for competitive employment must include the following three components: pay at minimum wage or higher; a job located in an integrated community setting; and a job that was not set aside for a particular population. Employment may be with or without interventions, assistance, or supports, typically provided by staff of a vocational or other rehabilitation program. The individual may have obtained the job with the assistance of a vocational program or on their own. (Continued on the next page)
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14- Employment Status
Other Employment Refers to employment not otherwise classified as full-time or part-time integrated community employment. This may include, but is not limited to, the following:
Work Adjustment Training: Facility or community based training program that teaches the meaning, value and demands of work, while developing the soft skills needed to obtain competitive employment. Participation in Work Adjustment Training programs is time-limited, with a long-term goal of obtaining competitive employment. Participation in a Work Adjustment Training program is set aside for certain populations and/or other participants of a rehabilitation program.
Transitional Employment Placement: Secured by a vocational agency and set aside for certain populations. Employment is paid and is in an integrated community business setting. Individuals are actual employees of the company, not of the vocational agency. Individuals are paid at least minimum wage and preferably the prevailing rate received by regular company employees for the same job.
Homemaker: When an individual manages their family household, and performs household duties for others, as a principal occupation.
Student If an individual is currently in an educational institution, including, but not limited to, secondary or post-secondary education, trade school, or vocational college, and not involved in any employment activity, they shall be categorized as “student”. If an individual is in an educational institution, but also competitively employed or involved in any other type of employment, they shall be categorized in the appropriate employment category. Unpaid Rehabilitation Activity Individuals engaging in any rehabilitation activity not already specified in one of the other categories (employed or student), including, but not limited to, work exploration, pre-vocational skill building groups and activities, community activities such as church groups, social skill building activities, mobility training, adjustment to disability training, volunteerism, seeking employment, etc. Inactive in the Community Refers to individuals who are not currently employed, looking for work, or involved in any other rehabilitation activity. It may also refer to individuals who are retired or individuals who are inmates of institutions. Use this category only if the individual does not fit in any other category.
Updates 10/01/2018 Field added.
Examples A Member works 20 hours per week. Enter 25
15- Dependent Children
Field Label SP_WOMAN_DC
Description Identifies Members who have dependent child(ren). Includes children that have been removed and are in the custody of DCS.
Valid Values Y - Yes N - No X - Not applicable due to gender/sex
Rules and Definitions
Female Only. If the Member is male, then ‘X’ is the only accepted value
Updates 10/01/2018 Field added.
Examples The Member is a woman with a dependent child or children. Enter Y
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16- Social Supports of Recovery
Field Label SUPPORT_GROUPS_PARTICIPATION
Description How often did the Member participate in any self-help or recovery groups (such as Alcoholics Anonymous, Narcotics Anonymous, WRAP/WELL, Recovery Center programming, etc.) in the past 30 days?
Valid Values 1 - No attendance in the past month 2 - 1-4 times in past month 3 - 5-12 times in past month
4 - 13-20 times in past month 5 - 21 or more times in past month
Rules and Definitions
Entry must be ascertained by a clinical professional.
Updates 10/01/2018 Field added.
Examples The Member has participated in a self-help group 2 times in the past month. Enter 2
17- Military Status
Field Label MILITARY_STATUS
Description Is the Member a current or former Member of the U.S. Army, Army Reserve/National Guard, U.S. Navy, Navy Reserve, U.S. Marine Corps, Marine Corps Reserve, U.S. Air Force OR are they a military family Member?
Valid Values
A - Active Military B - Veteran C - Retired Veteran D - Disabled Veteran (See Rules and Definitions)
E - Military Family Member F - No Active or Veteran Military Status G - Unknown (See Rules and Definitions) X - Not applicable due to age (0 through 16 only)
Rules and Definitions
D – Disabled Veteran A veteran whose disability was a result of an injury or disease that was incurred or aggravated while on active duty or active duty for training; or from injury, heart attack, or stroke that occurred during inactive duty training. A disability may apply to physical and mental health conditions.
G – Unknown An individual who may not disclose their military status, if any. For individuals age 16 and younger, the only valid values allowed are ‘X’ and ‘E’.
Updates 10/01/2018 Field added.
Examples A Member reports that they are currently serving in the U.S. Army. Enter A A Member is 15 years old and reports not having a family Member in the military. Enter X
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18- CASII Intensity Level
Field Label CASII_INTENSITY_LEVEL
Description
The CASII (Children and Adolescent Service Intensity Instrument) applies to children ages 6 thru 17, measuring objective quantifiable criteria for determination of service intensity. It describes an array of services and a level of service intensity rather than a specific treatment setting or program. It does not describe a recommended level of care. The CASII is required as part of the initial 45 day assessment period, then at a minimum annually and thereafter, and at the end of treatment from BH services.
Valid Values
00 - Basic Services for Prevention and Maintenance 01 - Recovery Maintenance and Health Management 02 - Outpatient Services 03 - Intensive Outpatient Services 04 - Intensive Integrated Services without 24-Hour Psychiatric Monitoring
05 - Non-Secure, 24-Hour Services with Psychiatric Monitoring 06 - Secure, 24-Hour Services with Psychiatric Management XX - Not applicable due to age (0-5, 18+)
Rules and Definitions
Entry must be ascertained by a clinical professional. If a Member is age 6 or older and less than age 18, a CASII Intensity Level is required every 6 months. If a Member is younger than 6 years OR 18 years old or greater CASII Intensity Level must be XX.
Updates 10/01/2018 Field added.
Examples A Member is assessed using the CASII at the time of the initial assessment and is determined to have needs requiring intensive integrated services without 24-hour psychiatric monitoring. Enter 04
19- CASII Intensity Date
Field Label CASII_INTENSITY_DATE
Description The CASII Intensity Date must reflect the date on which the CASII Intensity Level (Field 18) was assessed. The CASII is required as part of the initial 45 day assessment period, at a minimum annually and thereafter, and at the end of treatment from BH services.
Valid Values YYYYMMDD Format
Rules and Definitions
Entry must be ascertained by a clinical professional. A valid date value must be provided each time a CASII Intensity Level is provided. If data is submitted via file upload and level the CASII Intensity level is XX, leave all eight (8) spaces blank in place of the date (spaces 50 to 57).
Updates 10/01/2018 Field added.
Examples Date is recorded as the 4 digit year, 2 digit month and 2 digit day. A Member’s CASII Intensity Level (Field 19) changed on March 26, 2018. Enter 20180326
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20- Substance Use Primary Type
Field Label SA_PRIMARY_TYPE
Description The primary psychoactive substance used.
1001 - Methamphetamine/Speed (CNS Stimulants 1201 - Other Stimulants 1308 - Benzodiazepines (CNS Depressants) 1605 - Other Sedatives/Tranquilizers (CNS Depressants) 1703 - Inhalants 2002 - Other Drugs
Rules and Definitions
Entry must be ascertained by a clinical professional.
If valid value “0001” (None) is used, then:
Only valid values of “none / no use” will be accepted in Substance Use Primary Fields (21-23), in the Substance Use Secondary Fields (24-27), and in the Substance Use Tertiary Fields (28-31).
If a valid value other than “0001” (None) is entered, then:
This value may NOT be repeated in Substance Use Secondary Type or Substance Use Tertiary Type (used only once).
When entering multiple substance use, Substance Use Primary Type, Substance Use Secondary Type, and Substance Use Tertiary Type must be populated in order.
Fields 21-Substance Use Primary Frequency and 22-Substance Use Primary Route cannot be null.
Updates 10/01/2018 Field added.
Examples The Member’s primary substance use has been heroin. Enter 0501
21- Substance Use Primary Frequency
Field Label SA_FREQUENCY_1
Description The frequency of use of the current primary substance use (Field 20-Substance Use Primary Type).
Valid Values
1 - No use during the past month 2 - 1 –3 times in past month 3 - 1 – 2 times per week 4 - 3 – 6 times per week
5 - 1 or more times per day 6 - No use during the past 3 months 7 - No use during the past 6 months 8 - No use during the past 12 months
Rules and Definitions
Entry must be ascertained by a clinical professional.
If “0001” (None) is entered for Substance Use Primary Type (Field 20), then only a valid value “1” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member has been using heroin one time per day for the past month. Enter 5
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22- Substance Use Primary Route
Field Label SA_ROUTE_1
Description The route of administration of the current primary substance use (Field 21-Substance Use Primary Type).
Valid Values 1 - Oral 2 - Smoking 3 - Inhalation
4 - Injection 6 - No use during the past month
Rules and Definitions
Entry must be ascertained by a clinical professional. If “0001” (None) is entered for Substance Use Primary Type (Field 21), then only a valid value “6” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member has been administering heroin via intravenous injection. Enter 4
23- Substance Use Primary Age First Use
Field Label SA_AGE_1
Description The Member’s age at first use of the reported current primary substance use (Field 21- Substance Use Primary Type).
Valid Values 01-99 - Years of age 00 - No use
Rules and Definitions
Entry must be ascertained by a clinical professional. If “0001” (None) is entered for Substance Use Primary Type (Field 20), then only a valid value “00” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member began using heroin at age 25. Enter 25
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24- Substance Use Secondary Type
Field Label SA_SECONDARY_TYPE
Description The secondary psychoactive substance used.
1001 - Methamphetamine/Speed (CNS Stimulants 1201 - Other Stimulants 1308 - Benzodiazepines (CNS Depressants) 1605 - Other Sedatives/Tranquilizers (CNS Depressants) 1703 - Inhalants 2002 - Other Drugs
Rules and Definitions
Entry must be ascertained by a clinical professional. If valid value “0001” (None) is used in Field 20-Substance Use Primary Type, then:
Only a valid value “0001” (None) will be accepted.
Only valid values of “none / no use” will be accepted in Substance Use Secondary Fields (24-27). If a valid value other than “0001” (None) is entered, then:
This value may NOT be repeated in Substance Use Primary Type or Substance Use Tertiary Type (used only once).
When entering multiple substance use, Substance Use Primary Type, Substance Use Secondary Type, and Substance Use Tertiary Type must be populated in order.
Fields 25-Substance Use Secondary Frequency and 26-Substance Use Secondary Route-cannot be null.
Updates 10/01/2018 Field added.
Examples The Member’s secondary substance use was alcohol. Enter 0201
25- Substance Use Secondary Frequency
Field Label SA_FREQUENCY_2
Description The frequency of use of the current secondary substance use (Field 24-Substance Use Secondary Type).
Valid Values
1 - No use during the past month 2 - 1 –3 times in past month 3 - 1 – 2 times per week 4 - 3 – 6 times per week
5 - 1 or more times per day 6 - No use during the past 3 months 7 - No use during the past 6 months 8 - No use during the past 12 months
Rules and Definitions
Entry must be ascertained by a clinical professional.
If “0001” (None) is entered for Substance Use Secondary Type (Field 24), then only a valid value “1” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member has used alcohol three times in the past month. Enter 2
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26- Substance Use Secondary Route
Field Label SA_ROUTE_2
Description The route of administration of the current secondary substance use (Field 25-Substance Use Secondary Type).
Valid Values 1 - Oral 2 - Smoking 3 - Inhalation
4 - Injection 6 - No use during the past month
Rules and Definitions
Entry must be ascertained by a clinical professional.
If “0001” (None) is entered for Substance Use Secondary Type (Field 24), then only a valid value “6” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member has been administering alcohol orally. Enter 1
27- Substance Use Secondary Age First Use
Field Label SA_AGE_2
Description The Member’s age at first use of the reported current secondary substance use (Field 25- Substance Use Secondary Type).
Valid Values 01-99 - Years of age 00 - No use
Rules and Definitions
Entry must be ascertained by a clinical professional.
If “0001” (None) is entered for Substance Use Secondary Type (Field 24), then only a valid value “00” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member began using alcohol at age 15. Enter 15
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28- Substance Use Tertiary Type
Field Label SA_TERTIARY_TYPE
Description The tertiary psychoactive substance used.
1001 - Methamphetamine/Speed (CNS Stimulants 1201 - Other Stimulants 1308 - Benzodiazepines (CNS Depressants) 1605 - Other Sedatives/Tranquilizers (CNS Depressants) 1703 - Inhalants 2002 - Other Drugs
Rules and Definitions
Entry must be ascertained by a clinical professional.
If valid value “0001” (None) is used in Field 20-Substance Use Primary Type and Field 24-Substance Use Secondary Type then:
Only a valid value “0001” (None) will be accepted.
Only valid values of “none / no use” will be accepted in fields the Substance Use Tertiary Fields (28-31). If a valid value other than “0001” (None) is entered, then:
This value may NOT be repeated in Substance Use Primary Type or Substance Use Secondary Type (used only once).
When entering multiple substance use, Substance Use Primary Type, Substance Use Secondary Type, and Substance Use Tertiary Type must be populated in order.
Fields 29-Substance Use Tertiary Frequency and 30-Substance Use Tertiary Route cannot be null.
Updates 10/01/2018 Field added.
Examples The Member’s tertiary substance use has been methamphetamine. Enter 1001
29- Substance Use Tertiary Frequency
Field Label SA_TERTIARY_3
Description The frequency of use of the current tertiary substance use (Field 29-Substance Use Tertiary Type).
Valid Values
1 - No use during the past month 2 - 1 –3 times in past month 3 - 1 – 2 times per week 4 - 3 – 6 times per week
5 - 1 or more times per day 6 - No use during the past 3 months 7 - No use during the past 6 months 8 - No use during the past 12 months
Rules and Definitions
Entry must be ascertained by a clinical professional.
If “0001” (None) is entered for Substance Use Tertiary Type (Field 28), then only a valid value “1” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member has used methamphetamine 5 times in the past month. Enter 4
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30- Substance Use Tertiary Route
Field Label SA_ROUTE_3
Description The route of administration of the current tertiary substance use (Field 29-Substance Use Tertiary Type).
Valid Values 1 - Oral 2 - Smoking 3 - Inhalation
4 - Injection 6 - No use during the past month
Rules and Definitions
Entry must be ascertained by a clinical professional.
If “0001” (None) is entered for Substance Use Tertiary Type (Field 29), then only a valid value “6” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member has been administering methamphetamine by smoking. Enter 2
31- Substance Use Tertiary Age First Use
Field Label SA_AGE_3
Description The Member’s age at first use of the reported current tertiary substance use (Field 29- Substance Use Tertiary Type).
Valid Values 01-99 - Years of age 00 - No use
Rules and Definitions
Entry must be ascertained by a clinical professional.
If “0001” (None) is entered for Substance Use Tertiary Type (Field 28), then only a valid value “00” will be accepted.
Updates 10/01/2018 Field added.
Examples The Member began using methamphetamine at age 28. Enter 28
AzCH-Complete Care Plan Provider Disputes 1870 W. Rio Salado Parkway, Ste. 2A Tempe, AZ 85281
STATE FAIR HEARINGS
AzCH-Complete Care Plan Provider State Fair Hearings 1870 W. Rio Salado Parkway, Ste. 2A Tempe, AZ 85281
www.azcompletehealth.com
Federal law requires that providers ensure all services are provided in a culturally competent manner and are accessible to all members, including those with limited-English proficiency (LEP), limited reading skills, who are deaf or hard of hearing, or have diverse cultural and ethnic backgrounds. To assist in meeting these requirements, Arizona Complete Health-Complete Care Plan offers participating providers and members access to interpreters at no cost.
ORAL INTERPRETATION AND AMERICAN SIGN LANGUAGE
Interpreter assistance needs to be and is available to both providers and members at no cost 24 hours a day, seven days a week, 365 days a year. These services ensure access to qualified interpreters trained on health care terminology and a wide range of interpreting protocols and ethics; as well as support to address common communication needs across cultures. Providers are responsible for providing interpreters as requested. They may use certified bilingual staff, a language vendor, or utilize the Arizona Complete Health-Complete Care Plan interpreter resources to provide interpreters to members who require or request them. To meet language assistance established requirements, providers must ensure that the language assistance meets the established requirements as follows:
Utilize licensed interpreters for the Deaf and the Hard of Hearing and/or provide auxiliary aids that meet the needs of the individual upon request.
o Auxiliary aids include computer-aided transcriptions, written materials, assistive listening devices or systems, closed and open captioning, and other effective methods of making aurally delivered materials available to persons with hearing loss.
o The Arizona Commission for the Deaf and the Hard of Hearing provides a listing of licensed interpreters, information on auxiliary aids and the complete rules and regulations regarding the profession of interpreters in the State of Arizona. (Arizona Commission for the Deaf and the Hard of Hearing www.acdhh.org or 602-542-3323 (V/TTY)).
Ensure that interpreters are available at the time of the appointment.
Ensure that members with limited English proficiency are not subject to unreasonable delays in the delivery of services including access to providers after hours.
Extend the same participation opportunities in programs and activities to all members regardless of their language preferences.
Provide services to members with LEP that are as effective as those provided to others.
ORAL INTERPRETATION AND AMERICAN SIGN LANGUAGE CONTINUED
Restricted use of certain persons to interpret or facilitate communication- A Provider shall NOT:
1. Require an individual with limited English proficiency to provide their own interpreter;
2. Rely on an adult accompanying an individual with limited English proficiency to interpret or facilitate communication, except:
a. In an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no qualified interpreter for the individual with limited English proficiency immediately available;
b. Where the individual with limited English proficiency specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances;
3. Rely on a minor child to interpret or facilitate communication, except in an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no qualified interpreter for the individual with limited English proficiency immediately available;
4. Rely on staff other than qualified bilingual/multilingual staff to communicate directly with individuals with limited English proficiency.
Qualified interpreter for an individual with limited English proficiency as defined in section 1557 of the Affordable Care Act- means an interpreter who via a remote interpreting service or an on-site appearance:
o Adheres to generally accepted interpreter ethics principles, including client confidentiality;
o Has demonstrated proficiency in speaking and understanding both spoken English and at least one other spoken language;
o Is able to interpret effectively, accurately, and impartially, both receptively and expressly, to and from such language(s) and English, using any necessary specialized vocabulary, terminology and phraseology.
Please make sure the following is recorded in the member’s medical record:
o Language needs of the member, as well as the their request for or refusal of interpretation
WRITTEN TRANSLATION
Providers Must Provide Written Translation with their own resources. - Providers shall ensure written translations are provided in the following manner:
1. Written materials that are critical to obtaining services (also known as vital materials) shall be made available in the prevalent non-English language spoken for each LEP population in the Contractor’s service area. [42 CFR 438.3(d)(3)] Oral interpretation services shall not substitute for written translation of vital materials.
2. All written materials for members shall be translated into Spanish regardless whether or not they are vital.
3. In general, any document that requires the signature of the Member, and that contains vital information such as the treatment, medications or notices, or service plans must be translated into their preferred/primary language upon request.
4. Both the English and translated versions must be maintained in the Member’s record.
5. The provider shall provide easy-to-understand print and member information materials, materials in alternative formats, as well as signage in the languages commonly used by the populations in the service area. This includes the production of materials with consideration of members with LEP or limited reading skills, those with diverse cultural and ethnic backgrounds, and those with visual or auditory limitations.
In addition, to comply with the communication and language assistance requirements in the National Standards for Culturally and Linguistically Appropriate Services (CLAS) and the Affordable Care Act (ACA) Section 1557, providers must comply with the following:
o Post nondiscrimination notices in lobbies and on websites. Notices must include a nondiscrimination statement, the availability of interpretive assistance for patients with LEP, and the availability of auxiliary aids and services for individuals with disabilities, including informing them how to obtain the aids and services. The statement must include the availability of a grievance procedure for discrimination complaints and information about how to file a complaint. The notice must also contain information regarding how to file a discrimination complaint with the HHS Office of Civil Rights (OCR).
o Post taglines in lobbies and on websites that advise members that they can receive an interpreter in their preferred language at medical points of contact. These statements notify individuals of the availability of language assistance and must include taglines in at least the top 15 languages utilized in Arizona.
o Taglines and nondiscrimination notices must be included in correspondence sent to the member.
Report Appropriately for Language Assistance - T1013, Interpretation
o T1013 must be reported – by behavioral health service providers when providing language assistance delivered by certified bilingual staff or when provided by a language vendor. This code is used to track language assistance that is being provided (languages other than English, including ASL).
o Interpretation must be reported in conjunction with another service that cannot be delivered effectively without the availability of sign language or interpreter assistance, never a standalone code.
ADDITIONAL INFORMATION
If you have questions regarding the information contained in the update, please contact your Provider Engagement Specialist or email [email protected].
2.7.1 Vaccine for Children (VFC) (manual edition updated and hyperlink added) More information is available in the Vaccines for Children (VFC) Program Operations Guide 2018 per AHCCCS or visit https://azdhs.gov/
4.3.13 Further Considerations for Denials of Requested Services (forms
and attachment list renaming and retirement of forms)
Forms:
Provider Manual Form 10.1.6 Out of Home Admission Concurrent Review
Provider Manual Form 10.1.8 Out of Home Concurrent Review Pre-Authorization Out-of-Home
Provider Manual Form 10.1.10 Inpatient Discharge Summary
Provider Manual Form 10.1.11 Request for Expedited Authorization
SECTION 5 – CREDENTIALING AND RE-CREDENTIALING REQUIREMENTS
5.7 Modifications (hyperlink added)
www.azcompletehealth.com
5.9 Recredentialing Process and Requirements (hyperlink added)
The recredentialing of providers is completed every 36 months. As part of the recredentialing process, providers are notified 180 days in advance of the expiration of their credentials. The Credentialing Department will mail, fax or email notifications to the providers at least three times within the notification cycle. In order to avoid a lapse in network participation status, the recredentialing application and required documents must be valid at the time of approval. Any provider that fails to recredential timely, will have to undergo the initial credentialing process. Providers that fail to recredential cannot request provisional credentialing status. The provider will be required to complete and submit applicable credentialing applications, data forms and all required supplemental documentation. The forms and detailed submission instructions can be found here: https://www.azcompletehealth.com/providers/become-a-provider/credentialing-forms.html.
8.1 Member Grievance and Provider Complaint Process (content added)
Any person may file a grievance to express dissatisfaction with any aspect of a member or prospective member’s care. A grievance may be filed orally or in writing. Similarly, providers may file grievances for any reason including dissatisfaction with The Health Plan with respect to its customer service or operations as it relates to the provider’s care or treatment of The Health Plan member.
8.3 Grievance and Investigations Concerning Persons with Serious Mental Illness (forms
hyperlinked)
Any person may request an SMI Grievance Investigation by completing the Appeal or Serious Mental Illness Grievance Form (ACOM Chapter 400, Section 446, Attachment A) and delivering it to The Health Plan at the following address:
Arizona Complete Health-Complete Care Plan Attn: Grievance and Appeal Department 1870 W. Rio Salado Parkway Suite 2A Tempe, AZ 85281 Fax: (866) 714-7998
8.6 Notice of Appeal Resolution (number of days change)
A Notice of Appeal Resolution must contain:
The results of the resolution process and the date it was completed; and
For those appeals not resolved wholly in favor of the Title XIX/XXI eligible person:
o The Title XIX/XXI eligible person’s right to request a State Fair Hearing by submitting a written request to The Health Plan no later than 120 days from the date of receipt of The Health Plan’s Notice of Appeal Resolution;
o The right to request to receive services while the State Fair Hearing is pending, if applicable, and how to do so;
o The factual and legal basis for the decision; and
o An explanation that the Title XIX/XXI eligible person may be held liable for the cost of benefits being appealed if the State Fair Hearing decision results in The Health Plan decision being upheld.
8.5.1.3 Delivery of Notices and Appeal Decisions (content changes)
Provision of notice shall be evidenced by retaining a copy of the notice in the comprehensive clinical record of the person receiving or requesting services (See the Appeal or Serious Mental Illness Grievance Form located in the ACOM Chapter 400, Section 446, Attachment A)
8.5.2 Notice Requirements for Persons Being Evaluated for or with Serious Mental
Illness (forms hyperlinked)
A Notice of Decision and Right to Appeal (for Individuals with a Serious Mental Illness) (Appeal or Serious Mental Illness Grievance Form located in the ACOM Chapter 400, Section 446, Attachment A must be provided to persons with SMI or to persons applying for SMI services when:
SECTION 9 – COMPLAINCE
No changes this month.
SECTION 10 – QUALITY MANAGEMENT REQUIREMENTS
10.8.1 Reporting Requirements (forms hyperlinked)
Reporting must be done using AHCCCS ACOM Policy 201, Attachment A,
AHCCCS Notification to Waive Medicare Part D Copayment
(https://www.azahcccs.gov/shared/ACOM/) Members in a Medical Institution That
Is Funded by Medicaid. Providers must not wait until the person has been
discharged from the medical institution to submit the form.
SECTION 11 – SPECIFIC PHYSICAL HEALTH PROVIDER REQUIREMENTS
11.11.2 Referrals (hyperlink added)
Psychotropic medications are listed in The Health Plan Drug List, available on the provider website at www.azcompletehealth.com. For additional information regarding pharmacy benefits, contact Envolve Pharmacy Solutions.
11.21.2 Use of Telemedicine (behavioral health added to list and reference hyperlinked)
Reporting Part D Enrollment and US Applications (removed)
Reporting Part D Enrollment and LIS Applications
Providers must track Part D enrollment and LIS application status for Medicare eligible Members. AHCCCS has developed Provider Manual Form 3.1.1, Tracking of Medicare Part D Enrollment which can be used by The Health Plan or the provider to track persons eligible for Medicare. This will assist The Health Plan to ensure that Medicare eligible persons are enrolled in a Part D plan and apply for the LIS program, if applicable. Providers are directed to call the Provider Service Center to obtain a copy of this forms, if needed, at 1-866-796-0542.
12.1.7.1 Special Considerations for Persons Determined to Have a Serious Mental Illness
(SMI) (form name change and hyperlink added)
Prior to the termination of services for persons with a SMI who have been receiving behavioral health services and subsequently decline to participate in the screening/referral process, The Health Plan must provide written notification of the intended termination using the Appeal or Serious Mental Illness Grievance Form located in the ACOM Chapter 400, Section 446, Attachment A. Also see Section 8.5 — Notice and Appeal Requirements (SMI and GMH/SA Non-Title XIX/XXI).
12.5.2.4 Appeals or Service Plan Disagreements (form name change and hyperlink
added)
In cases that a person determined to have a SMI and/or legal or designated representative disagree with some or all of the Non-Title XIX/XXI covered services included in the service plan, the person and/or legal or designated representative must be given a copy of the Appeal or Serious Mental Illness Grievance Form located in the ACOM Chapter 400, Section 446, Attachment A by the behavioral health representative on the team.
12.7 General and Informed Consent to Treatment (hyperlink added)
AHCCCS recognizes two primary types of consent: general consent and informed consent (AMPM 320-Q)
12.7.1 General Requirements (form name change, wording added)
In initiating general care for The Health Plan Members, providers are required to use informed consent forms that include all the elements identified in the Provider Manual Form 3.7.1, General Consent to Treatment. The form can be obtained by calling the Provider Services Call Center at 866-796-0542.
Providers prescribing psychotropic medications for The Health Plan Members are required to use informed consent forms that include all the elements identified in AHCCCS AMPM Section 310-V, Attachment A.
12.7.2 General Consent (form name change)
Administrative functions associated with a Member’s enrollment do not require consent, but before any services are provided, general consent must be obtained. General consent is usually obtained during the intake process and represents a person’s, or if under the age of 18, the person’s parent, legal guardian or lawfully authorized custodial agency representative’s, written agreement to participate in and to receive non-specified (general) services. Providers are required to use Provider Manual Form 3.7.1, General Consent to Treatment which can be obtained by calling the Provider Services Call Center at 866-796-0542, and to have a policy in place to monitor completion of general consents.
12.7.3.4 Psychotropic Medications, Complementary and Alternative Treatment and
Telemedicine (form name change, hyperlink added, content added)
Prior to the initiation of any psychotropic medication or initiation of Complementary and Alternative Treatment (CAM) (see Section 12.8 — Psychotropic Medication: Prescribing and Monitoring). The use of Provider Manual Form 3.7.1, General Consent to Treatment (AHCCCS AMPM Section 310-V, Attachment A) is recommended as a tool to review and document informed consent for psychotropic medications which can be obtained by calling he Provider Services Call Center at 866-796-0542; and
Prior to the delivery of services through telemedicine.
Informed Consent for Telemedicine:
Before a health care provider delivers health care via telemedicine, verbal or written informed consent from the member or their health care decision maker must be obtained. Refer to AMPM Policy 320-I,
Informed consent may be provided by the behavioral health medical practitioner or registered nurse with at least one year of behavioral health experience. When providing informed consent it must be communicated in a manner that the member and/or legal guardian can understand and comprehend.
Exceptions to this consent requirement include: o If the telemedicine interaction does not take place in the physical
presence of the member, o In an emergency situation in which the member or the member’s
health care decision maker is unable to give informed consent, or o To the transmission of diagnostic images to a health care provider
serving as a consultant or the reporting of diagnostic test results by that consultant.
12.7.3.5 Electro-Convulsive Therapy (ECT), Research Activities, Voluntary Evaluation
and Procedures or Services with Known Substantial Risks or Side Effects
(reference to AHCCCS form)
Written informed consent must be obtained from the person, parent, or legal guardian, unless treatments and procedures are under court order, in the following circumstances:
o Before the provision of (ECT);
o Prior to the involvement of the person in research activities;
o Prior to the provision of a voluntary evaluation for a person. The use of AMPM Exhibit 320-Q-1, Application for Voluntary Evaluation is required for persons with SMI and is recommended as a tool to review and document informed consent for voluntary evaluation of all other populations; and
o Prior to the delivery of any other procedure or service with known substantial risks or side effects.
If a member is currently identified as a member in need of Special Assistance, a notation of “Special Assistance” and a completed AHCCCS AMPM 320-R, Attachment A, Notification of Member in Need of Special Assistance should already exist in the clinical record. However, if it is unclear, Behavioral Health Homes and contracted Behavioral Health Inpatient Facilities can contact The Health Plan Independent Oversight Committee Liaison ([email protected] ) to inquire about current status. The Behavioral Health Plan maintains a database on members in need of Special Assistance and shares data with Health Homes and contracted Behavioral Health Inpatient Facilities on a regular basis (at a minimum quarterly).
12.11.5 Notification Requirements to the Office of Human Rights (content changed, email
address added)
Behavioral Health Homes and contracted Behavioral Health inpatient Facilities must use the current electronic Special Assistance Notification Form found on the AHCCCS QM Portal. The report must be saved and forwarded to the Behavioral Health Plan Special Assistance Department at [email protected]
Independent Oversight Committees receive confidential information related to Special Assistance members and are expected to safeguard the information in accordance with the requirements set out in ACOM, Policy 447.
12.17.11 Transfer of a Special Assistance member (wording change)
Notice of a request to transfer, for all Special Assistance members, must be
shared with The Health Plan Human Rights Committee Liaison
through the Provider Portal and submitting the transfer packet. All changes
and updates to a Special Assistance member’s services, including transfers,
requires collaboration with the person assigned to meet Special Assistance
needs.
12.17 Additional Behavioral health Homes Requirements (addition of Health Homes for
children and adults)
The Behavioral Health Homes serving children required to meet these requirements include: Arizona Children’s Association, Casa de los Ninos, CODAC, Community Health Associates, Community Partners Integrated Health, COPE Community Services, Easter Seals Blake Foundation, El Rio Health Center, Horizon Health and Wellness, Intermountain Health Care, Jewish Family & Children’s Service , LaFrontera Center, LaFrontera EMPACT, Marana Health Care, Pathways Behavioral Health, Pinal Hispanic Council, Rural Center for Border Health, SEABHS-Southeastern Arizona Behavioral Health Services, , Southwest Behavioral & Health Services, Touchstone Behavioral Health, and Valle Del Sol Inc.
The Behavioral Health Homes serving adults required to meet these requirements include: Banner U of A Healthcare, CODAC, Community Bridges, Inc., Community Health Associates, Community Partners Integrated Health, COPE Community Services, El Rio Health Center, Horizon Health and Wellness, Intermountain Health Care, Jewish Family and Children’s Services, LaFrontera Center, LaFrontera EMPACT, Marana Health Care, Pathways Behavioral Health, Pinal Hispanic Council, Rural Cetner for Boarder Health, SEABHS-Southeastern Arizona Behavioral Health Services, Southwest Behavioral & Health Services, and Valle Del Sol Inc.
12.17.12 Behavioral Health Home Requirements Related to Facilities (Licensed
Hospital Facility, Behavioral Health Inpatient Facility, Behavioral Health
Residential Facility, Behavioral Health Supportive Homes, and HCTC
Admissions (form name change)
Providers must submit the Out Of Home (OOH) request packet to The Health Plan within two work days following a treatment team request for out-of-home placements, and receive prior authorization for Behavioral Health Inpatient Facilities (formerly RTC), Licensed Hospital Facilities (formerly Level I Inpatient), Behavioral Health Inpatient Facility (formerly Level I Sub-Acute Facilities), Behavioral Health Residential, Behavioral Health Supportive Home and Home Care Training for the Home Care Client (HCTC) services before admitting a Member, unless exemption in writing to this requirement is provided by The Health Plan. See Provider Manual Form 10.1.6, Concurrent Review which can be obtained by calling the Provider Services Call Center at 866-796-0542.
12.17.12.1 Discharge Plans/Outpatient Follow Up (content deletion)
Providers must identify and develop discharge aftercare plans prior to admission to an out-of-home placement and must provide outpatient clinical services within seven (7) days of a Member's discharge from a facility. Providers must submit Provider Manual Form 10.1.10, Inpatient Discharge Summary by secure fax within:
72 hours of admission, and
at time of concurrent review or if the discharge plan is revised
upon discharge
This form can be obtained by calling the Provider Services Call Center at 866-796-0542 and must be completed fully and comprehensively.
SECTION 13 – HEALTH PLAN COORDINATION OF CARE REQUIREMENTS
13.3.5.1 Pre-Petition Screenings and Court-Order Evaluations (website hyperlink added)
The county protocols can be located on The Health Plan website www.azcompletehealth.com
SECTION 14 – SPECIFIC BEHAVIORAL HEALTH PROGRAM REQUIREMENTS
14.2.1 72-Hours Rapid Response Requirements for Children (renumbering of form)
See Provider Manual Attachment 3.2.1, DCS Child Welfare Timelines and Provider Manual Attachment 6.1.1 Rapid Response Guidance Manual which can be obtained by calling the Provider Services Call Center at 866-796-0524 for more information.
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14.13.3 Residential Services Treatment (correction of section number)
Residential Substance Use Treatment services are available to adults and adolescents who are TXIX eligible and to individuals who are NTXIX, but eligible for Substance Abuse Block Grant (SABG) funds, as described in Provider Manual 12.10, Special Populations, and who are screened using the ASAM as needing this level of care.
SECTION 15 – TRAINING AND PEER SUPPORT SUPERVISION REQUIREMENTS
No changes this month.
SECTION 16 – DELIVERABLE REQUIREMENTS
EC-305 Updated date
EC-312 Updated
EC-317 Retired
FN-101 Updated
FN-401 Updated
FN-402 Updated
OI-206 Due date change
RF-1002 Provider update
SECTION 17 – REFERENCES
No changes this month.
SECTION 18 – PROVIDER MANUAL FORMS AND ATTACHMENTS
Only changes noted below:
2.3 Maternity Services
2.3.2 Notification of Pregnancy (NOP)-Spanish
2.10 Housing for ADULTS with a Serious Mental Illness
Provider Manual Form 2.10.1 AHCCCS Property Acquisition Rehab Application
Provider Manual Form 2.10.1 AHCCCS Property Acquisition Rehab Form Instructions
3.1 Medicare Part D Prescription Drug Coverage
Provider Manual Form 3.1.1 Tracking of Medicare Part D Enrollment
3.3 Specialty Provider Requirement
Provider Manual Form 3.3.3 Specialty Agency Monthly Summary
