AzCH-CCP September 2024 Provider Manual Now Available

Section

Title

Revision

1.2.1

AHCCCS Enrolled Title XIX/XXI Adults with SMI

Section updated to reflect statewide coverage due to Care1st and AzCH-CCP migration.

1.2.2

AHCCCS Enrolled Title XIX/XXI Adults and Children, excluding Adults with SMI

Section updated to reflect statewide coverage due to Care1st and AzCH-CCP migration.

1.2.4

Grant Funded Mental Health, Opioid Use Disorder, and Substance Use Disorder Services

Section updated to reflect statewide coverage due to Care1st and AzCH-CCP migration.

1.2.4.1

AHCCCS Enrolled Non-Title XIX Adults with SMI (BH Services Only)

Section moved (was previously Section 1.2.2) and updated to reflect statewide coverage due to Care1st and AzCH-CCP migration.

1.2.5

Crisis Service to Arizona Residents

Section updated to reflect statewide coverage due to Care1st and AzCH-CCP migration. Health Plan Crisis Service contact information updated.

1.2.6

{Reserved}

Section added as placeholder for future information.

1.3.1

Verifying Eligibility

Section added to include language on provider responsibility for verifying member eligibility prior to rendering services.

1.8

Advertising

Section updated to reflect current language regarding use of Health Plan logos and requirements on approval of use.

2.1.2

{Reserved}

Section added as placeholder for future information.

2.2

Maternity Services

Section updated to add language on coverage of doula services and maternity services in a group setting.

2.2.2

General Obstetrical Standards of Care

Section updated to add language encouraging providers to use the Arizona Perinatal Psychiatry Access Line.

2.2.3

Maternity Appointment Standards

Section updated to add language on requirements for prenatal visits and postpartum services.

2.2.9

High Risk Maternity and Perinatal Care Management

Section updated to reflect additional high risk perinatal conditions that should be referred to the Health Plan Care Management Team.

2.2.11

Outreach, Education, and Community Resources for Pregnant Members

Section updated to reflect current community resources.

2.3

Family Planning for Title XIX/XXI Adults with SMI

Section updated to reflect current coverage for family planning services.

2.3.5

Annual Preventative Care

Section updated to reflect current age range for HPV vaccine coverage.

2.4.3

EPSDT Well-Child Basic Elements

Section updated to reflect current elements of a well-child exam.

2.4.5

Developmental Screening Tools

Section updated to reflect current developmental screening tools available for members.

2.4.9

Arizona Early Intervention (AzEIP)

Section updated to reflect current reimbursement criteria and details on use of AHCCCS AzEIP Speech Therapy Fee Schedule.

2.5

Dental Services

Section updated to reflect current Health Plan Dental partner and contact info for dental related issues.

2.6

Optical Services

Section updated to reflect current Health Plan Optical partner.

2.8.1

Overview of Crisis Intervention Services

Section updated to reflect statewide coverage due to Care1st and AzCH-CCP migration. Health Plan Crisis Service contact information updated.

2.9

Second Responder Crisis Services

Section updated to reflect current program description and coverage areas for services.

4.3.10.1

Certification of Need (CON) for Services

Section updated to add special instructions for submitting documentation to support medical necessity for BH/PH inpatient and Sub-Acute Admissions, as well as Behavioral Health Residential Facilities.

4.3.10.2

Re-Certification of Need (RON) for Services

Section updated to add special instructions for submitting documentation to support medical necessity for BH/PH inpatient and Sub-Acute Admissions, as well as Behavioral Health Residential Facilities.

4.6.1

Nursing Facility Requirements (PASRR)

Section updated to reflect current requirements on Level I PASRR screenings.

4.6.2

PASRR Level I Screenings

Section updated to reflect additional current requirements on Level I PASRR screenings.

4.6.3

PASRR Level II Screenings

Section updated to reflect current requirements on Level II PASRR screenings.

4.6.4

Criteria (PASRR)

Section updated to reflect current requirements on Level II PASRR criteria.

4.6.9

Resident Review (PASRR)

Section added with information on requirements for Resident Review for individuals experiencing a Significant Change.

4.6.10

Request for Hearing (PASRR)

Section added with information on the process an individual can take to request a hearing if they believe there has been an erroneous determination regarding PASRR.

4.13.9

Input from the Health Plan Pre-Contracted Providers

Address updated to submit written requests for changes to the Health Plan Drug List.

4.15

Electronic Visit Verification

Section updated throughout, please review in full.

5

{Reserved}

Section added as placeholder for future information.

6.7.3

Notification and Maintenance Requirements

Section updated to add language on the responsibility of providers to identify demographic data and to report those changes within 10 days, per AMPM 610.

8.3

Claim or Encounter Submission Requirements

Section updated to include additional language regarding claim submission requirements.

8.4

Claim Submission Time Frames

Section updated to include language on acceptable and unacceptable proof of timely filing.

8.5.1

CMS-1500 Claim Form

Section updated to include requirement to include rendering provider information for FQHCs and RHCs.

8.5.4

Corrected Claim Submission

Section updated to provide to include current processes for submitting corrected claims.

8.13

Specific Billing Requirements

Section updated to add language for Modifier 50 (bilateral procedure), Modifier SG (Ambulatory Surgical Center facility service) and Dialysis.

8.14

Vaccines for Children Billing Procedures

Section updated to add language on use of 90461.

8.17

Resubmissions, Replacements and Voids

Section updated to provide to include current processes for resubmission of claims.

8.19.1

Fraud, Waste and Abuse (FWA) Claim or Encounter Edits

Section updated to add verbiage on Arizona Revised Statute ARS 36-2918.01 and requirements to report FWA.

8.21

{Reserved}

Section added as placeholder for future information.

8.23

Transportation

Section updated to add verbiage on requirements of including pick up and drop off addresses on claims.

8.24.5

{Reserved}

Section added as placeholder for future information.

8.24.6

Performance Sanctions

Section updated throughout, please review in full.

10.1

Member Rights

Section updated to reflect current member rights as outlined in 42 CRF Section 438.100 and AMPM 940.

10.2

Cultural Competence System of Care Requirements

Section updated to add language on the use of person first language.

10.3

Verification of U.S. Citizenship or Lawful Presence for Public Behavioral Health Benefits

Section updated to reference additional sections of Provider Manual that cover requirements of eligibility screening.

10.8

Fraud, Waste and Program Abuse Reporting

Section updated to add language on requirements to report FWA and for providers to ensure adequate FWA training, as well as to include updated examples of FWA.

10.8.1

Methods for Reporting Fraud, Waste, and Abuse

Section updated to add timeframe for when to report FWA.

10.10.1

Criteria Used in Encounter Validation Studies

Section updated to reflect current definitions of Timeliness, Accuracy Errors, and Encounter Omission Errors definitions.

11.2.3.1

Minimum Information (Comprehensive Clinical Record)

Section updated to add language on requirements for documenting telemedicine services and records for members receiving services through the school system.

11.2.3.2

Physical Health Record

Section updated to add language on requirements for documenting developmental screening, maternity care screenings, ASD screening and financial screenings (at intake).

11.2.3.3

Behavioral Health Record

Section updated to include requirements on SDOH assessment or screening documentation.

11.2.7

Medical Record Audits

Section updated to include requirements on evidence of coordination of care and identification of SDOH/HRSN.

11.3.1

Complete Care & Regional Behavioral Health Integrated Performance Measures

Section updated to reflect current HEDIS or Other Adult/Child Performance Measures.

11.7.2

Process of Evaluation and Resolution of Quality of Care Concerns

Section updated to reflect current actions the Health Plan takes in the QOC process.

11.7.3

Tracking/Trending of Quality of Care Issues

Section updated to reflect that QOC data related to provider education, training and staff credentialing is shared with the Health Plan Workforce Development Operation per ACOM 407.

11.10.2

Reporting Incidents, Accidents, and Deaths to the Health Plan

Section updated to reflect current list of IAD activities that require reporting to the Health Plan/.

12.6

Social Determinants of Health

Section updated to add language on the Closed Loop Referral System (CLRS).

12.20.3

Use of Telemedicine and Remote Patient Monitoring

Section updated to add language on coverage of audio-only services.

12.21

Transplants

Section updated throughout, please review in full.

13.6.1.1

Minimum Elements of the Behavioral Health Assessment

Section updated to include language on requirements if an assessment was completed by another provider.

13.10.5.21

Arizona State Hospital (ASH) Conditional Release

Section updated to reflect current process of release review.

13.11.5

MHBG Contracted Provider Requirements

Section updated to include Early Serious Mental Illness (ESMI).

13.14.3

Periodic Updates to AHCCCS (OOS)

Section updated to add language on timeline for notification to AHCCCS regarding members who discharged from out of state placement.

13.17

Program Changes

Section updated to reflect current process for providers to notify the health plan of any major changes to their agency (i.e. closure, move, addition of programming, etc.).

13.18

Additional Integrated Health Home Requirements

Section updated to reflect current Integrated Health Homes serving children and adults.

13.18.1

Screening and Service Members with Complex Needs

Section updated to add language on requirements for screening children.

13.18.1.2

Dedicated Health Care Coordinators (DHCCs)

Section updated to reflect current requirements regarding DHCC responsibilities and caseload ratios.

13.18.1.3

Requirements for Integrated Health Homes Meeting the Needs of Members with High/Complex Needs

Section updated to reflect current requirements regarding ensuring services for members with high or complex needs.  

13.18.2.3

Outpatient Services

Section updated to add additional examples of case management activities.

13.18.2.5

Answering Service

Section updated to reflect current requirements that Integrated Health Homes need to meet for after-hour calls.

13.18.5.2

Behavioral Health Professionals

Section updated to add language on BHP requirements per AMPM 310-B.

13.18.5.15

Telemedicine

Section updated to add language on recommended “meet and greet” events in communities where telemedicine services are provided.

13.20.2.3

Discharge Planning (BH Inpatient and Licensed Hospitals)

Section updated to reflect required timeframe for submission of discharge plan to the health plan.

13.20.6.1

Behavioral Health Residential Facility Services

Section updated to include language on requirements of services as outlined in AMPM 320-V.

13.22.1

Referrals for Employment Services

Section added to provide verbiage on the referral of members for employment or Vocational Rehab services.

14.4

Coordination of Care with Other Governmental Agencies

Section updated to add language on how to obtain policies, protocols, and procedures on coordinating with various governmental agencies, per AMPM 541.

15.1.1

Integrated Health Home Urgent Engagement Responsibility

Section updated to reflect member eligibility for UE in a Behavioral Health Inpatient Facility (BHIF).

15.3

Birth to Five Provider Program Requirements

Section updated to include language on coordination of care requirements per AMPM 581.

15.11.2

Children’s Therapeutic Foster Care

Section updated to add clarifying language on the purpose of TFC and to reflect current processes around members who go AWOL.

15.11.3

Program Requirements – Treatment Planning (TFC)

Section updated to reflect current requirements that should be included on a treatment plan for Therapeutic Foster Care.

15.11.4

Expected Treatment Outcomes (TFC)

Section updated to reflect current treatment outcome requirements for Therapeutic Foster Care.

15.11.5

Criteria for Admission (TFC)

Section updated to reflect current admission criteria for Therapeutic Foster Care.

15.11.6

Criteria for Continued Stay (TFC)

Section updated to reflect current criteria for continued stay for Therapeutic Foster Care.

15.11.7

Criteria for Discharge (TFC)

Section updated to reflect current discharge criteria for Therapeutic Foster Care.

15.11.8

Program Requirements (TFC)

Section updated to reflect current program requirements for Therapeutic Foster Care.

15.11.9

TFC Agency Roles/Responsibilities

Section updated to reflect current provider roles and responsibilities for Therapeutic Foster Care.

15.11.10

TFC Family Provider Roles/Responsibilities

Section updated to reflect current family provider roles and responsibilities for Therapeutic Foster Care.

15.12.3

Residential Treatment Services

Section updated to add language on requirements to establish policies and procedures around MOUD, per AMPM 320-V.

15.12.7

Program Requirements for Providers of IV Drug and Opioid Treatment Services

Section updated to add language on adhering to AHCCCS Opioid Treatment Requirements, OTP closure notifications, and AHCCCS Opioid Services Locator.

15.15.4

Community Observation Unit Capacity Requirements

Sections updated to reflect current Observation Unit Facilities and Capacity throughout the state.

15.17.4

Criteria for Admission (Adult BH Therapeutic Homes)

Section updated to reflect current guidelines for determining medical necessity.

15.17.7

Criteria for Discharge (Adult BH Therapeutic Homes)

Section updated to reflect current guidelines for determining medical necessity.

15.17.8

Planned Admissions (Adult BH Therapeutic Homes)

Section updated to reflect current timelines for review of prior authorization requests and reconsideration requests.

15.20

Transition Age Youth

Section updated to add language on requirements for transition age youth services as outlined in AMPM 520 and 587.

15.21

Behavioral Health Services for Children in DCS Care, Kinship Placement, or Adopted

Section updated throughout, please review in full.

16

Training and Workforce Development

Section updated throughout, please review in full.

17

EC-301-31 Crisis Observation Notification of Admissions Deliverable

Deliverable updated to reflect current providers required to submit.

17

EC-312 Crisis Mobile Team Readiness Review Deliverable

Deliverable updated to reflect current providers required to submit and due date.

17

FN-101 Quarter End YTD Deliverable

Deliverable updated to reflect current providers required to submit.

17

FN-401 Quarterly Financial Statements Deliverable

Deliverable updated to reflect current providers required to submit and due date.

17

FN-402 Financial Statements Deliverable

Deliverable updated to reflect current providers required to submit.

17

FN-403 Non-Title Funding Expenditure Report Deliverable

Deliverable updated to reflect current due date.

17

FN-405 Uniform Guidance Audit/Single Audit Deliverable

Deliverable updated to reflect current providers required to submit.

17

FN-408 Federal Grant Policies Deliverable

Deliverable updated to reflect current due date.

17

RF-1013 PASRR Level II Evaluations Deliverable

Deliverable updated to reflect current providers required to submit.

17

RF-1016 Notification of Change Deliverable

Deliverable updated to reflect current description.

17

RF-1031 Key Provider Contacts Deliverable

Deliverable added for Behavioral Health Providers.

17

RF-1032 BHRF Smartsheet Deliverable

Deliverable added for Behavioral Health Residential Facilities.

17

RF-1033 IOP Smartsheet Deliverable

Deliverable added for Intensive Outpatient (IOP) Providers.