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Reminder of Discharge Planning Requirements for Members Designated SMI

Date: 03/24/25

Reminder: Discharge Planning Requirements for SMI Designated Members

 

Effective January 17, 2025, AHCCCS updated the AHCCCS Medical Policy Manual (AMPM) Policy 1020-Utilization Management to require all short-term, long-term hospital, and institutional discharges for SMI-designated members to follow ARS 36-2903.16 to ensure proper care planning, coordination, and management.

We encourage you to review this communication and AMPM 1020 thoroughly and share with your team(s) to confirm you comply with AHCCCS requirements.

 

Follow-up Appointments:

  • Follow-up appointments with PCPs or specialists shall be scheduled within 7 business days of discharge, unless the member is admitted to a facility with evaluation upon admission.
  • Follow-up appointments for behavioral health services shall be scheduled within 7 business days of discharge, unless the member is admitted to a facility with evaluation upon admission.

 

Care Coordination:

If the member has community behavioral health services established, coordination of care shall occur between the inpatient facility, member, and established community behavioral health provider(s) prior to discharge from the inpatient facility promoting safe and clinically appropriate continuum of care treatment and support services exist (as outlined in AMPM Policy 310-B based on the member identified needs.

 

Medication Management:

Prior to discharge, the provider of the inpatient behavioral services shall make active efforts to verify the member’s previous or existing documentation related to psychiatric and non-psychiatric medication records via the HIE and other sources.

  • If discharged with prescribed medication(s), a follow-up with a prescribing professional must occur before the prescription expires to prevent lapses.
  • If an appointment is unavailable, the outpatient provider must coordinate services to ensure no lapse in medication refills.

 

Medication List Upon Discharge:

The discharging facility must provide the member (and representative, if applicable) with a complete list of all prescribed psychiatric, other prescribed, and regular/as-needed over-the-counter medications.

 

Discharge Documentation:

The discharging facility must send a discharge summary, inpatient service plan, and complete medication list to the designated outpatient behavioral health provider.

If you have questions about this communication, please contact Dee Reny, Senior Director of Care Management, at Dee.A.Reny2@azcompletehealth.com.