Skip to Main Content

Provider Resources

Arizona Complete Health provides the tools and support you need to deliver the best quality of care. Please view our listing on the left, or below, that covers forms, guidelines, helpful links, and training.

Choosing Wisely

Arizona Complete Health is pleased to introduce the Choosing Wisely initiative. The American Board of Internal Medicine (ABIM) Foundation encourages practitioners and patients to "Choose Wisely." This initiative seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures.

Please visit choosingwisely.org to download informational resources for your patients and clinicians to promote shared-decision making.

Partnerships in Care (PiC) Program

In our Partnerships in Care program, we collaborate with selected providers that serve our high-need members to maximize provider strengths and offer clinical support to improve patient outcomes.

If you are identified as a provider that could benefit from participation in the Partnerships in Care program through a data analysis, we will notify you via email and provide a detailed introduction about the program . We will then use data analytics and clinical reviews to collaborate with you to highlight areas of strengths and opportunities to help improve the lives of our members.

What is Care Coordination?

  • The intentional exchange of information between two or more participants (including the member) who are involved in the member’s care to facilitate the appropriate delivery of healthcare services.
  • Care coordination is an essential element in treatment planning, service titration, and the discharge planning processes.

The Benefits of Care Coordination

  • Collaboration between the internal and external treatment team is emphasized to better serve the member.
  • The member’s needs are supported, and a holistic system of care is integrated.
  • It assists in the development of comprehensive treatment planning that leads to more appropriate services titration or referrals.
  • Care coordination consists of anything that bridges gaps in the member’s recovery.
  • A holistic approach to healthcare results in the best outcomes.

Who Should Coordinate Care?

  • Care coordination includes a variety of individuals on the treatment team:
    • Behavioral health providers (e.g., Counselors, Social Workers, Substance Use Counselors, Psychiatrist)
    • Physical health providers (e.g., PCP, Pharmacist, Neurologist)
    • Specialty care services (e.g., Physical Therapists, Occupational Therapists, Speech Therapy)
    • Educational and community supports (e.g., Teachers, School Psychologists, Mentors)
    • Family members (e.g., parent, guardian, spouse, sibling)

Considerations

  • Release of information must be signed by the member or their guardian prior to any outreach.
  • Method of care coordination is based on each member’s needs (e.g., phone, fax, meeting).
  • Request and review records from previous or current providers to align care and member needs.
  • Notify member and/or guardian about coordination occurring.

What Could Happen If Coordination of Care Does Not Occur?

  • Multiple providers may be treating different diagnosis and/or presenting problems.
  • Multiple treatment plans with competing goals can complicate or impede the treatment process for the member.
  • Symptoms may become exacerbated.
  • Duplication of efforts and services provided may occur.

Important Steps of Treatment Planning

  • Treatment plan goals should:
    • Align with assessment, diagnosis, and presenting symptoms
    • Be member driven and individualized
    • Serve as a guide towards the client’s recovery and be referenced frequently
  • Clinical Documentation in a treatment plan should include interventions that are being used, measurable target dates for each goal, and member’s strengths.

Creating a Member-Focused Treatment Plan Using Specific, Measurable, Attainable, Relevant, And Time Frame (SMART) Goals

  • This method helps goals to be measured and adjusted over time to show incremental progress or regression.
    • If progress is not occurring, ask yourself, “What can we do differently?” and reflect changes in the updated treatment plan if the goal needs to be amended to improve attainability.
  • Goals should have a time frame of no more than 90 days.
    • Can the goal be met in 1 month, 2 months, or 3 months?
  • Goals should be member driven and align with their desired outcome.
    • Use direct member quotes for identified goals to use member language and ensure their understanding.
  • Goals should be strengths based and individualized.
  • It is recommended that each goal has two interventions: one for the member and one for the provider.

Tools to Aid in SMART Goal Development

  • Biopsychosocial assessment – triage for member’s needs
  • Diagnosis and presenting problem – clear supportive symptoms and behaviors that align with diagnosis
  • In-depth interview with member and support – assess the desired outcome and strengths
  • Motivational interviewing – consider stage of change the member is in and how they want treatment to help them

Considerations

  • Baseline behaviors and what is attainable for the member
  • Barriers to meeting the goal
  • Developmental age and stage of the member
  • Goals should be updated after a crisis, hospitalization or change in diagnosis
  • Ensure that the timeframe and interventions for the goal align
  • Goal should be tangible and able to answer “yes” or “no” if the goal was met at the treatment review

What is Titration?

  • Titration implies stepping the member down in their services in order to match their clinical presentation, progress, baseline, and supports.
    • Example: Member A. was receiving therapy 4x/month. Due to member’s progress, increase in supports, and coping skills, Member A. is being titrated to receive therapy 2x/month. Member will be evaluated with current service package and continue titration of services as progress continues.
  • Services should also be reduced slowly when recovery is occurring to avoid worsening of symptoms, feelings of abandonment by the client, and empower the use of skills learned. 

Why is Titrating Services Important?

  • Promotes independence and working towards effective independent functioning
    • Discharge should be discussed with the members openly at the start and throughout treatment. A key goal of therapy is to work towards effective independent functioning.
    • This process includes helping members identify their natural support systems and assisting with coordination of care to support their step-down plan and access community-based resources.
    • Studies demonstrate that it is not necessary to be in therapy for years in order to achieve improvement in symptoms.
  • Helps to ensure individualized treatment
    • Treatment type and duration should always be matched appropriately to the nature and severity of the member’s presenting problems.
    • Length of treatment also varies with the type of treatment provided.
  • Discourages unhealthy attachments
    • Titration helps discourage unhealthy attachments to treatment providers because it promotes independence and monitors the member’s progress. It ensures that a member isn’t stuck in one level of care or becomes too dependent on a provider or services.

Barriers to Titration Services

  • Sunshine Health recognizes that barriers may be present for providers and members.
  • If symptoms worsen, services can be titrated up to increase frequency and duration of services, if the documentation supports the medical necessity of that service and authorization is obtained.

Discharge Planning Process

  • Discharge planning is not a one-time event. It requires collaboration with the entire treatment team including providers, member, family, and additional supports.
  • Discharge planning should begin on the first day of treatment and continue to be assessed and frequently discussed with the member.
  • The discharge plan should be written clearly and agreed to by the member.
  • Titrating services, which is the continuous appraisal of current needs, will also help identify when discharge is appropriate.
  • Discharge should occur when: All the treatment goals and needs have been addressed, OR member has reached their baseline, OR the member has reached the maximum benefit of services for that level of care.

Step-down Planning Process

  • Members should begin their step-down plan when they have shown improvement and are meeting their goals and objectives.
  • Members should also have been compliant with treatment recommendations and are no longer severely functionally impaired.
  • To prepare for transition, encourage the use of the skills learned in treatment:
    • Self-care reminders
    • Coping skills
    • Medication regiments
    • Accessing and utilizing support systems
  • Recommend potential referrals to connect the member to natural supports prior to discharge to allow practice using services such as:
    • AA/NA and sponsors
    • Senior centers or respite
    • Employment programs
    • Spiritual or religious supports
    • Community mentors or peer support specialists
    • Sports/hobby groups
    • Online supports (e.g., apps, online groups)
  • Discharge plans and instructions on how to return for care if needed should be provided to the member and openly discussed. They should be informed that they can resume services if needed.

Consider Family Readiness

  • Refer family to parent education/training, if needed.
  • Equip the family with tools and steps to take if the need for treatment arises again.
  • Ensure the family’s inclusion on discharge planning.

Additional Info

Schools and Behavioral Health Providers: The Benefits of Partnership

Children spend much of their day at school and what takes place within the school community has a tremendous impact on children. Ensuring a safe and healthy school environment is critical to student success. That healthy environment includes providing our schools with the tools and supports they need to address mental health issues, behavioral health needs and substance use concerns. Arizona is home to many outstanding providers that already support schools and students with behavioral health care services.

Find more Information for School Based Behavioral Health Services (PDF)

The Youth Engagement Specialist (YES) Program

The Youth Engagement Specialist (YES) program serves children in elementary, middle, and high schools throughout northern, central and southern Arizona. Arizona Complete Health-Complete Care Plan funds the YES program through Mental Health Block Grant dollars

Parents, teachers, and school staff can make referrals to the YES program by identifying qualifying students. An eligible student would be identified as needing behavioral health services to better function in school and in their community.

The following providers are utilizing the YES progam to deliver behavioral health services in schools:

These providers work in over two hundred schools throughout Arizona in Cochise, Coconino, Mohave, Pima, Santa Cruz, Yavapai, and Yuma counties. 

Available Funding for School-Based Services

When a child is referred to a behavioral health provider from a school, they may be eligible for Title 19/21 funding through AHCCCS.  In addition, if the child is uninsured or underinsured they may be eligible for Non-Title 19 Medicaid funds (eligibility is determined by Solari).  Schools can refer students to any behavioral health provider within the Arizona Complete Health-Complete Care Plan network of providers for  counseling for anxiety, depression, social isolation, stress, behavioral issues, or any other mental health services. If the child is underinsured or uninsured families will not receive a bill for these services; they may be  eligible for Non-Title 19 Medicaid funding.

Arizona Complete Health-Complete Care Plan Providers with both Title 19/21 and Non-Title 19/21 Funding:

    For more information

    If a school, school district, or behavioral health provider would like more information on obtaining a behavioral health partnership in their community or if there are any questions about any of the programs above, please contact us.

    You can also visit AHCCCS to find out more about Accessing Behavioral Services in Schools.

    Arizona Health Care Cost Containment System is collaborating with Health Current for Arizona’s Health Information Exchange (HIE). The HIE connects electronic health record systems of providers, allowing the exchange of patient information.

    Arizona Complete Health-Complete Care plan is requesting our providers to participate in this initiative and become part of the HIE.

    What are the benefits for providers to participate in the HIE?

    • Provides real-time access to critical patient data during the COVID-19 pandemic
    • Improves coordination of care and transitions of care
    • Saves time be eliminating calls anf axes to other providers
    • Reduces costs and improves health outcomes
    • Helps avoid costly mistakes and improves patient safety

    Health Current HIE Services

    Alerts

    Notifications sent to designated clinicians or individuals based upon patient panel. A patient panel is a practice or payer provided list of patients members they wish to track. Alerts include:

    • Inpatient Alerts
    • Emergency Department Alerts
    • Ambulatory Alerts
    • Patient Centered Date Home Alerts
    • Clinical Results Alerts
    • COVID-19 Alerts

    Direct Email

    Secure email accounts that provide the means for registered users to exchange patient protected health information with other DirectTrust-certified email accounts. Direct Email is often used to receive Alerts.

    Portal

    Secure web-based access that allows selected patient data to be viewed online.

    PMP Data

    Access to Arizona’s controlled substance prescription monitoring program (PMP) database is available through the HIE Portal.

    Data Exchange

    Electronic interfaces between patient tracking systems and the HIE. Exchanges include Unidirectional and Bidirectional.

    Clinical Summary

    A comprehensive Continuity of Care Document containing up to 90 days of the patient’s most recent clinical and encounter information.

     

    HIE Onboarding Program

    Through funding available from the Arizona Health Care Cost Containment System (AHCCCS), Health Current offers the HIE Onboarding Program to support the participation of eligible AHCCCS hospitals and providers in statewide health information exchange (HIE). 

    The program provides an administrative offset in recognition of the costs the eligible HIE participant has incurred to complete bidirectional HIE connectivity.  Due to limited funding, this program is available on a first come, first served basis.

    The financial payments are as followed:

    • Community Provider (1-25 providers)  - $5,000
    • Community Provider (26+ providers) - $10,000
    • FQHC, FQHC Look-Alike & RHC - $10,000
    • Hospital $20,000

    For more information on Health Current HIE Services, visit www.healthcurrent.org

    AAC evaluations and devices are covered services for all integrated AHCCCS members.

    The process we follow is outlined below:

    1. When a provider determines an AAC evaluation is needed, the provider writes a referral/prescription for an AAC assessment to be performed by a speech language pathologist (SLP)
    2. We work with the provider to identify a SLP who will conduct the AAC evaluation. For help locating a SLP, please contact us at 1-888-788-4408 (TTY/TDD 711).
    3. The SLP completes the AAC evaluation and determines if an AAC device is needed
    4. If an AAC device is needed, the SLP submits a prior authorization request to us for the appropriate AAC Device

    If approved SLP works with our contracted Durable Medical Equipment provider to provide you with the ACC and works with you and/or your family to schedule training on the device

    Helpful Links