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Specific Behavioral Health Program Requirements

Urgent Engagement is the process of engaging people into care who have experienced a crisis or have been admitted to an inpatient facility. It is intended to engage persons into care, rather than fulfilling an administrative function. The process includes ensuring effective coordination of care, engagement, discharge planning, a Serious Mental Illness (SMI) screening when appropriate (reference Provider Manual section 12.6), screening for eligibility, referral as appropriate, and prevention of future crises. Once the Behavioral Health Home completes the urgent engagement process, the Behavioral Health Home is the entity that is responsible for coordination of necessary service and discharge planning. Urgent Engagements are required to be started within one hour (at a Community Observation Center) or 24 hours (at a Behavioral Health Inpatient Facility).

14.1.1 Behavioral Health Home Urgent Engagement Responsibility

Behavioral Health Homes must accept referrals and requests for Urgent Engagements 24 hours a day and seven days a week. Providers are required to record, report and track completion of Urgent Engagements.

For persons who are not yet enrolled in Medicaid, Block Grant programs or the Marketplace, Behavioral Health Homes are required to continue to pursue coverage for the person.

One Hour Urgent Engagements at a Community Observation Unit (COU)

AzCH-CCP enrolled and State Only (N19/NSMI) inidviduals who receives services at a Community Observation Unit and identifies as not engaged with a BH provider must be referred for urgent engagement. The Behavioral Health Home must arrive within one hour of the request. Once a Behavioral Health Home makes contact with the member, they are responsible for discharge planning for that member, including transportation and a follow up appointment. The urgent engagement at a COU should be an abbreviated intake in order to quickly gather the information needed. The engagement process can be completed in a follow up appointment (preferably within the next 24-48 hours).

24-hour Urgent Engagements at a Behavioral Health Inpatient Facility (BHIF)

Every AzCH-CCP enrolled or State Only individual who lives in The Health Plan covered service area and is hospitalized at a Behavioral Health Inpatient Facility and is not in active care with a Behavioral Health Home, is eligible for an urgent engagement. The selected Behavioral Health Home has 24-hours to arrive at the facility and complete the Urgent Engagement assessment.  In the event the individual is sleeping or otherwise unable to participate in the Urgent Engagement process, the Behavioral Health Home shall reschedule the Urgent Engagement assessment within 24-hours and inform The Health Plan of the status.

The Health Home shall transmit the User Engagement Disposition form to AzCHDISPO@azcompletehealth.com within 24-hours of completing assessment.

Provider Manual Form 6.1.1 Urgent Response Disposition can be obtained by calling the Provider Services Call Center at 866-796-0542.

24-hour Urgent Engagements at a Physical Health Inpatient Facility

Every AzCH-CCP enrolled or State Only individual who lives in The Health Plan covered service area and is hospitalized at a Physical Health Inpatient Facility and is not in active care with a Behavioral Health Home, is eligible for an urgent engagement assessment. Behavioral Health Homes are required to arrive at the facility and complete the urgent engagement assessment within 24 hours of the request.  In the event the individual is sleeping or otherwise unable to participate in the urgent engagement process, the Behavioral Health Home shall reschedule the urgent engagement assessment within 24-hours and inform The Health Plan of the status.

24-hour SMI Evaluation at a Behavioral Health Facility (BHIF)

Every AzCH-CCP enrolled or State Only individual who lives in a The Health Plan covered service area and is hospitalized at a Behavioral Health Inpatient Facility for psychiatric reasons, and is not in active care with a Behavioral Health Home, and presents with a need for an SMI evaluation is eligible to be assessed for an SMI diagnosis.

The Behavioral Health Home shall complete the Urgent Engagement assessment with 24-hours and transmit the Urgent Engagement Disposition form to AzCHDISPO@azcompletehealth.com  within 24-hours of completing assessment.

The Behavioral Health Home shall submit the SMI evaluation packet within seven days of the Urgent Engagement assessment to the designated SMI Evaluation provider, Community Response Network (CRN).

SMI Evaluation at the Arizona State Hospital (ASH)

The purpose of the SMI evaluation services for persons from The Health Plan geographic area admitted to ASH are for discharge planning.  The Behavioral Health Home has seven calendar days to complete the assessment and submit the Urgent Engagement Disposition form to AzCHDISPO@azcompletehealth.com within 24-hours.

The Behavioral Health Home shall submit the SMI evaluation packet within seven days of the Urgent Engagement assessment to the designated SMI Evaluation provider, Community Response Network (CRN).

Behavioral Health Homes activated by the Urgent Engagement process are required to enroll members and non-eligible members refusing services during the COE process.   Once the member is Court Ordered, the Behavioral Health Home is required to proceed with engagement and service delivery; including, an SMI screening.

14.1.2 Capacity to Travel

Behavioral Health Homes must maintain capacity to travel to locations within Arizona to complete Urgent Engagements.

14.1.3 Computer and Wireless Specifications

Behavioral Health Homes must verify Urgent Engagement staff have access to a laptop, mobile printer and wireless web connectivity to allow access to electronic medical information in the field. The computer and wireless specifications meet or exceed The Health Plan requirements.

14.2.1 72-Hour Rapid Response Requirements for Children

Health Plan contracted Behavioral Health Homes must complete a rapid response assessment within 72 hours of Health Plan activation for all children who are taken into the custody of DCS, regardless of Title XIX/XXI eligibility status.

Within 72-hours of the Health Plan Rapid Response dispatch, the Behavioral Health Home must conduct a face-to-face visit with the child in their placement in order to:

  • Complete an assessment to identify immediate safety needs and presenting problems of the child to stabilize behavioral health crises and to be able to offer immediate services the child may need;
  • Provide behavioral health services to each child with the intention of reducing the stress and anxiety that the child may be experiencing, and offering a coherent explanation to the child about what is happening and what can be expected to happen in the near-term;
  • Provide or arrange needed behavioral health services to each child’s new caregiver, including guidance about how to respond to the child’s immediate needs in adjusting to foster care, behavioral health symptoms to watch for and report, assistance in responding to any behavioral health symptoms the child may exhibit, and identification of a contact within the behavioral health system;
  • Ensure that each child and family is referred for ongoing behavioral health services as indicated by the assessment and service plan and ensure that services start within 21 days of the Rapid Response Assessment.
  • Initiate the development of the Child and Family Team (CFT) for each child (see Child and Family Team Practice Tool); and
  • Provide the DCS Specialist with written findings and recommendations for medically necessary covered services within 24 hours of Rapid Response assessment. This information shall be utilized during the initial Preliminary Protective Hearing, which occurs within 5 to 7 days of the child’s removal. (See Provider Manual Section 12.2.1, DCS Child Welfare Timelines)

Additionally, Behavioral Health Homes are expected to engage the family from which the child was removed within 5 days of the Rapid Response in order to engage them in the assessment process and invite them to participate in the Child and Family Team meeting. The Behavioral Health Home is expected to help the parents identify appropriate services and support them in the enrollment process.

Behavioral Health Homes are required to attend the Pre-Hearing Conference and Preliminary Protective Hearing to present their assessment and recommendations and continue to engage the family.

14.2.1.1 Capacity to Travel

Behavioral Health Homes must maintain capacity to travel to locations within Arizona to complete a 72 Hour Rapid Response assessment.

14.2.1.2 Tracking of Transfers

When applicable following a Rapid Response, Behavioral Health Homes must track the transfer of enrolled Members to other Health Plan contracted Behavioral Health Homes through the Health Plan Provider Portal and continue providing coordination and treatment services until the receiving agency has fully accepted the transfer as indicated in the Provider Portal.

14.2.1.3 Computer and Wireless Specifications

Behavioral Health Homes must verify Rapid Response staff have access to a laptop, mobile printer and wireless web connectivity to allow access to electronic medical information in the field. Computer and wireless specifications must meet or exceed Health Plan requirements.  Ongoing Service Requirements for Comprehensive Medical and Dental Plan (CMDP) Eligible DCS Involved Children. Behavioral Health Homes are expected to provide services for a period of at least six months following the Rapid Response assessment unless the Behavioral Health Home receives a written request from the guardian or the DCS case closes.

14.2.2 Ongoing Service Requirements for CMDP Eligible DCS Involved Children

Behavioral Health Services for DCS involved children must stay open for at least six months following the Rapid Response assessment unless the Behavioral Health Homes receives a written request from the guardian or DCS closes out the member.

DCS Involved Children must receive at least one service, identified on their service plan each calendar month.

Behavioral Health Homes must ensure that services are provided to children within 21 days of the following:

  • Rapid Response Assessment
  • Initial/Intake Assessment
  • Update of the Comprehensive Assessment
  • Agreement of the Child Family Team

Behavioral Health Homes are expected to participate in all court hearings as appropriate for members in their care.

Behavioral Health Homes are required to coordinate care for all CMDP members who become detained in a county detention facility located outside of the Health Plan service area.

Behavioral Health Homes are expected to engage the biological parents, foster parents, kinship parents and adoptive parents throughout the course of treatment. The purpose of this engagement is to engage the parents and caretakers in the assessment process and invite them to participate in the Child and Family Team meeting. The Behavioral Health Home is expected to help the parents identify appropriate services and support them in the enrollment process.

When the DCS Specialist/Legal Guardian is not available, the Behavioral Health Home must recognize the signature of the foster or kinship placement for the purpose of coordinating outpatient behavioral health services. Foster and kinship placements may sign a release of information, consent to treat, the service plan and other necessary documentation. If there is a disagreement between the placement and the DCS Specialist about services, the Legal Guardian/DCS Specialist shall make the final decision.

The DCS Specialist/Legal Guardian must be the one to sign a child in the legal custody of DCS in to a Home Care Training for the Home Care Client (HCTC), Behavioral Health Residential Facility (BHRF), Behavioral Health Inpatient Facility (BHIF), Brief Intervention Program (BIP) or a hospital.

14.2.3 Requirements of Jacobs Law/ ACOM Policy 449

14.2.3.1 Requirements of the Foster Care Hotline

AzCH-CCP contracts with the Arizona Crisis Line to maintain a Foster Care Hotline for the specific purpose of answering calls about DCS involved children from Foster, Kinship and Adoptive Parents. The Foster Care Hotline shall be available 365/24/7 to meet the needs of the child and family.

Appropriate calls to the Arizona Crisis Line, Foster Care Hotline, may include but are not limited to:

  • Initiate a Rapid Response at the 73rd hour, not previously initiated by DCS
  • Placement initiated Request for 72 Hour Out of Home Determination due to dangerous or threatening behaviors
  • Request for Crisis Mobile team
  • Request for referral to a Secondary Responder/Placement Stabilization Program

When a foster parent, kinship placement, group home or law enforcement official calls the Foster Care Hotline to initiate a Rapid Response, the Foster Care Hotline staff must immediately email the Health Plan Rapid Response Program at AzCHDCSRR@azcompletehealth.com  and the DCS Child Services liaison.

14.2.3.2 ACOM Policy 449 Requires

The Foster Care Hotline is required to send out a Crisis Mobile Team if a foster, kinship or adoptive parent requests a 72 Hour Higher Level of Care Determination.

The Crisis Mobile Team shall determine if the child needs to go to a hospital, CRC or BIP (for AzCH-CCP members) to ensure the safety of the child while the team meets to determine further clinical needs of the child. If the CMT determines the child is safe to stay in the current environment, a safety plan must be developed prior to leaving the home.

The Crisis Mobile Team shall immediately inform the Behavioral Health Home and The Health Plan CMDP Coordinators at the AzCHDCS@azcompletehealth.com  email of the call and the need for an Emergency CFT.

The Behavioral Health Home is required to have an Emergency CFT to identify the needs of the member and if appropriate follow the Health Plan process for securing the appropriate level of care for the member.

14.2.3.3 Crisis Response for DCS Involved Members and Adopted Children

When the AzCH-CCP Foster Care Hotline is called because the member is in crisis or is showing dangerous or threatening behaviors, a crisis mobile team shall be dispatched.

Crisis Mobile Team providers are required to arrive within 2 hours of dispatch.

Crisis Mobile Teams that do not arrive within 2 hours are expected to call the Foster Care Hotline and report the missed timeframe

AzCH-CCP Foster Care Hotline is required to notify the DCS Child Services Liaison via email of any CMT dispatches that do not meet the 2 hour required response time.

All calls received by the AzCH-CCP Foster Care Hotline must be tracked and reported to The Health Plan using Deliverable EC-301-25 Foster Care Hotline Call Report.

The EC-301.25 Foster Care Hotline Call Report is due the 10th of every month for the previous month. 

Behavioral Health Respite Home Providers must meet the requirements of AAC R9-10-1601.

14.3.1 Authorization and Continued Stay Requirements

Behavioral Health Respite Home providers must meet all prior authorization and continued stay requirements for Behavioral Health Supportive Homes as spelled out in this Provider Manual and as directed by The Health Plan.

Birth to Five providers must provide screening, assessment, service planning, interventions and practices specifically designed to meeting the unique needs of children age Birth to Five and their families. Providers are required to utilize the AHCCCS Practice Tools “Working with the Birth to Five Population” and “Psychiatric and Psychotherapeutic Best Practices for Children Birth Through Five Years of Age” for additional guidance.

Birth to Five providers must demonstrate active participation in state, regional and community sponsored best practices development and committed to working to build community knowledge base and expertise.

Brief Intervention Program providers must maintain an intensive treatment program to deliver services 24 hours a day, 7 days a week, 365 days a year with the purpose of helping persons live successfully in the community. Brief Intervention Program providers must deliver supportive and treatment services necessary to support the Member in the community and must verify access to the services 24 hours a day, 7 days a week, 365 days a year to respond to crises, as appropriate.

14.5.1 Staffing

Brief Intervention Program providers must provide adequate staffing to maintain the safety of the Members and protect them from harm.

14.5.2 Participation Limit

Brief Intervention Program providers must limit participation in the program to ten (10) days per episode.

14.5.3 Coordination with Teams and Family

Brief Intervention Program providers must coordinate with treatment teams and family members, as appropriate, to verify continuity of care. Child and Family Teams/Adult Recovery Teams must be conducted within 72 business hours after admission. Each Brief Intervention Program provider must submit a report as indicated in Section 16 – Deliverable Requirements.

Providers can be considered “Consumer Operated” if they comply with the requirements as outlined in the SAMHSA Consumer Operated Services Evidence-Based Practices Kit. Consumer Operated Providers can hold a behavioral health license from the Arizona Department of Health Services Division of Licensing, or in some situations can be certified as a Community Service Agency per AHCCCS AMPM 961, Community Service Agency Title XIX Certification. Community Service Agency Application forms can be found on the AHCCCS website at https://www.azahcccs.gov/shared/MedicalPolicyManual/.

14.7.1 General Requirements for Crisis Line providers

14.7.1.1 Referrals

Crisis Line providers must comply with the requirements outlined in Provider Manual Section 14.13, Substance Use Disorder Treatment Requirements.

14.7.1.2 After Hours

Crisis Line providers must maintain an administrator–on-call to address any after-hours, weekend or holiday concerns or issues.

14.7.1.3 Services

Services must be individualized to meet the needs of Members and families. Crisis Line providers must assess the Member's perspective on treatment progress, in order to verify that the Member's perspectives are honored and they are effectively engaged in treatment planning and in the process of care. Crisis Line providers must provide monitoring, feedback and follow up after crisis based on the changing needs of the individual. The family must be treated as a unit and included in the treatment process, when determined to be clinically appropriate. Crisis Line providers must obtain and document child, family and Member input in treatment decisions.

14.7.1.4 Substance Use Disorders (SUD) Services

Crisis Line providers providing SUD services must develop services that are designed to reduce the intensity, severity and duration of substance use and the number of relapse events, including a focus on life factors that support long-term recovery as appropriate.

14.7.1.5 Coordination of Care

Crisis Line providers must contact the Behavioral Health Home following a member’s utilization of crisis services. Crisis Line providers must verify coordination and continuity within and between service providers and natural supports to resolve initial crisis and to reduce further crisis episodes over time.

14.7.1.6 Community-Based Alternatives

Crisis Line providers must promote community-based alternatives instead of treatments that remove the Members from their family and community. In situations where a more restrictive level of care is temporarily necessary, Crisis Line providers must work with the Member to transition back into community-based care settings as rapidly as is clinically feasible and must partner with community provider agencies to develop and offer services that are alternatives to more restrictive institutionally or facility based care.

14.7.1.7 Staff Requirements and Training

All Clinical Supervisors must meet the appropriate Arizona Board of Behavioral Health Examiners requirements to conduct clinical supervision. Crisis Line providers must demonstrate completion of all Arizona Department Health Services Division of Licensing training requirements are met for all direct care staff. All staff Members must complete an annual training in Cultural Competency and annual Fraud & Abuse Training, and providers must maintain documentation verifying completion of the training. In addition, providers must verify that all staff and family of Members who provide Peer Support or Family Support have adequate training to support them in successfully fulfilling the requirements of their position

Crisis Line providers must notify The Health Plan of any staff changes or incidents impacting credentialing involving Behavioral Health Professionals or Behavioral Health Medical Professionals within forty-eight (48) business hours of any additions, terminations or changes.

14.7.1.8 Quality Improvement

Crisis Line providers must participate in clinical quality improvement activities that are designed to improve outcomes for Arizona Members.

14.7.1.9 Electronic Health Record (EHR)

Crisis Line providers are highly encouraged to have in place a fully operational EHR; including, electronic signature, and remote access, as required to meet Federal Medicaid and Medicare requirements. In addition, Crisis Line providers must allow State and The Health Plan staff access to the EHR for the purpose of conducting audits.

14.7.2 Service Requirements

Crisis Line providers must maintain a twenty-four (24) hours per day, seven (7) days per week crisis response system that has a single toll-free crisis telephone number and the discretion to establish a local crisis telephone number. The crisis line must:

  • Be widely publicized within the covered service area and included prominently on The Health Plan website, the Member Handbook, Member newsletters, and as a listing in the resource directory of local telephone books;
  • Be staffed with a sufficient number of staff to manage a telephone crisis response line to comply with the requirements of the Agreement;
  • Be answered within three (3) telephone rings, or within 15 seconds on average, with an average call abandonment rate of less than 3% for the month.
  • Include triage, referral and dispatch of service providers and patch capabilities to and from 911 and other crisis providers as applicable;
  • Offer interpretation or language translation services to persons who do not speak or understand English and for the deaf and hard of hearing; and
  • Provide Nurse On-Call services twenty-four (24) hours per day, seven (7) days per week to answer general healthcare questions from SMI Members receiving physical health care services and to provide them with general health information and self-care instructions.

14.7.2.1 Staff Requirements

Crisis Line providers must follow the requirements below:

  • Establish and maintain the appropriate ADHS Division of Licensing license to provide required services.
  • Maintain appropriate Arizona licensed medical staff, Arizona licensed Behavioral Health Professionals, ADHS Division of Licensing facility licenses, qualified Behavioral Health Technicians and Paraprofessionals, and Peer Support staff to adequately address and triage Member calls and verify the safe and effective resolution of calls.
  • Maintain bilingual (Spanish/English) capability on all shifts and employee interpreter services to facilitate crisis telephone counseling for all callers.
  • Provide consistent clinical supervision to verify services are in compliance with the Arizona Principles and all ADHS Division of Licensing, and State supervision requirements are met.
  • Employ adequate staff to implement the Crisis AfterCare Recovery program.
  • Employ one (1) full-time American Indian Warm-line Program Coordinator and part-time tribal Member employees representing the Tribal Nations served by The Health Plan who have tribal Members living on tribal lands in Arizona.

14.7.2.2 Telephone Call Response Requirements

Crisis Line providers must verify that all calls for Crisis Mobile Teams and Nurse Line are answered within three telephone rings, or within fifteen (15) seconds, as measured by the monthly Average Speed of Answer. All crisis calls and Nurse Line calls must be live answered.

Crisis Line providers must report monthly, quarterly, and annually, all phone access statistics to include: total number of calls received, number and percent abandoned, average speed of answer, and number of calls outside standards. Crisis Line providers must report daily a phone access report that identifies number of calls outside standards, amount of time to answer call for each call outside standards, and number of abandoned calls associated with call outside standards.

14.7.2.3 Crisis Counseling, Triage, Tracking, Mobile Team Dispatch and Resolution

Crisis Line providers must meet the following requirements:

  • Provide crisis counseling, triage and telephonic follow-up 24/7/365. All crisis calls must be live answered. Crisis callers must not receive a prompt, voice mail message, or be placed in a phone queue.
  • Provide crisis counseling and triage services to all persons calling The Health Plan Crisis Line, regardless of the caller's eligibility for Medicaid services.
  • Review Crisis Plans identified in The Health Plan data system to assist with crisis resolution and suggest appropriate interventions.
  • Dispatch mobile team services delivered by provider agencies and must track mobile team intervention resolution in compliance with protocols established or approved by The Health Plan. Crisis Line providers must report on a weekly and monthly basis these dispatches in a format approved by The Health. Daily reports may be required as needed.
  • Assess the safety of a crisis scene prior to mobile team dispatch and track mobile teams to monitor the safety of the mobile team staff.
  • Follow-up with Members, crisis mobile team staff, Integrated Care Managers, and system partners to verify appropriate follow-up and coordination of care.
  • Assess Member dangerousness to self and others and provide appropriate notification to The Health Plan, Behavioral Health Home Health Care Coordinator, and obtain information on Member's consistent use of medications to minimize dangerousness and promote safety to the Member and community.
  • Follow community standards of care and best practice guidelines to warn and protect Members, family members and the community due to threats of violence.
  • Document all interactions and triage assessments to facilitate effective crisis resolution and validate interventions.
  • Conduct a follow-up call within seventy-two (72) hours to make sure the caller has received the necessary services. Verify Members are successfully engaged in treatment before closing out the crisis episode and follow-up to verify system partner and Member satisfaction with the care plan.
  • Support the mobile teams and arrange for transports, ambulance, etc.
  • Dispatch and track requests for 1 hour Urgent Engagements. Dispatch and Track requests for 24 hour Urgent Engagement referrals after hours.
  • Monitor and make best efforts to verify that 1 hour Urgent Engagements are completed within 1 hour of Behavioral Health Home activation.  Provider must document and report any reported response delay reason, monitor and make best efforts to verify that 24 hour Urgent Engagements are completed within twenty-four (24) hours of notification by health plans, hospitals, or detention centers. Provider must document and report any reported response delay reasons.
  • Track all Urgent Engagement requests to verify Members are engaged in follow-up care.
  • Provide reports that track and summarize the requests for, daily pending inpatient report, daily call statistics report, CMT timeliness report, re-entry reports, urgent response report, acute health plan inquiry log, crisis indicator data report, client activity report, second responder tracking and 24 Hour Mobile Urgent Intake requests the disposition of such assessments in a format established or approved by The Health Plan.
  • Make reasonable attempts to verify that the dispositions and intake appointments are completed.
  • Document and report any delay reasons to The Health Plan in real time for all Urgent Response requests.

14.7.3 Customer Service, Member Outreach, Engagement

14.7.3.1 Customer Service

Crisis Line providers must provide customer service functions on behalf of The Health Plan when The Health Plan offices are closed. Crisis Line providers must complete transactions for Customer Service after-hours without referring anyone to call back during regular business hours unless the call is regarding a claim. The Health Plan Customer Service telephone number must be forwarded to The Crisis Call Center whenever The Health Plan offices are closed and occasionally, as arranged in advance, through Work Force Management.

14.7.3.2 Safety Net

Crisis Line providers must serve as a "safety net" to The Health Plan Members by re-engaging Members into treatment, as identified by The Health Plan and per data provided by The Health Plan.

14.7.3.3 Documentation and Monitoring

Crisis Line providers must document and monitor consistent use of crisis services for persons identified as High Need by The Health Plan, provider agencies or by family report. All High Need situations involving dangerousness to self or others must be staffed immediately with an independent licensed supervisor and the supervision must be documented in the record.

14.7.3.4 Grievances and Service Gaps

Crisis Line providers must notify The Health Plan through The Health Plan data systems of any service delivery problems, grievances, service gaps and concerns raised by Members, family members, and system partners.

14.7.3.5 Encounters

Crisis Line providers must encounter and document all services in compliance with the AHCCCS Covered Behavioral Health Service Guide.

14.7.3.6 Quality Improvement

Crisis Line providers must conduct outreach calls, The Health Plan, to facilitate quality improvement initiatives, as determined by The Health Plan, such as but not limited to the timely completion of Service Plans, use of medications, Health Care Coordinator selection and Member satisfaction, consistent use of treatment services, and frequency of treatment team meetings. Crisis Line providers must participate in satisfaction surveys sponsored by the State and The Health Plan as requested and must conduct satisfaction surveys from reports generated by The Health Plan.

14.7.3.7 Coordination of Care

Crisis Line providers must facilitate effective coordination of care with provider agency staff to promote effective recovery for Members. Crisis Line providers must track resolution until Member reports being successfully engaged in care and consistently engages in treatment.

14.7.3.8 Member Assistance and Providing Information

Crisis Line providers must assist Members in getting their prescriptions filled, obtaining services, resolving access to care problems, and obtaining medically-necessary transportation services. Crisis Line providers must also refer Members for outpatient services and warm transfer callers to agencies or service providers whenever possible upon completion of the call. Follow up calls shall be made to verify referred caller made and kept appointment. Crisis Line providers must explain to callers the process to access services, authorization process for Behavioral Health Inpatient and Hospital services and provide names and locations of intake agencies accessible to the caller.

Members must be informed about The Health Plan website, Member rights and grievance and appeal procedures as appropriate. Crisis Line providers must assist Members in addressing third party liability and "payer of last resort" issues related to accessing services including pharmacy services.

Crisis Line providers must assist Members in managing their own care, in better understanding their rights, in identifying and accessing resources and in more effectively directing their care.

14.7.3.9 Member Eligibility

Crisis Line providers must research Member eligibility for services on behalf of providers and Members and make available eligibility information to callers to assist access to care. Crisis Line providers must make available to Members, family members, and provider agencies treatment information about Evidenced Based Practices and shall assist callers in becoming better informed about services and recovery.

14.7.3.10 Peer Outreach and Coordination

Crisis Line providers must successfully coordinate services with PFROs; including, Peer Crisis AfterCare Programs, Peer Warm Lines, Peer Community Reentry Programs, and Peer Hospital Discharge Programs.

14.7.3.11 Crisis

Crisis Line providers must participate in all trainings and crisis coordination meetings required or requested by the State and/or The Health Plan. Crisis Line providers must successfully implement a Crisis AfterCare Recovery Team, employing program staff during peak hours Monday through Friday. The Crisis AfterCare Recovery Team must conduct outreach, service coordination and crisis stabilization services to Members following mobile crisis team visits, crisis telephone calls, hospitalization and The Health Plan coordination of care requests. In addition, Crisis Line providers must document coordination efforts in The Health Plan software systems.

14.7.3.12 Certified Health Care Coordinator

Crisis Line providers must support and strengthen the role of the Certified Health Care Coordinator through care facilitation, being careful to not diminish the relationship between the Member and the Health Care Coordinator.

14.7.3.13 American Indian Warm-line Program (aka Tribal Warm Line)

Providers must successfully implement an American Indian Warm-line Program and transfer system that includes (at least) part-time tribal Member employees (aka Tribal Support Partners) from the tribes served by The Health Plan. Tribal Support Partners must conduct calls (inbound/outbound) to facilitate member engagement in treatment, instill hope and promote recovery.

14.7.3.14 Tribal Warm Line (TWL) Service Requirements

  • The TWL must be answered by a Tribal Support Partner Monday through Friday, 9:00 AM to 9:00 PM.
  • Outside of these hours, the TWL must be answered by the crisis line, with a follow-up call by a Tribal Support Partner during the TWL operating hours.
  • Tribal Support Partners must be trained in identifying crisis calls and transferring calls between systems.
  • Tribal Warm Line staff must participate in all trainings and coordination meetings required or requested by the State and/or The Health Plan.

14.7.3.15 24/7 Online Scheduling System

Crisis Line providers must successfully implement a 24/7 online scheduling system to schedule emergent follow-up appointments and urgent intake assessments with an outpatient provider following a crisis episode.

Crisis Mobile Team providers must provide crisis mobile team services in the assigned geographic areas and in accordance to State and The Health Plan requirements.

14.8.1 Supervision by Independently Licensed Behavioral Health Professional

Crisis Mobile Team providers must verify that the Crisis Mobile Team Program is clinically supervised by a The Health Plan Credentialed Independently Licensed Behavioral Health Professional. Crisis Mobile Team providers must verify all Risk Assessments and crisis notes are reviewed and signed off by a The Health Plan Credentialed Independently Licensed Behavioral Health Professional within 24 business hours.

14.8.2 Crisis Mobile Team Provider

Crisis Mobile Team providers must coordinate all services through The Health Plan Crisis Mobile Team provider and follow crisis protocols established by The Health Plan and community stakeholders. Crisis Mobile Team providers must work collaboratively with The Health Plan Crisis Line Provider to receive mobile team dispatches, coordinate all services, and facilitate crisis resolution planning. Crisis Mobile Team providers must report all staffing changes to The Health Plan Network Development Department through the EC-312 deliverable. Crisis mobile team providers are required to carry, and use as required, GPS enabled phones provided by crisis line provider. Crisis Mobile Team Agencies are required to have a super-user available within their agency for technical support. GPS phones will enable one number electronic dispatching from the crisis line provider. GPS phones must be kept with crisis mobile team staff on shift at all times. Crisis Mobile Team staff must be trained in appropriate use of the GPS phones. Crisis Mobile Team providers are required to cover the cost of damaged or lost GPS phones as requested by The Health Plan crisis phone provider. If you are assigned a GPS enabled cellular device, it is a condition precedent that you read and sign your specific User Agreement prior to receiving any such cellular device or devices.

14.8.3 Coordination Calls and Coordination with Outpatient Department

Crisis Mobile Team providers must participate in crisis coordination calls and meetings to facilitate effective working relationships. Crisis Mobile Team providers must verify mobile team services are closely linked to the provider's outpatient department and that coordination of care is occurring with outpatient providers for members who have been in a crisis.  If the crisis occurs during business hour, the expectations is that the coordination occurs in real time.

14.8.4 Staffing and Training

Crisis Mobile Team providers must employ adequate staff to consistently meet the requirements for crisis mobile teams. Crisis mobile teams must have the capacity to serve specialty needs of population served including youth and children, Tribal members, and developmentally disabled. Crisis Mobile Team providers must ensure adequate coverage to maintain full crisis team capacity as a result of staff illnesses and vacations. All direct care crisis staff must be Critical Incident Stress Management (CISM) trained. Crisis Mobile Team providers must participate in training events sponsored by The Health Plan and the State to enhance the performance of the crisis system.

14.8.5 Mobile Crisis Vehicles

A mobile crisis team must be able travel to the place where the individual is experiencing the crisis. Crisis Mobile Team providers must provide and maintain mobile crisis vehicles to facilitate transports and field interventions.

14.8.6 Title 36 Screenings

Crisis Mobile Team providers must ensure Title 36 screenings are conducted by staff other than mobile team staff unless The Health Plan holds a contract with the applicable County, in which case the mobile crisis team should follow the requirements specified in that contract. See Section 12.9 - Pre-Petition Screening.

14.8.7 Telephone and Internet Connectivity

Crisis Mobile Team providers shall be provided GPS enabled cell phones for all crisis staff on duty and must verify effective connectivity. Crisis Mobile Team providers must provide internet and telephone connectivity through cell phone technology to verify staff have the capacity to communicate spontaneously by phone and the internet while in the field. Crisis Mobile Team providers must verify each mobile team has the capability to wirelessly connect and access the electronic medical information in the field as well as email. In addition, Provider must verify the computer and wireless specifications meet or exceed The Health Plan requirements.

14.8.8 Safety

Crisis Mobile Team providers must verify the safety of Members under the care of the Crisis Mobile Team at all times, and verify at-risk Members are monitored and supervised by professional staff in person as long as the person remains at a Danger to Self/Danger to Others (DTS/DTO).

14.8.9 Follow Up Care

Crisis Mobile Team providers must record referrals, dispositions, and overall response time. Crisis Mobile Team providers must verify all Members are effectively engaged in follow up care before terminating crisis services.

14.8.10 Services

Crisis Mobile Team assessment and intervention services in the community are available to any person in the county regardless of insurance or enrollment status. Upon dispatch, Crisis Mobile Team response time expectations are as follows: No Crisis Mobile Team response should be greater than 90 minutes; or if the Crisis Mobile Team is presently located in the same town/city as the law enforcement call, the response time will be no greater than 30 minutes; or if the Crisis Mobile Team is not presently located in the same town/city as the law enforcement call, the response time is no greater than 90 minutes

Crisis Mobile Teams must have the ability to assess and provide immediate crisis intervention and make reasonable efforts to stabilize acute psychiatric or behavioral symptoms, evaluate treatment needs, and develop individualized plans to meet the individual’s needs. Crisis Mobile Team providers must deliver crisis response, crisis assessment and crisis stabilization services that facilitate resolution, not merely triage and transfer. Crisis Mobile Team providers must initiate and maintain collaboration with fire, law enforcement, emergency medical services, hospital emergency departments, AHCCCS Complete Care Health plans and other providers of public health and safety services to inform them of how to use the crisis response system, to coordinate services and to assess and improve the crisis services.

14.8.11 Tracking

Crisis Mobile Teams must maintain adequate licenses to allow each team to utilize and update The Health Plan Risk Management/High Needs Tracking System to effectively coordinate care for Members in crisis.

Crisis Stabilization providers must provide crisis stabilization services in the assigned areas on a 24/7/365 basis and in accordance to State and The Health Plan requirements. Crisis assessment and crisis services must facilitate resolution, not merely triage and transfer. Crisis Living Rooms must be furnished to resemble a home living area, including the following: showers, rest rooms, living room furniture, kitchen, refrigerator, dining table, and microwave oven.

14.9.1 Supervision and Staffing

Crisis Stabilization providers must verify that the Crisis Living Room Program is clinically supervised by a The Health Plan Credentialed Independently Licensed Behavioral Health Professional. Crisis Stabilization providers must verify all Crisis Living Room Assessments are reviewed and signed off by a The Health Plan Credentialed, Independently Licensed Behavioral Health Professional. Crisis Stabilization providers must verify adequate staff capacity to meet variations in the demand for services. Crisis Stabilization providers must verify all direct care crisis staff are CISM trained.

14.9.2 Coordination through Crisis Line Provider

Crisis Stabilization providers must coordinate all services through The Health Crisis Line Provider and follow crisis protocols established by The Health Plan. Crisis Stabilization providers must work collaboratively with The Health Plan Crisis Line Provider to coordinate all services, and facilitate crisis resolution planning.

14.9.3 Outpatient Coordination and Follow Up

Since the Crisis Living Room is an outpatient facility, Crisis Stabilization providers must verify Members are not allowed to remain in the living room for more than 23 hours a day. Crisis Stabilization providers must verify crisis living room services are closely linked to the provider's outpatient department and that coordination of care is occurring with outpatient providers for members who have been in a crisis. Crisis Stabilization providers must verify all Members are effectively engaged in follow-up care before terminating crisis services. This includes coordinating care with the members ACC Health Plan.

14.9.4 Accepting Referrals

Crisis Stabilization providers must embrace a "No Wrong Door" philosophy and accept all voluntary referrals, regardless of ability to pay, clinical presentation, degree of intoxication, or benefit status. Crisis Stabilization providers must accept all referrals from law enforcement and the community.

In a health emergency, Provider is required to verify eligibility for Covered Services in accordance with The Health Plan Provider Manual and with federal, State, and local laws relating to the provision of Emergency Medical Services (including but not limited to A.A.C. R9-22-201 et seq. and 42 CFR 438.114), provided that nothing in this provision shall be deemed to require Provider to violate federal or State law regarding the provision of Emergency Medical Services. Provider is required to notify The Health Plan-designated crisis line provider within twenty-four (24) hours or by the next business day of rendering or learning of the rendering of Emergency Medical Services to a Member.

14.9.5 Transportation

Crisis Stabilization providers must coordinate transportation to facilitate or coordinate care and discharge planning.

14.9.6 Participation in Training and Coordination Calls

Crisis Stabilization providers must participate in training events sponsored by The Health Plan and the State to enhance the performance of the crisis system. Crisis Stabilization providers must participate in crisis coordination calls and meetings to facilitate effective working relationships.

14.9.7 Tracking and Electronic Medical Information

Crisis Stabilization providers must maintain adequate licenses to allow Crisis Living Room staff to utilize The Health Plan Risk Management /High Needs Tracking System to effectively coordinate care for Members in crisis. Crisis Stabilization providers must verify the Crisis Living Room is equipped with a computer, printer and web connectivity to allow access to electronic medical information.

Crisis Transportation providers must provide medically-necessary transportation services in the assigned geographic areas and in accordance to State and The Health Plan requirements. Crisis Transportation providers must establish and maintain appropriate licenses to provide transportation services identified in the Scope of Work.

14.10.1 Coordination

Crisis Transportation providers must coordinate all services through The Health Plan Crisis Line Provider and follow crisis protocols established by The Health. Crisis Transportation providers must participate in crisis coordination calls and meetings to facilitate effective working relationships as requested.

14.10.2 Staff Requirements

Staffing must consistently meet AHCCCS, the State, ADHS Division of Licensing, and The Health Plan requirements. Crisis Transportation providers must verify staff capacity to meet availability requirements as identified in provider’s contract with The Health Plan. Crisis Transportation providers must maintain appropriately trained, supervised, and ADHS Division of Licensing and AHCCCS qualified transportation professionals to conduct transports.

Crisis Transportation providers must provide consistent supervision to verify services are in compliance with the Arizona Principles, and verify all ADHS Division of Licensing regulations and State supervision requirements are met. In addition, all staff transporting Members must maintain DES Fingerprint Clearance cards and maintain copies in Personnel files.

14.10.3 Training

Crisis Transportation providers must participate in training events sponsored by The Health Plan and the State as requested, and verify staff complete all required trainings and document trainings.

14.10.4 Vehicles and Cell Phones

Crisis Transportation providers must provide and maintain safe, clean and updated vehicles to facilitate transportation. Crisis Transportation providers must provide cell phones for all transportation staff on duty to verify effective connectivity and safety.

14.10.5 Billing and Paperwork

Crisis Transportation providers must bill all medically-necessary transportation services utilizing transportation service codes. Crisis Transportation providers must maintain appropriate paperwork in accordance with State and AHCCCS regulations. Crisis Transportation providers must encounter and document all services in compliance with the AHCCCS Covered Behavioral Health Service Guide.

Behavioral Health providers must make available HIV education, screening and counseling services to The Health Plan-enrolled Members.

14.11.1 HIV Risk Assessments

Behavioral Health Providers must make available HIV Risk Assessments to Members which includes pre-test discussions and counseling that assists the client in identifying the behaviors that may have possibly exposed the person to HIV.

14.11.2 Health Education, Health Promotion and Counseling

Health Education and Health Promotion services (including assistance and education about health risk reduction and lifestyle choices) must be provided to Members at substance use, mental health and community facilities in Arizona. Providers must make available to Members information regarding HIV transmission and prevention, and should assist Members in identifying the behaviors that may expose them to HIV.

Behavioral Health providers must make available Pre-Test Counseling to Members to assist in identifying the behaviors that may have possible exposed them to HIV, focusing on the Member's own unique circumstances and risk and helping the Member set and reach an explicit behavior-change goal to reduce the chance of acquiring or transmitting HIV. Provider must make available to Members information regarding HIV transmission and prevention and the meaning of HIV test results. In addition, providers must help the Member to identify the specific behaviors putting them at risk for acquiring or transmitting HIV and commit to steps to reduce their risk.

Providers must make available Post-Test Counseling including summarization of identified risks, review of the Member's risk reduction plan, discussion of next test time or when the confirmation blood draw shall occur if the Member tested positive for HIV, scheduling an appointment for receiving future results, obtaining information on sexual or drug using contacts to enable partner notification process to occur, and providing information and assistance in accessing the HIV Care System.

14.11.3 Prevention Case Management

Providers must provide HIV Prevention Case Management services to any individual requesting assistance from the provider in obtaining resources and accessing needed social services.

14.11.4 Clinical Laboratory Improvement Amendment (CLIA)

Providers of HIV testing services must obtain and retain a Clinical Laboratory Improvement Amendments (CLIA) certificate and verify all HIV Testing is administered in accordance with the CLIA requirements.

14.12.1 Authorization and Continued Stay Requirements

HCTC Providers must meet all l licensing and scope of work requirements as outlined by licensing, the Covered Behavioral Health Services Guide, and all prior authorization and continued stay requirements for HCTC as listed in Provider Manual Section 10 and as directed by The Health Plan. HCTC shall be utilized as an alternative to more restrictive levels of care when clinically indicated.

Providers are required to provide culturally-competent, evidence-based substance use treatment to a person who is experiencing acute and severe behavioral health and/or substance use symptoms, which may include emergency reception and assessment; crisis intervention and stabilization; individual, group and family counseling; outpatient detoxification and referral. Services provided to each member must be individualized to meet the member’s unique treatment needs.

Substance use disorders may include a range of conditions that vary in severity over time, from problematic, short-term use of substances, to severe and chronic disorders requiring long-term and sustained treatment and recovery management.

All substance use treatment programs delivered by any provider within The Health Plan system of care must:

  • Provide for:
    • Member and family education and involvement;
    • Brief intervention;
    • Acute stabilization and treatment;
    • Assessment of other needs including housing and vocational interests and goals;
    • A focus on life factors that support long-term recovery to facilitate reduction of the intensity, severity and duration of substance use and the number of relapse events; and
    • A return of the member to the workplace or school, as appropriate.
  • Monitor member retention in treatment, provide engagement efforts and outcomes of treatment, modify treatment approaches as needed;
  • Provide physician oversight of medical treatment including methadone, medication and detoxification services, as clinically appropriate;
  • Provide or make available Tuberculosis (TB), HIV, and Hepatitis B and C education, screenings and treatment services;
  • Coordinate continuity of care between service providers and other agencies;
  • Utilize the American Society of Addiction Medicine (ASAM) in assessing persons with substance use disorders. In addition, the provider must screen all persons with substance use disorders for the need for residential treatment services and document the screening. All Members seeking treatment for Substance Use Disorders must receive an ASAM assessment at intake and at least every six months during treatment;
  • Promote the use of Motivational Interviewing Principles in substance use treatment; verify access to new treatment alternatives targeted to the needs of specific high-risk populations, such as Members with co-occurring substance use and mental illness, according to the Arizona Principles for behavioral health care;
  • Demonstrate which evidence based practice is utilized, how training is conducted and how fidelity is monitored;
  • Document in each member record which evidence based practice is being utilized during treatment of the member, and;
  • Be provided by clinicians who are overseen by a Behavioral Health Professional (BHP) with experience in substance use disorders and treatment.

Providers must maintain the capacity to conduct drug screening/testing on members, as defined by AHCCCS Covered Behavioral Health Services Guide and as deemed clinically appropriate by the member’s treatment team.

While not required, The Health Plan supports the use of drug screening during the substance use screening, assessment and treatment process.

14.13.1 Psychosocial Outpatient Services

Substance use treatment providers must make individualized outpatient services available to assist the client in reducing or eliminating substance use/abuse. A continuum of services including therapy (individual, group, family), case management, peer support, vocational services and any other service identified in the AHCCCS Covered Behavioral Health Services Guide must be available and must utilize and maintain fidelity to evidence-based methods.

14.13.2 Intensive Outpatient Services

Substance use treatment providers that offer intensive outpatient programming must ensure that operates at least three (3) hours per day and at least three (3) times per week, as required by AHCCCS Covered Behavioral Health Services Guide. Intensive Outpatient Services are limited to Mediciad enrolled members and persons with substance use disorders receiving substance use treatment.

14.13.3 Residential Services Treatment

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.

Behavioral health residential facilities (BHRFs) providing substance use treatment must ensure length of stay is consistent with member’s needs and meets medical necessity. Treatment must remain individualized for each member, dependent upon ASAM placement criteria and treatment needs.

All residential treatment facilities are subject to Utilization Management review as per Provider Manual Section 10.

14.13.4 Substance Abuse Transitional Facilities

Substance Abuse Transitional Facility Providers must provide SUD treatment services through a licensed Substance Abuse Transitional Facility on a 24/7/365 basis. See R9-10-1401 et seq. Substance Abuse Transitional Facility Providers must verify appropriate clinical supervision to safely administer treatment services and verify availability of medical staff to provide appropriate medical consultation and supervision. To verify Members receive appropriate follow up care, providers must verify coordination of care. Substance Abuse Transitional Facility Providers must utilize Peer Support staff to maximize opportunities for Members to understand and embrace recovery. Immediate and ongoing detoxification and psychiatric crisis stabilization services must be provided in the least restrictive setting, consistent with individual and family need and community safety.

14.13.5 Continuing Care, Discharge Planning, Aftercare Planning

Designated staff at the treatment provider engages the member, family/guardian and natural supports to actively participate in discharge planning. Discharge planning begins at the time of admission and continues to be an active part of the treatment/service planning process. It is recommended that agencies create an individualized, medically and clinically comprehensive crisis plan as part of discharge planning.

At a minimum the discharge plan must:

Include realistic/quantifiable/measurable goals and objectives to inform when the member is discharge ready;

  • Identify specific skills and supports the member needs in order to be successful upon discharge from a specific level of care;
  • Include referrals to community resources, including 12–step programs and/or SMART Recovery;
  • Reflects active coordination of care with providers and all involved agencies; and
  • Include arrangements for therapy and other applicable psychiatric services provided in a timely manner.

14.13.6 Developing a Relapse Prevention Plan

At a minimum the relapse prevention plan:

  • Includes the member’s identification of what relapse would look like;
  • Identifies possible stressful events and triggers;
  • Describes signs and symptoms that a relapse is imminent;
  • Describes recommended interventions and the persons responsible;
  • Identifies resources or supports to contact if in crisis, including phone numbers;
  • Identifies interventions to avoid; and
  • Assesses for potential safety issues.

14.13.7 Program Requirements for Providers of IV Drug and Opioid Treatment Services

Providers must fully educate the Member about all treatment options and strategies to promote recovery from opiate abuse; including, health risks, relapse risks, and alternative treatments.

IV Drug and Opioid Treatment Providers (OTPs) must maintain current policies and procedures designed to verify adherence to The Health Plan Provider Manual, 42 CFR Par 8, SAMHSA - Treatment Improvement Protocol 49, AHCCCS Practice Protocol - Buprenorphine Guidance, the American Psychiatric Association Practice Guideline - Treatment of Patients with Substance Use Disorders, the Drug Enforcement Administration (DEA) and any applicable accreditation requirements.

IV Drug and Opioid Treatment Providers must also ensure Members have access to any medically necessary lab or physical health screening as referenced in the SAMHSA Treatment Improvement Protocol 49.

All Opioid Treatment Providers must have in place written policies and procedures describing their agency’s Diversion Control Program.

All OTPs must have information on the Dangers of Street Drugs posted in their clinic lobbies.

14.13.8 Promotion of Recovery

Treatment must promote recovery, minimizing the impact of substances on the Member's life and assisting the Member in reaching the maximum level of functioning in life appropriate for the Member.

Assessment and treatment for adolescents that act out sexually must be supervised by qualified clinicians using acceptable treatment modalities based on Evidenced Based Practices for the treatment of adolescents who act out sexually and in accordance with State and Federal laws. Treatment teams must include Licensed Clinicians, Health Care Coordinators, and in-home family support staff. Providers of services to adolescents who act out sexually must verify Treatment and Discharge Planning is developed through Child and Family Team Practice.

Providers of services to adolescents who act out sexually must develop an effective Safety Plan that safeguards the Member and community from re-offending. Providers of services to adolescents who act out sexually must place the adolescent in a treatment program with adolescents of similar age and developmental maturity level, when group treatment is prescribed by the treatment provider.

Providers of services to adolescents who act out sexually must comply with the professional Code of Ethics of the Association for the Treatment of Sexual Abusers. Reference: www.atsa.com.

Providers of services to adults who act out sexually must provide treatment services geared toward preventing further offenses and safeguarding the community from harm. Services must include assessments related to inappropriate sexual behavior, treatment planning, family support services, address family reunification and visitation, collaborate with probation/parole or other supervision  or multidisciplinary professionals, engage community supports,   include transition services and continuity of care.

Treatment must be supervised by qualified clinicians using acceptable treatment modalities based on Evidenced Based Practices for the treatment of adults who act out sexually and in accordance with State and Federal laws. Providers of services to adults who act out sexually must verify treatment teams include Licensed Clinicians, Health Care Coordinators, and in home family support staff. Treatment and Discharge Planning must be provided through Integrated Team Meetings.

Providers of services to adults who act out sexually must develop an effective Safety Plan that addresses risk management and safeguards the Member and community from re-offenses. Providers of services to adults who act out sexually must place the adult in a treatment program with adults of similar age and developmental maturity level, when group treatment is prescribed by the treatment provider.

14.16.1 Purpose Of Program

To provide crisis intervention services to a person for the purpose of stabilizing or preventing a sudden, unanticipated, or potentially dangerous behavioral health condition, episode, or behavior. These intensive and time limited services are designed to prevent, reduce, or eliminate a crisis situation and are provided 24 hours a day, 7 days a week, 365 days a year.

14.16.2 Services To Be Provided

14.16.2.1 Health, Risk and Acuity Assessments for Triage

All individuals entering the facility (based on Arizona Division of Licensing approval to accept members) shall have a basic health, risk and acuity screening completed by a qualified behavioral health staff member as defined by ACC R9-10-114. Triage assessments shall be completed within fifteen (15) minutes of an individual’s entrance into the facility. Any individual demonstrating an elevated health risk shall be seen by appropriate staff to meet the member’s needs.

14.16.2.2 Comprehensive Screening and Assessment

Comprehensive screenings and assessments shall be completed on all individuals presenting at the facility to determine the individual’s behavioral health needs and immediate medical needs. Assessments are required to be completed by a qualified behavioral health professional as defined by ARS Title 32 and ACC R9-10-101. Screening and assessment services may result in a referral to community services, enrollment in The Health Plan system of care, admittance to crisis stabilization services, or admittance to inpatient services. At minimum, a psychiatric and psychosocial evaluation, diagnosis and treatment for the immediate behavioral crisis shall be provided. Breathalyzer analysis of Blood Alcohol Level and/or specimen collections for suspected drug use may be provided as clinically appropriate.

14.16.2.3 Crisis Intervention Services

Crisis intervention services (stabilization) is an immediate and unscheduled behavioral health service provided in response to an individual’s behavioral health issue, to prevent imminent harm, to stabilize, or resolve an acute behavioral health issue. Crisis stabilization services are able to be provided for a maximum of 23 hours and designed to restore an individual’s level of functioning so that the individual might be returned to the community with coordinated follow up services. Services provided include assessment, counseling, intake and enrollment, medical services, nursing services, medication and medication monitoring, and the development of a treatment plan. Discharge planning and coordination of care shall begin immediately upon admission and shall be developed through coordination with the Behavioral Health Home, and the Adult Recovery Team (ART) or Child and Family Team (CFT) as appropriate.

14.16.2.4 Provider Title 36 Emergency Petition

If licensed to provide court ordered evaluation and treatment, the provider shall verify that services and examinations necessary to fulfill the requirements of ARS §36-524 through ARS §36-528 for emergency applications for admission for involuntary evaluation are provided in the least restrictive setting available and possible with the opportunity for the individual to participate in evaluation and treatment on a voluntary basis. Prior to seeking an individual’s admission to a Behavioral Health Inpatient facility for Court Ordered Evaluation (COE) Provider shall make all reasonable attempts to engage the individual in voluntary treatment and discontinue the use of the involuntary evaluation process.

Provider shall verify that staff members are available to provide testimony at Title 36 hearings upon the request of County courts.

14.16.3 Reporting Requirements

Provider shall submit all documents, reports and data in accordance with the Deliverable Schedule in Section 16 – Deliverable Requirements. All deliverables shall be submitted in the format prescribed by The Health Plan and within the time frames specified. Provider is required to submit any additional documents and/or ad hoc reports as requested by The Health Plan.

14.16.4 Community Observation Unit Capacity Requirements

14.16.4.1 Pima County Banner UMC Crisis Response Center Community Observation Unit Capacity

Provider shall have a capacity of 34 (chairs) for adults, 18 years or older, and eight (8) chairs for children, to provide accommodations for overnight stay as mandated by ADHS Division of Licensing Services in accordance with AAC Title 9, Chapter 10. Provider shall have capacity to provide facility-based 23-hour crisis observation/stabilization services for at least 34 adults and at least eight (8) children at any one time.

14.16.4.2 Pima County CBI Center Community Observation Unit Capacity

Provider shall have a capacity of forty (40) chairs for adults, 18 years or older, to provide accommodations for overnight stay as mandated by ADHS Division of Licensing Services in accordance with AAC Title 9, Chapter 10. Provider shall have capacity to provide facility-based. 23-hour crisis observation/stabilization services for at least forty (40) adults at any one time.

14.16.4.3 Yuma County Horizon Health and Wellness Community Observation Unit Capacity

Provider shall have a capacity of 14 (chairs) and one patient bedroom for adults, 18 years or older, to provide accommodations for overnight stay as mandated by ADHS Division of Licensing Services in accordance with AAC Title 9, Chapter 10. Provider shall have capacity to provide facility-based. 23-hour crisis observation/stabilization services for at least 15 adults at any one time.

14.16.4.4 Pinal County Horizon Health and Wellness Community Observation Unit Capacity

Provider shall have a capacity of 24 (chairs) and two patient bedrooms for adults, 18 years or older, to provide accommodations for overnight stay as mandated by ADHS Division of Licensing Services in accordance with AAC Title 9, Chapter 10. Provider shall have capacity to provide facility-based. 23-hour crisis observation/stabilization services for at least 26 adults at any one time.

14.16.4.5  Pinal County Community Bridges, Inc. Facility Capacity

Provider shall have a capacity of 16 sub acute beds with the ability to covert for 23 hours chairs and law enforcement drop offs for adults,18 years or older, to provide accommodations for overnight stay as mandated by ADHS Division of Licensing Services in accordance with AAC Title 9, Chapter 10.

14.17.1 Program Requirements

Providers delivering ACT Team services are required to establish ACT teams that comply with the requirements outlined in the SAMHSA Assertive Community Treatment (ACT) Evidence-Based Practices Kit, https://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345, in communities approved by the Health Plan.

14.17.2 Fidelity to the Model

Providers delivering ACT Team services shall participate in SAMSHA EBP fidelity audits coordinated with the Health Plan on an annual basis at minimum.

14.17.3 Reporting Requirements

Provider shall submit all documents, reports and data in accordance with the Deliverable Schedule as indicated in Section 16 – Deliverable Requirements. All deliverables shall be submitted in the format prescribed by the Health Plan and within the time frames specified. Provider is required to submit any additional documents and/or ad hoc reports as requested by the Health Plan.

14.17.4 Other Requirements

ACT Team providers must participate in all trainings and meetings required or requested by AHCCCS and/or The Health Plan n.  ACT Team providers must coordinate for continuity of care between provider, member’s Behavioral Health Home, stakeholders (Adult Protective Services, Probation Officer, Department of Corrections, and other agencies), and other Specialty Providers (both physical and behavioral health) involved with the member.

14.18.1 Program Requirements

Engagement Specialists are required to adhere to the parameters outlined in the Engagement Specialist Guide and Engagement Specialist Program Objectives Handbook.

  • Outcomes of the Engagement Program include:
    • Increase access to behavioral health and physical health services,
    • Reduce number of citizens without medical coverage, and
    • Increase engagement into services.

14.18.2 Staff Requirements

Agencies must verify that Engagement Specialists complete the following required trainings and credentials:

  • Mental Health First Aid,
  • Certified Application Counselor,
  • Arizona Department of Insurance Certified Application Counselor License, and
  • Veteran Navigator through the Arizona Coalition for Military Families.

14.18.3 Deliverables

 Engagement Specialist Log must be completed by each provider – see Section 16 - Deliverables.