References, Definitions and Acronyms

AHCCCS Definitions as set forth in the current AHCCCS ACC-RBHA, and NTXIX contracts and amendments, ACOM and AMPM policies, AHCCCS Contract and Policy Dictionary, and relevant AHCCCS manuals as periodically amended and published by AHCCCS at the links
below.

•  AHCCCS Contracts 
•  Guides, Manuals,Policies 
•  AHCCCS Contract and Policy Dictionary

 

ADULT RECOVERY TEAM ("ART")

A defined group of individuals that includes, at a minimum, the member, their family, a behavioral health representative, and any individuals important in the member’s life that are identified and invited to participate by the member. This may include system partners such as extended family members, friends, family support partners,
healthcare providers, community resource providers, representatives from churches, synagogues or mosques, agents from other service systems like Probation or the Administrative Office of the Courts (AOC). The size, scope, and intensity of involvement of the team members are determined by the objectivesestablished for the adult, the needs of the family in providing for the adult, and by which individuals are needed to develop an effective service plan and can therefore expand and contract as necessary to be successful on behalf ofthe adult should this be needed or required.

 ADVERSE BENEFIT DETERMINATION

• The denial or limited authorization of a requested service, including determinations based on the type or level of service, requirements for medical necessity, appropriateness, setting, or effectiveness of a covered benefit;
• The reduction, suspension, or termination
  of a previously authorized service;
• The denial, in whole or in part, of payment for a service; the failure to provide services in a timely manner; the failure of the Health Plan to act within the established timeframes regarding the standard resolution of grievances and appeals;
• The denial of a member's request to obtain services outside the network; and/or
• The denial of a member's request to dispute a financial liability, including cost sharing, copayments, premiums, deductibles, coinsurance, and other member financial liabilities

AFFILIATE

A person or entity controlling, controlled by, or under common control with AzCH - Arizona Complete Care.

AHCCCS REGISTERED PROVIDER

A provider that enters into an agreement with AHCCCS under A.A.C. R9-22-703(A) and meets licensing or certification requirements to provide covered services.

 ARIZONA DEPARTMENT OF ECONOMIC SECURITY ("ADES")

The State agency that has the powers and duties set forth in A.R.S. § 41-1951, et seq.

 ASSESSMENT INTERVENTION CENTER (“AIC”)

A time limited, intensive program serving children and families that delivers services in an ADHS-licensed BHRF (Provider Type B8). The program’s focus is on thorough psychiatric, psychological, and family systems evaluations, a comprehensive behavioral analysis; and development of targeted interventions individualized for each
member and family. The program is designed for up to a thirty (30) day treatment period. The initial fourteen (14) days of service do not require prior authorization. Additional services require a concurrent authorization on or before the fourteenth (14th) day of service. The maximum length of stay is thirty (30) days. The goal of the program is to answer the question “What supports and interventions are needed for this member to live successfully in the community?”

BEST PRACTICES

Evidence-based practices, promising practices, or emerging practices.

 BRIEF INTERVENTION PROGRAM (BIP)

Is a time-limited, intensive crisis intervention program, currently for AzCH members, which delivers services in an ADHS licensed BHRF (Provider Type B8) to help persons live successfully in the
community. The program includes crisis, supportive and treatment services. No prior authorization is needed for the first 5 days. 

 A CFT or ART meeting must be conducted within three (3) business days of a member’s admission to the program.

 If an extension in the stay is needed to further stabilize after the initial 5 days, an authorization is required for an extension of 5 additional days. The clinical documentation must be submitted to support medical necessity. The maximum length of stay is ten (10) days.

 There are limited beds in the community designed as discharge BIP beds for members who do not qualify for medical necessity in a behavioral health level 1 facility but the member needs stabilization prior to returning to their previous living arrangements.

 AzCH – ARIZONA COMPLETE CARE PROVIDER MANUAL

Provider Manual including any amendments, appendices, modifications, supplements, bulletins, or notices related to the AzCH - Arizona Complete Care Provider Manual that may be made from time to time and available on AzCH - Complete Health Plan’s website. AzCH- Complete Health Plan shall use its reasonable efforts to give Subcontractor advance notice of any amendment or modification of the AzCH–Complete Health Plan Provider Manual that materially affects Subcontractor's

 CLAIM

A service billed under a fee-for-service arrangement.

COMMUNITY SERVICE AGENCY ("CSA")

An agency that is contracted directly by the Health Plan and registered with AHCCCS to provide rehabilitation and support services consistent with the staff qualifications and training. Refer to the AHCCCS Covered Behavioral Health Services Guide for details, AHCCCS AMPM 965 - COMMUNITY SERVICE AGENCIES. 

 COMPLEX NEEDS

The presence of significant behavioral challenges that impact the safety of a member, facility personnel, and/or other members for which additional staff support is needed to address and successfully treat the member’s behavioral challenges in the facility.

 CONFLICT OF INTEREST ("COI")

Any situation in which the Subcontractor or an individual employed or retained by the Subcontractor is in a position to exploit a contractual, professional, or official capacity in some way for personal or organizational benefit that otherwise would not exist.

 CONTRACT YEAR ("CY")

The time period that corresponds to the federal fiscal year, October 1 through September 30 used for financial reporting purposes.

 CULTURAL COMPETENCY 

A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals which enables that system, agency, or those professionals to work effectively in cross-cultural situations. Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities.

 DEDICATED HEALTH CARE COORDINATOR

The job title used by AzCH-Arizona Complete Care to describe the role Subcontractor employees performrelated to assisting a High Needs Member and family in achieving recovery. These
duties include all duties formerly assigned to the role of the Case Manager and include intensive case management services, management of care, coordination of services, employment support, health promotion, motivational interviewing, assisting with service planning and other similar services to support recovery.

DELIVERABLES

The reports and other deliverables the Subcontractor are required to provide to AzCH - Arizona Complete Care pursuant to the AzCH - Arizona Complete Care Provider Manual.

 DIRECT CARE STAFF

In the case where a Subcontractor is a health care entity, a person or entity who is employed by or otherwise engaged by Subcontractor to provide Covered Services to Members.

 FISCAL YEAR ("FY")

The State budget year: July 1 through June 30. This is to be distinguished from the Contract Year, as defined above.

 FORMULARY

A list of covered medications available for treatment of Members.

 FREEDOM TO WORK (also referred to as TICKET TO WORK)

Eligible individuals under the Title XIX program that extends eligibility to individuals 16 through 64 year old who meet SSI disability criteria, and whose earned income after allowable deductions is at or below 250% of the FPL, and who are not eligible for any other Medicaid program. These members must pay a premium to AHCCCS, depending
on income.

 HEALTH CARE COORDINATOR

Health Care Coordinator is the job title used by AzCH - Arizona Complete Care to describe the required duties performed by Subcontractor (Provider) employees related to coordinating
physical health, behavioral health, and social services in a member-focused manner with the goals of improving whole person health outcomes, and more effective and efficient use of resources. Health Care Coordinators, often referred to as Health Care Coordinators, Case Managers, Integrated Care Managers, or Care Coordinators; provide accessible, comprehensive, and continuous coordination of care based on effective working relationships with members and accumulated knowledge over time of members’ health care challenges and strengths. Health Care Coordinators build on members’ strengths to promote wellness, recovery, and resiliency.

 MAY

Something is permissive.

 MEDICAL EXPENSE DEDUCTION

Title XIX waiver Member whose family income exceeds the limits of all other Title XIX categories (except ALTCS) and has family medical expenses that reduce income to or below 40% of the Federal Poverty Level. Medical Expense Deduction members may or may not have a categorical link to Title XIX.

 MEDICAL INSTITUTION

An acute care hospital, psychiatric hospital—Non IMD, psychiatric hospital – IMD—, Residential Treatment Center—Non IMD, psychiatric hospital – IMD—, Skilled Nursing Facility, or Intermediate Care Facility for persons with intellectual disabilities.

 MEDICATIONS LIST

The same meaning as "Formulary” or “Preferred Drug List” (PDL).

 MUST

Denotes the imperative.

NATIONAL CLAS STANDARDS

The U.S. Department of Health and Human Services Office of Minority Health standards for Culturally and Linguistically Appropriate Services ("CLAS"), which may be amended or supplemented from time to time and are included as Exhibit F. The National CLAS Standards aim to improve health care quality and advance health equity by
establishing a framework for organizations to serve the nation's increasingly diverse communities.

 OFFICE OF INDIVIDUAL AND FAMILY AFFAIRS (OIFA)

An AHCCCS bureau that builds partnerships with individuals, families of choice, youth, communities, organizations to promote recovery, resiliency, and wellness. OIFA collaborates with key leadership and community members in the decision-making process at all levels of the behavioral health system. In partnership with the community, OIFA advocates for the development of culturally inclusive environments that are welcoming to individuals and families. establishes structures to promote diverse youth, family, and individual voices in leadership positions throughout Arizona, delivers training, technical assistance and instructional materials for individuals and their families, ensure peers support and family support are available to all persons receiving services and their families, and monitors contractor performance and measure outcomes.

 OIFA Alliance

 A collaborative of all health plan OIFAs in Arizona, including the AHCCCS OIFA.

 OUTREACH

Activities to identify and encourage Members or potential Members, who may be in need of, but not yet receiving physical or behavioral health services.

 PAYOR

AzCH–Arizona Complete Care or another entity that is responsible for funding Covered Services to Members.

PRIVILEGING

The process used to determine if credentialed clinicians are competent to perform certain treatment interventions, based on training, supervised practice, and/or competency testing.

 PROFIT

The excess of revenues over expenditures, in accordance with Generally Accepted Accounting Principles, regardless of whether Subcontractor is a for-profit or a not-for-profit entity.

 PROVIDER NETWORK

The agencies, facilities, professional groups, and professionals or other persons under subcontract to AzCH-Complete Care Plan to provide Covered Services to Members, including the Subcontractor to the extent the Subcontractor directly provides CoveredServices to Members.

 PSYCHIATRIST

A person who is a licensed physician as defined in A.R.S. Title 32, Chapter 13 or Chapter 17 and who holds psychiatric board certification from the American Board of Psychiatry and Neurology, the American College of Osteopathic Neurologists and Psychiatrists, or the American Osteopathic Board of Neurology and Psychiatry; or is board eligible.

 REHABILITATION SERVICES ADMINISTRATION ("RSA")

The Division within Arizona Department of Economic Security.

 SAMHSA

The Substance Abuse and Mental Health Services Administration, which is a part of the U.S. Public Health Service leads public health efforts to advance the behavioral health of the
nation.

 SHALL

Something is mandatory.

 SHOULD

Denotes a preference.

 SMI MEMBER

A member who meets the criteria and has been enrolled with a Serious Mental Illness as defined in A.R.S. 36-550.

 SMI MEMBER RECEIVING PHYSICAL HEALTH CARE SERVICES

A Title XIX eligible adult who is eligible to receive both behavioral and physical health care services through AzCH - Arizona Complete Care's provider network.

 SPECIALTY ASSESSMENT

A specialized assessment written by a Specialty Provider to determine an eligible individual’s level of functioning and medical necessity for the specialty services provided by the Specialty Provider. All persons being served in the public health system must have an assessment upon an initial request for services with updates occurring at least annually. The Specialty Assessment must be utilized to collect necessary information that will inform providers of how to plan for effective care and treatment of the individual for the medical condition being treated. AzCH -Arizona Complete Care does not have a mandated Specialty Assessment template but all Behavioral Health Assessments must include all elements outlined in Policy 105, Assessment and Service Planning and be in accordance with all stateand federal regulations.

 SPECIALTY SERVICE PLAN

A written plan for services written
by the Specialty Provider upon an eligible individual’s request for services. Specialty Service Plans require periodic updates to the plan to meet the changing health needs for persons who continue to meet medical necessity for requested services. AzCH - Arizona Complete Care does not mandate a specific service plan template. All Specialty Service Plans must be written in accordance with all state and federal regulations.

 STEP THERAPY

The practice of initiating drug therapy
for a medical condition with the most cost-effective and safest drug and
stepping up through a sequence of alternative drug therapies as a preceding treatment option fails.

 SUPPORT SERVICES

Covered Services as defined in the AHCCCS Covered Behavioral Health Services Guide.

 TICKET TO WORK

Has the same meaning as "Freedom to Work."

 TRAUMA-INFORMED CARE ("TIC")

An approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges
the role that trauma has played in the lives of people who receive services and people who provide services (SAMHSA Center for Trauma Informed Care).

AHCCCS Related Acronyms

Competency: is defined as worker’s demonstrated ability to
perform the basic requirements of a job intentionally, successfully, and
efficiently, multiple times, at or near the required standard of performance.

Competency Development is a systematic approach for ensuring that workers are adequately prepared to perform the basic requirements of their jobs. Competency based WFD.

Workforce Capability is the interpersonal, cultural, clinical/medical, and technical competence of the collective workforce or individual worker.

Workforce Capacity is the number of qualified, capable, and culturally representative personnel required to sufficiently deliver services to members.

Workforce Connectivity is the workplace’s linkage to sources of potential workers, information required by workers to perform their jobs, and technologies for connecting to workers and/or connecting workers to information.

Workplace Culture is the developing of a shared vision of the integrated healthcare process from a member’s perspective – including philosophy, experience, and delivery.

Workforce Development is an approach to improve outcomes by enhancing the knowledge, skills, and competencies of the workforce in order to create, sustain, and retain a viable workforce. It aids in changes to culture, changes to attitudes, and changes to people’s potential to influence outcomes.