Frequently Asked Questions

General Questions

• Q1: What is an AHCCCS Complete Care Health Plan (ACC Plan) and how is it different than my current health plan?

  A: Today most AHCCCS members have one health plan for physical healthcare services, and one health plan for behavioral healthcare services. An ACC Plan will give members access to a network of physical and behavioral healthcare providers for services. An ACC Plan will provide services for members with Children’s Rehabilitative Services (CRS) conditions. The ACC Plan will manage the network and all covered services. A member’s chosen ACC Plan will be the only Medicaid payer to providers for enrolled members.

• Q2: When is the change to ACC Plans happening?

  A: AHCCCS Complete Care (ACC) starts on October 1, 2018.

• Q3: Who will be affected by this change?

  A: Most adults and children on AHCCCS will be enrolled with ACC Plans, including members currently enrolled in CRS.

  ACC will not affect members in the Arizona Long Term Care System (ALTCS), including those enrolled with DES/DDD. There are a few exceptions for members who are also eligible for CRS services. For more information about members enrolled with CRS, see http://www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/CRS/.

  ACC will not affect members determined to have a Serious Mental Illness (SMI).

  With the exception of foster care children currently enrolled in CRS, ACC will not affect most children in foster care enrolled in the Comprehensive Medical and Dental Program (CMDP).

• Q4: How will an ACC Plan benefit me?

  A: The ACC Plan will join physical and behavioral health services together. Members will benefit by only having one health plan. The ACC Plan will help coordinate care for better outcomes and improved whole health for the member.

  The ACC Plan offers choice of health plans for children in CRS.

• Q5: Will covered services change?

  A: Members will still have access to the same AHCCCS covered services with ACC Plans as they do with current health plans and Regional Behavioral Health Authorities (RBHAs).

• Q6: What are the geographic service areas (GSA) to be served by ACC Plans?

  A: More than one ACC Plan will be available in each GSA:

  • The Central GSA will serve Pinal, Gila, and Maricopa counties.
  • The South GSA will serve Pima, Santa Cruz, Graham, Yuma, Cochise, Greenlee, and LaPaz counties.
  • The North GSA will serve Mohave, Yavapai, Coconino, Apache, and Navajo counties.

  Note: ZIP codes 85542, 85192, 85550 are part of the South GSA to keep the San Carlos tribal land in one GSA.

• Q7: What are the available ACC Plans in each geographic service area (GSA)?

  A: The available service plans in each GSA can be found at: https://www.azahcccs.gov/shared/News/PressRelease/AHCCCSAwardsContractstoManagedCareOrganizations.html

• Q8: Will I be assigned to an ACC Plan or will I have choice of available ACC Plans?

  A: Members in an acute health plan that will also be an ACC Plan in their service area will stay with their current health plan. These members will have choice of other ACC Plans in their annual enrollment choice month.

  Members in a health plan that will not be an ACC Plan in their service area will be assigned an ACC Plan. Members in the same household will be assigned to the same ACC Plan. AHCCCS will send letters to tell members their assigned ACC Plan by the end of June, 2018. Members will be allowed to choose a different ACC Plan in their service area in July, 2018. ACC Plans will begin on October 1, 2018.

  Some members in an acute plan that will also be an ACC Plan (not affiliated with their assigned RBHA) in their service area, who received behavioral health services through the RBHA in 2017, will be given a one-time choice to move to an ACC Plan that is affiliated with the RBHA in their service area. These members will be notified in late June 2018 and will be allowed to make their choice during the month of July, 2018.

• Q9: Can I continue to access the same providers?

  A: Members should review the network of each ACC Plan to see each plan’s providers.

  All ACC Plans must give at least a 90-day transition period for members who have an established relationship with a primary care provider (PCP) who does not work with the new ACC Plan. During that time, the member may continue to get care from their PCP while the member and/or ACC Plan find a PCP in the ACC Plan. However, even with this ACC Plan requirement, a provider may choose not to see a member enrolled with a plan the provider does not participate with.

  Plans must also allow members who are getting active treatment for a serious and chronic physical, developmental or behavioral health condition to keep getting services from their provider until the treatment ends, or six months, whichever happens first. This will be allowed even if the provider does not participate in the member’s new ACC Plan. However, even with this ACC Plan requirement, a provider may choose not to see a member enrolled with a plan the provider does not participate with.

• Q10: What will Regional Behavioral Health Authorities (RBHAs) continue to provide?

  A: RBHAs will no longer serve most adults and children. This is because behavioral health services will be provided by the ACC Plan. RBHAs will continue to serve:

  • Foster children enrolled in CMDP, including those CMDP members who have a CRS condition.
  • Members enrolled with DES/DDD.
  • Individuals determined to have a Serious Mental Illness.

  RBHAs will continue to provide crisis, grant funded and state-only funded services.

• Q11: Will current CRS members have to change health plans?

  A: Yes, most CRS members will be enrolled in ACC Plans. Today most members with CRS conditions are enrolled with UnitedHealthcare Community Plan for all or part of their services. CRS members getting physical health services from UnitedHealthcare Community Plan will have choice of ACC Plans. The ACC Plan will be responsible for providing all covered services for persons with CRS qualifying conditions. Some exceptions apply.

  See http://www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/CRS/ for more information for members with CRS conditions who are enrolled in other programs.

• Q12: Will my ACC Plan offer a Medicare Advantage Plan?

  A: Each ACC Plan is required to have a Medicare Advantage Dual Special Needs Plan. This will allow members to align their Medicare and ACC Plans. Members should contact their new ACC Plan for more information. Members that change health plans may need to make future changes to Medicare enrollment to continue to be aligned.

• Q13: Will my foster child’s coverage with Comprehensive Medical Dental Program (CMDP) change?

  A: CMDP will continue to serve foster care children for physical health services. The RBHA will continue to provide behavioral health services. Children in Foster Care with CRS qualifying conditions will get physical health services, including services for their CRS condition, through CMDP and behavioral health services through the RBHA.

• Q14: Why are the names of the Regional Behavioral Health Authorities (RBHAs) changing on October 1, 2018?

  A: To further the goal of integration and enhance operational efficiency, starting October 1, 2018, with the implementation of AHCCCS Complete Care (ACC) Plans, AHCCCS is requiring that a single health plan brand (and legal entity) be established for ACC Plans that are affiliated with a current AHCCCS RBHA in the same service area. Due to this requirement, the RBHA names will be changing.

• Q15: What will Regional Behavioral Health Authorities (RBHAs) continue to provide?

  A: RBHAs will no longer serve most adults and children. This is because behavioral health services will be provided by the ACC Plan. RBHAs will continue to serve:

  • Foster children enrolled in CMDP, including those CMDP members who have a CRS condition.
  • Members enrolled with DES/DDD.
  • Individuals determined to have a Serious Mental Illness.

  There will be no changes to RBHA covered services for those members they continue to serve. RBHAs will also continue to provide crisis, grant funded and state‐only funded services.

American Indian Members' Questions

• Q1: What is the American Indian Health Program (AIHP) and who does it serve?

  A: The American Indian Health Program (AIHP) is currently a fee for service program administered by AHCCCS for eligible American Indians. AIHP reimburses for physical and behavioral health services when provided by or through the Indian Health Services (IHS) or tribally owned or operated organizations. AIHP also pays for physical health services with other medical facilities, such as your local hospital. These facilities are called “non-IHS/638 facilities.”

• Q2: What changes are happening for AIHP and when will they be effective?

  A: Currently most members that are enrolled in AIHP are also enrolled with a Regional Behavioral Health Authority (RBHA) or Tribal RBHA for behavioral health services. On October 1, 2018, AIHP will pay for and handle physical and behavioral health services for most eligible American Indian adults and children. AIHP will also pay for services related to a Children’s Rehabilitative Services condition. Members will still be allowed to choose AIHP and a TRBHA (when available) for behavioral health services.

• Q3: How will AHCCCS Complete Care impact American Indian members?

  A: In addition to the changes to AIHP, American Indian members who have not been determined to be seriously mentally ill will have the choice of integrated care through either AIHP or through AHCCCS Complete Care (“ACC”) health plan. When a member chooses AIHP, the member also has the choice of a TRBHA (when available) to have their care coordinated by the TRBHA.

  See additional FAQs related to AHCCCS Complete Care.

• Q4: Will American Indian members still be allowed to change enrollment?

  A: American Indian members can still choose to change enrollment between AIHP (with or without TRBHA enrollment) or the AHCCCS Complete Care (ACC) Plan at any time by calling AHCCCS at 602-417-7100 or 1-800-334-5283. However, a member can still only change from one ACC Plan directly to a different ACC Plan once a year. American Indian members may continue to choose to receive services at any time from an IHS facility or a tribally owned and/or operated 638 facility.

• Q5: Will there be changes for American Indian members who are determined to be seriously mentally ill?

  A: American Indian members who are determined to be seriously mentally ill (“SMI”) will receive services from the RBHA but can also still choose AIHP for physical health services. American Indian members determined to be SMI that currently receive services with the TRBHA will stay the same. There is no change in service delivery or choice.

• Q6: Will the crisis system change?

  A: No, the crisis system will remain the same.

Provider FAQs - AHCCCS Complete Care for American Indians

• Q1: What Changes With AHCCCS Complete Care (ACC)?

  A: Today most AHCCCS members have one health plan for physical healthcare services, and one health plan for behavioral healthcare services. Effective October 1, 2018, American Indian Fee-for-Service (“FFS”) members will have the choice of integrated care: the American Indian Health Program (“AIHP”) or an AHCCCS Complete Care (“ACC”) health plan. AIHP members will also be able to choose care coordination for behavioral health care through a TRBHA (when available). AIHP and ACC Plans provide integrated physical and behavioral health services for most eligible American Indian adults and children, as well as pay for services related to a Children’s Rehabilitative Services condition.

• Q2: What ACC Plans Are In Each Geographic Service Area (GSA)?

  A:

  • Statewide: American Indian Health Program
  • North GSA: Care 1st, Steward Health Choice (Apache, Coconino, Mohave, Navajo and Yavapai Counties)
  • Central GSA: Arizona Complete Health - Complete Care Plan, Banner University Family Care, Care 1st, Molina Healthcare, Mercy Care, Steward Health Choice, UnitedHealthcare Community Plan (Maricopa, Gila and Pinal Counties)
  • South GSA: Arizona Complete Health-Complete Care Plan, Banner University Family Care,UnitedHealthcare Community Plan* (Pima, Cochise, Graham, Greenlee, La Paz, Santa Cruz and Yuma Counties). Zip codes 85542, 85192, 85550 representing San Carlos Tribal area are included in the South GSA.

  *Pima County Only

• Q3: Will Providers Contract With AIHP and All ACC Plans?

  A: Effective October 1, 2018, AIHP will provide both physical and behavioral health care for most members. However, American Indian members with a Seriously Mentally Ill (SMI) determination will continue to receive behavioral health services from the RBHA or TRBHA (where available). There is no change in service delivery or choice. American Indian members can also choose to change enrollment between AIHP or the ACC Plan at any time. However, a member can only change from one ACC Plan to another one time per year. American Indian members may continue to choose to receive services at any time from an IHS facility, or a tribally owned or operated organization.

• Q4: Will there be changes for American Indian members who are determined to be seriously mentally ill?

  A: Effective October 1, 2018, AIHP will provide both physical and behavioral health care for most members. However, American Indian members with a Seriously Mentally Ill (SMI) determination will continue to receive behavioral health services from the RBHA or TRBHA (where available). There is no change in service delivery or choice. American Indian members can also choose to change enrollment between AIHP or the ACC Plan at any time. However, a member can only change from one ACC Plan to another one time per year. American Indian members may continue to choose to receive services at any time from an IHS facility, or a tribally owned or operated organization.

• Q5: What Happens To My Patients After 10/01/2018 If Their Health Plan Is No Longer In Their Service?

  A: AHCCCS sent notification letters to impacted members to assist in transitioning to a new health plan. Members may call AHCCCS for assistance, from area codes (480), (602), and (623) call 602-417-7100, and from area codes (520) and (928) call 1-800-334-5283.

Questions from Members with CRS Conditions

• Q1: Will my covered services change under AHCCCS Complete Care?

  A: Under AHCCCS Complete Care (and other plans as noted), members will have access to the same array of covered services as they do under their current health plan.

• Q2: Will CRS members have to change health plans?

  A: Currently, most members with CRS conditions are enrolled with UnitedHealthcare Community Plan, a single statewide health plan that covers all or a portion of their services. Effective October 1, 2018, CRS members will be enrolled with, and will have choice of, an AHCCCS Complete Care (ACC) plan for all services (CRS, non-CRS physical health services, and behavioral health services). The ACC Plan will provide all medically necessary covered services for members with CRS qualifying conditions.

  See more information for members with CRS conditions who enrolled in other programs at: www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/CRS/

• Q3: What are the geographic service areas (GSA) in AHCCCS Complete Care?

  A: More than one ACC Plan will be available in each geographic service area:

  • Central GSA – Pinal, Gila, Maricopa
  • South GSA – Pima, Santa Cruz, Graham, Yuma, Cochise, Greenlee, LaPaz
  • North GSA – Mohave, Yavapai, Coconino, Apache, Navajo

  Note: Zip codes 85542, 85192, 85550 are included in the South GSA.

• Q4: What are the available ACC Plans in each geographic service area (GSA)?

  A: See the ACC Plans in each GSA at http://www.azahcccs.gov/ACC.

• Q5: Will my foster child’s Comprehensive Medical Dental Program (CMDP) coverage change?

  A: Children in foster care who have CRS conditions will receive all physical health services, including services for their CRS condition, from CMDP. Like all children in foster care, they will transition to the Regional Behavioral Health Authority (RBHA) in their area for behavioral health services. AHCCCS and CMDP are evaluating future integration options for foster children, with a target date of 2020.

• Q6: If my child is enrolled in AIHP, how will she/he receive CRS services?

  A: The American Indian Health Program (AIHP will provide physical and behavioral health services, including CRS services, to children enrolled in that program.

• Q7: How will members with CRS qualifying conditions who are enrolled in ALTCS DDD (through DES) receive services?

  A: Members with developmental disabilities and CRS conditions who are enrolled in Arizona Long Term Care will remain with UnitedHealthcare Community Plan for physical health services related to their CRS conditions and for all behavioral health services. These members will use their assigned DDD health plan for all non-CRS related physical health services. Find more information about plans to integrate ALTCS/DDD services at: https://des.az.gov/services/disabilities/developmental-disabilities/integrated-health-plan.

• Q8: How will members with CRS conditions who are determined to have a serious mental illness (SMI) receive services?

  A: Any member with a CRS condition who is determined to have an SMI (and who is not enrolled with DES/DDD) will move to the RBHA for all physical, behavioral, and CRS services.

• Q9: Will I be assigned to an ACC health plan or will I have choice of ACC Plan?

  A: Members will initially be assigned to an available ACC plan or a plan with other family members assigned to it. Members will be notified of that assignment by the end of June 2018, and can elect to change plans (within their GSA) during the month of July.

• Q10: How will CRS conditions be determined and will members still have a CRS designation?

  A: The CRS application and referral process will remain essentially the same. Members will continue to be referred to the AHCCCS Division of Member Services for CRS determination. ACC health plans will be notified when a member has been determined to have a CRS condition, and should ensure first provider visit within 30 days of CRS designation

• Q11: How will the health plans ensure that members with CRS Special Health Care Needs get the comprehensive care they need?

  A: The ACC and other plans will assign care coordinators who will ensure a first provider visit within 30 days of CRS designation. In addition, an initial service plan and a comprehensive service plan will be coordinated and developed by the plan and the providers.

  ACC and other plans will be required to treat all members with CRS qualifying conditions as a child/young adult with special health care needs. The health plan will recognize that in addition to a primary care provider, children/young adults with CRS qualifying conditions may receive services from subspecialists who manage care related to their condition(s) and coordinate with other specialty services.

  Services should be provided using an integrated family-centered, culturally competent, multispecialty, interdisciplinary approach that includes the following elements:

  • A process for using a centralized, integrated medical record that is accessible to the health plan and service providers consistent with Federal and State privacy laws to facilitate wellcoordinated care,
  • A process for developing and implementing a Service Plan accessible to the health plan and service providers that is consistent with Federal and State privacy laws that contains the clinical, medical, and administrative information necessary to monitor coordinated treatment plan implementation, and
  • Collaboration with individuals, groups, providers, organizations and agencies charged with the administration, support or delivery of services for persons with special health care needs.
• Q12: Can members and families continue to access Multi-Specialty Interdisciplinary Clinics (MSICs)?

  A: Yes, families can use MSICs in their area and community based providers in the plan’s network. Health plans will be required to offer current MSICs in their network in the geographic area they are serving. If a plan is not successful with a long-term contract with an MSIC and the MSIC agrees, the ACC Plan shall allow members to use the MSICs for non-emergency conditions while the health plan contracts with a new MSIC.

• Q13: Can my child continue to receive services from current providers?

  A: Parents and members should review the network of each ACC plan to determine which plan to enroll with to ensure continued access to current providers.

  Transition requirements for all ACC plans require that members who are receiving an active course of treatment, identified in the service plan for a serious and chronic physical, developmental or behavioral health condition, be allowed to receive the services from their established provider for the duration of their treatment or six months; whichever occurs first, regardless of whether or not the specialist participates in the health plan’s provider network. However, it should be noted that even with this above requirement, a provider may choose not to see a member enrolled with a plan the provider does not participate with.

• Q14: Will anything change at age 21 for a member with a CRS designation?

  A: Members enrolled in ACC: Starting October 1, 2018, for ACC members, the CRS designation will be discontinued at age 21. However, the ACC Plan will receive information from AHCCCS identifying the adult member as former CRS and the member will be considered an adult with special health care needs.

  There will no longer be a choice to remain enrolled or “opt-in” to CRS. This is because after September 30, 2018, CRS members and their families will have choice of ACC plans that will all serve members with CRS conditions.

  Current CRS members over the age of 21 who are NOT enrolled with DES/DDD will be assigned to an ACC plan, but will have a choice to pick another ACC plan in their area. Watch for a letter in the mail for this choice.

  If a Multi-Specialty Interdisciplinary Clinic (MSIC) has practitioners and specialists whose scope of practice allows them to treat adults, those members age 21 and older wanting to continue services with the MSIC may do so.

  Members enrolled with DES/DDD: DES is working with UnitedHealthcare Community Plan to continue providing statewide CRS and behavioral health services for members who:

  • are enrolled with DES/DDD; and
  • are ALTCS eligible; and
  • have a CRS designation.

  This is scheduled to begin on October 1, 2018. DES/DDD plans to continue to allow members to “opt in” after 21 years of age. Members will receive a letter from AHCCCS prior to their 21st birthday giving them steps on how to make this choice.

• Q15: Will there be any changes to how other insurance coverage is handled?

  A: There will not be any changes regarding how other insurance is handled. Families of children with CRS conditions that have commercial insurance will have the choice of utilizing the commercial network for services related to the CRS condition in addition to the ACC Plan network.

  • When the member receives services from providers within the ACC Plan network, the ACC Plan is responsible for payment of covered services, although AHCCCS is the payor of last resort.
  • Families wishing to obtain services from commercial providers (outside of the ACC Plan network) for treatment of their children’s CRS condition will be required to use their available private insurance coverage or Medicare to cover treatment for CRS covered conditions. In these circumstances, the ACC Plan shall be the secondary payer responsible for payment in accordance with AHCCCS Contractor Operations Manual Policy 201 and 203.
  • The ACC Plan shall be responsible for all medically necessary covered CRS services provided through the ACC Plan’s network when the member’s Medicare or private insurance expires, is exhausted, certain annual or lifetime limits are reached, or the member’s private insurance/Medicare does not cover the CRS condition. Unless the ACC Plan refers the member out of network the ACC Plan will have no payment responsibility for services received outside of network when the member’s Medicare or private insurance expires, is exhausted, certain annual or lifetime limits are reached, or the member’s private insurance/Medicare does not cover the CRS condition.

Provider Questions

• Q1: When will the ACC Plans get the data of their membership and how will providers know which plan their members are assigned?

  A: ACC Plans will begin receiving potential new member information from AHCCCS starting in August. This information will be utilized for relinquishing and receiving plans to share member information to coordinate care and work to ensure a smooth transition.

  ACC Plans will receive the notification of their new members on the 9/28/18 daily 834 during September month end processes (either late 9/29/18 or early 9/30/18). The changes will be reflected in the normal AHCCCS verification places (AHCCCS Online, 270/271, etc.) for providers.

• Q2: How will open service authorizations be transitioned?

  A: The receiving ACC Plan will receive information on open prior authorizations from the plan the member is leaving and shall honor previously approved prior authorizations for a minimum period of 30 days.

• Q3: Have there been provider forums?

  A: AHCCCS has held numerous public and targeted group forums to educate members, providers and interested stakeholders. Presentations can be requested and available forums viewed at: https://www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/CommunityResources/.

• Q4: Will ACC Plans continue to hold provider forums and participation like the RBHAs do?

  A: The ACC Plans are required to hold a provider forum no less than semi-annually. The forum must be chaired by the Contractor’s Administrator/CEO or designee. The purpose of the forum is to improve communication between the Contractor and its providers. The forum shall be open to all providers and shall not be the only venue available to providers to communicate and participate in issues affecting the provider network.

  In addition to the provider forum, the Contractor shall coordinate a meeting with a broad spectrum of behavioral health providers to gather input; discuss issues; identify challenges and barriers; problem-solve; share information and strategize ways to improve or strengthen the health care service delivery. These meetings shall be held no less than quarterly in the first year of the Contract and semi-annually thereafter.

• Q5: Will behavioral health providers contract with all ACC Plans?

  A: All AHCCCS registered providers are free to contract with any or all of the ACC Plans.

• Q6: Will all ACC Plan have to offer the same behavioral health and CRS covered services now offered to members through the RBHAs and UnitedHealthcare Community Plan CRS?

  A: Covered services are not changing and ACC Plans will be responsible for providing the same array of medically necessary covered services.

• Q7: What will be included in the letters that go out to members?

  A: Members in exiting plans will be given a brief explanation of the reason for the letter describing the change and their new plan assignment. Members will be provided with phone numbers for each plan as well as plan website information to review network and other plan information. Finally, members will be provided with information on how to change to a different ACC Plan using a member portal that will be available starting on July 1st or by calling AHCCCS starting on July 2nd.

  Members enrolled with a continuing plan that is not affiliated with the RBHA, who are identified by AHCCCS as having received at least $1,000 in RBHA behavioral health services for dates of service in calendar year 2017, will be given will be given a one-time choice of the ACC Plan that is affiliated with the RBHA. These letters will describe this one time choice members are getting prior to October 1st along with information on how to change to a different ACC Plan using a member portal.

  All letters will also provide information to American Indian members regarding their options for choice and service delivery. Lastly, the letter provides notice that all ACC Plans (with exception of Molina Healthcare) will have an affiliated Medicare Special Needs plan that the member can enroll with if they are dual Medicare and Medicaid eligible. Molina Healthcare was not approved to offer a Medicare plan starting January 1, 2019 and will plan for a January 1, 2020 implementation of this requirement.

• Q8: What is being done to share market provider rates versus AHCCCS fee for service rates?

  A: This information has been shared with the Managed Care Organizations.

• Q9: How will member assignment to ACC Plans work?

  A: Members currently in a health plan that will be an ACC Plan in their service area on October 1, 2018 will stay with their current health plan. Members currently in a health plan that will not be an ACC Plan in their service area will be assigned an ACC Plan. Members in the same household will be assigned to the same ACC Plan. Assignment to a plan is based initially on assignment to new and small plans and then on an algorithm with target percentages that are based on RFP scoring.

  AHCCCS will send member letters with their assigned ACC Plan by the end of June, 2018. Members will be allowed to choose a different ACC Plan in their service area in July, 2018. ACC Plans will begin service to members on October 1, 2018.

  Some members currently in a plan that will also be an ACC Plan (not affiliated with their assigned RBHA) in their service area, who received behavioral health services through the RBHA in 2017, will be given a one-time choice to move to the ACC Plan that is affiliated with the RBHA in their service area. These members will be notified in late June 2018 and will be allowed to make their choice during the month of July, 2018.

  For more information on member auto-assignment starting October 1, 2018, see the paragraph on Auto-Assignment Algorithm on page 50 of the RFP http://www.azahcccs.gov/PlansProviders/Downloads/RFPInfo/YH19/ACC_RFP_11022017.pdf.

• Q10: If I need to contact an ACC Plan in my area to explore contracting, who do I contact?
  Care1st Health Plan (ID 010254)
  1-866-560-4042
  Central, North

  Steward Health Choice Arizona (ID 010497)
  1-800-322-8670
  Central, North

  Molina Healthcare (ID 010500)
  1-800-424-5891
  Central

  
  

  Mercy Care (ID 010306)
  1-800-624-3879
  Central

  Banner-University Family Care (ID 010314)
  1-800-582-8686
  Central, South

  UnitedHealthcare Community Plan (ID 010158)
  1-800-348-4058
  Central, Pima

  Arizona Complete Health-Complete Care Plan (ID 010422)
  1-888-788-4408
  Central, South
• Q11: For behavioral health providers, what will be done with demographics and how those are reported by behavioral health providers?

  A: AHCCCS is in the process of paring down the required data set elements as well as determining what services, providers, and Contractors to which the DUG will apply. Please see more information at: https://www.azahcccs.gov/PlansProviders/Demographics/.

• Q12: What is happening with grant and housing money?

  A: Responsibility for administering grant funds (for non-Title XIX members and/or services) and housing services will remain with the RBHAs. The ACC Plan shall assist members with how to access these services and shall coordinate care for the member as appropriate.

• Q13: Will ACC Plans be responsible for continuing Justice System Collaboration that the RBHAs were required to do?

  A: Yes. Utilizing existing collaborative protocols as a foundation, AHCCCS will require the ACC plans to work together with other ACC Plans and RBHAs in their area to continue and develop consistent collaborative protocols with each County, District, or Regional Office of: Administrative Office of the Courts, Juvenile Probation and Adult Probation, Arizona Department of Corrections and Arizona Department of Juvenile Corrections, and the Veteran’s Administration.

  The plans shall develop strategies to communicate timely data for coordination of care, development of treatment plans, safe transition into the community upon release, and to optimize the use of services in connection with Mental Health Courts and Drug Courts.

  In addition, in order to facilitate members transitioning out of jails and prisons into communities, ACC Plans are required to participate in criminal justice system “reach-in” care coordination efforts. The ACC Plans shall collaborate with criminal justice partners (e.g. Jails, Sherriff’s Office, Correctional Health Services, Arizona Department of Corrections, including Community Supervision, Probation, Courts), to identify justice-involved members in the adult criminal justice system with physical and/or behavioral health chronic and/or complex care needs prior to member’s release.

• Q14: Who is responsible for payment of Court Ordered Evaluation (COE) and Court Ordered Treatment (COT)?

  A: The ACC Plan is required to develop a collaborative process with the counties to ensure coordination of care and information sharing for timely access to pre-petition screening, court ordered evaluation (COE), and court ordered treatment (COT) provided as described in AMPM Policy 320-U.

  Under A.R.S. §36-545.06, the cost of pre-petition screening and COE remains a county responsibility unless the county has an agreement with AHCCCS under A.R.S. § 36-545.07 to provide those services for the county. If such an agreement exists, the RBHA contract will include those services within the scope of the RBHA’s responsibilities.

  The ACC Plan is responsible for medically necessary, covered behavioral health treatment that is court ordered but not including services associated with the pre-petition screening and COE for their enrolled members. Services that are Medicaid covered for a Medicaid enrolled member that are separate from the COE services and medically necessary physical health services are the responsibility of the ACC Plan during the COE time period.

• Q15: What changes may be coming to ACC due to changes with the AHCCCS waiver?

  A: Information regarding potential waiver authority changes can be found at: https://www.azahcccs.gov/shared/FiveYear.html or https://www.azahcccs.gov/Resources/Federal/PendingWaivers/priorquartercoveragewaiveramendment.html

• Q16: How will a provider know that a member is designated to have a Children’s Rehabilitative Services designation?

  A: After designation by AHCCCS, the member can be identified as having a CRS condition with the specific CRS segment that is a component of the eligibility verification. There will be no change to how it exists today.

• Q17: Will there be changes to the AHCCCS Covered Behavioral Health Services Guide?

  A: AHCCCS is in the process of transitioning the AHCCCS Covered Behavioral Health Services Guide (CBHSG) into the AHCCCS Medical Policy Manual (AMPM Policies 310-B, Behavioral Health Services and 320-T, Non-Discretionary Federal Grants). No changes are being made to the Medicaid covered behavioral health services benefit. AMPM Policy 320-T will expand to cover more information regarding funding/services related to the Non-Title XIX population. The B2 Matrix, which is now part of the AHCCCS CBHSG, will continue to be maintained by AHCCCS and available for stakeholders to view on the AHCCCS website. These changes are anticipated to be completed by October 1, 2018.

• Q18: What happens to my patients after 10/1/18 if I am not contracted with their new health plan?

  A: To ensure a smooth transition for members, if non-contracted providers agree to continue to serve an established patient, ACC Plans must reimburse PCPs for services provided before January 1, 2019 or Specialists before April 1, 2019. See a more comprehensive description of member transition requirements that are included in the AHCCCS/ACC Plan contracts that affect non-contracted providers at www.azahcccs.gov/AHCCCS/Downloads/ACC/EXHIBIT_G.pdf

Crisis Service Questions (Updated 01/22/2020)

• Q1: Will crisis service responsibility or delivery change for State Only members that are Non- Medicaid/KidsCare eligible (Non-Title XIX/Title XXI)?

  A: Crisis stabilization services for state only members will remain the responsibility of the RBHAs. RBHAs will continue to serve the same geographic service areas they serve today with no change on October 1, 2018 and with no AHCCCS Complete Care (ACC) plan or American Indian Health Program (AIHP) involvement.

• Q2: Will crisis service responsibility or delivery change for Medicaid/KidsCare members (Title XIX/Title XXI)?

  A: Crisis stabilization services (including, but not limited to, related transportation “ to” and facility charges) will remain the responsibility of the RBHAs. RBHAs will continue to serve the same geographic service areas they serve today. The RBHAs are responsible for the delivery of timely crisis services, including telephone, community-based mobile, and facility-based stabilization (including observation not to exceed 24 hours), along with any associated covered services delivered by the crisis provider in these settings during the first 24 hours. Although the ACC plan or AIHP is responsible for care coordination and medically necessary covered services (which may include follow up stabilization services) post-24 hours, the RBHA will remain responsible for any costs associated with follow up phone calls related to the crisis episode post-24 hours. The crisis provider is able to make follow up phone calls post-crisis as they do today; however, this does not take away from all care coordination and discharge requirements for the ACC plans or AIHP.

  The RBHAs will be responsible for notifying the ACC plan within 24 hours (7 days a week) of a member engaging in crisis services so that subsequent services can be coordinated and covered through the ACC Plan or AIHP. The ACC Plan or AIHP should be provided clinical recommendations related to the need for any follow up and stabilization services, (with the exception of phone calls, as noted above) and the ACC Plan or AIHP will be responsible for these services.

  The ACC Plan or AIHP will be responsible for all other medically necessary services related to a crisis episode after the initial 24 hours covered by the RBHA, and shall ensure timely follow up and care coordination, whether the member received crisis services within, or outside the GSA, to ensure stabilization of the member and appropriate delivery of ongoing necessary treatment and services.

• Q3: What services are considered a crisis service and when are the RBHA and ACC Plans responsible?

  A: AHCCCS recognizes that the processes and practices currently in place may be different depending on the area, hospital, crisis service provider and/or RBHA.

  See table below for behavioral health services/assessment responsibility by specific service codes for by population and various settings. Please note that this table includes common crisis service codes but is not meant to serve as a comprehensive listing of potential services delivered by a crisis provider (including, but not limited to, Medication Assisted Treatment).

  Service	Population	Setting	Codes	Responsible Party
  Crisis services within first 24 hours	Medicaid, KidsCare and State Only	All settings except observation crisis stabilization units	H2011, S9484, S9485	RBHA
  Crisis services within first 24 hours	Medicaid, KidsCare and State Only	Observation crisis stabilization units	S9484, S9485, H0031, H0038, 90791, T1002, T1016	RBHA
  Crisis phones	Medicaid, KidsCare and State Only	Telephonic	T1016	RBHA
  Assessments	Medicaid, KidsCare	ED/Medical Floor	H0031, 90791, 90792	ACC/AIHP or RBHA for integrated member with SMI
  ED visits	Medicaid, KidsCare	ED	99281 -99285 (Not considered “crisis services”)	ACC/AIHP or RBHA for integrated member with SMI
  ED visits	State Only	ED	99281 -99285 (Are considered “crisis services”)	RBHA
  Assessments for pre-petition screening (for consideration for COE referral)	Medicaid, KidsCare and State Only	All		County or county designation
  SMI assessments for SMI determination	Medicaid, KidsCare	All		ACC/AIHP
  SMI assessments for SMI determination	State Only	All		RBHA

• Q4: What entity is responsible for Crisis Observation and Stabilization Unit services and all other necessary covered services to ACC members after 24 hours?
  A: The ACC plan or AIHP is responsible for all medically necessary services to Medicaid/KidsCare (Title XIX/Title XXI) enrolled members after 24 hours of crisis services.
• Q5: How will crisis services be handled for members crossing GSAs?

  A: The RBHA located in the RBHA GSA where the crisis occurs is responsible for the first 24 hours of crisis services.

  The RBHA geographic service areas (GSA) remain the same on October 1, 2018 and are different than the ACC GSAs or the statewide AIHP. All Central GSA crisis service is provided by Mercy Care RBHA (formerly known as Mercy Maricopa Integrated Care – MMIC). All Northern GSA crisis service, including Gila County, is provided by Steward Health Choice Arizona RBHA (formerly known as Health Choice Integrated Care – HCIC). All Southern GSA crisis service, including Pinal County, will remain with Arizona Complete Health- Complete Care Plan RBHA (formerly known as Cenpatico Integrated Care - CIC).

• Q6: If a RBHA covers crisis services for an individual that is not Medicaid/KidsCare eligible (Non-TXIX/XXI) at the time of service delivery, and the person is later determined Medicaid/KidsCare eligible (TXIX/XXI), what will occur?

  A: All crisis services up to 72 hours for NTXIX/XXI individuals are covered by the RBHA.

  Effective October 1, 2018, for newly enrolled TXIX ACC or AIHP members that are assigned to a RBHA for Non-TXIX services, the RBHAs will be responsible for any behavioral health services during prior period coverage (the time period starting with the effective date of eligibility when a member is TXIX eligible for covered services but is not yet enrolled in a plan). If services were provided utilizing Non-TXIX funding during the prior period coverage time-period, and the member subsequently becomes eligible for TXIX coverage that overlays this time period, the RBHA will be responsible for reclassifying the services as funded by TXIX. The ACC plan or AIHP will be responsible for behavioral health (non-crisis related) starting on the day AHCCCS is notified of a member’s TXIX eligibility.

• Q7: What entity is responsible for the cost of SMI assessments and determinations?

  A: ACC plans or AIHP are responsible for SMI assessments, including urgent evaluations when a member is hospitalized, which will be reviewed and used by the AHCCCS vendor in determining member SMI eligibility status. RBHAs are responsible for assessments for Non-TXIX/XXI members.

  RBHAs will be responsible for SMI assessments for those incarcerated due to suspended eligibility for Medicaid.

  The AHCCCS administration pays the SMI determination vendor directly for the SMI determinations.

• Q8: Please provide billing clarification for crisis stabilization codes S9484 and S9485.

  A: AHCCCS is in the process of transitioning the AHCCCS Covered Behavioral Health Services Guide (CBHSG) into the AHCCCS Medical Policy Manual. The following guidance should be used as the most current directive for billing these crisis stabilization codes effective October 1, 2018.

  AHCCCS will be implementing the following policy clarification regarding billing instructions effective October 1, 2018 for Crisis Intervention Mental Health Services (Stabilization) - S9484 and S9485:

  A single provider cannot bill both codes in the first 24 hours of a crisis episode, for the same member.

  S9484 - The billing unit is one hour and may only be billed if the services delivered are 5 hours or less in duration within a single crisis episode.

  S9485 - The billing unit is per diem and may only be billed if the service duration is more than 5 hours in a single crisis episode. The claim should be billed to the RBHA based on the expectation that this service be limited to 24 hours in duration which supports up to one per diem unit be billed.

  Example: If an individual comes in at 9 p.m., and is still present at the crisis stabilization facility at 2pm the following day, only one per diem S9485 service will be billed to the RBHA. If that same individual had instead been discharged from the crisis stabilization program at 1 a.m. the following day, 4 hours of S9484 would be billed to the RBHA for that episode.

  The ACC Plan or other Contractor of enrollment may be billed using either code for services provided to members awaiting an inpatient placement after 24 hours in the crisis stabilization unit.

• Q9: For the American Indian Health Program, under the Division of Fee for Service Management, how will crisis services be billed?

  A: For AIHP members, for the first 24 hours, crisis services should be billed to the RBHA. Services up to and including the fifth hour should be billed using the hourly code of S9484. Services over the fifth hour, up to and including the 24th hour, should be billed per diem using S9485.

  After the first 24 hours, i.e., the 25th hour forward, crisis services should be billed to AIHP. Services up to and including the fifth hour should be billed using the hourly code of S9484. Services over the fifth hour, up to and including the 24th hour, should be billed per diem using S9485.

  In situations where the crisis services overlap days, the per diem code can span the two dates. The crisis provider would bill the first per diem as described above for dates of service 1 and 2, and the second per diem for dates of service 2 and 3, if applicable. The crisis provider may also bill hourly as described above, if applicable, in addition to the per diem.

  Example:

  Crisis services were initiated at 3 p.m. on Monday (day 1) and ended at 6 p.m. on Tuesday (day 2). The per diem code S9485 should be billed once to the RBHA for the first 24 hour time period. This date span is from 3 p.m. Monday to 3 p.m. Tuesday. On Tuesday (day 2), the hourly code S9484 should be billed to AIHP for the 3 hours (from 3 p.m. to 6 p.m.) beyond the initial 24 hours of crisis.

  Crisis services were initiated at 3 p.m. on Monday (day 1) and ended at 11 p.m. on Tuesday (day 2). The per diem S9485 should be billed once to the RBHA for the first 24 hour time period. This date span is from 3 p.m. Monday to 3 p.m. Tuesday. On Tuesday (day 2) the per diem code should be billed to AIHP since the crisis services (from 3 p.m. to 11 p.m.) extended beyond 5 hours.

  For mobile services, H2011 should be used and the HT modifier added for the two-person multi-disciplinary team.

• Q10: Please provide guidance on what entity is responsible for transportation that has historically been covered by crisis funding. Specifically address transportation to and from a Crisis Observation and Stabilization Unit.

  A: Emergent and non-emergent medical transportation from the Crisis Observation and Stabilization Unit to another level of care or other location shall be the ACC Plan or American Indian Health Program (AIHP) responsibility, regardless of the timing within the crisis episode.

  Generally, the ACC Plan or AIHP is responsible for covering transportation to and from providers for services which are the responsibility of the ACC plan or AIHP. Transportation during a crisis episode to a crisis service provider will be the responsibility of the RBHA.

  B: (RBHAs): if clinically appropriate, crisis mobile teams are responsible for providing or coordinating transportation for individuals to a higher level of care. In these cases, crisis mobile teams must provide transportation to the nearest appropriate facility capable of stabilizing, triaging and determining medical necessity for ongoing care, in accordance with AMPM 310-BB.