A Recent History and Olmstead Activities

System-Related

  • Arnold v. Sarn Stipulation: As part of the Arnold v. Sarn Stipulation for Providing Community Services and for Terminating the Litigation, signed in January 2014, the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS) and the State of Arizona agreed to provide certain community services and terminate the litigation. The agreement included an increase of services in four areas: Assertive Community Treatment, Supported Employment, Supportive Housing and Peer and Family Services. Each of these areas had target goals to expand service capacity and all goals were met by July 2017.
  • Autism Spectrum Disorder (ASD) Advisory Committee: The Autism Spectrum Disorder (ASD) Advisory Committee was appointed in Spring 2015 and charged with articulating a series of recommendations to the State for strengthening the health care system’s ability to respond to the needs of AHCCCS members with or at risk for ASD, including those with comorbid diagnoses. The charge included focusing on tasks related to more access to services for members and assisting members in becoming more independent in the community.
  • Foster Care Community Liaison: Stemming from the 2016 Arizona House Bill 2442 (Jacob’s Law), AHCCCS created a new position titled Foster Care Community Liaison within the Office of Individual and Family Affairs, whose purpose is to collect and share the voice of youth involved with the Department of Child Safety (DCS) at all levels of the Medicaid system.
  • Administrative Simplification: On July 1, 2016, the Arizona Department of Health Services, Division of Behavioral Health Services (DBHS) merged with AHCCCS in an effort to streamline monitoring and oversight of the Regional Behavioral Health Authorities throughout Arizona. DBHS and AHCCCS had historically been partnered working to improve care for Arizonans receiving behavioral health services. Governor Ducey recommended formalizing the partnership by bringing DBHS and AHCCCS together. The administrative simplification did not change services members can receive, nor did it change how members receive services.
  • Housing: In 2016, AHCCCS became responsible for the management and oversight of AHCCCS housing and services for persons with an Serious Mental Illness designation under administration simplification. If AHCCCS were a housing authority, it would be the third largest in the state of Arizona with an annual budget of $27.7 million in non-Medicaid, state-only funds to provide rent subsidies for almost 3,000 AHCCCS members with an SMI designation, and for a small number of high-need individuals in need of behavioral health and/or substance use treatment. AHCCCS also administers the State SMI Housing Trust Fund (SMI HTF) to which approximately $2 million of state funds are appropriated per year, to expand housing capacity for persons with an SMI designation. Since 2017, SMI HTF money has been invested to construct or acquire 246 new affordable housing units for AHCCCS members with an SMI designation. AHCCCS also collaborates with local housing authorities, tax credit programs, and the HUD Continuum of Care (HUD CoC) program to provide PSH capacity for an additional 1,500 members.
  • Targeted Investment (TI) Program: In 2017, AHCCCS initiated the Targeted Investments (TI) Program, which is a strategy to provide financial incentives to eligible AHCCCS providers who meet certain benchmarks for integrating and coordinating physical and behavioral health care for Medicaid beneficiaries. The TI Program incentivizes prescribed care coordination processes for different participating groups, such as TIP justice clinics (e.g., required Forensic Peer and Family Support Training); adult healthcare providers (e.g., screening all members for social risk factors and behavioral health disorders); and pediatric healthcare providers (e.g., requirement to identify community-based resources and referral procedures for members).
  • Behavioral Health Expansion in Schools: While schools have historically been approved settings for Medicaid-covered behavioral health services, in 2018 $3 million in state General Fund dollars were appropriated to expand behavioral health services in schools; $1 million of this funding is being used in a partnership with the Arizona Department of Education to provide mental health training to schools and school districts.
  • Project AWARE: A five-year SAMHSA grant that began in 2018 in an effort to address Arizona’s challenges to individual, family, and community mental health and wellness in schools, Arizona Project AWARE planned and implemented strategies and activities to build and maintain infrastructure for mental health services in Arizona schools for school-age children; conduct outreach and engagement with school-aged youth and their families to increase mental health awareness; and provide professional development and training.
  • Integrated Care: On October 1, 2018, AHCCCS established a new integrated system called AHCCCS Complete Care (ACC) that joined physical and behavioral health services together to treat all aspects of our members’ health care needs under a single, chosen health plan.
  • COVID-related Flexibilities: Beginning in March, 2020, AHCCCS, through CMS-approved flexibilities, implemented a number of changes in response to the COVID-19 Public Health Emergency to ensure ongoing access to care.
  • AHCCCS Housing Administrator: Beginning October 1, 2021, AHCCCS has contracted with Arizona Behavioral Health Corporation (ABC) to administer all AHCCCS housing subsidy programs for persons with Serious Mental Illness (SMI) and General Mental Health/Substance Use (GMH/SU) designations. The goal is to reduce barriers to housing, standardize and expedite housing processes, improve member service, and increase housing outcomes and capacity. These services will support the ability of members in the subsidy programs to maintain community-based housing and independent living.

Contracts/Policies

  • Credentialed Family-Support Services: In 2016, AHCCCS established a state-level policy that created an opportunity for family members with lived experiences to be trained and provide family support services.
  • Contract Requirement for ACC MCOs to Create OIFA Departments: In 2018, AHCCCS added a requirement to contract for each AHCCCS Complete Care (ACC) Managed Care Organization (MCO) to create an internal Office of Individual and Family Affairs (OIFA) department to fulfill the OIFA mission.
  • Expanding Behavioral Health Diagnosis Codes: Late in 2018, AHCCCS made the decision to create a more comprehensive list of Behavioral Health diagnosis codes to ensure members with Autism Spectrum Disorder, and related disorders, had access to behavioral health services.
  • Child and Family Team (CFT) Training Development: In 2019, AHCCCS, in conjunction with the health plans and providers, revised the Child and Family Team Practice training into a single uniform training program with a standardized set of competencies and fidelity assurance tool to allow better continuity, integration, and coordination of care.
  • Expanding Access to Behavior Analytic Services: In 2019, AHCCCS policy was revised to recognize behavior analysis services as a covered behavioral health service, without age or diagnostic limitations, and the benefit of these services to increase functional skills, adaptive skills, social skills, and independence, while teaching new behaviors and reducing behaviors that interfere with behavioral and physical health. This allows members to remain in their homes and participate in community activities.
  • Contract Requirements for ADES/DDD MCO to Create an OIFA Department: In 2019, AHCCCS added a requirement to contract for Division of Developmental Disabilities (DDD) Managed Care Organization (MCO) to create an internal Office of Individual and Family Affairs (OIFA) department to fulfill the OIFA mission.
  • Telehealth Services: During the COVID-19 pandemic, AHCCCS added flexibilities to telehealth coverage to promote physical distancing and limit the spread of COVID-19 while also promoting access to healthcare; these flexibilities are posted in the AHCCCS COVID-19 FAQs on telehealth. Additionally, AHCCCS has provided guidance on services that can be permanently available via Telehealth. Telehealth service delivery can make access to health care more convenient, saving time and transportation costs.
  • New Division of Developmental Disabilities (DDD) Health Plan Integration: Beginning October 1, 2019, behavioral health service responsibility for DDD members transitioned from the Regional Behavioral Health Authorities (RBHAs) to integrated health plans contracted with DDD (DDD Health Plans). These DDD Health Plans will offer eligible members physical and behavioral health services, Children’s Rehabilitative Services (CRS) and limited long term services and supports (LTSS): nursing facilities, emergency alert system services, and habilitative physical therapy for members age twenty-one (21) and over. All other LTSS and Support Coordination will be provided by DDD. This model will enhance care treatment between providers and improve member health.
  • Contract Requirements for DCS/CHP MCOs to Create an OIFA Department: In April, 2021, AHCCCS added a requirement to contract for Department of Child Safety Comprehensive Health Plan (DCS CHP) Managed Care Organization (MCO) to create an internal Office of Individual and Family Affairs (OIFA) department to fulfill the OIFA mission.

Initiatives

  • Good Government Award: In 2017, AHCCCS, the Arizona Department of Corrections, and the Arizona Department of Economic Security shared the Good Government Award for improving inmates’ access to health care upon their release.
  • Employment First Executive Order: In 2017, Governor Ducey signed an Executive Order declaring Arizona an Employment First state, which includes people with disabilities having access to integrated work settings.
  • Expansion of SAMHSA Evidence-Based Practice Fidelity: Since 2019, efforts have been made to expand evidence-based fidelity reviews outside of Maricopa County and into the northern and southern RBHAs to increase services in the following four areas: Assertive Community Treatment, Supported Employment, Supportive Housing and Peer and Family Services.
  • Whole Person Care Initiative (WPCI): Initially introduced in late-2019, the AHCCCS Whole Person Care Initiative (WPCI) addresses members’ social risk factors of health in order to improve health outcomes and reduce costs. AHCCCS is collaborating with the health plans to provide housing, employment, criminal justice, and non-emergency transportation, as well as home and community-based services interventions to our members.
  • Arizona Emergency COVID-19 Project: Through a SAMHSA grant awarded in April, 2020 called the Arizona Emergency COVID-19 grant, AHCCCS is providing crisis intervention services, mental and substance use disorder treatment, and other related recovery support for children and adults impacted by the COVID-19 pandemic for individuals with serious mental illness, individuals with substance use disorders, and/or individuals with co-occurring serious mental illness and substance use disorders.
  • Health Equity Committee: Formally established in July 2020, the Health Equity Committee is tasked with understanding health disparities and developing strategies to ensure health equity for all AHCCCS members.

Upcoming

  • COE/COT Statewide Training Development: AHCCCS, in conjunction with health plans, community-based stakeholders, advocacy groups, and county court administrators, is reviewing court rules, state statutes, and current processes to identify opportunities to improve statewide training for supporting individuals navigating the Court Ordered Evaluation and Treatment process. The goal is to have this training completed during the Spring/Summer of 2022.
  • Housing and Health Opportunities (H2O) Waiver Amendment: AHCCCS is requesting an amendment to the 1115 Research and Demonstration Waiver to seek waiver and expenditure authority to implement the AHCCCS Housing and Health Opportunities (H2O) demonstration. The goal of the AHCCCS H2O demonstration is to enhance and expand housing services and interventions for AHCCCS members who are homeless or at risk of becoming homeless. It is anticipated that AHCCCS will receive a response to the waiver amendment request by 10/1/2022.
  • Behavioral Health Referral and Intake Policy Simplification: Effective October 1, 2021, the AHCCCS Medical Policy Manual (AMPM) Policies 580 and 320-O are being revised to eliminate the requirement of having a separate, formal intake process in order for behavioral health services to be provided. This policy change formally recognizes the systemic shift of integration of physical and behavioral health services while also relieving the administrative burden for the providers.
  • Closed-Loop Referral System (CLRS): A critical tool of the AHCCCS Whole Person Care Initiative (WPCI) in addressing social risk factors of health for AHCCCS members is the implementation of the Closed-Loop Referral System (CLRS). This allows providers to screen for needs and connect members to community organizations and resources to address social risk factors of health. The CLRS will begin rolling out a pilot program with a small group of providers in the summer of 2021 with an anticipated overall implementation in late-2021/early-2022.
  • 24/7 Statewide Crisis Number: With an anticipated implementation date of 10/1/2022, AHCCCS is in process of developing a single, statewide crisis phone vendor responsible for implementing an easy to use, 24/7 crisis phone number and crisis response system, including mobile team dispatch. All MCOs will be required to collaborate and contract with this statewide crisis phone vendor.
  • AHCCCS Licensing Software for CALOCUS and LOCUS: AHCCCS is (or “will”) require implementation of the Child and Adolescent Level of Care Utilization System (CALOCUS) as the statewide instrument to determine service intensity and acuity needs for all child members. In an effort to reduce financial implications associated with this requirement, AHCCCS has licensed the software, allowing for integration of the software into providers' electronic health records. In the future completed assessment scores will be integrated into the Health Information Exchange (HIE). AHCCCS intends to evaluate future requirements for the use of the adult version of the tool, the Level of Care Utilization System (LOCUS) for adult members.