AHCCCS Contractor Operations Manual (ACOM)
Information Regarding COVID-19
In response to Medicaid-related questions from providers and contractors arising from the COVID-19 pandemic, AHCCCS has developed a list of Frequently Asked Questions (FAQs) Regarding Coronavirus Disease 2019 (COVID-19) which is updated regularly. It is important to note that there are instances where the information presented in the CMS-approved flexibilities and COVID-19 FAQs does not align with provisions set forth by the AHCCCS Contractor Operations Manual (ACOM). In these instances the CMS-approved flexibilities and FAQs take precedence and are controlling.
Name Change
Effective April 1, 2021 Comprehensive Medical and Dental Program (CMDP) will be changing to Comprehensive Health Plan (CHP). AHCCCS is in the process of revising all pertinent documents to reflect the new name.
The AHCCCS Contractor Operations Manual (ACOM) provides information applicable to the Managed Care Organization (MCO) Contractors. It consolidates and provides ease of access to the Administrative, Claims, Financial, and Operational policies of the AHCCCS Administration. The ACOM provides information to both the MCO Contractors and their subcontractors who have delegated responsibilities under a contract. The ACOM has authority in conjunction with Federal and State regulations, other Agency Guides and Manuals, and applicable contracts.
How to Submit Public Comments
AHCCCS provides up to a 45-day public comment period prior to publishing AHCCCS Contractor Operations Manual (ACOM) and AHCCCS Medical Policy Manual (AMPM) policies that have a substantial change. Should an expedited time period be required, the expedited time period will not be less than two weeks. Tribal members, stakeholders, and the general public are able to review and submit comments regarding changes being presented.
Click the link below to review policies currently posted for public comment.
The AHCCCS Contract and Policy Dictionary provides a centralized location for definitions that are found in the various ACOM and AMPM Policies. You may view the AHCCCS Contract and Policy Dictionary from our Guides and Manuals page at the following link: AHCCCS CONTRACT AND POLICY DICTIONARY.
To view ACOM Policies, select Policy from the ACOM Table of Contents below.
- 100 - AHCCCS Contractor Operations Manual - Reserved
- 101 - Marketing
- 103 - Fraud, Waste and Abuse
- Attachment A - Representations and Certifications of Contractor
- Attachment A-1 - Disclosure Information - Disclosure of Ownership and Control
- Attachment B - Corporate Compliance Work Plan-Sample
- Attachment C - External Audit Plan Template
- 104 - Continuity of Operations and Recovery Plan
- 106 - Certification of MAOs Serving Dual Eligible Members
- 107 - State-Contracted MAO Dual Eligible Special Needs Plans
- 108 - AHCCCS Security Rule Compliance
- 109 - Institution for Mental Disease 15 Day Limit
- 110 - Mental Health Parity
- 111 - AHCCCS Pharmacy and Therapeutics Committee
- 301 - ALTCS E/PD Program Tiered Reconciliation
- 302 - Cost Settlement for Coronavirus Disease of 2019 Vaccine
- 303 CYE 25 - Community Reinvestment (All Lines of Business Except E/PD)
- Attachment A CYE 25 - Community Reinvestment Plan Template
- Attachment B CYE 25 - Community Reinvestment Report
- 303 CYE 25 – Community Reinvestment E/PD Only
- Attachment A CYE 25 - Community Reinvestment Plan Template
- Attachment B CYE 25 - Community Reinvestment Report
- 304 - Premium Tax Reporting
- 305 CYE 25 - Performance Bond and Equity Per Member Requirements (All Lines of Business Except E/PD)
- Attachment A CYE 25 - Performance Bond Annual Attestation Statement
- Attachment B CYE 25 - Performance Bond Form
- Attachment C CYE 25 - Instructions for Wire/ACH Transfers of Funds to AHCCCS via Arizona State Treasurer
- 305 CYE 25 - Performance Bond and Equity Per Member Requirements E/PD ONLY
- Attachment A CYE 25 - Performance Bond Annual Attestation Statement
- Attachment B CYE 25 - Performance Bond Form
- Attachment C CYE 25 - Instructions for Wire ACH Transfers of Funds to AHCCCS via Arizona State Treasurer
- 306 CYE 25 - Alternative Payment Model Initiative - Withhold and Quality Measure Performance Incentive
- Attachment A CYE 25 - Alternative Payment Model Quality Measures Performance Scores
- Attachment B CYE 25 - Federal Limit Test
- 306 CYE 24 – Alternative Payment Model Initiative – Withhold and Quality Measure Performance Incentive
- Attachment A CYE 24 – Alternative Payment Model Quality Measures Performance Scores
- Attachment B CYE 24 – Federal Limit Test
- 306 CYE 23 - Alternative Payment Model Initiative – Withhold and Quality Measure Performance Incentive
- Attachment A CYE 23 - Alternative Payment Model Quality Measures Performance Scores
- Attachment B CYE 23 - Federal Limit Test
- 307 CYE 24 – Alternative Payment Model Initiative – Strategies and Performance-Based Payments Incentive
- 307 CYE 23 - Alternative Payment Model Initiative – Strategies and Performance-Based Payments Incentive
- 310 - Delivery Supplemental Payment
- 311 CYE 25 and Forward - ACC and ACC-RBHA Program Tiered Reconciliation
- 311 CYE 23 and CYE 24 - ACC and ACC-RBHA Program Tiered Reconciliation
- 314 - Auto-Assignment Algorithm
- 317 - Change in Contractor Organizational Structure
- 323 - ACC-RBHA Non-Title XIX-XXI Profit Limit
- 324 - Targeted Investments Program
- 325 - Targeted Investments 2.0 Program
- 326 - Fixed Administrative Cost Component Reconciliation for ACC and ACC-RBHA
- 327 - Pediatric Services Initiative
- 330 - Access to Professional Services Initiative
- 401 - Change of Contractor: AHCCCS Complete Care Contractors
- 402 - Member Transition for Annual Enrollment Choice and Eligibility Changes
- 403 - Enrollment Choice in a County with Choice and Change of Contractor: ALTCS Contractors
- 404 - Contractor Website and Member Information
- 405 - Cultural Competency, Family/Member Centered Care, and Language Access Plan
- 406 - Member Handbook and Provider Directory
- 407 - Workforce Development
- 408 - Administration Actions
- 409 - Contractor Office of Individual and Family Affairs
- 412 - Claims Recoupment and Refunds
- 414 - Requirements for Service Authorization Decisions and Notices of Adverse Benefit Determination
- 415 - Provider Network Development and Management Plan; Periodic Network Reporting Requirements
- 416 - Provider Manual and Required Notifications
- 417 - Appointment Availability, Transportation Timeliness, Monitoring, and Reporting
- 418 - Provider and Affiliate Advances, Equity Distributions, Loans, and Investments
- 421 - Contract Termination Nursing Facilities and Alternative Home and Community Based Settings
- 423 - Financial Responsibility for Court Ordered Treatment for DUI/Domestic Violence or Other Criminal Offenses
- 424 - Verification of Receipt of Paid Services
- 425 - Social Networking
- 426 - CRS Application, Designation, and Coverage
- 429 - Direct Care Worker Training and Testing Program
- 431 - Copayment
- 433 - Member Identification Cards
- 434 - Coordination of Benefits and Third Party Liability
- 435 - Telephone Performance Standards and Reporting
- 436 - Network Standards
- 437 - Financial Responsibility for Services after the Completion of Court-Ordered Evaluation
- 438 – Administrative Services Subcontractor Evaluation
- Attachment A - Administrative Services Subcontract Checklist
- Attachment B - Administrative Services Subcontractor Evaluation Report Template
- 439 - Material Changes Provider Network and Business Operations
- 440 - Managed Care Expiration or Termination of Contract
- 442 - Opt Out Request for a Member with a Serious Mental Illness Designation
- 444 - Notice of Appeal Requirements (Serious Mental Illness Appeals)
- Attachment A - AHCCCS Notice of SMI Grievance and Appeal Procedure
- Attachment B - Notice of Legal Rights for Persons with Serious Mental Illness
- Attachment C - Notice of Decision and Right to Appeal (for Individuals with an SMI)
- Attachment D - Notice of Discrimination Prohibited
- 445 - Submission of Request for Hearing
- 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness
- 447 - Employment
- Attachment A – Reserved
- 448 - Permanent Supportive Housing - Reserved
- 449 - Behavioral Health Services for Children in Department of Child Safety (DCS) Custody and Adopted Children
