Division of Behavioral Health Services
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BHS Definitions List (revised 10/01/14)
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Material change is an alteration or development within a provider network that may reasonably be foreseen to affect the quality or delivery of services provided under this contract.
Maternity care includes identification of pregnancy, prenatal care, labor/delivery services, and postpartum care.
Maternity Care Coordination
Maternity care coordination consists of the following maternity care related activities: determining the member's medical or social needs through a risk assessment evaluation; developing a plan of care designed to address those needs; coordinating referrals of the member to appropriate service providers and community resources; monitoring referrals to ensure the services are received; and revising the plan of care, as appropriate.
A physical or mechanical device, material, or equipment attached or adjacent to a behavioral health recipient's body that the person cannot easily remove that restricts the freedom of movement or normal access to one's body, but does not include a device, material or equipment:
- Used for surgical or orthopedic l reasons; or
- Necessary to allow a person to heal from a medical condition or to participate in a treatment program for a medical condition.
(42 CFR 482.13(1)(i))
Mechanical Restraint, Sub-Acute Agency
Any device, article, or garment attached or adjacent to a behavioral health recipient's body that the person cannot easily remove and that restricts the behavioral health recipient's freedom of movement or normal access to the behavioral health recipient's body but does not include a device, article, or garment:
- Used for surgical or orthopedic purposes, or
- Necessary to allow a behavioral health recipient to heal from a medical condition or to participate in a treatment program for a medical condition.
(A.A.C. R9 20-101)
Medical Behavioral Health Practitioner
An individual licensed and authorized by law to use and prescribe medication and devices, as defined in A.R.S. § 32-1901, and who is one of the following with at least one year of full-time behavioral health work experience: a. A physician; b. A physician assistant; or c. A nurse practitioner.
Acute care hospital, psychiatric hospital (non-Institution for Mental Disease), Residential Treatment Center (non-IMD), Intermediate Care Facility for People with Mental Retardation (ICF/MR), psychiatric hospital – IMD, Residential Treatment Center – IMD or Skilled Nursing Facility (SNF).
An integrated process or system that is designed to assure appropriate utilization of health care resources, in the amount and duration necessary to achieve the desired health outcomes, across the continuum of care (from prevention to end of life care).
(A.R.S. § 12-2291) All communications related to a patient's physical or mental health or condition that are recorded in any form or medium and that are maintained for purposes of evaluation or treatment, including records that are prepared by a health care provider or by other providers. Medical records do not include materials that are prepared in connection with utilization review, peer review or quality assurance activities.
Medically Necessary Covered Services
Behavioral health services provided by qualified service providers within the scope of their practice to prevent disease, disability, and other adverse health conditions or their progression or to prolong life that are aimed at achieving the following:
- The prevention, diagnosis, and treatment of behavioral health impairments;
- The ability to achieve age-appropriate growth and development; and
- The ability to attain, maintain, or regain functional capacity.
Medical Necessity Criteria (MNC)
Services by a provider to identify or treat an illness that has been diagnosed or suspected. The services are consistent with the diagnosis and treatment of a condition and the standards of good medical practice. The services are required for other than convenience, and are the most appropriate supply or level of service.
A physician, physician assistant or registered nurse practitioner.
All communications related to a patient's physical or mental health or condition that are recorded in any form or medium and that are maintained for purposes of evaluation or treatment, including records that are prepared by a health care provider or by other providers. Medical records do not include materials that are prepared in connection with utilization review, peer review or quality assurance activities. (A.R.S. § 12-2291)
Medicare Advantage Prescription Drug Plan (MA-PD)
A Medicare Advantage plan that provides qualified prescription drug coverage.
Medicare Part A
(Hospital Insurance) that covers inpatient care including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care.
Medicare Part B
(Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Medicare Part C
Medicare Advantage Plans are health plan options (like an HMO or PPO) approved by CMS and are sometimes called "Part C" or "MA Plans." Medicare Advantage plans provide both Medicare Part A and Part B covered services. Medicare Advantage Plans may also offer extra coverage, such as:
- Health and wellness programs; and
- Medicare Part D prescription drug coverage (usually for an extra cost).
Medicare pays a fixed amount for the services covered by Medicare and offered by private companies. These companies must follow rules set by Medicare. Medicare Advantage Plans are not supplemental insurance. Medicare Advantage Plans include the following:
- Preferred Provider Organization (PPO) Plans;
- Health Maintenance Organization (HMO) Plans;
- Private Fee-for-Service (PFFS) Plans;
- Medical Savings Account (MSA) Plans; and
- Special Needs Plans (SNP). These are Medicare plans that also offer Part D.
Medicare Part D
Medicare prescription drug coverage.
Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.
Member Information Materials
Any materials given to a behavioral health recipient. This includes, but is not limited to; member handbooks, member newsletters, surveys, and health related brochures and videos. It also includes templates of form letters and Web site content as well.
A substantial disorder of the person's emotional processes, thought, cognition or memory. Mental disorder is distinguished from:
- Conditions that are primarily those of drug abuse, alcoholism or mental retardation, unless, in addition to one or more of these conditions, the person has a mental disorder;
- The declining mental abilities that directly accompany impending death; and
- Character and personality disorders characterized by lifelong and deeply ingrained antisocial behavior patterns, including sexual behaviors that are abnormal and prohibited by statute unless the behavior results from a mental disorder.
Mental Health Agency
"Mental health agency" includes a regional authority, service provider, inpatient facility, or an agency licensed to conduct screening, evaluation and treatment under this Chapter.
Mental Health Care Power of Attorney
A designated agent who may make decisions about mental health treatment on behalf of a person if the person is found incapable. These decisions shall be consistent with any wishes the person has expressed in the mental health care directive, mental health care power of attorney, health care power of attorney or other advance directive.
Mental Health Provider
Any physician or provider of mental health or behavioral health services involved in evaluating, caring for, treating or rehabilitating a patient.
Mental Retardation (MR) 1
For purposes of this policy, and as defined by the American Association on Mental Retardation. Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. Per Federal guidelines, the impairment must be manifested before age 22. The impairment must be likely to continue indefinitely and result in substantial functional impairments in major life activities.
1 Please note that the American Association on Mental Retardation is currently the American Association on Intellectual and Developmental Disabilities (AAIDD) and Mental Retardation is currently referred to as "Intellectual disability". This policy reflects terminology in accordance with the 42 C.F.R. 483.103(3)(i).
An intentional, reckless or negligent action or omission that exposes a behavioral health recipient to a serious risk of physical or emotional harm. Mistreatment includes but is not limited to:
- Abuse, neglect or exploitation;
- Corporal punishment;
- Any unreasonable use or degree of force or threat of force not necessary to protect the person or another person from bodily harm;
- Infliction of mental or verbal abuse, such as screaming, ridicule, or name calling;
- Incitement or encouragement of others to mistreat a behavioral health recipient;
- Transfer or the threat of transfer of a behavioral health recipient for punitive reasons;
- Restraint or seclusion used as a means of coercion, discipline, convenience or retaliation;
- Use of medication as punishment;
- Any act in retaliation against a behavioral health recipient for reporting an incident of mistreatment; and
- Commercial exploitation including but not limited to requiring work with no pay, use of photographs for commercial purposes without consent, spending funds belonging to enrolled persons without consent.