Last Revision Effective Date:

1.0 

Scope [PDF 26K]

8/15/07

2.0 

Introduction [PDF 109K]

3.0 

Clinical Operations

3.1 

Eligibility Screening for AHCCCS Health Insurance, Medicare Part D Prescription Drug Coverage, and the Limited Income Subsidy Program [PDF 142K]

3.2 

Appointment Standards and Timeliness of Service [PDF 129K]

3.3 

Referral Process [PDF 115K]

3.4 

Co-payments [PDF 115K]

3.5 

Third Party Liability and Coordination of Benefits [PDF 173K]

3.6 

Member Handbooks [PDF 39K]

3.7 

Clinical Liaison [PDF 58K]

3.8 

Outreach, Engagement, Re-Engagement and Closure [PDF 154K]

3.9 

Intake, Assessment and Service Planning [PDF 200K]

3.10 

SMI Eligibility Determination [PDF 121K]

3.11 

General and Informed Consent to Treatment [PDF 123K]

3.12 

Advance Directives [PDF 46K]

3.13 

Covered Behavioral Health Services [PDF 97K]

3.14 

Securing Services and Prior Authorization [PDF 88K]

3.15 

Psychotropic Medications: Prescribing and Monitoring [PDF 85K]

3.16 

Medication Formulary [PDF 109K]

3.17 

Transition of Persons [PDF 201K]

3.18 

Pre-petition Screening, Court Ordered Evaluation and Treatment [PDF 128K]

3.19 

Special Populations [PDF 110K]

3.20 

Credentialing and Privileging [PDF 97K]

3.21 

Service Prioritization for Non-Title XIX/XXI Funding [PDF 85K]

3.22 

Out-of-State Placements for Children and Young Adults [PDF 68K]

3.23 

Cultural Competence [PDF 93K]

4.0 

COMMUNICATION AND CARE COORDINATION

4.1 

Disclosure of Behavioral Health Information [PDF 160K]

4.2 

Behavioral Health Medical Record Standards [PDF 126K]

4.3 

Coordination of Care with AHCCCS Health Plans, Primary Care Providers and Medicare Providers  [PDF 98K]

4.4 

Coordination of Care with Other Governmental Entities [PDF 184K]

5.0 

MEMBER RIGHTS AND PROVIDER Claims Disputes

5.1 

Notice Requirements and Appeal Process for Title XIX and Title XXI Eligible Persons [PDF 169K]

5.2 

Member Complaints [PDF 136K]

5.3 

Grievance and Request for Investigations for Persons Determined to have a Serious Mental Illness [PDF 56K]

5.4 

Special Assistance for SMI Members [PDF 77K]

5.5 

Notice and Appeal Requirements (SMI and General) [PDF 126K]

5.6 

Provider Claims Disputes [PDF 114K]

6.0 

DATA AND BILLING REQUIREMENTS

6.1 

Submitting Tribal Fee-for-Service Claims to AHCCCS [PDF 58K]

6.2 

Submitting Claims and Encounters to the RBHA [PDF 56K]

7.0 

REPORTING REQUIREMENTS

7.1 

Fraud and Program Abuse Reporting [PDF 84K]

7.2 

Medical Institution Reporting for Medicare Part D [PDF 97K]

8/15/08

7.3 

Seclusion and Restraint Reporting [PDF 84K]

7.4 

Reporting of Incidents, Accidents and Deaths [PDF 98K]

7.5 

Enrollment, Disenrollment and Other Data Submission [PDF 115K]

8.0 

PERIODIC AUDITS AND SURVEYS

8.1 

Encounter Validation Studies [PDF 81K]

8.2 

Reserved

8.3 

Consumer and Family Satisfaction Survey [PDF 47K]

8.4 

Performance Improvement Projects [PDF 84K]

8.5 

Medical Care Evaluation Studies [PDF 82K]

9.0 

TRAINING AND DEVELOPMENT

9.1 

Training Requirements [PDF 66K]

10.0 

T/RBHA SPECIFIC REQUIREMENTS

11.0 

DEFINITIONS

12.0 

FACT SHEETS (under construction)

13.0 

FORMS AND ATTACHMENTS

14.0 

INDEX [PDF 465K]

4/15/08