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Ajo Mountains, Ajo, Pima County
  
  ADHS/DBHS Provider Manual
Community Partnership of Southern Arizona (CPSA) Edition

Revised September 1, 2010
        Revision Notices

If you have questions or need assistance in using the 2004 Provider Manual, please contact Charlie Delgado at (520) 784-5359, or Charlene.Delgado@cpsa-rbha.org.

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0.0 TABLE OF CONTENTS
 
1.0 SCOPE
 
2.0 INTRODUCTION
 
3.0 CLINICAL OPERATIONS
   3.1 Eligibility Screening for AHCCCS Health Insurance, Medicare Part D Prescription Drug Coverage, and the Limited Income Subsidy Program
   3.2 Appointment Standards and Timeliness of Service
   3.3 Referral and Intake Process
   3.4 Co-Payments
   3.5 Third Party Liability and Coordination of Benefits
   3.6 Member Handbooks
   3.7 Clinical Liaison
   3.8 Outreach, Engagement, Re-Engagement and Closure
   3.9 Intake, Assessment and Service Planning
   3.10 SMI Eligibility Determination
   3.11 General and Informed Consent to Treatment
   3.12 Advance Directives
   3.13 Covered Behavioral Health Services
   3.14 Securing Services and Prior Authorization
   3.15 Psychotropic Medications: Prescribing and Monitoring
   3.16 Medication Formulary
   3.17 Transition of Persons
   3.18 Pre-Petition Screening, Court Ordered Evaluation and Treatment
   3.19 Special Populations
   3.20 Credentialing and Privileging
   3.21 Service Package for Non-Title XIX/XXI Persons Determined to Have a Serious Mental Illness (SMI)
   3.22 Out-of-State Placements for Children and Young Adults
   3.23 Cultural Competence
4.0 COMMUNICATION AND CARE COORDINATION
   4.1 Disclosure of Behavioral Health Information
   4.2 Behavioral Health Medical Record Standards
   4.3 Coordination of Care with AHCCCS Health Plans and Primary Care Providers
   4.4 Coordination of Care with Other Government Entities
5.0 MEMBER RIGHTS AND PROVIDER CLAIMS DISPUTES
   5.1 Notice Requirements and Appeal Process for Title XIX and Title XXI Eligible Persons
   5.2 Member Complaints
   5.3 Grievance and Request for Investigation for Persons Determined to Have a Serious Mental Illness (SMI)
   5.4 Special Assistance for SMI Members
   5.5 Notice & Appeal Requirements (SMI and General)
   5.6 Provider Claims Disputes
6.0 DATA AND BILLING REQUIREMENTS
   6.1 Submitting Tribal Fee-for-Service Claims to AHCCCS
   6.2 Submitting Claims and Encounters to the RBHA
7.0 REPORTING REQUIREMENTS
   7.1 Fraud and Program Abuse Reporting
   7.2 Medical Institution Reporting for Medicare Part D
   7.3 Seclusion and Restraint Reporting
   7.4 Reporting of Incidents, Accidents and Deaths
   7.5 Enrollment, Disenrollment and Other Data Submission
   7.6 Duty to Report Abuse, Neglect or Exploitation
   7.7 Duty to Warn
8.0 PERIODIC AUDITS AND SURVEYS
   8.1 Encounter Validation Studies
   8.3 Behavioral Health Recipient Statisfaction Survey
   8.4 Performance Improvement Projects
   8.5 Medical Care Evaluation Studies
9.0 TRAINING AND DEVELOPMENT
   9.1 Training Requirements
10.0 T/RBHA SPECIFIC REQUIREMENTS
   10.1 Members Residing in Boarding Homes
   10.2 DELETED; See Section 3.13
   10.3 Supported Housing Services
   10.4 Document Translation Services
   10.5 Interpreting Services
   10.6 Youth Transitioning to Adulthood
   10.7 System Collaboration with State/County Agencies
   10.8 Inquiry from Potential Provider
   10.9 Level I Prior Authorization Child and Family Team Process
   10.10 Distribution & Monitoring of ADHS/DBHS & CPSA Protocols for Network Management
   10.11 Network Provider ASAM Protocol for Detoxification Services
   10.12 Boarding Home Protocol
   10.13 Center for Excellence
   10.14 Crisis Planning and Risk Assessment
   10.15 Network/SAMHC Interface for Persons Presenting with Crisis Without Specific Medication Issues
   10.16 Out-of-Home Placement Monitoring Protocol
   10.17 Behavioral Health Medical Professional Involvement in the Child and Family Team and Adult Recovery Team Process
   10.18 Network Involvement in Collaborative Pre-Release Planning and Decision Making for Youth being Released from ADJC Secure Care Protocol
   10.19 Rural Service Provider Protocol
   10.20 Pre-Assignment of Substance Abuse Residential or Detoxification Non-Title XIX Members to a Comprehensive Service Network
   10.21 Psychiatric Health Facility (PHF) Treatment Provision Protocol
   10.22 Network Inpatient Treatment
   10.23 Mother Child Addictions Services/Mothers Caring About Self GSA 5
   10.24 Extended Care Unit (ECU) Referral, Utilization, and Treatment Provision
   10.25 Comprehensive Service Networks Urgent and After Hours Services Protocol
   10.26 Telemedicine Services
   10.27 Guidelines for Enrolled Members in Emergency Departments
   10.28 Adult Services Protocol for Network Coordination with SAMHC Behavioral Health Services for Crisis Subacute Bed Admission
   10.29 Individual Counseling and Therapy Referrals
   10.30 Network/Community Service Agency Coordination of Care
   10.31 Urgent Behavioral Health Resonse - GSA 3
   10.32 Urgent Behavioral Health Response – GSA 5
11.0 DEFINITIONS
 
12.0 FACT SHEETS (Under Construction)
 
13.0 FORMS AND ATTACHMENTS
 
14.0 INDEX
 

 
CPSA receives funding from the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS), Arizona Health Care Cost Containment System (AHCCCS), and Substance Abuse and Mental Health Services Administration (SAMHSA).
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