Regional Behavioral Health Authority

HEALTH

White Mountain Apache

ABHS

ADHS/DBHS Provider Manual and ABHS Member Handbook

TABLE OF CONTENTS

SCOPE

1.0

INTRODUCTION

2.0

         3.0           CLINICAL OPERATIONS

Eligibility Screening for AHCCCS Health Insuracne, Medicare Part D Prescription Drug Coverage, and the Limited Income Subsidy Program


3.1

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ARIZONA DEPARTMENT OF HEALTH SERVICES


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AHCCCS INFORMATION




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Indian Health Service Behavioral Health



Appontment Standards and Timeliness of Service


3.2

Referral Process


3.3

Co-Payments


3.4

Third Party Liability and Coordination of Benefits


3.5

ABHS Member Handbook

Member Handbooks


3.6

Clinical Liaison


3.7

Outreach, Engagement, Re-Engagement and Closure


3.8

Intake, Assessment and Service Planning


3.9

SMI Eligibility Determination


3.10

General and Informed Consent to Treatment


3.11

Advance Directives


3.12

Covered Behavioral Health Services


3.13

Securing Services and Prior Authorization


3.14

Psychotropic Medications: Prescribing and Monitoring


3.15

Medication Formulary


3.16

Transition of Persons


3.17

Pre-Petition Screening, Court Ordered Evaluation and Tratment


3.18

Special Populations


3.19

Credentailing and Privileging


3.20

Service Prioritization for Non-Tile XIX/XXI Funding


3.21

Out-of-State Placements for Children and Young Adults


3.22

Cultural Competence


3.23

Reserved


Crisis Intervention Services


3.25

Housing for Individuals Determined to have a Serious Metnal Illness (SMI)


3.26

Disclosure of Behavioral Health Information


4.1

Behavioral Health Medical Record Standards


4.2

Coordination of Care with AHCCCS Health Plans, Primary Care Providers and Medicare Providers


4.3

Coordination of Care with Other Governmental Entities


4.4

Partnership with Families and Family-run Organizations in the Children’s Behavioral Heath System


4.5

         4.0           COMMUNICATION AND CARE COORDINATION

Notice Requirements and Appeal Process for Title XIX and Title XXI Eligible Persons


5.1

Member Complaints


5.2

Grievance and Request for Investigations for Persons Determined to have a Serious Mental Illness


5.3

Special Assistance for SMI Members


5.4

Notice and Appeal Requirements (SMI and General)


5.5

         5.0          MEMBER RIGHTS AND PROVIDER CLAIMS DISPUTES

Provider Claims Disputes


5.6

Submitting Claims and Encounters


6.1

Submitting Claims and Encounters to the RBHA


6.2

         6.0          DATA AND BILLING REQUIREMENTS

         7.0          REPORTING REQUIREMENTS

Fraud and Abuse Reporting


7.1

Institutions for Mental Disease (IMD) Reporting


7.2

Seclusion and Restraint Reporting


7.3

Reporting and Incidents, Accidents and Deaths


7.4

Enrollment, Disenrollment and Other Data Submission


7.5

Duty to Report Abuse

s

7.6

Duty to Warn


7.7

         8.0          PERIODIC AUDITS AND SURVEYS

Encounter Validation Studies


8.1

Independent Case Review


8.2

Consumer and Familiy Satisfaction Survey


8.3

Performance Improvement Projects


8.4

Medical Care Evaluation Studies


8.5

         9.0          TRAINING AND DEVELOPMENT

Training Requirements


9.1

         10.0         T/RBHA SPECIFIC REQUIREMENTS

Health and Safety


10.0

Emergency Preparedness and Business Continuity

10.2

HIS Notification Requirements


10.3

DEFINITIONS

11.0

FACT SHEETS

12.0

FORMS AND ATTACHMENTS

13.0

INDEX

14.0

Provider Listing

On Call Packet