DBHS-NARBHA Provider Policy Manual

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 Services
• 3-14 Securing Services and Prior Authorization
• 3-15 Psychotropic Medication: Prescribing and Monitoring
• 3-16 Medication Formularies
• 3-17 Transition of Persons
• 3-18 Pre-Petition Screening, Court-Ordered Evaluation and Court-Ordered Treatment
• 3-19 Special Populations
• 3-20 Credentialing and Recredentialing
• 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, Primary Care Providers and Medicare Providers
• 4-4 Coordination of Care with Other Governmental 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 Requests for Investigation for Persons Determined to have a Serious Mental Illness (SMI)
• 5-4 Special Assistance for Persons Determined to have a Serious Mental Illness
• 5-5 Notice and Appeal Requirements (SMI and Non-SMI/Non-Title XIX/XXI)
• 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 REQUIRMENTS

• 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
• 8-2 Independent Case Review
• 8-3 Behavioral Health Recipient Satisfaction Survey
• 8-4 Quality Improvement Projects
• 8-5 MCE Studies

9.0 TRAINING AND DEVELOPMENT

• 9-1 Training Requirements

10.0       T/RBHA SPECIFIC REQUIREMENTS

• 10-1 Financial Management and Reporting
• 10-2 Environment of Care and Infection Control
• 10-3 Care Delivery
• 10-4 Subacute and TGC-Psychiatric Acute Care Unit (PAC) Census Data
• 10-5 Prevention Procedures
• 10-6 Coordination of Care for Referrals to In-Network GSA 1 NARBHA Inpatient, and Chemical Dependency (CD) Residential Facilities
• 10-7 Sentinel Events
• 10-8 Member Education/Communication
• 10-9 HIPAA Joint NARBHA RA Privacy Notice
• 10-10 Clinical Telemedicine Services
• 10-11 Member Rights
• 10-12 Member Representative Function
• 10-13 Provider Compliance Programs for Fraud and Abuse
• 10-14 Notifying NARBHA of Intent to Pay Fee-For-Service Provider Services
• 10-15 Crisis Screening, Assessment and Mobile Crisis Services
• 10-16 Transition to Adulthood Services
• 10-17 Member Choice and Transfers between Providers
• 10-18 Clinical Practice Protocols and Guidelines 
• 10-20 Accessing Interpretation and Translation Services

11.0 DEFINITIONS

12.0 FACT SHEETS

13.0 FORMS (click for all forms)

14.0 INDEX