Recent Revisions
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What's New
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Chapters Affected
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2013-02
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Exhibit 610-1, AHCCCS Provider Type.
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2013-01
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Main Table of Contents. Chapter 1200, Arizona Long Term Care System Services and
Settings for Members Who are Elderly And/Or Have Physical Disabilities and/or Have
Developmental Disabilities, Policy 1230-A, Direct Care Services (Attendant Care,
Personal Care, and Homemaker. Chapter 1200, Policy 1240-E, Habilitation. Chapter
1300, Self-Directed Attendant Care (SDAC) Operations. Chapter 1600, Case
Management, Policy 1620, ALTCS Case Management Procedures. Exhibit 1620-5,
Case Management Standards Assisted Living Center/Single Occupancy Form
(Reserved). Exhibit 1620-13, Service Plan. Exhibit 1620-17, HCBS Needs Tool.
Chapter 1600, Policy 1630, Case Management Administrative Procedures.
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2012-13
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Chapter 300, Medical Policy For AHCCCS Covered Services, Policy 310-V,
Prescription Medications/Pharmacy Services.
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2012-12
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Chapter 300, Medical Policy For AHCCCS Covered Services, Policy 310-DD Covered
Transplant and Related Immunosuppressant Medications. Chapter 1200, Arizona
Long Term Care system Services and Settings for Members Who are Elderly and/or
Have Physical Disabilities and/or Have Developmental Disabilities, Policy 1240-
Direct Care Services.
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2012-11
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Chapter 300, Medical Policy For AHCCCS Covered Services, Policy 310-V, Prescription
Medication/Pharmacy Services. Chapter 300, Medical Policy for AHCCCS Covered Services,
Policy 310-K, Hospital Inpatient Services and Exhibit 300-3D, Inpatient Limit: Member
& Contractor Responsibility Acute & ALTCS Members 21 Years of Age and Older (Medicaid
Only, QMB Dual and Non-QMB Dual Status). Chapter 900, Quality Management and Performance
Improvement Program, Policy 950, Credentialing and Recredentialing Processes.
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2012-10
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Chapter 800, Fee-For-Services Quality and Utilization Management, Chapter Overview
and Policy 810, Utilization Management Overview.
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2012-9
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Chapter 100, Manual Overview and Appendix J, FFS Mileage Reimbursement Form for
FFS Independent Service Providers.
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2012-8
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Chapter 300, Policy 320-B, AHCCCS Member Participation in Experimental Treatment.
Chapter 1000, Utilization Management Program. Chapter 1100, Federal Emergency Services
(FES) Program. Chapter 1200, ALTCS Services and Settings for Members Who Are Elderly
and/or Have Physical Disabilities and/or Have Developmental Disabilities. Chapter
1600, Case Management, Policy 1620-F, Tribal Fee-For-Service Standard.
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2012-7
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Chapter 600, Provider Qualifications and Provider Requirements.
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2012-6
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Appendix K, Select ALTCS Case Management Forms in Spanish, Exhibit 1620-15, Assisted
Living Facility (ALF) Residency Agreement.
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2012-5
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Chapter 700, School-Based Claiming Program/Direct Service Claiming. Chapter 1600,
Case Management, Exhibit 1620-17, Home and Community Based Services (HCBS) Needs
Assessment Tool. Exhibit 1620-15, Alternative Living Facility (ALF) Residency Agreement
was also amended.
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2012-4
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Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-V, Prescription
Medication/Pharmacy Services was revised. Language was added to reflect the implementation
of 340B reimbursement per A.A.C. R-9-22-710. This reimbursement methodology will
be used by AHCCCS and its Contractors for Federally Qualified Health Centers (FQHC)
and FQHC Look-Alike Pharmacies, and Contract Pharmacies that have entered into a
340B drug purchasing agreement with any 340B entity. The effective date for this
policy is 4/9/2012. Chapter 300, Medical Policy for AHCCCS Covered Services, Policy
320-I, Telehealth and Telemedicine, was revised for clarification of services that
are covered when delivered via telemedicine. Definitions were also revised and added
to this policy. A list of specific services was added that are covered when delivered
via telemedicine. Exceptions to the use of telecommunications have also been added
to the policy. Chapter 400 Medical Policy for Maternal and Child Health, Exhibit
430-2, AHCCCS Recommended Childhood and Adolescent Immunization Schedules was revised.
The Centers for Disease Control and Prevention (CDC) has extended the MCV4-D (Menactra
vaccine) to use in children as young as nine months of age. The Exhibit has been
revised to reflect this change. Chapter 900, Quality Management and Performance
Improvement Program, was revised and updated in order to provide clarification.
The peer review committee standards, behavioral health facilities and notification
in writing of any adverse actions taken against a health care provider were revised.
Language was removed for requirements related to Contractors’ review of the Medicare
Exclusion Database (MED) and the review of the results or medical record audits.
In addition, language regarding Provider-Preventable Conditions as required in 42
CFR Section 447.26, was also added. Additional hospital days or other additional
charges resulting from Healthcare Acquired Conditions or Other Provider Preventable
Conditions will not be reimbursed. This section of the policy is effective 7/01/2012.
Chapter 1000, Utilization Management Program, was revised in order to update and
provide clarification. The areas of discharge planning, inter-rater reliability
and the grievance process were each revised for clarification. Language was added
to reflect the 25 inpatient day limit and reporting requirements for Quarterly Utilization
Management Plan and Non-Transplant Catastrophic Reinsurance was also revised. As
in Chapter 900, language regarding Provider-Preventable Conditions was added to
Chapter 1000. This section of the policy is effective 7/01/2012. Chapter 1100, Federal
Emergency Services (FES) Program, was revised to clarify requirements and coverage
within the program. This revision specifically clarifies emergency service settings,
requirements for outpatient dialysis, provider requirements, and the exclusion of
transplant services from coverage under the FESP. Chapter 1600, Case Management,
Exhibit 1620-6, Behavioral Health Reinsurance Request Form was revised. The revision
of this exhibit provides a place for reporting changes in Contractor enrollment
for members who are approved for Behavioral Health Reinsurance. Appendix A, EPSDT
Improvement and Adult Quarterly Monitoring Report Instruction and Template, was
revised. This Appendix has been revised to reflect the EPSDT and adult requirements
found in AMPM Chapter 400, Medical Policy for Maternal and Child Health.
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2012-3
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Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-K, Hospital
Inpatient Services was revised. The following language was struck from policy to
reflect 2010 AHCCCS benefit changes related to podiatry services, “Podiatry services
performed by a podiatrist and ordered by a primary care provider.” Chapter 300,
Medical Policy for AHCCCS Covered Services, Policy 310-S, Observation Services,
was revised regarding the practice of documenting when a patient has changed from
inpatient to observation by a physician or authorized individual within 12 hours
after admission as an inpatient. The following sentence was struck to bring the
policy into conformity with current practice, “Inpatient to Observation must be
made by a physician or authorized individual and occur within 12 hours after admission
as an inpatient.” Chapter 300, Medical Policy for AHCCCS Covered Services, Policy
310-Z, Sleep Studies (Polysomnography), 320-K-1, Tobacco Cessation Product Policy,
Exhibit 320-K-1, Prior Authorization Protocol for Smoking Cessation Aids, and Policy
320-L, Neuropsychological Testing, were routinely reviewed with only minor grammatical
and/or formatting changes being made. Chapter 300, Medical Policy for AHCCCS Covered
Services, Policy 310-BB, Transportation, was revised. Language was added to define
ambulatory vehicle, stretcher van, wheelchair van and taxi. Requirements for medically
necessary non-emergency transportation furnished by non-ambulance providers have
been added to the policy. Organizational changes have also been made for greater
clarity. Chapter 500, Care Coordination Requirements, Policy 570, Community Collaborative
Care Teams, is a new policy to this chapter. A work group comprised of ADHS/DBHS,
RBHA, DDD, family members and AHCCCS staff came together for a one year time period
to establish a process for DHS/DBHS and DDD to collaboratively address the needs
of complex, multi-diagnosed ALTCS/DDD members with behaviors that have not responded
to traditional care settings and interventions. The policy organizes staff with
clinical experience at the RBHA and DDD district level to respond to and address
issues with this population. Legal references and provider types in Chapter 600,
Provider Qualifications and Provider Requirements, Exhibit 610-1, were updated.
Chapter 800, Fee-For-Service Quality and Utilization Management, Policy 820, Prior
Authorization Requirements, was revised. Language related to authorization requirements
to receive non-emergency transportation services for American Indian Health Plan
members was relocated from Policy 310-BB, Transportation, to Policy 820, Prior Authorization
Requirements
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2012-2
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Chapter 600, Provider Qualification and Requirements, Policy 610 AHCCCS Provider
Qualifications, has been revised per the Affordable Care Act to reflect that institutions
(companies/facilities) are required to pay an enrollment fee. In addition, specific
provider types will require an OIG site visit prior to enrollment and are subject
to unannounced post enrollment site visits. The effective date of these changes
was January 1, 2012. Exhibit 610-1, AHCCCS Provider Types, was revised to eliminate
the provider types for School Based Guidance Counselor and School Based Certified
School Psychologist with an effective date of 7/1/2011.
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2012-01
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Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-S, Observation
Services, has been updated to clarify that as long as medical necessity exists there
is no maximum time limit for observation services. Chapter 800, Fee-For-Service
Quality and Utilization Management, Policy 820, Prior Authorization Requirements,
was also revised regarding observation services. Language was added to clarify that
as long as medical necessity exists there is no maximum time limit for observation
services.
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2011-10
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Chapter 300, Medical Policy for AHCCCS Covered Services, Exhibit 300-1, AHCCCS Coved
Services, Acute Care, has been updated to reflect current legislation, A.R.S. 36-2907
and 2989 which adds hospice car e to the list of covered services. Minor technical
changes in formatting were also made. Chapter 300, Medical Policy for AHCCCS Covered
Services, Policy 310-S, Observation Services, was revised to clarify that when observation
exceeds 24 hours, medical review will be performed. The effective date of this policy
is 11/01/2011. Chapter 500 Care Coordination Requirements Policy 530, Member Transfers
Between Facilities was revised. Repetitive language related to stabilization of
a member during transfer was removed from Policy 530. The effective date of the
policy is 11/01/2011. Chapter 500 Care Coordination Requirements, Policy 540, Other
Care Coordination Issues, was revised and Arizona Department of Health Services
Children’s Rehabilitative Services program was corrected to Children’s Rehabilitative
Services Program. Chapter 500, Care Coordination Requirements, Policy 550, Member
Records and Confidentiality was revised. The reference to Policy 650 was removed
from this policy because Policy 650 is currently a reserved section in the AMPM.
Chapter 800, Fee-For-Service Quality and Utilization Management, Policy 820, Prior
Authorization Requirements was revised. Pursuant to R9-22-204 and R9-22-215, AMPM
Policy 820, Prior Authorization Requirements, has been revised to reflect the elimination
of prior authorization requirements for several services. Policy 820 was also revised
regarding observation services. This language is consistent with language added
to Policy 310-S, Observation Services, as discussed above. The effective date of
this policy is 11/01/2011.
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2011-9
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Chapter 300, Exhibit 300-3D, Inpatient Limit: Member and Contractor Responsibility,
Acute & ALTCS Members 21 Years of Age and Older (Medicaid Only, QMB Dual and Non-QMB
Dual Status), was added to Chapter 300 of the AMPM to reflect the fiscal responsibilities
which vary dependent on the member status (Medicaid Only, QMB Dual and Non-QMB Dual
Status). Chapter 300, Policy 310-B, Behavioral Health Services, was revised. It
has been amended to reflect the decrease in the number of respite hours from 720
to 600 hours within a one year time period for adults and children receiving ALTCS
Services and/or Behavioral Health Services. Chapter 300, Policy 310-K, Hospital
Inpatient Services, has been revised. Language has been added to reflect the 25
day inpatient hospital limit with a one-year time period for adults in the Acute
and ALTCS programs. Chapter 300, Policy 310-S, Observation Services has been revised.
Language has been added to reflect the 25 day inpatient hospital limit as described
in policy 310-K. Chapter 4000, Policy 410, Maternity Care Services, has been revised.
Language has been added to reflect the 25 day inpatient hospital limit as described
in Policy 310-K and its application to 48/96 hour hospital stays for childbirth.
Chapter 500, Exhibit 520-1, Acute ETI Form, has been revised. Language has been
added to capture the number of inpatient hospital days utilized toward the 25 day
inpatient limit and/ or the number of respite hours utilized toward the 600 hour
limit used within the current benefit year. Chapter 800, Policy 820, Prior Authorization
Requirements, has been revised. Language has been added to reflect the 25 day inpatient
hospital limit as described in Policy 310-K and to correspond with language added
in Policy 410 regarding pregnancy hospital stays. Chapter 1200, Policy 1250-E, Respite
Care, has been revised. The policy was amended to reflect the decrease in the number
of respite hours from 720 to 600 hours within a one year time period for adults
and children receiving ALTCS Services and/or Behavioral Health Services. Chapter
1600, Exhibit 1620-9, ALTCS ETI Form. Language has been added to capture the number
of inpatient hospital days utilized toward the 25 day inpatient limit and/ or the
number of respite hours utilized toward the 600 hour limit used within the current
benefit year. Appendix H, Policy for Management of Acute Behavioral Health Situations,
has been added as an appendix to the AMPM. This Policy addresses the management
of acute behavioral health situations in non-behavioral health units. Language has
been added to Policy 1620-VII, Policy 310-B, the AMPM Main Table of Contents and
Appendices Table of Contents in the AMPM to reference this new policy found in Appendix
H.
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2011-8
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Chapter 300, Policy 310-R, Nursing Facility (NF) Services, was revised. Language
was changed to require 60 days for the acute care Contractor to notify DMS. Chapter
300, Policy 320-C, Breast and Cervical Cancer Treatment Program, was revised. Language
was added to allow AHCCCS Division of Member Services to send follow-up treatment
forms for the BCCTP to AHCCCS Department of Fee-for-Service Management/Prior Authorization
Unit or the IHS/638 BCCTP clinic. Chapter 300, Policy 320-F, HIV/AIDS Treatments
Services, was reviewed. It was determined that no changes to this policy were necessary
at this time. Chapter 600, Exhibit 610-1, AHCCCS Provider Types, was revised. Language
was changed for Provider type 85 from Licensed Independent Social Worker (LISW)
to Licensed Clinical Social Worker (LCSW) in order to conform to A.R.S. Title 32,
Chapter 33, Article 5. Chapter 400, Policy 410, Maternity Care Services, and Exhibit
410-1, AHCCCS Certificate of Necessity for Pregnancy Termination, were revised.
Language has been added to require additional documentation to provide information
necessary to allow AHCCCS and its Contractors to verify that the pregnancy termination
meets the requirements for either the federal or state-only classifications.
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2011-7
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Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-E, Dialysis,
this policy was reviewed and no changes were made. Chapter 300, Medical Policy for
AHCCCS Covered Services, Policy 320-G, Lung Volume Reduction Surgery (LVRS), this
policy was reviewed and no changes were made. Chapter 300, Medical Policy for AHCCCS
Covered Services, Policy 320-M, Medical Marijuana, AMPM policy 320-M was created
to state AHCCCS’ policy on medical marijuana in response to the Arizona Medical
Marijuana Act passed by Arizona voters in 2010. This policy specifies that
AHCCCS does not cover medical marijuana as a medical or a pharmacy benefit.
Policy 310-T, Physician Services, and 310-V, Prescription Medication/Pharmacy Services,
had language added to reference Policy 320-M. Chapter 1200, ALTCS Services
and Settings for Members Who Are Elderly and/or Have Physical Disabilities and/or
have Developmental Disabilities, Policy 1240-M, Nutritional Assessments and Nutritional
Therapy, and Chapter 400, Medical Policy for Maternal and Child Health, Policy 430,
EPSDT Services, changes were made to both policies to reflect the elimination of
prior authorization from AHCCCS Administration for commercial oral nutritional supplements
for FFS members in the ALTCS program. Language was also added to clarify the
roles of Tribal ALTCS Case Managers.
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2011-6
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Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-J, Hospice Services,
Per ARS§§36-2907 and 2989, hospice care has been added to the list of covered services
and has been revised to reflect this addition. Chapter 300, Medical Policy
for AHCCCS Covered Services, Policy 310-L, Hysterectomy, language has been added
to the hysterectomy policy to ensure adherence with federal regulations and provide
greater clarity regarding when this procedure may or may not be indicated.
Chapter 400, Medical Policy for Maternal and Child Health, Exhibit 430-2, Recommended
Childhood and Adolescent Immunization Schedules, the Advisory Committee on Immunization
Practices (ACIP) updated its recommendation for the use of tetanus and diphtheria
toxoids and acellular pertussis (Tdap) vaccines as well as meningococcal conjugate
vaccines. These new guidelines were published in the January 28, 2011 issue
of the “MMWR Morbidity and Mortality Weekly Report.” The immunization schedules
in Exhibit 430-2, have been updated to reflect these recommendations. Chapter 1200,
Arizona Long Term Care System Services and Settings for Members Who Are Elderly
and/or Have Physical Disabilities and/or Have Developmental Disabilities, Policy
1250-E, Respite Care, and Chapter 1600, Case Management, Policy 1620-III, Cost Effectiveness
Study Standard, these policies were amended to ensure the conformity of AHCCCS respite
care policy with current regulation.
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2011-5
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Chapter 300, Medical Policy for AHCCCS Covered Services, Policies 310-G, Eye Examinations/Optometry
Services, 310-L, Hysterectomy, 310-O, Maternal and Child Health Services, Policy
310-R, Nursing Facility Services, Policy 310-W, Radiology and Medical Imaging, and
Policy 310-CC, Triage/Screening and Evaluation of Emergency Medical Conditions were
reviewed to ensure adherence to current federal and state regulations. It was determined
that no changes to the above policies were necessary at this time. Chapter 300,
Medical Policy for AHCCCS Covered Services, Policy 310-B, Behavioral Health Services,
Appendices E & F, Childhood and Adolescent Behavioral Health Tool Kits and Adult
Behavioral Health Tool Kits, were also reviewed to ensure adherence to current federal
and state regulations. Dates that are no longer relevant were removed and minor
language changes were made to clarify titles in the appendices. Chapter 300, Medical
Policy for AHCCCS Covered Services, Policy 310-I, Home Health Services & Policy
310-X, Rehabilitation Therapies (Occupational, Physical and Speech) were reviewed.
Language has been added to reflect the application of the physical therapy benefit
limit to home and community settings such as the member’s own home and alternative
residential settings.
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2011-4
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Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-DD, Covered
Transplants and Immunosuppressant Medication
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2011-3
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Chapter 1200, Arizona Long Term Care System Services and Settings for Members Who
are Elderly and/or Have Physical Disabilities and/or have developmental Disabilities,
Exhibit 1230-1, ALTCS Alternative Residential Settings, Service Codes and Applicable
Units of Service, Chapter 1300, Self Directed Attendant Care (SDAC) Option, Appendix
K, Select ALTCS Case Management Forms in Spanish
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2011-02
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AMPM Main Table of Contents, Chapter 300, Medical Policy for AHCCCCS Covered Services,
Chapter Overview and Policy 330, Covered Conditions and Services for the Children’s
Rehabilitative Services (CRS) Program, Chapter 400, Medical Policy for Maternal
and Child Health Policy 450, has been reserved, Chapter 500, Care Coordination Requirement
Overview, Policy 520, Member Transitions, Policy 520-F, Transition to an Acute Care/ALTCS
contractor by a CRS Member who is turning 21 years of age, Policy 560, CRS Care
Coordination and Service Plan (SP) Management
Chapter 1000, Medical Management/Utilization Management Policy 1020, MM/UM Scope
and Components.
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2011-01
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Chapter 400, Medical Policy for Maternal and Child Health, Exhibit 430-4 & 430-5,
Chapter 900, Quality Management and Performance Improvement Program, Chapter 1200,
ALTCS Services and Settings for the Elderly and/or Disabled, Policy 1240, Home and
Community Based Services, Supervisory Visits applicable to all Homemaker, Personal
Care, and Attendant Care Agencies, and Attendant Care Agencies, Policy 1240-D Community
Transition Services, Chapter 1300, Self Directed Attendant Care (SDAC) Option, Chapter
1600, Case Management.
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2010-8
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Chapter 100- Introduction, Children’s Rehabilitative Services (CSR), Children’s
Rehabilitative Services Recipient, Chapter 300 Medical Policy for AHCCCCS Covered
Services, Policy 310-A, Audiology, 310-B, Behavioral Health Services, Policy 310-C,
Breast Reconstruction after Mastectomy, Policy 310-AA, Total Parenteral Nutrition,
300-3C, Application of Physical Therapy 15 visit Outpatient Limit for Acute and
ALTCS members 21 years of age and older, Chapter 1000, Utilization Management, Policy
1020, MM/UM Scope and components, Section C, New Exhibits, Exhibit 1030-/A, Medical
Management/Utilization Management Plan Checklist, Exhibit 1030-B, Medical Management
Plan Template, Exhibit 1030-C, Work Plan Template Sample, Chapter 1600 ALTCS Case
Management
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2010-07
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Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-J, Hospice Services/End
of Life Care, Policy 310-V, Prescription Medication / Pharmacy Services, Chapter
700, School based Claiming Program / Direct Service Claiming, Policy 710, Medical
and Financial Records
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2010
- 06
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Chapter 300, Chapter Overview, Exhibit 300-1 AHCCCS Covered Services for Acute Care,
Exhibit 300-3 and attachments, Policy 310-D, Dental services for members 21 years
and older, Policy 310-H, Health Risk Assessment and Screening Tests, Policy 310-P
Medical Supplies, DME and Orthotic Prosthetic Devices, Policy 310-U, Foot and Ankle
Services, Policy 310-X, Rehabilitative Services, Policy 310-DD, Covered Transplants
and Immunosuppressant Medications, Policy 320-D, Reserved (formerly Cochlear Implantation),
Policy 320-J, High Frequency Chest Wall Oscillation, Chapter 400, Medical Policy
for Maternal and Child Health, Policy 430 EPSDT Services, Section C. 8. Cochlear
and Osseointegrated Implantation, Chapter 500, Care Coordination Requirements, Policy
510, Primary Care Providers PCPs, Chapter 500, Care Coordination Requirements Policy
510, Primary Care Providers PCPs, Chapter 700, School Based Claiming Program/ Direct
Service Claiming Policy 720, Covered Services, Section C, Therapies Chapter
800, Fee-For-Service Quality and Utilization Management Policy 820, Prior Authorization
Requirements, Chapter 900, Quality Management and Performance Improvement Program
Policy 950, Credentialing and Recredentialing Processes, Chapter 1000, Medical Management
/ Utilization Management Policy 1010, General Requirements, Section C. MM/UM Administrative
Oversight, Chapter 1200, ALTCS, Services and Settings for Members who are Elderly
and/or have Physical Disabilities and/or have Developmental Disabilities Policy
1250-F, Therapies, Chapter 1600, Policy Exhibit 1620-9, ALTCS Enrollment Transition
Information Form
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2010 -
05
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Chapter 700, School-Based Claiming Program / Direct Service Claiming; Chapter 800,
Fee-For-Service Quality and Utilization Management; Chapter 300, Policy 310-M, Immunizations
Policy; Exhibit 1240-4, AHCCCS/ALTCS FFS Home Modification Request/Justification
Form; Chapter 1250-E, Respite Example deleted; Exhibit 1620-14, AHCCCS/ALTCS Member
Contingency/Back-Up Plan;
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2010-04
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Chapter 1600: Policy 1610 - Components of ALTCS Case Management, Policy 1620-II
- Needs Assessment/Care Planning Standard, Policy 1620-IV - Placement/Service Planning
Standard, Exhibit 1620-10 - Sample Important Member Rights Notice Form, Exhibit
1620-14 - AHCCCS/ALTCS Member Contingency/Back-Up Plan.
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2010-03
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Chapter 300: Policy 310-N - Laboratory, Policy 310-R - Nursing Facility Services,
Policy 320-H - Medical Foods; Chapter 400: Policy 430 - EPSDT Services, Exhibit
430-2 - Recommended Childhood Immunization Schedule; Chapter 1200: Exhibit 1210-1
- DME Included in the NF and ICF for the Mentally Retarded FFS Per Diem Rate; Appendix
D - Medical Foods Flow Charts.
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2010-02
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Chapter 1600: Policy 1620 - Case Management Standards, Exhibit 1620-14 - AHCCCS/ALTCS
Contingency/Back-up Plan.
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2010-01
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Chapter 300: Exhibit 300-1 - AHCCCS Covered Services - Acute Care, Policy 310-J
- Hospice Services, Policy 310-X - Rehabilitation Therapies (Occupational, Physical
and Speech Therapy); Chapter 600: Exhibit 610-1 - AHCCCS Provider Types; Chapter
700: Policy 720 - School Based Claiming Program - Covered Services; Chapter 1200:
Policy 1250 - Therapies.
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December 2009
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Chapter 1200: Exhibit 1240-6 - ALTCS HCBS Service Codes and Units of Service; Chapter
1600: Exhibit 1620-10 - Sample - Important Member Rights Notice Form; Appendix F:
Adult Behavioral Health Tool Kits
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November 2009
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Chapter 1200: Exhibit 1240-4 - AHCCCS/ALTCS FFS Home Modification Request/Justification
Form; Appendix A: EPSDT and Adult Quarterly Monitoring Report
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October 2009 - second release
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Policy 320-A: Affiliated Practice Dental Hygienist Policy; Policy 430: EPSDT Services;
Policy 720-C: Nursing and Personal Care Services
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October 2009 - first release
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Chapter 100: Entire Chapter Reviewed and Modified; Chapter 300 - Policy Changes
Related to Benefit Redesign: Policy 310-N - Laboratory, Policy 310-T - Physician
Services, Policy 310-Z - Sleep Studies (Polysomnography), Policy 310-EE - Negative
Pressure Wound Therapy; Chapter 300 - Other Changes: Policy 310-D - Dental Services
or Members 21 Years of Age and Older, Policy 310-V - Prescription Medication/Pharmacy
Services, Policy 310-DD - Covered Transplants and Related Immunosuppressant Medication,
Policy 320-L - Neuropsychological Testing; Chapter 400: Entire Chapter Reviewed
and Modified; Chapter 900: Entire Chapter Reviewed and Modified; Chapter 1200: Policy
1210 - Institutional Services and Settings; Appendix A: EPSDT Improvement and Adult
Quarterly Monitoring Report Instructions and Template; Appendix B: AHCCCS EPSDT
Tracking Forms
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September 2009
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Chapter 300-Policy 310-S: Observation Services; Chapter 800-Policy 820-P: Observation
Services that Exceed 24 Hours; Chapter 1600-Exhibit 1620-10
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June 2009
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Chapter 300-Policy 320-K: Tobacco Cessation Product Policy; Chapter 1200-Policy
1200-Overview
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April 2009
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Appendix E-Childhood and Adolescent Behavioral Health Tool Kits; Appendix F-Adult
Behavioral Health Tool Kits; Chapter 300-Policy 310B-Behavioral Health Services;
Chapter 400-Policy 430-EPSDT
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February 2009
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Chapter 300-Policy 310DD & Policy 320-B; Chapter 800-Policy 810; Chapter 1100,
Appendix G-Behavioral Health Services Guide
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January 2009
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Chapter 400-Policy 430 & Exhibit 430-2; Chapter 1200-Policy 1240-M; Chapter
1600-Policy 1620 & Policy 1630
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NOTE: Contact AHCCCS for prior revision information.
