AHCCCS Medical Policy Manual Revision History

Recent Revisions
What's New Chapters Affected
2014-05 Chapter 300, Medical Policy for AHCCCS Covered Services Exhibit 300-3B, Dental HCPC Code Information (Limited to Adult Members 21 Years of Age and Older)
2014-04 Chapter 700, School-Based Claiming Program/Direct Service Claiming – Policy 710, Medical and Financial Records
2014-03 Chapter 800, Fee for Service Quality and Utilization Management, Policy 810, Utilization Management Overview; Appendix K, Exhibits 1620-11, Sample Critical Service Gap Report, 1620-15, Assisted Living Facility (ALF) Residency Agreement, and 1620-16 Assisted Living Facility (ALF) Financial Change Agreement
2014-02 Chapter 800, Fee for Service Quality and Utilization Management, Policy 810, Utilization Management Overview; Appendix K, Exhibits 1620-11, Sample Critical Service Gap Report, 1620-15, Assisted Living Facility (ALF) Residency Agreement, and 1620-16 Assisted Living Facility (ALF) Financial Change Agreement
2014-01 Appendix A, Reporting Templates; Appendix B, EPSDT Standards and Tracking Forms; Chapter 400, Policies 430-450, Medical Policy for Maternal and Child Health; Chapter 900, Policy 950, Credentialing and Recredentialing Processes.
2013-09 Chapter 300, Policy 310-P, Medical Supplies, DME, Orthotic/Prosthetic Devices; Policy 310-M, Immunizations; Policy 310-Z, Sleep Studies (Polysomnography)
2013-08 Chapter 100, Introduction; Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-B, Behavioral Health Services, Policy 310-J, Hospice Services; Policy 310-K, Hospital Inpatient Services, Policy 310-R, Nursing Facility (NF) Services, Policy 320-E, Health and Behavior Intervention, Policy 320L, Neuropsychological Testing, Policy 330, Covered Conditions and Services for the Children’s Rehabilitative Services (CRS) Program, Exhibit 310-1, AHCCCS Rule Emergency Medical and BM Services for Non-FES Members; Chapter 500, Care Coordination Requirements. Policy 570, Community Collaborative Care Teams; Chapter 600, Provider Qualifications and Provider Requirements, Policy 610, AHCCCS Provider Qualifications; Chapter 700, School-Based Claiming Program/Direct Service Claiming, Policy 720, Covered Services; Chapter 900, Quality Management and Performance Improvement Program, Policy 910 QM/PI Program Administrative Requirements, 920 QM/PI Program Scope; Chapter 1000, Medical Management / Utilization Management (MM/UM), Policy 1020; Chapter 1100, Federal Emergency Services Program; 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; Chapter 1600, Case Management, Policy 1610, 1620, 1620-G, 1620-I, and Exhibits 1620-2 and 1620-6
2013-07 Chapter 300, Medical Policy for Covered Services, Policy 330, covered conditions and Services for the Children’s rehabilitative Services (CRS) Program. Chapter 400, Medical Policy for Maternal and Child Health. Exhibits 400-1, 400-2A, 400-2B, 400-2C, 410-1, 410-2, 410-3, 410-4, 410-5, 410-6, 420-1, and 420-2. Chapter 500, Care Coordination Requirements, Policy 540, Other Care Coordination Issues and Policy 560, CRS Care Coordination and Service Plan (SP) Management. Chapter 900, Quality Management and Performance Improvement Program
2013-06 Chapter 300, Policy 310-T, Physician Services, 310-H, Health Risk Assessment and Screening Tests and Exhibit 300-3, Benefit Change Implementation.
2013-05 Chapter 300, Policy 310-EE, Negative Pressure Wound Therapy (NPWT).
2013-04 Main Table of Contents. Chapter 300, Policies, 310-A, Audiology, 310-N, Laboratory, 310-Y, Respiratory Therapy, 310-AA, Total Parenteral Nutrition, and 310-DD, covered Transplants and Immunosuppressant Medications.
2013-03 Chapter 1200, Policy 1230-A, Assisted Living Facilities. Exhibit 1620-13, Service Plan located in Appendix K, Select ALTCS Case Management Forms in Spanish. Exhibit 1300-3, Agency with Choice Individual Representative Form located in Appendix K, Select ALTCS Case Management Forms in Spanish.
2013-02 Exhibit 610-1, AHCCCS Provider Type.
2013-01 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.
2012-13 Chapter 300, Medical Policy For AHCCCS Covered Services, Policy 310-V, Prescription Medications/Pharmacy Services.
2012-12 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.
2012-11 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.
2012-10 Chapter 800, Fee-For-Services Quality and Utilization Management, Chapter Overview and Policy 810, Utilization Management Overview.
2012-9 Chapter 100, Manual Overview and Appendix J, FFS Mileage Reimbursement Form for FFS Independent Service Providers.
2012-8 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.
2012-7 Chapter 600, Provider Qualifications and Provider Requirements.
2012-6 Appendix K, Select ALTCS Case Management Forms in Spanish, Exhibit 1620-15, Assisted Living Facility (ALF) Residency Agreement.
2012-5 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.
2012-4 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.
2012-3 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
2012-2 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.
2012-01 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.
2011-10 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.
2011-9 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.
2011-8

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.

2011-7 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.
2011-6

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. 

2011-5 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.
2011-4

Chapter 300, Medical Policy for AHCCCS Covered Services, Policy 310-DD, Covered Transplants and Immunosuppressant Medication

2011-3

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

2011-02

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.

2011-01

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.

2010-8 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
2010-07 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
2010 - 06 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
2010 - 05 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;
2010-04 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.
2010-03 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.
2010-02 Chapter 1600: Policy 1620 - Case Management Standards, Exhibit 1620-14 - AHCCCS/ALTCS Contingency/Back-up Plan.
2010-01 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.
December 2009 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
November 2009 Chapter 1200: Exhibit 1240-4 - AHCCCS/ALTCS FFS Home Modification Request/Justification Form; Appendix A: EPSDT and Adult Quarterly Monitoring Report
October 2009 - second release Policy 320-A: Affiliated Practice Dental Hygienist Policy; Policy 430: EPSDT Services; Policy 720-C: Nursing and Personal Care Services
October 2009 - first release 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
September 2009 Chapter 300-Policy 310-S: Observation Services; Chapter 800-Policy 820-P: Observation Services that Exceed 24 Hours; Chapter 1600-Exhibit 1620-10
June 2009 Chapter 300-Policy 320-K: Tobacco Cessation Product Policy; Chapter 1200-Policy 1200-Overview
April 2009 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
February 2009 Chapter 300-Policy 310DD & Policy 320-B; Chapter 800-Policy 810; Chapter 1100, Appendix G-Behavioral Health Services Guide
January 2009 Chapter 400-Policy 430 & Exhibit 430-2; Chapter 1200-Policy 1240-M; Chapter 1600-Policy 1620 & Policy 1630

NOTE: Contact AHCCCS for prior revision information.