View American Indian Member FAQs (.pdf)
View Provider FAQs - AHCCCS Complete Care for American Indians (.pdf)
View FAQs for Members with CRS Conditions (.pdf)
View Crisis Service FAQs (.pdf)(Updated 10/6/2020)
View FAQs for Providers (.pdf)
View Non-Title XIX/XXI FAQs (.pdf)
View the ACC Provider Flyer (.pdf)
A: Today most AHCCCS members have one health plan for physical healthcare services, and one health plan for behavioral healthcare services. An ACC Plan will give members access to a network of physical and behavioral healthcare providers for services. An ACC Plan will provide services for members with Children’s Rehabilitative Services (CRS) conditions. The ACC Plan will manage the network and all covered services. A member’s chosen ACC Plan will be the only Medicaid payer to providers for enrolled members.
A: AHCCCS Complete Care (ACC) starts on October 1, 2018.
A: Most adults and children on AHCCCS will be enrolled with ACC Plans, including members currently enrolled in CRS.
ACC will not affect members in the Arizona Long Term Care System (ALTCS), including those enrolled with DES/DDD. There are a few exceptions for members who are also eligible for CRS services. For more information about members enrolled with CRS, see http://www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/CRS/.
ACC will not affect members determined to have a Serious Mental Illness (SMI).
With the exception of foster care children currently enrolled in CRS, ACC will not affect most children in foster care enrolled in the Comprehensive Medical and Dental Program (CMDP).
A: The ACC Plan will join physical and behavioral health services together. Members will benefit by only having one health plan. The ACC Plan will help coordinate care for better outcomes and improved whole health for the member.
The ACC Plan offers choice of health plans for children in CRS.
A: Members will still have access to the same AHCCCS covered services with ACC Plans as they do with current health plans and Regional Behavioral Health Authorities (RBHAs).
A: More than one ACC Plan will be available in each GSA:
Note: ZIP codes 85542, 85192, 85550 are part of the South GSA to keep the San Carlos tribal land in one GSA.
A: The available service plans in each GSA can be found at: https://www.azahcccs.gov/shared/News/PressRelease/AHCCCSAwardsContractstoManagedCareOrganizations.html
A: Members in an acute health plan that will also be an ACC Plan in their service area will stay with their current health plan. These members will have choice of other ACC Plans in their annual enrollment choice month.
Members in a health plan that will not be an ACC Plan in their service area will be assigned an ACC Plan. Members in the same household will be assigned to the same ACC Plan. AHCCCS will send letters to tell members their assigned ACC Plan by the end of June, 2018. Members will be allowed to choose a different ACC Plan in their service area in July, 2018. ACC Plans will begin on October 1, 2018.
Some members in an acute plan that will also be an ACC Plan (not affiliated with their assigned RBHA) in their service area, who received behavioral health services through the RBHA in 2017, will be given a one-time choice to move to an ACC Plan that is affiliated with the RBHA in their service area. These members will be notified in late June 2018 and will be allowed to make their choice during the month of July, 2018.
A: Members should review the network of each ACC Plan to see each plan’s providers.
All ACC Plans must give at least a 90-day transition period for members who have an established relationship with a primary care provider (PCP) who does not work with the new ACC Plan. During that time, the member may continue to get care from their PCP while the member and/or ACC Plan find a PCP in the ACC Plan. However, even with this ACC Plan requirement, a provider may choose not to see a member enrolled with a plan the provider does not participate with.
Plans must also allow members who are getting active treatment for a serious and chronic physical, developmental or behavioral health condition to keep getting services from their provider until the treatment ends, or six months, whichever happens first. This will be allowed even if the provider does not participate in the member’s new ACC Plan. However, even with this ACC Plan requirement, a provider may choose not to see a member enrolled with a plan the provider does not participate with.
A: RBHAs will no longer serve most adults and children. This is because behavioral health services will be provided by the ACC Plan. RBHAs will continue to serve:
RBHAs will continue to provide crisis, grant funded and state-only funded services.
A: Yes, most CRS members will be enrolled in ACC Plans. Today most members with CRS conditions are enrolled with UnitedHealthcare Community Plan for all or part of their services. CRS members getting physical health services from UnitedHealthcare Community Plan will have choice of ACC Plans. The ACC Plan will be responsible for providing all covered services for persons with CRS qualifying conditions. Some exceptions apply.
See http://www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/CRS/ for more information for members with CRS conditions who are enrolled in other programs.
A: Each ACC Plan is required to have a Medicare Advantage Dual Special Needs Plan. This will allow members to align their Medicare and ACC Plans. Members should contact their new ACC Plan for more information. Members that change health plans may need to make future changes to Medicare enrollment to continue to be aligned.
A: CMDP will continue to serve foster care children for physical health services. The RBHA will continue to provide behavioral health services. Children in Foster Care with CRS qualifying conditions will get physical health services, including services for their CRS condition, through CMDP and behavioral health services through the RBHA.
A: To further the goal of integration and enhance operational efficiency, starting October 1, 2018, with the implementation of AHCCCS Complete Care (ACC) Plans, AHCCCS is requiring that a single health plan brand (and legal entity) be established for ACC Plans that are affiliated with a current AHCCCS RBHA in the same service area. Due to this requirement, the RBHA names will be changing.
A: RBHAs will no longer serve most adults and children. This is because behavioral health services will be provided by the ACC Plan. RBHAs will continue to serve:
A: The American Indian Health Program (AIHP) is currently a fee for service program administered by AHCCCS for eligible American Indians. AIHP reimburses for physical and behavioral health services when provided by or through the Indian Health Services (IHS) or tribally owned or operated organizations. AIHP also pays for physical health services with other medical facilities, such as your local hospital. These facilities are called “non-IHS/638 facilities.”
A: Currently most members that are enrolled in AIHP are also enrolled with a Regional Behavioral Health Authority (RBHA) or Tribal RBHA for behavioral health services. On October 1, 2018, AIHP will pay for and handle physical and behavioral health services for most eligible American Indian adults and children. AIHP will also pay for services related to a Children’s Rehabilitative Services condition. Members will still be allowed to choose AIHP and a TRBHA (when available) for behavioral health services.
A: In addition to the changes to AIHP, American Indian members who have not been determined to be seriously mentally ill will have the choice of integrated care through either AIHP or through AHCCCS Complete Care (“ACC”) health plan. When a member chooses AIHP, the member also has the choice of a TRBHA (when available) to have their care coordinated by the TRBHA.
See additional FAQs related to AHCCCS Complete Care.
A: American Indian members can still choose to change enrollment between AIHP (with or without TRBHA enrollment) or the AHCCCS Complete Care (ACC) Plan at any time by calling AHCCCS at 602-417-7100 or 1-800-334-5283. However, a member can still only change from one ACC Plan directly to a different ACC Plan once a year. American Indian members may continue to choose to receive services at any time from an IHS facility or a tribally owned and/or operated 638 facility.
A: American Indian members who are determined to be seriously mentally ill (“SMI”) will receive services from the RBHA but can also still choose AIHP for physical health services. American Indian members determined to be SMI that currently receive services with the TRBHA will stay the same. There is no change in service delivery or choice.
A: No, the crisis system will remain the same.
A: Today most AHCCCS members have one health plan for physical healthcare services, and one health plan for behavioral healthcare services. Effective October 1, 2018, American Indian Fee-for-Service (“FFS”) members will have the choice of integrated care: the American Indian Health Program (“AIHP”) or an AHCCCS Complete Care (“ACC”) health plan. AIHP members will also be able to choose care coordination for behavioral health care through a TRBHA (when available). AIHP and ACC Plans provide integrated physical and behavioral health services for most eligible American Indian adults and children, as well as pay for services related to a Children’s Rehabilitative Services condition.
A:
*Pima County Only
A: Effective October 1, 2018, AIHP will provide both physical and behavioral health care for most members. However, American Indian members with a Seriously Mentally Ill (SMI) determination will continue to receive behavioral health services from the RBHA or TRBHA (where available). There is no change in service delivery or choice. American Indian members can also choose to change enrollment between AIHP or the ACC Plan at any time. However, a member can only change from one ACC Plan to another one time per year. American Indian members may continue to choose to receive services at any time from an IHS facility, or a tribally owned or operated organization.
A: Effective October 1, 2018, AIHP will provide both physical and behavioral health care for most members. However, American Indian members with a Seriously Mentally Ill (SMI) determination will continue to receive behavioral health services from the RBHA or TRBHA (where available). There is no change in service delivery or choice. American Indian members can also choose to change enrollment between AIHP or the ACC Plan at any time. However, a member can only change from one ACC Plan to another one time per year. American Indian members may continue to choose to receive services at any time from an IHS facility, or a tribally owned or operated organization.
A: AHCCCS sent notification letters to impacted members to assist in transitioning to a new health plan. Members may call AHCCCS for assistance, from area codes (480), (602), and (623) call 602-417-7100, and from area codes (520) and (928) call 1-800-334-5283.
A: Under AHCCCS Complete Care (and other plans as noted), members will have access to the same array of covered services as they do under their current health plan.
A: Currently, most members with CRS conditions are enrolled with UnitedHealthcare Community Plan, a single statewide health plan that covers all or a portion of their services. Effective October 1, 2018, CRS members will be enrolled with, and will have choice of, an AHCCCS Complete Care (ACC) plan for all services (CRS, non-CRS physical health services, and behavioral health services). The ACC Plan will provide all medically necessary covered services for members with CRS qualifying conditions.
See more information for members with CRS conditions who enrolled in other programs at: www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/CRS/
A: More than one ACC Plan will be available in each geographic service area:
A: See the ACC Plans in each GSA at http://www.azahcccs.gov/ACC.
A: Children in foster care who have CRS conditions will receive all physical health services, including services for their CRS condition, from CMDP. Like all children in foster care, they will transition to the Regional Behavioral Health Authority (RBHA) in their area for behavioral health services. AHCCCS and CMDP are evaluating future integration options for foster children, with a target date of 2020.
A: The American Indian Health Program (AIHP will provide physical and behavioral health services, including CRS services, to children enrolled in that program.
A: Members with developmental disabilities and CRS conditions who are enrolled in Arizona Long Term Care will remain with UnitedHealthcare Community Plan for physical health services related to their CRS conditions and for all behavioral health services. These members will use their assigned DDD health plan for all non-CRS related physical health services. Find more information about plans to integrate ALTCS/DDD services at: https://des.az.gov/services/disabilities/developmental-disabilities/integrated-health-plan.
A: Any member with a CRS condition who is determined to have an SMI (and who is not enrolled with DES/DDD) will move to the RBHA for all physical, behavioral, and CRS services.
A: Members will initially be assigned to an available ACC plan or a plan with other family members assigned to it. Members will be notified of that assignment by the end of June 2018, and can elect to change plans (within their GSA) during the month of July.
A: The CRS application and referral process will remain essentially the same. Members will continue to be referred to the AHCCCS Division of Member Services for CRS determination. ACC health plans will be notified when a member has been determined to have a CRS condition, and should ensure first provider visit within 30 days of CRS designation
A: The ACC and other plans will assign care coordinators who will ensure a first provider visit within 30 days of CRS designation. In addition, an initial service plan and a comprehensive service plan will be coordinated and developed by the plan and the providers.
ACC and other plans will be required to treat all members with CRS qualifying conditions as a child/young adult with special health care needs. The health plan will recognize that in addition to a primary care provider, children/young adults with CRS qualifying conditions may receive services from subspecialists who manage care related to their condition(s) and coordinate with other specialty services.
Services should be provided using an integrated family-centered, culturally competent, multispecialty, interdisciplinary approach that includes the following elements:
A: Yes, families can use MSICs in their area and community based providers in the plan’s network. Health plans will be required to offer current MSICs in their network in the geographic area they are serving. If a plan is not successful with a long-term contract with an MSIC and the MSIC agrees, the ACC Plan shall allow members to use the MSICs for non-emergency conditions while the health plan contracts with a new MSIC.
A: Parents and members should review the network of each ACC plan to determine which plan to enroll with to ensure continued access to current providers.
Transition requirements for all ACC plans require that members who are receiving an active course of treatment, identified in the service plan for a serious and chronic physical, developmental or behavioral health condition, be allowed to receive the services from their established provider for the duration of their treatment or six months; whichever occurs first, regardless of whether or not the specialist participates in the health plan’s provider network. However, it should be noted that even with this above requirement, a provider may choose not to see a member enrolled with a plan the provider does not participate with.
A: Members enrolled in ACC: Starting October 1, 2018, for ACC members, the CRS designation will be discontinued at age 21. However, the ACC Plan will receive information from AHCCCS identifying the adult member as former CRS and the member will be considered an adult with special health care needs.
There will no longer be a choice to remain enrolled or “opt-in” to CRS. This is because after September 30, 2018, CRS members and their families will have choice of ACC plans that will all serve members with CRS conditions.
Current CRS members over the age of 21 who are NOT enrolled with DES/DDD will be assigned to an ACC plan, but will have a choice to pick another ACC plan in their area. Watch for a letter in the mail for this choice.
If a Multi-Specialty Interdisciplinary Clinic (MSIC) has practitioners and specialists whose scope of practice allows them to treat adults, those members age 21 and older wanting to continue services with the MSIC may do so.
Members enrolled with DES/DDD: DES is working with UnitedHealthcare Community Plan to continue providing statewide CRS and behavioral health services for members who:
This is scheduled to begin on October 1, 2018. DES/DDD plans to continue to allow members to “opt in” after 21 years of age. Members will receive a letter from AHCCCS prior to their 21st birthday giving them steps on how to make this choice.
A: There will not be any changes regarding how other insurance is handled. Families of children with CRS conditions that have commercial insurance will have the choice of utilizing the commercial network for services related to the CRS condition in addition to the ACC Plan network.
A: ACC Plans will begin receiving potential new member information from AHCCCS starting in August. This information will be utilized for relinquishing and receiving plans to share member information to coordinate care and work to ensure a smooth transition.
ACC Plans will receive the notification of their new members on the 9/28/18 daily 834 during September month end processes (either late 9/29/18 or early 9/30/18). The changes will be reflected in the normal AHCCCS verification places (AHCCCS Online, 270/271, etc.) for providers.
A: The receiving ACC Plan will receive information on open prior authorizations from the plan the member is leaving and shall honor previously approved prior authorizations for a minimum period of 30 days.
A: AHCCCS has held numerous public and targeted group forums to educate members, providers and interested stakeholders. Presentations can be requested and available forums viewed at: https://www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSCompleteCare/CommunityResources/.
A: The ACC Plans are required to hold a provider forum no less than semi-annually. The forum must be chaired by the Contractor’s Administrator/CEO or designee. The purpose of the forum is to improve communication between the Contractor and its providers. The forum shall be open to all providers and shall not be the only venue available to providers to communicate and participate in issues affecting the provider network.
In addition to the provider forum, the Contractor shall coordinate a meeting with a broad spectrum of behavioral health providers to gather input; discuss issues; identify challenges and barriers; problem-solve; share information and strategize ways to improve or strengthen the health care service delivery. These meetings shall be held no less than quarterly in the first year of the Contract and semi-annually thereafter.
A: All AHCCCS registered providers are free to contract with any or all of the ACC Plans.
A: Covered services are not changing and ACC Plans will be responsible for providing the same array of medically necessary covered services.
A: Members in exiting plans will be given a brief explanation of the reason for the letter describing the change and their new plan assignment. Members will be provided with phone numbers for each plan as well as plan website information to review network and other plan information. Finally, members will be provided with information on how to change to a different ACC Plan using a member portal that will be available starting on July 1st or by calling AHCCCS starting on July 2nd.
Members enrolled with a continuing plan that is not affiliated with the RBHA, who are identified by AHCCCS as having received at least $1,000 in RBHA behavioral health services for dates of service in calendar year 2017, will be given will be given a one-time choice of the ACC Plan that is affiliated with the RBHA. These letters will describe this one time choice members are getting prior to October 1st along with information on how to change to a different ACC Plan using a member portal.
All letters will also provide information to American Indian members regarding their options for choice and service delivery. Lastly, the letter provides notice that all ACC Plans (with exception of Molina Healthcare) will have an affiliated Medicare Special Needs plan that the member can enroll with if they are dual Medicare and Medicaid eligible. Molina Healthcare was not approved to offer a Medicare plan starting January 1, 2019 and will plan for a January 1, 2020 implementation of this requirement.
A: This information has been shared with the Managed Care Organizations.
A: Members currently in a health plan that will be an ACC Plan in their service area on October 1, 2018 will stay with their current health plan. Members currently in a health plan that will not be an ACC Plan in their service area will be assigned an ACC Plan. Members in the same household will be assigned to the same ACC Plan. Assignment to a plan is based initially on assignment to new and small plans and then on an algorithm with target percentages that are based on RFP scoring.
AHCCCS will send member letters with their assigned ACC Plan by the end of June, 2018. Members will be allowed to choose a different ACC Plan in their service area in July, 2018. ACC Plans will begin service to members on October 1, 2018.
Some members currently in a plan that will also be an ACC Plan (not affiliated with their assigned RBHA) in their service area, who received behavioral health services through the RBHA in 2017, will be given a one-time choice to move to the ACC Plan that is affiliated with the RBHA in their service area. These members will be notified in late June 2018 and will be allowed to make their choice during the month of July, 2018.
For more information on member auto-assignment starting October 1, 2018, see the paragraph on Auto-Assignment Algorithm on page 50 of the RFP http://www.azahcccs.gov/PlansProviders/Downloads/RFPInfo/YH19/ACC_RFP_11022017.pdf.
A: AHCCCS is in the process of paring down the required data set elements as well as determining what services, providers, and Contractors to which the DUG will apply. Please see more information at: https://www.azahcccs.gov/PlansProviders/Demographics/.
A: Responsibility for administering grant funds (for non-Title XIX members and/or services) and housing services will remain with the RBHAs. The ACC Plan shall assist members with how to access these services and shall coordinate care for the member as appropriate.
A: Yes. Utilizing existing collaborative protocols as a foundation, AHCCCS will require the ACC plans to work together with other ACC Plans and RBHAs in their area to continue and develop consistent collaborative protocols with each County, District, or Regional Office of: Administrative Office of the Courts, Juvenile Probation and Adult Probation, Arizona Department of Corrections and Arizona Department of Juvenile Corrections, and the Veteran’s Administration.
The plans shall develop strategies to communicate timely data for coordination of care, development of treatment plans, safe transition into the community upon release, and to optimize the use of services in connection with Mental Health Courts and Drug Courts.
In addition, in order to facilitate members transitioning out of jails and prisons into communities, ACC Plans are required to participate in criminal justice system “reach-in” care coordination efforts. The ACC Plans shall collaborate with criminal justice partners (e.g. Jails, Sherriff’s Office, Correctional Health Services, Arizona Department of Corrections, including Community Supervision, Probation, Courts), to identify justice-involved members in the adult criminal justice system with physical and/or behavioral health chronic and/or complex care needs prior to member’s release.
A: The ACC Plan is required to develop a collaborative process with the counties to ensure coordination of care and information sharing for timely access to pre-petition screening, court ordered evaluation (COE), and court ordered treatment (COT) provided as described in AMPM Policy 320-U.
Under A.R.S. §36-545.06, the cost of pre-petition screening and COE remains a county responsibility unless the county has an agreement with AHCCCS under A.R.S. § 36-545.07 to provide those services for the county. If such an agreement exists, the RBHA contract will include those services within the scope of the RBHA’s responsibilities.
The ACC Plan is responsible for medically necessary, covered behavioral health treatment that is court ordered but not including services associated with the pre-petition screening and COE for their enrolled members. Services that are Medicaid covered for a Medicaid enrolled member that are separate from the COE services and medically necessary physical health services are the responsibility of the ACC Plan during the COE time period.
A: Information regarding potential waiver authority changes can be found at: https://www.azahcccs.gov/shared/FiveYear.html or https://www.azahcccs.gov/Resources/Federal/PendingWaivers/priorquartercoveragewaiveramendment.html
A: After designation by AHCCCS, the member can be identified as having a CRS condition with the specific CRS segment that is a component of the eligibility verification. There will be no change to how it exists today.
A: AHCCCS is in the process of transitioning the AHCCCS Covered Behavioral Health Services Guide (CBHSG) into the AHCCCS Medical Policy Manual (AMPM Policies 310-B, Behavioral Health Services and 320-T, Non-Discretionary Federal Grants). No changes are being made to the Medicaid covered behavioral health services benefit. AMPM Policy 320-T will expand to cover more information regarding funding/services related to the Non-Title XIX population. The B2 Matrix, which is now part of the AHCCCS CBHSG, will continue to be maintained by AHCCCS and available for stakeholders to view on the AHCCCS website. These changes are anticipated to be completed by October 1, 2018.
A: To ensure a smooth transition for members, if non-contracted providers agree to continue to serve an established patient, ACC Plans must reimburse PCPs for services provided before January 1, 2019 or Specialists before April 1, 2019. See a more comprehensive description of member transition requirements that are included in the AHCCCS/ACC Plan contracts that affect non-contracted providers at www.azahcccs.gov/AHCCCS/Downloads/ACC/EXHIBIT_G.pdf
