Frequently Asked Questions

View General FAQs as PDF

View American Indian Member FAQs as PDF

View FAQs for Members with CRS Conditions as PDF

General Questions

American Indian Members' Questions

Questions from Members with CRS Conditions


  • Q: What is an AHCCCS Complete Care Health Plan (ACC Plan) and how is it different than my current health plan?

    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.

  • Q: When is the change to ACC Plans happening?

    A: AHCCCS Complete Care (ACC) starts on October 1, 2018.

  • Q: Who will be affected by this change?

    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).

  • Q: How will an ACC Plan benefit me?

    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.

  • Q: Will covered services change?

    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).

  • Q: What are the geographic service areas (GSA) to be served by ACC Plans?

    A: More than one ACC Plan will be available in each GSA:

    • The Central GSA will serve Pinal, Gila, and Maricopa counties.
    • The South GSA will serve Pima, Santa Cruz, Graham, Yuma, Cochise, Greenlee, and LaPaz counties.
    • The North GSA will serve Mohave, Yavapai, Coconino, Apache, and Navajo counties.

    Note: ZIP codes 85542, 85192, 85550 are part of the South GSA to keep the San Carlos tribal reservation in one GSA.

  • Q: What are the available ACC Plans in each geographic service area (GSA)?
  • Q: Will I be assigned to an ACC Plan or will I have choice of available ACC Plans?

    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.

  • Q: Can I continue to access the same providers?

    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.

  • Q: What will Regional Behavioral Health Authorities (RBHAs) continue to provide?

    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:

    • Foster children enrolled in CMDP, including those CMDP members who have a CRS condition.
    • Members enrolled with DES/DDD.
    • Individuals determined to have a Serious Mental Illness.

    RBHAs will continue to provide crisis, grant funded and state-only funded services.

  • Q: Will current CRS members have to change health plans?

    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.

  • Q: Will my ACC Plan offer a Medicare Advantage Plan?

    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.

  • Q: Will my foster child’s coverage with Comprehensive Medical Dental Program (CMDP) change?

    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.

  • Q: What is the American Indian Health Program (AIHP) and who does it 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.”

  • Q: What changes are happening for AIHP and when will they be effective?

    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.

  • Q: How will AHCCCS Complete Care impact American Indian members?

    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.

  • Q: Will American Indian members still be allowed to change enrollment?

    A: American Indian members can still choose to change enrollment between AIHP or the AHCCCS Complete Care (ACC) Plan at any time. However, a member can still only change from one ACC Plan to another once a year.

    American Indian members may continue to choose to receive services at any time from an IHS facility or tribally owned or operated organizations.

  • Q: Will there be changes for American Indian members who are determined to be seriously mentally ill?

    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.

  • Q: Will the crisis system change?

    A: No, the crisis system will remain the same.

  • Q1: Will my covered services change under AHCCCS Complete Care?

    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.

  • Q2: Will CRS members have to change health plans?

    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/

  • Q3: What are the geographic service areas (GSA) in AHCCCS Complete Care?

    A: More than one ACC Plan will be available in each geographic service area:

    • Central GSA – Pinal, Gila, Maricopa
    • South GSA – Pima, Santa Cruz, Graham, Yuma, Cochise, Greenlee, LaPaz
    • North GSA – Mohave, Yavapai, Coconino, Apache, Navajo
    Note: Zip codes 85542, 85192, 85550 are included in the South GSA.

  • Q4: What are the available ACC Plans in each geographic service area (GSA)?

    A: See the ACC Plans in each GSA at http://www.azahcccs.gov/ACC.

  • Q5: Will my foster child’s Comprehensive Medical Dental Program (CMDP) coverage change?

    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.

  • Q6: If my child is enrolled in AIHP, how will she/he receive CRS services?

    A: The American Indian Health Program (AIHP will provide physical and behavioral health services, including CRS services, to children enrolled in that program.

  • Q7: How will members with CRS qualifying conditions who are enrolled in ALTCS DDD (through DES) receive services?

    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.

  • Q8: How will members with CRS conditions who are determined to have a serious mental illness (SMI) receive services?

    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.

  • Q9: Will I be assigned to an ACC health plan or will I have choice of ACC Plan?

    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.

  • Q10: How will CRS conditions be determined and will members still have a CRS designation?

    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

  • Q11: How will the health plans ensure that members with CRS Special Health Care Needs get the comprehensive care they need?

    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 process for using a centralized, integrated medical record that is accessible to the health plan and service providers consistent with Federal and State privacy laws to facilitate wellcoordinated care,
    • A process for developing and implementing a Service Plan accessible to the health plan and service providers that is consistent with Federal and State privacy laws that contains the clinical, medical, and administrative information necessary to monitor coordinated treatment plan implementation, and
    • Collaboration with individuals, groups, providers, organizations and agencies charged with the administration, support or delivery of services for persons with special health care needs.
  • Q12: Can members and families continue to access Multi-Specialty Interdisciplinary Clinics (MSICs)?

    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.

  • Q13: Can my child continue to receive services from current providers?

    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.

  • Q14: Will anything change at age 21 for a member with a CRS designation?

    A: Starting October 1, 2018, the CRS designation will be discontinued at age 21 and the ACC Plan will consider the member an adult with special health care needs. Given choice of ACC Plans, there will no longer be a need to allow the option to remain enrolled with the single statewide health plan. Current members enrolled in CRS that are over the age of 21 will be assigned an ACC plan with choice of other available ACC plans in their area. Please refer to Question 13 for more information.

  • Q15: Will there be any changes to how other insurance coverage is handled?

    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.

    • When the member receives services from providers within the ACC Plan network, the ACC Plan is responsible for payment of covered services, although AHCCCS is the payor of last resort.
    • Families wishing to obtain services from commercial providers (outside of the ACC Plan network) for treatment of their children’s CRS condition will be required to use their available private insurance coverage or Medicare to cover treatment for CRS covered conditions. In these circumstances, the ACC Plan shall be the secondary payer responsible for payment in accordance with AHCCCS Contractor Operations Manual Policy 201 and 203.
    • The ACC Plan shall be responsible for all medically necessary covered CRS services provided through the ACC Plan’s network when the member’s Medicare or private insurance expires, is exhausted, certain annual or lifetime limits are reached, or the member’s private insurance/Medicare does not cover the CRS condition. Unless the ACC Plan refers the member out of network the ACC Plan will have no payment responsibility for services received outside of network when the member’s Medicare or private insurance expires, is exhausted, certain annual or lifetime limits are reached, or the member’s private insurance/Medicare does not cover the CRS condition.