What is a Children’s Rehabilitative Services (CRS) Designation?
Historically, members with CRS qualifying conditions who were eligible for CRS had their specialty services provided by a single health plan, and received their non-CRS services through another health plan.
Beginning on October 1, 2018, members that qualify for a CRS designation and are NOT enrolled with DES/DDD have a choice of AHCCCS Complete Care (ACC) plans that service their area. The ACC plan manages care for all services (including CRS, other non-CRS physical health services, and all covered behavioral health services).
Effective 10/01/2019, members enrolled with DES/DDD will use their assigned DES/DDD plan for all of their CRS and non-CRS physical health and behavioral health services. DES/DDD continues to provide long-term care services for these members.
Foster Care Members: Foster care members are covered for their CRS and non-CRS physical health care needs by the Comprehensive Medical and Dental Program (CMDP) through the Department of Child Safety.
American Indian/Alaska Native Members: American Indian and Alaska Native members with a CRS designation have a choice of an ACC Plan or the American Indian Health Program.
Members needing a CRS designation determination should be referred to the AHCCCS Division of Member and Provider Services (DMPS). Members have access to the same AHCCCS covered services as they did prior to October 1, 2018.
History of CRS Integration Initiatives
Arizona’s Children’s Rehabilitative Services (CRS) program, authorized by ARS 36-261 et seq., was originally created in 1929 to serve children with complex health care needs who required specialized services coordinated by a multidisciplinary team. The State of Arizona opted into the Medicaid program in 1982. CRS was folded under the AHCCCS umbrella in order to leverage federal dollars in providing medically necessary care. However, the CRS program and the services provided remained “carved out” of the AHCCCS managed care model, a model designed to facilitate accessibility to quality cost-effective care.
Historically, the CRS carve-out program provided specialty services to children with specific qualifying medical conditions. Care and services for the CRS qualifying condition(s) were provided through a sole CRS Contractor. However, that same member may also have received other acute care services through a different AHCCCS Contractor or through the American Indian Health Program (AIHP), or received long-term care services through a different AHCCCS Long Term Care Contractor, as well as receiving behavioral health services through a Regional Behavioral Health Authority (RBHA) or a Tribal Regional Behavioral Health Authority (TRBHA).
This fragmentation caused confusion for families and providers, and created payment and care coordination responsibility issues between delivery systems. Improving the situation required a model design that reduced fragmentation and ensured optimal access to primary, specialty and behavioral health care and which offers effective coordination of all service delivery through one AHCCCS Contractor.
AHCCCS proposed an alternative to the “carve out” model of service delivery and payment for services provided to CRS-eligible individuals. Specifically, proposing that the model be replaced by a payer integration model that required one contractor/payer to assume responsibility for the delivery and payment of multiple services (i.e. services related specifically to CRS conditions as well as services related to primary care and, potentially, other needs like behavioral health). Ultimately, the purpose of such a model was to ensure optimal access to important specialty care as well as effective coordination of all service delivery.
As of October 1, 2013, AHCCCS integrated all services for most children enrolled in the acute care program with CRS qualifying conditions through one CRS Contractor, UnitedHealthcare Community Plan (UHCCP) with the goals of improved member outcomes and satisfaction, reduced member confusion, improved care coordination, and streamlined administration. At the same time, children with CRS qualifying conditions enrolled in the Arizona Long Term Care System (ALTCS), other than the Division for Developmental Disabilities, were fully integrated into their ALTCS Contractor for all primary care, specialty care, long term care, and behavioral health care including care and services related to a CRS condition.
As noted above, effective October 1, 2018, in order to provide choice of plans, members determined by AHCCCS DMPS to meet the criteria in R-9-22-1301 through 1305 and not enrolled in DES/DDD or CMDP will be given a CRS designation. These members will have a choice of AHCCCS Complete Care (ACC) plans that services their area. The ACC plan will include medically necessary services for physical and behavioral health and services related to the CRS condition. CRS members can receive care in the community and/or in multi-specialty interdisciplinary clinics (MSIC).
American Indian and Alaska Native members, who meet the criteria in R-9-22-1301 through 1305, will have a choice of ACC Plan or the American Indian Health Program. Members enrolled with DES/DDD will use their assigned DES/DDD plan for their CRS and non-CRS physical health coverage and all behavioral health services. DES/DDD will continue to provide long term care services for these members. CMDP members will be covered for their CRS and non-CRS health care needs by CMDP.