Children’s Rehabilitative Services (CRS)
What is CRS?
Arizona’s Children’s Rehabilitative Services (CRS) program provides medical and behavioral health care, treatment, and related support services to Arizona Health Care Cost Containment System (AHCCCS) members who meet the eligibility criteria and completed the application to be enrolled in the CRS program and have been determined eligible.
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 the 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 Plan (AIHP), or received long-term care services through a different AHCCCS Long Term Care Contractor or the American Indian Fee-for-Service environment, 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 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 is 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 United Healthcare Community Plan (UCCP) 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, specialty, long term care, and behavioral health care including care and services related to a CRS condition. To ensure a smooth transition, AHCCCS conducted a comprehensive readiness review process, weekly monitoring of the CRS Contractor’s network development efforts, systems testing and oversight of the transition of member data from relinquishing Contractors to UHCCP. In total, over 80 evaluation elements were reviewed to determine UHCCP’s readiness to administer members’ acute, behavioral health, and CRS-related benefits. AHCCCS continues to monitor UHCCP’s progress in serving the CRS membership through its standard oversight mechanisms. AHCCCS will continue to work with the Contractor to improve processes and coordination with the goal of streamlining the delivery of services and enhancing the outcomes and experience for members and their families.