Children’s Rehabilitative Services (CRS) Referrals

Before October 1, 2018, Children’s Rehabilitative Services (CRS) provided medical treatment to AHCCCS members who have CRS-qualifying conditions. See Arizona Administrative Code A.A.C. R9-22-1303 Qualifying Medical Conditions for a list of CRS-qualifying conditions. Although CRS members got the same AHCCCS covered medical and behavioral health services as non-CRS members, there was no choice of health plan once a member was determined to be eligible for CRS. There was only one health plan available statewide.

Beginning on October 1, 2018:

AHCCCS Members with a CRS Designation Who Are NOT Enrolled in DES/DDD or Comprehensive Medical and Dental Program (CMDP) for Foster Children

Members who are determined to be eligible for CRS and are not enrolled in DES/DDD or CMDP will have choice of an AHCCCS Complete Care (ACC) plan. The ACC plan will include:

  • medically necessary physical health care;
  • medically necessary behavioral health care; and
  • care for the CRS condition.

American Indian and Alaska Native members with a CRS-qualifying condition will have a choice of ACC Plan or the American Indian Health Program for all services. American Indian and Alaska Native members, on- or off-reservation, may choose to get services from:

  • an American Indian Health Facility including an Indian Health Service (IHS) Facility;
  • a Tribally-Operated 638 Health Program; or
  • an Urban Indian Health Program

AHCCCS Members Who Are Enrolled with DES/DDD

Members with developmental disabilities enrolled in DES/DDD and AHCCCS/CRS will remain with United Healthcare Community Plan for behavioral health services and physical health services related to their CRS conditions. These members will use their assigned DDD health plan for all non-CRS related physical health services.

AHCCCS Members with a CRS Designation Who Are Determined to Have a Serious Mental Illness (SMI)

Any member with a CRS designation who:

  • is determined to have an SMI; and
  • is not enrolled with DES/DDD
will get physical health, behavioral health and CRS condition services from the Regional Behavioral Health Authority (RBHA) in their area.

CMDP Members who are in Foster Care

Children in foster care who have CRS conditions will receive all physical health services, including services for their CRS condition, from the Comprehensive Medical and Dental Program (CMDP). Like all children in foster care, they will receive behavioral health services from the RBHA in their area.

What Will Be Different for CRS Referrals Made After 10/01/2018?

The CRS application and referral process will remain essentially the same. Members under the age of twenty-one (21) will continue to be referred to the AHCCCS Division of Member Services for a CRS designation as described below. ACC health plans will be notified when a member has been determined to have a CRS condition. A member will not be enrolled in the CRS program unless AHCCCS eligibility is established.

Once approved for the CRS program, the member’s ACC plan, RBHA or CMDP will be notified of the CRS designation and should ensure first provider visit is within 30 days of the CRS designation. The member’s plan will manage care for the CRS condition(s), as well as, the physical and behavioral health services for members. CRS members can get care in the community, and/or in multi-specialty interdisciplinary clinics (MSICs).

https://www.azahcccs.gov/PlansProviders/CurrentProviders/CRSreferrals.html

CRS Application and Instructions

To refer a member for CRS designation, fill out and mail or fax an application to the AHCCCS CRS Unit, with medical documentation that supports the applicant has a CRS-qualifying condition.

The application MUST be submitted with supporting medical documentation.

For Questions Regarding the CRS Program

  • Contact the AHCCCS CRS Enrollment Unit at: 602-417-4545 or 1-855-333-7828