Children’s Rehabilitative Services Application Instructions	

The Arizona Health Care Cost Containment System (AHCCCS) Division of Member and Provider Services (DMPS) Children’s Rehabilitative Services (CRS) Unit reviews applications for customers who want a CRS designation.

To get a CRS designation, AHCCCS customers must need active treatment for one of the medical conditions defined in A.A.C. R9-22-1303. If the customer is not currently enrolled with AHCCCS, must enroll by:
•	Applying online at www.healthearizonaplus.gov; 
•	Calling AHCCCS toll free at 1 (800) 654-8713; or
•	Going to https://www.azahcccs.gov/Members/GetCovered/apply.html, printing and completing an AHCCCS application.

NOTE: Customers cannot receive a CRS designation or CRS services until they become an AHCCCS member.
How to Apply for the CRS Designation
To apply for a CRS designation, a CRS application can be filled out and submitted with medical records that support the potential CRS condition. Submit the completed application to the CRS Unit. Without a completed and approved application, the customer's medical condition will be treated by the AHCCCS health plan.

Click the links below to access the CRS application:
•	CRS Application in English
•	CRS Application in Spanish

Anyone can fill out an application including a family member, doctor, or health plan representative. The CRS Unit can also help with completing the application. You can contact the CRS Unit at (602) 417-4545 or 1 (855) 333-7828.

You must send the information supporting the medical diagnosis and the need for treatment. Customers can contact their doctor to help collect the medical information.
For questions or help completing the application contact:
Children’s Rehabilitative Services Unit (CRS)
(602) 417-4545 or 1 (855) 333-7828

A completed application and medical information can be sent to:
•	Mail: AHCCCS/Children's Rehabilitative Services 
801 E Jefferson St
MD3500
Phoenix, AZ 85034
•	Fax: (602) 252-5286

The CRS Unit will send a written notice when the CRS application has been approved or denied.