AHCCCS Contractor Operations Manual (ACOM)
Information Regarding COVID-19
In response to Medicaid-related questions from providers and contractors arising from the COVID-19 pandemic, AHCCCS has developed a list of Frequently Asked Questions (FAQs) Regarding Coronavirus Disease 2019 (COVID-19) which is updated regularly. It is important to note that there are instances where the information presented in the COVID-19 FAQs does not align with provisions set forth by the AHCCCS Contractor Operations Manual (ACOM). In these instances the FAQs take precedence and are controlling.
The purpose of the ACOM is to consolidate and provide ease of access to the Administrative, Claims, Financial, and Operational Policies of the AHCCCS Administration. The ACOM Manual provides information to Contractors and subcontractors who are delegated responsibilities under a contract. The ACOM should be referenced in conjunction with State and Federal regulations, other Agency manuals, and applicable contracts.
How to Submit Public Comments
ACOM and AMPM Policies and related materials that have been opened for review/revisions and will serve to provide Tribal Consultation Notification/Public Comment can be found at the below location. This location allows stakeholders to review and submit comments regarding proposed revisions. The Policies will be open for comment for not more than 45 days unless otherwise stipulated. Should an expedited time period be utilized, the expedited time period will not be less than two weeks. The comment deadline will be specified on each document.
To view ACOM Policies, select Policy from the ACOM Table of Contents below.
- 103 - Fraud, Waste and Abuse
- Attachment A - Representations and Certifications of Contractor
- Attachment A-1 - Disclosure Information - Disclosure of Ownership and Control
- Attachment B - Corporate Compliance Work Plan-Sample
- Attachment C - External Audit Plan Template
- 404 - Contractor Website and Member Information
- Attachment A - Organizations Recognized by AHCCCS
- Attachment B - Contractor Website Certification Checklist
- Attachment C - Member Information Attestation Statement
- 429 - Direct Care Worker and Testing Program the Policy
- 432 - Benefit Coordination and Fiscal Responsibility for Behavioral Health Services and Physical Health Services
- 433 - Member Identification Cards
- 436 - Network Standards
- 100 - AHCCCS Contractor Operations Manual Overview
- 101 - Marketing
- 103 - Fraud, Waste and Abuse
- Attachment A - Representations and Certifications of Contractor
- Attachment A-1 - Disclosure Information - Disclosure of Ownership and Control
- Attachment B - Corporate Compliance Work Plan-Sample
- Attachment C - External Audit Plan Template
- 104 - Continuity of Operations and Recovery Plan
- 106 - Certification of MAOs Serving Dual Eligible Members
- 107 - State-Contracted MAO Dual Eligible Special Needs Plans
- 108 - AHCCCS Security Rule Compliance
- 109 - Institution for Mental Disease 15 Day Limit
- 110 - Mental Health Parity
- 111 - AHCCCS Pharmacy and Therapeutics Committee
- Attachment A - Performance Bond Annual Attestation Statement
- Attachment B - Performance Bond Form
- Attachment C - Instructions for Wire ACH Transfers of Funds to AHCCCS via Arizona State Treasurer
- Attachment A - Maricopa County & Greater AZ Contractor Title XIX XXI Reconciliation Example CYE 16
- Attachment B - Maricopa County Contractor Title XIX XXI Reconciliation Example CYE 17
- Attachment C - Greater AZ Contractor Title XIX XXI Reconciliation Example CYE 17
- Attachment D - Maricopa County and Greater AZ Contractors Title XIX XXI Reconciliation Example CYE 18
- Attachment E - Maricopa County & Greater AZ Contractors Title XIX XXI Reconciliation Example CYE XX
- Attachment F - Non-Title XIX XXI Profit Limit Example CYE XX
- 401 - Change of Contractor: AHCCCS Complete Care Contractors
- 402 - Member Transition for Annual Enrollment Choice and Eligibility Changes
- 403 - Enrollment Choice in a County with Choice and Change of Contractor: ALTCS Contractors
- 404 - Contractor Website and Member Information
- 405 - Cultural Competency, Language Access Plan, and Family-Member Centered Care
- 406 - Member Handbook and Provider Directory
- 407 - Workforce Development
- 408 - Sanctions
- 412 - Claims Recoupment
- 413 - Gap in Critical Services
- 414 - Requirements for Service Authorization Decisions and Notices of Adverse Benefit Determination
- 415 - Provider Network Development and Management Plan
- Attachment A - Network Attestation Statement
- Attachment B - Network Development and Management Plan Checklist
- Attachment C - ALTCS EPD Contractor Supplement
- Attachment D - Provider Changes Due to Rates Report
- Attachment E - HCBS Service Delivery Standard Report
- Attachment F - DME Service Delivery Reporting
- 416 - Provider Information
- 417 - Appointment Availability, Monitoring, and Reporting
- 418 - Provider and Affiliate Advances, Equity Distributions, Loans, and Investments
- 421 - Contract Termination Nursing Facilities and Alternative Home and Community Based Settings
- 423 - Financial Responsibility for Court Ordered Treatment for DUI/Domestic Violence or Other Criminal Offenses
- 424 - Verification of Receipt of Paid Services
- 425 - Social Networking
- 426 - CRS Application, Designation, and Coverage
- 429 - Direct Care Worker Training and Testing Program
- 431 - Copayment
- 432 - Benefit Coordination and Fiscal Responsibility for Behavioral Health Services and Physical Health Services
- 433 - Member Identification Cards
- 434 - Coordination of Benefits and Third Party Liability
- 435 - Telephone Performance Standards and Reporting
- 436 - Network Standards
- 437 - Financial Responsibility for Services after the Completion of Court-Ordered Evaluation
- 438 – Administrative Services Subcontractor Evaluation
- 439 - Material Changes Provider Network and Business Operations
- 440 - Managed Care Expiration or Termination of Contract
- 442 - Member with a Serious Mental Illness' Request to Opt Out from a Regional Behavioral Health Authority to an AHCCCS Complete Care Contractor
- 444 - Notice of Appeal Requirements (Serious Mental Illness Appeals)
- Attachment A - AHCCCS Notice of SMI Grievance and Appeal Procedure
- Attachment B - Notice of Legal Rights for Persons with Serious Mental Illness
- Attachment C - Notice of Decision and Right to Appeal (for Individuals with an SMI)
- Attachment D - Notice of Discrimination Prohibited
- 445 - Submission of Request for Hearing
- 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness
- 447 - Employment
- Attachment A - Psychiatric Rehabilitation Progress Report Specifications for RBHA SMI
- Attachment B - Psychiatric Rehabilitation Progress Report Specifications for GMH SU
- 448 - Housing
- Attachment A - AHCCCS Housing Acquisition-Renovation Application
- Attachment B - AHCCCS Housing Acquisition-Renovation Checklist
- Attachment C - AHCCCS Declaration of Covenants, Conditions, and Restrictions (CC & Rs)
- Attachment D - AHCCCS Housing Acquisition and/or Renovation or New Construction Operating and Funding Agreement - Sample
- 449 - BH Services for Children in DCS Custody and Adopted