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 CMS-approved flexibilities and COVID-19 FAQs does not align with provisions set forth by the AHCCCS Contractor Operations Manual (ACOM). In these instances the CMS-approved flexibilities and FAQs take precedence and are controlling.
Name Change
Effective April 1, 2021 Comprehensive Medical and Dental Program (CMDP) will be changing to Comprehensive Health Plan (CHP). AHCCCS is in the process of revising all pertinent documents to reflect the new name.
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 and 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.
(New public comment web page)
To view ACOM Policies, select Policy from the ACOM Table of Contents below.
Policies with Changes that include revisions due to CMDP Integration of Behavioral Health Services
Pursuant to Laws 2019, 1st Regular Session, Chapter 305, behavioral health services for children in DCS custody were anticipated to transition from the RBHA Contractors to DCS/ CMDP effective October 1, 2020. However, this implementation has been delayed. Revisions that have already been completed for ACOM and AMPM Policies and Attachment(s), related to this anticipated integration [listed in document provided below], will remain in the impacted policies but will not be applicable until such time that CMDP behavioral health service integration is implemented. Revisions unrelated to the integration of behavioral health services for CMDP members; will continue to be effective October 1, 2020.
POLICIES WITH CHANGES THAT INCLUDE REVISIONS DUE TO CMDP INTEGRATION OF BEHAVIORAL HEALTH SERVICES- 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
- Attachment A - Reserved
- 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
- 301 - ALTCS EPD Program Tiered Reconciliation
- 302 - Cost Settlement for Coronavirus Disease of 2019 Vaccine
- 304 - Premium Tax Reporting
- 305 - Performance Bond and Equity Per Member Requirements
- 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
- 306 - Alternative Payment Model Initiative - Withhold and Quality Measure Performance Incentive
- Attachment A - Alternative Payment Model Quality Management Performance Measure Standards
- Attachment B - Alternative Payment Model Quality Performance Measure Scores
- Attachment B - Alternative Payment Model Quality Performance Measure Scores
- Attachment C - Federal Limit Test
- 307 - Alternative Payment Model Initiative - Strategies and Performance-Based Payments Incentive
- Attachment A - Learning Action Network - Alternative Payment Model Framework Strategies
- Attachment B CYE 20 - Alternative Payment Model Strategies and Performance-Based Payments Incentive Certification
- Attachment B CYE 21 - Alternative Payment Model Strategies and Performance-Based Payments Incentive Certification
- Attachment B CYE 22 - Alternative Payment Model Strategies and Performance-Based Payments Incentive Certification
- Attachment C - Alternative Payment Model Strategies and Performance-Based Payments Incentive Performance Measure and Medical Loss Ratio Report
- Attachment D - Alternative Payment Model Strategies - Value Based Purchasing (VBP) - Medical Loss Ratio (MLR) Report
- 308 - Reconciliation of Title XIX Behavioral Health Prior Period Coverage Expenses for RBHAs
- 310 - Delivery Supplement Payment
- 311 - ACC Program Tiered Reconciliation
- 314 - Auto-Assignment Algorithm
- 317 - Change in Contractor Organizational Structure
- 320 - Reserved
- 321 - Payment Reform E-Prescribing
- 323 - Regional Behavioral Health Authorities Title XIX/XXI Reconciliation and Non-Title XIX/XXI Profit Limit
- Attachment A - Non-Title XIX XXI Profit Limit - Example
- Attachment B - Maricopa County and Greater AZ Contractors Title XIX XXI Reconciliation - Example for CYE 09-30-XX
- Attachment C - Maricopa County and Greater AZ Contractors Title XIX XXI Reconciliation - Example for CYE Ended 09-30-22
- Attachment D - Reserved
- Attachment E - Reserved
- Attachment F - Reserved
- Attachment G - Reserved
- 324 - Targeted Investments Program
- 325 - Access to Professional Services Initiative and Reconciliation
- Attachment A - Health Plan Access to Professional Services Initiative (APSI) - Reconciliation Sample
- 326 - Fixed Administrative Cost Component Reconciliation for ACC
- 327 - Pediatric Services Initiative
- 330 - Access to Professional Services Initiative
- 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 and Refunds
- 413 - Reserved
- 414 - Requirements for Service Authorization Decisions and Notices of Adverse Benefit Determination
- 415 - Provider Network Development and Management Plan; Periodic Network Reporting Requirements
- 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 - Reserved
- Attachment F - Value-Based Providers-Centers of Excellence Checklist
- Attachment G - Therapeutic Foster Care and Adult Behavioral Health Therapeutic Home Report
- 416 - Provider Information
- 417 - Appointment Availability, Transportation Timeliness, 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
- 448 - Housing Program
- Attachment A - Reserved
- Attachment B - Reserved
- Attachment C - Reserved
- Attachment D - Reserved
- 449 - Behavioral Health Services for Children in Department of Child Safety (DCS) Custody and Adopted Children