AHCCCS Medical Policy Manual (AMPM)

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 Medical Policy Manual (AMPM). In these instances the CMS-approved flexibilities and FAQs take precedence and are controlling.

COVID-19 FAQs

 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 AHCCCS Medical Policy Manual (AMPM) provides information to Contractors and Providers regarding services that are covered within the AHCCCS program. The AMPM is applicable to both Managed Care and Fee-for-Service members.

The AMPM should be referenced in conjunction with State and Federal regulations, other Agency manuals [AHCCCS Contractors' Operations Manual (ACOM) and the AHCCCS Fee-for-Service Manual], 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.


Tribal Consultation Notification and Public Comment
(New public comment web page)
Instructions to Submit Public Comment

To view AMPM Policies, select Policy from the AMPM 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
  • 320-B, AHCCCS Member Participation In Experimental Services
  • 320-C, Breast and Cervical Cancer Treatment Program
  • 320-G, Lung Volume Reduction Surgery
  • 320-I, Telehealth
  • 320-M, Medical Marijuana
  • 320-N, Hepatitis C Virus (HCV) Prior Authorization Requirements for Direct Acting Antiviral (DAA) Medication         Treatment
  • 320-O, Behavioral Health Assessments and Treatment Service Planning
  • 320-P, Serious Mental Illness Eligibility Determination
  • 320-Q, General and Informed Consent
  • 320-R, Special Assistance for Members with Serious Mental Illness
  • 320-S, Behavior Analysis Services
  • 320-T1 - Block Grants and Discretionary Grants
  • 320-T2 - Non-Title XIX XXI Services and Funding (Excluding Block Grants and Discretionary)
  • 320-U – Pre-Petition screening, Court Ordered Evaluation, and Court Ordered Treatment
  • 320-V – Behavioral Health Residential Facilities
  • 320-W - Therapeutic Foster Care for Children
  • 320-X - Adult Behavioral Health Therapeutic Homes
  • 1620-A, Initial Contact Visit Standard
  • 1620-B, Needs Assessment Care Planning Standard
  • 1620-C, Cost Effectiveness Study Standards
  • 1620-D, Placement and Service Planning Standard
  • 1620-E, Service Plan Monitoring and Reassessment Standard
  • 1620-F,Tribal Fee-For-Service Standard
  • 1620-G, Behavioral Health Standards
  • 1620-H, Transitional Program Standard
  • 1620-I, High Cost Behavioral Health Reinsurance Standard
  • 1620-J, Out-Of-State Placement Standard
  • 1620-K, Skilled Nursing Need Standard
  • 1620-L, Case File Documentation Standard
  • 1620-M, Contractor Change Standard
  • 1620-N, Service Closure Standard
  • 1620-O, Abuse, Neglect, and Exploitation Reporting Standard
  • Exhibit 1620-1, Case Management Timeframes
  • Exhibit 1620-2, ALTCS Member Change Report
  • Exhibit 1620-3 - Uniform Assessment Tool and Guidelines
  • Exhibit 1620-4, Acute Care Only -D- Placement Guidelines
  • Exhibit 1620-6, High Cost Behavioral Health Reinsurance Form
  • Exhibit 1620-7 - Fee-For-Service Out-of-State Nursing Facility Placement Request Form
  • Exhibit 1620-8, Contractor Change Request Form
  • Exhibit 1620-9, ALTCS Enrollment Transition Information (ETI) Form
  • Exhibit 1620-10, AHCCCS Person Centered Service Plan
  • Exhibit 1620-12, Spouse Attendant Care Acknowledgement of Understanding
  • Exhibit 1620-13, ALTCS Member Service Plan
  • Exhibit 1620-14, Reserved
  • Exhibit 1620-15, Assisted Living Facility (ALF) Residency Agreement
  • Exhibit 1620-16, Assisted Living Facility (ALF) Financial Change Agreement
  • Exhibit 1620-17, Home And Community Based Service Member Needs Assessment - Guidelines
  • Exhibit 1620-17, HCBS Needs Assessment
  • Exhibit 1620-18, ALTCS Member Service Options - Decision Tree
  • Exhibit 1620-19, Services included in High Cost Behavioral Health Reinsurance Calculation
  • Exhibit 1620-20, Prior Authorization of Services for ALTCS Members