I. URPOSE - azahcccs.gov

1 AHCCCS MEDICAL POLICY MANUAL SECTION 320 SERVICES WITH SPECIAL CIRCUMSTANCES 320-V Page 1 of 10 320-V - BEHAVIORAL HEALTH RESIDENTIAL FACILITIES EFFECTIVE DATE: 02/08/19 APPROVAL DATES: 10/18/18, 02/07/19 I. PURPOSE This Policy applies to AHCCCS Complete Care (ACC) and RBHA Contractors; Behavioral Health Residential Facility (BHRF) Providers serving Fee-For-Service (FFS) Programs as delineated within this Policy, including TRBHA and the American Indian Health Program (AIHP); and all FFS populations, excluding Federal Emergency Services (FES). (For FES, see AMPM Chapter 1100).

2 This Policy establishes requirements for the provision of care and services in a (BHRF). II. DEFINITIONS ADULT RECOVERY TEAM (ART) A group of individuals that, following the nine Guiding Principles for Recovery-Oriented Adult Behavioral Health Services and Systems, work in collaboration and are actively involved in a person's assessment, service planning and service delivery. At a minimum, the team consists of the person, his/her guardian (if applicable), advocates (if assigned), and a qualified behavioral health representative. The team may also include members of the enrolled person's family, physical health, behavioral health or social service providers, representatives or other agencies serving the person, professionals representing various areas of expertise related to the person's needs, designated representatives or other persons identified by the enrolled person.

3 BEHAVIORAL HEALTH CONDITION Mental, Behavioral, or Neurodevelopmental Disorder (F01-F99) diagnosis defined by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). BEHAVIORAL HEALTH RESIDENTIAL FACILITY (BHRF) As Specified in R9-10-101, a health care institution that provides treatment to an individual experiencing a behavioral health issue that limits the individual s ability to be independent or causes the individual to require treatment to maintain or enhance independence. AHCCCS MEDICAL POLICY MANUAL SECTION 320 SERVICES WITH SPECIAL CIRCUMSTANCES 320-V Page 2 of 10 BEHAVIORAL HEALTH PARAPROFESSIONAL As specified in R9-10-101, an individual who is not a behavioral health professional who provides behavioral health services at or for a health care institution according to the health care institution s policies and procedures that: 1.

4 If the behavioral health services were provided in a setting other than a licensed health care institution, the individual would be required to be licensed as a behavioral professional under Title 32, Chapter 33; and 2. Are provided under supervision by a behavioral health professional. BEHAVIORAL HEALTH PROFESSIONAL (BHP) a. An individual licensed under Title 32, Chapter 33, whose scope of practice allows the individual to: i. Independently engage in the practice of behavioral health as defined in 32-3251, or ii. Except for a licensed substance abuse technician, engage in the practice of behavioral health as defined in 32-3251 under direct supervision as defined in R4-6- 101, b.

5 A psychiatrist as defined in 36-501, c. A psychologist as defined in 32-2061, d. A physician, e. A behavior analyst as defined in 32-2091, f. A registered nurse practitioner licensed as an adult psychiatric and mental health nurse, or g. A registered nurse. BEHAVIORAL HEALTH TECHNICIAN (BHT) As specified in R9-10-101, an individual who is not a behavioral health professional who provides behavioral health services at or for a health care institution according to the health care institution s policies and procedures that: a. If the behavioral health services were provided in a setting other than a licensed health care institution, the individual would be required to be licensed as a behavioral professional under Title 32, Chapter 33; and b.

6 Are provided with clinical oversight by a behavioral health professional. BHRF STAFF For the purpose of this policy, BHRF staff means any employee of the BHRF agency including but not limited to Administrators, Behavioral Health Paraprofessionals, Behavioral Health Professionals (BHP) and Behavioral Health Technicians. AHCCCS MEDICAL POLICY MANUAL SECTION 320 SERVICES WITH SPECIAL CIRCUMSTANCES 320-V Page 3 of 10 CHILD AND FAMILY TEAM (CFT) A defined group of individuals that includes, at a minimum, the child and his or her family, a behavioral health representative, and any individuals important in the child s life that are identified and invited by the child and family to participate.

7 This may include teachers, extended family members, friends, family support partners, healthcare providers, coaches, and community resource providers, representatives from churches, synagogues, or mosques, agents from other service systems like Department of Child Safety (DCS) or the Division of Developmental Disabilities (DDD). The size, scope, and intensity of involvement of the team members are determined by the objectives established for the child, the needs of the family in providing for the child, and by who is needed to develop an effective service plan, and can therefore expand and Contract as necessary to be successful on behalf of the child.

8 CO-OCCURRING For the purpose of this Policy, Co-Occurring will be defined as the coexistence of both a behavioral health and a substance use disorder. MEDICATION ASSISTED TREATMENT (MAT) The use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. NATURAL SUPPORT Provided by those individuals who know or are related to the member/family, but do not provide a paid service, such as a grandparent or neighbor who is connected to the member/ family. PEER/RECOVERY SUPPORT SERVICE Intentional partnerships based on shared lived experiences to provide social and personal support.

9 This support is coupled with specific, skill-based training, coaching, or assistance to bring about social or personal change at the individual, family or community level. These services can include a variety of individualized and personal goals, including living preferences, employment or educational goals and development of social networks and interests. PEER/RECOVERY SUPPORT SPECIALIST For purposes of this Policy, an individual trained, credentialed, and qualified to provide peer/recovery support services within the AHCCCS Program. AHCCCS MEDICAL POLICY MANUAL SECTION 320 SERVICES WITH SPECIAL CIRCUMSTANCES 320-V Page 4 of 10 SERVICE PLAN A complete written description of all covered health services and other informal supports which includes individualized goals, family support services, care coordination activities and strategies to assist the member in achieving an improved quality of life.

10 TREATMENT PLAN For the purpose of this Policy, Treatment Plan is defined as: A complete written description of all services to be provided by Behavioral Health Residential Facility (BHRF). The Treatment Plan shall be based on the intake assessments and outpatient Service Plan. III. POLICY Care and services provided in a BHRF are based on a per diem rate (24-hour day), require prior and continued authorization and do not include room and board. Contractors shall refer to ACOM Policy 414 for standard and expedited request timeframes and requirements. For information on prior authorization requirements for FFS members refer to the FFS web page.