In accordance with House Bill 2442 (HB 2442), also known as Jacob’s Law, and Arizona Health
Care Cost Containment System (AHCCCS) Policy 449, Mercy Maricopa has made the following
updates to its Member Handbook.
The text highlight in yellow indicates new information.
(Page 8) Building a clinical team
Individuals eligible for behavioral health services through AHCCCS are assigned to a T/RBHA
based on where they live. American Indians, however, who are assigned to a TRBHA, have the
option to choose to receive their services from a RBHA or TRBHA. You have been assigned to
Mercy Maricopa because you live within Mercy Maricopa service area. You will continue to
receive services from Mercy Maricopa, unless you move to where Mercy Maricopa does not
provide services, with one exception. If you are an AHCCCS-eligible child in the custody of
Department of Child Safety (DCS) and move to a different county due to the location of an outof-home placement (e.g., foster home, kinship or group home) but remain with the same court
of jurisdiction, you will remain with Mercy Maricopa. You may continue any current treatment
in the out-of-home placement’s county and/or seek any new or additional treatment in the outof-home placement’s county of residence regardless of Mercy Maricopa’s provider network.
This is to be coordinated with your Child and Family Team. Individuals who are not AHCCCS
eligible will be enrolled with a T/RBHA for behavioral health services. Enrollment with a T/RBHA
is also based on where a person lives.
(Page 9) Child and Family Team
The Child and Family Team (CFT) is a defined group of people that includes, at a minimum, the
child and his/her family and/or out-of-home caregiver, a behavioral health representative, and
any individuals important in the child’s life that are identified and invited to participate by the
child and family. This may include, for example, teachers, extended family members, friends,
family support partners, healthcare providers, coaches, community resource providers,
representatives from religious affiliations like churches, synagogues or mosques, or agents from
other service systems like Arizona Department of Child Safety (DCS) or Division of
Developmental Disabilities (DDD), etc. 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 resources needed to develop an effective service plan. The Child
and Family Team can expand and contract as necessary to be successful on behalf of the child.
(Page 16) Choosing a provider
A provider network is a group of providers who work with a T/RBHA and are available to
provide behavioral health services. Mercy Maricopa will help you choose a provider from within
the provider network. If you would like to select a provider based on convenience, location or
cultural preference, please tell Mercy Maricopa Member Services. You will need to contact the
provider to make, change, or cancel your appointments. You may also contact Mercy Maricopa
if you would like assistance with making, changing, or canceling your appointments.
If you need help with scheduling your appointments, contact Mercy Maricopa Member Services
at 602-586-1841 or toll-free at 1-800—564-5465. After selecting and contacting a provider, you
should be seen within seven (7) days for an intake assessment and within 21 days for ongoing
appointment.
For children in the custody of DCS and/or children who are adopted, in the event an intake isn’t
provided within 7 days and/or clinically necessary services aren’t provided within 21 days, DCS,
the adoptive parent or the out-of-home caregiver (e.g., foster parent, kinship or group home)
should contact the Mercy Maricopa Designated DCS Point of Contact at
[email protected] and the AHCCCS Customer Service line at 602-364-4558. You may
then contact any AHCCCS-registered providers directly, regardless of whether they’re a part of
the Mercy Maricopa provider network.
If you are not happy with your current provider, contact Mercy Maricopa Member Services to
discuss other available options.
If you are getting substance abuse services that are funded by the Substance Abuse Block Grant
(SABG), you have the right to get services from a provider to whose religious character you do
not object. If you object to the religious character of your substance abuse provider, you may
ask for a referral to another provider of substance abuse treatment. You will get an
appointment with the new provider within 7 days of your request for a referral, or earlier if
your behavioral health condition requires. The new provider must be available to you and
provide substance abuse services that are similar to the services that you were receiving at the
first provider.
(Page 29) Service coverage for unique groups
Children in the custody of DCS
For any child who has been removed from the home by DCS, the foster parent, group home
staff, foster home staff, relative or other person or agency in whose care the child is currently
placed can consent to evaluation and treatment for routine medical and dental treatment and
procedures, including behavioral health services.
Examples of behavioral health services in which out-of-home caregivers can consent to include:
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Assessment and service planning
Counseling and therapy
Rehabilitation services
Medical Services
Psychiatric evaluation
Psychotropic medication
Laboratory services
Support Services
Case Management
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Personal Care Services
Family Support
Peer Support
Respite
Sign Language or Oral Interpretive Services
Transportation
Crisis Intervention Services
Behavioral Health Day Programs
DCS must consent to inpatient psychiatric acute care services, residential treatment services,
therapeutic group homes, and Home Care Training to Home Care Client (HCTC).
Examples of medical and dental treatment and procedures out-of-home caregivers can consent
to include:
• Routine medical and dental treatment and procedures, including early periodic
screening, diagnosis and treatment services, and services by health care providers to
relieve pain or treat symptoms of common childhood illnesses or conditions.
(Page 31) Consent to treatment
Consent for Children in the Custody of DCS
In cases where the parent is unavailable to provide general or informed consent and the child is
being supervised by a caregiver who is not the child’s legal guardian (e.g., grandparent) and
does not have power of attorney, general and informed consent must be obtained from one of
the following:
o Lawfully authorized legal guardian;
o Foster parent, group home staff or other person with whom the Department of
Economic Security/Department of Child Safety (DES/DCS) has placed the child; or
o Government agency authorized by the court.
If someone other than the child’s parent intends to provide general and, when applicable,
informed consent to treatment, the following documentation must be obtained and filed in the
child’s comprehensive clinical record:
Individual/Entity
Legal guardian
Relatives
Other person/agency
Documentation
Copy of court order assigning custody
Copy of power of attorney document
Copy of court order assigning custody
DCS Placements (for children removed from
the home by DCS), such as:
Foster parents/Group home staff/Foster
home staff/Relatives/Other person/agency in
whose care DES/DCS has placed the child
Copy of Notice to Provider – Educational and
Medical (DCS Form FC-069)
(Page 47) The twelve principles for the delivery of services to children:
3. Collaboration with others:
When children have multi-agency, multi-system involvement, a joint assessment is
developed and a jointly established behavioral health services plan is collaboratively
implemented.
Client-centered teams plan and deliver services.
Each child’s team includes the child and parents and/or any foster parents out-of-home
caregiver, any individual important in the child’s life who is invited to participate by the child or
parents. The team also includes all other persons needed to develop an effective plan,
including, as appropriate, the child’s teacher, the child’s DCS and/or DDD caseworker, and the
child’s probation officer.
The team:
a) Develops a common assessment of the child’s and family’s strengths and needs
b) Develops an individualized service plan
c) Monitors implementation of the plan
d) Makes adjustments in the plan if it is not succeeding