CHAPTER 1 – INTRODUCTION TO HEALTH CHOICE INTEGRATED CARE
1.0 – SCOPE
Health Choice Integrated Care (HCIC) operates as the designated Regional Behavioral Health Authority
(RBHA) and Integrated RBHA. HCIC is designated by the Arizona Department of Health Services/Department
of Behavioral Health Services (ADHS/DBHS) as being responsible for the planning, implementation, funding,
monitoring and administration of publicly funded comprehensive behavioral health services to the Title XIX
eligible persons either being diagnosed as Seriously Mentally Ill (SMI), or designated as General Mental Health
(GMH), Substance Abuse (SA) and Children/Adolescents (CA) while coordinating physical health care for these
members with AHCCCS acute care plans.
The HCIC Northern Arizona Geographic Services Area consists of over 66,000 square miles, or approximately
half of the geographic area of Arizona, and includes the counties of Mohave, Yavapai, Coconino, Navajo,
Apache, Gila and portions of Graham. Despite enormous geographic distances and sparsely populated
communities, HCIC has established, and continues to expand, enhance and shape, a full continuum of
covered physical health and behavioral health services to meet member's needs.
Health Choice Integrated Care is committed to providing quality care and services to our members,
access to care for their behavioral and medical health (integrated care) needs. We use a holistic
approach to care, focusing on members’ goals with an understanding their unique and specific needs.
Our experience facilitates access to high-quality, integrated care to people who have complex needs
through partnerships with providers and community resources to ensure those needs are met.
The Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) has
developed expectations for each Tribal and Regional Behavioral Health Authority (T/RBHA) Provider
Manual, which includes content specific to their geographic service areas (GSAs) and communities. The
Health Choice Integrated Care Provider Manual describes public behavioral and integrated care health
system requirements for any entity that directly provides behavioral health/integrated care services.
These entities may include:
•
•
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Behavioral health/integrated care contracted and non-contracted providers, including those that
provide emergency and post-stabilization services;
Behavioral health/integrated care prevention services providers; and
Regional Behavioral Health Authorities.
The Health Choice Integrated Care (HCIC) Provider Manual is applicable to defined populations that
may access public behavioral health/integrated care services. These populations include:
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Title XIX and Title XXI enrolled behavioral health members;
•
Behavioral health members receiving emergency/crisis services;
•
Non-Title XIX persons determined to have a Serious Mental Illness;
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Special populations, including persons receiving services through the Substance Abuse Block
Grant (SABG);
•
Non-enrolled persons participating in ADHS/DBHS prevention sponsored activities;
•
Non-enrolled persons participating in ADHS/DBHS HIV Early Intervention services;
•
Other populations, based on the availability of funding and the prioritization of available funding.
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Providers are contractually obligated to adhere to and comply with all terms of the plan and provider
contract, including all requirements described in this manual in addition to all federal and state
regulations governing the plan and the provider. Health Choice Integrated Care may or may not
specifically communicate such terms in forms other than the contract and this provider manual. While
this manual contains basic information about the Arizona Department of Health Services/Division of
Behavioral Health Services (ADHS/DBHS) as well as Arizona Health Care Cost Containment System
(AHCCCS) requirements, providers are required to fully understand and apply these requirements when
administering covered services.
Please refer to http://www.azdhs.gov/bhs/ for further information regarding ADHS/DBHS regulations.
Health Choice Integrated Care has comprehensive policies and procedures in place throughout its
departments that assure all compliance and regulatory standards are met. Policies and procedures are
reviewed on an annual basis and required updates made as needed.
1.1 – INTRODUCTION
OVERVIEW OF THE ARIZONA PUBLIC BEHAVIORAL HEALTH SYSTEM
The Arizona Health Care Cost Containment System (AHCCCS) is the single state Medicaid Agency
and provides funding to ADHS/DBHS to administer behavioral health benefits for persons who are
Title XIX and Title XXI eligible.
ADHS/DBHS contracts with Tribal and Regional Behavioral Health Authorities (T/RBHAs) who, in turn,
subcontract with community providers that administer behavioral health programs and services for
children and adults and their families. ADHS/DBHS is responsible for the oversight of the
administration of behavioral health services for several populations funded through various sources.
Arizona state law requires ADHS/DBHS to administer community based treatment services for adults
who have been determined to have a Serious Mental Illness (see 9 A.A.C. 21).
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides funding to
ADHS/DBHS through two block grants:
•
The Substance Abuse Block Grant (SABG) supports a variety of substance abuse services in both
specialized addiction treatment and more generalized behavioral health settings, and
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The Community Mental Health Services Block Grant (CMHS) supports Non-Title XIX services to
children determined to have Serious Emotional Disturbance (SED) and adults determined to have
Serious Mental Illness (SMI).
ADHS/DBHS administers other federal, state and locally funded behavioral health services.
Individuals can get more information about ADHS/DBHS programs by visiting:
http://www.azdhs.gov/bhs.
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PARTNERING WITH TRIBAL AND REGIONAL BEHAVIORAL HEALTH AUTHORITIES (T/RBHAs)
ADHS/DBHS, in partnership with the Health Choice Integrated Care, promote collaboration and
encourage family centered, personalized and culturally relevant healthcare services that result in
positive outcomes for persons. The expected outcomes include but are not limited to:
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Improved functioning;
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Reduced symptoms stemming from behavioral health conditions;
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Improved overall health, both behavioral and physical; and
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Improved quality of life for families and individuals.
TRIBAL AND REGIONAL BEHAVIORAL HEALTH AUTHORITIES (T/RBHAs)
ADHS/DBHS contracts with Regional Behavioral Health Authorities (RBHAs) to deliver behavioral
health services to six Geographic Service Areas (GSAs). Each RBHA must have a network of providers
to deliver all covered behavioral health services. RBHAs contract with behavioral health providers to
provide the full array of covered behavioral health services.
T/RBHAs by County and GSA
T/RBHA
Cenpatico Behavioral Health of Arizona
Community Partnership of Southern Arizona
(CPSA)
Cenpatico Behavioral Health of Arizona
Northern Arizona Regional Behavioral Health
Authority (NARBHA)
Cenpatico Behavioral Health of Arizona
Health Choice Integrated Care
Pascua Yaqui Tribe of Arizona
Gila River Indian Community
White Mountain Apache Tribe
Counties
Greenlee, Graham, Cochise and
Santa Cruz
Pima
Yuma and La Paz
Mohave, Coconino, Apache,
Navajo and Yavapai
Pinal and Gila
Maricopa
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GSA
3
5
2
1
4
6
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OVERVIEW OF HEALTH CHOICE INTEGRATED CARE
The State of Arizona has chosen Health Choice Integrated Care, as the new Regional Behavioral Health
Authority (RBHA) for the Greater Arizona Northern Region which includes the following Counties:
Mohave, Coconino, Yavapai, Apache, and Navajo, Gila and Pinal.
Under contract with Health Choice Integrated Care, providers are expected to follow the contents of this
provider manual, Health Choice Integrated Care Policies and Procedures as well as fulfill the scope of the
contract terms. Health Choice Integrated Care maintains a provider relations department for providers
to ask questions and request technical assistance as well as to discuss contractual and program changes.
For more information about Health Choice Integrated Care, its departments and their functions, please
visit www.HealthChoiceIntegratedCare.com.
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ADHS/DBHS SYSTEM PRINCIPLES
All healthcare services must be delivered in accordance with ADHS/DBHS system principles.
ADHS/DBHS supports a healthcare system that includes:
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Easy access to care;
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Behavioral health member and family involvement;
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Collaboration with the Greater Community;
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Effective innovation;
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Expectation for improvement; and
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Cultural competency.
Easy Access to Care
• Accurate information is readily available that informs healthcare members, families and
stakeholders how to access services;
• The healthcare network is organized in a manner that allows for easy access to behavioral
health/integrated care services; and
• Services are delivered in a manner, location and timeframe that meet the needs of healthcare
members and their families.
Behavioral health member and family involvement
Behavioral health members and families are active participants in behavioral health delivery system
design, prioritization of behavioral health resources and planning for and evaluating the services
provided to them; and behavioral health members, families and other parties involved in the person
and family’s lives are central and active participants in the assessment, service planning and delivery
of behavioral health services and connection to natural supports.
Collaboration with the Greater Community
• Stakeholders including general medical, child welfare, criminal justice, education and other
social service providers are actively engaged in the planning and delivery of integrated
services to behavioral health members and their families;
• Relationships are fostered with stakeholders to maximize access by healthcare members and
their families to needed resources such as housing, employment, medical and dental care, and
other community services; and
• Providers of healthcare services collaborate with community stakeholders to assist healthcare
members and families in achieving their goals.
Effective Innovation
• Healthcare providers are continuously educated in and use best practices;
• The service system recognizes that substance abuse and other mental health disorders are
inextricably intertwined, and integrated substance abuse and mental health evaluation and
treatment is the community standard; and
• Interested healthcare members and families are provided training and supervision to be
retained as providers of peer support services.
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Expectation for Improvement
• Services are delivered with the explicit goal of assisting people to achieve or maintain success,
recovery, gainful employment, success in age-appropriate education, return to or preservation of
adults, children and families in their own homes, avoidance of delinquency and criminality, selfsufficiency and meaningful community participation;
• Services are continuously evaluated, and modified if they are ineffective in helping to meet
these goals; and
• Healthcare providers instill hope that achievement of goals is possible even for the most
disabled.
Cultural Competency
Cultural competence in health care demonstrates the ability of systems to provide care to persons with
diverse values, beliefs and behaviors. As such, service delivery is tailored to meet the person’s social,
cultural, and linguistic needs, including the needs of the deaf and hard of hearing. As healthcare
providers, the goal should be to create a behavioral health system of care that fits everyone’s needs. To
accomplish this goal, it is necessary to ensure that staff providing services have the skills to meet the
person’s unique family, culture, natural supports, traditions, strengths and sexual orientation or gender
identity when developing a person’s individual treatment plan. ADHS/DBHS endorses the following
activities for ensuring a culturally competent behavioral health system:
•
•
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Healthcare service providers are recruited, trained and evaluated based upon competency in
linguistic and culturally appropriate skills in responding to the individual needs of each healthcare
member and family;
Health Choice Integrated Care management reflects cultural diversity in values and in policies; and
Health Choice Integrated Care management and behavioral health service providers strive to
improve through periodic cultural self-assessment and modify individual services or the system as a
whole when applicable.
Integration of Primary Health and Behavioral Healthcare
Health Choice Integrated Care utilizes an integrated care approach to positively impact the health and
quality of life of our high-risk members diagnosed with a SMI. HCIC ensures services in Northern
Arizona are accessible, offer choice to members, are wellness and recovery oriented, are culturally
relevant, include specialty services, and are fully integrated or co-located.
ARIZONA CHILDREN’S PRINCIPLES
ADHS/DBHS requires that behavioral health services be delivered to all children according to the
Arizona Children’s Principles (See 12 Principles for Children's Health).
PRINCIPLES FOR PERSONS DETERMINED TO HAVE A SERIOUS MENTAL ILLNESS (SMI)
The service delivery system shall operate in accordance with the following principles for persons who
have been determined to have SMI and their families (See Principles for Persons with a Serious Mental
Illness).
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REVISIONS TO THE HEALTH CHOICE INTEGRATED ARE PROVIDER MANUAL
Policies established as medical policies are updated annually or more frequently, if changes are
necessary. Other sections of the Provider Manual are updated on an ongoing basis, but at a minimum,
sections will be reviewed every year. For information or changes that must be communicated
immediately, ADHS/DBHS issues Policy Clarification Memorandums and posts them to the ADHS/DBHS
website at http://www.azdhs.gov/bhs/policy/memos.php. Health Choice Integrated Care
incorporates any changes made by ADHS/DBHS into their provider manual as soon as it’s received.
Healthcare providers and others may provide comments and request for revisions to the Provider
Manual. Healthcare providers and other interested persons should contact the Health Choice
Integrated Care Network Development Department at (877) 923-1400 to provide input and requests
for updates.
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Providers should note that policy revisions will be available both on Health Choice Integrated
Care's website at www.HealthChoiceIntegratedCare.com, and via email to all contracted
providers.
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Provider Notices: Notices to providers regarding changes in program policy or procedures will
also be distributed via e-mail to contracted providers and posted to
www.HealthChoiceIntegratedCare.com.
Health Choice Integrated Care must provide an updated copy of the Provider Manual to ADHS/DBHS on
a yearly basis for approval and prior to distribution to their Provider Network. In addition, current
versions of Health Choice Integrated Care Provider Manual policies must be posted to our website
(including policies added to Section 10.0).
AHCCCS requires that ADHS/DBHS review and approve all policies pertaining to Title XIX and Title XXI
eligible persons. As such, any policies developed by Health Choice Integrated Care that establishes
requirements for the provision of behavioral health services must be submitted to the ADHS/DBHS Policy
Office prior to implementation.
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Last Revised: October, 2015