/ Chapter 500
AHCCCS Medical Policy Manual
Policy 541
Coordinationofchildren’sCarewithOther GovernmentAgencies

541- Coordination of Children’s Care with Other Government Agencies[1]

Initial

Effective Date: 07/01/2016[2]

  1. Purpose

This Policy applies to Acute Care, ALTCS E/PD, CRS, DCS/CMDP (CMDP), DES/DDD (DDD), RBHA Contractors, and Fee-For-Service (FFS) Programs as delineated within Policy.

AHCCCS requires Contractors to develop and maintain a collaborative relationship with other government entities that deliver services to members and their families to ensure access to services, consistent quality and to coordinate care.

Appropriate authorizations to release information shall be obtained prior to releasing information.The Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS)AHCCCS expects T/RBHAs and providers to cooperate and actively work with other government entities and agencies serving members. ADHS/DBHSAHCCCS to have has Intergovernmental Agreements (IGAs), Interagency Service Agreements (ISAs), and Memorandums of Understanding (MOUs) with several state, county, tribal, and local agencies to facilitate collaboration regarding members involved with multiple systems.

ADHS/DBHSAHCCCS requires its cContractors to develop and maintain a collaborative relationship with other government entities that deliver services to enrolled members and their families to ensure access to services, consistent quality and to coordinate care

  1. Definitions

Adult Clinical Team - 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, mental 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]

Child and Family Team (CFT) / A defined group of people that includes, at a minimum, the child and his/her family, a behavioral health representative, and any individuals important in the child’s life and who are identified and invited to participate by the child and family. This may include, for example, physical health provider, teachers, extended family members, friends, family support partners, healthcare providers, coaches, community resource providers, representatives from churches, synagogues or mosques, agent from other service systems like the Arizona Department of Child Safety (DCS) or the 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 by which individuals are needed to develop an effective service plan, and can therefore expand and contract as necessary to be successful on behalf of the child.
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.
State Placing Agency / One of the following government agencies with the authority to place a student in a residential treatment center for care, safety, or treatment: Department of Juvenile Corrections, Department of Economic Security, Department of Child Safety, the Arizona Health Care Cost Containment System or the Administrative Office of the Court. (A.R.S. §15-1181(12).
Team Decision Making / When an emergency removal of a child has occurred or the removal of a child is being considered, a Team Decision Making (TDM) Meeting is held. The purpose of the meeting is to discuss the child’s safety and where they will live.

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  1. Policy

T/RBHARBHAsContractorsmust shall develop policies, protocols and procedures that describe how members will be served and how care will be coordinated and managed with other governmental entities. The T/RBHARBHAContractorsis are responsible for ensuring that all needed collaboration with government agencies occurs.

T/RBHARBHAsContractorswill shall ensure that all required protocols and agreements with State agencies are embedded included[4] in provider manuals and required in expectations of their contracted providers. T/RBHARBHAsContractorswill shall develop mechanisms and processes to identify any and all barriers to timely services, access to care, coordination of care and quality of services for eligible and enrolled members served by other governmental entities and work collaboratively to remove barriers to care and resolve any quality concerns.

  1. Children’s Services
  1. T/RBHAContractorRBHAs shall strive to be consistent with the service goals established by other agencies serving the child and/or family.
  1. Behavioral health Sservice pPlans mustshall be directed by the Child and Family Team (CFT) toward the behavioral health needs of the child,[5] and the Tteam should seek the active inclusion of participation of[6] other involved agencies in the planning process.
  1. T/RBHARBHAContractorsswill shall ensure that service delivery is consistent with the ADHS AHCCCS Child and Family Team Practice Protocol Tool[7] and the Arizona-Vision Twelve Principles for Children Service Delivery as outlined in AMPM Policy 430the Arizona Vision.
  1. Arizona Department of Child Safety (DCS)
  1. General Requirements

i.

  1. Ensure an urgenta rapid response - for children and their families upon a child being removed from their home. (SeeRefer to ACOM Policy 417.,) Appointment Availability, Monitoring and Reporting)
  2. Coordinate the development of the behavioral health Sservice pPlan with the child welfareDCS case plan to avoid redundancies and/or inconsistencies.

iii.Ensure an urgent response - for children and their families upon a child being removed from their home.[8]

  1. Provide the DCS Specialist and the juvenile court with preliminary findings and recommendations on behavioral health risk factors, symptoms and service needs for court[9] hearings.
  2. Perform an aAssessment and identify behavioral health needs of the child, the child’s parents and family and provide necessary behavioral health services, including support services to temporary caretakers.caregivers[10].
  3. As appropriate[11], eEngage the child’s parents, family, temporary caretakerscaregivers and DCS Specialist in the behavioral health assessment and service planning process as members of the CFT.
  4. Attend team meetings such as Team Decision Making (TDM) and Family Group Decision Meetings (as appropriate) [12]for the purpose of providing input about the child and family’s behavioral health needs. When it is possible, TDM and CFT meetings should be combined.
  5. Coordinate , communicate and expedite[13] necessary services to stabilize in-home and out-of-home placements provided by DCS.
  6. Provide behavioral health services in support of family reunification and/or other permanency plans identified by DCS. Ensure that behavioral health needs of eligible parents and family members are identified and metaddressed. Ensure responsive[14]

ix. cCoordinatione activities and service delivery that supports the DCS child and family plans and facilitates adherence to DCS[15] established timeframes (see ACOM Policy 417, Appointment Availability, Monitoring and ReportingPolicy 417, Appointment Standards and Timeliness of Service and AMPM Policy 580, Behavioral Health Referral and Intake Processand ) and Practice ToolProtocols, Transition to Adulthood, Unique Behavioral Health Needs of Children, Youth and Families iInvolved with DCS and Child and Family Team (CFT). Coordination activities should include coordination with the adult service adult providers rendering of services to adult family members. [16]inclusive of participation in CFT and other case planning activities.

  1. Practice ToolsProtocols: Transition to Adulthood, The Unique Behavioral Health Service Needs of Children, Youth and Families iInvolved with DCS, and Child and Family Team (The Child and Family Team).
  2. Coordination activities should include coordination with the adult service adult providers rendering of services to adult family members. [17]inclusive of participation in CFT and other case planning activities.
  1. DCS/ADHS Arizona Families F.I.R.S.T. (Families in Recovery Succeeding Together) Program
  1. T/RBHARBHAContractorssmust shall ensure that behavioral health providers coordinate with parents/families referred through the Arizona Families F.I.R.S.T (AFF) program (see Exhibit 541-1, Overview of the Arizona Families F.I.R.S.T. (AFF) Program Model and Referral Process) [18]and particpateparticipate in the family’s CFT to coordinate services for the family and temporary caretakers.
  1. The AFF program provides expedited access to substance abuse use treatment for parents and caregivers referred by /DCS and the ADES/Family Assistance Administration (FAA) Jobs Program. ADHS/DBHS AHCCCS participates in statewide implementation of the program with DCS. T/RBHARBHAContractorss and providers mustshall:
  1. Accept referrals for Title XIX and Title XXI eligible and enrolled members and families referred through AFF.
  2. Accept referrals for Non-Title XIX and Non-Title XXI members and families referred through AFF and provide services, if eligible.
  3. Ensure that services made available to members who are Non-Title XIX and Non-Title XXI eligible are provided by maximizing available federal funds before expending state funding as required in the Governor’s Executive Order 2008-01Governor’s Executive Order 2008-01, ensuring that TXIX is the payor of first resort for all TXIX eligible individuals.
  4. Collaborate with DCS, the ADES/FAA JobsOBS Program and sSubstance Abuse uUse tTreatment providers to minimize duplication of assessments. and achieve positive outcomes for families, and

e.Develop procedures for collaboration in the referral process to ensure effective service delivery through the T/RBHARBHAContractors behavioral health system. Appropriate authorizations to release information mustshall be obtained prior to releasing information.

  1. Substanceabuse use treatment for families involved with /DCS mustshall be family centered, provide for sufficient support services and mustshall be provided in a timely manner to promote permanency for children, stability for families, to protect the health and safety of abused and/or neglected children and promote economic security for families.
  1. Contractors RBHAs and behavioral health providers are expected to collaborate and coordinate care for behavioral health members with behavioral health needs involved with Arizona Department of Juvenile Corrections (ADJC) and the Administrative Offices of the Court (AOC).
  1. Arizona Department of Education (ADE), Schools, or Other Local Educational Authorities

AHCCCS Contractors are required to work in collaboration with the ADE in support of school environments that promote behavioral health for children and assist with resources and referral linkages for children with behavioral health needs. For children receiving services through Contractors, ADHS/DBHSAHCCCS has delegated to Contractorsits authority as a State Placing Agency under A.R.S. §15-1181 tfor children receiving special education services pursuant to A.R.S. §15-761 et seq.[19] o the Contractors. This includes the authority to place a student at a Behavioral Health Inpatient Facility which provides care, safety and treatment. the functions and responsibilities as a State Placing Agency to the T/RBHARBHAs. As such it is the expectation of ADHS/DBHSAHCCCS that T/RBHARBHAs must work in collaboration with the ADE in support of school environments that promote behavioral health for children and to assist with resources and referral linkages for children with behavioral health needs.

  1. The T/RBHARBHAContractorsmustshall ensure that behavioral health providers collaborate with schools and help a child achieve success in school byas follows:

:

  1. Workingin collaboration with the school and sharinge information to the extent permitted by law and authorized by the child’s parent or legal guardian. (sReferee toAMPM Policy 550, Medical Records and Confidentiality).,

i.For children who receivinge special education services, actively considerinclude information[20] and recommendations contained in the Individualized Education Program (IEP) during the ongoing assessment and service planning process (see AMPM Policy 320).(see AMPM Policy 320-O, Behavioral Health Assessments, Service Planning and Inpatient Discharge Planning),[21]

  1. For children receiving special education services, ensuring that tThe behavioral health provider or designee shall participates with the school in developing the child’s IEP and share partner the in the implementation of behavior treatment al health interventions[22]plan interventions, if applicable.,
  2. Invitinge teachers and other school staff to participate in the CFT if agreed to by the child and legal guardian.,
  3. Having a clear uUnderstanding of the IEP requirements as described in the Individuals with Disabilities Education Act (IDEA) of 2004.
  4. EnsurSupport accommodations ing thatfor[23] students with disabilities who qualify for accommodations under Section 504 of the Rehabilitation Act of 1973.[24] are provided adjustments in the academic requirements and expectations to accommodate their needs and enable them to participate in the general education program, and

f. Ensuringe that transitional planning occurs prior to and after discharge of an enrolled child from any out-of-home placement.

  1. Department of Economic Security (ADES)

1.Arizona Early Intervention Program (ADES/AzEIP)

T/RBHARBHAContractors mustshall ensure that behavioral health providers coordinate member care with AzEIP by:

  1. Ensuring that children birth to three years of age arebirths to three years of age are referred to AzEIP in a timely manner when information obtained in their the child’behavioral health assessment reflects developmental concerns.,
  2. Ensuring that children found to require behavioral health services as part of the AzEIP evaluation process receive appropriate and timely service delivery.,
  3. Ensuring that, if an AzEIP team has been formed for the child, the behavioral health provider will coordinate team functions so as to avoid duplicative processes between systems.,and

Coordinating enrollment in the T/RBHA children’s system of care when a child transfers to the children’s DDD system.

  1. Arizona Department of Economic Security/ Division of Developmental Disabilities (ADES/Division of Developmental Disabilities (DDD))

mMembers qualifying for services through DDD can fall into several different categories based on their eligibility status and the extent of their diagnosed disability. Here are the three general groupings and the services offered to those members:

Type of DDD Eligibility / What behavioral health services are available? / Who is responsible for providing the behavioral health services?*
Title XIX and eligible for Long Term Care / All Title XIX covered services / [25]Contractors and contracted providers
Title XIX and not eligible for Long Term Care / All Title XIX covered services / Contractors and contracted providers**
Non-Title XIX / Services provided based on eligibility for services* / Contractors and contracted providers based on eligibility for services**
Type of DDD Eligibility / What behavioral health services are available? / Who is responsible for providing the behavioral health services?*
Title XIX and eligible for ALTCS / All Title XIX covered services / [26]RBHAContractors and contracted providers
Title XIX and not eligible for ALTCS / All Title XIX covered services / RBHAContractors and contracted providers**
Non-Title XIX / Services provided based on eligibility for services* / RBHAContractors and contracted providers based on eligibility for services**

*DDD American Indian members, title XIX and XXI, on- or off-reservation, eligible to receive services, may choose to receive services at any timethrough a Tribal Regional Behavioral Health Authority (TRBHA)[27]

**See Policy 320-T, Special Populations320-T, Special PopulationsNon-Discretionary Federal Grants. .

[28]RBHAContractors mustshall ensure that behavioral health providers coordinate member care with DDD by:

  1. Working in collaboration with DDD staff and service providers involved with the member.,
  1. Providing assistance to DDD providers in managing difficult behaviors.,
  1. Inviting DDD staff to participate in the development of the behavioral health service plan and all subsequent planning meetings as members of the member’s clinical team (see AMPM Policy 320-O),
  1. Incorporating information and recommendations in the Individual or Family Support Plan (ISP) developed by DDD staff, when appropriate, while developing the member’s ISP.,
  2. Ensuring that the goals of the ISP, of a member diagnosed with developmental disabilities who is receiving psychotropic medications, includes reducing behavioral health symptoms and achieving optimal functioning, not merely the management and control of challenging behavior.,
  1. Actively participating in DDD team meetings, and.
  1. For members diagnosed with Pervasive Developmental Disorders and Developmental Disabilities, sharing all relevant information from the initial assessment and ISP with DDD to ensure coordination of services.

For DDD members with a co-occurring behavioral health condition or physical health condition who demonstrate inappropriate sexual behaviors and/or aggressive behaviors, a Community Collaborative Care Team (CCCT) may be developed. For additional information regarding the roles and responsibilities of the CCCT and coordination of care expectations, please seerefer to the AMPM Policy 570, Community Collaborative Care TeamsPolicy 570, Community Collaborative Care Teams.

RBHAContractor’s mustshall develop and make available to providers policies and procedures that include information on DDD specific protocols or agreements.

3.Arizona Department of Health Services/ Bureau of Residential Facilities Licensing

When a member receiving behavioral health services is residing in an assisted living facility, the T/RBHA and behavioral health providers must coordinate with the Bureau of Residential Facilities Licensing to ensure that the facility is licensed and that there are no existing violations or legal orders. The T/RBHA and behavioral health providers must also determine and ensure that the member living in an assisted living facility is at the appropriate level of care. The T/RBHA and the behavioral health provider can coordinate with the Bureau of Residential Facilities Licensing to determine the level of care that a particular assisted living facility is licensed to provide.