Arizona Department of Health Services Effective Date: XX/XX/XXXX10/01/201015/2011

Division of Behavioral Health Services Last Review Date: XX/XX/XXXX08/24/2011

Policy and Procedures Manual Last Effective Date: 10/1501/20110

POLICY QM 2.8 TECHNOLOGY

A. PURPOSE: To establish the Arizona Department of Health Services/Division of

Behavioral Health Services (ADHS/DBHS) policy and process related to the review and approval of new technologies and/or psychotherapeutics, including the usage of new applications for established technologies and/or psychotherapeutics.New medications may be considered a new technology for purposes of this policy.

B. SCOPE:This policy applies to ADHS/DBHSTribal/Regional Behavioral Health Authorities (T/RBHAs) and their subcontractors.

C. POLICY: ADHS/DBHS will ensure review and adoption of new technologies and/or adoption of new uses to existing technologies utilize evidence based research and guidelines. Adoption of evidence based research and guidelines include a meta-analysis of related peer reviewed literature.

D. REFERENCES: A.R.S. §9-22-201

AHCCCS/ADHS Contract

ADHS/RBHA Contracts

AHCCCS Medical Policy Manual, Chapter 1000, Policy 1020

ADHS/DBHS AnnualMedical Management/Utilization Management Plan

E. DEFINITIONS:

Approval

The process by which ADHS/DBHS allows the use of a new technology or change in use of an existing technology or psychotherapeutic.

Evidence Based Practice

Practices, based on research findings and expert or consensus opinion in regard to available evidence, that are expected to produce a specific clinical outcome.

Experimental or Investigational Therapies

Treatments which are not generally considered standard of care within the psychiatric medical community. In addition, these therapies are not usually considered a covered benefit by the state and federal statute.

Peer Reviewed Literature

Scientific studies critically assessed by scholars in the author's field or specialty and deemed eligible for publication. The review process is used to ensure studies are sound and findings are valid.

Technology

Any device or apparatus which is designed or manufactured to reduce the severity of behavioral health diagnoses symptoms recognized by DSM-IV-TR and/or the ICD 9. Technology for the purposes of this policy does not include medications which are reviewed within the purview of the Pharmacy and Therapeutics committee.

F. PROCEDURES

1. Providers may initiate a request for T/RBHA coverage ofnew approved technologies and/or psychotherapeutics, including the usage of new applications for established technologies and/or psychotherapeutics by submitting the proposal in writing to the T/RBHA Medical Director for review. The proposal must include (at a minimum):

a)Medical necessity criteria;

b)Documentation supporting medical necessity;

c)A cost analysis for the new technology; and

d)Peer reviewed literature indicating the efficacy of the new technology or the modification in usage of the existing technology.

2. T/RBHAs shall participate in the review of new approved technologies and/or psychotherapeutics, including the usage of new applications for established technologies and/or psychotherapeutics through the T/RBHA Pharmacy and Therapeutics Committee and the Medical Management Committee.

3. T/RBHAs shall review requests and inform the requestor and member of the decision to provide the technology in a timely manner.When the request is accompanied with a service authorization request, the decision for coverage must be completed in a timely manner, within 3 business days for an expedited request, 14 days for a standard request, with an extension of up to 14 additional days if the extension is in the best interest of the recipient.

4. Discussion reflecting consideration of anew approved technology and/or psychotherapeutic, including the usage of a new application for established technologyand/or psychotherapeutic and the T/RBHAs determination of coverage shall be documented in the Pharmacy and Therapeutics Committee meeting minutes and the Medical Management Committee meeting minutes.

5. The T/RBHA will notify ADHS/DBHS of its decision to cover a new approved technology and/or psychotherapeutic, including the usage of new applications for established technologyand/or psychotherapeutic within 30 days of reaching that determination.

6. Consideration for systemic implementation of the coverage of thetechnology will be prioritized for consideration by ADHS/DBHS based on trends and the meta-analysis of peer reviewed literature.

APPROVED BY:

______

Laura K. Cory Nelson, M.D. Date

CEO, Arizona State Hospital

Acting Deputy Director

Division of Behavioral Health Services

Chief Medical Director

Arizona Department of Health Services

______

Steven Dingle, M.D. Date

Acting Chief Medical Officer

Arizona Department of Health Services

Arizona State Hospital

______

ADHS/DBHS Division of Behavioral Health Services

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