White Mountain Apache Regional Behavioral Health Authority 

2.0

INTRODUCTION

3.0

CLINICAL OPERATIONS

3.1

Eligibility Screening for AHCCCS Health Insurance. Medicare Part D Prescription

Drug Coveratge, and the Limited Income Subsidy Program

3.2

Appointment Standards and Timeliness of Service

Apache Behavioral Health Services, Inc.

3.3

Referral Process and Intake Process

3.4

Co-Payments

3.5

Third Party liability and Coordination of Benefits

3.6

3.7

3.8

3.9

Member Handbooks

Resurved

Outreach, Enagagement, Re-Engagement and Closure

Assessment and Service Planning

3.10

SMI eligibility Determination

3.11

General and Informed Consent to Treatment

3.12

Advnace Directives

3.13

Covered Behavioral Health Services

3.14

Securing Services and prior Authorization

3.15

Psycholtropic Medications: Prescribing and Monitoring

3.16

Medication List

3.17

Transition of Persons

3.18

3.19

3.20

3.21

3.22

3.23

3.24

3.25

Crisis Intervention Services

Reserved

Cultural Competence

Out-of-State Placements for Children and Young Adults

Reserved

Credentialing and Privileging

Special Populations

Pre-Petition Screening, Court Ordered Evaluation and Court Ordered Treatment

3.26

Housing for individuals determined to have a Serious Mental Illness (SMI)

4.0

COMMUNICATION AND CARE COORDINATION

4.1

Disclosure of Behavioral Health Information

4.2

Behavioral Health Medical Record Standards

4.3

Coordination of Care with AHCCCS Health Plans, Primary Care Providers and

4.4

Coordination of Care with Other Governmental Entities

4.5

Partnership with Families and Family-Run Organization in the Children's

Medicare Providers

Behavioral Health System

5.0

MEMBER RIGHTS AND PROVIDER CLAIMS DISPUTES

5.1

Notice Requirements and Appeal Process for Title XIX and Title XXI Eligible Persons

5.2

Member Complaints

5.3

Grievance and Request for Investigations for Persons Detemined to have a

Serious Mental Illness

5.4

Persons Detemined to have a Serious Mental Illness

5.1

Notice and Appeal Requirements (SMI and Non-SMI/Non-Ttile XIX/XXI)

5.2

Provider Claims Disputes

6.0

DATA AND BILLING REQUIRMENTS

Submitting Tribal Fee-for-Service Claims to AHCCCS

6.1

6.2

Submitting Claims and Encounters to the RBHA

7.0

REPORTING REQUIREMENTS

7.1

Fraud and Program Abuse Reporting

7.2

Medical Institution Reporting for Medicare Part D

7.3

Seclusion and Restraint Reporting

7.4

Reporting and Incidents, Accidents and Deaths Reporting

7.5

Enrollment, Disenrollment and Other Data Submission

7.6

Duty to Report Abuse, Neglect or Exploitation

7.7

Duty to Warn

8.0

PERIODIC AUDITS AND SURVEYS

8.1

Encounter Validation Studies

8.2

Reserved

8.3

Behavioral Health recipient Satisfactor Survey

8.4

Performance Improvement Projects

8.5

Medical Care evaluation Studies

9.0

TRAINING AND DEVELOPMENT

Training Requirements

9.1

9.2

Peer Support/Recovery Support Training Certifications and Supervision Req.

10.0

T/RBHA SPECIFIC REQUIREMENTS

Health and Safety

10.1

10.2

Emergency Preparedness and Business Continuity

10.3

HIS Notification Requirements

11.0

DEFINITIONS

12.0

FACT SHEETS

13.0

14.0

FORMS AND ATTACHMENTS

INDEX