Provider Manual February 2020 Update

www.MercyCareAZ.org

March 2, 2020

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, and Division of Developmental Disabilities

Effective 2/29/2020, Mercy Care's Provider Manual has been updated. All changes in the manual are highlighted in yellow. Detailed changes for each chapter are as follows:

Chapter 100 – Mercy Care Provider Manual General Terms

MC Chapter 3 – Network Management Overview – Updated this section to rename Provider Relations to Network Management. This was updated throughout the manual.
Section 4.28 – Cultural Competency, Health Literacy and Linguistic Services – Language Line information updated to reflect recent provider notification update.
Section 4.47 – Mercy Care Web Portal - Updated lines of business under portals and added Pro-Pat information based on recent provider notification.
Section 12.10 – Reporting and Monitoring of Seclusion and Restraint – E-mail address in this section has been updated.
Section 13.07 – Provider Authorization - This section has been revised to reflect the reimplementation of ProPat per recent provider notification.
Section 16.01 – Contract Requirements – Course name changed.

Chapter 200 - Mercy Care Complete Care (MCCC) and Mercy Care DD (Mercy DD) Plan Specific Terms

Section 3.00 – Behavioral Health Overview – Corrected “Care” to “Case”.
Section 3.03 – Emergency Services – Updated phone number for Crisis Response Network.
Section 3.04 – Case Management Caseload Ratio Guideline - Language changed and added to each LOB, as it applies to all.
Section 3.09 – DDD Coordination of Care – Highlighted language changes were made to this section.
Section 3.10 – DD Members with SMI Designation, Provider Requirements - This is a new section added to the Provider Manual.
Section 3.12 – General and Informed Consent - Corrected “Care” to “Case”.
Section 3.19 – Out of State Treatment for Behavioral Health – Changes made to CFT language.
Section 3.26 – Housing for Individuals Determined to have Serious Mental Illness (SM) for Central GSA – Changes made in regard to DD. Corrected “Care” to “Case”.
Section 3.27 – Employment & Rehabilitation Services for Individuals Determined to be Eligible for Title XIX/XXI Behavioral Health Service Benefit – New section added to Provider Manual.
Section 4.01 – Funding – New section regarding Governor’s Office – Substance Use Disorder Funds (SUDS) and Eligibility added to this section.
Section 4.02 – Appointment Availability Standards – Changes made in accordance with AHCCCS policy changes.
Section 4.03 – Outreach, Engagement, Reengagement and Closure – New bullet added for At Risk Crisis Plans in accordance with AHCCCS instruction.
Section 4.05 – Special Populations - Corrected “Care” to “Case”.
Section 5.10 – Behavioral Health Medications - Language added to match DDD contract language.
Section 6.00 – Peer and Family Support Services - This section rewritten based on updates to AMPM policies 963 and 964.
Section 7.01 – Dental Covered Services - Updated language to match AHCCCS policy.

Chapter 300 – Mercy Care Long Term Care Plan Specific Terms

Section 4.03 – Case Management Caseload Ratio Guidelines - Language changed and added to each LOB, as it applies to all.
Section 4.04 – Emergency Services – Change made to appropriate Crisis Response Network phone number.
Section 4.05 – Crisis Intervention Services - Section has been added to the Chapter 300 Provider Manual from the ACC Provider Manual.
Section 4.21 – Minimum Elements of the Behavioral Health Assessment - New language added to the Provider Manual in accordance with AHCCCS instruction.
Section 6.00 – Peer and Family Support Services - This section rewritten based on updates to AMPM policies 963 and 964.
Section 7.00 – Dental Services - Updated language to match AHCCCS policy.

Chapter 400 – Mercy Care RBHA Plan Specific Terms

Section 1.00 – About Mercy Care RBHA - Language change from regarding Grants.
Section 1.01 – Overview of the Arizona Public Behavioral Health System – Additional language clarification regarding grants.
Section 2.01 – Additional Behavioral Health Appointment Availability Information - Changes made to language.
Section 2.03 – Outreach, Engagement, Reengagement and Closure - At Risk Crisis Plans information was inserted into the Provider Manual based on a AHCCCS request. A new section regarding Outreach to Service Members, Veterans, and Families was added about PsychArmor references.
Section 2.04 – Emergency Services - Change made to appropriate Crisis Response Network phone number.
Section 2.05 – Crisis Intervention Services - This section was requested to be added to both MCLTC and RBHA chapters. It is currently in the ACC chapter.
Section 2.07 -Clinical Guidelines - Moved from General Terms Chapter to RBHA Chapter as it only applies to RBHA.
Section 2.12 – Housing for Individuals Determined to have Serious Mental Illness (SMI) - Updates to language made.
Section 2.13 – Services with Special Circumstances – Non-Title XIX/XXI Behavioral Health Services Benefit – New section added.
Section 3.00 – Provider Selection - Change made to reflect new phone number.
Section 3.04 – Case Management Caseload Ratio Guidelines - Language changed and added to each LOB, as it applies to all.
Section 4.00 – Covered and Non-Covered Services - Changed reference to AMPM Policy 310-B per AHCCCS change.
Section 5.04 – Out of State Treatment for Behavioral Health - Updated access to AHCCCS behavioral health policy.
Section 7.00 – Peer and Family Support Services - This section rewritten based on updates to AMPM policies 963 and 964
Section 8.00 – Dental Services - Updated language to match AHCCCS policy.
Section 10.02 – Coordination of Behavioral Health Care with Other Governmental Entities - Language changes made.

You can access our Provider Manual on our Provider Manual web page.

As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.

Thanks for all you do!