On 10/1/2020, AHCCCS released new policies in the AMPM: 320-W Therapeutic Foster Care for Children - TFC (formerly known as Home Care Training for Home Care Clients HCTC) and 320-X Adult Behavioral Health Therapeutic Homes - ABHTH (formerly known as Adult HCTC). These policies establish requirements for the provision of care and services to members in these settings and include Criteria for Prior Authorization and Continued Stay.
Mercy Care has adopted the criteria outlined in these policies. Currently Mercy Care has an established process for Prior Authorization and Continued Stay for Child and Adolescent HCTC and will be implementing the criteria outlined in AMPM 320-W Therapeutic Foster Care for Children -TFC.
Effective January 18, 2021, Mercy Care will require Prior Authorization and Continued Stay review for ABHTH according to the criteria outline in AMPM 320–X Adult Behavioral Health Therapeutic Homes - ABHTH.
Approved prior authorizations will be valid for 30 days from the date of determination. After that period, a new prior authorization request with current clinical information must be submitted.
Mercy Care respects member choice and will support all available options within our contracted network that are available. However due to the treatment level of care required, there may not be a treatment provider available that has all the member’s preferences. If a member and/or guardian declines treatment when an available ABHTH has been offered, it will be considered a withdrawal of the request for services. If a member in the community already approved for ABHTH admits to a higher level of care, such as a behavioral health inpatient hospital or sub-acute facility, the ABHTH will be closed and a new application for ABHTH will need to be submitted with current clinical information.
All BHIF, BHRF, TFC & ABHTH providers must fax in notification of admission to Mercy Care AZ Utilization Management Department, fax number- 855-825-3165. . Below please find both Notification Forms:
Both of these forms may also be accessed on our Forms web page for each line of business.
For ABHTFH authorizations will be provided for the first 14 days and upon receipt of the treatment tentative discharge plan increased up to increments of 90 days. Providers are responsible for continued stay reviews with Mercy Care according to the schedule review date.
We appreciate your continued assistance, support and cooperation!
