Provider Manual October 2019 Update

www.MercyCareAZ.org

December 11, 2019

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

Effective 10/01/2019, Mercy Care's Provider Manual has been updated with the below changes:

Detailed changes to each chapter are as follows:

Chapter 100 – Mercy Care Provider – General Terms:

MC Chapter 1 - Introduction to Mercy Care

Section 1.01 - About Mercy Care and Section 1.02 - Disclaimer - Section updated adding Mercy Care DD information to the section.
Section 1.04 - Eligibility and PCP Assignment - Entire section updated.

MC Chapter 2 – Mercy Care Contact Information

Section 2.00 - Mercy Care Contact Information - Added Mercy DD Behavioral Health Coordinator.

MC Chapter 4 – Provider Responsibilities

Section 4.12 – Monitoring Controlled and Non-Controlled Medication Utilization - New section added in accordance with AHCCCS AMPM 310-FF – Monitoring Controlled and Non-Controlled Medication Utilization.
Section 4.16 - Standards for Providers Managing Behaviors - New section regarding regulations for Managing Behaviors.
Section 4.21 - End of Life Care - End of Life notification added to Provider Manual.

MC Chapter 5 – Early and Periodic Screening, Diagnostic and Treatment

Section 5.09 – Blood Lead Screening - Blood Lead section revised to match the AHCCCS EPSDT letter sent to providers regarding blood lead guidelines.

MC Chapter 6 – Children’s Rehabilitative Services

Sections 6.01 - Integration Initiatives and 6.03 - Who is Eligible for CRS - Updated information regarding ACC and Mercy DD Children’s Rehabilitative Services and Eligibility.

MC Chapter 10 – Care Management and Disease Management

All Sections have been rewritten to update for Mercy Care DD.

MC Chapter 12 – Quality Management

All sections rewritten and updated with Mercy Care DD information.

MC Chapter 13 – Referrals and Authorizations

Section 13.07 – Prior Authorization, Section, 13.12 – Pharmacy Prior Authorization, Section 13.13 – Nutritional Assessment and Nutritional Therapy and Section 13.14 – Metabolic Medical Foods - Updated with new wording and information.

Chapter 200 – Mercy Care Complete Care – Plan Specific Terms:

MCCC/Mercy DD Chapter 1 – Mercy Care Complete Care and Mercy Care DD Overview

Section 1.00 – MCCC and Mercy DD Overview - Updated chapter with new Mercy Care DD information.

MCCC/Mercy DD Chapter 3 – Behavioral Health

Section 3.07 – Behavioral Health Provider Coordination of Care Responsibilities, Section 3.08 – DDD Coordination of Care, Section 3.16 – Reporting of Seclusion and Restraint, Section 3.17 – Out of State Treatment for Behavioral Health, Section 3.18 – Behavioral Health Assessment and Service Planning Overview, Section 3.19 - Assessments, Section 3.20 – Minimum Element of the Behavioral Health Assessment, Section 3.21 – Provider Submits a Complex Case Request, Section 3.22 – Update to Assessment and Service Plan, Section 3.23 – Transfer Assessment and Section 3.24 – Housing for Individuals Determined to have Serious Mental Illness (SMI) - Sections updated and rewritten.
Section 3.25 - Collection of Demographic and Clinical Data Timeframes - Moved from the RBHA chapter to the Mercy Care Complete Care/Mercy Care DD chapter.

MCCC/Mercy DD Chapter 4 – General Mental Health/Substance Use (GMH/SU)

Section 4.05 – Special Populations - Updated some repetitive wording.

MCCC/Mercy DD Chapter 5 – Pharmacy Management

Requested to add Pharmacy Section to each line of business per AHCCCS. In addition, language updates were made by our Pharmacy Department.

MCCC/Mercy DD Chapter 6 – Partnership Requirements with Families and Family Run Organizations

Section 6.00 – Peer and Family Support Services - Language changes to address AMPM Policy 963 – Peer and Recovery Support Training, Credentialing and Supervision Requirements. This will be included in all 3 line of business’ chapters.

MCCC/Mercy DD Chapter 8 – Grievances, Appeals and Claim Disputes

Requested to add Grievances, Appeals and Claims Dispute to each line of business per AHCCCS.
Updated language regarding QM quality of care concerns.

Chapter 300 – Mercy Care Long Term Care – Plan Specific Terms:

MCLTC Chapter 1 – Mercy Care Long Term Care Overview

Section 1.00 – Mercy Care Long Term Care Overview - Updated chapter with new Mercy Care DD information.

MCLTC Chapter 2 – Network Provider Service Delivery Requirements

Section 2.16 – Contract Terminations – Nursing Facilities and Alternative Residential Settings - Wording clarified regarding QM Department role under Contract Terminations – Nursing Facilities and Alternative Residential Setting.

MCLTC Chapter 4 – Behavioral Health

Section 4.15 – Reporting of Seclusion and Restraint, Section 4.16 – Out of State Treatment for Behavioral Health, Section 4.17 – Behavioral Health Assessment and Service Planning Overview, Section 4.18 – Assessments, Section 4.19 – Minimum Elements of the Behavioral Health Assessment, Section 4.20 – Provider Submits a Complex Case Request, Section 4.21 – Update to Assessment and Service Plan, Section 4.22 – Transfer Assessment and 4.23 – Housing for Individuals Determined to have Serious Mental Illness (SMI) - Several changes made throughout this chapter based AHCCCS request to move from the Mercy RBHA chapter to the MCLTC chapter. Includes an address change.

MCLTC Chapter 5 – Pharmacy Management

Requested to add Pharmacy Section to each line of business per AHCCCS. In addition, language updates were made by our Pharmacy Department.

MCLTC Chapter 6 -Partnership Requirements with Families and Family-Run Organizations

Section 6.00 – Peer and Family Support Services - Language changes to address AMPM Policy 963 – Peer and Recovery Support Training, Credentialing and Supervision Requirements. This will be included in all 3 line of business’ chapters.

MCLTC Chapter 7 – Dental and Vision Services

Section 7.00 - Dental Services - Revised language slightly to clarify the $1000.00 benefit for LTC members.

MCLTC Chapter 8 – Grievances, Appeals and Claim Disputes

Requested to add Grievances, Appeals and Claims Dispute to each line of business per AHCCCS.
Updated language regarding QM quality of care concerns.

Chapter 400 – Mercy Care RBHA – Plan Specific Terms:

RBHA Chapter 1 – Mercy RBHA Overview

Section 1.02 – Overview of Mercy RBHA - Updated chapter with new Mercy Care DD information.

RBHA Chapter 2 – Network Provider Service Delivery Requirements

Section 2.03 – Outreach, Engagement, Reengagement and Closure - Language change regarding Follow-Up After Significant and/or Critical Events.

RBHA Chapter 6 – Pharmacy Management

Requested to add Pharmacy Section to each line of business per AHCCCS. In addition, language updates were made by our Pharmacy Department.

RBHA Chapter 7 – Partnership Requirements with Families and Family-Run Organizations

Section 7.00 – Peer and Family Support Services - Language changes to address AMPM Policy 963 – Peer and Recovery Support Training, Credentialing and Supervision Requirements. This will be included in all 3 line of business’ chapters.

RBHA Chapter 10 – Coordination of Care with AHCCCS Health Plans, PCPs and Medicare Providers

Section 10.01 – Coordination of Care with AHCCCS Health Plans, PCPs and Medicare Providers - Updated language regarding QM quality of care concerns.
Paragraph added under Emergency Behavioral Health Services regarding care coordination of MAT services.

RBHA Chapter 13 – Service Authorization

Section 13.04 – How to Request a Prior Authorization - Update to refer to AMPM 320-V.
Section 13.13 – Retrospective Review - Updated addresses.

You can access our Provider Manual on our Provider Manual web page. All changes to the Provider Manual are highlighted in yellow.

As always, don't hesitate to contact your Mercy Care Provider Relations 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!