Provider Manual April 2021 Update

www.MercyCareAZ.org

May 14, 2021

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Mercy Care DCS CHP, and Mercy Care DD

Effective 4/1/2021, the Mercy Care 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

Section 1.01 – About Mercy Care – Department of Child Safety Comprehensive Health Plan information added.
Section 5.06 – PCP Application of Fluoride Varnish – Wording regarding additional applications has changed and the AHCCCS Policy referenced updated.
Section 13.11 – Bariatric Surgery Criteria -Section revised to update criteria.
Section 13.12 - Pharmacy Prior Authorization – Minor wording change to licensed pharmacists.
Section 13.13 – Applied Behavioral Analysis - New section added regarding Applied Behavioral Analysis and appropriate prior authorization procedures.
Chapter 16 - All Sections - Changes made throughout this chapter to include Mercy Care DCS CHP and other minor changes.

Chapter 200 - Mercy Care Complete Care (MCCC), Department of Child Safety Comprehensive Health Plan and Mercy Care DD (Mercy DD) Plan Specific Terms

MC Chapter 1 – Mercy Care Complete Care/Mercy Care DD/Department of Child Safety Comprehensive Health Plan Overview - Updated information to include DCS CHP language.
Section 3.03 – Emergency Services- Language updated for this whole section regarding emergency services and DCS CHP.
MC Chapter 8 – Grievances, Appeals and Claim Disputes - The entire chapter has been updated to include information about DCS CHP as well as other language updates.

Chapter 300 – Mercy Care Long Term Care Plan Specific Terms

Section 8.01 – Provider Claim Disputes- Updated language regarding State Fair Hearing requests.
Section 8.02 - Appeals - Minor updated language.
Section 4.12 – Prior Authorization Requirements and Process – New section added.
Section 4.13 – General and Informed Consent - Added more detail regarding psychotropic informed consent and where to get the form on the AHCCCS website.
Section 5.10 – Behavioral Health Medications - Updated language to match AMPM Policy 510 and ACC.
MCLTC Chapter 9 – Scopes of Work - Updated information added to the provider manual regarding Scopes of Work.

Chapter 400 – Mercy Care RBHA Plan Specific Terms

Section 1.00 – About Mercy Care RBHA - Updated Block Grant reference from the AHCCCS AMPM 320-T1.
Section 1.01 - Overview of the Arizona Public Behavioral Health System – Updated reference to AHCCCS AMPM 320-T2 - Non-Title Services XIX/XXI and Funding.
Section 2.01 - Additional Behavioral Health Appointment Availability Information - Updated language in the topic For Behavioral Health and Initial Physical Health Appointments for members in legal custody of the Department of Child Safety (DCS) and adopted children.
Section 2.02 – Referral and Intake Process - Updated language in the DCS Integrated Rapid Response Referrals. Updated Assigned Behavioral Health Clinic (ABHC) name. Updated CALOCUS references.
Section 2.07 – Assessment and Service Planning - Updated CALOCUS references.
Section 2.14 Services with Special Circumstances - Non-Title XIX/XXI Behavioral Health Services Benefit - Updated reference to AHCCCS Medical Policy Manual, Policy 320-T1 Block Grants and Discretionary Grants, Attachment A. Updated reference to AHCCCS Medical Policy Manual 320-T1, Exhibit I.
Section 3.03 – Case Management Contact Guidelines - Updated references to Assigned Behavioral Health Clinic (ABHC).
Section 5.04 – Out of State Treatment for Behavioral Health - Updated references to Assigned Behavioral Health Clinic (ABHC).
Section 6.10 - Behavioral Health Medications - Polypharmacy info rmation updated.
Section 7.01 – Incorporating Peer and Family Voice and Choice in Integrated Care Service Delivery - Advisory Council language updated.
Section 11.00 - Concurrent Review - Updated name Child and Adolescent TFC
Section 13.04 - How to Request a Prior Authorization - Updated TFC name.
RBHA Chapter 18 - Scopes of Work – Updated information added to the provider manual regarding Scopes of Work.

You can access the Mercy Care 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!