www.MercyCareAZ.org

April 11, 2023

Federal Block Grant Out-of-Home Services



Applicable to: Non-Title XIX/XXI Children

                           

The following residential treatment codes and providers at each level-of-care are now covered for eligible Non-Title XIX/XXI children under the Mental Health Block Grant (MHBG) – Child Carveout:

Behavioral Health Residential Facility (H0018)

  • Florence Crittenton
  • Mingus Mountain Academy (BHRF)
  • New Hope of Arizona
  • Youth Development Institute


Behavioral Health Inpatient Facility (0124)

  • Mingus Mountain Academy (BHIF)
  • Youth Development Institute


Therapeutic Foster Care (S5145)

  • Christian Family Care


Mercy Care manages available Non-Title XIX/XXI resources to deliver care continuum consistent with AHCCCS Medical Policy Manual (AMPM) Section 320-T1 and the covered services for priority populations within AMPM Exhibit 300-2b. Services provided through Non-Title XIX/XXI funding are not an entitlement. Services provided through Non-Title XIX/XXI funding are limited by the availability of funds. Select services and levels of care provided through Non-Title XIX/XXI funding may require prior authorization for medical necessity and are subject to the following limitations per eligible Non-Title XIX/XXI individual per contract year: 

  • SUD residential 30 days (adults)
  • BHRF 180 days (adults)
  • BHRF 180 days (child)
  • BHIF 120 days (child)
  • TFC 180 days (child)  

 

Mercy Care requires Prior Authorization and Concurrent reviews on all Behavioral Health Inpatient Facility (BHIF), Behavioral Health Residential Facility (BHRF) and Therapeutic Foster Care (TFC formerly Known as HCTC) levels of care.

 

Outpatient behavioral health clinical teams are required to submit the PRIOR AUTHORIZATION REQUEST FOR CHILDREN AND ADOLESCENTS BHIF, BHRF and HCTC Form by fax with all required attachments prior to any referral to an Out-of-Home provider. This form can be found in the Mercy Care Provider Forms web page under the Prior Authorization Request for Children and Adolescents BHIF, BHRF, HCTC form. Please note on the form the request is for use of the MHBG.​


Mercy Care has a referral coordinator for all approved requests who will match the members needs to MHBG-SED Network Providers that provide services that can address these needs. The requesting outpatient provider will be emailed a referral form indicating the facilities to send referral packets. ​

 

If a request is approved, it is only valid for a 60-day period after which a new prior authorization request with updated clinical information will need to be submitted.​ Providers delivering out-of-home treatment interventions must assist children to apply for AHCCCS after 30 days Out-of-Home (OOH) treatment. 


If you have any questions about this provider notice, please contact one of the following:


Grants


Utilization Management

Child/Adolescent Services

Adult Services


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!


                           
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