DCS Comprehensive Health Plan

Arizona Early Intervention Program (AzEIP) Referrals and Services

Statement/Purpose

The Department of Child Safety Comprehensive Health Plan (DCS CHP) coordinates with the Arizona Early Intervention Program (AzEIP) to facilitate the provision of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and medically necessary early intervention services for members under three years of age.

Definitions

Arizona Early Intervention Program (AzEIP): Arizona’s statewide interagency system of early services and supports for families of infants and toddlers, birth through two years of age, with disabilities or delays. AzEIP is established by Part C of the Individuals with Disabilities Education Act (IDEA), which provides eligible children and their families access to services to enhance the capacity of families and caregivers to support the child’s development.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT): A comprehensive child health program of prevention, treatment, correction, and improvement of physical and behavioral health conditions for members under the age of 21, to ensure availability and accessibility of health care resources as well as to assist Medicaid recipients in effectively utilizing these resources. EPSDT services provide comprehensive health care through primary prevention, early intervention, diagnosis, medically necessary treatment, and follow-up care of physical and behavioral health conditions for Arizona Health Care Cost Containment System (AHCCCS) members under 21 years of age. EPSDT services include screening services, vision services, dental services, hearing services and all other medically necessary mandatory and optional services as specified in Federal Law 42 U.S.C. 1396d(a) to correct or ameliorate defects and physical and behavioral health illnesses and conditions identified in an EPSDT screening whether or not the services are covered under the AHCCCS State Plan. Limitations and exclusions, other than the requirement for medical necessity and cost effectiveness, do not apply to EPDST services.

Individual Family Service Plan (IFSP): A formal written document developed and implemented for the purposes of obtaining special education services for eligible children from birth to three years of age.

Policy

DCS CHP coordinates with AzEIP to implement EPSDT and early intervention services and referrals for DCS CHP enrolled children. Services include medically necessary physical therapy, occupational therapy, speech therapy and care coordination. Services are coordinated within the framework of Medical Management (MM) and EPSDT activities and within timelines set by AHCCCS and AzEIP.

DCS CHP in conjunction with its MCO contractor is responsible for:

• Educating providers about the AzEIP procedures when the need for medically necessary services are identified for members from birth up to 3 years of age;

• Ensuring medically necessary services are initiated within 45 days of a completed Individual Family Service Plan (IFSP) when services are requested by the AzEIP service coordinator;

• Coordinating services with AzEIP until the services are determined by the PCP or AZEIP service provider to no longer be medically necessary;

• Reimbursing all AHCCCS AzEIP providers whether or not they are contracted with Mercy Care.

DCS CHP does not require authorization for AzEIP therapy evaluations or re-evaluations.

Requests from Primary Care Providers (PCPs) for AzEIP services are reviewed for medical necessity via the prior authorization or retro authorization process, to determine authorization and reimbursement. The prior authorization process is implemented to issue notices when services are denied suspended or reduced. Approval for services may be pended, until an evaluation has been completed by the provider and services may be denied if the PCP determines there is no medical need for services based on the results of the evaluation.

DCS CHP supports in-home AzEIP therapy services

Procedure

DCS CHP in conjunction with the MCO contractor coordinates with and educates AzEIP service coordinators, PCPs, service providers, and Department of Child Safety Specialists (DCSS) to process medically necessary EPSDT services including:

• AzEIP AHCCCS Member Service Request Forms;

• Evaluation reports, reevaluation documentation and developmental summaries;

• Any supporting documentation for services requested;

• Individual Family Service Plans (IFSPs), if applicable;

• AzEIP service visits with the custodial guardian or caregiver as necessary or as requested; and

• PCP visits if needed.

Monitoring and Reporting

DCS CHP monitors AzEIP therapy and services and reports trends to the quarterly MM Committee