DCS Comprehensive Health Plan

Policy Creation and Review

Statement/Purpose

The Department of Child Safety Comprehensive Health Plan (DCS CHP) ensures that all health plan policies and procedures are developed and maintained to promote an integrated, coordinated approach for the delivery of services to members.

Policy

DCS CHP and its subcontracted MCO are responsible for developing, implementing, publishing and maintaining written, health plan specific policies and procedures that comply with Federal and State statutes, program requirements and best practices.

Procedures

Policy Formatting Requirements

DCS CHP policies are formatted using an approved template published in the DCS CHP Shared Drive. General policy formatting requirements include:

• Policy title;

• Policy number (assigned by DCS CHP Health Policy Administrator);

• Responsible function area;

• Approval and effective dates;

• Policy Statement;

• Authority (legal/contract references);

• Definitions, Policy, and Procedure;

• References and Related Forms (as applicable);

• Signature block; and

• Revision history with review dates.

Additional policy manuals are incorporated by reference within DCS CHP policies, including:

• AHCCCS Contractors Operations Manual (ACOM): contains administrative, claims, financial, and operational policies of AHCCCS.

• AHCCCS Medical Policy Manual (AMPM): contains policies regarding services that are covered within the AHCCCS program.

• DCS Administrative Policy Manual: contains agency-wide operational policies applicable to all DCS employees.

• DCS Program Policy Manual: provides overall child welfare guidance to DCS field staff based on applicable federal and state laws and administrative code.

• DCS Practice Guidelines: contains service and field guides to enhance family engagement and service delivery.

Collaboration

DCS CHP Function Area Managers obtain input and provide oversight on policy creation and revision from internal and external subject matter experts (SMEs) and/or other identified stakeholders, including the subcontracted MCO. Input may be solicited through workgroups, review of draft policies and procedures, and/or discussions at Medical Management and/or Quality Management meetings.

DCS CHP Policy Committee

The DCS CHP Policy Committee provides oversight of DCS CHP’s internal policies. The committee reviews and approves new DCS CHP policies and substantive modifications to existing policies at least annually, and when immediate review is required.

Policy updates are presented to the committee and discussed during dedicated monthly meetings. In lieu of formal committee meetings, DCS CHP policies may be reviewed, discussed and approved amongst committee members via email and/or via Microsoft Forms for tracking purposes.

The committee is chaired by DCS CHP’s Chief Medical Officer (CMO), or designee, and is comprised of DCS CHP Managers, SMEs and DCS policy unit representatives. A designated Health Policy Administrator oversees the committee’s administrative activities including scheduling meetings, recording minutes and tracking policy determinations for audit purposes.

Policy Review

DCS CHP and its subcontracted MCO review active health plan policies and substantive modifications to existing policies at least annually, and when immediate review is required.

DCS CHP Function Area Managers and the DCS CHP Policy Committee are responsible for initiating annual policy review.

The DCS CHP Health Policy Administrator works with the Policy Committee members to coordinate review, revision, approval, and maintenance activities for all health plan policies. This includes scheduling meetings, sending necessary agendas and attachments, documenting meeting minutes, and maintaining policy documents in electronic files.

Policy determinations made by the committee include but are not limited to:

• Approval with no recommended changes;

• Approval subject to minor changes;

• Recommendation to implement the policy as a desktop procedure;

• Approval extension if additional information is required for adequate annual review;

• Denial with comment;

• Retirement and archive, if the policy is no longer applicable or redundant to another existing policy.

Policy determinations are recorded in committee meeting minutes.

Policy determinations that affect the subcontracted MCO are promptly communicated through the DCS CHP Compliance Team.

Upon completion of committee review and approval, the DCS CHP Health Policy Administrator collects applicable signatures and informs all affected function areas that the policy is signed and final. DCS CHP staff are informed of new or revised policies and procedures. Staff training is facilitated by function area as applicable.

Health plan policies that set forth clinical requirements, quality improvement, and oversight standards, are approved and signed by the CMO. All other health plan policies are dated and signed by the responsible function area manager and DCS CHP’s Chief Executive Officer (CEO).

DCS CHP and its subcontracted MCO provide initial and ongoing staff training that includes an overview of health plan policies, including AHCCCS policy and procedure manuals, contract requirements, and State and Federal requirements specific to individual job functions.

Retirement of Policies

A policy may be retired if its content has been merged into an existing or new policy or if the Policy Committee determines that the policy is no longer applicable to health plan operations and practices. The date of and reason for retirement are recorded in the DCS CHP Policy Tracking Matrix.

Contractor Oversight

DCS CHP reviews the policies and procedures of its contracted MCO at least annually and upon significant program changes. If DCS CHP deems a policy or procedure submitted by its contracted MCO to be inefficient and/or place an unnecessary burden on members or providers, DCS CHP works with its MCO to change the policy or procedure within a time period specified by DCS CHP. Annual review activities are tracked and recorded on the DCS CHP Policy Matrix.

Published Policies

DCS CHP policies and procedures are published in a standard format to the DCS Policy Library, https://dcs.az.gov/about/policy, to ensure consistent communication. Notification is made to DCS CHP’s subcontracted MCO through DCS CHP Compliance outlining policy updates when new policies are implemented and/or significant material changes are made.

Reporting

The DCS CHP Health Policy Administrator tracks and records policy review and approval dates in the DCS CHP Policy Matrix located in the DCS CHP Shared Drive. The policy matrix provides the following information:

• Policy title and assigned number;

• Responsible function area;

• Review and approval dates;

• Signature dates;

• Policy effective dates;

• Policy review schedule; and

• Annual policy training required by each function area.