Chapter 3 : Section 7.2

Behavioral Health & Substance Abuse Services for Children and Young Adults

Procedures

DCS Comprehensive Health Plan (CHP) System of Care (SOC) Team

The DCS CHP SOC provides consultation and technical assistance to Department staff, Child and Family Team (CFT) members (including parents, guardians and/or custodians, out-of-home caregivers, behavioral health providers and other system partners), facilitates collaboration between the Department, behavioral health care providers and system partner, and contributes to the Department’s reasonable efforts to provide necessary health services to children and families.

To receive assistance from the DCS CHP SOC, contact the DCS CHP SOC at: chpsystemofcare@AZDCS.gov or DCS CHP at (602) 351-2245 and request to be connected to the System of Care Team. Contact the DCS CHP SOC to request technical assistance in securing behavioral health services and addressing concerns about the timeliness, sufficiency, or quality of behavioral health services.

Before securing behavioral health services for children through a DCS contract consult with the DCS CHP SOC.

Eligibility

All children in out-of-home care are eligible to receive health care services through their assigned health plan, which may include Mercy Care DCS CHP, Arizona Long Term Care Services (ALTCS) Health Plans and TRHBAs.

Other Insurance

Medicaid is the payer of last resort for members with other health insurance. Mercy Care DCS CHP, as a Medicaid Health Plan, coordinates benefits with the other health insurance plans. Deductibles and co-pays are paid by Mercy Care DCS CHP. Notify Mercy Care DCS CHP Member Services (602-212-4983 or 833-711-0776) if a new member has other health insurance. This should be done at the time of enrollment or as soon as it is known. Caregivers should not pay out of pocket costs for services. Caregivers should direct providers to bill Mercy Care DCS CHP.

If a child is a ward of the court on an in-home petition, determine if the child’s parent, guardian and/or custodian has private health insurance. If the family does not have health insurance, refer the family to the Department of Economic Security (DES) to apply for insurance through AHCCCS.

Behavioral Health Services

Within 24 hours of removal, submit an Integrated Rapid Response Assessment (IRRA) Referral and a copy of the Temporary Custody Notice or court orders for each child entering out-of-home care to Mercy Care DCS CHP (dispatch@crisisnetwork.org). The IRRA provider will complete an assessment within 72 hours of receiving the IRRA Referral.

For children in out-of-home care, it is recommended that the DCS Specialist accompany the child and the parent, guardian, and/or custodian or out-of-home care provider to the intake and assessment appointments if possible, to provide information and pertinent records, and sign the consent to treatment document. If the DCS Specialist is unavailable to attend the appointment, the parent, guardian, and/or custodian or out-of-home care provider may sign the consent.

Monitor and ensure that the youth is obtaining services in a timely manner. See Standard Timeliness of Behavioral Health Services (DCS-1285A).

Include the Behavioral Health provider on the Attachment A for reports to the Juvenile Court.

Notify the Behavioral Health provider of all case plan staffings. Provide copies of the DCS case plan to the Behavioral Health provider.

Child and Family Teams and Individualized Service Plans

Participate in the Child and Family Team (CFT) process to assist with initial and ongoing assessment and service planning activities to meet the unique needs of the youth. The assigned DCS Specialist or their supervisor attends every CFT meeting in person, by phone or electronically, and is knowledgeable about the child at the time of the CFT meeting.

Every child receiving behavioral health services will have an Individualized Service Plan (ISP) developed by the CFT, which is facilitated by the behavioral health provider. Participate in the development of the ISP. See Twelve Principles to Develop the Individualized Behavioral Health Plan, DCS-1289A and the AHCCCS Child and Family Team Practice Tool.

The DCS Specialist, or their Supervisor, shall attend CFT meetings either in person, by telephone or teleconference, and be prepared to discuss any reasonably available and relevant information about the child.

During the Child and Family Team, if there are concerns the Twelve Principles are not being followed or there are disagreements between the CFT and the Department or child for requested services, contact the DCS Program Supervisor and the SOC Team.

Provide the following documents and assessment information to the Child and Family Team to be considered in the development of the ISP:

• behavioral health assessments and any screening instruments or assessments used such as Screening, Brief Intervention and Referral to Treatment (SBIRT), American Society of Addiction Medicine (ASAM), and Adverse Childhood Experiences (ACEs);

• the parent and/or guardian history and assessment;

• recent crisis assessment, recent or historical psychiatric evaluation, and medication list;

• Individual Education Plan (IEP), 504 Plan and/or school records;

• Individualized Family Service Plan (IFSP);

• DCS case plan;

• juvenile probation or parole plan;

• medical plan from the primary care physician;

• DES/Division of Developmental Disabilities’ individual service plan;

• historical assessments, evaluations, services, outcome of services; and

• any other plans of care designed to meet the needs of the child or young adult.

Accessing Services Out-of-Region

The child will be assigned to a behavioral health clinic based on the area the child is residing when the child enters care. The assigned behavioral health clinic will continue to coordinate services regardless of the location in Arizona of the out-of-home caregiver.

The Specialist may request a change in the assigned Behavioral Health Clinic to serve the best interest of the child, which may include the following:

• there is a change in court venue;

• in anticipation of exiting care as a result of reunification, adoption or guardianship; or

• when a child is being placed with their sibling group being served by a different Behavioral Health Clinic.

Out-of-Home Caregiver Rights and XIX Behavioral Health Services

The out-of-home caregiver (foster home, kinship home, kinship foster care, a shelter provider, a receiving home or a group foster home) of a child who is eligible under Title XIX or XXI of the Social Security Act, who identifies behavioral health services are not in place or that a child in their care has urgent need for behavioral health services, may directly contact a Mercy Care contracted provider or Mercy Care Member Services for a screening and evaluation of the child.

The out-of-home caregiver may consent to evaluation and treatment for routine behavioral health services. This does not include inpatient psychiatric acute services, BHIF residential treatment centers, behavioral health residential facility, and therapeutic foster care.

The out-of-home caregiver cannot refuse to consent for treatment for medically recommended services.

The out-of-home caregiver cannot terminate behavioral health services.

The out-of-home caregiver can call the crisis line for the county in which they reside for any behavioral health emergency regardless of eligibility.

For children in out-of-home care, upon completion of the initial evaluation by the Behavioral health provider if services based on the evaluation are not received within twenty-one (21) days, the out-of-home caregiver may access services directly from any AHCCCS registered provider.

For children in out-of-home care, the out-of-home caregiver may contact Mercy Care DCS CHP to coordinate crisis services for the child if the crisis service provider is not being responsive, within 2 hours, to the situation.

The out-of-home caregiver may request the Health Plan to fund residential treatment for a child displaying threatening behavior. This request must go through the Child and Family Team. Once received, the Health Plan has 72 hours to make a determination on the prior authorization request.

For a child who moves with their out-of-home caregiver to another county, the out-of-home caregiver may choose to have the child continue any current treatment and/or seek any new or additional treatment in the new county of residence.

The out-of-home caregiver shall immediately notify the Department of any changes in behavioral health services.

Court Ordered Behavioral Health Services

When health services have been court ordered and have not been approved by the HP contact the DCS CHP System of Care Coordinator (SOCC) assigned to the field office for assistance to determine next steps. Provide the SOCC with a copy of the order, the history of services in which the child has been engaged, contact information for the health provider and any relevant clinical documentation and evaluations (including IEPs).

Whenever possible, the court should be provided the child’s history of services so this information can be consider prior to issuing an order. Contact the Assistant Attorney General to file a motion for reconsideration of the order, if necessary.

Prior Authorization

Services that require prior authorization by the health plan include:

• Behavioral Health Inpatient Facility (BHIF, also known as residential treatment center [RTC]);

• Behavioral Health Residential Facility (BHRF, also known as therapeutic group homes [TGH]);

• Therapeutic Foster Care (formerly known as Home Care Training - HCTC);

• Electroconvulsive Therapy (ECT); and

• Transcranial Magnetic Stimulation (TMS).

The health plan provider High Needs Case Manager (HNCM) must provide the health plan with documentation that includes but is not limited to:

• Three most recent CFT meeting notes;

• Three most recent psychiatric provider progress notes;

• Current services providers most recent progress note;

• Any psychological, neuropsychological, and/or psychosexual evaluation or testing that has occurred in the past year; and/or

• Most recent Individualized Education Plan (IEP) or 504 plan from child’s school.

Denials and Appeal Process

If the Health Plan issues a Notice of Adverse Determination (NOA) regarding denial, change or termination of funding for a behavioral health service, contact the System of Care Coordinator (SOCC) assigned to the field office or 602-351-2245 within 5 days of receiving of the NOA. The SOCC and DCS Specialist will review the circumstances and determination the actions necessary to secure services for the child.

The SOCC will collaborate with the DCS BH Appeals Coordinator, DCS Specialist, DCS Program Supervisor and the High Needs Case Manger (HNCM) to discuss reasons for service funding denial and offer a recommendation as to whether an appeal should be filed.

If the decision is made to appeal a denial, change or termination, the DCS Specialist will provide the DCS BH Appeals Coordinator with documentation and clinical records (evaluations, discharge summaries, treatment summaries, etc.) to support the appeal. The DCS Behavioral Health Appeals Coordinator will review the documentation and request and additional documentation needed from the DCS Specialist.

The DCS BH Appeals Coordinator will:

• file the appeal within 10 calendar days of the NOA for termination, suspension or reduction of a service; or

• file the appeal within 60 calendar days of the NOA for denial of a service.

For questions about the Appeals Process contact the SOCC or the Statewide Behavioral Health Appeals Coordinator. Email CCHPNotification@azdcs.gov and begin the subject line with APPEAL.

One-to-One Care Supports

If a child cannot be placed in a living arrangement appropriate for their behavioral health needs, then one-to- one care supports for the child may be requested to ensure the safety of the child and other children in the home. One-to-one care supports may be authorized when:

• a child requires continuous monitoring or supports for medical or behavioral health needs;

• is currently in a DCS licensed congregate care setting;

• cannot immediately be placed in a living situation that meets the child’s needs; and

• an initial request for one-to-one service has been made to the CFT, if applicable.

Requests for one-to-one supports may be made by the DCS Specialist, Supervisor, CMDP staff or Placement Administration staff. The request must be submitted to the Placement Administration and shall be authorized by the Placement Administration Program Administrator or designee.

One-to-one care supports should be temporary and last only as long as there is a medical or behavioral health need. One-to-one care supports are not intended for situations where a child has a living arrangement appropriate to meet their medical or behavioral health needs.

If one-to-one care supports are needed for a child placed in out-of-home behavioral health treatment, contact the SOCC assigned to the field-office.

Out-of-Home Behavioral Health Treatment Services

Out-of-Home Behavioral Health Treatment Services are a covered benefit for DCS CHP members. Assist in securing these services when they are determined to be medically necessary, based on prior authorization or continued authorization stay criteria. These services include inpatient psychiatric hospitalization, Behavioral Health Inpatient Facility (BHIF), Behavioral Health Residential Facility (BHRF) and Therapeutic Foster Care (TFC).

A child should always be treated in the least restrictive, most home-like setting possible to meet their behavioral health needs. Out-of-Home Behavioral Health Treatment Services are only medically necessary if community-based interventions are not sufficient to meet the child’s needs.

Treatment in a behavioral health residential program is short-term. Discharge planning begins the day of admission. The Specialist should be actively involved in the discharge planning process. This should be done in conjunction with the residential program, the youth’s behavioral health home/outpatient team, and other members of the CFT. A safe and appropriate discharge plan includes behavioral health treatment services the youth will need upon exiting the residential program in order to maintain and build upon treatment gains; as well as the actual place the youth will live. The HNCM is responsible for notifying the Health Plan of the youth’s discharge plan.

If a child needs out-of-state treatment at a Behavioral Health Inpatient Facility (BHIF), complete an ICPC referral. See ICPC: Overview, Referrals & Placement. See Medical Services for ICPC Children for information on coordinating coverage for the child’s medical and behavioral health care needs.

If a request for Therapeutic Foster Care has been denied by Mercy Care DCS CHP, provide the Placement Administration with a copy of the treatment packet to consider High Needs Foster Care (HNFC) as outlined in DCS 19-03 Caregiver Selection Protocols.

Inpatient Psychiatric Acute Services

When a child needs services through Inpatient Psychiatric Hospitalization, please refer to Inpatient Psychiatric Assessment and Psychiatric Acute Services .

Behavioral Health Inpatient Facility (BHIF) Services, also known as Residential Treatment Centers (RTC)

When a child needs services through a BHIF, also known as "Residential Treatment Center (RTC)”, refer to Arranging Treatment in a Behavioral Health Inpatient Facility.

Substance Abuse Services

The Department shall refer children and young adults to Arizona Families FIRST (AFF), when:

• A child in out-of-home care who is in the temporary custody of the Department, adjudicated dependent, or the subject of a Voluntary Placement Agreement, and whose behavior indicates a need for substance use assessment, treatment or recovery.

• Young adults participating in Extended Foster Care whose behavior indicates a need for a substance abuse assessment, treatment or recovery.

• A child in a family that is receiving in-home case management services from DCS, and whose behavior indicates a need for substance use assessment, treatment, or recovery to prevent entry or re-entry into out-of-home care.

See the AFF service guide for additional information.

Health Services for Young Adults in Extended Foster Care

Determine if the young adult has health insurance through AHCCCS-Young Adult Transitional Insurance (YATI) and assist the young adult to enroll if needed. See Services and Supports to Prepare Youth for Adulthood.

The Department may fund behavioral health services for young adults 18-20 years old in DCS extended foster care who are not Title XIX eligible. See Services and Supports to Prepare Youth for Adulthood.

Documentation

Update the Legal tab in Guardian.

File a copy of the assessment, CFT, Individual Service Plans, treatment summaries, evaluation documentation, Termination Notices, Notice of Action, and other pertinent information about services and progress received from the RBHA in the hard copy case record.

Document Child and Family Team or Adult Recovery Team meetings in Notes in Guardian.

Document activities to facilitate continued access to services when a child moves to a new RBHA area in Notes in Guardian.

Document results of a Clinical Case Review in Notes in Guardian.

Effective Date: October 1, 2021

Revision History: November 30, 2012, March 14, 2017, November 17, 2017, August 16, 2019, February 1, 2021, April 1, 2021, June 25, 2021