DCS Comprehensive Health Plan

Policy Development and Review

Statement/Purpose

The DCS Comprehensive Health Plan (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.

Definitions

Policy:

DCS CHP and its contracted 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

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 CHP Policy Coordinator);

• Responsible function area;

• Approval and effective dates;

• Legal/contract references;

• Signature block; and

• Revision history with review dates.

Additional policy manuals are incorporated by reference within 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 administrate 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 contracted MCO. Input may be solicited through workgroups, review of draft policies and procedures, and/or discussions at Medical Management and/or Quality Management meetings.

CHP Policy Committee

The CHP Policy Committee provides oversight of CHP’s internal policies. The committee reviews and approves new 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 CHP policies may be reviewed, discussed and approved amongst committee members via email.

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

Policy Review

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

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

The CHP Policy Coordinator works with the Policy Committee 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 contracted MCO are promptly communicated through the DCS CHP Compliance Team.

Upon completion of committee review and approval, the CHP Policy Coordinator 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 policy and procedures. Staff training is facilitated as needed.

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 contracted 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. A corresponding written notification is submitted to CHP’s contracted MCO outlining policy updates.

Reporting

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

• Policy name and assigned number;

• Responsible function area;

• Review and approval dates;

• Approval/signature dates;

• Policy publication dates;

• Associated documents and forms, and

• Associated process flows/desktop references.