Tribal Health Program (THP)

The Division of Developmental Disabilities (DDD) Tribal Health Program (THP) is a fee-for-service program that allows eligible members to receive services at any Arizona Health Care Cost Containment System (AHCCCS) registered fee-for-service provider in Arizona that sees fee-for-service THP members.

THP members receive assessed Long Term Services and Supports (LTSS), or Home and Community Based Services (HCBS), from one or more DDD Qualified Vendors. These services are typically assessed by the member’s Support Coordinator.

American Indian/Alaska Native (AI/AN) members can also receive physical and behavioral health services from any Indian Health Service (IHS) provider or tribally owned/operated facility at any time without prior approval.

This table outlines the current options for members:

American Indians/Alaska Natives (AI/AN) that choose the DDD THP can receive behavioral health services from a Tribal Regional Behavioral Health Authority (TRBHA), if one is available in their area. To receive behavioral health services from a TRBHA, members should call the AHCCCS Enrollment Unit:

• From area codes (480), (602), and (623) call 602-417-7100
• From area codes (520) and (928) call 1-800-334-5283

The DDD Tribal Health Program (THP) AHCCCS Health Plan ID #110007, site code 62. The site code will differ is member is enrolled with a TRBHA. Those can be found on the Arizona Health Care Cost Containment System (AHCCCS) Tribal Regional Behavioral Health Authorities web page.

Obtaining THP Services

THP members may receive health care services from AHCCCS-registered providers that see THP fee-for-service members or Indian Health Facilities (the Indian Health Service, tribally-operated "638" health programs, urban Indian health clinics).

Provider Directory

The Provider Directory is a searchable listing of AHCCCS registered providers by specialty. Call the provider’s office and verify if they accept DDD-THP prior to scheduling an appointment.

To search for a provider, you can click the drop-down arrow on Specialty to select All or a specific type of Specialty, such as an Audiologist or Pediatric Psychiatrist. When you search, a listing of AHCCCS registered providers will appear and the provider’s Name, Specialty, Address and Phone number will be listed. Providers with multiple office locations will be listed under each location. You can also narrow your search by ZIP code or city.

The searchable online Arizona Health Care Cost Containment System provider directory is available on the AHCCCS website.

Unique Program Choices

AI/AN members can switch their enrollment between DDD-THP and a DDD managed health care plan and back again at any time. However, a member can change from one managed health care plan to another (for example, Mercy Care Plan to United Healthcare Community Plan) only once a year.

Contact to Change Enrollment:

• Email DDD Member Transition Enrollment
• Call DDD at 844-770-9500, select language option, then Option 7 health care services, then option 1 health plan change.

Behavioral Health Residential Facility Medical Necessity Criteria

If a member has a diagnosed behavioral health condition that reflects the symptoms and behaviors necessary for a request for residential treatment level of care, the behavioral health condition causing the significant functional and/or psychosocial impairment shall be evidenced in the assessment by the following:

1. At least one area of significant risk of harm within the past three months as a result of:
   • Suicidal/aggressive/self-harm/homicidal thoughts or behaviors without current plan or intent,
   • Impulsivity with poor judgment/insight,
   • Maladaptive physical or sexual behavior,
   • Member’s inability to remain safe within his or her environment despite environmental supports (i.e. informal supports), or
   • Medication side effects due to toxicity or contraindications, and
2. At least one area of serious functional impairment as evidenced by:
   • Inability to complete developmentally appropriate self-care or self regulation due to member’s behavioral health condition(s);
   • Neglect or disruption of ability to attend to majority of basic needs, such as personal safety, hygiene, nutrition or medical care;
   • Frequent inpatient psychiatric admissions or legal involvement due to lack of insight or judgment associated with psychotic or affective/mood symptoms or major psychiatric disorders;
   • Frequent withdrawal management services, which can include but are not limited to, detox facilities, MAT, and ambulatory detox;
   • Inability to independently self-administer medically necessary psychotropic medications despite interventions such as education, regimen simplification, daily outpatient dispensing, and long-acting injectable medications; or
   • Impairments persisting in the absence of situational stressors that delay recovery from the presenting problem.
3. A need for 24-hour behavioral health care and supervision to develop adequate and effective coping skills that will allow the member to live safely in the community;
4. Anticipated stabilization cannot be achieved in a less restrictive setting;
5. Evidence that appropriate treatment in a less restrictive environment has not been successful or is not available, therefore warranting a higher level of care; and
6. Member agrees to participate in treatment. In the case of those who have a health care decision maker, including minors, the health care decision maker also agrees to, and participates as part of, the treatment team.
7. Agreement to participate in treatment is not a requirement for individuals who are court-ordered to a secured Behavioral Health Residential Facility (BHRF),
8. Member’s outpatient treatment team, shall be part of the pre-admission assessment and treatment plan formulation, including when the documentation is created by another qualified provider. Exception to this requirement exists when the member is evaluated by the Crisis provider, Emergency Department, or Behavioral Health Inpatient Facility, and
9. The BHRF shall notify the member’s outpatient treatment team of admission prior to creation of the BHRF treatment plan.

Members with Questions About THP Can Contact DDD THP

• Member Services: 1-844-770-9500 ext. 7 TTY/TDD 711 or Email the DDD Customer Service Center.
• Nurse Triage Line: 480-267-7267
• Find a provider
• Find a pharmacy
• Tribal Health Program Formulary
• Autism Spectrum Disorder Providers (search Board Certified Behavior Analysts)
• Clinical Practice Guidelines

DDD Tribal Relations

Information for Fee-for-Service Providers

Member Frequently Asked Questions

General Questions

1. How do I find a qualified placement/provider/vendor near me?
   THP members can find a physical or behavioral health provider near them using the provider search on the Arizona Health Care Cost Containment System (AHCCCS) website or by calling member services at 1-844-770-9500 ext. 7.

   THP members can find a home and community based services provider near them using the provider search on the Division of Developmental Disabilities (DDD) website or by calling member services at 1-844-770-9500 ext. 7.

Tribal Health Program (THP) Name Change Questions

1. What is the DDD-Tribal Health Program (THP) and who does it serve?
   The DDD-Tribal Health Program (THP) was previously known as the DDD-American Indian Health Plan. It is a fee for service program administered by DDD for DDD and ALTCS eligible American Indian/Alaska Natives (AI/AN). THP pays for physical and behavioral health services. These services can be provided by:
   • AHCCCS registered providers
   • Indian Health Services (IHS)
   • Tribally owned or operated organizations (638 programs/facilities)
   • Urban Indian Health Centers
2. Will the name change impact my services?
   No. DDD Tribal Health Program members will continue to have access to the same services and providers.
3. How can DDD THP members receive help to make appointments with providers?
   The Arizona Health Care Cost Containment System (AHCCCS) Provider Directory can be searched by specialty or location. Support Coordinators can assist members to identify an AHCCCS registered provider.
4. What is the difference between a Fee-For-Service program and Managed Care?
   A fee-for-service program allows American Indian/Alaska Native (AI/AN) members to use any AHCCCS registered provider who accepts AHCCCS fee-for-service rates. A Managed Care plan has a network of providers. This network must be used to receive covered services. The DDD Health Plans offered by Mercy Care and UnitedHealthcare Community Plan are managed care plans. AI/AN members have the choice to select the option that works best for them.

Behavioral Health Questions

1. If a DDD AI/AN member has a Serious Mental Illness (SMI) designation, what plan options does the member have?
   A DDD AI/AN member with an SMI designation has 4 enrollment options as shown in the following table:

Children's Rehabilitative Services (CRS) are only available to individuals who qualify.