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Policies
Welcome to the DDD policy page.
DDD develops policies that conform to state, federal, and contractual requirements. DDD has five policy manuals, which include the Operations, Medical, Eligibility, Behavior Supports, and Provider manuals. Changes in policy are communicated to contracted DDD providers via electronic policy notifications, which are also sent to all DDD employees, Providers, Administrative Services Subcontractors, and individuals who have opted to receive notifications.
Pursuant to Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA) and other nondiscrimination laws and authorities, ADES does not discriminate on the basis of race, color, national origin, sex, age, or disability. Persons that require a reasonable accommodation based on language or disability should contact ADES’s Office of Equal Opportunity at [email protected]. Requests should be made as early as possible to ensure the State has an opportunity to address the accommodation.
Use the expandable sections below to view Policies or download the DDD Complete Set of All Policy Manuals.
Operations Manual
The Division Operations Manual consolidates and provides ease of access to the Division’s Administrative, Claims, Financial, and Operational Policies. The manual should be referenced in conjunction with State and Federal regulations, AHCCCS Contractor’s Operations Manual (ACOM), and applicable contracts.
Download the complete Division Operations Policy Manual.
DDD Operations Manual downloadable chapter files.
Chapter 100 - Administration
- 100 - Management of DDD Policies and Procedures
- 101 - Marketing
- 102 - DDD Administrative Forms and Other Written Material
- 103 - Fraud, Waste and Abuse
- 104 - Continuity of Operations/Emergency Preparedness Plan
- 108 - Security Rule Compliance
- 109 - Institution for Mental Disease 15-Day Limit
- 110 - Mental Health Parity
- 111 - Performance Monitoring
- 112 - Employee Supports and Resources
Chapter 200 - Claims
- 201 - Medicare Cost Sharing for Members Covered by Medicare and Medicaid
- 203 - Claims Processing
- 205 - Ground Ambulance Transportation Reimbursement Requirements for Non-Contracted Providers
Chapter 300 Financial
- 302 - Prior Period Coverage Reconciliation: Administrative Services Subcontractors
- 305 - Performance Bond and Equity Per Member Requirements
- 314 - Auto-Assignment Algorithm
- 317 - Change in Organizational Structure
- 320 - Health Insurer Provider Fee
Chapter 400 - Operations
- 404 - Contractor Website and Member Information Material
- 405 - Cultural Competency, Language Access Plan, and Family/Member Centered Care
- 406 - Member Handbook and Provider Directory
- 407 - Workforce Development
- 409 - Office of Individual and Family Affairs
- 412 - Claims Recoupment and Refunds
- 414 - Requirements for Service Authorization Decision and Notices of Adverse Benefit Determination
- 415 - Provider Network Development and Management Plan Periodic; Network Reporting Requirements
- 416 - Provider Information
- 417 - Appointment Availability, Transportation Timeliness, Monitoring and Reporting
- 418 - Provider and Affiliate Advances, Equity Distributions, Loans & Investments
- 424 - Verification of Receipt of Paid Services
- 426 - Children's Rehabilitative Services Application, Designation, and Coverage
- 431 - Copayment
- 433 - Member Identification Cards
- 434 - Coordination of Benefits and Third Party Liability
- 435 - Telephone Performance Standards and Reporting
- 436 - Network Standards
- 438 - Administrative Services Subcontracts
- 439 - Material Changes: Provider Network and Business Operations
- 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness
- 449 - BH Services for Children in Dept of Child Safety Custody and Adopted Children
- 480 - Support Coordination (Case Management) Program Description
- 490 - Determining Support Coordination Service Staffing Needs
Chapter 1000 - Members and Families
- 1001-A - Rights and Responsibilities of Individuals Supported by the Division of Developmental Disabilities
- 1001-B - Responsibilities of Individuals Applying for and/or Receiving Supports and Services
- 1002 - Voter Registration
- 1003 - District Independent Oversight Committees
- 1004-A - Informed Consent
- 1005-A - Guardianship and Conservatorship or Surrogate Parent
- 1005-C - Authorized Representative for Arizona Long Term Care System Benefits
- 1005-D - Representative Payee
- 1007 - Supporting Separated or Divorced Families
Chapter 3000 - Network
- 3001 - Family Members as Paid Providers
- 3003 - Selection of Providers
- 3005 - Reserved
- 3006 - Short Term Emergency Situations (Residential and Day Programs)
- 3007 - Service Provider Information, Authority, and Notification
- 3008 - Electronic Monitoring
Chapter 4000 - Business Operations
- 4002 - Client Billing
- 4003 - Administrative Review/Appeal and Hearing Rights
- 4004 - Overview
- 4004-A - Definitions
- 4004-B - Member Funds System
- 4004-D - Responsibilities
- 4004-E - Safeguarding Member Funds
- 4004-F - Member Funds Security
- 4004-G - Disbursing Member Funds
- 4004-H - Member Funds, Provider Responsibilities
- 4004-I - Ledgers Maintained By Providers
- 4004-J - Bank Reconciliation
- 4004-K - Use of Member Funds
- 4004-M - Changes in a Member’s Status
- 4004-N - Investing Member Funds
- 4004-O - Termination of a Member’s Account or Change in Representative Payee
Chapter 5000
Chapter 6000 - Administrative Operations
- 6001-A - Confidentiality
- 6001-B - Release of Information
- 6001-C - Access to Personally Identifiable Information
- 6001-D - Permitted Uses and Disclosures of Protected Health Information
- 6001-E - Violations and Penalties
- 6001-F - Case Records
- 6001-H - Records Storage and Security
- 6001-I - Management and Maintenance of Records
- 6001-J - Records Management Litigation Hold
- 6002-D - Members At-Risk if Missing
- 6002-F - Investigative Process
- 6002-G - Reporting Member Abuse, Neglect and Exploitation
- 6002-I - Incident and Quality of Care Concern Corrective Actions and Closure
- 6002-M - Mortality Review Process
- 6003-C - Appeal Process for Members Who Receive State Funded Services
- 6003-D - Notice of Intended Action (State Only)
- 6003-E - Administration Review Process (State Only)
- 6003-F - Appealing Administrative Review Decisions
- 6003-G - Member Inquiry and Grievance Resolution
- 6003-H - Provider Inquiry and Grievance Resolution
- 6003-I - Arizona Long Term Care System Appeal Process
- 6003-J - Arizona Long Term Care Services State Fair Hearing Process
- 6003-K - Claim Disputes
- 6003-L - Attorneys at Planning Meetings
- 6003-N - Oral and Written Regulatory Inquiries
- 6003-O - Responding to Government Audits
- 6003-R - Compliance Concerns Reporting Requirements
- 6003-S - Compliance Program Training and Education
- 6003-U - Corporate Compliance Program Documentation
- 6004-A - Quality Management
- 6004-E - Operational Reviews
- 6004-G - Monitoring and Oversight
- 6005-A - Compliance Charter
- 6005-B - Compliance Investigation
- 6006 - AHCCCS Deliverable Submission Requirements
- 6007 - Records Management
Chapter 7000 - Privacy
- 7001 - Privacy Incident and Breach Notification
- 7002 - Authorization for Use and Disclosure of Protected Health Information
- 7003 - Minimum Necessary Standard for Uses and Disclosures or Protected Health Information
- 7004 - Accounting of Disclosures of Protected Health Information
- 7005 - Right to Request Restriction of Uses and Disclosures for Protected Health Information
- 7006 - Right to Request Amendment or Correction of Protected Health Information
- 7007 - Right to Receive Alternative Means of Communication for Protected Health Information
- 7008 - Notice of Privacy Practices for Protected Health Information
- 7009 - De-Identification Protected Health Information
- 7010 - Business Associate Agreements
Revision History
Medical Manual
The Division Medical Manual provides information regarding services that are covered within the Division’s program. The manual should be referenced in conjunction with State and Federal regulations, AHCCCS Medical Policy Manual (AMPM), and applicable contracts.
Download the complete Division Medical Policy Manual.
DDD Medical Manual downloadable chapter files
Chapter 100 Introduction
Chapter 200 Behavioral Health Practice Tools
- 210 - Working with the Birth through Five Population
- 211 - Psychiatric and Psychotherapeutic Best Practices for Children Birth through Five Years of Age
- 280 - Transition to Adulthood
Chapter 300 Medical Policy for Acute Services
- 300 - Chapter Overview
- 310-A - Audiology
- 310-B - Title XIX/XXI Behavioral Health Services
- 310-C Breast Reconstruction After Mastectomy
- 310-D1 - Emergency Dental Services for Members 21 Years of Age and Older
- 310-D2 - Arizona Long Term Care System Adult Routine Dental Services
- 310-E - Dialysis
- 310-F - Emergency Medical Services
- 310-H - Health Risk Assessment and Screening Tests
- 310-I - Home Health Services
- 310-J - Hospice Services
- 310-K - Hospital Inpatient Services
- 310-L - Hysterectomy
- 310-M - Immunizations
- 310-N - Laboratory
- 310-P - Medical Supplies, Durable Medical Equipment, and Prosthetic Devices (Acute Care Services)
- 310-S - Observation Services
- 310-V - Prescription Medication/Pharmacy Services
- 310-X - Rehabilitative or Developmental Occupational Therapy, Physical Therapy, and Speech Pathology Services
- 310-Y - Respiratory Therapy
- 310-BB - Transportation for Physical and Behavioral Health Services
- 310-DD - Covered Transplants and Related Immunosuppressant Medications
- 310-FF - Monitoring Controlled and Non-Controlled Medication Utilization
- 310-GG - Nutritional Therapy Metabolic Foods and Total Parenteral Nutrition
- 310-HH - End of Life Care and Advance Care Planning
- 310-II - Genetic Testing
- 310-KK - Biomarker Testing
- 320-B - Member Participation in Experimental Services and Clinical Trials
- 320-F - HIV/AIDS Treatment Services
- 320-G - Lung Volume Reduction Surgery
- 320-I - Telehealth and Telemedicine
- 320-M - Medical Marijuana and CBD Oil Products
- 320-O - Behavioral Health Assessments, Service, and Treatment Planning
- 320-P - Serious Emotional Disturbance and Serious Mental Illness Eligibility Determinations
- 320-S - Behavior Analysis Services
- 320-U - Pre-Petition Screening, Court Ordered Evaluation and Court Ordered Treatment
- 320-V - Behavioral Health Residential Facilities
- 320-W Therapeutic Foster Care for Children
- 320-X Adult Behavioral Health Therapeutic Homes
- 320-Z Members On Conditional Release
- 330 - Covered Conditions and Services for Children’s Rehabilitative Services
Chapter 400 Medical Policy for Maternal and Child Health
- 410 - Maternity Care Services
- 411 - Women’s Preventative Care Services
- 420 - Family Planning Services and Supplies
- 430 - Early and Periodic Screening, Diagnostic and Treatment Services
- 431 - Dental Oral Health Services for EPSDT Eligible Members
- 450 - Out of State Placements for Behavioral Health Treatment
Chapter 500 Care Coordination Requirements
- 510 - Primary Care Providers
- 520 - Member Transitions
- 530 - Member Transfers Between Facilities
- 540 - Electronic Visit Verification
- 541 - Coordination of Care with Other Government Agencies
- 570 - Behavioral Health Provider Case Management
- 580 - Child and Family Team
- 582 - Support and Rehabilitation Services for Children, Youth, and Young Adults
- 583 - Family Involvement in the Children's Behavioral Health System
- 584 - Youth Involvement in the Children's Behavioral Health System
- 585 - Unique Needs of Children, Youth, and Families Involved with the Department of Child Safety
- 586 - Children's Out-of-Home Services
- 590 - Behavioral Health Crisis Services and Care Coordination
Chapter 600 Provider Qualifications and Provider Requirements
Chapter 700 School Based Claiming Program - Direct Services Claiming
Chapter 900 - Quality Management / Performance Improvement Program
- 910 - Quality Management and Performance Improvement Program Scope
- 920 - Quality Management and Performance Improvement Program Administrative Requirements
- 940 - Medical Records and Communication of Clinical Information
- 950 - Credentialing and Recredentialing Processes
- 960 - Quality of Care Concerns
- 961 - Incident, Accident, and Death Reporting
- 962 - Reporting and Monitoring of Seclusion and Restraint
- 963 - Peer and Recovery Support Service Provision Requirements
- 964 - Credentialed Family Support Partner Requirements
- 966 - Immediate Jeopardy
- 969 - Collaborating with Peers and Families
- 970 - Performance Measures
- 971 - Measurement Selection and Reporting
- 980 - Performance Improvement Projects
Chapter 1000 Medical Management
- 1010 - Medical Management Administrative Requirements
- 1020 - Utilization Management
- 1021 - Care Management
- 1022 - Justice Reach-In
- 1023 - Disease Chronic Care Management
- 1024 - Drug Utilization Review
- 1040 - Outreach, Engagement and Re-Engagement for Behavioral Health
Chapter 1200 Services and Settings
- 1210 - Institutional Services and Settings
- 1230-A - Assisted Living Facilities
- 1230-C - Community Residential Settings and Room and Board
- 1240-A - Attendant Care and Homemaker (Direct Care Services)
- 1240-A1 - Exhibit 1240A-1 , Attendant Care Supervision Requirements Age 17 and Under
- 1240-A2 - Exhibit 1240A-2, Attendant Care Supervision Requirements Age 18 and Above
- 1240-A3 - Exhibit 1240A-3 , Attendant Care Supervision Documentation Requirements
- AHCCCS 1240A - Policy Guidance regarding background check requirements
- 1240-C - Community Transition Services
- 1240-D - Emergency Alert System
- 1240-E - Habilitation Services and Day Services
- 1240-F - Home Delivered Meals
- 1240-G - Skilled Nursing and Licensed Health Aide Services
- 1240-G1 - Exhibit, Skilled Nursing Matrix
- 1240-I - Home Modifications
- 1240-J - Employment Services
- 1250-D - Respite
- 1250-E - Therapies (Rehabilitative and Habilitative)
- 1250-Y - Scheduled Transportation
- 1280 - State Funded Services
- 1290 - Behavioral Health Advocacy
Chapter 1300 Member Directed Options
Chapter 1600 Case Management
- 1601 - Assignment of Support Coordinators
- 1610 - Guiding Principles and Components of Support Coordination
- 1620-A - Initial Contact / Visit Standard
- 1620-B - Needs Assessment / Care Planning Standard
- 1620-C - Cost Effectiveness Study
- 1620-D - Placement and Service Planning for ALTCS Eligible Members
- 1620-E - Service Plan Monitoring and Reassessment Standards
- 1620-G - Behavioral Health Standards
- 1620-K - Skilled Nursing Need Standard
- 1620-L - Case File Documentation
- 1620-N - Service Closure and Case Closure
- 1620-O - Abuse, Neglect and Exploitation Reporting Standard
- 1620-P - Interdisciplinary Collaboration
- 1621 - Enhanced Staffing Ratios
- 1630 - Administrative Standards
- 1640 - Targeted Support Coordination Standards
- 1650 - Division Only Eligibility (DD-Only) Support Coordination Standards
Revision History
Eligibility Manual
The Division Eligibility Manual provides information regarding eligibility with the Division and the application process. The manual should be referenced in conjunction with State and Federal regulations and applicable contracts.
Download the complete Division Eligibility Manual.
DDD Eligibility Manual downloadable chapter files.
Chapter 200
- 200 - Requirements for Division Eligibility Overview
- 200-A - Residency
- 200-B - Citizenship or Legal Residency
- 200-C - Social Security Numbers
- 200-E - Responsible Person and Application
- 200-G - Diagnostic and Functional Criteria for Persons Age Six and Above
- 200-H - Criteria for Children Birth to Age 6
- 200-I - Adult Applicants with Limited Documentation
Chapter 201 - Applicants with Down Syndrome
Chapter 400 - Eligibility Determination Process
Chapter 600 - Re-Determination of Eligibility
Chapter 700 - Determination of ALTCS Eligibility
Chapter 800 - Eligibility for the Arizona Intervention Program
Chapter 900 - Eligibility Categories
Revision History - Eligibility Policy Manual Revision History
Behavior Supports Manual
The Division Behavior Supports Manual provides information regarding Behavioral Health Supports and Services. The manual should be referenced in conjunction with State and Federal regulations, Article 9, and applicable contracts.
Download the complete Division Behavior Supports Manual.
DDD Behavior Supports Manual downloadable chapter files.
Chapter 100 - Applicability Definitions and Guiding Principles
Chapter 200 - Prohibitions and Restricted Techniques
Chapter 300 - Sanctions
Chapter 400 - Program Review Committee
Chapter 500 - Planning Team Responsibilities
Chapter 600 - Training
Chapter 700 - Behavior Modifying Medications
Chapter 800 - Behavior Plan Development and Monitoring
Chapter 900 - Emergency Measures
Revision History - Behavior Supports Manual Revision History
Provider Manual
The Division Provider Manual provides information to Division contractors regarding provider responsibilities and requirements. The manual should be referenced in conjunction with State and Federal regulations, AHCCCS Policy Manuals, and applicable contracts.
Download the complete Division Provider Manual.
DDD Provider Manual downloadable chapter files.
Preface - Intended Users of the Provider Policy Manual
Chapter 1 - Introduction to the Division of Developmental Disabilities
Chapter 2 - Provider Responsibilities and Expectations
Chapter 3 - Provider Customer Service and Network Support
Chapter 4 - Covered and Non-Covered Service
Chapter 5 - Emergency Room Utilization
Chapter 6 - Early and Periodic Screening, Diagnostic and Treatment
Chapter 7 - Dental/Oral Health Care
Chapter 8 - Family Planning
Chapter 9 - PCP Assignments
Chapter 10 - Referrals to Specialists
Chapter 11 - ALTCS Inquiries, Grievances, Claim Disputes, and Appeals
Chapter 12 - Billing and Claim Submission
Chapter 13 - Utilization Management
Chapter 16 - Remittance Advice, Eligibility, and Cost Sharing
Chapter 17 - Prior Authorization Requirements
Chapter 18 - Claims Medical Review
Chapter 19 - Concurrent Review
Chapter 20 - Fraud, Waste and Abuse
Chapter 22 - Pharmacy Services
Chapter 23 - Appointment Standards
Chapter 24 - Americans with Disabilities Act
Chapter 25 - Eligibility Verification
Chapter 26 - Cultural Competency and Member and Family Centered Care
Chapter 27 - Peer Review and Inter-Rater Reliability
Chapter 28 - Member Rights
Chapter 29 - Advising or Advocating on Behalf of a Member
Chapter 30 - Clinical Practice Guidelines
Chapter 31 - Transitioning Members Between DDD Health Plans
Chapter 34 - Provider Publications
Chapter 35 - Reporting Requirements for Progress Reports and Other Documentation
Chapter 36 - Fire Safety
Chapter 37 - Therapy Services - Occupational, Physical, and Speech Language
Chapter 38 - Emergency Communication When Transporting a Member
Chapter 40 - Insurance Requirements for Qualified Vendors
Chapter 41 - Termination of a Qualified Vendor Agreement Upon Request of the Qualified Vendor
Chapter 42 - Electronic Monitoring in Program Sites
Chapter 43 - Respite Provided at Camp to Division Members
Chapter 46 - Agency With Choice
Chapter 47 - Managing Vendor Call Lists, Vendor Directories, Scope of Services and Reporting Requirements
Chapter 48 - Credentialing of Contracted Providers
Chapter 49 - Responsible Driving
Chapter 50 - Vendor Call Requirements for Qualified Vendors
Chapter 51 - Oversight and Monitoring of Developmental Home Services
Chapter 52 - Habilitation Staffing Schedule Requirements and Annual Review
Chapter 53 - Supporting Children In Care of the Department of Child Safety In Community Residential Settings
Chapter 54 - Group Home Requirements
Chapter 57 - Third Party Liability Waiver Requests
Chapter 58 - Medication Management Services
Chapter 59 - Benefit Coordination and Fiscal Responsibility for BH Svc and PH Services
Chapter 60 - Required Notifications
Chapter 61 - Home and Community Based Services (HCBS) Certification and AHCCCS Provider Enrollment
Chapter 62 - Electronic Visit Verification
Chapter 63 - Workforce Development
Chapter 64 - Preventing Member Abuse, Neglect and Exploitation
Chapter 65 - Providing Out of State Services
Chapter 66 - Behavioral Health
Chapter 67 - General and Informed Consent
Chapter 68 - Advance Directives
Chapter 69 - Care Coordination
Chapter 70 - Qualified Vendor Incident Reporting
Chapter 71 - Life Safety Inspection
Appendix A - QV Provider Instructions – Agency with Choice Option
Appendix B - DDD Agency with Choice User Guide – Focus Vendor
Appendix C - Medicaid Encounter Data Validation
Revision History - Provider Manual Revision History
AdSS Medical Manual
The Administrative Services Subcontractors (AdSS) Medical Manual provides information on the medical policies for acute services,maternal and child health, care coordination requirements, provider qualifications and responsibilities, quality management and performance improvement program, medication management, and services and settings of the AdSS. The manual should be referenced in conjunction with State and Federal regulations, AHCCCS Contractor’s Operations Manual (ACOM), the Division Medical Manual and applicable contracts.
Download the complete Administrative Services for Subcontractors (AdSS) Medical Policy Manual
AdSS Medical Policy Manual downloadable chapter files
Chapter 200 Behavioral Health Practice Tools
- 210 - Working with the Birth through Five Population
- 211 - Psychiatric and Psychotherapeutic Best Practices for Children Birth through Five Years of Age
- 280 - Transition to Adulthood
Chapter 300 Medical Policy for Acute Services
- 310-B - Title XIX/XXI Behavioral Health Services
- 310-C - Breast Reconstruction After Mastectomy
- 310-D1 - Dental Services for Members 21 Years of Age and Older
- 310-D2 - Arizona Long Term Care System Adult Dental Services
- 310-F - Emergency Medical Services
- 310-G - Eye Examinations/Optometry Services
- 310-I - Home Health Services
- 310-J - Hospice Services
- 310-L - Hysterectomy
- 310-M - Immunizations
- 310-P - Medical Equipment, Medical Devices and Medical Supplies
- 310-R - Nursing Facility Services
- 310-V - Prescription Medication/Pharmacy Services
- 310-X - Rehabilitative or Restorative Occupational Therapy, Physical Therapy, and Speech Pathology Services
- 310-BB - Transportation for Physical and Behavioral Health Services
- 310-DD - Covered Transplants and Related Immunosuppressant Medications
- 310-FF - Monitoring Controlled and Non-Controlled Medication Utilization
- 310-GG - Nutritional Therapy Metabolic Foods and Total Parenteral Nutrition
- 310-HH - End of Life Care and Advance Care Planning
- 310-II - Genetic Testing
- 310-KK - Biomarker Testing
- 320-B - Member Participation in Experimental Services and Clinical Trials
- 320-I - Telehealth and Telemedicine
- 320-M - Medical Marijuana and CBD Oil Products
- 320-O - Behavioral Health Assessments, Service, and Treatment Planning
- 320-P - Serious Emotional Disturbance and Serious Mental Illness Eligibility Determinations
- 320-Q - General and Informed Consent
- 320-R - Special Assistance for Persons with Serious Mental Illness
- 320-S - Behavior Analysis Services
- 320-U - Pre-petition Screening, Court Ordered Evaluation and Court Ordered Treatment
- 320-V - Behavioral Health Residential Facilities
- 320-W - Therapeutic Foster Care for Children
- 320-X - Adult Behavioral Health Therapeutic Homes
- 320-Z - Members on Conditional Release
Chapter 400 Medical Policy for Maternal and Child Health
- 410 - Maternity Care Services
- 411 - Women's Preventive Care Services
- 420 - Family Planning Services and Supplies
- 430 - Early and Periodic Screening, Diagnostic and Treatment Services
- 431 - Dental Oral Health Services for EPSDT Eligible Members
- 450 - Out-of-State Placements Behavioral Health Treatment
Chapter 500 Care Coordination Requirements
- 510 - Primary Care Providers
- 520 - Member Transitions
- 530 - Member Transfers Between Facilities
- 540 - Other Care Coordination Issues
- 541 - Coordination of Care with Other Government Agencies
- 542 - Electronic Visit Verification
- 560 - CRS Care Coordination and Service Plan Management
- 570 - Behavioral Health Provider Case Management
- 580 - Child and Family Team
- 582 - Support and Rehabilitation Services for Children, Youth, and Young Adults
- 583 - Family Involvement in the Children's Behavioral Health System
- 584 - Youth Involvement in the Children's Behavioral Health System
- 585 - Unique Needs of Children, Youth, and Families Involved with the Department of Child Safety
- 586 - Children's Out-of-Home Services
- 590 - Behavioral Health Crisis Services and Care Coordination
Chapter 600 Provider Qualifications and Provider Requirements
- 610 - AHCCCS Provider Qualifications
- 670 - Federally Qualified Healthcare Centers and Rural Health Clinics Reimbursement
Chapter 900 Quality Management and Performance Improvement Program
- 910 - Quality Management and Performance Improvement Program Scope
- 920 - Quality Management and Performance Improvement Administrative Requirements
- 930 - Reserved
- 940 - Medical Records and Communication of Clinical Information
- 950 - Credentialing and Recredentialing Processes
- 960 - Quality of Care Concerns
- 961 - Incident, Accident, and Death Reporting
- 962 - Reporting and Monitoring of Seclusion and Restraint
- 963 - Peer and Recovery Support Service Provision Requirements
- 964 - Credentialed Family Support Partner Requirements
- 965 - Community Service Agencies
- 969 - Collaborating with Peers and Families
- 970 - Performance Measures
- 980 - Performance Improvement Projects
Chapter 1000 Medical Management
- 1001 - Second Level Review
- 1010 - Medical Management Administrative Requirements
- 1020 - Utilization Management
- 1021 - Care Management
- 1022 - Justice Reach-In
- 1023 - Disease Chronic Care Management
- 1024 - Drug Utilization Review
- 1040 - Outreach, Engagement and Re-Engagement for Behavioral Health
- 1050 - Reserved
- 1060 - Reserved
Chapter 1200 Services and Settings
- 1210 - Institutional Services and Settings
- 1240-D Emergency Alert System
- 1250-E Therapies (Rehabilitative and Habilitative)
Revision History
AdSS Operations Manual
The Administrative Services Subcontractors (AdSS) Operations Manual provides information on the Administrative, Claims, Financial, and Operational responsibilities and requirements of the AdSS. The manual should be referenced in conjunction with State and Federal regulations, AHCCCS Contractor’s Operations Manual (ACOM), the Division Operations Manual, and applicable contracts.
Download the complete Administrative Services for Subcontractors (AdSS) Operations Policy Manual.
AdSS Operations Policy Manual downloadable chapter files.
Chapter 100 Administration
- 101 - Marketing
- 103 - Fraud, Waste and Abuse
- 104 - Continuity of Operations/Emergency Preparedness Plan
- 106 - Certification of Medicare Advantage Plans Serving Dual Eligible Medicare–AHCCCS Members
- 108 - AHCCCS Security Rule Compliance
- 109 - Institution for Mental Disease 15 Day Limit
- 110 - Mental Health Parity
Chapter 200 Claims
- 201 - Medicare Cost Sharing for Members Covered by Medicare and Medicaid
- 203 - Claims Processing
- 205 - Ground Ambulance Transportation for Non-Contracted Providers
Chapter 300 Financial
- 305 - Performance Bond and Equity per Member Requirements
- 307 - Alternative Payment Model Initiative - Strategies and Performance-Based Payments Incentive
- 311 - CYE20 and Forward - Tiered Capitation Reconciliation
- 312 - Children's Rehabilitative Services Program Reconciliation
- 314 - Auto-Assignment Algorithm
- 317 - Change in Organizational Structure
- 320 - Health Insurer Fee
Chapter 400 Operations
- 401 - Change of DDD Health Plan and Administrative Services Subcontractors
- 402 - Member Transition for Annual Enrollment Choice and Eligibility Changes
- 404 - Contractor Website and Member Information
- 405 - Cultural Competency, Language Access Plan and Family Member Centered Care
- 406 - Member Handbook and Provider Directory
- 407 - Workforce Development
- 408 - Sanctions
- 409 - Office of Individual and Family Affairs
- 412 - Claims Recoupment and Refunds
- 414 - Requirements for Service Authorization Decisions and Notice of Adverse Benefit Determination
- 415 - Provider Network Development and Management Plan; Periodic Network Reporting Requirements
- 416 - Provider Information
- 417 - Appointment Availability, Transportation Timelines, Monitoring and Reporting
- 418 - Provider and Affiliate Advance and Loan Request
- 421 - Contract Termination: Nursing Facilities and Alternate Home and Community Based Settings
- 423 - Financial Responsibility for Court Ordered Treatment for DUI/Domestic Violence or Other Criminal Offenses
- 424 - Verification of Receipt of Paid Services
- 425 - Social Networking
- 426 - Children's Rehabilitation Services Application, Designation and Coverage
- 431 - Copayment
- 433 - Member Identification Cards
- 434 - Coordination of Benefits and Third Party Liability
- 435 - Telephone Performance Standards and Reporting
- 436 - Network Standards
- 437 - Financial Responsibility for Services After the Completion of Court-Ordered
- 438 - Administrative Services Subcontracts Evaluation
- 439 - Material Changes: Provider Network and Business Operations
- 440 - Managed Care Expiration or Termination of Contract
- 444 - Notice and Appeal Requirements (Serious Mental Illness Appeals)
- 445 - Submission of Hearing Requests
- 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness
- 448 - Housing
- 449 - Behavioral Health Services for Children in Department of Child Safety Custody and Adopted Children
- 470 - Management and Maintenance of Records Related to Medicaid Line of Business
Chapter 1000 Justice Reach-In
Chapter 5000 Reinsurance
Revision History
AdSS DDD Only Health Plan Deliverables
- ASD Secret Shopper Audit List and Audit Results Report
- Behavioral Health Out of Home
- HIPAA Reporting
- Notification of All Hospital Admissions
- Members with Diabetic and A1C Report
- Members Determined SMI - Special Assistance Report
- Pressure Ulcer Report
- Supplement to Grievance and Appeal System
- Pregnant Women and Postpartum
- Behavioral Health Utilization Services Data
- Retrospective Review Deliverable
- Encounter Submission and Tracking (ESTR)
- Behavioral Health Out of Home
- High Needs and High-Cost Care Management Program
- Prescription Drug Utilization
- Telephone (Administrative Performance Measures)
- Unplanned Transitions
- Utilization Management
Tribal Health Program (THP) Deliverables
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Arizona State Resources
Pursuant to Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA) and other nondiscrimination laws and authorities, ADES does not discriminate on the basis of race, color, national origin, sex, age, or disability. Persons that require a reasonable modification based on language or disability should submit a request as early as possible to ensure the State has an opportunity to address the modification. The process for requesting a reasonable modification can be found at Equal Opportunity and Reasonable Modification