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Policies

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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 Manual.

DDD Operations Manual downloadable chapter files.
Manual Chapter Policy
Chapter 100 - Administration 101 - Marketing
Chapter 100 - Administration 103 - Fraud, Waste and Abuse
Chapter 100 - Administration 104 - Continuity of Operations/Emergency Preparedness Plan
Chapter 100 - Administration 108 - Security Rule Compliance
Chapter 100 - Administration 109 - Institution for Mental Disease 15-Day Limit
Chapter 100 - Administration 110 - Mental Health Parity
Chapter 200 - Claims 203 - Claims Processing
Chapter 200 - Claims 205 - Ground Ambulance Transportation Reimbursement Requirements for Non-Contracted Providers
Chapter 300 Financial 302 - Prior Period Coverage Reconciliation:  Administrative Services Subcontractors
Chapter 300 - Financial 305 - Performance Bond and Equity Per Member Requirements
Chapter 300 - Financial 314 - Auto-Assignment Algorithm
Chapter 300 Financial 317 - Change in Organizational Structure 
Chapter 300 - Financial 320 - Health Insurer Provider Fee
Chapter 300 - Financial 321 - Payment Reform E-Prescribing
Chapter 300 Financial 325 - Access to Professional Services Initiative and Reconciliation
Chapter 400 - Operations 404 - Contractor Website and Member Information Material
Chapter 400 - Operations 406 - Member Handbook and Provider Directory
Chapter 400 - Operations 407 - Workforce Development
Chapter 400 - Operations 412 - Claims Recoupment
Chapter 400 - Operations 414 - Requirements for Service Authorization Decision and Notices of Adverse Benefit Determination
Chapter 400 - Operations 415 - Provider Network Development and Management Plan Periodic; Network Reporting Requirements
Chapter 400 - Operations 416 - Provider Network Information
Chapter 400 - Operations 417 - Appointment Availability, Monitoring and Reporting
Chapter 400 - Operations 418 - Provider and Affiliate Advances, Equity Distributions, Loans & Investments
Chapter 400 - Operations 424 - Verification of Receipt of Paid Services
Chapter 400 - Operations 426 - CRS Referrals, Enrollment, and Coverage
Chapter 400 - Operations 431 - Copayment
Chapter 400 - Operations 435 - Telephone Performance Standards and Reporting
Chapter 400 - Operations 436 - Network Standards
Chapter 400 - Operations 438 - Administrative Services Subcontracts
Chapter 400 - Operations 439 - Material Changes: Provider Network and Business Operations
Chapter 400 - Operations 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness
Chapter 400 - Operations 449 - BH Services for Children in Dept of Child Safety Custody and Adopted Children
Chapter 1000 - Members and Families 1001A - Basic Human and Disability Related Rights
Chapter 1000 - Members and Families 1001B - Responsibilities of Individuals Applying for and/or Receiving Supports and Services
Chapter 1000 - Members and Families 1001C - Rights of Persons with Developmental Disabilities Living in Residential Settings
Chapter 1000 - Members and Families 1002 - Voter Registration
Chapter 1000 - Members and Families 1003 - District Independent Oversight Committees
Chapter 1000 - Members and Families 1004A - Informed Consent
Chapter 1000 - Members and Families 1004B - Consent to Medical Treatment of Minors, Incapacitated Minors, and Incapacited Adults
Chapter 1000 - Members and Families 1005A - Guardianship and Conservatorship or Surrogate Parent
Chapter 1000 - Members and Families 1005C - Authorized Representative for Arizona Long Term Care System Benefits
Chapter 1000 - Members and Families 1005D - Representative Payee
Chapter 1000 - Members and Families 1006 - Healthcare Directives/Advance Directives (AHCD)
Chapter 2000 - Support Coordination 2005 - Referral and Placement in Services
Chapter 2000 - Support Coordination 2006 - Arizona Long Term Care Non-Users
Chapter 3000 - Network 3001 - Family Members as Paid Providers
Chapter 3000 - Network 3002 - Home and Community Based Service Delivery
Chapter 3000 - Network 3003 - Selection of Providers
Chapter 3000 - Network 3005 - Reserved
Chapter 3000 - Network 3006 - Short Term Emergency Situations (Residential and Day Programs)
Chapter 3000 - Network 3007 - Service Provider Information, Authority, and Notification
Chapter 4000 - Business Operations 4001 - Third Party Liability
Chapter 4000 - Business Operations 4002 - Client Billing
Chapter 4000 - Business Operations 4003 - Administrative Review/Appeal and Hearing Rights
Chapter 4000 - Business Operations 4004 - Overview
Chapter 4000 - Business Operations 4004A - Definitions
Chapter 4000 - Business Operations 4004B - Member Funds System
Chapter 4000 - Business Operations 4004D - Responsibilities
Chapter 4000 - Business Operations 4004E - Safeguarding Member Funds
Chapter 4000 - Business Operations 4004F - Member Funds Security
Chapter 4000 - Business Operations 4004G - Disbursing Member Funds
Chapter 4000 - Business Operations 4004H - Member Funds, Provider Responsibilities
Chapter 4000 - Business Operations 4004I - Ledgers Maintained By Providers
Chapter 4000 - Business Operations 4004J - Bank Reconciliation
Chapter 4000 - Business Operations 4004K - Use of Member Funds
Chapter 4000 - Business Operations 4004M - Changes in a Member’s Status
Chapter 4000 - Business Operations 4004N - Investing Member Funds
Chapter 4000 - Business Operations 4004O - Termination of a Member’s Account or Change in Representative Payee
Chapter 5000 5000 - Reinsurance Policy
Chapter 6000 - Administrative Operations 6001A - Confidentiality
Chapter 6000 - Administrative Operations 6001B - Release of Information
Chapter 6000 - Administrative Operations 6001C - Access to Personally Identifiable Information
Chapter 6000 - Administrative Operations 6001D - Lawful Disclosure of Confidential Information
Chapter 6000 - Administrative Operations 6001E - Violations and Penalties
Chapter 6000 - Administrative Operations 6001F - Case Records
Chapter 6000 - Administrative Operations 6001G - Documentation Requirements
Chapter 6000 - Administrative Operations 6001H - Records Storage and Security
Chapter 6000 - Administrative Operations 6001I - Management and Maintenance of Records
Chapter 6000 - Administrative Operations 6002C - Reporting Requirements
Chapter 6000 - Administrative Operations 6002D - Members At-Risk if Missing
Chapter 6000 - Administrative Operations 6002F - Investigative Process
Chapter 6000 - Administrative Operations 6002G - Abuse and Neglect
Chapter 6000 - Administrative Operations 6002H - Referral to Other Investigative Agencies
Chapter 6000 - Administrative Operations 6002I - Incident and Quality of Care Concern Corrective Actions and Closure
Chapter 6000 - Administrative Operations 6002J - Trending For Quality Improvement
Chapter 6000 - Administrative Operations 6002K - Information Sharing
Chapter 6000 - Administrative Operations 6002M - Mortality Review Process
Chapter 6000 - Administrative Operations 6002N - Fraud and False Claims
Chapter 6000 - Administrative Operations 6002O - Health Care Acquired Conditions
Chapter 6000 - Administrative Operations 6003A - Definitions
Chapter 6000 - Administrative Operations 6003B - Informal Resolution/Grievance Process Non-Arizona Long Term Care System
Chapter 6000 - Administrative Operations 6003C - Appeal Process for Members Who Receive State Funded Services
Chapter 6000 - Administrative Operations 6003D - Notice of Intended Action (State Only)
Chapter 6000 - Administrative Operations 6003E - Administration Review Process (State Only)
Chapter 6000 - Administrative Operations 6003F - Fair Hearings and Appeals
Chapter 6000 - Administrative Operations 6003G - Arizona Long Term Care System Grievance Process
Chapter 6000 - Administrative Operations 6003H - Arizona Long Term Care System Notice of Adverse Benefit Determination
Chapter 6000 - Administrative Operations 6003I - Arizona Long Term Care System Appeal Process
Chapter 6000 - Administrative Operations 6003J - Arizona Long Term Care System Fair Hearing Process
Chapter 6000 - Administrative Operations 6003K - Claim Disputes
Chapter 6000 - Administrative Operations 6003L - Attorneys at Planning Meetings
Chapter 6000 - Administrative Operations 6003M - Conducting All Meetings
Chapter 6000 - Administrative Operations 6003N - Oral and Written Regulatory Inquiries
Chapter 6000 - Administrative Operations 6003O - Responding to Government Audits
Chapter 6000 - Administrative Operations 6003P - Standards of Conduct
Chapter 6000 - Administrative Operations 6003Q - Anti-Retaliation
Chapter 6000 - Administrative Operations 6003R - Compliance Concerns Reporting Requirements
Chapter 6000 - Administrative Operations 6003S - Compliance Program Training and Education
Chapter 6000 - Administrative Operations 6003T - Compliance Program Integrity Hotline
Chapter 6000 - Administrative Operations 6003U - Corporate Compliance Program Documentation
Chapter 6000 - Administrative Operations 6003V - Division Program Integrity Standards
Chapter 6000 - Administrative Operations 6004A - Quality Management
Chapter 6000 - Administrative Operations 6004B - Internal Oversight
Chapter 6000 - Administrative Operations 6004C - External Oversight
Chapter 6000 - Administrative Operations 6004D - Division Oversight Findings
Chapter 6000 - Administrative Operations 6004E - Operational Reviews
Chapter 6000 - Administrative Operations 6004F - Compliance Program
Chapter 6000 - Administrative 6004G - Monitoring and Oversight
Chapter 6000 - Administrative 6005A - Compliance Charter
Chapter 6000 - Administrative 6005B - Compliance Investigation
Operations Manual 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 Manual.

DDD Medical Manual downloadable chapter files.
Manual Chapter Policy
Chapter 100 Introduction 100D - Policy Manual Definitions
Chapter 200 Behavioral Health Practice Tools 210 - Working with the Birth through Five Population
Chapter 200 Behavioral Health Practice Tools 211 - Psychiatric and Psychotherapeutic Best Practices for Children Birth through Five Years of Age
Chapter 200 Behavioral Health Practice Tools 230 - Support and Rehabilitation Services for Children, Adolescents, and Young Adults
Chapter 200 Behavioral Health Practice Tools 280 - Transition to Adulthood
Chapter 300 Medical Policy for Acute Services 300 - Chapter Overview
Chapter 300 Medical Policy for Acute Services 310A - Audiology
Chapter 300 Medical Policy for Acute Services 310AA - Total Parenteral Nutrition
Chapter 300 Medical Policy for Acute Services 310B - Title XIX/XXI Behavioral Health Services
Chapter 300 Medical Policy for Acute Services 310BB - Transportation
Chapter 300 Medical Policy for Acute Services 310D - Dental Services
Chapter 300 Medical Policy for Acute Services 310DD - Organ Transplant
Chapter 300 Medical Policy for Acute Services 310E - Dialysis
Chapter 300 Medical Policy for Acute Services 310F - Emergency Medical Services
Chapter 300 Medical Policy for Acute Services 310FF - Drug Utilization Review and Monitoring
Chapter 300 Medical Policy for Acute Services 310H - Health Risk Assessment and Screening Tests
Chapter 300 Medical Policy for Acute Services 310HH - End of Life Care and Advance Care Planning
Chapter 300 Medical Policy for Acute Services 310I - Home Health Services
Chapter 300 Medical Policy for Acute Services 310J - Hospice Services
Chapter 300 Medical Policy for Acute Services 310K - Hospital Inpatient Services
Chapter 300 Medical Policy for Acute Services 310L - Hysterectomy
Chapter 300 Medical Policy for Acute Services 310M - Immunizations
Chapter 300 Medical Policy for Acute Services 310N - Laboratory
Chapter 300 Medical Policy for Acute Services 310O - Maternal and Child Health Services
Chapter 300 Medical Policy for Acute Services 310P - Medical Supplies, Durable Medical Equipment, and Prosthetic Devices (Acute Care Services)
Chapter 300 Medical Policy for Acute Services 310S - Observation Services
Chapter 300 Medical Policy for Acute Services 310T - Physician Services
Chapter 300 Medical Policy for Acute Services 310V - Prescription Medication/Pharmacy Services
Chapter 300 Medical Policy for Acute Services 310W - Radiology and Medical Imaging
Chapter 300 Medical Policy for Acute Services 310X - Rehabilitative Therapy
Chapter 300 Medical Policy for Acute Services 310Y - Respiratory Therapy
Chapter 300 Medical Policy for Acute Services 320A - Affiliated Practice Dental Hygienist
Chapter 300 Medical Policy for Acute Services 320E - Health and Behavior Intervention
Chapter 300 Medical Policy for Acute Services 320F - HIV/AIDS Treatment Services
Chapter 300 Medical Policy for Acute Services 320G - Lung Volume Reduction Surgery
Chapter 300 Medical Policy for Acute Services 320H - Medical Foods
Chapter 300 Medical Policy for Acute Services 320I - Telehealth and Telemedicine
Chapter 300 Medical Policy for Acute Services 320K - Tobacco Cessation Product
Chapter 300 Medical Policy for Acute Services 320-M - Medical Marijuana and CBD Oil Products
Chapter 300 Medical Policy for Acute Services 320-O - Behavioral Health Assessments and Treatment/Service Planning
Chapter 300 Medical Policy for Acute Services 320-P - Serious Mental IIlness Eligibility Determination
Chapter 300 Medical Policy for Acute Services 320-S - Behavior Analysis Services
Chapter 300 Medical Policy for Acute Services 320-U - Pre-Petition Screening, Court Ordered Evaluation and Court Ordered Treatment
Chapter 300 Medical Policy for Acute Services 320V - Behavioral Health Residential Facilities
Chapter 300 Medical Policy for Acute Services 320-W Therapeutic Foster Care for Children
Chapter 300 Medical Policy for Acute Services 320-X Adult Behavioral Health Therapeutic Homes
Chapter 300 Medical Policy for Acute Services 330 - Covered Conditions and Services for Children’s Rehabilitative Services
Chapter 400 Medical Policy for Maternal and Child Health 410 - Maternity Care Services
Chapter 400 Medical Policy for Maternal and Child Health 411 - Women’s Preventative Care Services
Chapter 400 Medical Policy for Maternal and Child Health 420 - Family Planning Services and Supplies
Chapter 400 Medical Policy for Maternal and Child Health 430 - Early and Periodic Screening, Diagnostic and Treatment Services
Chapter 400 Medical Policy for Maternal and Child Health 431 - Dental Oral Health Services for EPSDT Eligible Members
Chapter 400 Medical Policy for Maternal and Child Health 450 - Out of State Placements for Behavioral Health Treatment
Chapter 500 Care Coordination Requirements 510 - Primary Care Providers
Chapter 500 Care Coordination Requirements 520 - Member Transitions
Chapter 500 Care Coordination Requirements 530 - Member Transfers Between Facilities
Chapter 500 Care Coordination Requirements 540 - Other Care Coordination Issues
Chapter 500 Medical Policy for Acute Services 541 - Coordination of Care with Other Government Agencies
Chapter 500 Care Coordination Requirements 550 - Member Records and Confidentiality
Chapter 500 Care Coordination Requirements 570 - Community Collaborative Care Teams
Chapter 500 Care Coordination Requirements 580 - Behavioral Health Referral and Intake Process
Chapter 600 Provider Qualifications and Provider Requirements 610 - AHCCCS Provider Qualifications
Chapter 600 Provider Qualifications and Provider Requirements 640 - Advance Directives
Chapter 600 Provider Qualifications and Provider Requirements 680-C Pre-Admission Screening and Resident Review
Chapter 700 School Based Claiming Program - Direct Services Claiming 700 - School Based Claiming For Medicaid
Chapter 800 Fee-For-Service Quality and Utilization Management 810 - Retrospective Review
Chapter 900 - Quality Management / Performance Improvement Program 910 - Quality Management/Performance Improvement Program Administrative Requirements
Chapter 900 - Quality Management / Performance Improvement Program 920 - Quality Management/Performance Improvement (QM/PI) Program Scope
Chapter 900 - Quality Management / Performance Improvement Program 940 - Medical Records and Communication of Clinical Information
Chapter 900 - Quality Management / Performance Improvement Program 950 - Credentialing and Recredentialing Processes
Chapter 900 - Quality Management / Performance Improvement Program 960 - Quality of Care Concerns
Chapter 900 - Quality Management / Performance Improvement Program 961 - Incident, Accident, and Death Reporting
Chapter 900 - Quality Management / Performance Improvement Program 966 - Immediate Jeopardy
Chapter 900 - Quality Management / Performance Improvement Program 970 - Performance Measures
Chapter 900 - Quality Management / Performance Improvement Program 980 - Performance Improvement Projects
Chapter 1000 Medical Management 1000 - Chapter Overview
Chapter 1000 Medical Management 1010 - Medical Management Administrative Requirements
Chapter 1000 Medical Management 1020 - Medical Management Scope and Components
Chapter 1000 Medical Management 1030 - Reporting Requirements
Chapter 1000 Medical Management 1040 - Outreach, Engagement and Re-Engagement for Behavioral Health
Chapter 1200 Services and Settings 1200 - Overview
Chapter 1200 Services and Settings 1210 - Institutional Services and Settings
Chapter 1200 Services and Settings 1230A - Assisted Living Facilities
Chapter 1200 Services and Settings 1230C - Room and Board
Chapter 1200 Services and Settings 1240A - Attendant Care and Homemaker (Direct Care Services)
Chapter 1200 Services and Settings 1240A1 - Exhibit 1240A-1 , Attendant Care Supervision Requirements Age 17 and Under
Chapter 1200 Services and Settings 1240A2 - Exhibit 1240A-2, Attendant Care Supervision Requirements Age 18 and Above
Chapter 1200 Services and Settings 1240A3 - Exhibit 1240A-3 , Attendant Care Supervision Documentation Requirements
Chapter 1200 Services and Settings AHCCCS 1240A - Policy Guidance regarding background check requirements  
Chapter 1200 Services and Settings 1240C - Community Transition Services
Chapter 1200 Services and Settings 1240D - Emergency Alert System
Chapter 1200 Services and Settings 1240E - Habilitation Services
Chapter 1200 Services and Settings 1240G - Home Nursing
Chapter 1200 Services and Settings 1240G1 - Exhibit, Skilled Nursing Matrix
Chapter 1200 Services and Settings 1240H - Home Health Aide
Chapter 1200 Services and Settings 1240I - Home Modifications
Chapter 1200 Services and Settings 1250B - Hospice
Chapter 1200 Services and Settings 1250C - Medical and Acute Care Services
Chapter 1200 Services and Settings 1250D - Respite
Chapter 1200 Services and Settings 1250E - Therapies (Rehabilitative and Habilitative)
Chapter 1200 Services and Settings 1250F - Medical Supplies, Equipment, Appliances, and Customized Durable Medical Equipment
Chapter 1200 Services and Settings 1250G - Nutritional Assessments and Nutritional Therapy
Chapter 1200 Services and Settings 1250H - Transportation
Chapter 1200 Services and Settings 1280 - State Funded Services
Chapter 1600 Case Management 1610 - Guiding Principles and Components of Support Coordination
Chapter 1600 Case Management 1620A - Initial Contact / Visit Standard
Chapter 1600 Case Management 1620B - Needs Assessment / Care Planning Standard
Chapter 1600 Case Management 1620C - Cost Effectiveness Study
Chapter 1600 Case Management 1620D - Placement and Service Planning for ALTCS Eligible Members
Chapter 1600 Case Management 1620E - Service Plan Monitoring and Reassessment Standards
Chapter 1600 Case Management 1620G - Behavioral Health Standards
Chapter 1600 Case Management 1620K - Skilled Nursing Need Standard
Chapter 1600 Case Management 1620L - Case File Documentation
Chapter 1600 Case Management 1620N - Service Closure and Case Closure
Chapter 1600 Case Management 1620O - Abuse, Neglect and Exploitation Reporting Standard
Chapter 1600 Case Management 1630 - Administrative Standards
Chapter 1600 Case Management 1640 - Targeted Support Coordination Standards
Chapter 1600 Case Management 1650 - Division Only Eligibility (DD-Only) Support Coordination Standards
Medical Manual 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.
Manual Chapter Policy
Chapter 100 Responsibilities
Chapter 200 200 - Requirements for Division Eligibility Overview
Chapter 200 200A - Residency
Chapter 200 200B - Citizenship or Legal Residency
Chapter 200 200C - Social Security Numbers
Chapter 200 200E - Responsible Person and Application
Chapter 200 200G - Diagnostic and Functional Criteria for Persons Age Six and Above
Chapter 200 200H - Criteria for Children Birth to Age 6
Chapter 200 200I - Adult Applicants with Limited Documentation
Chapter 400 Eligibility Determination Process
Chapter 500 Assignment of Support Coordinators
Chapter 600 Re-Determination of Eligibility
Chapter 700 Determination of ALTCS Eligibility
Chapter 800 Eligibility for the Arizona Intervention Program
Chapter 900 Eligibility Categories
Chapter 1000 Responsibilities of the Member/Responsible Person
Eligibility 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.
Manual Chapter Policy
Chapter 100 Definition and Applicability
Chapter 200 Prohibitions
Chapter 300 Violations
Chapter 400 Program Review Committee
Chapter 500 Individual Support Plan Team Responsibilities
Chapter 600 Restitution
Chapter 700 Behavior Modifying Medication, Monitoring Behavior Modifying Medications and Treatment Plans
Chapter 900 Emergency Measures and Physical Management Techniques
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.

Preface - Intended Users of the Provider Policy Manual

DDD Provider Manual downloadable chapter files.
Manual Chapter Policy
Chapter 1 Introduction to the Division of Developmental Disabilities
Chapter 2 Provider Responsibilities and Expectations
Chapter 3 Provider Service Departments
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 21 False Claims Act
Chapter 22 Pharmacy Services
Chapter 23 Appointment Standards
Chapter 24 Americans with Disabilities Act
Chapter 25 Enrollment 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 Consumer
Chapter 30 Clinical Practice Guidelines
Chapter 31 Transitioning Members Between DDD Health Plans
Chapter 32 Separation of Children and Adults in Center Based Programs
Chapter 33 Assessment Requirement for Members Placed in Residential Settings
Chapter 34 Provider Publications
Chapter 35 Progress Reporting Requirement
Chapter 36 Fire Safety
Chapter 37 Therapy Services - Occupational, Physical, and Speech Language
Chapter 38 Emergency Communication When Transporting a Member
Chapter 40 Insurance
Chapter 41 Termination of a Qualified Vendor Agreement Upon Request of the Qualified Vendor
Chapter 42 Electronic Monitoring/Surveillance System in Program Sites
Chapter 43 Respite Provided at Camp to ALTCS Members
Chapter 44 Qualified Vendor Responsibilities For Planning Team Meetings
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 Daily Habilitation Staffing Schedule
Chapter 57 Third Party Liability
Chapter 58 Medication Management Services
Chapter 59 Benefit Coordination and Fiscal Responsibility for BH Svc and PH Svc
Chapter 60 Notifications to Qualified Vendors
Chapter 61 HCBS Certification and Provider Enrollment
Chapter 62 Electronic Visit Verification
Chapter 63 Workforce Development
Chapter 64 Preventing Member Abuse, Neglect and Exploitation
Chapter 65 Requirements for Qualified Vendors and Providers Providing Medicaid Services Outside the State and Country
Chapter 66 Behavioral Health
Chapter 67 General and Informed Consent
Chapter 68 Advance Directives
Chapter 69 Care Coordination
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
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 Division Administrative Services for Subcontractors (AdSS) Medical Manual

DDD AdSS Manual downloadable chapter files.
Manual Chapter Policy
Chapter 300 Medical Policy for Acute Services
Chapter 200 210 - Working with the Birth through Five Population
Chapter 200 211 - Psychiatric and Psychotherapeutic Best Practices for Children Birth through Five Years of Age
Chapter 200 230 - Support and Rehabilitation Services for Children, Adolescents, and Young Adults
Chapter 200 280 - Transition to Adulthood
Chapter 300 310-B Title XIX/XXI Behavioral Health Services
Chapter 300 310-D1 Dental Services for Members 21 Years of Age and Older
Chapter 300 310-D2 Arizona Long Term Care System Adult Dental Services
Chapter 300 310-G Eye Examinations/Optometry Services
Chapter 300 310-I Home Health Services
Chapter 300 310-J Hospice Services
Chapter 300 310-K Hospital Inpatient Services
Chapter 300 310-M Immunizations
Chapter 300 310-P Medical Equipment, Medical Devices and Medical Supplies
Chapter 300 310-R Nursing Facility Services
Chapter 300 310-V Prescription Medication/Pharmacy Services
Chapter 300 310-DD Covered Transplants and Related Immunosuppressant Medications
Chapter 300 310-FF Drug Utilization, Review and Monitoring
Chapter 300 310-GG Nutritional Assessments and Nutritional Therapy
Chapter 300 310-HH End of Life Care and Advance Care Planning
Chapter 300 320-H Medical Foods
Chapter 300 320-I Telehealth and Telemedicine
Chapter 300 320-M Medical Marijuana and CBD Oil Products
Chapter 300 320-O Behavioral Health Assessments and Treatment/Service Planning
Chapter 300 320-P Serious Mental Illness Eligibility Determination
Chapter 300 320-Q General and Informed Consent
Chapter 300 320-R Special Assistance for Persons with Serious Mental Illness
Chapter 300 320-S Behavior Analysis Services
Chapter 300 320-U Pre-petition Screening, Court Ordered Evaluation and Court Ordered Treatment
Chapter 300 320-V Behavioral Health Residential Facilities
Chapter 300 320-W Therapeutic Foster Care for Children
Chapter 300 320-X Adult Behavioral Health Therapeutic Homes
Chapter 400 Medical Policy for Maternal and Child Health
Chapter 400 410 Maternity Care Services
Chapter 400 411 Women's Preventive Care Services
Chapter 400 420 Family Planning Services and Supplies
Chapter 400 430 Early and Periodic Screening, Diagnostic and Treatment Services
Chapter 400 431 Dental Oral Health Services for EPSDT Eligible Members
Chapter 400 450 Out-of-State Placements Behavioral Health Treatment
Chapter 500 Care Coordination Requirements
Chapter 500 510 Primary Care Providers
Chapter 500 520 Member Transitions
Chapter 500 540 Other Care Coordination Issues
Chapter 500 541 Coordination of Care with Other Government Agencies
Chapter 500 542 Electronic Visit Verification
Chapter 500 560 CRS Care Coordination and Service Plan Management
Chapter 500 580 Behavioral Health Referral and Intake Process
Chapter 600 Provider Qualifications and Provider Requirements
Chapter 600 640 Advance Directives
Chapter 600 670 Federally Qualified Healthcare Centers and Rural Health Clinics Reimbursement
Chapter 600 680-C Pre-Admission Screening and Resident Review
Chapter 900 Quality Management and Performance Improvement Program
Chapter 900 910 Quality Management/Performance Improvement Program Scope
Chapter 900 920 Quality Management/Performance Improvement (QM/PI) Administrative Requirements
Chapter 900 930 Reserved
Chapter 900 940 Medical Records and Communication of Clinical Information
Chapter 900 950 Credentialing and Recredentialing Processes
Chapter 900 960 Quality of Care Concerns
Chapter 900 961 - Incident, Accident, and Death Reporting
Chapter 900 963 Peer and Recovery Support Service Provision Requirements
Chapter 900 964 Credentialed Parent/Family Support Requirements
Chapter 900 965 Community Service Agencies
Chapter 900 970 Performance Measures
Chapter 900 980 Performance Improvement Projects
Chapter 1000 Medication Management
Chapter 1000 1010 Medical Management Administrative Requirements
Chapter 1000 1020 Medical Management Scope and Components
Chapter 1000 1040 Outreach, Engagement and Re-Engagement for Behavioral Health
Chapter 1000 1050 Reserved
Chapter 1000 1060 Reserved
Chapter 1200 Services and Settings
Chapter 1200 1210 Institutional Services and Settings
Chapter 1200 1240-D Emergency Alert System
Chapter 1200 1250-E Therapies (Rehabilitative and Habilitative)
Chapter 1200 1250-F Customized Durable Medical Equipment, and Appliances
Revisions AdSS Medical Manual 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 AdSS Operations Manual.
 
DDD AdSS Manual downloadable chapter files.
Chapter 100 Administration
Chapter 100 101 Marketing
Chapter 100 103 Fraud, Waste and Abuse
Chapter 100 104 Continuity of Operations/Emergency Preparedness Plan
Chapter 100 106 Certification of Medicare Advantage Plans Serving Dual Eligible Medicare–AHCCCS Members
Chapter 100 108 AHCCCS Security Rule Compliance
Chapter 100 109 Institution for Mental Disease 15 Day Limit
Chapter 100 110 Mental Health Parity
Chapter 200 Claims
Chapter 200 201 Medicare Cost Sharing for Members Covered by Medicare and Medicaid
Chapter 200 203 Claims Processing
Chapter 200 205 Ground Ambulance Transportation Non-Contracted
Chapter 300 Financial
Chapter 300 305 Performance Bond and Equity per Member Requirements
Chapter 300 307 Alternative Payment Model Initiative - Strategies and Performance-Based Payments Incentive
Chapter 300 311 CYE20 and Forward - Tiered Capitation Reconciliation
Chapter 300 312 Children's Rehabilitative Services Program Reconciliation
Chapter 300 314 Auto-Assignment Algorithm
Chapter 300 317 Change in Organizational Structure
Chapter 300 320 Health Insurer Fee
Chapter 300 321 Payment Reform E-Prescribing
Chapter 300 325 Access to Professional Services Initiative and Reconciliation
Chapter 400 Operations
Chapter 400 401 Change of DDD Health Plan and Administrative Services Subcontractors
Chapter 400 402 Member Transition for Annual Enrollment Choice and Eligibility Changes
Chapter 400 404 Contractor Website and Member Information
Chapter 400 405 Cultural Competency, Language Access Plan and Family Member Centered Care
Chapter 400 406 Member Handbook and Provider Directory
Chapter 400 407 Workforce Development
Chapter 400 408 Sanctions
Chapter 400 412 Claims Recoupment
Chapter 400 414 Service Authorization and Notice of Adverse Benefit Determination
Chapter 400 415 Provider Network Development and Management Plan; Periodic Network Reporting Requirements
Chapter 400 416 Provider Information
Chapter 400 417 Appointment Availability, Transportation Timelines, Monitoring and Reporting
Chapter 400 418 Provider and Affiliate Advance and Loan Request
Chapter 400 421 Contract Termination: Nursing Facilities and Alternate Home and Community Based Settings
Chapter 400 423 Financial Responsibility for Court Ordered Treatment for DUI/Domestic Violence or Other Criminal Offenses
Chapter 400 424 Verification of Receipt of Paid Services
Chapter 400 425 Social Networking
Chapter 400 426 Children's Rehabilitation Services Application, Designation and Coverage
Chapter 400 431 Copayment
Chapter 400 433 Member Identification Cards
Chapter 400 434 Coordination of Benefits and Third Party Liability
Chapter 400 435 Telephone Performance Standards and Reporting
Chapter 400 436 Network Standards
Chapter 400 437 Financial Responsibility for Services After the Completion of Court-Ordered
Chapter 400 438 Administrative Services Subcontracts Evaluation
Chapter 400 439 Material Changes: Provider Network and Business Operations
Chapter 400 440 Managed Care Expiration or Termination of Contract
Chapter 400 444 Notice and Appeal Requirements (Serious Mental Illness Appeals)
Chapter 400 445 Submission of Requests for Hearing Documents
Chapter 400 446 Grievances and Investigations Concerning Persons with Serious Mental Illness
Chapter 400 448 Housing
Chapter 400 449 Behavioral Health Services for Children in Department of Child Safety Custody and Adopted Children
Chapter 400 470 Management and Maintenance of Records Related to Medicaid Line of Business
Chapter 5000 5000 Reinsurance Policy
Revisions
Revision History

AdSS DDD Only Health Plan Deliverables

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