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	1001D - Program Values and Guiding Principles
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	2001 - Planning Team Members
Chapter 2000 - Support Coordination	2002 - Planning Meetings
Chapter 2000 - Support Coordination	2003 - Planning Documents
Chapter 2000 - Support Coordination	2004 - Service Authorizations
Chapter 2000 - Support Coordination	2005 - Referral and Placement in Services
Chapter 2000 - Support Coordination	2006 - Arizona Long Term Care Non-Users
Chapter 2000 - Support Coordination	2007 - Case Closure
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 - Notification of Network Changes
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	4004C - Policy
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	4004L - Reviewing Member’s Accounts
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 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 Related to the Medicaid Line of Business
Chapter 6000 - Administrative Operations	6002A - Definitions of Incidents and Serious Incidents
Chapter 6000 - Administrative Operations	6002B - Incident Management System Definitions
Chapter 6000 - Administrative Operations	6002C - Reporting Requirements
Chapter 6000 - Administrative Operations	6002D - Members At-Risk if Missing
Chapter 6000 - Administrative Operations	6002E - Incident Reports
Chapter 6000 - Administrative Operations	6002F - Fact Finding
Chapter 6000 - Administrative Operations	6002G - Abuse and Neglect
Chapter 6000 - Administrative Operations	6002H - Referral to Other Investigative Agencies
Chapter 6000 - Administrative Operations	6002I - Incident Closure and Corrective Actions
Chapter 6000 - Administrative Operations	6002J - Trending For Quality Improvement
Chapter 6000 - Administrative Operations	6002K - Information Sharing
Chapter 6000 - Administrative Operations	6002L - Mortality Review Audits
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	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 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	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 - Monitoring Controlled and Non-Controlled Medication Utilization
Chapter 300 Medical Policy for Acute Services	310H - Health Risk Assessment and Screening Tests
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-P - Serious Mental IIlness Eligibility Determination
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	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
Chapter 400 Medical Policy for Maternal and Child Health	430 - Early Periodic Screening, Diagnostic and Treatment Services
Chapter 400 Medical Policy for Maternal and Child Health	431 - Oral Health Care (EPSDT-Age Members)
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 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 - Utilization Management Overview
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	950 - Credentialing and Recredentialing Processes
Chapter 900 - Quality Management / Performance Improvement Program	960 - Tracking and Trending of Member and Provider Issues
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	1030 - Reporting Requirements
Chapter 1000 Medical Management	1040 - Outreach, Engagement, Re-Engagement and Closure 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 Centers
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 - Components of Support Coordination
Chapter 1600 Case Management	1620G - Behavioral Health Standards
Chapter 1600 Case Management	1630 - Administrative Standards
Chapter 1600 Case Management	1640 - Targeted 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	200D - Consent for Application for Services
Chapter 200	200E - Responsible Person and Application
Chapter 200	200F - Cooperation with Arizona Long Term Care System Eligibility Process
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 300	Referral Procedures
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
Chapter 1001	Inventory for Client and Agency Planning
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, Diagnosis and Treatment
Chapter 7	Dental
Chapter 8	Family Planning
Chapter 9	PCP Assignments
Chapter 10	Referrals to Specialists
Chapter 11	ALTCS 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	Formulary Information
Chapter 23	Appointment Standards
Chapter 24	Americans with Disabilities Act
Chapter 25	Enrollment Verification
Chapter 26	Cultural Competency
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	Change of Contractor
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	Responsible Person/Caregiver Participation in Therapy Sessions
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 45	After Hours Telephone Survey
Chapter 46	Agency With Choice
Chapter 47	Managing Vendor Call Lists, Provider Directories, Scope of Services and Reporting
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	Provider Notifications
Chapter 61	HCBS Certification and Registration
Chapter 62	Qualified Vendor Management of Gaps in Critical Services
Chapter 63	Workforce Development
Appendix A	QV Provider Instructions – Agency with Choice Option
Appendix B	DDD Agency with Choice User Guide – Focus Vendor
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 300	310-B 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 Supplies, Durable Medical Equipment, and Prosthetic Devices (Acute Care Services)
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 Monitoring Controlled and Non-controlled Medication Utilization
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 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 Applied Behavior Analysis
Chapter 300	320-U Pre-petition Screening, Court Ordered Evaluation and Court Ordered Treatment
Chapter 300	320-V Behavioral Health Residential Facilities
Chapter 400	Medical Policy for Maternal and Child Health
Chapter 400	410 Maternity Care Services
Chapter 400	420 Family Planning
Chapter 400	430 Early Periodic Screening, Diagnosis and Treatment Services
Chapter 400	431 Oral Health Care (EPSDT-Age Members)
Chapter 400	450 Out-of-State Placements for Children or young Adults for 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	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 Administrative Requirements
Chapter 900	920 Quality Management/Performance Improvement (QM/PI) Program Scope
Chapter 900	930 Reserved
Chapter 900	940 Medical Records and Communication of Clinical Information
Chapter 900	950 Credentialing and Recredentialing Processes
Chapter 900	960 Tracking and Trending of Member and Provider Issues
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	1050 Coordination of Care with Other Government Entities for Behavioral Health Services
Chapter 1000	1060 Training Requirements for Behavioral Health Providers
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 Notices of Adverse Benefit Determination and Notices of Extension for Service Authorizations
Chapter 400	415 Provider Network Development and Management Plan: Periodic Network Reporting Requirements
Chapter 400	416 Provider Information
Chapter 400	417 Appointment Availability, 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
Revisions	Revision History

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