Overview of the Arizona Public Behavioral Health
Partnering with Tribal and Regional Behavioral
Tribal and Regional Behavioral Health Authorities
Overview of The T/RBHA
ADHS/DBHS System Principles
Arizona Children’s Principles
Principles for Persons determined to
have a Serious Mental Illness
What is the purpose of the Provider Manual?
Use of Terms
How is the Provider Manual Structured?
When does the Provider Manual go into effect?
Revisions to the Provider Manual
Department of Health Services/Division of Behavioral Health Services
(ADHS/DBHS) presents the ADHS/DBHS Provider Manual. ADHS/DBHS has
developed the statewide provider manual to articulate the requirements
of the behavioral health system. The ADHS/DBHS Provider Manual contains
requirements applicable to direct providers of Arizona’s publicly
funded behavioral health services. Each Tribal and Regional Behavioral
Health Authority (T/RBHA) adds geographic specific area information
and creates a T/RBHA specific version of the document. For hyperlinks
to T/RBHA specific versions of the Provider Manual, go to http://www.azdhs.gov/bhs/provider/index.htm.
Overview of the Arizona Public
Behavioral Health System
- The Arizona
Department of Health Services/Division of Behavioral Health Services
(ADHS/DBHS) administers behavioral health programs and services
for children and adults and their families. ADHS/DBHS is responsible
for administering behavioral health services for several populations
funded through various sources.
- The Arizona
Health Care Cost Containment System (AHCCCS), the state Medicaid
Agency, provides funding to the ADHS/DBHS to administer behavioral
health benefits for persons receiving Title XIX and Title XXI
acute care services.
state law requires ADHS/DBHS to administer community based treatment
services for adults who have been determined to have a serious
- The Substance
Abuse and Mental Health Services Administration (SAMHSA) provides
funding to ADHS/DBHS through two block grants:
Substance Abuse Prevention and Treatment Performance Partnership
(SAPT) Block Grant supports a variety of substance abuse services
in both specialized addiction treatment and more generalized
behavioral health settings, and
- The Community
Mental Health Services Performance Partnership (CMHS) Block
Grant supports Non-Title XIX services to severely emotionally
disturbed (SED) children and
adults determined to have a serious mental illness.
administers other federal, state and locally funded behavioral
Partnering with Tribal and
Regional Behavioral Health Authorities
in partnership with the Tribal and Regional Behavioral Health Authorities
(T/RBHAs), promote collaboration and encourage family centered,
personalized and culturally relevant behavioral health services
that result in positive outcomes for persons. The expected outcomes
include but are not limited to:
- Reduced symptoms
stemming from behavioral health problems; and
quality of life for families and individuals.
Tribal and Regional
Behavioral Health Authorities (T/RBHAs)
with Regional Behavioral Health Authorities (RBHAs) to deliver behavioral
health services to six geographic service areas (GSAs). Each RBHA
must have a network of providers to deliver all covered behavioral
health services. A RBHA may either deliver services directly or
subcontract with behavioral health providers.
ADHS also contracts
with Tribal Regional Behavioral Health Authorities (TRBHAs). The
Tribal RBHAs include Pascua Yaqui Tribe of Arizona, and the Gila
River Indian Community. As of July 1, 2004, the Navajo Nation transitioned
from a Tribal RBHA to a Tribal Contractor providing Medicaid and
state-only services to members of the Navajo Nation through a new
by County and GSA
Partnership of Southern Arizona (CPSA-3)
Graham, Cochise and Santa Cruz
Partnership of Southern Arizona (CPSA-5)
Health of Arizona (Cenpatico-2)
Arizona Regional Behavioral Health Authority (NARBHA)
Coconino, Apache, Navajo and Yavapai
Health of Arizona (Cenpatico-4)
Yaqui Tribe of Arizona
River Indian Community
Overview of T/RBHA
Gila River Regional Behavioral Health Authority (RBHA) provides
comprehensive behavioral health services to Native Americans and
others residing on the Gila River Indian Reservation. The RBHA also
serves members of the Gila River Indian Community who reside off
reservation. The Gila River Indian Community, one of 21 federally
recognized American Indian tribes in Arizona, is located in south-central
Arizona, approximately 35 miles south of Phoenix. Residents of the
community are primarily comprised of two tribes, the Pima (O’odham
Akimel) and Maricopa (Pee Posh).
health services must be delivered in accordance with ADHS/DBHS system
principles. ADHS/DBHS supports a behavioral health delivery system
- Easy access
health recipient and family member involvement;
with the Greater Community;
for improvement; and
competency, including the needs of deaf and hard of hearing.
Access to Care
information is readily available that informs behavioral health
recipients, family members and stakeholders how to access
- The behavioral
health network is organized in a manner that allows for easy
access to behavioral health services; and
are delivered in a manner, location and timeframe that meet
the needs of behavioral health recipients and their families
health recipient and family member involvement
health recipients and family members are active participants
in behavioral health delivery system design, prioritization
of behavioral health resources and planning for and evaluating
the services provided to them; and
health recipients, family members and other parties involved
in the person and family’s lives are central and active
participants in the assessment, service planning and delivery
of behavioral health services and connection to natural supports.
with the Greater Community
including general medical, child welfare, criminal justice,
education and other social service providers are actively
engaged in the planning and delivery of integrated services
to behavioral health recipients and their families;
are fostered with stakeholders to maximize access by behavioral
health recipients and their families to needed resources such
as housing, employment, medical and dental care, and other
community services; and
of behavioral health services collaborate with community stakeholders
to assist behavioral health recipients and family members
in achieving their goals.
health providers are continuously educated in and use best
- The services
system recognizes that substance abuse and other mental health
disorders are inextricably intertwined, and integrated substance
abuse and mental health evaluation and treatment is the community
health recipients and family members (who want to) are provided
training and supervision to become and be retained as providers
of peer support services.
are delivered with the explicit goal of assisting people to
achieve or maintain success, recovery, gainful employment,
success in age-appropriate education, return to or preservation
of adults, children and families in their own homes, avoidance
of delinquency and criminality, self-sufficiency and meaningful
are continuously evaluated, and modified if they are ineffective
in helping to meet these goals; and
health providers instill hope that achievement of goals is
possible even for the most disabled.
competence in health care demonstrates the ability of systems
to provide care to persons with diverse values, beliefs and
behaviors, including tailoring service delivery to meet the
person’s social, cultural, and linguistic needs. As behavioral
health care providers, the goal should be to create a behavioral
health system of care that fits everyone’s needs. To accomplish
this goal, it is necessary to ensure that staff providing services
have the skills to meet the person’s unique family, culture,
traditions, strengths and gender considerations when developing
a person’s individual treatment plan. ADHS/DBHS endorses
the following activities for ensuring a culturally competent
behavioral health system:
Behavioral health service providers are recruited, trained
and evaluated based upon competency in linguistically and
culturally appropriate skill in responding to the individual
needs of each behavioral health recipient and family members;
management reflects cultural diversity in values and in policies;
management and behavioral health service providers strive
to improve through periodic cultural self-assessment and modify
individual services or the system as a whole when applicable.
ADHS/DBHS requires that behavioral health services be delivered
to all children according to the Arizona Children’s Principles:
with the Child and Family
Respect for and active collaboration with the child and parents
is the cornerstone to achieving positive behavioral health outcomes.
Parents and children are treated as partners in the assessment process,
and the planning, delivery, and evaluation of behavioral health
services, and their preferences are taken seriously.
Behavioral health services are designed and implemented to aid children
to achieve success in school, live with their families, avoid delinquency,
and become stable and productive adults. Implementation of the behavioral
health services plan stabilizes the child’s condition and
minimizes safety risks.
When children have multi-agency, multi-system involvement, a joint
assessment is developed and a jointly established behavioral health
service plan is collaboratively implemented. Client-centered teams
plan and deliver services. Each child’s team includes the
child and parents and any foster parents, and any individual important
in the child’s life who is invited to participate by the child
or parents. The team also includes all other persons needed to develop
an effective plan, including, as appropriate, the child’s
teacher, the child’s Child Protective Services and/or Division
of Developmental Disabilities case worker, and the child’s
probation officer. The team (a) develops a common assessment of
the child and family’s strengths and needs, (b) develops an
individualized service plan, (c) monitors implementation of the
plan, and (d) makes adjustments in the plan if it is not succeeding.
Children have access to a comprehensive array of behavioral health
services, sufficient to ensure that they receive the treatment they
need. Case management is provided as needed. Behavioral health service
plans identify transportation that the parents and child need to
access behavioral health services, and how transportation assistance
will be provided. Behavioral health services are adapted or created
when they are needed but not available.
Behavioral health services are provided by competent individuals
who are adequately trained and supervised. Behavioral health services
are delivered in accordance with guidelines adopted by ADHS/DBHS
that incorporate “best practice.” Behavioral health
service plans identify and appropriately address behavioral symptoms
that are reactions to death of a family member, abuse or neglect,
learning disorders, and other similar traumatic or frightening circumstances,
substance abuse problems, the specialized behavioral health needs
of children who are developmentally disabled, maladaptive sexual
behavior, including abusive conduct and risky behavior, and the
need for stability and the need to promote permanency in class members’
lives, especially class members in foster care. Behavioral health
services are continuously evaluated and modified if ineffective
in achieving desired outcomes.
Children are provided behavioral health services in their home and
community to the extent possible. Behavioral health services are
provided in the most integrated setting appropriate to the child’s
needs. When provided in a residential setting, the setting is the
most integrated and most home-like setting that is appropriate to
the child’s needs.
Children identified as needing behavioral health services are assessed
and serviced promptly.
Tailored to the Child and Family
The unique strengths and needs of children and their families dictate
the type, mix, and intensity of behavioral health services provided.
Parents and children are encouraged and assisted to articulate their
own strengths and needs, the goals they are seeking, and what services
they think are required to meet these goals. Services are provided
in the language preferred by the child and family.
Behavioral health service plans strive to minimize multiple placements.
Service plans identify whether a class member is at risk of experiencing
a placement disruption and, if so, identify the steps to be taken
to minimize or eliminate the risk. Behavioral health service plans
anticipate crises that might develop and include specific strategies
and services that will be employed if a crisis develops. In responding
to crises, the behavioral health system uses all appropriate behavioral
health services to help the child remain at home, minimize placement
disruptions, and avoid the inappropriate use of the police and the
criminal justice system. Behavioral health service plans anticipate
and appropriately plan for transitions in children’s lives,
including transitions to new schools and new placements, and transitions
to adult services.
for the Child and Family’s Unique Cultural Heritage
Behavioral health services are provided in a manner that respects
the cultural tradition and heritage of the child and family. Services
are provided in Spanish to children and parents whose primary language
Behavioral health services include support and training for parents
in meeting their child’s behavioral health needs, and support
and training for children in self-management. Behavioral service
plans identify parents’ and children’s need for training
and support to participate as partners in the assessment process,
and in the planning, delivery, and evaluation of services, and provide
that such training and support, including transportation assistance,
advance discussions, and help with understanding written materials,
will be made available.
to Natural Supports
The behavioral health system identifies and appropriately utilizes
natural supports available from the child and parents’ own
network of associates, including friends and neighbors, and from
community organizations, including service and religious organizations.
Principles for Persons determined
to have a Serious Mental Illness
The service delivery system shall operate in accordance with the
following principles for persons who have been determined to have
a serious mental illness and their families:
- Human dignity;
- Respect for
the person’s individuality, abilities, needs, and aspirations
without regard to the client’s psychiatric condition;
freedom of choice and participation in treatment to the individuals
- Freedom from
the discomfort, distress and deprivation which arise from an unresponsive
and inhumane environment;
- Privacy including
the opportunity, wherever possible, to be provided clearly defined
private living, sleeping and personal care spaces;
- Humane and
adequate support and treatment that is responsive to the person’s
needs, that recognizes that a person’s needs may vary, and
that is sufficiently flexible to adjust to a person’s changing
- The opportunity
to receive services which are adequate, appropriate, consistent
with the person’s individual needs, and least restrictive
of the person’s freedom;
- The opportunity
to receive treatment and services that are culturally sensitive
in their structure, process and content;
- The opportunity
to receive services on a voluntary basis to the maximum extent
possible and entirely if possible;
of individuals into their home communities through housing and
residential services which are located in residential neighborhoods,
which rely as much as possible on generic support services to
provide training and assistance in ordinary community experiences,
and which utilize specialized mental health programs that are
situated in or near natural community services;
- The opportunity
to live in one’s own home and the flexibility of a service
system which responds to individual needs by increasing, decreasing
and changing service as needs change;
- The opportunity
to undergo normal experiences, even though such experiences may
entail an element of risk; provided however, that an individual’s
safety or well-being or that of others shall not be unreasonably
- The opportunity
to engage in activities and styles of living, consistent with
the person’s interests, which encourage and maintain the
integration of the individual into the community.
is the purpose of the Provider Manual?
The purpose of the provider manual is to ensure that a consistent
and reliable resource containing all standards and requirements
is readily available and easily accessible to all behavioral health
service providers. The provider manual was designed to assist behavioral
health service providers by serving as a reference for answers to
many frequently asked questions.
An attempt was made to use consistent terminology throughout the
provider manual to the extent possible. Persons An attempt was made
to use consistent terminology throughout the provider manual to
the extent possible. Persons receiving behavioral health services
are referred to as “behavioral health recipients” or
simply as “persons”. The use of the term T/RBHA conveys
both Tribal Regional Behavioral Health Authorities and Regional
Behavioral Health Authorities, though the manual also uses the term
Tribal Regional Behavioral Health Authority when a clearer distinction
is necessary. Some requirements only apply to RBHAs or Tribal RBHAs
and these terms should be interpreted as such when presented in
is the Provider Manual Structured?
The provider manual contains 14 main sections. Eight sections (Sections
3-10) contain policies and procedures delineating the standards
and requirements that must be met when delivering public behavioral
health services in the State of Arizona.
and Care Coordination
Rights and Provider Claims Disputes
Audits and Surveys
section of the provider manual, a standardized format was used to
present and organize the information. Most sections contain the
following topic headers:
Headers within Main Sections and What You Will Find In Each
You Will Find
the specific section number and title. The section number and
title correspond with the Table of Contents.
the content area, provides an overview of the section and describes
the reason for the requirement. The introduction section attempts
to answer the following questions: Why is the standard important?
and, What is the purpose of the requirement?
Identifies sources from where policy content was derived,
including contracts, IGAs, U.S.C., C.F.R., A.R.S., A.A.C., etc.
to whom the standards and requirements in the section apply.
|| A concise
statement that describes the intent of the topic area.
additional information relevant to the topic area. Although
presented in a user-friendly manner, the information described
under this header may be either directive or suggestive based
on how it is presented.
|| A list
of key words associated with the topic areas. All definitions
presented in the manual are consolidated in Section 11, “Definitions”.
|| Step by
step instructions for implementing the topic area.
does the Provider Manual go into effect?
- The provider
manual became effective on January 1, 2004. Each T/RBHA has incorporated
geographic specific information (e.g., crisis telephone numbers)
and T/RBHA specific requirements into the provider manual.
to the Provider Manual
The provider manual is updated on an ongoing basis, but at a minimum,
content will be reviewed every two years. Behavioral health providers
and others may provide comments and request for revisions to the
provider manual. Behavioral health providers and other interested
persons should contact: the Gila River RBHA Network Manager at
T/RBHAs must ensure
that the ADHS/DBHS Policy Office is included in communication to
providers when T/RBHA editions of the Provider Manual have been
updated. In addition, current versions of T/RBHA Provider Manual
policies must be posted to the T/RBHA website (including policies
added to Section 10.0). T/RBHAs and T/RBHA providers must not
remove ADHS/DBHS Provider Manual Template language without the
prior approval of the ADHS/DBHS Policy Office.
ADHS/DBHS review and approve all policies pertaining to Title XIX
and Title XXI eligible persons. As such, any policies developed by
the T/RBHA that establishes requirements for the provision of
behavioral health services must be submitted to the ADHS/DBHS
Policy Office prior to implementation.
Last Revised: 04/19/2007
Effective Date: 08/15/2007