Gila River Health Care Corporation
Gila River Health Care Corporation
PROVIDER MANUAL
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Arizona Department of Health Services

Division of Behavioral Health Services
PROVIDER MANUAL
Gila River Regional Behavioral Health Authority Edition


Section 3.13 Covered Behavioral Health Services

3.13.1 Introduction
3.13.2 Terms
3.13.3 Procedures
3.13.3-A. Covered services matrix
3.13.3-B. Medicare Part D Prescription Drug Coverage
3.13.3-C. Flex Funds

3.13.4 References
3.13.5 PM Forms
3.13.6 PM Attachments

3.13.1 Introduction
The Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) system of care offers an assortment of covered behavioral health services to meet the individual needs of persons eligible for behavioral health treatment. Covered behavioral health services assist and encourage each person to achieve and maintain the highest possible level of health and self-sufficiency. The type of behavioral health service covered is contingent on each person’s current eligibility status and, for some persons, is based on available funding.

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3.13.2 Terms
Definitions for terms are located online at http://www.azdhs.gov/bhs/definitions/index.php.  The following terms are referenced in this section:

Flex Funds

Medically necessary covered services

3.13.3 Procedures

3.13.3-A. Covered services matrix
PM Attachment 3.13.1, Covered Services Matrix, lists the available covered behavioral health services for T/RBHA enrolled persons and Non-Title XIX/XXI, persons determined to have a Serious Mental Illness. These services must be provided by AHCCCS registered providers or Medicare registered providers.

PM Attachment 3.13.1, Covered Services Matrix is a condensed summary of available behavioral health services and related funding sources. Behavioral health providers may reference the ADHS/DBHS Covered Behavioral Health Services Guide for more detailed information.

3.13.3-B. Medicare Part D Prescription Drug Coverage
Persons eligible for Medicare Part D must access the Medicare Part D prescription drug coverage by enrolling with a Medicare Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug plan (MA-PD).

3.13.3-C. Flex Funds
ADHS/DBHS may allocate a limited amount of grant monies to the T/RBHAs to be utilized as flex funds.

Flex funds may only be used for non-medically necessary goods and/or services that are described in the person’s service plan that cannot be purchased by any other funding source. Furthermore, the member receiving flex funds must meet the population requirements of respective Block Grant from which the funds originated. The good and/or service to be provided using flex funds must be related to one or more of the following outcomes:

  • Success in school, work or other occupation;
  • Living at the person’s own home or with family
  • Development and maintenance of personally satisfying relationships;
  • Prevention or reduction in adverse outcomes; and/or
  • Becoming or remaining a stable and productive member of the community.

Flex funds must not be used for:

  • Inpatient or other covered behavioral health services;
  • The purchase of major medical equipment;
  • The purchase or improvement of land;
  • The purchase, construction or permanent improvement of any building or other facility (with the exception of minor remodeling consistent with this Section); and
  • Any other prohibited activity as detailed in 45 CFR Part 96.135 et seq.

T/RBHAs and/or their subcontracted providers must use flex funds for the direct purchase of goods and/or services and may not provide flex funds as direct cash payments to behavioral health recipients or their families. See the ADHS/DBHS Covered Behavioral Health Services Guide for additional information regarding flex funds and applicable billing limitations.

How are flex funds accessed?
Each T/RBHA may approve flex fund services of up to $1,525 per individual/family per fiscal year. Clinical teams may access flex funds by: contacting the Gila River RBHA Clinical Manager at (602) 528-7136.

Approval of flex fund expenditures are made by a Gila River RBHA Clinical Manager based on available funding and the following criteria:

  • A determination that the requested goods and/or services cannot be purchased by any other funding source; and
  • A determination that the flex fund expenditure is described in the person’s service plan.

T/RBHAs must forward requests for approval of flex fund expenditures exceeding $1,525 per individual/family per fiscal year to flexfund@azdhs.gov using PM Form 3.13.1, SAPT/CMHS Flex Fund Request. All documentation supporting the need and utilization of flex funds including, yet not limited to, original receipts for goods or services purchased, and service plans indicating how the good or service relates to the treatment goals, must be made accessible to the T/RBHA and ADHS for auditing and financial tracking purposes. T/RBHAs must have a written procedure indicating where all supporting documentation is to be stored.

3.13.4 References
The following citations can serve as additional resources for this content area:

3.13.5 Forms

3.13.6 Attachments

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3.13 Covered Services
Last Revised: 12/20/2013
Effective Date: 12/20/2013

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