Behavioral Health Services Budget Updates

Frequently Asked Questions

Frequently Asked Questions – August 13, 2010

Q: Regarding NT19 members who go into the hospital, how will the doctors know they are there without having Case Managers? What about the Coordination of Care while they are in the hospital?
A: The RBHAs are notified when any RBHA-enrolled member is admitted to an inpatient setting. Utilization Review and discharge planning begins immediately and will include notification of the outpatient clinic either by the RBHA and/or by the hospital social worker. The outpatient clinic, including medical staff, nursing staff or other "extension" staff will continue to coordinate discharge planning with the hospital. Such coordination of care activities are encounterable services. For individuals admitted to the State Hospital, the RBHA is always actively involved prior to the admission and has a Liaison who stays involved throughout the stay.

Q: Will any of the benefit changes that AHCCCS has announced affect behavioral health services?
A: The State (AHCCCS) recently announced changes to covered services for adults related to physical health care. While most of these service changes do not impact behavioral health care, non emergency medical transportation for certain adult populations may be limited if approved by the federal government. Visit the AHCCCS website for more information.

Frequently Asked Questions – July 30, 2010

Q: If a NT19 person needs to take the name brand medication and has other insurance coverage, is Magellan approved to subscribe a 90 day supply for a mail in pharmacy to decrease the co-pay from 3 to 2 for the consumer?
A: The number of days prescribed is at the discretion of the provider since there may be safety concerns with prescribing greater than 30 day supply of medications.

Frequently Asked Questions – July 28, 2010

Q: What will happen to resources for non-US citizens?
A: Some non-US citizens have lawful presence in the U.S., certain categories are eligible for benefits--we have Guidance documents and lists of eligible categories to assist RBHAs and providers in verifying US Citizenship, lawful predocumentation of lawful presence in the U.S. are ineligible for the non-TXIX SMI medication benefit. The SAPT Block Grant does not require citizenship verification and emergency services are provided to anyone needing such assistance.

Q: Is there in fact any funding currently available for the "up to 72 hours of additional crisis stabilization?"
A: The amount of services paid for above minimum requirements as outlined in the guidelines will depend on the funding available. These decisions will be based on, among other things, the number of persons presenting for services.

Q: If the member is SMI, non19 and picks up his medications, what is the time frame within which the copay should be paid?
A: If the person will be paying the $3 ADHS/DBHS co-payment, he/she will pay at the time of the psychiatric assessment or psychiatric follow-up appointment. In this case, no co-pay will be collected at the pharmacy. If the person has a co-payment for his/her medication that is less than the ADHS/DBHS co-payment, he/she will pay the TPL co-payment at the pharmacy.

Frequently Asked Questions – July 9, 2010

Q: Is there a directory of low cost behavioral health services?
A: Please see our Community Resources webpage /bhs/updates/CommunityResources.htm where you will find links to Arizona Community Health Centers that offer reduced cost behavioral health services. In this webpage you will also find links to community organizations offering a variety of services at reduced cost and the RBHA's resources listings for the behavioral health consumer.

Frequently Asked Questions – July 2, 2010

Q: What if there is no generic version of the brand name medication I am taking? What if the generic medication is known not to work on the individual, from past experience?
A: Unfortunately at this time for NT19 members the only medication available is the generic medication listed on the Non-Title XIX/XXI Medication Formulary

Q: What is going to happen with the Coordination of Care between the sites, the Dr., and the pharmacy, because if the member does not have a CM, who will be doing all of the follow-through for things like getting meds filled, etc…?
A: The BHMP is the primary responsible party for coordination of care but she/he will be assisted by a nurse at the direct care clinics.

Q: What about those NT19 members who go into the hospital? How will the doctors know they are there without having CMs? What about the Coordination of Care while they are in the hospital?
A: The T/RBHA will work with the Arizona State Hospital to identify individuals who are Tx19 and nonTx19/SMI. The Inpatient Units will still coordinate with the T/RBHA for discharge planning for Non-19/SMI members. During this planning process members will receive assistance setting up appointments and discussing the limited medication benefit.

Frequently Asked Questions – June 18, 2010

Q: Can NT19 SMI clients, who are willing to pay for their services out of pocket, continue to receive those services (i.e. attend counseling and group therapy if the person is willing to pay for these services)?
A: YES, non-TXIX members who wish to pay out of pocket for services may do so. However, they will need to make arrangements with a provider who is willing and able to accommodate such a request.

Q: Is there ANY type of transportation that will be available for NT19 members after July 1? What about transportation for those NT19 members who live outside of the bus lines?
A: No. Beginning July 1st, 2010 the benefit for NT19 members is limited to the medication only benefit. Transportation will no longer be available.

Frequently Asked Questions – June 11, 2010

Q: Does the passage of Proposition 100 mean that the reductions to my benefits will not go into effect July 1st?
A: No. The benefit changes to the behavioral health system are based on the successful passage of Proposition 100. Had Proposition 100 not passed, the behavioral health system would have seen additional budget cuts resulting in additional service/benefits reductions.

Q: Can family members be trained to "play the role" of case managers?
A: A statewide training is available (developed by Magellan RBHA) to help train family members or other interested community members to navigate the system and advocate on behalf of their friends or loved ones with behavioral health challenges. See the DBHS' Community Resources site for this type of information as it becomes available: /bhs/updates/CommunityResources.htm

Q: Can a RBHA or provider terminate services to members before July 1, 2010, that will no longer be covered after July 1, 2010?
A: Services may not be reduced or discontinued before July 1, 2010 because they will not be covered after July 1, 2010 unless clinically necessary to safely and responsibly transition the individual to the reduced benefit package by the July 1, 2010 effective date.

Frequently Asked Questions – June 4, 2010

Q: How do I know if I qualify for VA health care benefits?
A: There are many ways that a Veteran may qualify to receive top-notch VA health care at over 1,400 medical centers and clinics across the nation. To read about eligibility visit http://www4.va.gov/healtheligibility/

Q: How do I apply for enrollment with the VA health care system?
A: Veterans can apply for enrollment in the VA health care system by completing VA Form 10-10EZ, Application for Health Benefits. The application form can be obtained by visiting, calling or writing any VA health care facility or Veterans' benefits office. Forms can also be requested toll-free from VA's Health Benefits Service Center at 1-877-222-VETS (8387). For enrollment details visit http://www4.va.gov/healtheligibility/application/

Q: How can I verify my enrollment with the VA health care system?
A: To verify your enrollment, call the VA toll-free at 1-877-222-VETS (8387) to get the facility's telephone number.

Q: What is a VA service-connected rating, and how do I establish one?
A: A service-connected rating is an official ruling by VA Regional Office that your illness or condition is directly related to your active military service. VA Regional Offices are also responsible for administering educational benefits, vocational rehabilitation and other benefit programs, including home loans. To obtain more information or to apply for any of these benefits, contact your nearest VA Regional Office at 1-800-827-1000 or visit us online at www.va.gov.
For more VA health care-related questions and answers, visit http://www4.va.gov/healtheligibility/library/pubs/healthcareoverview/#EnrollmentFAQs

Q: Will the RBHAs send us a letter that tells us specifically who to contact and where to call before July 1, 2010?
A: Yes, the RBHAs will be sending a letter out to every non-Title 19 recipient to officially inform them of this change. However, between now and July 1, 2010 you should be working closely with your clinical team to help develop a self-directed plan for where you'll be able to access services after June 30. You should still contact your clinic, even after July 1, 2010, if you have any questions. Reception staff or others will always be available to you during regular clinic hours, and you should still plan to be going to the clinic to meet with your doctor, get prescriptions and possibly have lab work done, if needed.

Q: If I have private insurance, am I definitely not Title 19?
A: It is possible to have private insurance and be Title 19, but every situation is different, so please check with your clinic or case manager as soon as possible to find out if you're Title 19 or not, if you're unsure.

Clinic Contact Information can be found at the following:

Maricopa County - www.MagellanofAZ.com/directory
Gila, Pinal, Yuma and La Paz Counties - www.cenpaticoaz.com/find-provider
Pima, Cochise, Graham, Greenlee, and Santa Cruz Counties - w3.cpsa-rbha.org/static/index.cfm?contentID=13
Coconino, Navajo, Yavapai, Apache and Mohave Counties - www.narbha.org/services/listings/

Q: How do you know if you are on a Medicare Part D program?
A: Please contact your clinic for help in determining what benefits are available to you, including what Medicare program you're currently enrolled in. See "Clinic Contact Information" above.

Q: If I'm non-Title 19 and am experiencing a mental/behavioral health crisis, what do I do? Who do I call?
A: If you're in a behavioral health crisis and need help, please call the appropriate crisis line:
Suicide/Crisis Hotlines by County:

1-800-631-1314 and 602-222-9444 (Maricopa County)
1-800-796-6762 or 520-622-6000 (Pima County)
1-800-586-9161 (Graham, Greenlee, Cochise and Santa Cruz Counties)
1-800-259-3449 (Gila River and Ak-Chin Indian Communities)
1-866-495-6735 (Yuma, La Paz, Pinal and Gila Counties)
1-877-756-4090 (Mohave, Coconino, Apache, Navajo and Yavapai Counties)

The crisis lines are available for both Title 19 and non-Title 19 recipients and staff are ready to take your call 24 hours per day, seven days a week. For emergencies, always dial 911.

Q: Who will pay for crisis hospitalization? What if my symptoms increase and I have to be hospitalized?
A: Inpatient treatment is no longer an available service for non-Title 19 individuals, meaning the state (through RBHAs) will no longer pay for hospitalization. However, that does not mean you can't go to a hospital or emergency room to receive care, but you will need to arrange for an alternative means of payment, including private insurance, Medicare, out-of-pocket payment or another means as is available to you. Many hospitals will work with you to help determine the best means for you to pay for services.

Q: Are the RBHAs, providers and/or ADHS/DBHS going to evaluate this new service package and what effect it is having on people after July 1, 2010?
A: Yes, the RBHAs, providers and ADHS/DBHS will be monitoring the system and services available for non-Title 19 individuals to be able to judge this new system's effectiveness and develop strategies and recommendations for improvement.

Q: Is this service change permanent or temporary?
A: The Arizona Legislature felt this change was necessary due to the state's incredible fiscal crisis. In order to reinstate services back to their original level, the legislature would need to allocate more funding back into the behavioral health system once the economy improves and more funding is available. Whether or not they will do that is unknown at this time.

Q: What does it mean that a non-Title 19 individual would receive medication management?
A: To receive medication management means that beginning July 1, 2010, a non-Title 19 recipient will only have access to generic prescription medication, necessary lab tests and doctor visits as part of his or her medication benefit. See /bhs/updates/budgetGuidelines.htm

Q: What will happen to the members that may be in the appeal process with AHCCCS when the July 1, 2010 deadline passes?
A: Effective July 1, 2010, all individuals who are not Title 19 will have only limited services available to them, including medication management and crisis services. If an individual becomes Title 19 (enrolled in AHCCCS) after July 1, 2010, they will have access to all the services that were available to everyone before July 1, 2010.

Frequently Asked Questions – May 3, 2010

Q: What services are Non Title 19 members eligible to receive?
A: If you are an adult with a serious mental illness (SMI), you will be able to receive generic only medications and support services related to the medication benefit, such as appointments with doctors and nurses, lab work and translation services. You would be responsible for costs for any other services.

There was a rumor going around that if you're Non Title 19, you'll only get to see a doctor once a year. This is not true; the medication benefit will allow for medical management appointments as clinically appropriate.

If you are Non Title 19 and not found to have a SMI, you are not eligible for services. You would be responsible for costs for any services. Crisis services are available for any person presenting with a behavioral health crisis, regardless of Medicaid eligibility or enrollment status.

Q: Will I be able to appeal cuts to services that are no longer paid for by the State due to budget cuts?
A: No. There are no appeal rights when services that are no longer covered (paid for) by the State are terminated or denied.

Q: What will I be able to appeal?
A: You may appeal a decision regarding your SMI eligibility (the decision that you do or don't have a serious mental illness), and decisions regarding services that are covered (paid for) by the State.

Q: Will transportation services be covered for Non Title 19 SMI members? If not, how will those without transportation make their appointments?
A: No, transportation services will not be covered. We encourage those who need transportation assistance to seek alternative community resources, such as a neighbor, friend, or family member. Bus tickets can also be purchased.

Q: What services will be provided to those who are Non Title 19 on Court-Ordered Treatment?
A: Individuals under court-order for treatment are eligible for the limited benefit available to all Non Title 19 members. (See above question: What services are Non Title 19 members eligible to receive?)

Q: How have the Priority Project Teams received community input?
A: The Priority Project Teams received input from various sources including over 30 community forums around the state. These were attended by DBHS staff who shared the feedback they heard from the public. Another source of input was the DBHS Updates Web site, where visitors were encouraged to leave questions, comments, concerns and ideas. All of this information was gathered and sent to the Priority Project Team leads for their review and consideration.

Q. How will DBHS ensure that the RBHAs do not run out of money for crisis services?
A. DBHS will work with the RBHAs to carefully plan and monitor the expenditure of crisis funds throughout the fiscal year in order to ensure that all individuals presenting in crisis are able to access services.

Q. Will Non Title 19 SMI individuals be placed in housing?
A. Non Title 19 SMI members currently residing in housing will be allowed to remain in housing until an alternative placement is identified; however, beginning May 3rd 2010, new housing placements will only be available to Title 19 enrolled individuals.

Q. Where can I find more detailed information on the changes that are occurring as a result of budget cuts?
A. Additional information can be found at the following link Additional Information

Q. What impact will these changes on have on children within the behavioral health system?
A. The majority of the changes pertain only to the adult SMI population. There have been no changes for children who are Title 19 eligible, but children who are non Title 19 are not eligible for services. Crisis services are available for any person presenting with a behavioral health crisis, regardless of Medicaid eligibility or enrollment status. Additional Information

Frequently Asked Questions – April 27, 2010
For those in Maricopa County, please see Magellan's Frequently Asked Questions.
More questions and answers will be posted on April 29, 2010.

Frequently Asked Questions – April 13, 2010

Regarding NTXIX SMI (Non-Title 19 Seriously Mentally Ill)
Q. Are services being cut for adults with a serious mental illness who do not qualify for Medicaid?
A. In response to recent budget cuts, the covered services will be changing for adults with serious mental illness who do not qualify for Medicaid. ADHS/DBHS has established a dedicated project team to research strategies to implement this necessary reduction in covered benefits. The project team, composed of peers, family members and agency representatives, is looking at a variety of options, including a medication only benefit, which would include a generic formulary paired with necessary blood work and appointments with prescribing clinicians. We are also looking at potential options for making some name-brand medications available as well.

Residential services, inpatient hospitalization, supported employment and other support services will be not covered services.

Over the next three weeks, ADHS/DBHS will discuss these options and others with community members, in order to arrive at a benefit package that is responsive to the needs of individuals while taking the limited funding into consideration.

Regarding NTXIX SMI (Non-Title 19 Seriously Mentally Ill): Crisis Services
Q. What crisis services will be cut or restructured?
A. ADHS/DBHS has established a dedicated project team to research strategies to maintain a comprehensive, effective, statewide crisis system while taking the limited funding into consideration. The project team, composed of peers, family members and agency representatives, is looking at a variety of options, including:

Requiring the availability of 24/7 crisis phone lines and crisis mobile teams.
Requiring short-term crisis stabilization, based on available funding.
Including peer support specialists on crisis mobile teams working side-by-side with a behavioral health technician or behavioral health professional.

Over the next three weeks, ADHS/DBHS will discuss these options and others with community members, in order to get their ideas on a crisis system that addresses the safety and stability of individuals in crisis while taking the limited funding into consideration.

Regarding Housing
Q. How will the $5.3 million housing appropriation be prioritized?
A. ADHS/DBHS has established a dedicated project team to research strategies for maximizing the benefits related to supported housing for adults with serious mental illness. The project team, composed of peers, family members and agency representatives, is looking at a variety of options, including:

Safely transitioning adults with a serious mental illness who do not qualify for Medicaid out of state funded programs.

Asking individuals to contribute to the cost of room and board in residential settings based on their ability to pay.

Over the next three weeks, ADHS/DBHS will discuss these options and others with community members, in order to get their ideas on supported housing while taking the limited funding into consideration.

Frequently Asked Questions – April 6, 2010

Q. What is the Difference between "Title 19" and "Non-Title 19"
A. Title 19 refers to funds that are provided for services to persons who qualify for the Arizona Health Care Cost Containment System (referred to as AHCCCS, pronounced "access") benefits. Title 19 is the same as Medicaid. Non-title 19 refers to persons who do not qualify for AHCCCS benefits

Q. What is AHCCCS?
A. The Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid Program. If someone is Title XIX (19), he or she is enrolled in AHCCCS/Medicaid. Title 19, AHCCCS and Medicaid refer to the same program in Arizona.

Q. How do I know if I am eligible for AHCCCS?
A. A. You can apply online for AHCCCS Health Insurance at https://www.healthearizona.org/app/Default.aspx using Health-e-Arizona. You can apply for yourself, your family, or someone close to you. You can also obtain more information about AHCCCS eligibility or apply for AHCCCS benefits by visiting the AHCCCS website at www.azahcccs.gov. Those who do not have access to the web can visit their local DES office. To find a local DES office please call (602) 542-4791.

Q. What is FPL?
A. Federal Poverty Level. The Federal Poverty Level is set by the federal government and is used as a basis for deciding eligibility for programs across the country. Someone is considered below the federal poverty level if they make less than $10,830, as an individual or $22,050 as a family of four.

Regarding Title 19 Benefits and Covered Services:
Q. What services will be available to those who qualify for AHCCCS/Title 19 behavioral health benefits?
Q. What, if any, children's services will be covered?
A. There is no change in services to persons who qualify for AHCCCS.

Regarding Non-Title 19 SMI Benefits:
Q. What services, if any, will be available for Non-Title 19 SMI?
Q. How will medications and supporting services be provided/paid for?
A. We have a team researching this issue. As soon as recommendations for services are developed, we will be sharing those recommendations with the public for review and input.

Q. What is a T/RBHA?
A. Tribal and Regional Behavioral Health Authority. DBHS contracts with T/RBHAs to provide behavioral health services in six designated geographic service areas. See the service area of each T/RBHA

Q. What is SMI?
A. SMI means seriously mentally ill or is often the same as a person with serious mental illness. SMI is a determination made by a T/RBHA based on a person's diagnosis and level of functioning.

Regarding the Crisis System:
Q. What crisis services will be cut or restructured?
A. We have a team researching this issue. As soon as recommendations for services are developed, we will be sharing those recommendations with the public for review and input.

Q. What are the options for a person who is suicidal/homicidal?
A. If you or a loved one are experiencing a crisis please call 1-800-273-TALK (8255). This is the National Suicide Prevention Hotline which will work with someone and find them local assistance and support. Select this link to view a list of crisis phone lines.

Regarding Supportive Housing:
Q. How will subsidized housing for the SMI consumer be affected by the cuts?
A. We have a team researching this issue. As soon as recommendations for services are developed, we will be sharing those recommendations with the public for review and input