Section
3.19 Special Populations
3.19.1
Introduction
3.19.2 References
3.19.3 Scope
3.19.4 Did you know…?
3.19.5 Objectives
3.19.6 Overview
3.19.7 Procedures
3.19.7-A. SAPT Block Grant
3.19.7-B. PATH Grant
3.19.7-C. COOL Program
3.19.1
Introduction
ADHS/DBHS receives Federal Block Grant and State appropriations
to deliver behavioral health services to special populations in
addition to Federal Medicaid (Title XIX) and the State Children’s
Health Insurance Program (Title XXI) funding. This funding is awarded
by Federal agencies and/or appropriated by the Arizona State Legislature
and made available to ADHS/DBHS. ADHS/DBHS then provides financial
assistance to each Regional Behavioral Health Authority (RBHA)*
to ensure the delivery of covered behavioral health services in
accordance with the requirements of the fund source.
This section
is intended to present an overview of the major Federal Block Grants
and other State programs that provide ADHS/DBHS and the public behavioral
health system with funding to deliver services to persons who may
otherwise not be eligible for covered behavioral health services.
It is important for behavioral health providers to be aware of:
- Who is eligible
and prioritized to receive services under these fund sources;
- What services
are available through each fund source; and
- How covered
services must be delivered as a condition of the grant or program.
3.19.2
References
The following citations can serve as additional resources for this
content area:
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3.19.3
Scope
To whom does this apply?
Persons who
are eligible to receive behavioral health services through the Substance
Abuse Prevention and Treatment Performance Partnership (SAPT) Block
Grant, the Projects for Assistance in Transition from Homelessness
(PATH) Program and the Correctional Officer/Offender Liaison (COOL)
Program.
3.19.4
Did you know?
SAPT Block Grant
- ADHS/DBHS
is the designated single state agency in Arizona to administer
the SAPT Block Grant. Each RBHA and the Gila River Healthcare
Corporation (TRBHA) is allotted a set dollar amount by ADHS/DBHS
to provide behavioral health services to the identified populations
covered under the grant.
- Pregnant
women and women (including teenagers) with children and their
families receive the highest service priority under the SAPT Block
Grant.
- T/RBHAs
are required to develop, expand and enhance a continuum of specialized
care for pregnant women and women with young children up to the
full annual grant award for substance abuse treatment services.
- The ADHS/DBHS
Bureau for Substance Abuse Treatment and Prevention Services maintains
a library of scientifically sound outreach strategies for injection
drug abusing populations that can be used to develop local programs.
- ADHS/DBHS
provides technical assistance and free access to HIV test kits
and specimen processing to support local implementation of HIV
services. Contact the ADHS/DBHS Bureau for Substance Abuse Treatment
and Prevention Services at (602) 364-4630.
- HIV drop-in
centers provide outreach and on-site HIV risk assessment, testing
and counseling services in Maricopa and Pima Counties. Outreach
sites include community alcohol/drug treatment centers, clinics
serving seriously mentally ill adults and other community agencies
such as jails and homeless shelters.
PATH Program
- PATH funds
are dedicated to outreach for persons who are homeless and potentially
have a serious mental illness.
COOL Program
- Every RBHA
has at least one Correctional Officer/Offender Liaison (COOL)
staff member who serves as the single point of contact to coordinate
referrals and treatment between parole officers and behavioral
health providers.
- In Maricopa
County, the Community Transition Specialist Program was initiated
to help coordinate housing and transition services for homeless
offenders participating in the COOL Program. Up to 20 persons
at a time are subsidized for short-term transitional housing in
apartment units.
- In addition
to case file reviews conducted by the RBHA for monitoring purposes,
ADHS/DBHS conducts random case file reviews at least annually
to ensure that the expectations of the COOL Program are met.
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3.19.5
Objectives
To ensure that behavioral health providers are aware of:
- Specific
Federal grants and State programs within the ADHS/DBHS public
behavioral health system;
- Special
populations and prioritized populations covered under each Federal
grant and State program; and
- Responsibilities
for delivering covered behavioral health services to the identified
special populations.
3.19.6
Overview
Substance Abuse Prevention and Treatment Performance
Partnership (SAPT) Block Grant
The SAPT Block Grant is an annual formula grant provided to the
states authorized by the United States Congress to support a national
system of substance abuse treatment and prevention programs and
services. The Block Grant supports primary prevention and treatment
services for priority substance abuse populations and others through
an annual allocation to Arizona. The SAPT Block Grant is used to
plan, implement and evaluate activities to prevent and treat substance
abuse and provide certain interventions for HIV and tuberculosis
disease in high-risk substance abusers.
Projects
for Assistance in Transition from Homelessness (PATH) Program
The Center for Mental Health Services (CMHS) of the Substance Abuse
and Mental Health Services Administration (SAMHSA) awards PATH grants
each fiscal year to all states that apply for funding. In Arizona,
the awards are granted to ADHS/DBHS, which subcontracts with behavioral
health providers who specialize in homeless outreach. ADHS/DBHS
currently contracts directly with Southwest Behavioral Health Services
to provide PATH services in Maricopa County. Northern Arizona Regional
Behavioral Health Authority (NARBHA) and Community Partnership of
Southern Arizona (CPSA) receive and administer PATH funding for
their respective geographic service areas.
Homeless outreach
services are interventions designed to assist individuals who are
homeless and potentially have a serious mental illness. The services
are to be provided in locations where persons who are homeless gather,
such as food banks, parks, vacant buildings and the streets. ADHS/DBHS
utilizes the PATH Formula Grant to provide an array of services
to persons who are homeless and are determined to have a serious
mental illness, including those with co-occurring substance abuse
problems.
Correctional
Officer/Offender Liaison (COOL) Program
The Correctional Officer/Offender Liaison (COOL) Program was established
in 1998 to better serve the substance abuse treatment and behavioral
health service needs of high-risk offenders on adult parole. Services
are provided through an Interagency Services Agreement between the
Arizona Department of Corrections and the Arizona Department of
Health Services to ensure expedited treatment and increased coordination
for persons transitioning from incarceration to community supervision.
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3.19.7
Procedures
3.19.7-A.
SAPT Block Grant
Who is covered and what populations are prioritized?
- SAPT Block
Grant funds are used to ensure access to treatment and long-term
recovery support services for:
- Pregnant
women/teenagers who use substances;
- Persons
who use drugs by injection; and
- Women and
teenagers with young (dependent) children and their families,
including women who are attempting to regain custody of their
children.
Do behavioral
health recipients have a choice of substance abuse providers?
Persons receiving substance abuse treatment services under the SAPT
Block Grant have the right to receive services from a provider to
whose religious character they do not object. Behavioral health
subcontractors providing substance abuse services under the SAPT
Block Grant must notify persons of this right using PM
Attachment 3.19.1. Providers must indicate that the
person has received notice in the person’s comprehensive clinical
record.
If a person
objects to the religious character of a behavioral health provider,
the provider must refer the person to an alternative provider within
7 days, or earlier when clinically indicated, after the date of
the objection. Upon making such a referral, providers must notify
the RBHA of the referral and ensure that the person makes contact
with the alternative provider. Providers within the Gila River RBHA
network should notify the assigned Gila River RBHA Clinician by
phone or in writing of any case involving a person objecting to
the religious character of a behavioral health provider prior to
making a referral to an alternative provider. The Gila River RBHA
Clinician will provide assistance in identifying an alternative
provider.
What services
must be made available to SAPT Block Grant special populations?
The following services must be made available to SAPT Block Grant
special populations:
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Specialty
Programs/Services for Women and Children
Behavioral health providers must provide specialized treatment and
recovery support services for women who are pregnant or have young
children and their families, including women and teenage mothers
who are attempting to regain custody of their children. Services
must treat the family as a unit and admit both women and their children
into treatment. The following services are provided at the treatment
site:
- Delivery
or referral for primary medical care for women;
- Delivery
or referral for primary pediatric care for children;
- Gender specific
substance abuse treatment;
- Therapeutic
interventions for children;
- Child care;
- Case management;
and
- Transportation.
The Gila River
RBHA contracts with two substance abuse residential treatment programs
that specialize in providing substance abuse treatment to Native
American youth and adults. Both programs have the capacity to serve
both RBHA enrolled members as well as their minor children. Primary
medical care is provided through Indian Health Services (IHS).
Interim
Services for Pregnant Women/Injection Drug Abuse (Non-Title XIX/XXI
only)
Interim services are available for Non-Title XIX/XXI priority populations
who are maintained on an actively managed wait list. Title XIX/XXI
eligible persons who also meet a priority population type may not
be placed on a wait list (see Section
3.2, Appointment Standards and Timeliness of Service).
The minimum required interim services include:
- Education
on risks of HIV transmission and the effects of substances on
the fetus;
- Risk assessment;
- Referrals
for HIV and tuberculosis screening and services; and
- Referrals
for primary and prenatal medical care.
HIV Early
Intervention Services
RBHAs, and Tribal RBHAs that receive SAPT Block Grant funding, must
establish services for HIV risk assessment, pre- and post-test counseling,
testing, case management and other supportive services at the site
where individuals receive covered services for drug/alcohol abuse
disorders. HIV risk assessment is included as part of the comprehensive
assessment process conduced by the Gila River RBHA Intake Coordinator.
HIV testing, pre-post testing counseling and specialty case management
services are available to Gila River RBHA enrolled members through
a RBHA Clinician who has been trained by the Arizona Department
of Health Services, Office of HIV/AIDS Prevention Program.
Considerations
when delivering services to SAPT Block Grant populations
SAPT Block Grant services must be designed to support the long-term
recovery needs of eligible persons. Specific requirements apply
regarding preferential access to services and the timeliness of
responding to a person’s identified needs (see Section 3.2,
Appointment Standards and Timeliness of Service for requirements).
Behavioral health providers must also submit specific data elements
to identify special populations and record limited clinical information
(see Section 7.5, Enrollment, Disenrollment and Other Data Submission
for requirements).
Limitations
SAPT Block Grant funds may be used to support all covered behavioral
health services listed in the ADHS/DBHS Covered Behavioral Health
Services Guide with the following limitations:
- Grant funds
may not be used to make cash payments to recipients of services
(Flex Funds).
- Grant funds
may not be used to provide covered services in penal or correctional
facilities.
- Grant funds
may not be used to provide inpatient hospital services.
Grant funds
may be used to provide short-term/emergency housing support services
(Supported Housing) for enrolled persons. All other expenditures
for long-term housing must be delivered in an OBHL licensed setting
where persons also receive covered substance abuse services.
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3.19.7-B:
PATH Grant
This section is not applicable to behavioral health providers
contracting exclusively with a Tribal RBHA.
Who is covered
and what populations are prioritized?
The PATH Grant provides funds for services to persons or families
who:
- Are homeless
or at imminent risk of becoming homeless; and
- Are suffering
from serious mental illness; or
- Have a substance
abuse disorder and are suffering from a serious mental illness.
Currently,
services are prioritized for:
- Homeless
persons determined to have a serious mental illness who also have
substance abuse issues;
- Persons
involved in domestic violence cases, especially when there is
a mental health or substance abuse problem;
- Homeless
women with children; and
- Elderly
homeless persons who have substance abuse dependency issues.
What services
are available to PATH Grant special populations?
The PATH Grant provides the following services and assistance:
- Outreach
and community education;
- Field assessment
and evaluations;
- Intake assistance/emergent
and non-emergent triage;
- Transition
assistance;
- Hotel vouchers
in emergency situations;
- Assistance
in meeting basic needs (e.g., applications for AHCCCS, SSI/SSDI,
food stamps; coordination of health care; etc.);
- Transition
into a behavioral health case management system;
- Assistance
in getting prescriptions filled;
- Moving assistance;
and
- Housing
referrals, both transitional and permanent placements.
PATH grant services
are provided through selected behavioral health providers that have
contracted with ADHS/DBHS or a RBHA designated to receive PATH funding.
To initiate a referral for PATH services, behavioral health providers
may contact:
- In Maricopa
County: Southwest Behavioral Health Services at (602) 257-9339;
- In Pima
County: La Frontera Center at (520) 884-9920; or
- In the NARBHA
region: Mohave Mental Health Clinic at (928) 757-8111.
PATH Grant
reporting requirements
This section is only applicable to behavioral health providers designated
to deliver PATH Grant services.
All designated PATH providers are responsible to submit the following
reports to ADHS/DBHS:
- Quarterly
reports that include the number of individuals receiving PATH
services (see PM Form 3.19.1). The report is to be submitted to
ADHS/DBHS on the 15th day of the month following the last reporting
quarter.
- Annual reports,
including a narrative and statistical report to ADHS/DBHS. The
annual report is due on February 1st of each year. This report
includes programmatic and cost data that identifies:
- The number
of individuals served (determined by established demographics);
and
- A comprehensive
written narrative outlining accomplishments and progress towards
meeting program goals.
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3.19.7-C:
COOL Program
Who is covered?
Persons in the COOL Program are:
- Adult adjudicated
parolees with substance abuse issues;
- Persons who
have not been determined to have a serious mental illness;
- Persons who
have been referred to the program by an assigned community supervision
(parole) officer; and
- Persons
who have yet to complete court mandated community supervision.
What services
are available to COOL Program populations?
Behavioral health services available to persons through the COOL
Program are inclusive of the comprehensive array of covered behavioral
health services detailed in Section 3.13, Covered Behavioral Health
Services and the ADHS/DBHS Covered Behavioral Health Services Guide.
For persons
on parole who are not Title XIX/XXI eligible, behavioral health
services are provided to the extent of available funding (see Section
3.4, Co-payments and Section 3.21, Service Prioritization for Non-Title
XIX/XXI Funding).
Screening
for Title XIX/XXI eligibility and applying for AHCCCS Health Insurance
Because Arizona Department of Corrections offenders are ineligible
to receive Title XIX/XXI benefits while incarcerated, behavioral
health providers must screen these persons for Title XIX/XXI eligibility
and, as indicated, apply for AHCCCS Health Insurance during the
intake process (see Section 3.1, Accessing and Interpreting Eligibility
and Enrollment Information and Screening and Applying for AHCCCS
Health Insurance).
Timeliness
of request for services
Persons receiving services through the COOL Program need timely
access to necessary behavioral health services. Special requirements
exist regarding the responsiveness to a referral initiated under
the COOL Program and when a first treatment service must be delivered
(See Section 3.2, Appointment Standards and Timeliness of Service
for requirements).
Notification
to parole officer
Behavioral health providers processing referrals through the COOL
Program must provide written notice to parole officers within 24
hours of acceptance or rejection of the initial request for services
(see Section 3.3, Referral Process for additional details).
Behavioral health
providers must notify a person’s community supervision (parole)
officer within 48 hours of the following:
- Person missing/no
show for intake appointment;
- Person refusing
services;
- Upon failure
to contact the person to initiate services, after a minimum of
one contact attempt; and
- Person not
adhering to treatment recommendations (leaving the program against
the advice of staff or failure to participate in behavioral health
services).
Vocational
services
Many persons receiving services under the COOL Program are unemployed
and would benefit from job development services. In Maricopa and
Pima Counties, the Arizona Department of Corrections employs job
developers; therefore, the community supervision (parole) officer
must be notified before a behavioral health provider offers supportive
employment services to a person involved with the COOL Program in
these counties. All other behavioral health providers in the remaining
geographic service areas must provide supportive employment services
to persons who would benefit from the service.
Demographic
and Clinical Data Submission
Behavioral health providers must submit specific data elements to
identify COOL Program persons (see Section 7.5, Enrollment, Disenrollment
and Other Data Submission for requirements).
Exiting
the COOL Program
Persons are closed from the COOL Program when community supervision
is completed. Behavioral health providers must submit changes in
required demographic data per Section 7.5, Enrollment, Disenrollment
and Other Data Submission. RBHA enrollment must continue for persons
who are Title XIX/XXI eligible and still need behavioral health
services. For Non-Title XIX/XXI persons, the continuation of services
is contingent on available funding. (See Section 3.21, Service Prioritization
for Non-Title XIX/XXI Funding.)
Reporting
Requirements
Offender attendance verification reports must be submitted to the
community supervision (parole) officer every month. The reports
include the type of service, date of service and whether or not
the person attended the service.
* In most
cases, Tribal RBHAs do not receive financial allotments for the
grants and programs identified in this section. An exception is
Gila River Healthcare Corporation that does receive SAPT Block Grant
monies from ADHS/DBHS.
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3.19
Special Populations
Last Revised: 09/03/2004
Effective Date: 10/15/2004
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