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 to receive services through these funding sources;
- How the funds are prioritized; and
- What services are available through each funding source.
3.19.2
References
The following citations can serve as additional resources for this
content area:
-
42 USC 290cc-21 et seq.
(The Stewart B. McKinney Homeless Assistance Amendments Act of
1990)
- 42
USC 300x-21 et seq.
(The Children’s Health Act of 2000)
- 42
CFR Part 54 Charitable Choice Provisions and Regulations
-
45 CFR Part 96 SAPT Block Grant Final Rules
-
A.R.S. §36-141
-
ADHS/RBHA Contract
- ADHS/Gila
River Health Care Corporation Intergovernmental Agreement
-
ADHS/DBHS Behavioral Health Covered Services Guide
-
ADHS/DBHS Prevention Framework for Behavioral Health
-
Section 3.1, Eligibility Screening for AHCCCS Health Insurance,
Medicare Part D Prescription Drug Coverage and the Limited
Income Subsidy Program (LIS)
-
Section 3.2, Appointment Standards and Timeliness of Service
-
Section 3.3, Referral Process
-
Section 3.4, Co-payments
-
Section 3.8, Outreach, Engagement, Re-engagement and Closure
-
Section 3.9, Assessment and Service Planning
-
Section 3.13, Covered Behavioral Health Services
-
Section 3.21, Service Prioritization for Non-Title XIX/XXI
Funding
-
Section 4.4, Coordination of Care with Other Governmental
Entities
-
Section 6.1, Submitting Tribal Fee-for-Service Claims to AHCCCS
-
Section 6.2, Submitting Claims and Encounters to the RBHA
-
Section 7.5, Enrollment, Disenrollment and Other Data Submission
Although the Tribal RBHAs do not receive financial allotments for the PATH and COOL programs, they do receive SAPT
Block Grant monies from ADHS/DBHS.
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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.
- Females who are pregnant or
have dependent children receive the highest service priority under the SAPT Block Grant.
T/RBHAs with SAPT treatment funds are required to develop, expand and enhance a continuum
of specialized care for pregnant females and females with dependent children up to the full
annual grant award for substance abuse treatment services.
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 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:
- Non-TXIX females with substance abuse disorders
who are also pregnant or have dependent children, including females who are attempting to regain custody
of their children;
- Non-TXIX injection drug users; and
- Any Non-TXIX person (youth or adult) who has a substance abuse disorder, pending availability of funds.
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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Behavioral health providers must provide
specialized, gender-specific treatment and recovery support services
for females who are pregnant or have dependent children and their
families. Services are also provided to mothers who are attempting
to regain custody of their children. Services must treat the family
as a unit. As needed, providers must admit both mothers and their
dependent children into treatment. The following services are
provided at the treatment site as needed:
- Referral for primary medical care for
pregnant females;
- Referral for primary pediatric care for
children;
- Gender-specific substance abuse
treatment;
- Therapeutic interventions for dependent
children;
T/RBHAs must ensure the following issues
do not pose barriers to access to obtaining substance abuse
treatment:
- Child care;
- Case management; and
- Transportation
T/RBHAs must publicize the availability
of gender-based substance abuse treatment for females who are
pregnant or have dependent children. Publicizing must include at a
minimum the posting of fliers at each site notifying the right of
pregnant females and females with dependent children to receive
substance abuse treatment services.
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)
The purpose of interim services is to reduce the adverse health effects
of substance abuse, promote the health of the individual, and reduce the
risk of transmission of disease. 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:
- Behaviors which increase the
risk of contracting HIV, Hepatitis C and other sexually transmitted diseases;
- Effects of substance use on
fetal development;
- Risk assessment/screening;
- Referrals
for HIV, Hepatitis C, and tuberculosis screening and services; and
- Referrals
for primary and prenatal medical care.
SAPT Reporting Requirements:
The T/RBHA must, on a monthly basis, provide ADHS/DBHS with a
comprehensive written report containing the following
information:
Outreach
Activities:
Number of
referrals received for substance abuse treatment;
- Location and number
of persons receiving substance abuse treatment as a result of
outreach efforts; and
- Number of persons on
managed waitlist.
Utilization
data:
Number of
persons served, identified by demographic categories such as
age, race, gender and ethnicity.
Allocation
of SAPT funding for the following populations and services:
- Females who are pregnant or who have dependant children;
- Injection drug users;
- Other Non-Title XIX/XXI persons with substance abuse disorders;
- HIV Early Intervention Services Prevention; and/or
- Other services (must include an explanation)
A list of
providers who provide services under the SAPT
block grant, listing the following identifying information:
- Provider name;
- ISATS-ID;
- CIS Provider ID;
- Contact information, including address, phone number and fax;
- Contract start date;
- Contract end date;
- Types of services provided;
- Service locations;
- Populations served;
- Capacity (i.e. number of beds);
- Availability of child care services;
- Availability of onsite pediatric and prenatal care; and
- Availability of gender specific treatment.
Other SAPT Requirements:
Each T/RBHA must designate:
-
A lead
substance abuse treatment coordinator who will be responsible
for ensuring T/RBHA compliance with all SAPT requirements;
-
A women’s
treatment coordinator;
-
A prevention
network coordinator; and
-
An HIV early
intervention services coordinator
The lead substance abuse treatment coordinator
must attend regular meetings with ADHS/DBHS to review services
and comply with ADHS/DBHS policies.
Each T/RBHA must
submit an annual plan regarding outreach activities and
coordination efforts with local substance abuse coalitions.
HIV Early
Intervention Services
Because persons
with substance abuse disorders are considered at high risk for
contracting HIV-related illness, SAPT Block Grant requires HIV
intervention services in order to reduce the risk of
transmission of this disease.
Who is eligible
for HIV early intervention services?
Requirements for
providers offering HIV early intervention services
- HIV early intervention service providers who accept funding
under the SAPT grant must provide HIV testing services.
- Behavioral health
providers must administer HIV testing services in accordance
with the Clinical Laboratory Improvement Amendments (CLIA)
requirements, which requires that any agency that performs HIV
testing must register with Centers for Medicare and Medicaid
Services (CMS) to obtain CLIA certification. However agencies
may apply for a CLIA Certificate of Waiver which exempts them
from regulatory oversight if they meet certain federal statutory
requirements. Many of the Rapid HIV tests are waived.
For a complete list of waived Rapid HIV tests please see (http://www.fda.gov/cdrh/clia/cliawaived.html).
Waived rapid HIV tests can be used at many clinical and
non-clinical testing sites, including community and outreach
settings. Any agency that is performing waived rapid HIV tests
is considered a clinical laboratory.
- Any provider planning to perform waived rapid HIV tests must
develop a quality assurance plan, designed to ensure any HIV
testing will be performed accurately. (See
http://www.cdc.gov/hiv/topics/testing/resources/guidelines/qa_guide.htm
for Centers for Disease Control Quality Assurance Guidelines)
- HIV early intervention service providers must ensure that
employees complete the HIV Prevention Counseling Training
provided through ADHS prior to performing rapid HIV testing and
other related services such as counseling, and providing
referrals.
- HIV early intervention service providers cannot provide HIV
testing until they receive a written HIV test order from a
licensed medical doctor, in accordance with
A.R.S. § 36-470.
- HIV early intervention service providers must actively
participate in regional community planning groups to ensure
coordination of HIV services.
- HIV early intervention service providers must submit HIV testing
data to the ADHS HIV testing database following each test
administered.
Minimum
performance expectations
T/RBHAs are expected to administer a minimum of 1
test per $100 in HIV funding.
HIV monitoring and reporting requirements
T/RBHAs collect monthly progress reports from
subcontractors and submit quarterly progress reports to
ADHS/DBHS. T/RBHAs must conduct an on-site visit with each HIV
provider at least once annually.
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 of SAPT Block Grant funds
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:
-
SAPT
funds may not be used to make cash payments to recipients of
services (Flex Funds;)
-
SAPT
funds may not be used to provide covered services in penal or
correctional facilities;
-
SAPT
funds may not be used to provide inpatient hospital services;
-
SAPT
funds may not be used to provide treatment services to people who do
not have a substance abuse disorder;
-
SAPT
funds may not be used to provide covered services to people who are
Title XIX/XXI eligible;
-
A T/RBHA may retain no more than a total of 11.5% of SAPT
funds for the sum total of administration and profit for each fiscal
year;
-
A T/RBHA may not deny any person SAPT
funded treatment services based on age.
SAPT 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 two working days 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: 03/15/2009
Effective Date: 03/15/2009
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