Section 3.2 Appointment Standards and Timeliness of Service

3.2.1 Introduction
3.2.2 References
3.2.3 Scope
3.2.4 Did you know…?
3.2.5 Definitions
3.2.6 Objectives
3.2.7 Procedures
3.2.7-A. Type of response by a T/RBHA or a behavioral health provider (non-hospitalized persons)
3.2.7-B. 24-hour urgent behavioral health response for children entering foster care
3.2.7-C. Appointments for psychotropic medications
3.2.7-D. Referrals for hospitalized persons not currently T/RBHA enrolled
3.2.7-E. Waiting times
3.2.7-F. Other requirements
3.2.7-G. Special populations

3.2.1 Introduction
It is vital that the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) system be responsive and accessible to all the persons it serves. It is the expectation of ADHS/DBHS that provider response to a person’s identified behavioral health service need is timely and based on behavioral health condition, resulting in the best possible behavioral health outcome for that person.

Response time is always determined by the acuity of a person’s assessed behavioral health condition at the moment he/she is in contact with the provider. ADHS/DBHS has organized responses into three categories: immediate responses, urgent responses, and routine responses.

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

• 42 C.F.R. § 438.206
• 42 C.F.R. § 438.210
• A.A.C. R9-20-503
• A.A.C. R9-21-304
• A.A.C. R9-22-210
• A.A.C. R9-22-1205(H)
• A.A.C. R9-22-502(B)
• A.A.C. R9-31-1205(H)
• AHCCCS/ADHS Contract
• ADHS/RBHA Contract
• ADHS/Tribal IGAs
• Substance Abuse Performance Partnership Block Grant
• Section 3.10, Serious Mental Illness Eligibility Determination Section 7.5, Enrollment, Disenrollment, and other Data Submission
• ADHS/DBHS Behavioral Health Covered Services Guide
• Child and Family Team Practice Protocol
• The Unique Behavioral Health Service Needs of Children, Youth, and Families Involved with CPS Practice Protocol
• Policy Clarification Memorandum: Appointment Standards for Referrals of Persons Needing Psychotropic Medications

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3.2.3 Scope
To whom does this apply?

• All Title XIX and Title XXI eligible persons;
• All persons determined to have a Serious Mental Illness; and
• All other persons based on available funding. Please note that at the time of determination that an immediate response is needed, a person’s eligibility and enrollment status may not be known. Behavioral health providers must respond to all persons in immediate need, until the situation is clarified that the behavioral health provider is not financially responsible. Persons who are determined ineligible for covered services may be referred to applicable community resources.

3.2.4 Did you know…?

• The first behavioral health service following the initial assessment may be another assessment service, if determined by the child and family team or person’s adult treatment team to be the most appropriate service.
• Persons being treated with or determined to be in need of psychotropic medications may need an appointment with an individual qualified to prescribe psychotropic medications before an initial assessment is completed.
  

3.2.5 Definitions
Immediate Response

Urgent Response

Routine Response

3.2.6 Objectives
To ensure the timely response and provision of medically necessary covered behavioral health services to persons based on their individual behavioral health conditions, including urgent responses for children taken into the custody of the Arizona Department of Economic Security/Division of Children, Youth and Families/Child Protective Services (ADES/DCYF/CPS.)

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3.2.7 Procedures

3.2.7-A. Type of response by a T/RBHA or a behavioral health provider (non-hospitalized persons)

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3.2.7-B. 24-hour urgent behavioral health response for children entering foster care

An urgent response (within 24 hours) is required for all children who are taken into the custody of Arizona Department of Economic Security/Division of Children, Youth and Families/Child Protective Services (ADES/DCYF/CPS) regardless of Title XIX or Title XXI eligibility status. The purposes for this urgent response are to:

• Identify immediate safety needs and presenting problems of the child, to stabilize behavioral health crises and to be able to offer immediate services the child may need;
• Provide behavioral health services to each child with the intention of reducing the stress and anxiety that the child may be experiencing, and offering a coherent explanation to the child about what is happening and what can be expected to happen in the near-term;
• Provide needed behavioral health services to each child’s new caregiver, including guidance about how to respond to the child’s immediate needs in adjusting to foster care, behavioral health symptoms to watch for and report, assistance in responding to any behavioral health symptoms the child may exhibit, and identification of a contact within the behavioral health system;
• Initiate the development of the Child and Family Team process for each child (see Child and Family Team Practice Protocol); and
• Provide the Arizona Department of Economic Security/Division of Children, Youth and Families/Child Protective Services (ADES/DCYF/CPS) Case Manager with findings and recommendations for behavioral health services that impact placement and/or visitation for the initial Preliminary Protective Hearing, which generally occurs within 5 days of the child’s removal.
  

3.2.7-C. Appointments for psychotropic medications
For persons who may need to be seen by an individual qualified to prescribe psychotropic medications (Physicians, Nurse Practitioners, Physician Assistants), it is very important that the person’s need for medication be assessed immediately and, if clinically indicated, that the person be scheduled for an appointment within a timeframe that ensures:

• The person does not run out of any needed psychotropic medications; or
• The person is evaluated for the need to start medications to ensure that the person does not experience a decline in their behavioral health condition.

Response for referrals or requests for psychotropic medications:

3.2.7-D. Referrals for hospitalized persons not currently T/RBHA enrolled
Behavioral health providers must quickly respond to referrals pertaining to eligible persons not yet enrolled in the T/RBHA who have been hospitalized for psychiatric reasons. Upon receipt of such a referral, the following steps must be taken:

• For referrals of Title XIX/XXI eligible persons:
  • Initial face-to-face contact, an assessment and disposition must occur within 24 hours of the referral/request for services; and
  • The person must be enrolled and the effective date of enrollment must be no later than the date of first contact. The person must be enrolled whether or not additional behavioral health services will be provided.
• For referrals of non-Title XIX/XXI eligible persons:
  Persons referred for eligibility determination of Serious Mental Illness:
  • Initial face-to-face contact and an assessment must occur within 24 hours of the referral/request for services. Determination of SMI eligibility must be made within timeframes consistent with Section 3.10, SMI Eligibility Determination; and
  • Upon the determination of the continued need for behavioral health services, the person must be enrolled and the effective date of enrollment must be no later than the date of first contact.
  All other persons:
  • Initial face-to-face contact, an assessment and disposition must occur within 24 hours of the referral/request for services based on available funding.

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3.2.7-E. Waiting times
ADHS/DBHS has established standards so that persons presenting for scheduled appointments do not have to wait unreasonable amounts of time. Unless a behavioral health provider is unavailable due to an emergency, a person appearing for an established appointment must not wait for more than 45 minutes.

Behavioral health providers arranging for, or providing, non-emergency transportation services for members must adhere to the following standards:

• A person must not arrive sooner than one hour before their scheduled appointment; and
• A person must not have to wait for more than one hour after the conclusion of their appointment for transportation home or to another pre-arranged destination.

3.2.7-F. Other requirements
Upon delivery of a covered behavioral health service, including emergency or crisis services, the person must be immediately enrolled in the behavioral health system and the effective date of enrollment must correspond with the date of first contact (see Section 7.5, Enrollment, Disenrollment and Other Data Submission). Persons who receive telephone crisis services only are not enrolled with the T/RBHA.

All referrals from a person’s primary care provider (PCP) requesting a psychiatric evaluation and/or psychotropic medications must be accepted and acted upon in a timely manner according to the needs of the person, and the response time must help ensure that the person does not experience a lapse in necessary psychotropic medications, as described in subsection 3.2.7-C, Appointments for psychotropic medications.

Title XIX and Title XXI persons must never be placed on a “wait list” for any Title XIX/XXI covered service. If the T/RBHA network is unable to provide medically necessary services for Title XIX or Title XXI persons, it must ensure timely and adequate coverage of needed services through an alternative provider until a network provider is contracted. In this circumstance, the T/RBHA must ensure coordination with respect to authorization and payment issues. In the event that a covered behavioral health service is temporarily unavailable to a Title XIX/XXI eligible person, the behavioral health provider must adhere to the following procedure. The behavioral health provider notifies the Gila River RBHA Clinical Manager within 1 working day of identifying that a medically necessary covered service is temporarily unavailable to a Title XIX/XXI eligible person. The Gila River RBHA Clinical Manager can be reached by phone at (602) 528-7136. The Gila River Clinical Manager coordinates with the Gila River Network Manager as needed to address the service gap. In the event that the Title XIX/XXI person is in an inpatient or residential facility, the Gila River may recommend to ADHS that the person remain in the facility until clinically appropriate outpatient services can be made available.

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3.2.7-G. Special populations
ADHS/DBHS receives some funding for behavioral health services through the Federal Substance Abuse Prevention and Treatment Performance Partnership Block Grant (SAPT). SAPT funds are used to provide services for Non-Title XIX/XXI eligible persons. As a condition of receiving this funding, certain populations are identified as priorities for the timely receipt of designated behavioral health services. Currently, all Regional Behavioral Health Authorities and the Gila River Health Care Corporation Tribal RBHA receive SAPT Block Grant funding through ADHS/DBHS; therefore any providers contracted with a RBHA or the Gila River Health Care Corporation must follow the requirements found in this section. All other Tribal RBHAs and their contracted behavioral health providers do not currently receive these funds, so the following expectations do not apply.

SAPT Block Grant Populations
The following populations are prioritized and covered under the SAPT Block Grant:

First: Pregnant injection drug users;
Then: Pregnant substance abusers;
Then: Other injection drug users; and
Finally: All other persons in need of substance abuse treatment

Response Times for Designated Behavioral Health Services Under the SAPT Block Grant (Based on available funding):

Corrections Officer/Offender Liaison (COOL) Program
This program does not apply to the Tribal RBHAs. The COOL Program has been established to serve the behavioral health service needs of high-risk offenders on parole from the Arizona Department of Corrections. Behavioral health providers must help ensure that persons referred through the COOL Program receive a first treatment service 14 days from the date of referral.

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3.2 Appointment Standards and Timeliness of Service
Last Revision: 11/16/2006
Effective Date: 03/15/2008