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Section
3.3 Referral Process
3.3.1
Introduction
3.3.2 References
3.3.3 Scope
3.3.4 Did you know…?
3.3.5 Definitions
3.3.6 Objectives
3.3.7 Procedures
3.3.7-A. Where to send referrals
3.3.7-B. Referral to a provider for a second
opinion
3.3.7-C. Referrals initiated by DES/DCYF pending
the removal of a child
3.3.7-D. Accepting referrals
3.3.7-E. Responding to referrals
3.3.7-F. Documenting and tracking referrals
3.3.7-G. Eligibility screening & supporting
documentation
3.3.1
Introduction
The referral process serves as the principal pathway by which persons
are able to gain prompt access to publicly supported behavioral
health services. It is critical that the referral process is efficient,
engaging and welcoming to the person and/or family member seeking
services, and leads to the provision of timely and appropriate behavioral
health services based on the urgency of the situation.
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3.3.2
References
The following citations can serve as additional resources for this
content area:
3.3.3
Scope
To whom does this apply?
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3.3.4
Did you know…?
The T/RBHA is responsible for managing referrals and wait lists
for Non-Title XIX/XXI persons in accordance with the SAPT Performance
Partnership Block Grant for identified priority populations when
behavioral health services are temporarily unavailable. If the T/RBHA
network is unable to provide medically necessary services to Title
XIX/XXI persons, it shall ensure timely and adequate coverage of
needed services through an out-of-network provider until a network
provider is contracted.
3.3.5
Definitions
Referral
for behavioral health services
Health
Care Professional
3.3.6
Objectives
In order to facilitate a person’s access to behavioral health
services in a timely manner, the T/RBHAs and providers will maintain
an effective process for the referral for behavioral health services
which includes:
- Communicating
to potential referral sources the process for making referrals
(e.g., centralized intake at T/RBHA, identification of providers
accepting referrals); the Gila River RBHA utilizes a centralized
intake process based out of the Hu Hu Kam Memorial Hospital in
Sacaton. The majority of referrals to the RBHA are initiated through
the submission of the ADHS/DBHS Referral for Behavioral Health
Services Form by the referral source. Referrals may also be made
by calling (602) 528-7100.
- Collecting
enough basic information about the person to determine the urgency
of the situation and subsequently scheduling the initial assessment
within the required timeframes and with an appropriate provider;
- Adopting
a welcoming and engaging manner with the person and/or person’s
legal guardian/family member;
- Keeping
information or documents gathered in the referral process confidential
and protected in accordance with applicable federal and state
statutes, regulations and policies; and
- Informing,
as appropriate, the referral source about the final disposition
of the referral.
3.3.7
Procedures
3.3.7-A.
Where to send referrals
Provider Directories. In situations in which the T/RBHA
does not have a single centralized intake process, provider directories
will be developed and distributed by the T/RBHA to the AHCCCS Health
Plans, Department of Economic Security (DES)/Division of Developmental
Disabilities District Program Administrators and, upon request,
to other referral sources. These directories will indicate which
providers are accepting referrals and conducting initial assessments.
It is important for providers to promptly notify the T/RBHA of any
changes that would impact the accuracy of the provider directory
(e.g., change in telephone or fax number, no longer accepting referrals).
The Gila River RBHA utilizes a centralized intake process based
out of the Hu Hu Kam Memorial Hospital in Sacaton. The RBHA does
not subcontract with providers to complete intakes.
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3.3.7-B.
Referral to a provider for a second opinion
Title XIX/XXI behavioral health recipients are entitled to a second
opinion. Upon a Title XIX/XXI eligible behavioral health recipient’s
request, the T/RBHA must provide for a second opinion from a health
care professional within the network, or arrange for the behavioral
health recipient to obtain one outside the network, at no cost to
the behavioral health recipient. Requests for a second opinion may
be made by contacting the behavioral health recipient’s Gila
River RBHA Clinician.
3.3.7-C.
Referrals initiated by DES/DCYF pending the removal of a child
Upon notification from DES/Division of Children, Youth and Families
(DCYF) that a child has been, or will imminently be, taken into
the custody of DES/DCYF (which includes Child Protective Services),
behavioral health providers are expected to respond in an urgent
manner (see Section
3.2, Appointment Standards and Timeliness of Service).
The behavioral health provider and DES/DCYF must coordinate a response
based on the best interests of the child.
3.3.7-D.
Accepting referrals
T/RBHAs or their providers are required to accept referrals for
behavioral health services 24 hours a day, 7 days a week. Referral
sources shall be requested to provide in writing or orally the following
information:
- Date and
time of referral;
- Information
about the referral source including name, telephone number, fax
number, affiliated agency, and relationship with the person being
referred;
- Name of
person being referred, address, telephone number, gender, age,
date of birth and, when applicable, name and telephone number
of parent or legal guardian;
- Whether
or not the person, parent or legal guardian is aware of the referral;
- Special
needs for assistance due to impaired mobility, visual/hearing
impairments or developmental or cognitive impairment;
- Accommodations
due to cultural uniqueness and/or the need for interpreter services;
- Information
regarding payment source (i.e., AHCCCS, private insurance, Medicare
or self pay) including the name of the AHCCCS health plan or insurance
company;
- Name, telephone
number and fax number of AHCCCS primary care provider (PCP) or
other PCP as applicable;
- Reason for
referral including identification of any potential risk factors
such as recent hospitalization, evidence of suicidal or homicidal
thoughts, pregnancy, and current supply of prescribed psychotropic
medications; and
- The names
and telephone numbers of individuals the member, parent or guardian
may wish to invite to the initial appointment with the referred
person.
Don’t
Delay…Act on a referral regardless of how much information
you have. While the information listed above will facilitate evaluating
the urgency and type of practitioner the person may need to see,
timely triage and processing of referrals must not be delayed because
of missing or incomplete information.
When psychotropic
medications are a part of an enrolled person’s treatment or
have been identified as a need by the referral source, please respond
as outlined in Section
3.2, Appointment Standards and Timeliness of Service.
For the convenience
of referral sources (e.g., AHCCCS health plans and AHCCCS primary
care providers, state agencies, hospitals) ADHS/DBHS has developed
the ADHS/DBHS Referral for Behavioral Health Services Form (PM
Form 3.3.1). The T/RBHAs and providers must make this
form available to their key referral sources. Referral sources,
however, may use any other written format or they may contact the
T/RBHAs and providers orally (e.g., telephone).
In situations
in which the person seeking services or his/her family member, legal
guardian or significant other contacts the T/RBHA or provider directly
about accessing behavioral health services, the T/RBHA or provider
shall ensure that the protocol used to obtain the necessary information
about the person seeking services is engaging and welcoming.
When an SMI
eligibility determination is being requested as part of the referral
or by the person directly, the T/RBHAs and providers must conduct
an eligibility determination for SMI in accordance with Section
3.10, SMI Eligibility Determination.
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3.3.7-E.
Responding to referrals
Follow-Up. When a request for behavioral health services
is initiated but the person does not appear for the initial appointment,
the T/RBHA or provider must attempt to contact the person and implement
engagement activities consistent with Section
3.8, Outreach, Engagement, Re-engagement and Closure.
Final Dispositions.
Within 30 days of receiving the initial assessment, or if the person
declines behavioral health services, within 30 days of the initial
request for behavioral health services, the T/RBHA or provider must
notify the following referral sources of the final disposition:
- AHCCCS health
plans;
- AHCCCS PCPs;
- Arizona
Department of Economic Security/Division of Children, Youth and
Families (specifically Child Protective Services and adoption
subsidy);
- Arizona
Department of Economic Security/Division of Developmental Disabilities;
- Arizona
Department of Corrections;
- Arizona
Department of Juvenile Corrections;
- Administrative
Offices of the Court;
- Corrections
Officer/Offender Liaison (COOL) Program;
- Arizona
Department of Economic Security/Rehabilitation Services Administration;
and
- Arizona
Department of Education and affiliated school districts.
The final disposition
must include 1) the date the person was or will be seen for the
initial assessment; and 2) the name and contact information of the
provider who will assume primary responsibility for the person’s
behavioral health care, or 3) if no services will be provided, the
reason why. When required, authorization to release information
shall be obtained prior to communicating the final disposition to
the referral sources referenced above. (See Section
4.1, Disclosure of Behavioral Health Information).
Corrections
Officer/Offender Liaison (COOL) Program
This program only applies to RBHAs, not 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 processing referrals through
this program must provide written notice to parole officers within
24 hours of acceptance or rejection of the initial request for services.
If accepted, the parole officer must also be provided with the name
of the behavioral health provider that will be rendering treatment
to the referred person.
3.3.7-F.
Documenting and tracking referrals
The T/RBHA or subcontracted provider shall document and track all
referrals for behavioral health services including, at a minimum,
the following information:
- Person’s
name and AHCCCS identification number;
- Name and
affiliation of referral source;
- Date of
birth;
- Type of
referral (immediate, urgent, routine) as defined in ADHS/DBHS
Section 3.2,
Appointment Standards and Timeliness of Service;
- Date and
time the referral was received;
- If applicable,
date and location of first available appointment and, if different,
date and location of actual scheduled appointment; and
- Final disposition
of the referral.
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3.3.7-G.
Eligibility screening & supporting documentation
Supporting Documentation
Persons who are not already AHCCCS eligible must be asked to bring
supporting documentation to the screening interview to assist the
behavioral health provider in identifying if the person could be
AHCCCS eligible (See Section
3.1, Accessing and Interpreting Eligibility and Enrollment Information
and Screening and Applying for AHCCCS Health Insurance).
Explain to the person that the supporting documentation will only
be used for the purpose of assisting the person in applying for
AHCCCS health care benefits. Let the person know that AHCCCS health
care benefits may help pay for behavioral health services. Ask the
person to bring the following supporting documentation to the screening
interview:
- Verification
of gross family income for the last month and current month (e.g.,
pay check stubs, social security award letter, retirement pension
letter);
- Social security
numbers for all family members (social security cards if available);
- For those
who have other health insurance, bring the corresponding health
insurance card (e.g., Medicare card);
- For those
not born in the United States, citizenship or immigration documents;
and
- For those
who pay for dependent care (e.g., adult or child daycare), proof
of the amount paid for the dependent care.
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3.3
Referral Process
Last Revision:10/20/2005
Effective Date: 01/01/2006
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