Mercy Care DCS CHP Members

Access to information and updates

Access to information
Q:  Is information for all families including foster/kinship as well as biological families?
A: Yes.  The PowerPoint and information below is important for the child's family as well as kinship and foster caregivers.  The information may apply more to some than others as the child and families move through the child welfare system.

Q: Will DCS staff be able to see when kids have seen the doctor and the dentist?
A: Technology solutions such as Family Connect are currently being developed so that DCS staff can view the child’s health care services. 

Updates
Q: Where can I look for updates?
A: You can find updates at www.mercycareaz.org and https://dcs.az.gov/services/cmdp websites. Before April 1, 2021, the CMDP Member Services can assist to answer questions related to physical health care. After April 1^st, the Mercy Care DCS CHP Member Services phone number will be available.

 

Adopted children and coverage, and children exiting care

Adopted children
Q: When a child is adopted from foster care, are they still eligible for coverage by Mercy Care DCS CHP?
A: No. Children are only eligible for Mercy Care DCS CHP while they are in foster care. Once a child is adopted, they may remain eligible for Arizona Health Care Cost Containment System (AHCCCS) Complete Care, or ACC. There are several health plans with an ACC contract that can serve the child in your care depending on where you live in the state. For available ACC plans, go to https://www.azahcccs.gov/Members/ProgramsAndCoveredServices/availablehealthplans.html.

Children exiting care
Q: Is there a time frame after a child exits out-of-care in which a parent/guardian needs to apply for AHCCCS?         
A: Some children that enter care received AHCCCS coverage through an Arizona Complete Care (ACC) plan prior to entry.   For those children, they may transition to back to the ACC, as long as they meet the eligibility requirements.   For other children, it is important for the parent/guardian to apply immediately.   You can work on this transition with the DCS Specialist as part of aftercare planning to prepare for this transition.       

Q: What about children who exited via guardianship prior to April 1, 2021; will they stay with AHCCCS or switch into the following year?           
A: Youth who are no longer in DCS care may be eligible for AHCCCS depending on their circumstances and eligibility once they exit.  Guardians can work with the DCS Specialist prior to exiting out-of-home care as part of aftercare planning to identify resources to apply for AHCCCS.       

Q: What about the behavioral health services when children return home and there is another Regional Behavioral Health Authority (RBHA) serving the county the family lives within?
A: RBHA will only serve adult SMI population, crisis, and block grants. Behavioral Health and Physical Health services would transition to the ACC health plan in which the child enrolls if the child continues to receive services from an AHCCCS health care plan.  

Q: What is the path for insurance when the child turns 18?
A: Young adults who have aged out of Arizona foster care may be eligible to receive health care through AHCCCS.  If a youth is eligible for Title XIX (Medicaid) and in foster care when they turn age 18, they may be eligible up to age 26.      

Q: Will Mercy Care DCS CHP cover young adults who remain engaged with DCS through its Extended Foster Care program?
A: No. Health care coverage through Mercy Care DCS CHP ends on the youth’s 18th birthday. Young adults who have aged out of Arizona foster care may be eligible to receive health care through AHCCCS.

Care management

Q: How will families be assigned a Care Manager? Can families request a Care Manager?
A: All DCS CHP members will receive some level of care management. Each child will be assessed and assigned to a care management level according to the complexity of the child’s physical and behavioral health care needs. Caregivers and providers can contact Mercy Care DCS CHP Member Services and request that the child be assessed care management services.

Q: Should the DCS Specialist invite the Mercy Care DCS CHP Care Manager to Child and Family Team (CFT) meetings?
A: Mercy Care DCS CHP care management staff will support the Child and Family Team (CFT) as needed. Their role traditionally does not involve participation in CFTs; however, based on the need and agenda for the meeting, they may participate in CFT meetings. Attendance of a Care Manager can be coordinated through the behavioral health CFT facilitator if needed. 

Q: Will Care Managers replace care coaches?     
A: Each health plan calls their staff roles by different names.  For Mercy Care DCS CHP, roles include:

• Care Manager: supports healthcare needs of the child and family from the health plan.
• System of Care Coordinators: provide support and technical assistance to the Child and Family Team Process.
• Resource Liaison: supports DCS caregivers and access to resources and contacts.
• Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Coordinator: monitor and follow up on provider service delivery to children.

Q: Will the CMDP Behavioral Health Clinical Coordinators (BHCC) transition to become Mercy Care Care Managers?      
A: No. CMDP Behavioral Health Clinical Coordinators (BHCC) will remain under DCS CHP. Their position name will change to DCS CHP System of Care Coordinators (SOCC). The DCS CHP System of Care team will remain an active support for the DCS Specialists and the Child and Family Team (CFT) process, providing consultation for and navigation of health care delivery statewide.

Child and Family Team, and children with tribal affiliation

Child and Family Team
Q: Will a behavioral health provider be required to attend every Child and Family Team (CFT) meeting?            
A: Yes. In order for a Child and Family Team (CFT) to be considered a CFT, there must be a behavioral health representative and the guardian/caregiver present. The assessment and/or recommendations of behavioral health professional (BHP) are included to guide the CFT process, though the BHP is not required to attend CFTs. BHPs are defined in AHCCCS Policy under AMPM 310-B., Examples include licensed behavioral health providers (i.e. psychiatrist, psychologist, physician, behavior analyst, registered nurse practitioner, and registered nurse).

Children with tribal affiliation
Q: Are children with tribal affiliation covered under Mercy Care DCS CHP?
A:  Yes. When children enter foster care, they are eligible for coverage by Mercy Care DCS CHP.  However, the child's tribe has the option to secure the child’s healthcare through a Tribal RBHA (T/RBHA) when there is one available as well as the Indian Health Service or a Tribal 638 Facility. The Tribe has the option under the Indian Child Welfare Act to determine where the child receives their healthcare. 

A child who is in tribal foster care, but not in of DCS custody, is not covered by MC DCS CHP.

View tribal relations information on the Member Resources page.

 

Continuity of care

Q: Are there concerns about continuity of care if a child leaves DCS custody and the CHP plan?  Would this overload Mercy Care?                
A: Currently, if someone leaves CMDP and wishes to remain with Mercy Care, in Maricopa County, Mercy Care is an ACC plan and an option for a child's ACC health plan.  The option of health plans upon exiting the system will vary depending on where a child resides.  Therefore, children moving from Mercy Care DCS CHP to Mercy Care ACC will not overload Mercy Care.  Please note, Mercy Care DCS CHP may have some slightly different benefits from the Mercy Care health plan, though they are both AHCCCS health plans and they both have the same baseline requirements to be a Medicaid health plan in Arizona.    

Q: Does Mercy Care DCS CHP include a dental plan?        
A: Yes. Mercy Care DCS CHP will be the single, statewide health plan, responsible for the physical, dental, vision and behavioral health services for the child welfare population.

Q: How do these changes affect grandchildren who did not go through DCS?       
A: Health plan changes only affect children in DCS out-of-home care.  Children who receive in home services only, who are not wards of the court or in the legal custody of DCS will not be affected.

Q: If a child in foster care is in need of a dentist, should the caregiver search for a dental provider now or wait until April 1?
A: If a child needs dental care now, please do not hesitate to get that care. Caregivers can contact CMDP before April 1 for assistance selecting a provider. It is the goal of Mercy Care DCS CHP to create a statewide provider network that will include the providers who are already serving children in foster care. Children who were receiving services from an out-of-network provider prior to April 1 will be allowed to continue with those services for up to one year after go-live without a prior authorization. This is to support the continuity of care and allow time for contracting activities to occur and/or to help transition the child to another provider.

Q: Who is responsible to make sure Early and Periodic Screening, Diagnostic and Screening (EPSDT) happens?           
A: Mercy Care will be responsible for the EPSDT measures with the oversight and partnership from DCS CHP. DCS CHP and Mercy Care will partner with DCS Specialists, health care providers and caregivers to make sure children receive all recommended EPSDT visits such as wellness and dental exams.

Q: Will Mercy Care contract directly with providers to assist with ensuring EPSDT service facilitation is done? Does it fall under a Health Home model?
A: Mercy Care has a robust contracted network that includes physical health providers, behavioral health providers and integrated providers that provide both physical and behavioral health services.  EPSDT services are able to be facilitated through the directly contracted providers with support from their assigned behavioral health clinic, as appropriate.  Additionally, Mercy Care DCS CHP will proceed with integrated Care Management to support timely EPSDT services.  

Q: Will Mercy Care DCS CHP cover vision services?           
A: Yes. Vision coverage will continue as currently covered by Medicaid.

Q: What can service providers do to ensure there are no disruptions in the services they are currently providing to families?
A: Service providers, who do not have a contract and are not in network with Mercy Care, can email OIFATeam@mercycareaz.org. Service providers should continue to provide services and bill Mercy Care DCS CHP. Out-of-network providers will be allowed to see our members up to one year post go-live without prior authorization for purposes of transition and continuity of care.

Q: What will the partnership look like between Mercy Care DCS CHP Care Managers and the health home’s High Needs Case Managers (HNCM)?        
A: The HNMC provide an intense level of continuous case management, specifically for children who have high/complex behavioral health needs. The HNCM provides additional support and rehabilitative services. All youth in out-of-home treatment settings (BHIF, BHRF, TFC) will be connected to a HNCM. Mercy Care DCS CHP Care Managers will assist caregivers in understanding and coordinating whole health needs and serves as an additional support to case management. Mercy Care DCS CHP Care Managers will not replace the Mercy Care Care Managers will be able to be a support to the High Needs Case Managers and do not replace any of the High Needs Case Manager’s functions.

Q: Will Mercy Care DCS CHP change the review process for therapeutic foster care treatment?        
A: Currently, therapeutic foster care treatment is a prior authorized service based on clinical necessity guidelines. Having a single health plan will improve administrative processing efficiencies, but will not change the clinical criteria used.

Q: Are there changes for families with children in out-of-home care to attend appointments for their children?
A: Generally, there are no changes to appointment attendance for children in out of home care.

Regarding coordination: When a case plan is family reunification, good faith efforts will be made to include a child’s parents in the delivery of health care services to children in out-of-home care. Limitations may exist outside of the Department, health care provider and DCS caregiver control.  

Q: When a child enters foster care for the first time, what is the timeframe to schedule a Wellness Check and other services for the child?
A: The expectations for child's wellness and behavioral health and dental have NOT changed, the expectations remain the same. The expectation for a child to see a primary care provider (PCP) for a Comprehensive Well Child visit is as soon as possible, no more than 30 days of entry to foster care. A Comprehensive Preventative Dental visit is to occur as soon as possible, but no more than 30 days of entry to foster care.  For behavioral health services, the Rapid Response referral must be made by DCS within 24 hours of removal.  The provider then has 72 hours to respond and schedule an assessment.  After the integrated rapid response assessment, an intake appointment is to occur within seven days, if this was not a part of the integrated rapid response assessment.  Within 21 days, any further services (I.e. individual therapy, group therapy, behavior coaching, specialty services, etc.) should have begun.

Coverage area

Q: Is Mercy Care DCS CHP providing coverage for all Arizona children in foster care, or will multiple AHCCCS Complete Care plans provide coverage to DCS CHP members?
A: Mercy Care DCS CHP will be the single, statewide health plan, responsible for the physical, dental, and behavioral health services for the child welfare population.

Q: What if a child is placed in out-of-home care outside of Arizona?         
A: If an out-of-state kinship or foster caregiver has been identified while the child is in DCS care, Mercy Care DCS CHP is responsible for providing health services for the child. The child’s DCS Specialist will coordinate with Mercy Care DCS CHP to obtain any information needed to establish physical, dental, and behavioral health care in the state the child will be residing in. Children may be categorically eligible for Medicaid in the receiving state.

DCS Specialists and foster care placement

DCS Specialists
Q: Will my DCS Specialist change because of this new health plan?           
A: No. Integrating to a single, statewide health plan, Mercy Care DCS CHP, will not impact the assignment of DCS Specialists. However, please know that DCS Specialist assignments may change for other reasons. 

Foster care placement
Q: Does the partnership with DCS and Mercy Care affect foster caregiver determination?
A: The health plan changes do not affect the selection of a child’s foster caregiver.           

Guardian system integration

Q: Will the new health plan be integrated with the new Guardian system?           
A:  Although not directly integrated, some health information will be available in Guardian and DCS Specialist and caregivers will have access to Family Connect.  Some members (youth age 14 years and older) may have access to the Mercy Care mobile app. 

Justice involved

Q: Do benefits stop if a youth goes to juvenile detention on a technical charge or only a new delinquent offense?       
A: The AHCCCS eligibility rules have not changed. Benefits stop for youth in juvenile detention if the youth’s AHCCCS eligibility is suspended.  If a youth is in detention but their AHCCCS eligibility is not suspended, then the Mercy Care DCS CHP plan will not be suspended. 

Q: I work for County Probation.  We typically complete an enrollment and disenrollment form when a youth enters and leaves out-of-home care. This form was mailed to DCS.  How will this change?
A: The enrollment and disenrollment process will not change for these youth.

Q: When a youth enters detention, if on a violation for probation, AHCCCS does not suspend.  Is this the same for Mercy Care DCS CHP?        
A: Mercy Care DCS CHP follows AHCCCS guidance and rules. The transition to DCS CHP and Mercy Care DCS CHP will not affect or change the current processes set forth by AHCCCS.

Members (ID cards, Notice to Provider form and welcome packets)

Notice to Provider form
Q: Will the Notice to Provider form still be used going forward after this change?              
A: Yes.  The Notice to Provider Form will be included in the child’s DCS Placement Packet.

Q: When will newly-licensed families receive the welcome packet?          
A: It depends on when a child is placed with you. You will receive a Mercy Care DCS CHP welcome packet only if you have a child placed with you in your care after April 1.            

Welcome packets
Q: Who receives the new letters and welcome packet for the children currently in care?  Is it the current placement or the DCS case manager?            
A: On April 1, the welcome packets will be distributed through a variety of ways including the via mail and/or the DCS Specialists. 

Q: Can group homes call DCS CHP to get replacement Member ID cards? 
A: Yes. Caregivers may call Mercy Care CHP Member Services for a replacement card.

Member ID cards

Q: Will birth families receive the child’s Member ID card and/or have access to the Mercy Care Family Connect portal?       
A: The child’s caregiver and assigned DCS Specialist will have the child’s health insurance card.  Access to Mercy Care’s Family Connect Portal will be rolled out in phases and will begin with a select group of DCS personnel.  Family members who are not the child’s caregiver will not have access.

Q: How can we get the Member ID insurance number as soon as the kids are removed?  
A: The most expedient way is to get initial guidance from the DCS Specialist working with the caregiver on the placement of a child.

Q: I was previously informed the Member ID numbers will remain the same.  Is this correct?               
A: The CMDP ID card number will change as of April 1, 2021 when Mercy DCS CHP issues new Member ID cards. DCS Specialists, and caregivers will receive the new member ID card about two weeks after April 1^st. This new ID card is what will be used to obtain services from a provider or pharmacy. You will still be able to get care for your child(ren) during this time without the Member ID card. There will be no interruption in getting or receiving care and services.

If your child needs care before you receive the new ID card:

1. Bring a copy of the email you will receive regarding Member ID card to the provider or pharmacy, or show it to them on your mobile phone or other mobile device.
2. Show your CMDP ID card, if you have one. It will have your child’s identification number on it. Tell the provider that Mercy Care is the payor and they can confirm eligibility by visiting our website at MercyCareAZ.org. Here the provider will click on the link in the upper right corner that reads “FamilyConnect.”
3. Show the provider or pharmacy your child’s Notice to Providers form.
4. Tell the provider or pharmacy the new health plan’s name is Mercy Care DCS CHP and that Mercy Care is the payor.
5. Tell the provider they can verify your child’s information on our secure provider portal, located on our website at MercyCareAZ.org. In the upper right hand corner they should look for the link that says DCS CHP FamilyConnect.
6. If the provider or pharmacy has trouble verifying the child's information, ask them to call Mercy Care DCS CHP Member Services at 602-212-4983 or 1-833-711-0776 (TTY/TDD 711).

Q: If you now use the CMDP number at the pharmacy, will there be instructions to use another number?
A: Please see previous answer.  The pharmacy will know how to adjust the information at the transaction point. The pharmacy will know what to do to make sure the youth is able to get their medications if all you have is the CDMP ID.

Q: What will happen if a caregiver needs to seek medical attention for a child in foster care on April 1, and they have not received the child’s new member ID card or number?
A: Mercy Care DCS CHP members will still be able to get care even if they don’t have their new member ID card on or after 4/1/21.  Providers have been instructed to accept CMDP ID cards until the caregiver receives the child’s new member ID card and number.

Q: Will Member ID cards be sent to the DCS Specialist or will they come to the placement?                
A: Member ID cards will be distributed through a variety means including the DCS Specialist as well as directly to caregivers when possible.    

Q: What should caregivers expect to receive in the Mercy Care DCS CHP Welcome Packet?               
A: After April 1, 2021, caregivers will receive a welcome packet from Mercy Care DCS CHP, which will include:

• A welcome letter containing the new Mercy Care DCS CHP Member ID card(s) and the child or children’s PCP assignment(s).
• Instructions to find the Member Handbook online, and instructions to request a printed copy if needed.

Q: Will a new card number be issued for children with DDD long-term care who have Mercy Care?
A: No. They should not receive a new card. Children who are currently under Mercy Care DDD long-term plan will stay under the DDD plan. They will not be transitioning to Mercy Care DCS CHP.

Q: Can I make a copy of the Member ID card for my spouse or other family members? Is that okay to do?
A: Yes.  You may also either call Mercy Care Member Services to request an additional member ID card.  

Q: Will a family be able to see their new placement right away in the Mercy Care app so they can get a prescription and appointments right away?      
A: Members ages 14 and older will have access to the Mobile application.  As soon as the member has their Member ID number that information can be used to access their loaded the app and you should be able to get their prescription and appointments right away.  That should not be a barrier to securing either one of those health care needs.

Pharmacy network and prior authorization

Pharmacy
Q: Is Sam's Club a covered pharmacy provider?  
A: Yes. Sam’s Club is in the pharmacy network.

Prior authorization
Q: Will prior authorization be needed to see specialists?
A:  Services that require prior authorization are going to remain the same. Depending on the service, prior authorization may be required based upon AHCCCS requirements and guidelines.

Q: Will the children in foster care be able to get braces now?
A: Currently, orthodontia decisions are based on medical necessity. This will not change under Mercy Care DCS CHP.

Q: Will there be a certain or specific department to send prior authorizations?
A: Yes.

Prior Authorization Customer Service
1-833-711-0776
Fax your prior authorization request to 1-800-217-9345
Submit authorizations through Mercy Care DCS CHP Web Portal
All prior authorization forms can be found at:
https://www.mercycareaz.org/providers/chp-forproviders/priorauth

Pharmacy prior authorizations- may be called, faxed or sent electronically:

Phone: 602-212-4983 and toll free 833-711-0776

Fax: 800-854-7614.

Provider coordination and provider network

Q: For coordination of care efforts, will professionals now coordinate with Mercy Care regarding the children's medical and dental needs, rather than CMDP?  If so, will a new contact email be released instead of the CDMP email?
A: We continue to conduct meetings and communicate with providers. Providers have been provided updates on the changes, including updates to provider manuals and reference materials.  

Q: Are CMDP providers essentially going to be Mercy Care DCS CHP providers?    
A: The majority of the CMDP providers will be coming into network at Mercy Care DCS CHP, however, always check to make sure the provider is in our contracted network at www.mercycareaz.org/findaprovider.

Q: Are the provider rates going up so we can keep experienced providers to serve our kids in DCS care?
A: That varies on contracting and it depends on the provider's individual situation.                

Q: Are we expecting changes to PMPM (per member per month)?
A: The DCS CHP Mercy Care network will be funded through a fee for service structure.  Dependent on location of the provider, this will vary based on whether this is a change for a provider.  We had providers in Maricopa County that were on block funding that are transitioning to fee for service.  Additionally, in the Northern and Southern that southern areas of the state, there were already providers on fee for service.  If a provider has any questions on this, please reach out to your assigned provider representative.

Q: Can you search Mercy Care’s provider network now to find out which providers will be in the Mercy Care DCS CHP provider network?
A: Yes. You can search the provider network for Mercy Care Complete Care. Go to https://www.mercycareaz.org/find-a-provider. When you select a plan, Mercy Care Complete Care will be the closest representation of what the network will be for Mercy Care DCS CHP. Our DCS CHP network is not yet showing in the provider search, and it won't be live until April 1, 2021 and is also being updated in real time.

Q: Cochise County and the rural areas do not have Mercy Care providers.  Is this something that is going to change?
A: Yes. Mercy Care CHP received a list of the providers from CMDP for physical health providers and from Health Choice (Northern Az) and from Arizona Complete Health (Southern Az) so that we could identify any providers that we were NOT contracted.  Mercy Care Network Administration has worked to outreach all the health care providers that the other RBHAs identified so in Cochise County where Mercy Care previously did not have an AHCCCS Complete Care presence nor a RBHA presence, now has contracted providers to meet the needs of kids in every county.  That's for physical, medical dental and behavioral.

Q: Is it probable most CMDP-approved places will be included? 
A: Yes, it is probable. However, that does not mean there will not be slight differences. Note that for up to a year after the plan goes live, you will be notified if there is a change in providers and you'll still be able to receive care for up to a year after DCS CHP goes live.

Q: Why isn’t the Mercy Care Department of Child Safety Comprehensive Health Plan DCS CHP listed on the www.MercyCareAZ.org website as a dropdown under the provider or pharmacy searches?       
A: The provider search function is still being built for this line of business. It will be available on 4/1, but you can search for a provider to see if they're in the network. Until 4/1, you can select Mercy Care Complete Care and that will give you an idea of our provider network.

Referrals and training

Referrals
Q: Do we still need to get referrals for certain doctors?  Like eyes, ears, throat, gastro, etc.?
A: The services that now require prior authorization will continue to require prior authorization.

Training
Q: Will licensed families get training on this information prior to a placement?
A: Yes. When foster families are being licensed by DCS, information on the health plan will be provided to those families as part of that training.