Behavioral Health

Members enrolled in DDD/ALTCS, including those with an SMI designation, will no longer receive behavioral health services under the RBHA as of 10/1/2019. These members will receive their services under their integrated DDD Health Plan.

Crisis services will be provided through the assigned RBHA based on your location.  You can view them by clicking here.

Respite Care

Respite is a service available through DDD/ALTCS and Mercy Care. Respite care gives caregivers a break to take time for themselves. A member’s need determines the number of respite hours. Respite services may be provided on a short-term basis (a few hours during the day). Respite can also be for longer periods involving overnight stays. The maximum number of hours available is 600 combined between behavioral health and DDD each benefit year (October 1 - September 30).

**720 hours during the current COVID-19 environment until September 30, 2020

Transitioning into the adult system for behavioral health services

Members enrolled in DDD transition into adulthood at age 18. The behavioral health system divides into General Mental Health/ Substance Use (GMH/SU) and Serious Mental Illness (SMI). There are a few differences between the covered services.

Services available for DDD/ALTCS members with an SMI designation:

  • An assigned case manager
  • Levels of care based on clinical need
  • Permanent Supportive Housing (PSH)
  • Short-term treatment for members eligible for AHCCCS (title-19 only)

GMH/SU services can include residential settings for substance use or eating disorders. DD members may receive case management support from a clinician. All other adult behavioral health services are available based on need.

To be eligible for SMI services, a person must have a qualifying SMI diagnosis and functional impairment as result of their diagnosis. Members must be at least 17½ years of age to have an SMI evaluation and SMI services start at the age of 18.

Members and/or their guardian/ legal representative can call Mercy Care Member Services at 602-263‑3000 or 1-800-624-3879 (TTY/TDD 711) to request an SMI evaluation. For more information, you can visit www.crisisnetwork.org and select “SMI.” You can also call 1-855-832-2866.

Admission is based on medical need as outlined in AHCCCS Medical Policy Manual (AMPM) - AMPM Policy 320-V.

Member has a diagnosed behavioral health condition, and has symptoms and behaviors necessary for a request for residential treatment. The behavioral health condition causing the significant functional and/or psychosocial impairment is shown in the assessment by the following:

  1. At least one area of significant risk of harm within the past three months as a result of:
    1. Suicidal/aggressive/self-harm/homicidal thoughts or behaviors without current plan or intent,
    2. Impulsivity with poor judgment/insight,
    3. Maladaptive physical or sexual behavior,
    4. Inability to remain safe within environment, despite environmental supports (i.e. informal supports), or
    5. Medication side effects due to toxicity or contraindications.

AND

  1. At least one area of serious functional impairment as evidenced by:
    1. Inability to complete developmentally appropriate self-care or self-regulation due to behavioral health condition(s),
    2. Neglect or disruption of ability to attend to majority of basic needs, such as personal safety, hygiene, nutrition, or medical care,
    3. Frequent inpatient psychiatric admissions, or legal involvement due to lack of insight or judgment associated with psychotic or affective/mood symptoms or major psychiatric disorders,
    4. Frequent withdrawal management services, which can include but are not limited to, detox facilities, MAT, and ambulatory detox,
    5. Inability to independently self-administer medically necessary psychotropic medications despite interventions such as education, regimen simplification, daily outpatient dispensing, and long-acting injectable medications, or
    6. Impairments persisting in the absence of situational stressors that delay recovery from the presenting problem.
  2. A need for 24 hour behavioral health care and supervision to develop adequate and effective coping skills that will allow the member to live safely in the community,
    1. Anticipated stabilization cannot be achieved in a less restrictive setting,
    2. Evidence that appropriate treatment in a less restrictive environment has not been
    3. successful or is not available, therefore warranting a higher level of care, and
    4. Member agrees to participate in treatment. In the case of those who have a Health Care Decision Maker (HCDM), including minors, the HCDM also agrees to, and participates as part of, the treatment team. Agreement to participate in treatment is not a requirement for individuals who are court ordered to a secured BHRF.