Photo by Mpho Mojapelo on Unsplash

AHCCCS is proposing changes to the AHCCCS Medical Policy Manual (“AMPM”) that would interfere with guardians’ authority in the decision-making process related to acute care facilities. This change would be unlawful as it is contrary to existing law including the Arizona Administrative Code and the Arizona Revised Statutes. AHCCCS continues to strip guardians’ rights per its AMPM. AHCCCS recently removed the guardian’s authority to alone consent to admission to a behavioral health residential facility (See AMPM 320-V). Thus, a person determined by the Superior Court of Arizona to be unable to make medical decisions is allowed to make medical decisions. Would AHCCCS do this to a person with Alzheimer’s who needs to get into an assisted living facility? No (it does not, the policy is very clear). Would AHCCCS do this to a person with a developmental disability who needs admission to a hospital? No (it does not, the policy is very clear). No, when it comes to consent to medically necessary services, the guardian is cut out only when the member has an SMI. Guardians are appointed by the court based on incapacity, demonstrated need, and least restrictive alternatives.  Their legal authority, and their role in caring for SMI persons, should be respected.

Behavioral Health Residential Facility (BHRF) policy

Please comment here on AHCCCS, comment deadline: November 22, 2021

ACMI is asking for families to tell us if you are experiencing any challenges with the behavioral care system. There is a forum on guardianship. You may also tell your story about other issues with the Arizona behavioral health system.

You must register (free) to post in the ACMI forums.

Parity not disparity
Behavioral health does not have parity in practice

I was speaking with a mother in crisis suffering through yet another psychiatric emergency with her adult son. His serious mental illness symptoms were frightening and possibly dangerous; he likely needed a medication adjustment. Easier said than done. His psychiatrist had been contacted, and an appointment was set. Before the appointment, there was an exacerbation of symptoms which resulted in a scuffle with a housemate and an assault.  Nothing that required medical attention, not this time.

The house staff was inclined to call the police, but his mother begged them to call his ACT (Assertive Community Team) instead. Keep in mind he was already in a 24hr residential treatment center due to his serious mental illness. The ACT team concurred that her son needed to go back to a psychiatric screening agency for re-assessment. After going to the psychiatric evaluation center, they determined that he needed an in-patient psychiatric bed. After waiting in a recliner bed overnight, he went to one of the community psychiatric hospitals.  The nurse practitioner from the community hospital did talk to the mother. If instead, he had ended up in jail and had been found guilty of assault, he would have lost his benefits. When a person with serious mental illness is sent to jail, often their medications are changed or missed for a while, so they come out requiring more extended hospital stays for stabilization.

Once he was admitted, the mother tried to talk to someone and provide them with his history. Her son has been ill for over 25 years. No one would talk to her even though she is his guardian. She called repeatedly. The phone is often not even answered. She finally reached the CEO as she often has had to do in the past; the staff ignore her requests for information. After that discussion with the CEO, communication improved marginally. But that did not stop a healthcare worker from refusing to send her son’s new medication regimen. The worker told her to call the CEO again; such blatant disrespect of guardians and families should not be tolerated.

Now contrast that with her recent experience with her husband, who had a medical emergency. He was quickly rushed to the hospital by paramedics. But unlike emergencies having to do with psychiatric crises, the police were not called. Had this emergency been due to a psychiatric problem, the police would have been called. Her son would have been cuffed and taken either to jail or perhaps a psychiatric evaluation center if he was lucky. Once at the hospital, everyone talked to her and included her in the decision-making process. There were many follow-up calls, and she did not have to escalate the issue to force people to communicate.

The treatment is of people with SMI in a psychiatric crisis is criminal. While we have parity laws, the reality is that we DO NOT have parity.