Don’t Roll the Dice!
After reading the new policy, we came up with some strategies families can utilize to improve the chances of getting a decent Behavioral Health Residential Facility (BHRF) referral and preventing losing your spot in line for BHRF. Always keep accurate, detailed notes; we cannot emphasize this enough.
Work with the clinical team who completes and submits the application to ensure that the following information is in the form. Specificity Matters!!
- List all previously failed BHRF programs.
- List your geographical preference, so the family and or support system remains intact.
- List any areas that can be triggers or traumatic for the member.
- List any allergies.
- Cannot navigate stairs.
- List any other details pertinent to social living (cannot tolerate animals, better with same-sex housemates and/or roommates, etc.)
Have you experienced losing your place in line for a BHRF due to either re-hospitalization or refusal of a BHRF placement? If so, please tell us about your experience:
Any person may request an SMI Grievance Investigation by either calling 602-586-1719 or 1-866-386-5794 (toll-free) or completing a form linked below and sending it to:
Attn: Grievance and Appeals Department
4755 S. 44th Place
Phoenix, AZ 85040
Appeal or Serious Mental Illness Grievance Form (AHCCCS ACOM Chapter 400, Section 446, Attachment A). https://www.azahcccs.gov/shared/Downloads/ACOM/PolicyFiles/400/446.pdf
June 19, 2020
New Process – Adult Behavioral Health Residential Facilities (BHRF) prior authorization
Applicable to: Mercy Care Complete Care, Mercy Care RBHA and Mercy Care DD
Effective Monday, June 29th, 2020, Mercy Care is implementing new processes for Adult Behavioral Health Residential Facilities (BHRF) Prior Authorization requests and approvals.
Approved prior authorizations will be valid for 30 days from the date of determination. After that period, a new prior authorization request with current clinical information must be submitted.
Mercy Care respects member choice and will support all available options. However, due to the treatment level of care required, there may not be a treatment provider available that has all of the members’ preferences. If a member and/or guardian declines treatment when an available BHRF has been offered, it will be considered a withdrawal of the request for services. If a member in the community already approved for a BHRF admits to a higher level of care, such as a behavioral health inpatient hospital or sub-acute facility, the BHRF approval will be closed and a new application for BHRF will need to be submitted with the current clinical information.
The provider must fax in the admission face sheet with a minimum of member name, DOB, AHCCCS ID, facility name and address, Level of Care (BHRF), Admit date, and primary diagnosis to Mercy Care AZ Utilization Management Department Fax # 855-825-3165. As always, don’t hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.