Site Content
Additional Information
The Division Operations Manual consolidates and provides ease of access to the Division’s Administrative, Claims, Financial, and Operational Policies. The manual should be referenced in conjunction with State and Federal regulations, AHCCCS Contractor’s Operations Manual (ACOM), and applicable contracts.
DDD Operations Manual downloadable chapter files.
Chapter 100 - Administration
- 100 - Management of DDD Policies and Procedures
- 101 - Marketing
- 102 - DDD Administrative Forms and Other Written Material
- 103 - Fraud, Waste and Abuse
- 104 - Continuity of Operations/Emergency Preparedness Plan
- 105 - External Government Entities and Legislative Hearings
- 108 - Security Rule Compliance
- 109 - Institution for Mental Disease 15-Day Limit
- 110 - Mental Health Parity
- 111 - Performance Monitoring
- 112 - Employee Supports and Resources
- 113 - Committee Membership
- 114 - State Employee Misconduct
Chapter 200 - Claims
- 201 - Medicare Cost Sharing for Members Covered by Medicare and Medicaid
- 203 - Claims Processing
- 205 - Ground Ambulance Transportation Reimbursement Requirements for Non-Contracted Providers
Chapter 300 Financial
- 302 - Prior Period Coverage Reconciliation: Administrative Services Subcontractors
- 305 - Performance Bond and Equity Per Member Requirements
- 314 - Auto-Assignment Algorithm
- 317 - Change in Organizational Structure
- 320 - Health Insurer Provider Fee
Chapter 400 - Operations
- 404 - Contractor Website and Member Information Material
- 405 - Cultural Competency and Language Access Requirements
- 406 - Member Handbook and Provider Directory
- 407 - Workforce Development
- 409 - Office of Individual and Family Affairs
- 412 - Claims Recoupment and Refunds
- 414 - Requirements for Service Authorization Decision and Notices of Adverse Benefit Determination
- 415 - Provider Network Development and Management Plan Periodic; Network Reporting Requirements
- 416 - Provider Manual and Required Notifications
- 417 - Appointment Availability, Transportation Timeliness, Monitoring and Reporting
- 418 - Provider and Affiliate Advances, Equity Distributions, Loans & Investments
- 424 - Verification of Receipt of Paid Services
- 425 - Social Networking
- 426 - Children's Rehabilitative Services Application, Designation, and Coverage
- 431 - Copayment
- 433 - Member Identification Cards
- 434 - Coordination of Benefits and Third Party Liability
- 435 - Telephone Performance Standards and Reporting
- 436 - Network Standards
- 438 - Administrative Services Subcontracts
- 439 - Material Changes: Provider Network and Business Operations
- 440 - Managed Care Expiration or Termination of Contract
- 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness
- 449 - BH Services for Children in Dept of Child Safety Custody and Adopted Children
- 480 - Support Coordination (Case Management) Program Description
- 490 - Determining Support Coordination Service Staffing Needs
Chapter 1000 - Members and Families
- 1001-A - Rights and Responsibilities of Individuals Supported by the Division of Developmental Disabilities
- 1001-B - Responsibilities of Individuals Applying for and/or Receiving Supports and Services
- 1002 - Voter Registration
- 1003 - District Independent Oversight Committees
- 1005-A - Guardianship
- 1005-C - Authorized Representative for Arizona Long Term Care System Benefits
- 1005-D - Representative Payee
- 1007 - Supporting Separated or Divorced Families
Chapter 3000 - Network
- 3001 - Family Members as Paid Providers
- 3003 - Selection of Providers
- 3005 - Reserved
- 3006 - Short Term Emergency Situations (Residential and Day Programs)
- 3007 - Service Provider Information, Authority, and Notification
- 3008 - Electronic Monitoring
Chapter 4000 - Business Operations
- 4002 - Client Billing
- 4003 - Administrative Review/Appeal and Hearing Rights
- 4004 - Overview
- 4004-A - Definitions
- 4004-B - Member Funds System
- 4004-D - Responsibilities
- 4004-E - Safeguarding Member Funds
- 4004-F - Member Funds Security
- 4004-G - Disbursing Member Funds
- 4004-H - Member Funds, Provider Responsibilities
- 4004-I - Ledgers Maintained By Providers
- 4004-J - Bank Reconciliation
- 4004-K - Use of Member Funds
- 4004-M - Changes in a Member’s Status
- 4004-N - Investing Member Funds
- 4004-O - Termination of a Member’s Account or Change in Representative Payee
Chapter 5000
Chapter 6000 - Administrative Operations
- 6001-F - Case Records
- 6001-J - Records Management Litigation Hold
- 6002-D - Members At-Risk if Missing
- 6002-F - Investigative Process
- 6002-G - Reporting Member Abuse, Neglect and Exploitation
- 6002-I - Incident and Quality of Care Concern Corrective Actions and Closure
- 6002-M - Mortality Review Process
- 6003-C - Appeal Process for Members Who Receive State Funded Services
- 6003-D - Notice of Intended Action (State Only)
- 6003-E - Administration Review Process (State Only)
- 6003-F - Appealing Administrative Review Decisions
- 6003-G - Member Inquiry and Grievance Resolution
- 6003-H - Provider Inquiry and Grievance Resolution
- 6003-I - Arizona Long Term Care System Appeal Process
- 6003-J - Arizona Long Term Care Services State Fair Hearing Process
- 6003-K - Claim Disputes
- 6003-L - Attorneys at Planning Meetings
- 6003-R - Compliance Concerns Reporting Requirements
- 6004-A - Service Provider Monitoring
- 6005-A - Compliance Charter
- 6005-B - Compliance Investigation
- 6006 - AHCCCS Deliverable Submission Requirements
- 6007 - Records Management
Chapter 7000 - Privacy
- 7001 - Privacy Incident and Breach Notification
- 7002 - Authorization for Use and Disclosure of Protected Health Information
- 7003 - Minimum Necessary Standard for Uses and Disclosures or Protected Health Information
- 7004 - Accounting of Disclosures of Protected Health Information
- 7005 - Right to Request Restriction of Uses and Disclosures for Protected Health Information
- 7006 - Right to Request Amendment or Correction of Protected Health Information
- 7007 - Right to Receive Alternative Means of Communication for Protected Health Information
- 7008 - Notice of Privacy Practices for Protected Health Information
- 7009 - De-Identification Protected Health Information
- 7010 - Business Associate Agreements
- 7013 - Confidentiality / Confidentiality Officer
Revision History
The Division Medical Manual provides information regarding services that are covered within the Division’s program. The manual should be referenced in conjunction with State and Federal regulations, AHCCCS Medical Policy Manual (AMPM), and applicable contracts.
DDD Medical Manual downloadable chapter files
Chapter 300 Medical Policy for Acute Services
- 300-1 Covered and Non-Covered Services with Special Circumstances
- 300-3 Integrated System of Care Structure, Values, and Principles
- 310-B - Title XIX/XXI Behavioral Health Services
- 310-C Breast Reconstruction After Mastectomy
- 310-D1 - Emergency Dental Services for Members 21 Years of Age and Older
- 310-D2 - Arizona Long Term Care System Adult Routine Dental Services
- 310-F - Emergency Medical Services
- 310-I - Home Health Services
- 310-J - Hospice Services
- 310-K - Hospital Inpatient Services
- 310-L - Hysterectomy
- 310-M - Immunizations
- 310-N - Laboratory
- 310-P - Medical Equipment, Medical Devices, and Medical Supplies
- 310-R - Nursing Facility Services
- 310-S - Observation Services
- 310-V - Prescription Medication/Pharmacy Services
- 310-W - Certified Community Health Worker/Community Health Representative
- 310-X - Rehabilitative or Developmental Occupational Therapy, Physical Therapy, and Speech Pathology Services
- 310-BB - Transportation for Physical and Behavioral Health Services
- 310-DD - Covered Transplants and Related Immunosuppressant Medications
- 310-FF - Monitoring Controlled and Non-Controlled Medication Utilization
- 310-GG - Nutritional Therapy Metabolic Foods and Total Parenteral Nutrition
- 310-HH - Advance Care Planning and End of Life Care
- 310-II - Genetic Testing
- 310-JJ Orthotic and Prosthetic Devices
- 310-KK - Biomarker Testing
- 310-PP Augmentative and Alternative Communication Device Systems
- 320-B - Member Participation in Experimental Services and Clinical Trials
- 320-G - Lung Volume Reduction Surgery
- 320-I - Telehealth and Telemedicine
- 320-M - Medical Marijuana and CBD Oil Products
- 320-O - Behavioral Health Assessments, Service, and Treatment Planning
- 320-P - Serious Emotional Disturbance and Serious Mental Illness Eligibility Determinations
- 320-Q - General and Informed Consent
- 320-R - Special Assistance for Members with Serious Mental Illness
- 320-S - Behavior Analysis Services
- 320-U - Pre-Petition Screening, Court Ordered Evaluation and Court Ordered Treatment
- 320-V - Behavioral Health Residential Facilities
- 320-W Therapeutic Foster Care for Children
- 320-X Adult Behavioral Health Therapeutic Homes
- 320-Z Members On Conditional Release
Chapter 400 Medical Policy for Maternal and Child Health
- 410 - Maternity Care Services
- 411 - Women’s Preventative Care Services
- 420 - Family Planning Services and Supplies
- 430 - Early and Periodic Screening, Diagnostic and Treatment Services
- 431 - Dental Oral Health Services for EPSDT Eligible Members
- 450 - Out of State Placements for Behavioral Health Treatment
Chapter 500 Care Coordination Requirements
- 510 - Primary Care Providers
- 520 - Member Transitions
- 530 - Member Transfers Between Facilities
- 540 - Electronic Visit Verification
- 541 - Coordination of Care with Other Government Agencies
- 550 - Serious Emotional Disturbance Identification
- 560 - CRS Care Coordination and Service Plan Management
- 570 - Behavioral Health Provider Case Management
- 580 - Child and Family Team
- 581 - Working with Birth to Five Population Integrated System of Care
- 582 - Support and Rehabilitation Services for Children, Youth, and Young Adults
- 583 - Family Involvement in the Children's Behavioral Health System
- 584 - Youth Involvement in the Children's Behavioral Health System
- 585 - Unique Needs of Children, Youth, and Families Involved with the Department of Child Safety
- 586 - Children's Out-of-Home Services
- 587 - Transition to Adulthood
- 590 - Behavioral Health Crisis Services and Care Coordination
Chapter 600 Provider Qualifications and Provider Requirements
Chapter 700 School Based Claiming Program - Direct Services Claiming
Chapter 800 - Fee-for-Service Quality and Utilization Management
Chapter 900 - Quality Management / Performance Improvement Program
- 910 - Quality Management and Performance Improvement Program Scope
- 920 - Quality Management and Performance Improvement Program Administrative Requirements
- 930 - Implementation and Fidelity Monitoring of SAMHSA Evidence Based Practices
- 940 - Medical Records and Communication of Clinical Information
- 950 - Credentialing and Recredentialing Processes
- 960 - Quality of Care Concerns
- 961 - Incident, Accident, and Death Reporting
- 962 - Reporting and Monitoring of Seclusion and Restraint
- 963 - Peer and Recovery Support Service Provision Requirements
- 964 - Credentialed Family Support Partner Requirements
- 966 - Immediate Jeopardy
- 969 - Collaborating with Peers and Families
- 970 - Performance Measures
- 971 - Measurement Selection and Reporting
- 980 - Performance Improvement Projects
Chapter 1000 Medical Management
- 1010 - Medical Management Administrative Requirements
- 1020 - Utilization Management
- 1021 - Care Management
- 1022 - Justice Reach-In
- 1023 - Disease Chronic Care Management
- 1024 - Drug Utilization Review
- 1040 - Outreach, Engagement and Re-Engagement for Behavioral Health
Chapter 1200 Services and Settings
- 1210 - Institutional Services and Settings
- 1230-A - Assisted Living Facilities
- 1230-C - Community Residential Settings and Room and Board
- 1240-A - Attendant Care and Homemaker (Direct Care Services)
- 1240-C - Community Transition Services
- 1240-D - Emergency Alert System
- 1240-E - Habilitation Services and Day Services
- 1240-F - Home Delivered Meals
- 1240-G - Skilled Nursing and Licensed Health Aide Services
- 1240-G1 - Exhibit, Skilled Nursing Matrix
- 1240-I - Home Modifications
- 1240-J - Employment Services
- 1250-D - Respite
- 1250-E - Therapies (Rehabilitative and Habilitative)
- 1250-Y - Scheduled Transportation
- 1290 - Behavioral Health Advocacy
Chapter 1300 Member Directed Options
Chapter 1600 Case Management
- 1601 - Assignment of Support Coordinators
- 1610 - Guiding Principles and Components of Support Coordination
- 1620-A - Initial Contact and Planning Meeting Standards for Members Newly Enrolled in ALTCS
- 1620-B - Person-Centered Needs Assessment and Service Planning Standards
- 1620-C - Cost Effectiveness Study
- 1620-D - Person-Centered Service Planning and Placement Standards
- 1620-E - Service Plan Monitoring and Reassessment Standards
- 1620-G - Behavioral Health Standards
- 1620-K - Skilled Nursing Need Standard
- 1620-L - Case File Documentation
- 1620-N - Service Closure and Case Closure
- 1620-O - Abuse, Neglect and Exploitation Reporting Standard
- 1620-P - Interdisciplinary Collaboration
- 1621 - Enhanced Staffing Ratios
- 1630 - Administrative Standards
- 1640 - Targeted Support Coordination Standards
- 1650 - Division Only Eligibility (DD-Only) Support Coordination Standards
Chapter 1700 AHCCCS Housing Program
Revision History
The Division Eligibility Manual provides information regarding eligibility with the Division and the application process. The manual should be referenced in conjunction with State and Federal regulations and applicable contracts.
DDD Eligibility Manual downloadable chapter files.
Chapter 200 - Eligibility Criteria for the Division of Developmental Disabilities
Chapter 400 - Initial Eligibility Determination Process
Chapter 600 - Re-Determination of Eligibility
Chapter 700 - Determination of ALTCS Eligibility
Chapter 900 - Eligibility Categories
Revision History - Eligibility Policy Manual Revision History
The Division Provider Manual provides information to Division contractors regarding provider responsibilities and requirements. The manual should be referenced in conjunction with State and Federal regulations, AHCCCS Policy Manuals, and applicable contracts.
DDD Provider Manual downloadable chapter files.
Preface - Intended Users of the Provider Policy Manual
Chapter 1 - Introduction to the Division of Developmental Disabilities
Chapter 2 - Provider Responsibilities and Expectations
Chapter 3 - Provider Customer Service and Network Support
Chapter 4 - Covered and Non-Covered Services
Chapter 5 - Emergency Room Utilization
Chapter 6 - Early and Periodic Screening, Diagnostic and Treatment
Chapter 7 - Dental/Oral Health Care
Chapter 8 - Family Planning
Chapter 9 - PCP Assignments
Chapter 10 - Referrals to Specialists
Chapter 11 - Inquiries, Grievances, Claim Disputes, and Appeals
Chapter 12 - Billing and Claim Submission
Chapter 13 - Utilization Management
Chapter 16 - Remittance Advice, Eligibility, and Cost Sharing
Chapter 17 - Prior Authorization Requirements
Chapter 18 - Claims Medical Review
Chapter 19 - Concurrent Review
Chapter 20 - Fraud, Waste and Abuse
Chapter 22 - Pharmacy Services
Chapter 23 - Appointment Standards
Chapter 24 - Americans with Disabilities Act
Chapter 25 - Eligibility Verification
Chapter 26 - Cultural Competency, Family/Member Centered Care, and Language Access Plan
Chapter 27 - Peer Review and Inter-Rater Reliability
Chapter 28 - Member Rights
Chapter 29 - Advising or Advocating on Behalf of a Member
Chapter 30 - Clinical Practice Guidelines
Chapter 31 - Transitioning Members Between DDD Health Plans
Chapter 33 - Marketing and Member Information
Chapter 34 - Provider Publications
Chapter 35 - Reporting Requirements for Progress Reports and Other Documentation
Chapter 36 - Fire Safety
Chapter 37 - Therapy Services: Occupational, Physical, and Speech-Language
Chapter 38 - Emergency Communication When Transporting a Member
Chapter 40 - Insurance Requirements for Qualified Vendors
Chapter 41 - Termination of a Qualified Vendor Agreement Upon Request of the Qualified Vendor
Chapter 42 - Electronic Monitoring in Program Sites
Chapter 43 - Respite Provided at Camp to Division Members
Chapter 46 - Agency With Choice
Chapter 47 - Managing Vendor Call Lists, Vendor Directories, Scope of Services and Reporting Requirements
Chapter 48 - Credentialing of Contracted Providers
Chapter 49 - Responsible Driving
Chapter 50 - Vendor Call Requirements for Qualified Vendors
Chapter 51 - Developmental Home Services Requirements
Chapter 52 - Habilitation Staffing Schedule Requirements and Annual Review
Chapter 53 - Supporting Children In Care of the Department of Child Safety In Community Residential Settings
Chapter 54 - Group Home Requirements
Chapter 57 - Third Party Liability Waiver Requests
Chapter 58 - Medication Management Services
Chapter 59 - Benefit Coordination and Fiscal Responsibility for BH Svc and PH Services
Chapter 60 - Required Notifications
Chapter 61 - Home and Community Based Services (HCBS) Certification and AHCCCS Provider Enrollment
Chapter 62 - Electronic Visit Verification
Chapter 63 - Workforce Development
Chapter 64 - Preventing Member Abuse, Neglect and Exploitation
Chapter 65 - Providing Out of State Services
Chapter 66 - Behavioral Health
Chapter 67 - General and Informed Consent
Chapter 68 - Advance Directives
Chapter 69 - Care Coordination
Chapter 70 - Qualified Vendor Incident Reporting
Chapter 71 - Life Safety Inspection
Chapter 72 - Employment Services Delivery Requirements
Chapter 77 - Qualified Vendors Supporting Members with Animals
Chapter 79 - Quality Management Plan
Appendix A - QV Provider Instructions – Agency with Choice Option
Appendix B - DDD Agency with Choice User Guide – Focus Vendor
Appendix C - Medicaid Encounter Data Validation
Revision History - Provider Manual Revision History
- ASD Secret Shopper Audit List and Audit Results Report
- Behavioral Health Out of Home
- HIPAA Reporting
- Notification of All Hospital Admissions
- Members with Diabetic and A1C Report
- Members Determined SMI - Special Assistance Report
- Pressure Ulcer Report
- Supplement to Grievance and Appeal System
- Pregnant Women and Postpartum
- Behavioral Health Utilization Services Data
- Retrospective Review Deliverable
- Encounter Submission and Tracking (ESTR)
- High Needs and High-Cost Care Management Program
- Prescription Drug Utilization
- Telephone (Administrative Performance Measures)
- Unplanned Transitions
- Utilization Management
- Top 10 Emergency Department Utilizers Template
- Concurrent Review
- Discharge Planning Review
- Supplemental DME Service Delivery Reporting
- Medical Criteria IRR Reporting