Revision Date: 01/01/16, 05/01/12, 01/01/11, 07/25/17

AHCCCS MEDICAL POLICY MANUAL

EXHIBIT 1620-1, CASE MANAGEMENT (CM) TIMEFRAMES

INITIAL CONTACT/VISIT TIMEFRAME Initial Contact (CM or designee) Within seven business days of enrollment Initial on-site visit Within 12 business days of enrollment Initial service start-up Within 30 calendar 1days of enrollment

CASE FILE UPDATES TIMEFRAME Initial Cost Effective Study (CES) Prior to placement/services Initial CES, when services in place at Within 12 business days of enrollment enrollment Prior to placement change to HCBS and annually for all HCBS members, and when CES update there is a change in the member’s condition, authorized services, or rates. CES when no discharge potential No updates required, CES will reflect “NONE”

CATS ENTRIES TIMEFRAMES CES/CA160 Within ten business days of date of action Placement/CA161 Within ten business days of date of action Service Plan/CA165 (Tribal only) Within five business days of date of action REASSESSMENT VISITS (Includes service plan review and signature) TIMEFRAMES HCBS member At least every 90 days Nursing Facility (NF) member At least every 180 days . At least every 90 days for home based Acute Care Only members – members may be phone contact but on-site visit required . At least every 180 days for institutionalized at least once a year members*

1 Clarification

Exhibit 1620-1 - 1 of 2

Effective Date: 01/01/11, 05/01/12, 01/01/16, 10/01/17 Revision Date: 01/01/16, 05/01/12, 01/01/11, 07/25/17 Developmentally Disabled (DD) members 12 years or older residing in a group home, unless the member is medically involved or Seriously At least every 180 days* Mentally Ill/Severely Emotionally Disabled (SMI/SED) Within 14 calendar days of the reassessment Service Initiation visit2

ADDITIONAL STANDARDS FOR MEMBERS TIMEFRAMES DETERMINED TO HAVE AN SMI 3 Identification ofALTCS E/PD and Tribal ALTCS members determined to have an SMI, service providers must be identified to meet the Within 5five days of the initial assessment member’s needs (for ALTCS E/PD and Tribal ALTCS)

Request for identified providers to participate in the development of the member’s service Within 10 days of the initial assessment plan

Interdisciplinary team to convene for review and discussion of the implementation of Within 20 days of the initial assessment4 member’s services

*The “Next Review Date” on the CA161/Placement Maintenance screen in Client Assessment Tracking System (CATS) will be calculated at 90 days for these members.

2 Clarification to match policy language

3 POST APC CHANGE: removed section on timeframes for SMI

4 Standards added regarding new SMI timelines for the EPD RFP