Serious Emotional Disturbance (SED) Determination Process Change
Date: 04/03/25
Serious Emotional Disturbance (SED) Determination Process Change
We’re communicating an immediate change to the SED Identification Process, which is a result of the federal government’s ARPA grant terminations. Solari will no longer be completing Serious Emotional Disturbance (SED) Eligibility Determinations. Solari will continue to be the determining entity for Serious Mental Illness (SMI) Eligibility Determinations for members aged 17.5 or older.
Starting Friday, March 28, 2025, children and adolescents are no longer being ‘determined’ SED via the process that AHCCCS initiated on 10/1/2023. Children and Adolescents are being identified as SED-qualifying. The temporary process for submitting information for SED identification is detailed below.
AHCCCS is now receiving information for SED identification using the email inbox: systemofcare@azahcccs.gov via encrypted email message.
Please enter SED IDENTIFICATION as the subject line. Once a member is identified as SED, AHCCCS will revise the AHCCCS PMMIS system to the updated Behavioral Health Category.
Temporary process for SED identification
If the provider identifies a child as meeting criteria for SED, the provider shall submit all the following information to AHCCCS in the encrypted email:
1. Member Name (Last Name, First Name)
2. Date of Birth
3. AHCCCS ID#
a. Note: A member is required to have an AHCCCS ID for AHCCCS to input information into the AHCCCS PMMIS system. In instances where an AHCCCS ID is not found and/or an enrollment is not active, providers shall coordinate with the ACC-RBHA/TRBHA Contractor (if applicable for Non-Title XIX/XXI eligibility) to ensure member eligibility records are created. Providers shall coordinate with the identified ACC-RBHA/TRBHA Contractors to receive the AHCCCS ID number and open enrollment to provide the information to AHCCCS to complete the process of SED identification.
4. The SED qualifying diagnosis from the list published on the AHCCCS Medical Coding Page of the AHCCCS website
5. CALOCUS level of care score is required for children ages 6 and over being served by an MCO provider (Level 0, Level 1, Level 2, Level 3, Level 4, Level 5, Level 6). Only CALOCUS level of care scores 2-6 are considered for SED identification. For a child under the age of six, 99 shall be provided as CALOCUS is not validated for this age category. 99 may also be entered for FFS members as the CALOCUS tool is recommended but not required
6. Provider SED identification – Indication of “yes” or “no” option. The “yes” option indicates that the child is identified SED. The “no” option is in the removal of the SED identification process within AHCCCS PMMIS system and further discussed below, and
7. Effective Date of SED Identification or Removal of SED Identification
The provider will communicate the SED qualifying diagnosis and CALOCUS score (if applicable) resulting in the SED identification to the member and HCDM and document this communication in the medical record.
The provider is required to reassess the member and update the CALOCUS at least every six months or more often as clinically indicated and shall submit updated results to AHCCCS as described above at the time of re-assessment.
Providers shall complete the SED Identification process for members up to the age of 18 for SED identification even when the member has completed an SMI determination at age 17.5 years to ensure SED identification through age 18. Refer to AHCCCS AMPM Policy 320-P - Eligibility Determinations for Individuals with Serious Mental Illness (SMI).
If any of the above information is missing, the child or adolescent will not be identified as SED. Please note that the “packet” previously required by Solari is no longer necessary. The child or adolescent must have an SED qualifying diagnosis and a CALOCUS score of 2 or above to be identified as SED. Children ages 5 and below and FFS members for which the CALOCUS is not required, the “yes” serves as provider attestation of functional impairment criteria.
The ACC-RBHA/TRBHA Contractors will ensure that ongoing services are immediately implemented upon notification that the SED identification is approved by AHCCCS by way of the updated Behavioral Health Category identified within the 834 member files received daily by all ACC-RBHA/TRBHA Contractors.
If a child or adolescent has discontinued or not engaged in behavioral health services for the previous six months, the member's SED behavioral health category will be removed. The ACC-RBHA/TRBHA Contractors will verify that the child or adolescent has not accessed behavioral health services previous six months and provide verification to the AHCCCCS Technical Coordination Unit (TCU) at TCUinquiry@azahcccs.gov to request the change of behavioral health category. In the rare instances that it is determined by the ACC-RBHA/TRBHA Contractor that verification cannot be provided, the ACC-RBHA/TRBHA Contractor will note these specific cases in the member’s record and utilize secure encrypted communication methods for further verification and resolution with AHCCCS.
An updated SED Identification FAQs will be posted on the AHCCCS website at https://azahcccs.gov/systemofcare.
Please share this notification within your organization and reach out for any questions to Virginia Cons, Director of Behavioral Health & Special programs, at vcons@azcomplethealth.com and Jessica Wolfson, Program Specialist at jessica.wolfson@azcomplethealth.com.