Mental Health Block Grant funding for members with Serious Mental Illness (MHBG SMI)
Date: 02/01/23
This communication applies to AzCH-CCP and Care1st MHBG SMI providers
1. This notification is to inform providers and provider billing staff of eligibility for the MHBG SMI Block Grant. AHCCCS has provided clarification of the below requirements.
2. Eligible members include
a. TXIX/XXI members with SMI determination receiving NTXIX Covered Services
b. NTXIX individuals with a SMI determination that are uninsured /underinsured
3. Members who have been SMI determined are members with a documented functional impairment and a SMI diagnosis and have been documented using the AHCCCS SMI statewide determination process through Solari or previous vendors.
4. The SMI determination process is the process outlined in AMPM Policy 320-P. This policy includes qualifying diagnoses.
5. If provider is currently providing services to members under the MHBG SMI funding source and the member does not meet the eligibility criteria, the provider should engage the members in participating in the SMI evaluation process or begin to work with them to find alternative funding under a different source other than MHBG SMI to meet their needs.
6. Per AMPM 320-T1, assessments are covered for NTXIX persons when they are conducted to determine SMI eligibility.
7. Based on the need to ensure the MHBG SMI funds are used appropriately, we will implement edits for claims using the following logic:
· After passing initial claim edits, claim will be subject to the criteria below:
o Member enrolled as State Only member
o 18 years or older on the date of service
o Claim has qualifying SMI diagnosis billed in 1st position on service line
o Member has SMI indicator on AHCCCS 834, e.g., SMI determined
§ If above criteria present, claim moves forward in adjudication process
§ If criteria not met, claim denies EXcS = SERVICE NOT COVERED; MBR NOT SMI DETERMINED
§ EXCEPTIONS, i.e., payment allowed:
o Member is on grandfather list (allowed through 10/31/23)
o Claim is billed with V1 modifier (Children’s Behavioral Health Services Fund) in any position
o Claim is billed with ET modifier (Crisis Services) in any position
o Claim is billed with UB modifier (SMI Determination Screening) in any position
References include:
· AHCCCS Medical Policy Manual 300-2b (AMPM 300-2b) Covered Services
· AHCCCS Medical Policy Manual 320-T1 (AMPM 320-P) Serious Mental Illness Determination
· AHCCCS Medical Policy Manual 320-T1 (AMPM 320 T-1) Block Grant and Discretionary Grants
If you have program questions, please reach out to Tania Long-Gervais at TALONG@azcompletehealth.com
If you have finance questions, please reach out to Susie Scott at SUSSCOTT@azcompletehealth.com
THANK YOU!