Policy 300, Exhibit 300-2B,
AHCCCS Covered Services Behavioral Health Non-Title XIX/XXI Persons
Services / Non-Title XIX/XXI
Persons Determined to have an SMI* / Non-Title XIX/XXI Persons Receiving Services Through SABG / Non-Title XIX/XXI juvenile’s with sedReceiving Services Through MHBG
Behavioral Health Counseling and Therapy / Individual / X / X / X
Group and Family / X / X / X
Assessment, Evaluation and Screening Services / Screening, Evaluation, Assessment, and Testing / X[i] / Xi / Xi
Other Professional / Alcohol and/or drug services: Intensive Outpatient (Treatment Program that operates at least three hours/day and at least three hours/day week and is based on an individualized treatment plan) including assessment, counseling, crisis intervention and activity therapies or education / N/A[ii] / X / N/Aii
Multisystemic Therapy for Juveniles / N/A / N/A / X
Mental Health Services (formerly Traditional Healing) / ** / ** / **
Auricular Acupuncture / ** / ** / **
Skills, Training and Development, and Psychosocial Rehabilitation Living Skills Training / X / X / X
Cognitive Rehabilitation / X / NA / X
Behavioral Health Prevention/Promotion Education and Medication Training and Support Services (Health Promotion) / X / X / X
Psycho Educational Services and Ongoing Support to Maintain Employment / X / X / X
Medical Services *** / *** / X[iii] / ***
Laboratory, Radiology, and Medical Imaging / X / X[iv] / X
Medical Management / X / Xiii / X
Electro-Convulsive Therapy / N/A / NA / NA
Case Management / X / X / X
Personal Care Services / X / X / X
Home Care Training Family (Family Support) / X / X / X
Self-Help/Peer Services / X / X / X
Home Care Training to Home Care Client (HCTC) / N/A / N/A / N/A
Unskilled Respite Care [v] / ** / ** / **
Supported Housing** / ** / ** / **
Sign Language or Oral Interpretative Services[vi] / X / X / X
Transportation / Emergency / X / N/A / N/A
Non-Emergency / X / X / X
Crisis Intervention Services / (Mobile Community Based) / X / X / X
(Stabilization, Facility Based) / X / X / X
(Telephone) / X / X / X
Hospital / N/A / N/A / NA
Subacute Facility / ** / X / X
Residential Treatment Center / ** / X / X
Behavioral Health Residential Facility
(Without Room and Board) / ** / X[vii] / X
Mental Health Services NOS (Room and Board)* / ** / X[viii] / Xvi
Supervised Behavioral Health Treatment and Day Programs / X / X / X
Therapeutic Behavioral Health Services and Day Programs / X / X / X
Community Psychiatric Supportive Treatment and Medical Day Programs / X / NA / X
Limitations:
* / This category refers to services funded through allocations for persons determined to have an SMI, including State General Funds, MHBG, and County Funds. Each service may not be available through each line of funding. Refer to allocation schedule for further funding detail.** / Provided based upon available funding
*** / See the Behavioral Health Drug List for further information on covered medication.
See the AHCCCS Covered Behavioral Health Services Guide for restrictions, scope and time limitations, provider requirements and eligibility limitations for Title XIX and Title XXI behavioral health services.
300, Exhibit 300-2B - 1 of 3
Effective Date: 06/13/17
Revision Dates: 01/01/01, 10/01/01, 06/01/07, 07/01/16, 01/19/17, 03/30/17
Services under this area allowable with some exceptions. Refer toFinancial Reporting Guide for RBHA Contractors for details
Non-Title XIX members in need of substance use services could be eligible for SUD services under SABG
Per AMPM 320-T, medications through SABG are limited to those identified by AHCCCS as SABG approved
Limited to services related to MAT
No more than 600 hours of respite care per contract year (October 1st through September 30th) per person
Contractors are to use administrative dollars before Non-Title XIX funding for these services
Limited to Residential treatment for substance use disorders
[viii] Refer to SABG FAQs for coverage limitations