R9-22-1202. ADHS, Contractor, Administration and CRS Responsibilities

A. ADHS responsibilities. ADHS is responsible for payment of behavioral health services provided to members, except as specified under subsection (D). ADHS’ responsibility for payment of behavioral health services includes claims for inpatient hospital services, which may include physical health services, when the principal diagnosis on the hospital claim is a behavioral health diagnosis. Behavioral health diagnoses are identified as “mental disorders” in the latest International Classification of Diseases (ICD) code set as required by AHC- CCS claims and encounters. B. ADHS/DBHS may contract with a TRBHA for the provision of behavioral health services for American Indian members. American Indian members may receive covered behavioral health services: 1. From an IHS or tribally operated 638 facility, 2. From a TRBHA, or 3. From a RBHA. C. Contractor responsibilities. A contractor shall: 1. Refer a member to a RBHA under the contract terms; 2. Provide EPSDT developmental and behavioral health screening as specified in R9-22-213; 3. Coordinate a member’s transition of care and medical records; and 4. Be responsible for providing covered inpatient hospital services, which may include behavioral health inpatient hospital services, when the principal diagnosis on the hospital claim is not a behavioral health diagnosis. D. Administration and CRS responsibilities. 1. The Administration shall be responsible for payment of behavioral health services provided to an ALTCS FFS or an FES member and for behavioral health services provided by IHS and tribally operated 638 facilities. The Administration is also responsible for payment of behavioral health services provided to these members during prior quarter coverage. 2. CRS shall be responsible for payment of behavioral health services provided to members enrolled with CRS.