TI 2.0 Application Example Documents
The following example documents are organized by Process Requirements 1 through 5 as seen on the TI 2.0 Application Summaries.
These examples are not one-size fits-all templates; applicants must create similar policies and procedures that are applicable to the organization. The examples are only intended to provide a visual representation and context of the application process.
Applicants must submit the TI 2.0 Provider Interest Form prior to completing the Application Document Review process. Documents submitted by organizations that completed the provider interest form by 9/15 will be prioritized for feedback. AHCCCS will accept application documents for feedback through 10/6.
The TI 2.0 Application Portal Closes on 10/20/2023.
|Scope of Work
|TI 2.0 Justice Commitment Letter/ Application Template|
|One letter is required per clinic applying to the TIP 2.0 Justice Program signed by the provider CEO or equivalent AND the clinic’s justice partner(s). Download the TI 2.0 Justice Commitment Letter Template and upload it into the TI 2.0 Application Portal.|
Process Requirements 1-5
PROCESS REQUIREMENT 1 (PCP & BH)
Procedures for screening all members for health-related social needs (HRSN) and other conditions affecting whole person health, and coordinating referrals and engagement with other providers serving that member or available to provide needed services to members, including communication protocols with accessible resources to ensure effective care coordination to meet members’ comprehensive health needs.
|1.1A HRSN Screening Procedure|
|1.1A HRSN Screening Procedure: Justice/Legal Screening Question Examples
|1.1B-D HRSN Screening Procedure|
|1.1E-G HRSN Screening Procedure|
PROCESS REQUIREMENT 2 (PCP & BH)
Identification of accountable position(s) to pursue whole person care and population health initiatives.
PROCESS REQUIREMENT 3 (PCP & BH)
Protocols for utilizing member-centered, culturally sensitive, evidence-based practices in trauma-informed care.
PROCESS REQUIREMENT 4 (PCP - ONLY)
Policies for identifying, tracking, and coordinating care for high-risk members, particularly those with identified social risk factors, to best allocate resources, reduce redundancies, and improve member experience.
PROCESS REQUIREMENT 5 (PCP - ONLY)
Policies that demonstrate how a psychiatric provider is readily available for consultation and processes that explain how the clinics collaborate with the consultant and other providers to manage the member's care.