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.

EHR Requirement
Scope of Work
  • One Scope Of Work is required per provider organization that is currently connected to the HIE.
  • Contact your internal IT and/or Contexture representative to acquire a Scope Of Work.
HIE Commitment Letter
  • One letter is required per provider organization that does not have a Scope Of Work to connect to the new platform.
  • The organization’s CEO or equivalent must sign the HIE Commitment Letter Template.
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


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
Question Phrasing:
    • In the past year, have you spent more than 2 nights in a row in a jail, prison detention center, or juvenile correctional facility? (Located in the Optional section)
  • VI-SPDAT Single Adult:
    • In the past year, have you spent more than 2 nights in a row in a jail, prison detention center, or juvenile correctional facility? (Located in the Optional section)
  • VI-SPDAT Family:
    • Do you or anyone in your family have any legal stuff going on right now that may result in them being locked up, having to pay fines, or that make it more difficult to rent a place to live?
    • Are there any children that have been removed from the family by a child protection service within the last 180 days?
    • Do you have any family legal issues that are being resolved in court or need to be resolved in court that would impact your housing or who may live within your housing?
1.1B-D HRSN Screening Procedure
1.1E-G HRSN Screening Procedure


Identification of accountable position(s) to pursue whole person care and population health initiatives.


Protocols for utilizing member-centered, culturally sensitive, evidence-based practices in trauma-informed care.


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.


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.