AHCCCS Contractor Operations Manual (ACOM)
Information Regarding COVID-19
In response to Medicaid-related questions from providers and contractors arising from the COVID-19 pandemic, AHCCCS has developed a list of Frequently Asked Questions (FAQs) Regarding Coronavirus Disease 2019 (COVID-19) which is updated regularly. It is important to note that there are instances where the information presented in the CMS-approved flexibilities and COVID-19 FAQs does not align with provisions set forth by the AHCCCS Contractor Operations Manual (ACOM). In these instances the CMS-approved flexibilities and FAQs take precedence and are controlling.
Name Change
Effective April 1, 2021 Comprehensive Medical and Dental Program (CMDP) will be changing to Comprehensive Health Plan (CHP). AHCCCS is in the process of revising all pertinent documents to reflect the new name.
The AHCCCS Contractor Operations Manual (ACOM) provides information applicable to the Managed Care Organization (MCO) Contractors. It consolidates and provides ease of access to the Administrative, Claims, Financial, and Operational policies of the AHCCCS Administration. The ACOM provides information to both the MCO Contractors and their subcontractors who have delegated responsibilities under a contract. The ACOM has authority in conjunction with Federal and State regulations, other Agency Guides and Manuals, and applicable contracts.
How to Submit Public Comments
AHCCCS provides up to a 45-day public comment period prior to publishing AHCCCS Contractor Operations Manual (ACOM) and AHCCCS Medical Policy Manual (AMPM) policies that have a substantial change. Should an expedited time period be required, the expedited time period will not be less than two weeks. Tribal members, stakeholders, and the general public are able to review and submit comments regarding changes being presented.
Click the link below to review policies currently posted for public comment.
The AHCCCS Contract and Policy Dictionary provides a centralized location for definitions that are found in the various ACOM and AMPM Policies. You may view the AHCCCS Contract and Policy Dictionary from our Guides and Manuals page at the following link: AHCCCS CONTRACT AND POLICY DICTIONARY.
To view ACOM Policies, select Policy from the ACOM Table of Contents below.
Note: Policies with a 10/01/24 Effective Date have been relocated above the current policy
- 100 - AHCCCS Contractor Operations Manual Overview
- 101 – 10/01/24 - Marketing
- Attachment A – 10/01/24 - Marketing Attestation Statement
- Attachment B – 10/01/24 - Marketing Activities Report
- 101 - Marketing
- 103 - Fraud, Waste and Abuse
- Attachment A - Representations and Certifications of Contractor
- Attachment A-1 - Disclosure Information - Disclosure of Ownership and Control
- Attachment B - Corporate Compliance Work Plan-Sample
- Attachment C - External Audit Plan Template
- 104 - Continuity of Operations and Recovery Plan
- 106 - Certification of MAOs Serving Dual Eligible Members
- 107 - State-Contracted MAO Dual Eligible Special Needs Plans
- 108 - AHCCCS Security Rule Compliance
- 109 - Institution for Mental Disease 15 Day Limit
- 110 - Mental Health Parity
- 111 - AHCCCS Pharmacy and Therapeutics Committee
- 301 - ALTCS E/PD Program Tiered Reconciliation
- 302 - Cost Settlement for Coronavirus Disease of 2019 Vaccine
- 303 - Community Reinvestment
- 304 – 10/01/24 - Premium Tax Reporting
- 304 - Premium Tax Reporting
- 305 – 10/01/24 - Performance Bond and Equity Per Member Requirements
- Attachment A – 10/01/24 - Performance Bond Annual Attestation Statement
- Attachment B – 10/01/24 - Performance Bond Form
- Attachment C – 10/01/24 - Instructions for Wire/ACH Transfers of Funds to AHCCCS via Arizona State Treasurer
- 305 - Performance Bond and Equity Per Member Requirements
- Attachment A - Performance Bond Annual Attestation Statement
- Attachment B - Performance Bond Form
- Attachment C - Instructions for Wire ACH Transfers of Funds to AHCCCS via Arizona State Treasurer
- 306 - Alternative Payment Model Initiative - Withhold and Quality Measure Performance Incentive
- Attachment A - Alternative Payment Model Quality Performance Measure Scores
- Attachment B - Federal Limit Test
- 306 - Alternative Payment Model Initiative - Withhold and Quality Measure Performance Incentive CYE23
- Attachment A - Alternative Payment Model Quality Performance Measure Scores
- Attachment B - Federal Limit Test
- 306 - Alternative Payment Model Initiative - Withhold and Quality Measure Performance Incentive (CYE 20 through CYE 22)
- Attachment A - ACC and EPD Contractors Alternative Payment Model Performance Measure Standards
- Attachment B - ACC and EPD Contractors Alternative Payment Model Performance Measure Scores
- Attachment C - Federal Limit Test
- 307 - Alternative Payment Model Initiative - Strategies and Performance-Based Payments Incentive
- 307 - Alternative Payment Model Initiative - Strategies and Performance-Based Payments Incentive CYE23
- 307 - Alternative Payment Model Initiative - Strategies and Performance-Based Payments Incentive (CYE 20 through CYE 22)
- Attachment A - Learning Action Network Alternative Payment Model Strategies
- Attachment B - CYE 20 - Alternative Payment Model Strategies and Performance Based Payments Incentive Certification
- Attachment B - CYE 21 - Alternative Payment Model Strategies and Performance Based Payments Incentive Certification
- Attachment B - CYE 22 - Alternative Payment Model Strategies and Performance Based Payments Incentive Certification
- Attachment C - Alternative Payment Model Strategies and Performance-Based Payments Incentive Performance Measure and Medical Loss Ratio Report
- Attachment D - Alternative Payment Model Strategies - Value Based Purchasing - Medical Loss Ratio Report
- 308 - Reconciliation of Title XIX Behavioral Health Prior Period Coverage Expenses for RBHAs
- 310 - Delivery Supplemental Payment
- 311 CYE 25 and Forward - ACC and ACC-RBHA Program Tiered Reconciliation
- 311 CYE 23 and CYE 24 - ACC and ACC-RBHA Program Tiered Reconciliation
- 311 - ACC Program Tiered Reconciliation (CYE19 through CYE22)
- 314 - Auto-Assignment Algorithm
- 317 – 10/01/24 - Change in Contractor Organizational Structure
- 317 - Change in Contractor Organizational Structure
- 321 - Reserved
- 323 - 10/01/24 - ACC-RBHA Non-Title XIX-XXI Profit Limit
- 323 - ACC-RBHA Non-Title XIX-XXI Profit Limit
- 323 - Regional Behavioral Health Authorities Title XIX/XXI Reconciliation (CYE 16 through CYE 22) and Non-Title XIX/XXI Profit Limit (SFY 17 through SFY 23)
- Attachment A - Non-Title XIX XXI Profit Limit - Example
- Attachment B - Maricopa County and Greater AZ Contractors Title XIX XXI Reconciliation - Example for CYE 09-30-XX
- Attachment C - Maricopa County and Greater AZ Contractors Title XIX XXI Reconciliation - Example for CYE 09-30-22
- 324 - Targeted Investments Program
- 325 - Targeted Investments 2.0 Program
- 326 - 10/01/24 - Fixed Administrative Cost Component Reconciliation for ACC and ACC-RBHA
- 326 - Fixed Administrative Cost Component Reconciliation for ACC and ACC-RBHA
- 327 - Pediatric Services Initiative
- 330 - Access to Professional Services Initiative
- 401 - Change of Contractor: AHCCCS Complete Care Contractors
- 402 – 10/01/24 - Member Transition for Annual Enrollment Choice and Eligibility Changes
- 402 - Member Transition for Annual Enrollment Choice and Eligibility Changes
- 403 - 10/01/24 - Enrollment Choice In A County With Choice And Change Of Contractor: ALTCS
- 403 - Enrollment Choice in a County with Choice and Change of Contractor: ALTCS Contractors
- 404 - 10/01/24 - Contractor Website and Member Information
- Attachment A - 10/01/24 - Organizations Recognized By AHCCCS
- Attachment B - 10/01/24 - Contractor Website Certification Checklist
- Attachment C - 10/01/24 - Member Information Attestation Statement
- 404 - Contractor Website and Member Information
- 405 - 10/01/24 - Cultural Competency, Family-Member Centered Care, and Language Access Plan
- 405 - Cultural Competency, Language Access Plan, and Family-Member Centered Care
- 406 - 10/01/24 - Member Handbook and Provider Directory
- Attachment A - 10/01/24 - Member Handbook Checklist
- Attachment B - 10/01/24 - Definitions For AHCCCS Members Pursuant to 42 CFR 438.10
- 406 - Member Handbook and Provider Directory
- 407 - Workforce Development
- 408 - Administration Actions
- 409 - Contractor Office of Individual and Family Affairs
- 412 - Claims Recoupment and Refunds
- 414 - Requirements for Service Authorization Decisions and Notices of Adverse Benefit Determination
- 415 – 10/01/24 - Provider Network Development and Management Plan; Periodic Network Reporting Requirements
- Attachment A – 10/01/24 - Network Attestation Statement
- Attachment B – 10/01/24 - Network Development and Management Plan Checklist
- Attachment D – 10/01/24 - Provider Changes Report
- Attachment F – 10/01/24 - Centers of Excellence Report and Checklist
- 415 - Provider Network Development and Management Plan; Periodic Network Reporting Requirements
- 416 – 10/01/24 - Provider Manual and Required Notifications
- 416 - Provider Information
- 417 – 10/01/24 - Appointment Availability, Transportation Timeliness, Monitoring, and Reporting
- Attachment A – 10/01/24 - Appointment Availability
- Attachment B – 10/01/24 - Transportation timeliness review
- 417 - Appointment Availability, Transportation Timeliness, Monitoring, and Reporting
- 418 - Provider and Affiliate Advances, Equity Distributions, Loans, and Investments
- 421 – 10/01/24 - Contract Termination: Nursing Facilities and Alternative Home and Community Based Services Settings
- 421 - Contract Termination Nursing Facilities and Alternative Home and Community Based Settings
- 423 - Financial Responsibility for Court Ordered Treatment for DUI/Domestic Violence or Other Criminal Offenses
- 424 - Verification of Receipt of Paid Services
- 425 - Social Networking
- 426 - CRS Application, Designation, and Coverage
- 429 - Direct Care Worker Training and Testing Program
- 431 - Copayment
- 433 – 10/01/24 - Member Identification Cards
- 433 - Member Identification Cards
- 434 - Coordination of Benefits and Third Party Liability
- 435 - Telephone Performance Standards and Reporting
- 436 – 10/01/24 - Network Standards
- 436 - Network Standards
- 437 - Financial Responsibility for Services after the Completion of Court-Ordered Evaluation
- 438 – 10/01/24 - Administrative Services Subcontractor Evaluation
- Attachment A - 10/01/24 - Administrative Services Subcontract Checklist
- Attachment B - 10/01/24 - Administrative Services Subcontractor Evaluation Report Template
- 438 – Administrative Services Subcontractor Evaluation
- Attachment A - Administrative Services Subcontract Checklist
- Attachment B - Administrative Services Subcontractor Evaluation Report Template
- 439 - Material Changes Provider Network and Business Operations
- 440 - Managed Care Expiration or Termination of Contract
- 442 - Opt Out Request for a Member with a Serious Mental Illness Designation
- 444 - Notice of Appeal Requirements (Serious Mental Illness Appeals)
- Attachment A - AHCCCS Notice of SMI Grievance and Appeal Procedure
- Attachment B - Notice of Legal Rights for Persons with Serious Mental Illness
- Attachment C - Notice of Decision and Right to Appeal (for Individuals with an SMI)
- Attachment D - Notice of Discrimination Prohibited
- 445 - Submission of Request for Hearing
- 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness
- 447 - Employment
- 448 - Permanent Supportive Housing
- 449 - Behavioral Health Services for Children in Department of Child Safety (DCS) Custody and Adopted Children
