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January 25, 2023

AHCCCS Awards Contract for Serious Mental Illness and Serious Emotional Disturbance Eligibility Determinations

AHCCCS has awarded a contract to Solari, Inc. to maintain and improve the standardized processes used to determine eligibility for Arizonans who may have a Serious Mental Illness (SMI), and to standardize the Serious Emotional Disturbance (SED) determination process, in order to ensure that individuals with these designations are promptly identified and enrolled. Solari’s initial contract is from October 1, 2023 through September 30, 2026 with options to extend, but not to exceed a total contract period of five years. Solari, Inc. held the prior contract for SMI determinations.

Solari, Inc. will continue to make eligibility determinations for individuals who may have a SMI. The SMI designation process applies to individuals who are 18 years of age or older or request or consent to a determination; those who are age 17.5 and currently receiving behavioral health services; and individuals ordered to undergo a determination by a Superior Court in Arizona. Solari, Inc. will also provide clinical decertifications of SMI designations, and ensure that criteria is applied consistently in accordance with AHCCCS Medical Policy Manual Chapter 320-P Serious Mental Illness Eligibility Determination. For more information, see the SMI Eligibility Determinations Frequently Asked Questions.

Additionally, this contract adds processes for the vendor to make eligibility determinations effective October 1, 2023 for individuals who may have a SED. The SED designation process applies to individuals up to age 18 who, in the past year, have met criteria for a mental disorder and who display functional impairment that substantially interferes or limits their functioning in a family, school, employment, or community environment. For more information see the SED Eligibility Determinations Frequently Asked Questions.

The added SED eligibility determination process will standardize criteria for making these determinations which, until this point, had largely been the responsibility of clinicians. SED-designated children are a population with special health care needs who can receive services (in addition to Medicaid funded services) through the federal Mental Health Block Grant. Moving the determination process to a single vendor aligns with federal expectations and will help to ensure Arizona’s ability to support the needs of this population.

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