A.R.S. § 36-2979.03: Enrollment in pilot program; application; delegation of clinical eligibility; waitlist management

(Conditionally Rpld.)

A. An individual who seeks to enroll in the pilot program shall apply through the individual's contractor. After determining the individual meets the SMI enhanced level of care criteria, the contractor shall forward the application to the administration for financial eligibility determination pursuant to section 36-2979.02, subsection B. If the individual is not yet enrolled with a contractor, the individual may apply through the administration.

B. Subject to the approval of the centers for medicare and medicaid services, available appropriations and the enrollment cap prescribed in section 36-2979.01, subsection F, the administration may delegate to contractors the authority to determine whether an applicant meets the SMI enhanced level of care criteria adopted by the administration pursuant to section 36-2979.02, subsection E and to manage pilot program waitlists, enrollment decisions and capacity prioritization for individuals who have been determined financially eligible by the administration.

C. The administration or a contractor exercising delegated authority under this section shall:

1. Apply the eligibility criteria adopted by the administration pursuant to section 36-2979.02.

2. Implement and maintain one or more waitlists, the total of which may not exceed one hundred applicants, for applicants for whom eligibility has been determined.

3. If the waitlist reaches one hundred applicants, implement an interest list for additional applicants and employ phased enrollment or other utilization controls as necessary to ensure that the enrollment cap prescribed in section 36-2979.01, subsection F is not exceeded.

4. Assign available pilot program capacity by applying the priority factors prescribed in subsection D of this section.

5. Report enrollment data to the administration in the form and frequency required by the administration by policy.

D. If the number of financially and clinically eligible individuals exceeds available pilot program capacity, the contractor shall assign available slots based on the highest clinical acuity and functional impairment defined by a methodology that takes into account the following priority factors:

1. Individuals under court-ordered treatment.

2. Individuals with legal guardianship due to psychiatric incapacity.

3. Individuals recently discharged from jail or prison, the state hospital or a behavioral health residential facility.

4. Individuals who are homeless or at imminent risk of homelessness.

5. Individuals with repeated crisis episodes, psychiatric hospitalizations or public safety involvement.

6. Individuals presenting significant safety risks due to psychiatric symptoms.

7. Individuals with high-intensity or complex psychotropic medication regimens requiring enhanced monitoring to ensure adherence and to identify potential adverse effects.

E. The administration shall retain authority to review and reverse contractor clinical eligibility and enrollment determinations and to audit contractor compliance with eligibility and enrollment requirements.

F. The administration may reserve a portion of available enrollment capacity for emergency or priority placements.