Ariz. Admin. Code § 9-21-303

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-21-303 - Eligibility Determination and Initial Assessment

A. Upon receipt of a request or referral for a determination of whether an individual is eligible for services under this Chapter, a regional authority shall schedule an appointment for an initial meeting with the applicant by a qualified clinician, to occur no later than seven days after the regional authority receives the request or referral.

B. During the initial meeting with an applicant by a qualified clinician, the qualified clinician shall:

1. Obtain consent to an assessment of the applicant from the applicant or, if applicable, the applicant's guardian;

2. Provide to the applicant and, if applicable, the applicant's guardian, the information required in R9-21-301(D)(2), a client rights brochure, and the notice required by R9-21-401(B);

3. Determine whether the applicant is competent, according to R9-21-206;

4. If, during the initial meeting with an applicant by a qualified clinician, the qualified clinician is unable to obtain sufficient information to determine whether the applicant is eligible for services under this Chapter:

a. Obtain authorization from the applicant or, if applicable, the applicant's guardian, for release of information, if applicable;

b. Request the additional information the qualified clinician needs in order to make a determination of whether the applicant is eligible for services under this Chapter; and

5. Initiate an assessment according to R9-21-305.

C. The qualified clinician in subsection (B) shall obtain information necessary to make an eligibility determination, including:

1. Identifying data and residence, including a social security number if available;

2. The reasons for the request or referral for services;

3. The individual's psychiatric diagnosis;

4. The individual's present level of functioning, based upon the criteria set forth in the definition of "seriously mentally ill";

5. The individual's history of mental health treatment;

6. The individual's abilities, needs, and preferences for services; and

7. A preliminary determination as to the individual's need for special assistance.

D. If at any time during the course of the eligibility process the qualified clinician determines that the individual has a current case manager, a current assessment, or an ISP, the clinician shall notify the client's case manager and terminate the eligibility process.

E. To be eligible for behavioral health services or community services according to this Chapter the individual must be:

1. A resident of the state of Arizona, and

2. Seriously mentally ill.

F. The qualified clinician in subsection (B) shall determine whether an applicant is eligible for services under this Chapter and provide written notice of the SMI eligibility determination to the applicant or, if applicable, the applicant's guardian according to the following time-frames:

1. If the qualified clinician obtains sufficient information during the initial meeting with the applicant to determine whether the applicant is eligible for services under this Chapter, within three days of the initial meeting with the applicant by the qualified clinician;

2. If the qualified clinician does not obtain sufficient information during the initial meeting with the applicant to determine whether the applicant is eligible for services under this Chapter, at the earliest of:

a. Within three days of obtaining sufficient information to determine whether the applicant is eligible for services under this Chapter, or

b. The time provided according to R9-21-301(E).

G. At the time a qualified clinician provides an applicant with written notice of an SMI eligibility determination according to subsection (F), the qualified clinician shall:

1. Provide written notice to the applicant:

a. That the applicant has the right to appeal the SMI eligibility determination according to R9-21-401, including the right to an administrative hearing according to A.R.S. § 41-1092.03; and

b. That, if the applicant is not eligible for services according to this Chapter, the applicant may reapply at any time; and

2. If the applicant is eligible for services under this Chapter:

a. Serve as the client's case manager or arrange for the provision of case management services for the client; and

b. Initiate with the client the development of a clinical team that may include:

i. Behavioral health professionals,

ii. Professionals other than behavioral health professionals,

iii. Behavioral health technicians,

iv. Family members,

v. Paraprofessionals, and

vi. Any individual whom the qualified clinician and the client deem appropriate and necessary to ensure that the assessment is comprehensive and meets the needs of the client.

H. Nothing in this rule shall be construed to require the qualified clinician to make the determination of whether the applicant is eligible for services under the Arizona Health Care Cost Containment System Administration (AHCCCSA) according to A.R.S. Title 36, Chapter 29.

Ariz. Admin. Code § R9-21-303

Adopted under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, § 61, effective October 7, 1992; received in the Office of the Secretary of State October 14, 1992 (Supp. 92-4). Amended under an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 301, §61, effective September 30, 1993 (Supp. 93-3). Amended by exempt rulemaking at 9 A.A.R. 3296, effective June 30, 2003 (Supp. 03-2). Amended by final rulemaking at 22 A.A.R. 2019, effective 7/12/2016.