How to Make a Referral

The following is the basic referral process for behavioral health services.

1. Determine the Needs of the Member.

Mercy Care Plan provides access to a variety of tools to help inform your decisions regarding behavioral health services.

Child/Adolescent Clinical Tool Kits

These AHCCCS tool kits are intended to assist a PCP in assessing the needs of a member age 5 to 17 years old regarding the following conditions and decisions regarding health care services provided by the PCP or subsequent referral to the RHBA if clinically indicated.

• ADHD
• Anxiety
• Depression

Adult Clinical Tool Kits

These AHCCCS tool kits are intended to assist a PCP in assessing the needs of an adult member regarding the following conditions and decisions regarding health care services provided by the PCP or subsequent referral to the RHBA if clinically indicated.

• ADHD
• Anxiety
• Depression
• Postpartum Depression

2. Refer the Member for Services.

To refer a member for behavioral health services, please fill out the appropriate form:

• For Magellan (Maricopa County only)
• All Other counties/RBHAs

Once the referral form is completed, please fax the form directly to the local RBHA. The RBHA fax numbers are as follows:

Magellan [Maricopa County RBHA]: (866) 892-5023
CPSA [Pima County RBHA]: (800) 443-0365
Cenpatico [RBHA for Grahman, Greenlee, Santa Cruz, Cochise, Pinal, Gila, Yuma and LaPaz Counties]: (800) 398-6182

3. Transition Care to a RBHA or the State Hospital.

When a member’s care is transferred to a RBHA provider, a seamless transition is important. This means continuing medications while the member is between providers and ensuring communication between providers so that there is no interruption in care.

For example, when a PCP has initiated medication management services for a member to treat a behavioral health disorder and the member is subsequently transferred to a RBHA, the PCP must give the member a prescription for enough medication — also known as bridge medication — so that there is no interruption in the medication regimen before the member’s first appointment with the RBHA provider. An MCP behavioral health coordinator is also assigned to assist in the transition of behavioral services.

When the PCP determines that the member should be transferred to a RBHA prescriber for evaluation and/or continued medication management services, the PCP should complete the following:

• Notification to the RBHA of the member’s current medications and timeframes for dispensing and refilling medications during the transition period,
• Notification to the RBHA of the reason for the transfer to the RBHA,
• PCP should forward all relevant medical records to the RBHA prior to member’s first scheduled appointment with the RBHA prescriber, and
• Medical records should be forwarded to the RBHA during the transfer and include at minimum the following: Diagnostic information, Medical history, medication history and all current prescriptions that have been provided for the member

PCPs should maintain documentation in the member’s medical record related to:

• Ongoing treatment during the transition period;
• The date that the member was referred;
• The reason the member was referred;
• Receiving contact name and pertinent information;
• The date that the medical record was forwarded to the RBHA; and
• Any other pertinent information.

For members needing to be admitted to the Arizona State Hospital for behavioral health treatment, a Maricopa Integrated Health System PCP will be assigned.

4. Transferring Behavioral Health Care from the RBHA back to the PCP.

When a RBHA is treating a member for ADHD, anxiety, depression, or postpartum depression and the member has stabilized, a step therapy program may be put in place to transfer care back to the PCP. The PCP has the option to agree to the transition to treat the behavioral health disorder. If you don’t agree with the transition, the member may stay with the RBHA or find another PCP who is willing to treat the condition.

When the member is referred back to the PCP by the RBHA for the treatment of anxiety, depression or ADHD, the PCP needs to provide the same medication at the same dose as the RBHA, unless there was a subsequent change in medical condition of the member. Further, if the member/parent reports the member having tried several medications/have participated in step therapy for anxiety, depression or ADHD, the PCP should consult, or obtain information from, the member’s previous RBHA provider prior to the current treatment regime.

The RHBA will notify the Mercy Care behavioral health coordinator of the transition, and the coordinator will assist in transitioning behavioral services. The coordinator is available to answer your questions at any time. You can call (602) 263-3000 to speak with the behavioral health coordinator.