SED identification for youth
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Guidance on how children and adolescents under 18 are identified as having a Serious Emotional Disturbance (SED) for access to MHBG-funded services and related enrollment/portal processes; applies to AHCCCS-eligible youth, providers, ACC-RBHAs, and AHCCCS registered behavioral health providers in Arizona.
Effective October 1, 2025, to be eligible for an SED identification a child or adolescent under 18 must have a qualifying diagnosis and functional impairment caused by the qualifying diagnosis.
CALOCUS is required for determining qualifying functional impairment (levels 2-6), but is not required for children age 5 and under or certain FFS members (use code '99' in DUGless).
Qualified clinicians must complete a comprehensive assessment no later than seven business days after a request for SED identification unless a current (within 6 months) assessment exists.
SED Identification & Coverage Criteria
SED Identification Eligibility
Covered when ALL of the following are met:
SED identification eligibility
- Assessment timing: A qualified clinician completes a comprehensive assessment no later than 7 business days after a request for SED identification unless a current assessment within the previous 6 months accurately reflects current functioning7 business days
If a prior assessment within 6 months is accurate it may be used
- Functional impairment measurement: CALOCUS score of 2, 3, 4, 5, or 6 OR when CALOCUS is not available (children age 5 and under or specified FFS members) document functional impairment in the comprehensive assessment and enter '99' in DUGlessCALOCUS 2-6 or '99' entry
CALOCUS not validated for children age 5 and under; CALOCUS recommended but not required for some FFS members (AIHP/TRBHA/FES)
- Submission requirements: Qualified clinician submits the SED identification via the DUGless Portal and provides required member information (AHCCCS ID, first and last name, date of birth, effective date) and confirms active AHCCCS enrollmentcomplete member fields
Submission cannot be made if required information is missing or the youth does not have active enrollment; only AHCCCS-registered providers may submit
An SED identification is an administrative determination, not a clinical diagnosis. It does not serve as a diagnostic label; rather, it qualifies uninsured or underinsured children and adolescents for Mental Health Block Grant (MHBG) funding when they have a qualifying diagnosis and demonstrable functional impairment caused by that diagnosis.
Before submitting an SED identification, confirm the youth has active AHCCCS enrollment. AHCCCS has committed to updating the SED identification in the DUGless Portal by the next business day. If a youth already had a confirmed open enrollment with an AHCCCS ID at the time of the SED identification and there is no Behavioral Health code change, the youth did not meet the eligibility criteria.
CALOCUS & Entry Codes
| 99 | Enter when CALOCUS is not available (children age 5 and under or FFS members such as AIHP/TRBHA/FES) |
Submission, Documentation, and Funding Coordination
Submit SED identification via DUGless Portal
Submission of SED identification must be completed through the DUGless Portal by AHCCCS-registered providers who have completed DUGless Portal registration. The qualified clinician (AHCCCS registered provider) must search for the member under the Supplemental Data section, indicate SED identification (Yes) or removal (No), and provide AHCCCS ID, member name, date of birth, and effective date of SED identification when submitting.
- Only AHCCCS registered providers who completed DUGless Portal registration can submit.
- Search for the member under Supplemental Data in DUGless.
- Indicate identification = Yes or removal = No.
- Provide AHCCCS ID, first and last name, date of birth, and effective date.
Coordinate with ACC-RBHA for MHBG-funded services
ACC-Regional Behavioral Health Authorities (ACC-RBHAs) use Mental Health Block Grant (MHBG) funding as payor of last resort; providers must coordinate with the member's ACC-RBHA for access to MHBG-funded services and network/provider availability.
- MHBG funding is allocated to ACC-RBHAs for uninsured/underinsured youth and is payor of last resort.
- Contact the ACC-RBHA for network providers and service availability in the member's geographic area; see AMPM Policy 320 T1 and Exhibit 300-2B for more information.
Document comprehensive assessment and CALOCUS-based functional impairment
A qualified clinician must document a comprehensive assessment demonstrating a qualifying SED diagnosis and functional impairment; perform a CALOCUS assessment (levels 2–6 qualify) when available and enter '99' in DUGless and clearly document impairment in the assessment when CALOCUS is not available (children age 5 and under or specified FFS members).
- Complete comprehensive assessment no later than seven business days after a request unless a current assessment within six months accurately reflects functioning.
- Use CALOCUS to evaluate functional impairment; qualifying CALOCUS levels are 2, 3, 4, 5, or 6.
- If CALOCUS is not available (children age 5 and under or AIHP/TRBHA/FES FFS members), enter '99' in DUGless and document functional impairment clearly in the comprehensive assessment.
- Although AHCCCS does not require submission of the assessment or CALOCUS, both may be reviewed in Behavioral Health Clinical Chart Audits.
Verify active AHCCCS enrollment before DUGless submission
Providers must confirm the youth has active AHCCCS enrollment with a contracted health plan before attempting submission; DUGless will not accept a submission for youth without active enrollment.
- Confirm or establish active enrollment prior to completing an SED identification or removal in DUGless.
- Refer to enrollment guidance (Question 7) if needed.
Complete all required DUGless fields or submission will be blocked
Incomplete submissions will prevent processing: if required member information or required entries are missing, the qualified clinician will be unable to submit the SED identification in DUGless.
- Required fields include AHCCCS ID, first and last name, date of birth, effective date of SED identification, and either a CALOCUS score (2–6) or entry of '99' when CALOCUS is not available.
- Also ensure a qualifying SED diagnosis is provided; missing any of these items blocks submission.
Key Definitions
SED Designation & Level of Care
SED designation (affects access to MHBG-funded services)
SED designation determines access to MHBG-funded services and remains until removal or aging out:
- Continued eligibility: Ongoing documentation of functional impairment and clinical need per plan/provider reviewN/A
Removal requires submission in DUGless selecting 'No' or occurs when youth turns 18
MHBG-funded Behavioral Health Services
MHBG-funded behavioral health services
Access to services under MHBG is subject to availability and coordination:
Providers must contact the ACC-RBHA to confirm network providers, service availability, and any coordination required; see AMPM Exhibit 300-2B and AMPM Policy 320 T1 for related service details
Background & Context
SED identification is an administrative determination used to establish eligibility for MHBG-funded medically necessary services for uninsured or underinsured youth. It requires both a qualifying diagnosis and evidence of functional impairment attributable to that diagnosis. The determination is administrative and is distinct from a clinical diagnosis — it identifies funding eligibility and access to specified behavioral health services rather than providing a diagnostic label.
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