CurrentOptumPolicy BH803AZ062025

Arizona Medicaid Supplemental Clinical Criteria — Behavioral Health

State-specific supplemental clinical criteria for behavioral health services under Arizona Medicaid managed by Optum, describing medical necessity, provider qualifications, and prior/continued authorization requirements for covered behavioral health programs and services.

Policy Summary

PayerOptum

PolicyArizona Medicaid Supplemental Clinical Criteria — Behavioral Health

Policy CodePolicy BH803AZ062025

Change TypeNo material changes

Effective DateJun 1, 2025

Next Review Date

Key ActionObtain prior and continued authorization for ABHTH per ACOM Policy 414 before billing; document individualized treatment plans and required progress reports.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

per diemABHTH payment basis

90 daysRecency window

30 daysABHTH plan timeline

8 hrs/dayH2014/H2017 daily max

AHCCCS coveredABA coverage

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Coverage and Medical Necessity Criteria

inv-01: ABHTH Admission

Covered when ALL of the following are met for admission to ABHTH:

ABHTH Admission Criteria: Recommendation for ABHTH comes through the ART process; assessment by a licensed Behavioral Health Professional documents a behavioral health diagnosis with symptoms/behaviors justifying ABHTH; within the past 90 days the member has had a disturbance of mood, thought, or behavior rendering them incapable of independent or age-appropriate self-care or self-regulation (moderate functional/psychosocial impairment); needs cannot reasonably be expected to improve with a less intensive level of care OR the member does not meet clinical criteria for a higher level of care OR appropriate treatment in a less restrictive environment has been unsuccessful or unavailable; at admission there is a documented discharge plan developed with the Health Care Decision Maker and relevant stakeholders including tentative disposition/living arrangement and aftercare recommendations.

inv-02: ABHTH Continued Stay

Continued stay in ABHTH requires ALL of the following:

ABHTH Continued Stay Criteria: Member continues to meet the diagnostic threshold for the behavioral health condition that warranted admission; continues to demonstrate (within the last 90 days) moderate functional or psychosocial impairment from disturbances of mood, thought, or behavior substantially impairing independent or appropriate self-care/self-regulation; active treatment is reducing the severity of identified disturbances and is empowering skill gains to function in the community; there is an expectation that continued treatment at ABHTH will improve the member's condition so this service will no longer be needed; the ART meets at least monthly to review progress and revise the Treatment Plan and/or Service Plan as needed.

inv-03: ABHTH Discharge

Discharge from ABHTH when ANY of the following are met:

ABHTH Discharge Criteria: Sufficient symptom or behavior relief as evidenced by completion of ABHTH treatment goals; member's functional capacity has improved so they can be safely cared for in a less restrictive level of care; member can participate in needed monitoring and follow-up or a provider is available to provide monitoring at a less restrictive level; appropriate services, providers, and supports are available to meet the member's current behavioral health needs at a less restrictive level; there is no evidence continued ABHTH would improve the member's clinical outcome; or continued stay presents risk of regression or decompensation.

inv-04: Behavior Analysis (ABA) Coverage

Behavior Analysis Services (ABA) covered when ALL of the following are met:

ABA Coverage Criteria: Services are based on assessments (standardized and/or non-standardized) using direct and indirect methods; an individualized behavior analysis treatment plan is developed by a Behavior Analyst specifying settings, modality (in-person/telehealth, group/individual), baseline target behaviors, measurable long‑ and short‑term objectives, criteria for progress, assessment and treatment protocols, schedule/roles for service delivery, and training/supervision requirements; frequent data review and plan adjustments are performed by the LBA with recommendations on intensity/duration; training, supervision, and fidelity evaluation for BCaBA/trainees/technicians and caregiver training/support are included; care coordination to generalize and maintain targets is documented; progress reports are produced at minimum every six months.

Behavior Analysis Services are an AHCCCS covered benefit for individuals with ASD and other diagnoses as justified by medical necessity.

inv-05: Family Support — Admission

Family Support Admission Criteria — covered when ALL of the following are met

Family/Parent Provider Certification: Individuals seeking certification/employment as a Parent/Family Support Provider or Trainer must have lived experience as a primary natural support for an adult with emotional, behavioral, mental health or substance use needs and meet requirements to function as a behavioral health professional, technician, or paraprofessional.

Service Delivery Staffing: Home care training and family support services must be provided by certified behavioral health professionals, behavioral health technicians, or behavioral health paraprofessionals as defined in policy (including licensed BHPs, behavior analysts, psychiatrists, psychologists, physicians, and qualified nurses where applicable).

Medical Necessity: Services are considered medically necessary regardless of diagnosis when documented behaviors or symptoms indicate benefit from behavioral health services and a valid ICD-10-CM code is used.

inv-06: Provider Case Management — Admission/Delivery/Billing

Provider Case Management — covered when ALL of the following are met

Need for assistance: Assistance is required to maintain, monitor, or modify covered services; brief telephone or face‑to‑face contacts are needed to maintain or enhance functioning; help is needed finding resources to meet basic needs; outreach, follow‑up of crisis contacts and missed appointments, and coordination with medical, dental, community resources, educational, social, judicial, and state agencies are necessary.

Service planning and documentation: The responsible Provider Case Manager completes an initial evaluation of case management needs and, with the treatment team and when possible the member, develops a service plan describing recovery/resiliency goals, strengths, problems, specific measurable goals, and interventions; the Case Manager may advocate for the member with permission and uses the initial clinical evaluation to inform the plan.

Billing limitations: Case management services provided in DLS licensed inpatient, residential, or day program settings are included in the facility rate and generally cannot be billed separately; a single provider may not bill case management time associated with a therapeutic interaction nor bill simultaneously with another service; multiple providers/agencies may bill when simultaneously providing case management (e.g., staffings) per policy rules; transportation is billed separately when applicable.

inv-07: Therapeutic Foster Care — Admission, Continued Stay, Discharge

Therapeutic Foster Care (TFC) — covered when ALL of the admission criteria are met

CFT recommendation and assessment: Recommendation for TFC must come through the Child and Family Team (CFT) process and follow assessment by a licensed Behavioral Health Professional confirming a behavioral health diagnosis that reflects symptoms/behaviors warranting TFC.

Recent functional impairment: Within the past 90 days the member has had a disturbance of mood, thought, or behavior rendering them incapable of independent or age‑appropriate self‑care or self‑regulation (moderate functional/psychosocial impairment) as identified by a BHP.

Level of care necessity: Because of the condition the member (1) cannot reasonably be expected to improve with a less intensive level of care, or (2) does not require a higher level of care, or (3) demonstrates appropriate treatment in a less restrictive environment was unsuccessful or unavailable, thereby warranting TFC.

Continued stay:

inv-08: Pre-Job Training and Development — Admission

Pre-Job Training and Development — covered when member demonstrates need in at least one listed employment preparation area

Areas of need: Member demonstrates need for pre‑job training in one or more areas such as career/educational counseling, job shadowing, assistance using educational resources, resume preparation, job interview skills, study skills, work activities, professional decorum/dress, time management, assistance finding employment, job training, Work Adjustment Training (WAT), or attendance at RSA/VR information sessions or job fairs.

inv-09: Peer and Recovery Support — Definition and Provider Qualifications

Peer and Recovery Support — coverage stance and service intent

Definition and intent: Peer and Recovery Support are intentional partnerships based on shared lived experience coupled with skill‑based training, coaching, or assistance to support social and personal change; services help members utilize service systems, cope with disability stressors, and pursue individualized goals (living preferences, employment/education, social networks); services may be individual, group, or family‑focused and aim to promote long‑term recovery.

Provider qualifications: Services must be provided by individuals trained, credentialed, and qualified to provide peer/recovery support services within AHCCCS programs per Contractor requirements.

inv-10: Initial Admission

Admission Criteria for Skills Training and Development (H2014) and Psychosocial Rehabilitation (H2017): Covered when ALL of the following are met

Admission criteria: Member has a DSM‑5‑TR diagnosis and an assessment documenting current symptoms, functional impairments, and service needs that form the basis for the service plan.

Functional impairments: Documentation of daily functional impairments that prevent independent living or community participation (including self‑care, household management, appropriate social engagement, friendships/relationships, exposure to exploitation, budgeting, recreation, development of social supports, and use of community resources).

Service plan: Specific rehabilitative H2014 and/or H2017 services and recovery‑oriented goals are identified and documented in the member's service plan.

Risk without services: Documentation that without these services the member is at risk of relapse, homelessness, eviction, or other major life disruption.

inv-11: Continued Therapy

Continued Service Criteria: Services continue only when ALL of the following conditions are met

Continued admission: Member continues to meet the admission criteria for H2014 and/or H2017 services.

Appropriate level: Member does not require a more intensive level of service and no less intensive service is appropriate to meet the member's needs.

Likelihood of benefit: There is a reasonable likelihood of continued benefit demonstrated by improvement in functional areas according to service plan goals.

Progress toward goals: Member is making progress toward rehabilitation goals; interventions, frequency, crisis/safety planning, and targeted discharge are outlined and adjusted as needed; the service plan is updated to reflect current active rehabilitation goals.

inv-12: Discharge

Discharge Criteria: Discharge when ANY of the following apply

Discharge conditions: Member has made significant progress toward service plan goals or another more appropriate level of care has been identified; presenting impairments and relapse potential are stabilized so the member can be managed without H2014 and/or H2017 services; or alternative support systems are secured to help the member maintain stability and independence in the community.

Admission to an Adult Behavioral Health Therapeutic Home (ABHTH) must not be used as an alternative to detention or incarceration. ABHTH placement is not appropriate when the primary need is secure custody or community safety for conduct-disordered behavior, nor should it be used to provide housing, shelter, supervision, or permanent placement in lieu of appropriate social services. If less restrictive treatment alternatives exist that meet the member’s clinical needs (or the member/health care decision maker is unwilling to participate in those alternatives), ABHTH admission is excluded.

Family support and provider case management services that are delivered within a DLS‑licensed inpatient, residential, or therapeutic/medical day program are included in the facility’s rate and generally may not be billed separately by that facility. Exceptions may apply per AHCCCS billing rules where noted; other non-facility providers may bill case management for services to members residing in or transitioning out of such settings when permitted by AHCCCS requirements.

Transportation for members and/or family members is not included in the service rate for ABHTH or related behavioral health services and must be billed separately using the appropriate transportation procedure codes per AHCCCS billing rules.

Use of ABHTH as a substitute for incarceration, as a means of providing housing or shelter, or whenever less restrictive alternatives are available and meet the member’s needs is explicitly excluded and therefore not medically necessary. Placement in ABHTH requires that clinical need, not social placement or custody considerations, drive the level‑of‑care decision.

Case management time that is associated with a therapeutic interaction may not be billed as case management, and a single provider may not bill case management simultaneously with another service for the same time period. These simultaneous‑billing limitations apply to prevent duplicate payment for therapeutic activities and will be subject to denial if billing rules are not followed.

Services that are not individualized, not consistent with the member’s documented behavioral health needs, furnished primarily for convenience, or where an equally effective, less costly option is available statewide may be denied as not medically necessary. Providers must ensure services are specific to assessed needs and documented in the service plan to avoid payment denials.

Billing Codes and Limits

Rehabilitation HCPCS CodesHCPCSCovered

H2014	Skills training and development, per 15 minutes
H2017	Psychosocial rehabilitation services, per 15 minutes

Recency of disturbance — within the past 90 days

Recency requirementMember must have had a disturbance of mood, thought, or behavior within the past 90 days that renders them incapable of independent or age‑appropriate self‑care or self‑regulation.

Use in admission/continued stay determinationsThe 90‑day window is applied to both ABHTH admission and continued‑stay criteria to document recent functional/psychosocial impairment.

Assessment sourceDisturbance must be documented via assessment by a licensed Behavioral Health Professional (BHP).

Daily service limit — Up to 8 hours per day

Daily maximumH2014 and H2017 services may be furnished up to 8 hours per day (billed per 15‑minute units).

Billing unit

Authorization, Documentation, and Billing Requirements

Prior Authorization

Prior Authorization Required

Prior and continued authorization is required for Adult Behavioral Health Therapeutic Home (ABHTH) services. These services are billed as a per diem (24-hour day) rate and do not include room and board under the Arizona State Plan. Contractors must follow ACOM Policy 414 for prior authorization timeframes and requirements.

ABHTH requires prior and continued authorization.
Services are per diem and exclude room and board (Arizona State Plan).
Refer to ACOM Policy 414 for prior authorization timeframes and requirements.

Documentation Required

TFC Admission Requirement

TFC admission must be recommended through the Child and Family Team (CFT) process and follow assessment by a licensed Behavioral Health Professional (BHP). At admission there must be documented discharge and transition planning developed with the Health Care Decision Maker and stakeholders.

Program Background and Context

Adult Behavioral Health Therapeutic Homes (ABHTH) are licensed community residences that provide daily behavioral interventions and assistance with self‑administration of medication and other ancillary supports in a family‑style licensed setting. ABHTHs deliver structured, therapeutic supports intended to maximize independent functioning rather than serve as housing or custodial placements.

Key Terms and Role Definitions

ABHTH definition — Adult Behavioral Health Therapeutic Home definition

DefinitionA licensed residence providing daily behavioral interventions within a licensed family setting to maximize community participation and independent functioning, including assistance with self‑administration of medication and ancillary services as indicated by the member's Treatment/Service Plan.

Programmatic supportProgrammatic support available to ABHTH providers 24 hours per day, seven days per week through the CHI.

Payment and authorizationCare and services are paid on a per‑diem (24‑hour day) basis, require prior and continued authorization, and do not include room and board per the Arizona State Plan for Medicaid.

Behavior Analysis Services — definition and scope

Purpose and scopeBehavior Analysis Services are AHCCCS‑covered for ASD and other diagnoses when medically necessary to increase functional/adaptive skills, teach new behaviors, increase independence, and reduce behaviors that interfere with health.

Level-Specific Admission, Continued Stay, and Discharge Criteria

Applied Behavior Analysis Requirements

inv-47: Applied Behavior Analysis Criteria

ABA services must be individualized, assessment-driven, and overseen by qualified Behavior Analysts.

ABA Assessment and Plan: Assessments include standardized and non‑standardized instruments using direct and indirect methods; the Behavior Analyst develops an individualized behavior analysis treatment plan specifying objectives, baselines, settings, modality, progress criteria, protocols, schedule, supervision, and caregiver training; the LBA adjusts intensity and duration based on data; progress reports are produced at minimum every six months; provider qualifications require oversight by a Behavior Analyst with responsibility for supervision, training, and clinical direction.

inv-48: Applied Behavior Analysis (ABA) — additional ABA criteria node

Service Administration for ABA: Treatment plan must specify setting, modality (in‑person/telehealth, group/individual), frequency/intensity/duration, data review, LBA supervision and adjustments, training/supervision for implementers, caregiver training, and coordination to support generalization and maintenance.

Program and Service Modalities

inv-49: Therapeutic Foster Care (TFC) — modality-specific node

TFC best practices: TFC requires 24/7 direct supervision by the TFC provider, ongoing training/supervision and support, participation in CFTs/IEPs/court hearings, documentation of behavior and progress per Service Plan, support for family contact and permanency planning, cultural/language matching considerations, assessment of household composition (including pets), medical needs, and geographic proximity to supports.

inv-50: Peer and Recovery Support Services — modality-specific node

Peer and Recovery Support Service elements: Service elements include instilling hope and recovery principles, sharing lived recovery experience, advocacy and systems navigation, psychiatric rehabilitation skills (strengths‑based, trauma‑informed care, motivational interviewing), group facilitation, CLAS standards, confidentiality/HIPAA and professional boundaries, and fostering member‑driven, person‑centered planning.

Service Frequency and Visit Limits

Behavior Analysis Services — progress report minimum frequency

Minimum frequencyBehavior Analysis Services require progress reports at minimum every six months that include member identification, assessment findings, outcomes, treatment dosage, and care coordination details.

Report contentProgress reports must include background information, assessment findings, measurable outcomes and progress, clinical recommendations, treatment dosage, family role, and transition/discharge planning.

OversightReports and adjustments must be consistent with professional behavior analysis standards and Arizona licensure/regulatory requirements.

Family support / home care training — Travel time included in rates where applicable

Travel time billingWhere applicable, provider travel time for family support/home care training is included in the service rates per core provider travel billing limitations.

Policy Summary

PayerOptum

PolicyArizona Medicaid Supplemental Clinical Criteria — Behavioral Health

Policy CodePolicy BH803AZ062025

Change TypeNo material changes

Effective DateJun 1, 2025

Next Review Date

Key ActionObtain prior and continued authorization for ABHTH per ACOM Policy 414 before billing; document individualized treatment plans and required progress reports.

SourceLink

On This Page

For continued TFC the member continues to meet diagnostic threshold, there is expectation that continued TFC will improve the member's condition so TFC will no longer be needed, the CFT meets at least monthly to review progress and revise the TFC treatment plan/ISP, and a transition caregiver is identified and actively involved when applicable.

Ongoing impairment and progress: Member continues to demonstrate (within the last 90 days) moderate functional or psychosocial impairment from disturbances of mood, thought, or behavior; active treatment is reducing severity of disturbances and TFC is enabling skill acquisition for community functioning.

Discharge criteria: Discharge when treatment goals are completed and symptom/behavior relief achieved; functional capacity has improved permitting less restrictive care; member can participate in follow‑up or a caregiver is available; appropriate supports/providers are available at a less restrictive level; there is no evidence continued TFC will improve outcomes; or continued stay may risk regression or decompensation. CFT review and assessment is required prior to discharge or escalation to a higher level of care.

High service need: Member's impairments and symptoms require frequent contact with crisis teams, emergency settings, the justice system, additional providers, or other services/supports indicating high service need.

Assessment frequency: A comprehensive assessment must be completed at least annually to inform or update the service plan and to justify ongoing medical necessity and continued placement in the least restrictive environment.

Services billed per 15‑minute unit (H2014/H2017).

Group exceptionH2014/H2017 group services at AHCCCS registered sites are not subject to core group size limit (see group ratio guidance).

Recommendation for TFC must come through the CFT process.
Assessment by a licensed BHP documenting diagnosis and functional impairments is required.
Documented discharge/transition plans (tentative disposition and aftercare recommendations) are required at time of admission.

Step Therapy

Step-Up Requirement for TFC

TFC admission requires evidence that the member's condition cannot reasonably be expected to improve with a less intensive level of care and that less restrictive treatment has been unsuccessful or unavailable.

Documentation that needs cannot be met in a less intensive level of care is required for admission.
Evidence that appropriate treatment in a less restrictive environment has not been successful or is not available must be provided.

Billing Rule

Prior Authorization and Billing for H2014 / H2017

Specific rehabilitative services H2014 (Skills Training and Development) and/or H2017 (Psychosocial Rehabilitation) must be identified in the member's service plan and billed per AHCCCS rules. Services must be individualized, consistent with documented behavioral health needs, and not exceed member needs.

H2014 and H2017 must be documented with specific goals in the service plan.
Services are individualized, specific, and consistent with symptoms or confirmed diagnosis.
Transportation is not included in the rate and must be billed separately.

Billing Rule

Billing Exclusion in Licensed Settings

Services provided in DLS-licensed inpatient, residential, or day program settings (including family support and case management when applicable) are included in the facility rate and may not be billed separately unless an exception applies per AHCCCS billing rules.

Family support services in DLS licensed inpatient, residential or day program settings are included in the rate and cannot be billed separately (with exceptions per AHCCCS).
Case management services in these settings are included in the rate and cannot be billed separately; external providers may bill case management when providing services to persons residing in or transitioning out of those settings.

Denial Risk

Billing Denials Risk

Billing submissions risk denial if services are not individualized, not supported by the service plan, inconsistent with the member's documented behavioral health needs, or otherwise not medically necessary. Ensure documentation supports the frequency, intensity, and type of service billed.

Claims may be denied if services are not individualized or consistent with the service plan and documented needs.
Services must be medically necessary and no equally effective, more conservative, or less costly alternative should be available statewide.

Documentation Required

Required Treatment Planning and Reporting

ABHTH and ABA treatment planning requirements: an ABHTH Treatment Plan must be developed within 30 days of placement and reviewed at least quarterly; treatment plans must be detailed, measurable, identify responsible individuals, coordinate with ART/CFT plans, and be provided to the member/health care decision maker.

ABHTH Treatment Plan developed by the CHI with the ABHTH Provider and ART within 30 days.
Treatment Plan must be reviewed at minimum quarterly and revised as appropriate.
Progress reports (e.g., ABA) and data review must be maintained; ABA protocols require frequent review of target behavior data and fidelity monitoring.

Documentation Required

Case Management Evaluation and Service Plan

The responsible Provider Case Manager must complete an initial case management evaluation at admission and develop a service plan describing recovery/resiliency goals, strengths, problems, measurable goals, and interventions. The service plan may be informed by the initial clinical evaluation and should guide coordinated care.

Initial evaluation of case management needs is required upon admission.
Service plan must include goals, strengths, problems, measurable objectives, and interventions.
Case management billing restrictions: cannot bill for time associated with a therapeutic interaction or simultaneously with other services in certain settings.

Authorization and dosingServices are prescribed/recommended in specific dosages, frequency, intensity, and duration by a qualified Behavioral Health Professional following assessment of the member and treatment targets.

Service componentsMust be assessment‑driven with an individualized behavior analysis treatment plan, frequent data review, plan adjustments by the LBA, staff/caregiver training, care coordination, and progress reports at minimum every six months.

Behavioral Health Professional — definition and licensing scope

DefinitionBehavioral Health Professional (BHP): an individual licensed under A.R.S. Title 32, Chapter 33 whose scope allows independent practice or practice under supervision (includes psychiatrists, psychologists, physicians, behavior analysts, psychiatric nurse practitioners, and registered nurses with psychiatric certification or one year behavioral health experience).

RoleBHPs perform assessments, diagnose behavioral health conditions, and authorize or oversee services such as ABHTH admission, TFC assessment, and individualized treatment planning.

Supervisory scopeBHPs provide clinical oversight for Behavioral Health Technicians and Paraprofessionals per institutional policies and regulatory standards.

Behavioral Health Technician — definition

DefinitionBehavioral Health Technician: an individual who is not a BHP who provides behavioral health services at or for a health care institution according to the institution's policies and procedures, with clinical oversight by a Behavioral Health Professional.

Practice contextIf services were provided outside a licensed health care institution, the individual would be required to be licensed as a behavioral health professional under A.R.S. Title 32, Chapter 33.

SupervisionTechnicians deliver services under clinical oversight of a licensed BHP and as specified by institutional policies and training requirements.

Behavioral Health Paraprofessional — definition

DefinitionBehavioral Health Paraprofessional: an individual who is not a behavioral health professional who provides behavioral health services at or for a health care institution according to the institution's policies and procedures.

ScopeParaprofessionals deliver services under institutional policies and clinical supervision by a Behavioral Health Professional as required.

Use casesMay be used to deliver skills training, psychosocial rehabilitation, or family/home care training when qualified and supervised per policy and regulatory requirements.

Peer and Recovery Support Services — definition and intent

DefinitionPeer and Recovery Support Services: intentional partnerships based on shared lived experience, coupled with specific skill‑based training, coaching, or assistance to promote social or personal change and long‑term recovery.

Service elementsServices include assistance with navigating service systems, developing plans of care, accessing supports, coping with disability stressors, group facilitation, coaching, mentoring, and support for employment/education and social network development.

Delivery and qualificationsServices may be provided individually, in groups, or to families and must be delivered by individuals trained, credentialed, and qualified per Contractor requirements.

Unskilled Respite — definition (short-term behavioral health services or general supervision)

DefinitionUnskilled Respite: short‑term behavioral health services or general supervision providing rest or relief to a family member or caregiver; may range from a few hours during the day to overnight stays and may be planned or unplanned.

PurposeProvides an interval of rest/relief to family or primary caregivers and includes activities to meet the social, emotional, and physical needs of the recipient during the respite period.

AssessmentIf unplanned respite is needed, agency personnel assess the situation with the caregiver and recommend the appropriate respite setting.

Family support services provided in certain licensed settings are included in facility rates and subject to billing rules and exceptions per AHCCCS guidance.

Multiple billingMore than one provider agency may bill for home care training family services at the same time if clinically indicated and documented.

H2014/H2017 (per 15-minute unit) — Up to 8 hours per day

Daily limitH2014 (Skills training and development) and H2017 (Psychosocial rehabilitation) are billed per 15‑minute unit and may be provided up to 8 hours per day.

Billing unitsBoth codes are payable in 15‑minute increments; ensure documentation of individualized service plan, frequency, and medical necessity for prior authorization when required.

Concurrent billingMultiple agencies may bill simultaneously for skills training services if clinically indicated and documented in the comprehensive assessment and treatment plan.

In-person group services at AHCCCS registered provider site — Group size up to 1:20

Allowed group size at registered siteIn‑person group services provided at an AHCCCS registered provider site shall not exceed a 1:20 ratio (group size up to 1:20).

Group limit exceptionH2014 and H2017 are not subject to the core billing group limit when provided in person at an AHCCCS registered provider site, but the 1:20 maximum applies.

DocumentationGroup services must be individualized, consistent with the member's diagnosis and service plan, and documented in the treatment plan and comprehensive assessment.