1. The SMI Evaluation and Determination Process

2. Eligibility and Care Services
On January 1, 2014, Crisis Response Network became the entity responsible for the Serious Mental Illness (SMI) determination process for Maricopa County
Effective October 1, 2015, DBHS designated CRN responsible for all SMI determinations in Arizona
As of July 1, 2016, AHCCCS and DBHS merged, but the standards for receiving SMI services did not change. It is CRN’s role to evaluate whether applicants meet the diagnostic and functional criteria required by the State for SMI eligibility

3. The Determination Process
An applicant meets with a qualified assessor
The assessor submits the SMI packet to CRN via web portal within one business day
CRN has either three, 20, or 90 days to make the determination (if given the consent to pend)
After the decision has been made, a notice is sent to the applicant and an notification is sent to the assessor

4. Packet Submissions: What is a Complete Packet?
Required Forms:
Consent for Assessment
Seriously Mentally Ill (SMI) Determination Form
Core Assessment
Additional Documents:
Waiver of Three Day Determination Form
Release of Information (ROI)
Data Disposition Sheet

5. Consent for Assessment
Chart cannot be processed without this consent
This form starts our timelines; NOT the date on the SMI determination form
AHCCCS requires providers submit the packet within one business day from the date of consent
Client must initial the appropriate line in addition to signing the form
If the client has a legal guardian, they must sign this form
A client who is not yet 18 cannot consent. Please assure you are submitting with enough time for a decision to be made prior to the client’s 18th birthday.

6. Waiver of Three Day Determination Form
A decision will be made within three days of submission: SMI, Non-SMI, or Pend (20/90)
If the client has a treatment history outside of your agency, it is in their best interest to allow the 20 day pend (releases of information must also be submitted)
90 day pend (EEP) is utilized for clients with a substance use diagnosis/concern. The client will be enrolled in an EEP program through your agency for 90 days year olds cannot participate in EEP
The client can choose 20 AND 90 days allowing the doctor more options
Check the appropriate box and have the client sign.
If this form is not submitted, the determination will be made in 3 days

7. Releases of Information (CRN)
Please fill out section two completely
If the client has elected to pend for records, you must include a release of information for any previous treating providers the client indicates
Please fill out as much information as possible for the provider: Full name (as opposed to Dr. Smith), address, phone
If there is an emergency contact, family member, friend, or any other person the client would like involved in their case, they must be included on the ROI

8. Seriously Mentally Ill (SMI) Determination Form
Can be completed by a BHT, but must be signed by BOTH the BHT and a BHP
Section 1(a) should be used to provide client specific symptoms related to the qualifying diagnosis
If there is no qualifying diagnosis, write that here
Functional criteria checked in categories (a), (b), or (c) must be related to the qualifying diagnosis.

9. Seriously Mentally Ill (SMI) Determination Form
Check all applicable criteria in categories (a), (b), and (c)
For every functional criteria checked, provide a description in the box provided with examples specific to the client

10. Seriously Mentally Ill (SMI) Determination Form
The risk of deterioration category should only be used for clients who DO NOT meet functional criteria currently
If you have checked any of the functional criteria in categories (a), (b), or (c), you would not use risk of deterioration
Explain the client’s risk here only if there are no functional criteria, otherwise leave this blank
The assessor should print, sign and clearly list credentials along with BHP if necessary

11. Seriously Mentally Ill (SMI) Determination Form
Section II: Final Serious Mental Illness Eligibility Determination is to be completed by CRN. Please leave this page blank including the signature

12. Core Assessment
SMI Packet cannot be processed without a core assessment
Any State approved core assessment form can be submitted
Must be updated if completed more than six months from the date of submission
Should be updated if significant changes have occurred since last assessment
Cannot be “Part E” annual update

13. Demographic Data Sheet (varies by region/provider)
This is helpful in creating the client’s profile
If an emergency contact is provided, please also include an ROI for this person
If guardian is checked ‘yes’ for an adult, please include the guardianship letters (power of attorney can only be accepted if a physician statement documenting incapacitation is also attached)
If the client is homeless, but has a mailing address, please provide this for notices

14. SMI Assessment Submission Portal
This should be the primary form of submission for all providers
The portal allows better tracking for us and a confirmation for providers
Choose the current ACC plan and the RBHA the applicant will be enrolled with if SMI

15. SMI Assessment Submission Portal
For new submissions, fill out all fields and attach any files
If you have attached the file successfully you will see it in the “attached” section

16. SMI Assessment Submission Portal
Choose your agency name from the drop-down provider prefill menu
Packet Submission Contact should be who we contact if there are issues with the submission
After submission, the Packet Submission Contact will receive a confirmation with a tracking number for reference
Clinical Contact: Should be who the CRN doctor will contact to staff the case

17. The Appeal Process
Every individual has the right to appeal their SMI decision
When appealing an SMI determination, the applicant has the right to an informal conference within 7 days of appeal:
Face-to-Face
Video Conferencing
Teleconference
If the applicant wishes to appeal this decision, they have the right to request an administrative hearing

18. Questions/Comments? CRN Eligibility and Care Services 1-855-832-2866
Website
Includes Tips, Application, Required Forms,
Submission Instructions, FAQ’s, etc.