AHCCCS Contractor Operations Manual (ACOM)
The ACOM contains all policies and exhibits applicable to awarded Managed Care Organization (MCO) contractors and their delegated subcontractors providing services to AHCCCS members. Its purpose is to consolidate and simplify access to administrative, claims, financial, and operational policies.
The ACOM operates with authority in conjunction with federal and state regulations, other agency guides and manuals, and applicable contracts.
AHCCCS Contract and Policy Dictionary
The AHCCCS Contract and Policy Dictionary offers a centralized location for definitions found within the various AHCCCS Contractor Operations Manual (ACOM) and AHCCCS Medical Policy Manual (AMPM) policies.
Public Comment Opportunity
Stakeholders, tribal members, and the general public are invited to provide feedback on policies Currently Open and under review. Additionally, AHCCCS welcomes general comments on all policies with in the AHCCCS Contractor Operations Manual (ACOM) and the AHCCCS Medical Policy Manual (AMPM).
Your input is valued and appreciated, as it helps shape and improve these policies.
How to Submit Public Comments
AHCCCS provides up to a 45-day public comment period prior to publishing AHCCCS Contractor Operations Manual (ACOM) and AHCCCS Medical Policy Manual (AMPM) policies that have a substantial change. Should an expedited time period be required, the expedited time period will not be less than two weeks. Tribal members, stakeholders, and the general public are able to review and submit comments regarding changes being presented.
To review policies currently posted for public comment, please visit the Public Comment page
To view ACOM Policies, select Policy from the ACOM Table of Contents below.
2024
- December 19, 2024
- December 3, 2024
- November 15, 2024
- November 07, 2024
- September 27, 2024
- September 05, 2024
- August 26, 2024
- August 13, 2024
- July 30, 2024
- July 18, 2024
- July 16, 2024
- June 27, 2024
- May 24, 2024
- May 20, 2024
- April 30, 2024
- March 20, 2024
- March 5, 2024
- February 13, 2024
- January 30, 2024
2023
2022
2020
2019
2018
2017
2016
2015
2014
- 100 - AHCCCS Contractor Operations Manual - Reserved
- 101 - Marketing
- 103 - Fraud, Waste and Abuse
- Attachment A - Representations and Certifications of Contractor
- Attachment A-1 - Disclosure Information - Disclosure of Ownership and Control
- Attachment B - Corporate Compliance Work Plan-Sample
- Attachment C - External Audit Plan Template
- 104 - Continuity of Operations and Recovery Plan
- 106 - Certification of MAOs Serving Dual Eligible Members
- 107 - State-Contracted MAO Dual Eligible Special Needs Plans
- 108 - AHCCCS Security Rule Compliance
- 109 - Institution for Mental Disease 15 Day Limit
- 110 - Mental Health Parity
- 111 - AHCCCS Pharmacy and Therapeutics Committee
- 301 - ALTCS E/PD Program Tiered Reconciliation
- 302 - Cost Settlement for Coronavirus Disease of 2019 Vaccine
- 303 CYE 25 - Community Reinvestment (All Lines of Business Except E/PD)
- Attachment A CYE 25 - Community Reinvestment Plan Template
- Attachment B CYE 25 - Community Reinvestment Report
- 303 CYE 25 – Community Reinvestment E/PD Only
- Attachment A CYE 25 - Community Reinvestment Plan Template
- Attachment B CYE 25 - Community Reinvestment Report
- 304 - Premium Tax Reporting
- 305 CYE 25 - Performance Bond and Equity Per Member Requirements (All Lines of Business Except E/PD)
- Attachment A CYE 25 - Performance Bond Annual Attestation Statement
- Attachment B CYE 25 - Performance Bond Form
- Attachment C CYE 25 - Instructions for Wire/ACH Transfers of Funds to AHCCCS via Arizona State Treasurer
- 305 CYE 25 - Performance Bond and Equity Per Member Requirements E/PD ONLY
- Attachment A CYE 25 - Performance Bond Annual Attestation Statement
- Attachment B CYE 25 - Performance Bond Form
- Attachment C CYE 25 - Instructions for Wire ACH Transfers of Funds to AHCCCS via Arizona State Treasurer
- 306 CYE 25 - Alternative Payment Model Initiative - Withhold and Quality Measure Performance Incentive
- Attachment A CYE 25 - Alternative Payment Model Quality Measures Performance Scores
- Attachment B CYE 25 - Federal Limit Test
- 306 CYE 24 – Alternative Payment Model Initiative – Withhold and Quality Measure Performance Incentive
- Attachment A CYE 24 – Alternative Payment Model Quality Measures Performance Scores
- Attachment B CYE 24 – Federal Limit Test
- 306 CYE 23 - Alternative Payment Model Initiative – Withhold and Quality Measure Performance Incentive
- Attachment A CYE 23 - Alternative Payment Model Quality Measures Performance Scores
- Attachment B CYE 23 - Federal Limit Test
- 307 CYE 25 – Alternative Payment Model Initiative – Strategies and Performance-Based Payments Incentive
- 307 CYE 24 – Alternative Payment Model Initiative – Strategies and Performance-Based Payments Incentive
- 307 CYE 23 - Alternative Payment Model Initiative – Strategies and Performance-Based Payments Incentive
- 310 - Delivery Supplemental Payment
- 311 CYE 25 and Forward - ACC and ACC-RBHA Program Tiered Reconciliation
- 311 CYE 23 and CYE 24 - ACC and ACC-RBHA Program Tiered Reconciliation
- 314 - Auto-Assignment Algorithm
- 317 - Change in Contractor Organizational Structure
- 323 - ACC-RBHA Non-Title XIX-XXI Profit Limit
- 324 - Targeted Investments Program
- 325 - Targeted Investments 2.0 Program
- 326 - Fixed Administrative Cost Component Reconciliation for ACC and ACC-RBHA
- 327 - Pediatric Services Initiative
- 330 - Access to Professional Services Initiative
- 401 - Change of Contractor: AHCCCS Complete Care Contractors
- 402 - Member Transition for Annual Enrollment Choice and Eligibility Changes
- 403 - Enrollment Choice in a County with Choice and Change of Contractor: ALTCS Contractors
- 404 - Contractor Website and Member Information
- 405 - Cultural Competency, Family/Member Centered Care, and Language Access Plan
- 406 - Member Handbook and Provider Directory
- 407 - Workforce Development
- 408 - Administration Actions
- 409 - Contractor Office of Individual and Family Affairs
- 412 - Claims Recoupment and Refunds
- 414 - Requirements for Service Authorization Decisions and Notices of Adverse Benefit Determination
- 415 - Provider Network Development and Management Plan; Periodic Network Reporting Requirements
- 416 - Provider Manual and Required Notifications
- 417 - Appointment Availability, Transportation Timeliness, Monitoring, and Reporting
- 418 - Provider and Affiliate Advances, Equity Distributions, Loans, and Investments
- 421 - Contract Termination Nursing Facilities and Alternative Home and Community Based Settings
- 423 - Financial Responsibility for Court Ordered Treatment for DUI/Domestic Violence or Other Criminal Offenses
- 424 - Verification of Receipt of Paid Services
- 425 - Social Networking
- 426 - CRS Application, Designation, and Coverage
- 429 - Direct Care Worker Training and Testing Program
- 431 - Copayment
- 433 - Member Identification Cards
- 434 - Coordination of Benefits and Third Party Liability
- 435 - Telephone Performance Standards and Reporting
- 436 - Network Standards
- 437 - Financial Responsibility for Services after the Completion of Court-Ordered Evaluation
- 438 – Administrative Services Subcontractor Evaluation
- Attachment A - Administrative Services Subcontract Checklist
- Attachment B - Administrative Services Subcontractor Evaluation Report Template
- 439 - Material Changes Provider Network and Business Operations
- 440 - Managed Care Expiration or Termination of Contract
- 442 - Opt Out Request for a Member with a Serious Mental Illness Designation
- 444 - Notice of Appeal Requirements (Serious Mental Illness Appeals)
- Attachment A - AHCCCS Notice of SMI Grievance and Appeal Procedure
- Attachment B - Notice of Legal Rights for Persons with Serious Mental Illness
- Attachment C - Notice of Decision and Right to Appeal (for Individuals with an SMI)
- Attachment D - Notice of Discrimination Prohibited
- 445 - Submission of Request for Hearing
- 446 - Grievances and Investigations Concerning Persons with Serious Mental Illness
- 447 - Employment
- 448 - Permanent Supportive Housing - Reserved
- 449 - Behavioral Health Services for Children in Department of Child Safety (DCS) Custody and Adopted Children