Frequently Asked Questions for Providers
What does it mean to be designated or determined eligible for SED or SMI services?
Serious Emotional Disturbance (“SED”) is a designation used in Arizona for children (0-18) who have a diagnosable mental, behavioral or emotional disorder which substantially interferes with or limits the child’s role or functioning in family, school or community activities.
Serious Mental Illness (“SMI”) is a designation used in Arizona for adults (18+) who need additional support because their mental illness impacts their ability to function.
What is looked at (criteria/qualifications) to diagnose someone or determine if they qualify for services?
Criteria for SED:
Applicants can be up to age 18 who, in the past year, have met criteria for a mental disorder and who display functional impairment that is directly related to an SED qualifying diagnosis which substantially interferes or limits their functioning in a family, school, employment, or community environment.
Functional impairment must have existed for most of the past six (6) months, or for most of the past three (3) months with an expected continuation of at least an additional three (3) months or they can also be at risk of deterioration – they are not currently functionally impaired, but they may deteriorate to such a level if treatment or supports are not provided.
Criteria for SMI:
Applicants must be 17.5 years of age and have serious functional impairment that is directly related to an SMI qualifying diagnosis that substantially interferes or limits their functioning in a family, school, employment, or community environment.
Functional impairment must have existed for most of the past 12 months, or for most of the past six (6) months with an expected continuation of at least an additional six (6) months or they can also be at risk of deterioration – they are not currently functionally impaired but they may deteriorate to such a level if treatment or supports are not provided.
How can I improve the success of a clinical staffing conducted regarding my members undergoing the determination process?
- Provide more than one clinical contact.
- Provide accurate contact information for clinical contacts.
- Clinical contacts ought to be the clinicians who are most familiar with the member’s day-to-day functioning.
- Take note of potential upcoming vacation time for the clinical contact. Provide a backup contact if they are to be out.
- Ensure your voicemail is accepting messages and has a clear greeting identifying that it is your line.
- Return clinical staffing messages within 24 hours maximum. Solari has very limited time to render a decision!
- Indicate the best method to be reached (email/phone).
- Provide your accurate, honest perspective in the evaluation packet.
How do I request/ask for an evaluation for services?
If you are already receiving services with an AHCCCS provider, you may ask your healthcare provider to submit an application for determination .
If you do not have a current Provider, please contact your assigned AHCCCS Complete Care (ACC) Plan or T/RBHA:
|Arizona Complete Health
|Banner University Family Care
|Molina Complete Care
|Health Choice Arizona
|United Healthcare Community Plan
|Gila River Behavioral Health Services
|White Mountain Apache Behavioral Health Services
If you are a provider, you may submit applications through this website on the Provider Submission Portal page.
What if I don't want SED or SMI services anymore?
All services are voluntary. You may choose not to receive services. Or, you can ask your clinical team about being assessed to have the designation removed.