Maternal and Child Health Services

Banner – University Family Care/AHCCCS Complete Care (B – UFC/ACC) and Banner – University Family Care/Arizona Long Term Care System (B – UFC/ALTCS) offers a wide variety of services and resources to help our maternity and pediatric members navigate their health care. We want your patients to be as healthy as possible.

Banner – University Health Plans (B – UHP) is committed to ensuring that all members have access to quality family planning, pre-pregnancy, prenatal, and postpartum services. Providing comprehensive care throughout the entire spectrum of family planning and maternity care is crucial in supporting the health of both mother and child.

Recognizing the importance of early and regular prenatal care, the B – UHP Maternal Child Health (MCH) team offers a multi-disciplinary care management program. This program is designed to assist pregnant members who may be at risk due to medical conditions, social circumstances, or issues with compliance and adherence. Our OB care team connects expectant mothers with appropriate community agencies and resources such as WIC, parenting classes, shelters, and substance abuse counseling. Care Managers also provide support and ensure compliance with prenatal care appointments and prescribed medical regimens. 

Well Women's Preventive Care Services

Annual well-women preventive care visits are a covered benefit for all women enrolled with AHCCCS. These visits provide regular preventive care and screening services to help promote essential lifestyle habits, identify risk factors for disease and address existing medical or behavioral health concerns. Detailed information on covered well-women's preventive care services is available in the current BUFC Provider Manual.

Family Planning Services and Supplies

Family planning services and supplies, when provided by physicians or practitioners are covered for members regardless of gender, who voluntarily choose to delay or prevent pregnancy. Family Planning Services and supplies include covered medical, surgical, pharmacological and laboratory benefits as well as the provision of accurate information and counseling to allow for members to make informed decisions about the specific family planning methods available. Detailed information on covered Family Planning Services and Supplies is available in the current BUFC Provider Manual.

Notification of Pregnancy

For the MCH team to initiate outreach and support activities, identify and address potential barriers to care, and encourage active member participation in their pregnancy health, early notification of pregnancy from providers is essential. This allows us to work collaboratively with our providers to achieve the best possible birth outcomes.

To determine which members require OB care management services, we ask that providers submit the Notice of Pregnancy form (NOP) no later than the second prenatal visit. The NOP form should include the Estimated Date of Confinement (EDC), Gravida/Para (GP) information, risk status, and prenatal records. Please fax all completed NOP forms to (520) 874-7026. 

Additionally, we accept direct referrals from providers and members for any pregnant member in need of care coordination, regardless of risk factors. 

Thank you for your partnership in ensuring the best possible care for our pregnant members.

Maternal Medication Assisted Treatment (MAT) Services & Resources

The directory below is being made available for providers to support in identifying Medication Assisted Treatment (MAT) services for our pregnant and postpartum members.

AHCCCS registered providers by Specialty

These are providers located in the state of Arizona, and these providers may or may not be contracted with all the AHCCCS Managed Care Organizations (MCOs). Specialty listing of AHCCCS registered providers will appear and the provider’s Name, Specialty, Address and Phone number will be listed. Providers with multiple office locations will be listed under each location.

Arizona Perinatal Psychiatry Access Line

At no cost, this phone line connects healthcare providers to perinatal psychiatrists. The line functions in real time, so providers can consult on treatment options for their patients struggling with mental health and substance use disorders.

 

The attending provider must acknowledge that a pregnancy termination has been determined medically necessary by submitting the Certificate of Medical Necessity for Pregnancy Termination. The form must be submitted with the Prior Authorization request form to obtain the Health Plan Medical Director’s signature. Please refer to the Provider Manual for further guidance on when to submit the certificate.

Maternal Child Health Contact Information

Banner – University Family Care/ACC: Maternal Child Health Department Contact Information

  • Michael Riegel, RN, BSN, Medical Management Director, (480) 827-5941
  • Heidi Haeder-Heild, LBSW, Medical Management Associate Director, (480) 827-5924
  • Mariam Magnuson, RN, MSN, Senior Manager, (520) 874-2349

The Maternal Child Health Department offers care management services to all members who are pregnant, postpartum, up to one year post delivery, or under the age of 21 and enrolled with Banner – University Family Care/ACC.

To submit a referral, send the member’s name, date of birth, AHCCCS ID number, member contact information, and reason for referral to BUHPMaternalChildHealth@bannerhealth.com.

 

EPSDT Well-Child Visits

All providers offering care to AHCCCS members under 21 years of age, shall use the AHCCCS EPSDT Clinical Sample Template to document age-specific, required information related to the EPSDT / Well-Child screenings and visits.

Alternatively – The provider’s Electronic Health Record may be used, so long as it includes ALL components present on the age-specific AHCCCS EPSDT form.

  • To download EPSDT Clinical Sample Templates, navigate directly to the AHCCCS website at: Medical Policy Manual, POLICY 430 - ATTACHMENT E – AHCCCS EPSDT CLINICAL SAMPLE TEMPLATES.
  • For each EPSDT/Well-Child visit, a copy of the completed and signed (by
    the clinician) EPSDT Form (or appropriate EHR), must be:
    • Placed in the member’s medical record AND
    • Sent to the member's Health Plan

Timely submission of EPSDT/Well-Child visit forms is very important to member care coordination. Submitting the visit forms (or copy of suitable EHR equivalent) to the Health Plan soon after the well-child visit allows us to: 

  • Member outreach by the plan, for follow-up and facilitation of referrals made during your care.
  • Resolution of potential barriers to care.
  • Engagement with other health plan teams/ resources to support the member and
    family.

Submitting EPSDT / Well-Child Visit Forms

There are three easy ways to submit your EPSDT forms or EHRs after a visit.

  • Secure email: BUHPEPSDTForms@BannerHealth.com
  • Secure Fax: (520) 874 – 7184
  • US Mail: Banner University Health Plans
    Attn: EPSDT
    5255 E. Williams Circle Ste 2050
    Tucson, AZ 85711
 

Children's Rehabilitative Services

CRS (Children’s Rehabilitative Services)

  • CRS is a special designation for AHCCCS children under 21, with certain qualifying medical conditions. 
  • CRS Members:
    • Get the same AHCCCS coverage as non-CRS members.  
    •  Encouraged to use the CRS / Multi-Specialty Interdisciplinary Clinics (MSICs) 
    • May also use any regular network providers in the community. 
  • The B – UHP has CRS Liaisons dedicated to each MSIC location in our service area and work to streamline care.  
  • Qualifying Diagnosis List

CRS Referrals & Applications: 

If you are caring for a child with a potential CRS eligible condition, we can help prepare and submit applications and required supporting documents. 

Send your CRS referrals and questions to: BUHPMaternalChildHealth@BannerHealth.com

Pediatric Nutrition Therapy

Nutritional Assessment and Services for EPSDT-Aged Members are covered by Banner Medicaid Health Plans. Nutritional assessments, performed by the member's PCP, are covered during EPSDT/Well-Child visit screenings and on an inter-periodic basis when medically necessary. Registered dieticians can also provide nutritional assessments when ordered by the PCP, especially for underweight or overweight EPSDT members. Prior Authorization is not required for nutritional assessments by PCPs or registered dieticians.

Nutritional therapy is covered for EPSDT-aged members on an enteral, parenteral, or oral basis when medically necessary to meet daily dietary requirements or supplement nutritional intake. Prior Authorization is required for commercial oral nutritional supplements, enteral nutrition, or parenteral nutrition, except for certain circumstances such as when the member is already receiving enteral/parenteral nutrition or during the first 30 days of temporary oral supplemental feedings after an emergent hospitalization. A certificate of medical necessity is also required for commercial oral nutrition: 

The Health Plan also covers nutritional therapy for WIC-eligible children with medical conditions, including necessary formulas not provided by WIC. Commercial oral nutritional supplements require medical necessity determination based on specific criteria outlined in [AMPM Policy 430 Early and Periodic Screening, Diagnostic, and Treatment Services]. Supporting documentation must accompany the Certificate of Medical Necessity, demonstrating compliance with criteria and including nutritional counseling, recent clinical notes, height/weight percentiles, and attempts to address nutritional concerns. Ongoing requests require follow-up documentation and assessment. Metabolic medical foods used to treat inherited metabolic disorders are covered as well, with specific requirements outlined in [AMPM Policy 310-GG, Section III., C. Metabolic Medical Foods].


 

Arizona Early Intervention Program

B – UHP is dedicated to enhancing access to developmental screening and evaluation for AHCCCS members aged 0-3 years to capitalize on early developmental opportunities. PCPs are key in this process; during an EPSDT visit, they assess developmental status using specific screening tools and parental discussions. If developmental concerns arise, the PCP may guide parents and direct referrals to the Arizona Early Intervention Program (AzEIP) without the need for prior authorizations for in-network providers, although out-of-network providers require prior authorization along with medical documentation.

PCPs need to perform a thorough EPSDT physical exam adhering to the established schedule and document any referrals to AzEIP or specialists on the relevant forms, then submit these to the health plan for review. If required evaluations by AzEIP or specialists haven't been carried out, B – UHP's coordinator will liaise with necessary parties to ensure completion.

For EPSDT eligible children needing services, AzEIP conducts evaluations to ascertain eligibility, then collaborates with families to forge an Individual Family Service Plan (IFSP), pinpointing the child's current development level and required interventions, which must be promptly shared with B – UHP. B – UHP processes these requests efficiently and communicates the determinations of service necessity. If PCPs ascertain that certain services are not medically necessary, B – UHP informs all parties and issues a Notice of Adverse Benefit Determination.

In cases where children age out of AzEIP eligibility or do not qualify, B – UHP's Maternal Child Health department takes the baton, offering targeted outreach, care coordination, and facilitating connections with other resources like Raising Special Kids and AzEIP's Central Directory of Resources. Additionally, for children over 3, PCPs can refer to the District of Residence for further developmental assistance in line with AZ Child Find Requirements.

If you are needing assistance with AzEIP, please call Ricardo Medina, EPSDT Supervisor at (520) 874-2697.