Fillable Printable Ohr Spec A Overview Faq With Dbhs Policy113Cited
Fillable Printable Ohr Spec A Overview Faq With Dbhs Policy113Cited
Ohr Spec A Overview Faq With Dbhs Policy113Cited
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Division of Health Care Advocacy
and Advancement
Office of Human Rights
Special Assistance
What? Special Assistance is the support provided to an individual who is unable - due to
a specific condition - to communicate his/her preferences and/or to participate effectively
in the development of his/her service plan, discharge plan, the appeal process and/or
grievance/investigation process.
Why? To identify and assist individuals with a Serious Mental Illness (SMI) who are
unable to independently take advantage of the services and rights protections provided for
by the SMI rules (A.A.C. R9-21-101, et seq.).
When? The Tribal or Regional Behavioral Health Authority (T/RBHA), contractor or
provider must assess individuals with SMI to determine if the person meets the Special
Assistance criteria on an on-going basis, but at a minimum prior to:
1) Individual Service Plan (ISP) planning and review,
2) Inpatient Treatment and Discharge Plan (ITDP) planning (and when the person
goes into an inpatient psychiatric setting), and
3) Investigation, grievance or appeal process (and when conditions exist to file a
grievance or appeal).
The details of the assessment must be documented in the clinical record, noting if the
individual meets criteria and how or how not.
Who? The T/R BHA, contr acto r or provider makes the clinical decision about whether an
individual meets criteria for Special Assistance. The first step is to determine if the
individual meets the following criteria:
1) The individual has been determined to have a Serious Mental Illness, and
2) The individual is unable to communicate preferences and/or participate
effecti vely in ISP, ITDP, grievanc e and/o r app eal p roces ses ; and
3) The individual’s inability is due to a specific condition: cognitive
ability/intellectual capacity, language barriers that an interpreter/translator cannot
address, and/or medical condition (including severe psychiatric symptoms).
• Individuals who have been deemed incapacitated pursuant to a guardianship (not
including limited guardianship) automatically meet criteria for Special Assistance.
• Proper application of the criteria will generally not result in identifying
individuals who 1) need things explained in more basic terms, 2) are able but not
willing to participate, 3) can speak and advocate for themselves but present with
interpersonal issues that make working with them challenging, 4) simply need
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more regular and effective engagement from the team or 5) have special needs
(see page 3).
• The criteria do not include whether someone is currently assisting the individual
or if the individual would benefit from or has requested the assistance of an OHR
advocate.
How? If the above criteria are met, the second step is to complete and submit the
AHCCCS 320R attachment F (Notification of a member in need of Special Assistance)
within five (5) days to notify OHR* – including any information on whether someone is
currently involved assisting the individual on a regular basis – such as a guardian, family
member, or friend.
OHR reviews the form to ensure that it states the basis for meeting criteria, contacts the
provider for clarification when needed, and then designates a person – a guardian, family
member, friend or OHR - to provide assistance to the individual determined in need of
Special Assistance in the following areas:
1) the development and implementation of their Individual Service Plan (ISP),
2) the development and implementation of their Inpatient Treatment Discharge Plan
(ITDP) when inpatient at a psychiatric facility,
3) the appeal and /o r griev ance/investigation processes, when warranted.
*Unless the individual is already identi fied a s Sp e c ia l Assistance.
Responsibilities of the T/RBHA, Contractor, Provider, Clinical Team
• Reply promptly to Office of Human Rights (OHR) requests for additional
information regarding the notification of need for Special Assistance. OHR
cannot process the form without all the necessary information.
• Once processed, maintain the Notification of Need for Special Assistance form
(all pages) in a prominent place in the individual’s comprehensive clinical record
and document the individual as Special Assistance on the ISP. If the provider
cannot locate the form, contact the designated OHR T/RBHA or contractor
contact to obtain a copy.
• Inform the individual in need of Special Assistance and explain the benefits of
having another person involved to provide Special Assistance.
• Ensure open communication is maintained with the person providing Special
Assistance (guardian, family member, friend or OHR advocate).
• Contact the person providing Special Assistance to involve them as required:
o In ISP planning and review (includes anytime the person is making
decisions about service options or proposed changes)
o When a person goes to an inpatient psychiatric setting and for ITDP
planning
o In a pending investigation, grievance or appeal (or when conditions exist
that may support filing a grievance or appeal, such as a possible rights
violation or failure to implement the ISP or ITDP, denial of or change to a
service, et c.).
• For individuals already identified as in need of Special Assistance whose
guardian, family member, or friend is providing Special Assistance, periodically
review whether the assigned person is meeting the Special Assistance needs, and
if not, promptly address it (either with the person or with OHR).
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Responsibilities of the Designated Person Providing Special Assistance
• Maintain regular contact with the individual to discuss their needs and
effectiveness of services received. When OHR is designated to provide
assistance, the assigned OHR advocate communicates with the individual on a
regular basis and works with the clinical team to ensure services are provided and
the individual’s rights are protected.
• Attend team meetings with the individual in need of Special Assistance, when the
meeting involves decisions about service options or proposed changes.
• Attend discharge planning meetings to help develop the ITDP when the individual
in need of Special Assistance is in an inpatient psychiatric setting.
• While the clinical team is primarily responsible for communication, maintain
regular contact with the clinical team, especially the individual’s case manager.
• Be familiar with A.A.C. R9-21-101 et seq. and the grievance/investigation and
appeals processes to know 1) what rights the individual has and 2) how to enforce
these rights.
• For guardians, family members or friends, contact OHR for information or
assistance with advocacy when needed.
Responsibilities of the Office of Human Rights
• Maintain a database on Special Assistance.
• Review grievances and appeals filed by individuals in need of Special Assistance
and provide assistance in resolving them, when needed and appropriate.
• Prepare report s on Special Assistance as follows:
o Monthly reports for the Human Rights Committee for each region
o Quarterly reports for each T/RBHA an d con tr actor for data reconciliation.
• Provide advocacy as needed to assigned Speci al A ss is tan ce clients (see previous
section).
• If an individual’s guardian, family member or friend is providing Special
Assistance, share information with them about OHR advocacy and provide
technical or direct assistance, when needed and appropriate.
Other Requirements
• Special needs are different from Special Assistance - special needs involve a
person not speaking English, not knowing how to read/write, being deaf, hard of
hearing, blind, or having a physical disability. The T/RBHA, contractors or
provider must accommodate special needs – no notification to OHR is required.
• The Human Rights Committee (HRC) for the region is responsible for making
regular visits to the residential settings of Special Assistance individuals to ensure
that their needs are being met and to determine their satisfaction with the care.
HRC members do not need an Authorization for Release of Information (ROI) in
order to visit individuals in need of Special Assistance, but they generally need a
ROI to view records or obtain any information about the individual.
• The individual, a guardian or a designated representative can appeal the
determination that an individual needs (or does not need) Special Assistance
through the SMI appeal process.
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• The T/RBHA Administration maintains data on individuals in need of Special
Assistance to support the T/RBHA, contractor and providers in meeting their
responsibilities.
Please visit the OHR webpage for other
resources: https://www.azahcccs.gov/AHCCCS/HealthcareAdvocacy.
