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Evaluations, Services and Resources for Members With a Serious Mental Illness (SMI)

Last update: October 14, 2020

The following information is meant to help determine SMI eligibility, status and evaluation.

What is an SMI?

  • While as many as one in five individuals receive a diagnosis of a mental health disorder at some time in their lives, only 4% of the U.S. population suffers from an SMI.1
  • According to the Arizona Health Care Cost Containment System (AHCCCS), an SMI is defined as a mental, behavioral or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.

1National Alliance on Mental Health

How does AHCCCS define SMI?

In Arizona, there are two required components of being eligible for an SMI diagnosis.

  • A functional impairment, which AHCCCS defines as having long-lasting impairment in at least one of four domains:
    • Inability to live independently without supervision
    • Risk of harm to self or others
    • Dysfunction in a role, such as school or work
    • Risk of further deterioration
  • A qualifying diagnosis
    • AHCCCS maintains a list of qualifying diagnoses here. These diagnoses include depressive disorders, mood disorders, psychotic disorders and post-traumatic stress disorders (PTSD).

What services are available for members with an SMI designation?

  • Individuals who have an SMI designation are likely to benefit from specialized ongoing care for their behavioral health condition.
  • There are agencies throughout the state called Behavioral Health Homes (BHH), many of which are prepared to treat SMIs.
  • Common services for someone with an SMI designation include: case management, medication management, peer/family support and in some instances, assistance with housing.
  • Not all individuals who have a qualifying diagnosis for SMI are designated as having an SMI by the state.
  • An evaluation process must occur in order to give someone the SMI designation and allow them to receive the additional benefits that this status provides.

Is my patient receiving behavioral health or SMI services already?

  • If you suspect your patient suffers from an SMI and would benefit from additional supports, start by determining if your patient already has an SMI designation. You can do this through the AHCCCS patient eligibility website.
  • The below example shows a member who has an SMI designation. If a patient is listed as having a general mental health (GMH) status, this means they do not currently have an SMI designation.
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How do I initiate an SMI evaluation for my patient?

  • There may be times when you have a patient who you believe would qualify for SMI designation, but they currently have a GMH designation. If this occurs, start by talking with the patient to determine if they have an existing BHH that could complete an SMI evaluation.
  • In Maricopa County, Crisis Preparation and Recovery (CPR) will complete evaluations for any member. You can call them at 480-804-9542 to start the referral process. Additionally, their website has helpful information related to SMI evaluations.
  • If you have questions or need assistance with this process, please call Provider Services at 800-445-1638.

Resources

  • To schedule an SMI evaluation in Maricopa County:
  • For more information about SMI determinations:
    • Crisis Response Network (CRN)
      • Phone: Call 602-845-3594 or 855-832-2866.
      • Online: Go to crisisnetwork.org/smi.
  • Crisis lines by county:
    • Maricopa County: Call 800-631-1314 or 602-222-9444.
    • Cochise, Graham, Greenlee, La Paz, Pima, Pinal, Santa Cruz and Yuma Counties: Call 866-495-6735.
    • Apache, Coconino, Gila, Mohave, Navajo and Yavapai Counties: Call 877-756-4090
    • Gila River and Ak-Chin Indian Communities: Call 800-259-3449.
    • Salt River Pima Maricopa Indian Community: Call 855-331-6432.