Smi decertification az 2026

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  1. Click ‘Get Form’ to open the smi decertification az in the editor.
  2. Begin by filling out the Member Contact Information section. Enter your name, guardian's name (if applicable), address, and phone numbers accurately.
  3. In the Decertification Requested By section, check all applicable boxes. If you are an SMI member requesting decertification, ensure you sign this form.
  4. Provide a detailed reason for your decertification request in the designated field. If prompted by a change in provider related to your integrated health plan, select 'Yes' and describe the situation.
  5. Complete the Clinical Recommendation section by entering the name and title of your physician or nurse practitioner, along with relevant dates and meeting frequency.
  6. Address potential impacts of decertification on mental healthcare access, physical healthcare access, housing, case management support, transportation, and treatment options in the provided fields.
  7. Ensure all required documentation is included in your submission checklist before finalizing your form.

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Individuals with a Serious Mental Illness (SMI) designation have access to additional support and resources. Case Management to help you coordinate your care so you can meet your recovery goals. Assertive Community Treatment (ACT) if your care needs exceed the standard.
Mental health issues can qualify for Social Security Disability or Long-Term Disability in Arizona, but the process can be complex. If youre considering applying for SSD or LTD due to a mental health condition, call Roeschke Law today at 800-975-1866 for a free consultation!
Being designated SMI in Arizona means your medications and other mental health services like counseling will be 100% covered even if you have insurance through your work or family.
Part B of Medicare is known as Supplementary Medical Insurance (SMI).
To be free from unnecessary seclusion or restraint, To be treated in the least restrictive environment, To have a discharge plan upon discharge from a hospital, To file a grievance if your rights have been violated, To have anyone of your choosing participate in your treatment planning, and The right to be

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A qualifying diagnosis is a mental health disorder that makes someone eligible for an SMI designation. The following types of mental illnesses qualify for SMI designation: Psychotic Disorders, Bi-Polar Disorders, or Obsessive-Compulsive Disorder. Depressive Disorders, Other Mood Disorders, Anxiety Disorders.
SMI Administrative Decertification An individual who has an SMI designation would need to contact the AHCCCS Clinical Resolution Unit (CRU) at 602-364- 4558, or 1-800-867-5308,. If you do not qualify for the SMI Administrative Decertification, you may be eligible for the SMI Clinical Decertification as described above.

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