2017 Collaborative Protocol between Cenpatico Integrated Care and Division of Developmental Disabilities
2017
Collaborative Protocol between
Cenpatico Integrated Care and
Division of Developmental Disabilities
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 1
Contents
Introduction ........................................................................................................................................................ 3
Referral for Behavioral Health Services .............................................................................................................. 3
Crisis and Emergent Referrals ............................................................................................................................. 3
Cenpatico Responsibilities .............................................................................................................................. 4
DDD Responsibilities ....................................................................................................................................... 4
Routine and Non-Emergent Referrals ................................................................................................................. 5
Cenpatico Responsibilities .............................................................................................................................. 5
DDD Responsibilities ....................................................................................................................................... 5
Adult Recovery Team & Child and Family Team Process .................................................................................... 6
Cenpatico Responsibilities .............................................................................................................................. 6
DDD Responsibilities ....................................................................................................................................... 6
Joint Responsibilities ...................................................................................................................................... 6
Crisis and Safety Planning ................................................................................................................................... 7
Joint Responsibilities ...................................................................................................................................... 7
Coordination with Qualified Behavioral Health Professional (QBHP) ................................................................. 8
Cenpatico Responsibilities: ............................................................................................................................. 8
DDD Responsibilities: ...................................................................................................................................... 8
Discharge Planning Process ................................................................................................................................. 9
Joint Responsibilities ...................................................................................................................................... 9
Community Collaborative Care Teams ................................................................................................................ 9
Coordination of Care & Member-Issue Resolution Process ................................................................................ 9
Cenpatico Responsibilities ............................................................................................................................ 10
DDD Responsibilities ..................................................................................................................................... 10
System Barrier Resolution Process ................................................................................................................... 11
Joint Responsibilities .................................................................................................................................... 11
Cenpatico Responsibilities ............................................................................................................................ 11
DDD Responsibilities ..................................................................................................................................... 12
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 2
Information Sharing and Member Privacy ........................................................................................................ 12
Joint Responsibilities .................................................................................................................................... 12
Signature Page .................................................................................................................................................. 13
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 3
Introduction
Cenpatico Integrated Care (herein referred to as Cenpatico) and the Division of Developmental Disabilities
(DDD) share a common goal to provide the highest quality services to individuals and families within our
shared areas. These areas include Pima, Pinal, Cochise, Graham, Greenlee, Santa Cruz, La Paz and Yuma
Counties. As a function of this common goal, we collectively aspire to provide services that are member driven,
flexible, easily accessible, innovative, and based on empirically supported best practice models.
Cenpatico and the Eastern, Southern and Northern Districts of the Division of Developmental Disabilities (DDD)
agree to coordinate activities associated with service delivery. Within this process, it is our vision to look at
every individual as a whole, without regard to their DD or behavioral health/General Mental Health (GMH) or
Sever Mental Illness (SMI) status or diagnosis. With this vision as the foundation of our partnership, we
believe that both DDD and Cenpatico will realize a bond and commitment to our mutual populations to
provide the most comprehensive and well-coordinated care possible.
To that end, Cenpatico and DDD acknowledge the value of sharing, utilizing, and following the assumptions
and guidelines formed within the Arizona Principles. We hereby recognize the extreme importance of the
Child and Family Team (CFT), as well as the Adult Recovery Team (ART) process. We agree that these services
are most effective when they:
Begin with the child, the adult, and his or her family (whatever that family composition may be)
Are collaborative in nature
Reflect the family’s voice
Respect their preferences, interests, needs, culture, language, and belief system
Provide opportunities for families to identify their roles within the structure of the behavioral health and DDD systems
Provide opportunities and techniques for members and their families to move through the recovery process to the maximum extent possible
Acknowledge child and family strengths
Referral for Behavioral Health Services
The referral process serves as the principal pathway by which persons are able to gain prompt access to
publicly supported services. Dependent upon an individual’s presenting concerns, either a crisis or routine
referral to behavioral health services may be needed.
Crisis and Emergent Referrals
Cenpatico IC seeks to ensure Members receive crisis services on a timely basis and, when appropriate, in their homes and communities. Crisis mobile teams are available to help Members obtain the appropriate crisis services. Cenpatico IC discourages providers from sending Members to emergency rooms for non-medical reasons.
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 4
To meet the needs of individuals in communities throughout Arizona, Cenpatico IC provides crisis intervention services through a contracted Crisis Call Center. Crisis services can be secured 24 hours per day, 7 days per week by calling the Crisis Call Center at 1-866-495-6735.
Cenpatico Responsibilities
Services provided to stabilize a crisis situation can be telephonic or face-to-face, dependent upon
member need. The response may include any needed covered behavioral health service including, but
not limited to:
o Assessment for need of higher level of care
o Danger to self/others
o Potential transport to inpatient facility
Behavioral health services provided within a timeframe indicated by clinical need, but no later than 2
hours from identification of need or as quickly as possible when a response within 2 hours is
geographically impractical. All Crisis Mobile Teams (CMTs) must respond within 2 hours.
Contracted agencies will provide immediate crisis response on all individuals needing such services.
Upon receipt of call by Nursewise, staff will triage call according to criteria. If the identified concern
cannot be resolved over the phone, a CMT will be dispatched to location of the member according to
time frames above.
If higher level of care is determined to be medically necessary, the CFT or ART shall be responsible for
convening a meeting once admission has occurred, so a discharge plan can be developed.
Discharge planning process must begin within 24 hours of admission to an inpatient facility. Please
Reference the Discharge Planning Process section of this document.
DDD Responsibilities
If the DDD Support Coordinator is making a referral for a member experiencing a behavioral health
crisis, he/she should request the “supervisor on call” for a more immediate response.
DDD Support Coordinator is encouraged to attend any behavioral health intake appointments, if the
family consents.
If an intake is necessary, DDD will assist in obtaining collateral information which may be helpful in
addressing each individual’s unique needs. While not required, information that may be helpful in
ensuring a member’s needs are identified during an intake may include, but is not limited to:
o Psychiatric assessments
o Psychological assessments
o Psycho-social and/or educational assessments
o IEPs (documentation from the school; with signed consent from the responsible person)
o ISPs (Individual Support Plan)
o Medical evaluations (if available)
o Specialty reports: neurological; eating disorder, physical, or speech therapy etc.
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 5
o Behavior plans/data (if available)
Routine and Non-Emergent Referrals
Cenpatico Responsibilities
If an AHCCCS-eligible individual receiving services through DES/DDD is referred for or requests an intake for
routine services, the Cenpatico Intake and Care Coordination Agency (ICC Agency) will attempt to ascertain the
location of the local DES/DDD office where that member is receiving services, and notify the Support
Coordinator of the intake and enrollment.
Appointment for initial assessment should be within 7 calendar days of referral or request for
behavioral health services.
The first behavioral health service following the initial assessment appointment within timeframes
indicated by clinical need, but no later than 23 calendar days of the initial assessment.
Services must include any necessary covered behavioral health service that will meet the member’s
behavioral health need regardless of their GMH or SMI status.
Services provided by ICC Agencies and Specialty Provider Agencies shall be aimed at rehabilitation and
acquisition of a skill or behavior. Long-term habilitation services, aimed at maintaining a skill or
behavior related to their DDD diagnosis, are the responsibility of DDD.
All services shall be provided based on the needs of the individual in the most clinically appointed time
frame.
DDD Responsibilities
If eligible members are not enrolled with a Cenpatico ICC Agency, the DDD Support Coordinator will
encourage, support and guide parent or legal guardian or member through the behavioral health
enrollment process. DDD will assist in obtaining an intake appointment upon individual’s request.
The DDD Support Coordinator is encouraged to attend the behavioral health intake appointment if the
member and family so chooses.
DDD will assist in obtaining collateral information which may be helpful in identifying and addressing
each individual’s unique needs during an intake. While not required, information that may be helpful
in ensuring a member’s needs are identified during intake may include, but is not limited to:
o Psychiatric assessments
o Psychological assessments
o Psycho-social and/or educational assessments
o IEPs (documentation from the school; with signed consent from the responsible person)
o ISPs (Individual Support Plan)
o Medical evaluations (if available)
o Specialty reports: neurological; eating disorder, physical, or speech therapy etc.
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 6
o Behavior plans/data (if available)
DDD Support Coordinator can assist member or family or legal guardian in obtaining transportation to
behavioral health intake appointment.
Adult Recovery Team & Child and Family Team Process
Coordination of care within the Cenpatico provider network occurs most commonly through a member-driven
treatment team approach.
At a minimum, the ART/CFT must include the member, behavioral health representative, DDD Support
Coordinator and should extend to any individuals important to the member’s life who are identified by the
team.
Cenpatico Responsibilities
In person participation in ART/CFT meetings is preferred, however Cenpatico providers will ensure
telephonic participation is possible for any team members unable to attend in person.
Provide a copy of the approved Individualized Service Plan and medication sheet, if applicable, along
with any assessments to the DDD Support Coordinator within seven (7) working days of completion of
the ART/CFT.
Individualized Service Plan/ISP reviews shall occur according to the needs and requirements of the
member during each ART/CFT meeting.
If requested, the member’s ICC Agency shall provide a copy of all Title 36 court orders for behavioral
health services to the appropriate district DDD Support Coordinator.
DDD Responsibilities
Provide copy of the DDD ISP within fifteen (15) working days, including any professional assessments
to the designated ICC Agency.
DDD Support Coordinator communicates with the ART/CFT facilitator to assist in the identification of
team members for the ART/CFT and assists by providing phone numbers and contact information.
The DDD Support Coordinator will monitor the effectiveness of behavioral health services provided to
any dually-enrolled member.
Joint Responsibilities
The development of the Individualized Service Plan (ISP) as well as the DDD 90 day review, are
completed by utilizing best practice guidelines and completed by collaboration, when possible.
All team members must be notified of changes in BH Recovery Coach or DDD Support Coordinator.
Notification of change in the ART/CFT Team or DDD Support Coordination should be given to the
appropriate agency within five (5) working days.
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 7
It is a shared responsibility to respect everyone’s time. Therefore providing as much notice as
possible, prior to the scheduling of any meeting and tentative agenda items, is a paramount part of the
process.
The ART/CFT Team which includes the DDD Support Coordinator shall have shared responsibility for
the supervision over ART/CFT Team activities as well as services/supports.
If guardianship is identified as a potential need or issue, the team will meet to discuss the surrogate
decision making process. Lack of guardianship or questions regarding guardianship shall not be a
barrier to the delivery of behavioral health services.
Communication needs to occur between both agencies, when there is a transition between RBHA’s
(inter-RBHA transfers), RBHA providers (intra-RBHA transfers), change in residency, and when there is
a transition from the children’s to the adult’s behavioral health system. The details of these transition
processes must be discussed in detail during the ART/CFT meetings in order to assure adequate
coordination of care.
Note: A “Professional Staffing” and an ART/CFT meeting are different. ART/CFT meetings must include the
member and a behavioral health representative. If these two parties are not both in attendance at a
meeting, the meeting is considered a professional staffing.
Note: At any time that respite services should be identified as a need on either side, it is critical to be
aware that the total number of respite hours is capped at 600 hours, regardless of whether those hours
are provided by the Division or Cenpatico.
Crisis and Safety Planning
Joint Responsibilities
In order to address and plan for barriers to implementing the Individualized Service Plan, the ART/CFT will
meet to develop a Crisis Plan and if needed, a Safety Plan. Every Individualized Service Plan will have a crisis
plan. However, safety plans are constructed when high-risk conditions are present. When a safety plan is
required, there will be significant overlap with the crisis plan.
A crisis plan will be documented and completed through the ART/CFT meeting.
o Crisis planning follows a four-step model that includes: Prediction, Functional Assessment,
Prevention, and Crisis Planning.
o Crisis plans will be specific and will include names and phone numbers, as well as
contingencies. Crisis plans should include a process, agreed upon timeframes and minimum
member’s to engage in emergency ART/CFT (i.e. in the event of placement disruption, the
team agrees particular members will come together within 24 hours to address the crisis).
o A copy of the plan will be immediately given to the team members and updated through the
team process as needed.
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 8
o Crisis planning may involve the community resources to aide with community preparedness.
However, disclosure to members of an ART/CFT who are not providers of health, mental
health or social services requires the authorization of the person or the person’s legal guardian
or parent.
o The DDD Support Coordinator will participate in the development and on-going maintenance
of the crisis and safety plan through participation at ART/CFT and on-going coordination of
care with the designated behavioral health providers.
A Safety Plan will be documented and completed through the ART/CFT meeting when high risk
conditions develop that put the member, family or community in immediate risk.
o Conditions that call for a Safety Plan can include, but are not limited to, sexual acting out,
suicidal ideation, elopement from placements and possible harm to member, family or
community.
o Safety plans will be specific and will include names, phone numbers and person specific actions
to make sure safety plan can be carried out effectively.
o A copy of the plan will be immediately given to the team members and updated through the
team process as needed.
Note: Teams are discouraged from using law enforcement or emergency room as interventions for reasons
that are non-medical or non-safety related.
Coordination with Qualified Behavioral Health Professional (QBHP)
DDD requires that a Behavioral Health Medical Practitioner (also known as a Qualified Behavioral Health
Professional (QBHP)) conduct a Consult and Review of Behavioral Health Service form (DDD-1463A) on all
dually-enrolled members every 90 days to review medications, behavior and functioning.
Cenpatico Responsibilities:
When DDD Support Coordinator submits Consult and Review of Behavioral Health Service form (DDD-
1436A) to ICC Agency Behavioral Health Medical Practitioner (BHMP), the ICC Agency will return
completed Consult and Review of Behavioral Health Service form (DDD-1436A) to Support Coordinator
within 10calendar days.
If Support Coordinator contacts the QBHP to complete Consult and Review of Behavioral Health
Service form (DDD-1436A) up to three times with no response, Cenpatico may request a corrective
plan of action.
DDD Responsibilities:
The DDD Support Coordinator will ensure a quarterly (90 day) consult is sent to ICC agency for the
member with the Qualified Behavioral Health Professional (QBHP). When the quarterly consult is
completed, the Support Coordinator will ensure information is documented in the member’s
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 9
record. Any concerns as a result of this consult, should prompt an ART/CFT meeting. Concerns should
be discussed during the next ART/CFT meeting. A copy of results will be provided at the next ART/CFT
meeting.
o It is preferable that this information be provided in the context of the team meeting or
medication review.
o If a consultation cannot take place in person or by phone, the Support Coordinator will submit
the Consult and Review of Behavioral Health Service form (DDD-1436A) to the Qualified
Behavioral Health Professional for completion. The Support Coordinator will review the
consultation with the team.
Discharge Planning Process
Joint Responsibilities
Should inpatient stay become necessary, discharge planning must begin immediately upon admission
between all involved agencies.
If the DDD Support Coordinator is not available on an emergent basis, then an alternate person,
Division staff, must be chosen to attend.
If clinical team determines the need for member is to require out of home placement, steps should be
taken by ICC agency to submit appropriate paperwork to Cenpatico.
If the most recent residence is questionable in any way, DDD Support Coordinator and/or Dedicated
Recovery Coach must communicate this information to the CFT/ART.
Community Collaborative Care Teams
Cenpatico has established the Consultation and Clinical Intervention (CCI) program (currently available in Pima
County only) in compliance with AHCCCS Policy Manual Chapter 570 – Community Collaborative Teams for
Select DDD Members. The purpose of this program is to communicate, collaborate, and coordinate services
and supports as well as address the complex behavioral, medical, and developmental needs of dually enrolled
Title XIX BH and ALTCS/DDD members with co-occurring behavioral health physical conditions. More
information specific to Cenpatico’s program can be located in the Cenpatico Provider Manual and
Attachments.
Coordination of Care & Member-Issue Resolution Process
All parties should strive to reach consensus/resolution at the ART/CFT level, and all resolutions should be
focused on ensure adequate and appropriate member care.
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 10
Cenpatico Responsibilities
If additional assistance with coordination of care is necessary to ensure member care, Cenpatico’s
Coordination of Care team can be of assistance. This team can be contacted by emailing
If additional team facilitation and/or issue resolution assistance is required to ensure member needs
are met, Cenpatico’s Clinical Team can be of assistance. This team can be contacted by emailing
[email protected] and requesting an ART Coach or CFT Coach (dependent upon
member’s age.)
Cenpatico Customer Service staff are available to accept and submit customer complaints with regard
to issues with service provision, member rights or coordination of care. The unit operates between
the hours of 8:00 am to 5:00 pm, Monday through Friday and can be reached at 1-866-495-6738.
Educate system partners about the rights and the process for filing complaints in a manner that is
understandable.
Cenpatico resolves to file and close the loop on all provided complaints. An oral or written notice will
be provided within 14 calendar days of the complaint.
Maintain confidentiality and privacy of complaint matters and records at all times.
If consensus/resolution cannot be achieved, the Cenpatico provider and/or Cenpatico staff will advise
the members of the team of the right to file a grievance or appeal, and provide assistance in filing
such, as necessary and appropriate.
DDD Responsibilities
If additional assistance with coordination of care is necessary to ensure member care, DDD may
contact Cenpatico’s Coordination of Care team for support. This team can be contacted by emailing
If additional team facilitation and/or issue resolution assistance is required to ensure member needs
are met, DDD may contact Cenpatico’s Clinical Team to intervene and be of support. This team can be
contacted by emailing [email protected] and requesting an ART Coach or CFT
Coach (dependent upon member’s age.)
Complaints pertaining to member specific situations can be reported to Cenpatico by utilizing their toll
free telephone number: 1-866-495-6738. To submit a written complaint, mail the complaint to:
Cenpatico Behavioral Health of Arizona
333 E. Wetmore Rd, Ste. 600
Tucson, AZ 85705
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 11
System Barrier Resolution Process
Joint Responsibilities
Cenpatico and DDD staff will meet at a minimum of bi-monthly to address system issues through Collaborative
Meetings.
Meetings must address at a minimum:
Joint training needs
What’s working and what’s not working
Distribution of Community Resource Information
Integration of family/member involvement
Attendance and/or presentations from area ICC Agency
Discussion about regulatory changes that affect both agencies
New or updated Practice Improvement Protocols, Clinical Guidance Documents and Technical
Assistance Documents
These Collaborative Meetings are intended to address systems barriers that have not been addressed at a
lower level. Attempts should be made to resolve issues at the lowest level in order to continue local
collaboration efforts. Cenpatico and DDD will also schedule ad hoc meetings as often as necessary to address
issues related to specific members.
Cenpatico Responsibilities
Cenpatico will participate in at least one meeting bi-monthly with DES/DDD and any other
community/agency partners, or stakeholders. At minimum representation from the Cenpatico clinical
team, a medical management administrator (i.e. Medical Director or designee) and Stakeholder Liaison
to DES/DDD and any other designated staff will attend these meetings. The focus of these meetings
will be system issues.
Cenpatico’s Stakeholder Liaison to DES/DDD will ensure system issues and barriers are discussed at
each Collaborative meeting. If not resolved, barrier items will remain active until the issue is resolved
to a satisfactory level.
Cenpatico’s Stakeholder Liaison will invite any identified members who may be of assistance in
reviewing or resolving the identified issues and/or barrier.
Cenpatico encourages ICC Agency management to hold regular collaborative meetings with DDD.
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 12
DDD Responsibilities
DDD will participate in at least one meeting bi-monthly with Cenpatico and any other
community/agency partners, or stakeholders. A minimum of program managers or district level staff,
and any other designated staff will attend these meetings.
The focus of these meetings will be system issues.
DDD management-level staff will forward issues to Cenpatico’s DES/DDD Stakeholder Liaison prior to
each Collaborative meeting.
DDD Support Coordinators are encouraged to forward issues to their immediate supervisor, who will
then forward to management level staff for discussion during a meeting.
DES/DDD will invite any identified members who may be of assistance in reviewing or resolving the
identified barrier.
Information Sharing and Member Privacy
Joint Responsibilities
Cenpatico and DDD agree to send all emails involving personal health information via
encryption/secure manner. Staff with either agency will indicate “[secure]” at the beginning of the
subject line. It is critical to note that in order for an email to be truly encrypted this exact verbiage
must be indicated in the subject line.
Currently, Cenpatico and DDD possess the same security programs.
Attachments can be no larger than four megabytes.
Faxes must be sent only to secured fax machines as required by HIPAA.
All other HIPAA compliance requirements must be followed.
Note: An interagency Service Agreement exists between the Arizona Health Care Cost Containment System (AHCCCS)
and the Arizona Department of Economic Security/Division of Developmental Disabilities (DDD), which allows for the
exchange of information between DDD, Cenpatico, and any of Cenpatico’s contracted agencies.
DDD/Cenpatico Collaborative Protocol Revised 11/7/16 Page | 13
Signature Page
Collaborative Protocol between Cenpatico Integrated Care and
Department of Developmental Disabilities
Effective Date: 01/01/2017
Last Revision Date: 11/7/2016
Cased on AHCCCS Contract Number: YH17-0001
End Date (if applicable): To be reviewed in one year
_Signature on File_______________________________ ___________________________
Cenpatico Interim CEO: Dr. Michael D. McKinney Date
_Signature on File_______________________________ ___________________________
DDD Behavioral Health Manager: Tyrone Peterson Date