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AHCCCS Update. Final Legislation. Authorizes Prop 204 Restoration and Expansion Provides AHCCCS Director with ability to levy an assessment against hospitals – includes ability to exempt Includes circuit breakers Governor had requested in case federal funding is reduced Restores Well-exams.

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AHCCCS Update

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Ahcccs update

AHCCCS Update

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Ahcccs update

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Final legislation

Final Legislation

  • Authorizes Prop 204 Restoration and Expansion

  • Provides AHCCCS Director with ability to levy an assessment against hospitals – includes ability to exempt

  • Includes circuit breakers Governor had requested in case federal funding is reduced

  • Restores Well-exams

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Budget and legislation

Budget and Legislation

  • Assumes 3% capitation rate for AHCCCS

  • Assumes 3% provider rate increase for BH and DD providers 10-1-13

  • Increases ambulance rates beginning 10-1-14

  • Repeals HCG 1-1-14 – stops enrollment 8-1-13

  • Increases cost sharing above federal limits

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Legislation continued

Legislation continued

  • Continues AHCCCS for 10 years

  • AHCCCS Medically preferred treatment options; report

  • AHCCCS may provider services if the services are

    • Medically recognized as the preferred treatment option consistent with Medicare

    • Are less expensive than all other treatment options

    • AHCCCS and contractors shall report on services and alternative treatments that would have been employed

  • Legislation was enacted establishing APR-DRGs as new IP system for 10-1-14

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Ahcccs reports

AHCCCS Reports

  • 12/1/13 - Non-emergency use of the ED

  • 12/31/13 – Air Ambulance – 5 year history and consistency with rules

  • 1/1/14 – Hospital Transparency – Charge-master Report – recommendations

  • 10/1/13 - Hospital Uncompensated Costs – change in uncomp costs and profitability

  • 8/1/14 – Hospital Assessment paid – coverage

  • 10/1/14 – Legislative circuit breaker and outcomes study committee – impact of decreased federal funds

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Phase ii

Phase II

  • Lawsuits

    • Referral – Constitution exempts laws necessary for the support and maintenance of the departments of the state government”

    • Prop 108 – does not apply to “fees and assessments that are authorized by statute, but are not prescribed by formula, amount or limit, and are set by a state officer or agency.”

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Ahcccs childless adult population

AHCCCS Childless Adult Population

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Ahcccs prop 204 parents

AHCCCS Prop 204 Parents

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Ahcccs adult expansion

AHCCCS Adult Expansion

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Ahcccs sobra kids expansion included

AHCCCS SOBRA Kids (Expansion Included)

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Ahcccs traditional tanf pop

AHCCCS Traditional TANF Pop.

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Ahcccs cumulative growth prop 204 expansion

AHCCCS Cumulative Growth (Prop 204 + Expansion)

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Health e arizona plus

Health E Arizona Plus

  • On schedule to bring up on 10-1-13

  • Considerable challenges remain

    • Lack of live testing to federal marketplace

    • CMS has not finalized regulations

    • Efforts to consolidate Medicaid call center support

    • Training materials for staff and public

    • Size – Scope – Timeframe – issues unknown

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Aca update

ACA Update

  • Received very positive system review by CMS as part of 10-1-13 implementation

  • Arizona has worked diligently to ensure that the Health-e-Arizona Plus system is compliant with Federal law and regulation and that it meets the needs and requirements of the state of Arizona and its beneficiaries.

  • They consistently look for and offer work for reuse; the Health-e Arizona system will be interoperable with the FFM and the FDSH. Arizona is very proactive and engaged in analyzing and inquiring clarification on CMS IT Guidance.

  • Arizona is has been an invaluable resource to several states including sharing of ideas, hosting on-site visits, and providing demonstrations of their system.  

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Maricopa rbha transition

Maricopa RBHA Transition

  • Magellan protesting award

  • 5-21 Stay issued by ADOA on transition related activitiy

  • 8-12-13 hearing date set for OAH

  • DHS has stated that given the stay and this timeframe October 1st is not achievable

  • AHCCCS working with DHS on Plan B – current structure – updating contracts/cap rates

  • Stay Tuned

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Blind spots update

Blind Spots Update

  • AHCCCS working to make data available for care coordination purposes

  • BH data to acute plans – PH data to RBHAs – I.H.S/638 date etc..

  • Recently received approval to provide Medicare Parts A, B and D data

  • January 1, 2014 implementation

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


Reinsurance yoy change

Reinsurance YOY change

FY 10 -5.44% - FY 11 3.34% - FY 12 -17.5%

  • Plan A -15.71%

  • Plan B -61.4%

  • Plan C -48%

  • Plan D -44%

  • Plan E -44%

  • Plan F -36%

  • Plan G -58%

  • Plan H -58%

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


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