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CYE 14 Mid-Year Cap Rate Adjustments - Confirmed

CYE 14 Mid-Year Cap Rate Adjustments - Confirmed. Acute Care 1/1/14 Coverage for HPV for adults aged 21-26 Expiration of Childless Adult mandatory copays effective 12/31/13 Acute Care 2/1/14 Rural Hospital Payments (please make payments as soon as possible!) ALTCS EPD 2/1/14

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CYE 14 Mid-Year Cap Rate Adjustments - Confirmed

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  1. CYE 14 Mid-Year Cap Rate Adjustments - Confirmed Acute Care 1/1/14 • Coverage for HPV for adults aged 21-26 • Expiration of Childless Adult mandatory copays effective 12/31/13 Acute Care 2/1/14 • Rural Hospital Payments (please make payments as soon as possible!) ALTCS EPD 2/1/14 • Quarterly NF Payments (10/1/13 – 12/31/13)

  2. CYE 14 Mid-Year Cap Rate Adjustments - Potential Acute Care • New mandatory copays – possibly 4/1/14 • EPSDT – Dental varnish in PCP offices – possibly 4/1/14 • Newborn screening – fee increase of $25 per test – possibly 4/1/14 • CYE 14 Risk Adjustment – retroactive to October 1, 2013 – targeting 4/1/14 (experiencing some system issues) BHS • Maricopa GSA rates – integration implementation – 4 /1/14 CMDP/DDD • Possible shift in IT admin support dollars from DDD to CMDP – possibly 7/1/14

  3. CYE 14 Mid-Year Cap Rate Adjustments - Potential All Programs Other Than Acute Care • New mandatory copays – next time rates are opened or 10/1/14 (or CMDP 1/1/15) • EPSDT – Dental varnish in PCP offices – next time rates are opened or 10/1/14 (or CMDP 1/1/15) • Newborn screening – fee increase of $25 per test – next time rates are opened or 10/1/14 (or CMDP 1/1/15) All Programs • Reviewing one category of FFS provider rates – more to come if any action taken

  4. CYE 15 Capitation Adjustments – Preliminary Issues FQHC/RHC/Look-Alike Payments (FQHC) • Contract language will be amended to mandate the payment of the AHCCCS-developed PPS rates • Currently MCOs must pay FQHCs rates comparable to rates paid to providers of similar services • In FFY 2012, total payments to FQHCs = ~$173 M • $65 M (37%) paid by MCOs • $108 M (63%) paid by AHCCCS • Current process is lacking in transparency

  5. CYE 15 Capitation Adjustments – Preliminary Issues ASC Shift • Cap rates will be reduced to reflect a shift in outpatient hospital services that could be moved to ASCs for equally efficacious treatment • This is in support of the AHCCCS Payment Modernization Mission: • To leverage the AHCCCS managed care model toward value based health care systems where patients’ experience and population health are improved, per-capita health care cost is limited to the rate of general inflation through aligned incentives with managed care organization and provider partners…

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