Ahcccs update
This presentation is the property of its rightful owner.
Sponsored Links
1 / 19

AHCCCS Update PowerPoint PPT Presentation


  • 91 Views
  • Uploaded on
  • Presentation posted in: General

AHCCCS Update. Medicaid Restoration. HEAplus Update. HEAplus went live to public on 10-19-13 Sending Account Transfers to FFM – FFM to State Ongoing challenges 20,000 processed Started pilot for roll out to eligibility workers Marketplace Enrollment – AZ – 120,071 (4-19-14)

Download Presentation

AHCCCS Update

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Ahcccs update

AHCCCS Update


Medicaid restoration

Medicaid Restoration

Reaching across Arizona to provide comprehensive quality health care for those in need


Heaplus update

HEAplus Update

  • HEAplus went live to public on 10-19-13

  • Sending Account Transfers to FFM –

  • FFM to State

    • Ongoing challenges

    • 20,000 processed

  • Started pilot for roll out to eligibility workers

  • Marketplace Enrollment – AZ – 120,071 (4-19-14)

  • HHS OIG Review starting already

Reaching across Arizona to provide comprehensive quality health care for those in need


Prop 204 childless adult restoration

Prop 204 Childless Adult Restoration

Reaching across Arizona to provide comprehensive quality health care for those in need


Ahcccs update

AHCCCS PROP 204 COMBINED POPULATIONS

Reaching across Arizona to provide comprehensive quality health care for those in need


Ahcccs update

Reaching across Arizona to provide comprehensive quality health care for those in need


Ahcccs traditional families

AHCCCS Traditional Families

Reaching across Arizona to provide comprehensive quality health care for those in need


Hospital assessment litigation

Hospital Assessment & Litigation

Assessment

  • AHCCCS worked with consultant and hospital stakeholders

  • Assessed $75 m in FY 2014

  • Model shows no systems negatively impacted

  • Finalizing rule for new rate for 7-1-14 –

    Litigation

  • Lawsuit brought by 36 Republican Legislators

  • Hearing held on Dec. 13th to determine standing

  • Won at Superior Court – Standing

  • Lost Standing at Court of Appeals

  • Requesting Supreme Court Review

Reaching across Arizona to provide comprehensive quality health care for those in need


Legislative session

Legislative Session

  • AHCCCS Budget had savings ($60 m)

  • Assumes 3% cap rate growth

  • No new funding for employee compensation

  • NF – BH – DD provider rate increases

  • Insulin Pumps only benefit added

Reaching across Arizona to provide comprehensive quality health care for those in need


Rbha update

RBHA Update

  • 4-1-14 – Implemented Maricopa RBHA MMIC

  • Transition went reasonably well – few challenges

    • Call Center

    • AHCCCS ID Cards

  • Greater AZ RFP for RBHA services – 10/1/2015

    • RFIs

    • Timeline – July Release – December Award

    • Waiver of Choice Posted

Reaching across Arizona to provide comprehensive quality health care for those in need


Dhs greater az guidance

DHS Greater AZ Guidance

  • Serious Mental Illness (SMI) Eligibility Determination will not be a Regional Behavioral Health Authority (RBHA) function.

  • GMH/SA Duals will have behavioral health services integrated into AHCCCS acute plans.

  • The Greater Arizona RFP will include integration of behavioral and physical health for the SMI population similar to the Geographical Service Area (GSA) 6 Contract.

  • The preferred GSA model will be a north/south split. The north/south split is contingent upon a waiver being granted by the Centers for Medicare and Medicaid Services (CMS) concerning choice of plans for acute care. If a waiver is not granted the GSA model will provide for member choice within the defined GSA(s).

Reaching across Arizona to provide comprehensive quality health care for those in need


Dhs greater az guidance cont

DHS Greater AZ Guidance Cont.

  • It is the intent of the ADHS to make every attempt to align GSA’s so that tribal nations will be kept whole in the assignment to a RB

  • Delivery of Crisis Services within Greater Arizona is dependent upon the CMS waiver determination. If a waiver is granted the crisis system will be the responsibility of each individual RBHA awarded a contract. If a waiver is not granted the RBHAs that are awarded contracts may be required to jointly create and manage a crisis system through a joint governance agreement as delineated within the RFP.

  • A RBHA will not be allowed to be awarded or hold a contract in more than one (1) GSA. For the purposes of this section a RBHA includes any entity holding a substantial financial, operational or organizational attachment to another entity operating as a RBHA within Arizon

  • Decisions around Dual Eligible-Special Needs Plan D-SNP. See Attachment

Reaching across Arizona to provide comprehensive quality health care for those in need


Provider rate changes

Provider Rate Changes

Reaching across Arizona to provide comprehensive quality health care for those in need


Hospital presumptive eligibility

Hospital Presumptive Eligibility

  • Requirement of the ACA

  • Hospitals and affiliated facilities eligible to submit streamlined PE applications

  • Application can not require:

    • SSN

    • Documentation of Citizenship

    • Verification of income

    • Signature of application

  • AHCCCS submitted SPA and Draft policy to CMS:

    • Emphasis on Program Integrity and leveraging HEAplus

    • Requirement of hospital staff to be subscribed users of HEAplus

    • Submission of complete application for 90% within PE period

    • 95% accuracy for PE determinations

    • Operational issues need to be resolved

    • Currently – 73% denial rate IP – 86% treat and release

Reaching across Arizona to provide comprehensive quality health care for those in need


Sovaldi

Sovaldi

  • Have had 18,000 Hep C members past 2 years

  • 25% Duals

  • Need National dialogue on pricing and medical management policies

  • NGA/NAMD hosting session in June

  • Have 127 members authorized

  • Policy update

Reaching across Arizona to provide comprehensive quality health care for those in need


Sovaldi con t

SovaldiCon’t.

Reaching across Arizona to provide comprehensive quality health care for those in need


Safety net care pool in millions

Safety Net Care Pool (in millions)

Reaching across Arizona to provide comprehensive quality health care for those in need


Health information exchange update

Health Information Exchange Update

  • Arizona Health-e Connection and Health Information Network of Az (HINAz) formally affiliated in Q1 2014

  • Current assessment of future HIE service offerings and technology platform underway

  • Upgrade of current HIE technology platform likely in late 2014

  • Vendor Evaluation Advisory Committee formed to evaluate HIE technology upgrade options

  • Opportunity for Medicaid health plan involvement on committee – contact Melissa Kotrys, CEO ([email protected]) to learn more


Other

Other

  • Copays –

    • 1-1-14 - 0-100% Childless Adults-not mandatory

    • 10-1-14 - 100-133% Adults - mandatory copays

    • 5% tracking challenges

  • PCP Bump – 12-31-14 scheduled termination

  • EHB – 3-17-14 formal SPA - 3-1-14 -15 PT

  • HCBS Rules – Forming Team to assess

Reaching across Arizona to provide comprehensive quality health care for those in need


  • Login