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Arizona PERM Pilot Round 1. Kim Sanchez Quality Compliance Administrator Phone: (602) 417-4563 Email: kim.a.sanchez@azahcccs.gov. AZ Organization Background. AHCCCS Arizona Medicaid Determines Eligibility for SSI MAO and Long Term Care. Department Of Economic Security (DES)

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arizona perm pilot round 1

Arizona PERM PilotRound 1

Kim Sanchez

Quality Compliance Administrator

Phone: (602) 417-4563

Email: kim.a.sanchez@azahcccs.gov

az organization background
AZ Organization Background

AHCCCS

Arizona Medicaid

Determines Eligibility for SSI MAO and Long Term Care

Department Of Economic Security (DES)

Determines eligibility for SNAP, TANF and Medicaid for non-disabled adults and children

MMIS

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

systems
Systems

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

perm pilot round 1
PERM Pilot Round 1
  • Sample 200 Medicaid, 0 CHIP
  • Pull at the individual level
  • Pull weekly samples (calendar week)
  • Review at the household level
  • Reviews pulled from December and February

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

resources
Resources
  • Social Interest Solutions – Developed HEAplus and our sampling programming
  • AHCCCS Medicaid QC staff – completed the reviews

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

challenges and resolutions
Challenges and Resolutions
  • Universes inconsistent
  • Eligibility “work arounds” developed after pilot proposal was submitted
  • Revisions to pilot proposal

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

universes inconsistent
Universes inconsistent
  • Universe totals did not align
    • Majority of samples pulled in April
    • Quality control check the samples
    • Clerical pulled system screens for reviewers
    • Assigned to staff in May
    • Had May and June to complete the reviews
  • Result: Limited time to complete reviews

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

eligibility work arounds developed after pilot proposal was submitted
Eligibility “work arounds” developed after pilot proposal was submitted
  • Eligibility workers not all in the new system
    • Eligibility determined in the old system
    • Some determinations in our universes were a preliminary denial decision
  • Result: Had to re-evaluate our review process, re-write our internal policy and re-train staff

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

revisions to pilot proposal
Revisions to Pilot Proposal
  • Proposal –stratification by submission method, including transfers from the FFM.
    • Revision 1 – no FFM referrals
  • Proposal – We proposed to complete 160 positive reviews and 40 negative reviews.
    • Revision 2 – 167 positive reviews, 33 negative reviews

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

pilot results
Pilot Results
  • Medicaid Active –

6 Income not budgeted

5 No valid signed application

4 budget unit established incorrectly

2 in receipt of Medicare

2 applied old budgeting rules

1 Relationship incorrectly coded

1 Income used was not reasonably compatible

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

pilot results1
Pilot Results
  • Medicaid Negative –

2 Notice not sent

3 Eligible for MAGI

        • Client double entered self-employment
        • Incorrectly denied
        • Denied when eligible for Emergency Services

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

preparation for 2nd round pilot
Preparation for 2nd Round Pilot
  • Stabilization of universes
  • Complete reviews of a State samples of cases transferred from the FFM
  • Revise our written procedures with more detail for reviewers to take into consideration eligibility “work arounds” established
  • Conduct additional staff training

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

questions

Questions?

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

thank you

Thank You.

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