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AHCCCS Update. Medicaid Restoration 12-1-134-1-14Change Prop 204 Restoration 67,770197,256129,486 Adult Expansion -16,319 KidsCare 46,7612,083(44,678)

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Presentation on theme: "AHCCCS Update. Medicaid Restoration 12-1-134-1-14Change Prop 204 Restoration 67,770197,256129,486 Adult Expansion -16,319 KidsCare 46,7612,083(44,678)"— Presentation transcript:

1 AHCCCS Update

2 Medicaid Restoration Change Prop 204 Restoration 67,770197,256129,486 Adult Expansion -16,319 KidsCare 46,7612,083(44,678) Family Planning 5,105-(5,105) AHCCCS for Families & Children (1931) 672,135699,42327,288 All Other 505,379550,35044,971 Total Enrollment 1,297,1501,465,431168,281 Reaching across Arizona to provide comprehensive quality health care for those in need 2

3 HEAplus Update HEAplus went live to public on Sending Account Transfers to FFM – FFM to State o Ongoing challenges o 20,000 processed Started pilot for roll out to eligibility workers Marketplace Enrollment – AZ – 120,071 ( ) HHS OIG Review starting already Reaching across Arizona to provide comprehensive quality health care for those in need 3

4 Prop 204 Childless Adult Restoration Reaching across Arizona to provide comprehensive quality health care for those in need 4

5 5 AHCCCS PROP 204 COMBINED POPULATIONS

6 Reaching across Arizona to provide comprehensive quality health care for those in need 6

7 AHCCCS Traditional Families 7 Reaching across Arizona to provide comprehensive quality health care for those in need

8 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 – Litigation Lawsuit brought by 36 Republican Legislators Hearing held on Dec. 13 th 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 8

9 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 9

10 RBHA Update – Implemented Maricopa RBHA MMIC Transition went reasonably well – few challenges o Call Center o AHCCCS ID Cards Greater AZ RFP for RBHA services – 10/1/2015 o RFIs o Timeline – July Release – December Award o Waiver of Choice Posted Reaching across Arizona to provide comprehensive quality health care for those in need 10

11 DHS Greater AZ Guidance 1.Serious Mental Illness (SMI) Eligibility Determination will not be a Regional Behavioral Health Authority (RBHA) function. 2.GMH/SA Duals will have behavioral health services integrated into AHCCCS acute plans. 3.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. 4.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 11

12 DHS Greater AZ Guidance Cont. 5.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 6.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. 7.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 8.Decisions around Dual Eligible-Special Needs Plan D-SNP. See Attachment Reaching across Arizona to provide comprehensive quality health care for those in need 12

13 Provider Rate Changes ProviderChangeProviderChange Hospital IP-10%Emergency22.3% Hospital OP-8.8%NEMT-11.6% NF (EPD).5%ASC-.1% Behavioral Health OP -10%Dental-13% Physician-13.8%FQHC32.2% PCP Parity14%Hospice12.5% 13 Reaching across Arizona to provide comprehensive quality health care for those in need

14 Hospital Presumptive Eligibility Requirement of the ACA Hospitals and affiliated facilities eligible to submit streamlined PE applications Application can not require: o SSN o Documentation of Citizenship o Verification of income o Signature of application AHCCCS submitted SPA and Draft policy to CMS: o Emphasis on Program Integrity and leveraging HEAplus o Requirement of hospital staff to be subscribed users of HEAplus o Submission of complete application for 90% within PE period o 95% accuracy for PE determinations o Operational issues need to be resolved o Currently – 73% denial rate IP – 86% treat and release 14 Reaching across Arizona to provide comprehensive quality health care for those in need

15 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 15

16 Sovaldi Con’t. LowHigh Treatment Cost – post Rebate $52,500$112,500 20% of Known Hep C Population 117,119,520250,970,400 Entire Known Hep C population 585,597,6001,254,852, Reaching across Arizona to provide comprehensive quality health care for those in need

17 Safety Net Care Pool (in millions) FFY 2012FFY 2013FFY 2014Totals SNCP$267.2$243.9$28.4$539.5 City of Phoenix $322.8$94.1$416.9 Totals$267.2$566.7$122.5$ Reaching across Arizona to provide comprehensive quality health care for those in need

18 Health Information Exchange Update Arizona Health-e Connection and Health Information Network of Az (HINAz) formally affiliated in Q 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 to learn

19 Other Copays – o % Childless Adults-not mandatory o % Adults - mandatory copays o 5% tracking challenges PCP Bump – scheduled termination EHB – formal SPA PT HCBS Rules – Forming Team to assess Reaching across Arizona to provide comprehensive quality health care for those in need 19


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