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AHCCCS Update. Prop 204 + Expansion 2 Reaching across Arizona to provide comprehensive quality health care for those in need.

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Presentation on theme: "AHCCCS Update. Prop 204 + Expansion 2 Reaching across Arizona to provide comprehensive quality health care for those in need."— Presentation transcript:

1 AHCCCS Update

2 Prop 204 + Expansion 2 Reaching across Arizona to provide comprehensive quality health care for those in need

3 Expansion Population 3 Reaching across Arizona to provide comprehensive quality health care for those in need

4 No Response Redes - % of Total 4 Reaching across Arizona to provide comprehensive quality health care for those in need

5 Prop 204 and Expansion Ages (CY 14) 5 Reaching across Arizona to provide comprehensive quality health care for those in need

6 GAO Medicaid Spending Report Duals excluded – 2009-2011 (No Expansion) 1% of Population = 25% of spend 5% = 50% of spend 25%= 75% of spend Bottom 50% = 8% of spend 6 Reaching across Arizona to provide comprehensive quality health care for those in need

7 GAO - Conditions of Members (%) ConditionAsthmaDiabetesHIV/AIDSMHSUDDeliveryLTCNone Asthma 24.53.965.129.16.57.317 Diabetes 18.52.652.423.93.112.729.7 HIV/AIDS 17.915.648.139.42.17.229 MH 17.618.72.826.74.011.942.9 SUD 20.822.66.070.84.510.215.6 Delivery 9.35.90.721.39.00.566 LTC 12.528.62.874.724.40.614.1 7 Reaching across Arizona to provide comprehensive quality health care for those in need

8 1332 Waivers Part of ACA Allows States to waive 1. QHP and EHB Statutes 2. Marketplace Requirements 3. Tax Credits – QHP Cost Sharing – Requires Legislation Statutory Principles o At least as comprehensive benefits – Affordable – offered to comparable number of residents 8 Reaching across Arizona to provide comprehensive quality health care for those in need

9 Overkill – by Atul Gwande Medicare Study on 26 low/no value Tests – 25-42% of Population received Example of Walmart Spine Centers of Excellence Transparency McAllen Texas - $3,000 per person reduction Premise – Unnecessary Care crowding out important care 20% of physicians in alternative payment models Focus on importance of primary care and PCMH 9 Reaching across Arizona to provide comprehensive quality health care for those in need

10 DD Acute RFI Questions 1.BH Integration 2.Support Payment Reform 3.Geographic Coverage 4.CRS Integration Long Term Future Discussions (Not for current RFI/RFP) – Fully Integrated Opportunities 10 Reaching across Arizona to provide comprehensive quality health care for those in need

11 Administrative Simplification 11 Reaching across Arizona to provide comprehensive quality health care for those in need

12 AHCCCS – DBHS Merger Staffing o Communicated with over 50 DBHS Staff about transitioning to AHCCCS o Goal of developing new Organization by 7-1-15 Other Areas of Focus o IT o Legal o Grants o Stakeholder Communication 12 Reaching across Arizona to provide comprehensive quality health care for those in need

13 Provider Rates 230 pages of public comments Wide variety of provider types Timeline o Week of June 8 th - Publish Draft Rates o June 17 th – Tribal Consultation o July 1 st – Submit SPAs to CMS o October 1 st - Implement 13 Reaching across Arizona to provide comprehensive quality health care for those in need

14 GMH/SA Duals Transition May 28 th Plan Specific Meetings 1.Network Status – Analysis – Contracting 2.Staffing 3.Data transfers – AHCCCS historical data – DEF Files 4.High risk populations 5.Provider – Member Communication 14 Reaching across Arizona to provide comprehensive quality health care for those in need

15 Legislative Implementation Update Teledentistry Orthotics MCO Prescription Drug Utilization Management MCO ED Utilization Management AHCCCS Waiver Submittal Requirements o Work – 5 Year limits – Cost Sharing NF Assessment Continuation 15 Reaching across Arizona to provide comprehensive quality health care for those in need


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