“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System AHCCCS Update Meeting – Systems Update – March 2014

“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Systems Update Topics  Cost Sharing (Copays)  Data Exchange/Blind Spots  DRG’s  ICD-10  FQHC/RHC  PCP Rate Parity  Security Audit  Other Our first care is your health care Arizona Health Care Cost Containment System 2

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 3 Cost Sharing (Copays)  Minor changes implemented 1/1/14 – No longer assigning mandatory copay levels 40 and 45 and elimination of copays for well visit codes  Addition modifications under evaluation and planned for 10/1/2014: Populations currently subject to mandatory and optional (nominal) copayments; Populations exempt from copayments; Amounts for applicable copayments; And services for which copayment apply are planned.

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 4 Data Exchange/Blind Spots AHCCCS will manage an ongoing exchange of encounter and claims data to Contractors in order to eliminate “blind spots” for services provided to a member shared by multiple programs (In compliance with Federal privacy regulations) Contractors should use this information to develop short- and long-term strategies to improve care coordination Ongoing – provide at least quarterly

“Reaching across Arizona to provide comprehensive quality health care for those in need” Data Exchange/Blind Spots (cont.)  Planned additions to the Data Exchange include the integration of - Medicare Paid Claims Data (Part D; D-SNP; Medicare FFS) – In progress  Technical Workgroup for this project held on 2/5/14  Addition of a requirement for 3 year history for all Acute and RBHA contractors who did not already receive them for a GSA or in whole; evaluation of timeframes for production in progress Our first care is your health care Arizona Health Care Cost Containment System 5

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 6 DRG’s  On schedule for 10/1/2014 (based upon Dates of Discharge) Implementation  DRG Project Webpage – “AHCCCS Transition to DRG- based Payment”  Proposed Final Rule currently available for public comment/review pdf pdf

“Reaching across Arizona to provide comprehensive quality health care for those in need” DRG’s (cont.)  Technical Workgroup Formed for this project; Meeting on a regular basis; Meeting materials and key action items/discussion available at px px  3 Key Forms of Project Documentation – AHCCCS Policy Document AHCCCS Rule AHCCCS DRG Calculator Our first care is your health care Arizona Health Care Cost Containment System 7

“Reaching across Arizona to provide comprehensive quality health care for those in need” DRG’s (cont.)  Finalizing all Policy decisions which will be shared with all Contractors as a component of the DRG Technical Workgroup  Testing 3M APR-DRG software  Contractors will be provided with and will be required to successfully execute a defined set of test scenarios  Contractor monthly project Milestone Reporting began in February, 2014 Our first care is your health care Arizona Health Care Cost Containment System 8

“Reaching across Arizona to provide comprehensive quality health care for those in need” DRG’s (cont.)  Current DRG Project Milestones: Complete Requirements and Design - In Progress - March 2014 Complete Coding – In Progress - May 2014 Internal Testing Begins - May 2014 Internal Testing Ends - July 2014 External Testing Begins (all plans/providers/ATR) - June 2014 System Implementation - September 2014 External Testing Ends (No earlier than) - September 2014 DRG Effective Date – October 1, 2014 (IP Dates of Discharge) Our first care is your health care Arizona Health Care Cost Containment System 9

“Reaching across Arizona to provide comprehensive quality health care for those in need” ICD-10  The AHCCCS ICD10 Project remains on schedule  AHCCCS ICD10 Project Milestones Requirements and Design Reference System - Completed Coding Reference Systems - Completed Requirements and Design All Other Systems – Completed Internal Testing Reference System - Completed Coding All other System Areas – Completed System Implementation Reference System – Completed Initial Reference Table Loads – Completed (validation of key policy impacts ongoing) Our first care is your health care Arizona Health 10

“Reaching across Arizona to provide comprehensive quality health care for those in need” ICD-10 (cont.) ICD10 Reference Table Extracts for Contractors – Distribute week of 3/24 Internal Testing All Other Systems – In Progress External Testing Began - January 2014 (with incremental begin dates as noted below)  837 Submissions (Claims/Encounters) - January 15 th 2014  Claims/Encounters Editing and Results Reporting (End to End) – March 15 th 2014  Reports – June 1 st 2014  ICD10/DRG Integrated End to End – June 1 st 2014 System Implementation - September 2014 Our first care is your health care Arizona Health Care Cost Containment System 11

“Reaching across Arizona to provide comprehensive quality health care for those in need” ICD-10 (cont.) External Testing Ends No earlier than September 2014 Reminder - ICD10 Effective Date October (Professional and Outpatient dates of service; Inpatient dates of discharge) Contractor Milestone Reporting and Tracking ongoing (began in June 2013); “Thanks to all for your timely submissions” Contractors will be provided with and will be required to successfully execute a defined set of test scenarios likely during and in conjunction with the ICD10/DRG Integrated End to End testing timeframe Our first care is your health care Arizona Health Care Cost Containment System 12

“Reaching across Arizona to provide comprehensive quality health care for those in need” ICD-10 (cont.)  Webpage Our first care is your health care Arizona Health Care Cost Containment System 13

“Reaching across Arizona to provide comprehensive quality health care for those in need” FQHC/RHC  FQHC/RHC Payment Alignment MCO’s will need to pay FQHC/RHC unique PPS rates for each “visit” (separate service not with same discipline)  Timeline October 1, 2014 implementation Provider registration letter and spreadsheet (will go out by May 2014, due by 8/15/14) Testing window for plans and providers (late July 2014 – early August 2014)  Tom will be covering key highlights in his overview today and technical details will be provided to Contractor Technical Staff at or before the next AHCCCS Technical Consortium Our first care is your health care Arizona Health Care Cost Containment System 14

“Reaching across Arizona to provide comprehensive quality health care for those in need” PCP Rate Parity  Payment of new claims, and 4 month window for retro processing concluded 11/30/2013  AHCCCS is working with individual contractors to ensure that all encounters eligible for the PCP Rate Parity have been appropriately identified and reprocessed  AHCCCS will make quarterly cost-settlement payments to the Contractor based upon adjudicated/approved encounter data.  Contractors will be required to refund payments to AHCCCS for any reduced claim payments in the event that a provider is subsequently “decertified” for enhanced payments Our first care is your health care Arizona Health Care Cost Containment System 15

“Reaching across Arizona to provide comprehensive quality health care for those in need” PCP Rate Parity (cont.)  Contractors will receive an initial limited data (i.e. one month) cost-settlement report to allow for an initial test later this week or early next week  First full cost-settlement report for PCP Rate Parity qualified encounters adjudicated/approved between 8/1/2013 and 12/31/2013 is in progress for distribution to Contractors no later than the week or April 7th  Please note, all valuation by AHCCCS reflects appropriate rates in effect for the encounter date of service (i.e. dates of service 1/1/14 and after will reflect the 1/1/14 PCP rates, etc…) Our first care is your health care Arizona Health Care Cost Containment System 16

“Reaching across Arizona to provide comprehensive quality health care for those in need” Security Audit  Reminder - First audit will be due June 1, 2014  Minor clarifications made to published policy in response to additional Contractor feedback made and distributed in January Our first care is your health care Arizona Health Care Cost Containment System 17

“Reaching across Arizona to provide comprehensive quality health care for those in need” Other  Implementing new Maricopa RBHA and Integrated SMI Contractor 4/1/14  AHCCCS 999 UB Lines HIPAA compliance changes proposed for 1/1/2015  Next Technical Consortium currently targeted for 4/9 Our first care is your health care Arizona Health Care Cost Containment System 18