“Reaching across Arizona to provide comprehensive quality health care for those in need” 1 AHCCCS Update

“Reaching across Arizona to provide comprehensive quality health care for those in need” Total Applicants by Month 2

“Reaching across Arizona to provide comprehensive quality health care for those in need” HEAplus Update  HEAplus went live to public on  Sending Account Transfers to FFM –  FFM to State Testing as of Ongoing challenges  Next Phase - Roll out to eligibility workers  Marketplace Enrollment – AZ – 57,611 (thru 3-1) 3

“Reaching across Arizona to provide comprehensive quality health care for those in need” Medicaid Restoration Change Prop 204 Restoration67,770156,15388,383 Adult Expansion-5,806 KidsCare46,7612,143(44,618) Family Planning5,105-(5,105) AHCCCS for Families & Children (1931)672,135652,659(19,476) All Other505,379526,07020,935 Total Enrollment1,297,1501,342,83145,681

“Reaching across Arizona to provide comprehensive quality health care for those in need” KidsCare Update – changes for 2-1  KidsCare I 5,800 Kids  roughly 3,500 to Medicaid  2,300 stay in KidsCare  KidsCare II 37,000 Kids  23,000 Medicaid  14,000 to FFM - Marketplace 5

“Reaching across Arizona to provide comprehensive quality health care for those in need” Prop 204 Childless Adult Restoration 6

“Reaching across Arizona to provide comprehensive quality health care for those in need” Prop 204 Parents Population 7

“Reaching across Arizona to provide comprehensive quality health care for those in need” Prop 204 Combined Populations 8

“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Adult Expansion 9

“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Traditional Families 10

“Reaching across Arizona to provide comprehensive quality health care for those in need” Hospital Assessment & Litigation Assessment  AHCCCS worked with consultant and hospital stakeholders  Assessed $75 m in FY 2014  Model shows no systems negatively impacted  Working with hospitals on new rate for – 3 models Litigation  Lawsuit brought by 36 Republican Legislators  Hearing held on Dec. 13 th to determine standing  Won at Superior Court – Standing  Oral arguments – Court of Appeals –

“Reaching across Arizona to provide comprehensive quality health care for those in need” Reports to Legislature  Emergency Department Utilization – 1.7% ($5.4 m) of total ED spending ($315 m) is for level I visit – less emergent  Hospital Uncompensated Care – from 2011 to 2012 Uncompensated care increased 45.8% Average operating margin went from 5.14% to 4.63% - 10% decrease Occupancy went from 62% to 59.9% - 3.4% decrease 12

“Reaching across Arizona to provide comprehensive quality health care for those in need” Reports to Legislature  Hospital chargemaster and transparency DHS UAR Report - $51 billion in charges - $13.5 billion payments Catalyst for Payment Reform – AZ one of 29 states with F for Transparency AHCCCS and DHS recommend working with hospital to make chargemaster reporting more meaningful AHCCCS will be more transparent and begin publishing charges and payments for top inpatient and outpatient procedures See Web for IP data 13

“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Budget Update  JLBC Budget assumes a $50 m GF reduction  Executive Budget down $75 m GF – slightly lower caseload forecasts  Both budgets account for growth of ACA and some utilization/cost growth plus impact of hospital assessment  Assume 3% cap rate growth 14

“Reaching across Arizona to provide comprehensive quality health care for those in need” Growth in National Health Exp. 15

“Reaching across Arizona to provide comprehensive quality health care for those in need” CBO Projected Healthcare Expenses 16

“Reaching across Arizona to provide comprehensive quality health care for those in need” Dual Delivery System Medicaid FFS Medicaid Managed Care Medicare FFS Arizona 73% 7% 9% 32% Medicare Advantage Arizona 12% 1% 5% 60% 17

“Reaching across Arizona to provide comprehensive quality health care for those in need” GAO Report – SNP Plans Profitability  2013 Report looked at 2011 data  Analysis looked at 71% of SNP enrollment – 121 plans  AZ 2012 overall SNP profit – 1.65% – 3 of 7 plans lost money - $850 m book of business – strong competition 18 GAO StudySNPPlans for all Members Revenue per member$12,959$9,934 Medical Expense82.7%86.4% Profits8.6%4.6%

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Results ChildrenAdultCRSSMI Health Plan4311 Health Care5341 Doctor4251 Specialist4352 Needed Care3332 Care Quickly2221 Dr. Communication2321 Plan Customer Service4422 Members Surveyed10,3025,0771,

“Reaching across Arizona to provide comprehensive quality health care for those in need” RBHA Update  Moving forward with Maricopa implementation with MMIC  Letters went out to members at end of February  Work has started on Greater AZ RFP for RBHA services – 10/1/2015 contract term RFIs Timeline – July Release – December Award Waiver of Choice Posted Decisions 20

“Reaching across Arizona to provide comprehensive quality health care for those in need” American Indian Health Plan Staffing & Resources Data Care Coordination Model Relationships AIHP Care Coordination 21

“Reaching across Arizona to provide comprehensive quality health care for those in need” An Example of an AIHP “Super Utilizer” A 57 year old male American Indian member has visited the ED of a non IHS/638 hospital 28 times and had 8 in-patient stays at an I.H.S/638 facility in the last 12 months. 3 of the in-patient stays were readmissions within 30 days of the original discharge date. He has diabetes, heart disease and mental health/substance abuse issues. 22

“Reaching across Arizona to provide comprehensive quality health care for those in need” NEMT Changes  – Providers obtain Tribal Business License  – Provider Registration Recertification Site visits – vehicle inspections – sign and logo on vehicles - employee review  AIHP Transportation Broker Current - RFI Process Fall – RFP Summer Implementation Our first care is your health care Arizona Health Care Cost Containment System 23

“Reaching across Arizona to provide comprehensive quality health care for those in need” FQHC Payments Our first care is your health care Arizona Health Care Cost Containment System 24

“Reaching across Arizona to provide comprehensive quality health care for those in need” FQHC/MCO Payment Alignment  October 1, 2014 implementation  Creating new Provider type – FQHC/RHC  Streamlined process  Modest claiming process changes  MCOs will need to pay FQHC unique PPS rate for each “visit” (separate service not within same discipline)  AHCCCS will continue quarterly/recon process  Have workgroup with FQHCs Our first care is your health care Arizona Health Care Cost Containment System 25

“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 26 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 developing a policy to include: Emphasis on Program Integrity Requirement of hospital staff to be subscribed users of HEAplus Submission of complete applications whenever possible  State Plan Amendment must be submitted by 3/31/14  More information to come

“Reaching across Arizona to provide comprehensive quality health care for those in need” HIT Update  AZHEC/HINAZ – Board Affiliations  HINAZ Medicaid funding for Providers  E-prescribe opportunities/requirements Our first care is your health care Arizona Health Care Cost Containment System 27 Adopt- Implement Meaningful Use Payments (in millions) Providers2,506409$56.5 Hospitals6734$111.5 Totals2,573445$168

“Reaching across Arizona to provide comprehensive quality health care for those in need” Other  Copays – % Childless Adults-not mandatory % Adults - mandatory copays 5% tracking challenges  PCP Bump – scheduled termination  EHB – formal SPA PT  HCBS Rules – Forming Team to assess Our first care is your health care Arizona Health Care Cost Containment System 28