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AHCCCS Update

AHCCCS Update. Total Applicants by Month. HEAplus Update. HEAplus went live to public on 10-19-13 Sending Account Transfers to FFM – FFM to State Testing as of 1-10-14 Ongoing challenges Next Phase - Roll out to eligibility workers Marketplace Enrollment – AZ – 57,611 (thru 3-1).

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AHCCCS Update

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  1. AHCCCS Update

  2. Total Applicants by Month

  3. HEAplus Update • HEAplus went live to public on 10-19-13 • Sending Account Transfers to FFM – • FFM to State • Testing as of 1-10-14 • Ongoing challenges • Next Phase - Roll out to eligibility workers • Marketplace Enrollment – AZ – 57,611 (thru 3-1)

  4. Medicaid Restoration

  5. 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

  6. Prop 204 Childless Adult Restoration

  7. Prop 204 Parents Population

  8. Prop 204 Combined Populations

  9. AHCCCS Adult Expansion

  10. AHCCCS Traditional Families

  11. 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 7-1-14 – 3 models Litigation • Lawsuit brought by 36 Republican Legislators • Hearing held on Dec. 13th to determine standing • Won at Superior Court – Standing • Oral arguments – Court of Appeals – 3-26-14

  12. 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

  13. 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

  14. 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

  15. Growth in National Health Exp.

  16. CBO Projected Healthcare Expenses

  17. Dual Delivery System

  18. 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

  19. CAHPS Results

  20. RBHA Update • Moving forward with 4-1-14 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

  21. American Indian Health Plan

  22. 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.

  23. NEMT Changes • 4-1-14 – Providers obtain Tribal Business License • 6-1-14 – Provider Registration Recertification • Site visits – vehicle inspections – sign and logo on vehicles - employee review • AIHP Transportation Broker • Current - RFI Process • Fall – RFP • Summer 2015 - Implementation Our first care is your health care Arizona Health Care Cost Containment System

  24. FQHC Payments Our first care is your health care Arizona Health Care Cost Containment System

  25. 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

  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 Our first care is your health care Arizona Health Care Cost Containment System

  27. 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

  28. Other • Copays – • 1-1-14 - 0-100% Childless Adults-not mandatory • 10-1-14 - 100-133% Adults - mandatory copays • 5% tracking challenges • PCP Bump – 12-31-14 scheduled termination • EHB – 3-17-14 formal SPA - 3-1-14 -15 PT • HCBS Rules – Forming Team to assess Our first care is your health care Arizona Health Care Cost Containment System

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