Duals Update

1. Duals Update Kijuana Wright May 21, 2014

2. Arizona Dual Eligible Enrollment 44%! Reaching across Arizona to provide comprehensive quality health care for those in need

3. Strategic Duals Alignment • Integration of all services – single accountable entity better capacity for care coordination • Payment modernization – single entity capable of better aligning incentives • Enhanced appropriate community placement for members at risk of institutionalization • Bends cost curve and improves member outcomes Reaching across Arizona to provide comprehensive quality health care for those in need

4. Dual Alignment Effort • Goal to increase member alignment (same health plan for delivery of Medicare and Medicaid services) • Planning passive enrollment for Acute members in August 2014, with October effective date • Move member to match Medicare plan with opportunity to opt-out • Approximately 7,500 members affected Reaching across Arizona to provide comprehensive quality health care for those in need

5. Dual Alignment Effort, continued • New process allows for better tracking and identification of members • Members will be notified by mail and have 60 days to call and opt-out if they do not wish to change health plans • All members who decline to move will not be included in future alignment efforts Reaching across Arizona to provide comprehensive quality health care for those in need

6. Ongoing Efforts • Future ongoing endeavors to align duals into the same plan planned for 1-2 times per year (acute and ALTCS in HBCS) • Incorporate plan best practices for Medicare-Medicaid eligible members • Contractual requirements • Operational reviews • Measurement of operational efficiencies and care coordination • Member satisfaction • Clinical outcomes Reaching across Arizona to provide comprehensive quality health care for those in need

7. Seamless Conversion • is an existing statutory and regulatory enrollment mechanism that permits organizations that offer both a Medicare Advantage (MA) plan and a non-MA health plan (e.g., Medicaid, employer) to seamlessly convert individuals in the non-MA plans into the MA plan when those individuals first become Medicare eligible. • See additional information in section 40.1.4 of Chapter 2 in the Medicare Managed Care Manual Reaching across Arizona to provide comprehensive quality health care for those in need

8. Seamless Conversion, continued • AHCCCS will identify members who will be newly eligible for Medicare for both ‘age-in’ and disability reasons at least 90 days in advance of eligibility date • Plans will learn of this prospective eligibility via the monthly 834 file • Newly eligible members coded ‘PM’ • Plans notify members within 60 days of eligibility giving them an opportunity to opt-out • Plans must submit proposal to CMS to signal their intent to participate in this process Reaching across Arizona to provide comprehensive quality health care for those in need

9. General Mental Health/Substance Abuse Benefit for Duals • Acute plans will be responsible for delivery of general mental health and substance abuse benefits for dual members effective 10/1/2015 • This population will be acute dual members who are eligible for Medicare Part A or B • Will not include members with SMI • As AHCCCS is the payer of last resort, the acute plans are not the primary payers of these members • Acute plans should discuss operational issues internally and report any concerns to AHCCCS Reaching across Arizona to provide comprehensive quality health care for those in need

10. Questions? Reaching across Arizona to provide comprehensive quality health care for those in need

11. Thank You Reaching across Arizona to provide comprehensive quality health care for those in need