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