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Rate Update

Rate Update. Shelli Silver May 21, 2014. FY 15 Budget . Intent language in Health BRB - cap rate increases not to exceed 3% in fiscal years 2015 , 2016 , or 2017 2% provider rate increase for NFs (part of ALTCS EPD budget - will have to make decision on impact to other programs )

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Rate Update

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  1. Rate Update Shelli Silver May 21, 2014

  2. FY 15 Budget • Intent language in Health BRB - cap rate increases not to exceed 3% in fiscal years 2015, 2016, or 2017 • 2% provider rate increase for NFs (part of ALTCS EPD budget - will have to make decision on impact to other programs) • 2% provider rate increase for DDD HCBS (intent language) Reaching across Arizona to provide comprehensive quality health care for those in need

  3. FY 15 Budget, cont. • 2% provider rate increase for BH providers (part of ADHS budget – intent language – will have to make decision on impact to other programs) • Increase to 74.74% of ADHS ambulance rates Reaching across Arizona to provide comprehensive quality health care for those in need

  4. Health Insurer Fee • Amending all contracts to add language that AHCCCS will fund the Health Insurer Fee (HIF) and associated tax liability • Acute – 10/1/13 retro Risk Adjustment amendment • EPD – 4/1/14 retro NF payment amendment • DDD – 7/1/14 renewal • BHS and CRS – 8/1/14 amendments Reaching across Arizona to provide comprehensive quality health care for those in need

  5. Health Insurer Fee, cont. • Still in discussions with CMS on method to adjust cap rates • ACOM Policy will be issued once final methodology known • Expect cap rates to be amended no sooner than October 2014 Reaching across Arizona to provide comprehensive quality health care for those in need

  6. FQHC PPS Rates • Still slated for 10/1/14 • Data analysis for cap rates ongoing • More information will be distributed when available Reaching across Arizona to provide comprehensive quality health care for those in need

  7. Lab Expenditures • New lab provider states lab tests can be performed with less blood, with quick turn-around on results, at 50% of Medicare rates • Locations in Walgreens • 7 day per week availability • AHCCCS may consider cap rate reduction which can be achieved via lab savings Reaching across Arizona to provide comprehensive quality health care for those in need

  8. Hospital Presumptive Eligibility • Effective 1/1/15 • FFS enrollment for HPE period • If recipient completes full AHCCCS application and is found eligible • FFS responsible for PPC • Enrollment with MCO from and after date of eligibility determination • Currently researching if there is conflict with DRG policies - will notify MCOs if yes, and if changes warranted Reaching across Arizona to provide comprehensive quality health care for those in need

  9. PCP Parity Cost Settlement • AHCCCS sent MCOs test file with one month sample – no concerns noted • Then sent two files for settlement: • “Catch-up” report – August through December 2013 adjudicated encounters • “First quarter 2014” report – January through March 2014 adjudicated encounters • Error just discovered; files to be corrected Reaching across Arizona to provide comprehensive quality health care for those in need

  10. PCP Rates Effective 1/1/15 • AHCCCS considering options for continuing/modifying PCP rate increase • Potential to simplify application of rate (e.g. across select primary care codes regardless of specialty/license/volume) • Funding constraint to continue “as-is” without enhanced Federal match • What happens if Congress continues program “as-is” in January 2015 retro to 1/1/15 Reaching across Arizona to provide comprehensive quality health care for those in need

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