AHCCCS Update: Budget and Enrollment, Waiver Update

1. AHCCCS Update May 16, 2012 Our first care is your health care Arizona Health Care Cost Containment System

2. Topics to Cover Meeting Purpose Budget and Enrollment Update AHCCCS Priorities Waiver Update Our first care is your health care Arizona Health Care Cost Containment System

3. Health Plan Meeting Goals of expanded format • Provide Current Information • Chance to have dialogue and ask questions • Transparent sharing of information • Level playing field Our first care is your health care Arizona Health Care Cost Containment System

4. Budget and Enrollment Our first care is your health care Arizona Health Care Cost Containment System

5. Total AHCCCS Population Our first care is your health care Arizona Health Care Cost Containment System 5

6. Waiver Population Our first care is your health care Arizona Health Care Cost Containment System 6

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

8. State Budget • Budget made spending assumptions for FY 2014 and FY 2015 • Near balanced over term WITH loss of one-cent sales tax starting in FY 2014 • Assumed $210 m GF cost for ACA Medicaid Coverage in FY 2015 • Included intent language that capitation rates not exceed 3% increase in FY 14 & 15 Our first care is your health care Arizona Health Care Cost Containment System

9. All AHCCCS Capitation Trends Our first care is your health care Arizona Health Care Cost Containment System Our first care is your health care Arizona health care cost containment system 9

10. AHCCCS Budget Issues • Capitation Rollover – Eliminated • Potential Funding Adjustments • Budget assumed 3% change – utilization – dependent on actuary analysis • 1-1-13 ACA Primary Care Rate change - CMS just issued rule • 4-1-13 – 2% increase for DD and BH providers • Need to complete access to care analysis but anticipate limited rate changes • Legislature eliminated statutory increases for IP/OP and ambulance rate tied to DHS structure Our first care is your health care Arizona Health Care Cost Containment System

11. Program Budget Status FY 2012 Estimate Medicaid System balanced Risk of Litigation (Prop 204 and Hospital)-Eliminated FY 2013 Request No NEW Cuts Anticipated – Population freezes remain Longer Term Medicaid Expansion on 1-1-14 will add hundreds of millions in state costs Our first care is your health care Arizona Health Care Cost Containment System

12. AHCCCS Spending Our first care is your health care Arizona Health Care Cost Containment System Our first care is your health care Arizona health care cost containment system 12

13. AHCCCS Priorities • ACA Planning • Triple Crown and Integration • Payment Reform • Program Integrity • Quality & HIT Our first care is your health care Arizona Health Care Cost Containment System

14. ACA & Supreme Court • Court evaluating Constitutionality of • Individual Mandate – Severability - Medicaid Expansion • What will be the outcome of the Supreme Court Ruling? • Constitutional • Individual Mandate Unconstitutional – Non-severable – • Individual Mandate Unconstitutional – Severable • Medicaid • Experts opine - outcome rests with 2 justices – Kennedy & Roberts Our first care is your health care Arizona Health Care Cost Containment System

15. Health Care Reform Timeframes • June 2012 – Supreme Court Ruling • July 2012 – If law upheld award RFP for Exchange System • September 2012 – Essential Benefits Decision • November 2012 – Level II Est. Grant • January 2013 – Secretary HHS Exchange Certification • July 2013 – Systems Readiness Testing • October 2013 – Exchange Enrollment begins • January 2014 – Exchange “Go Live” coverage Our first care is your health care Arizona Health Care Cost Containment System

16. Triple Crown and Integration Leverage Triple Crown Opportunities Maricopa RBHA – Statewide Acute - CRS Transparent and Engage Stakeholders Integration – Care Management for frail populations CRS – Duals – Members with SMI Manage/Leverage Unprecedented Competition Our first care is your health care Arizona Health Care Cost Containment System

17. Dual Members Demo Observations from 100,000 Feet Unprecedented Historical Opportunity to improve care Meetings with 1. CMS Administration 2. Congressional Staff 3. MEDPAC/MACPAC Concerns expressed by federal staff (non CMS) Speed – Size – MCO Capacity – Unresolved Issues – Medicare Principles State Efforts and Stakeholder Support not Elevating Our first care is your health care Arizona Health Care Cost Containment System

18. Triple Crown Timeline • July 2012 – Release Maricopa RBHA RFP • Oct 2012 – Maricopa RBHA Response Due • Nov 2012 – Release Acute/CRS RFP • Nov 2012 – Dual Demo/SNP Intent Notice (plans) • Jan 2013 – Award Maricopa RBHA • Jan 2013 – Acute/CRS RFP Responses Due • Feb 2013 – Dual Demo App Due (Plans) • March 2013 – Acute/CRS Award • October 2013 – Start Date Our first care is your health care Arizona Health Care Cost Containment System

19. MCO Expectations • Member Focused • Knowledgeable and effective • Care Management Expertise • Accountable • Flexible • Innovative • Share in Vision on improved health outcomes while bending the cost curve Our first care is your health care Arizona Health Care Cost Containment System

20. Payment Reform • Hospital Inpatient Reimbursement – Legislation passed • Payment Reform Pilots – Aligned incentives • Pay for Quality/Outcomes – Potentially Preventable Readmissions – future goal Our first care is your health care Arizona Health Care Cost Containment System Our first care is your health care Arizona health care cost containment system 20

21. Program Integrity • Health Plan Reviews of PI Efforts • AHCCCS undergoing State Auditor General Review – CMS Review – HHS IG Audit • PERM Study – payments and eligibility • RAC – Managed Care – RFI • NAMD Paper • Federal/State roles have become blurred and overlap • Access to federal data sources is challenging • Federal programs are not tailored to meet state priorities Our first care is your health care Arizona Health Care Cost Containment System

22. Quality Measures • Numerous federal efforts around updating and improving quality measures • Dr. Elliott active participant • CHIPRA Core – Comprehensive Well Child Core – Adult Core - Dual Eligible – Multiple Chronic Disease – Meaningful Use – CMS Access Measures • Expect measures to evolve over next contract cycle • HIT – looking to leverage ARRA investment • 319 EP - $6.7 m – 44 Hospitals - $54.5 m Our first care is your health care Arizona Health Care Cost Containment System

23. CMS Waiver • KidsCare II – 21,000 participants – 1-1-14 end date • Safety Net Care Pool – Uncompensated Care funding if local match – 1-1-14 end date • Ability to provide $13 m for ED and Trauma uncompensated costs with Prop 202 funds • Ability to provide uncompensated funds to I.H.S and 638 facilities for budget impacts Our first care is your health care Arizona Health Care Cost Containment System

24. Questions???? Our first care is your health care Arizona Health Care Cost Containment System