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CYE 15 Payment Reform Initiatives

CYE 15 Payment Reform Initiatives. Acute Care Continue CYE 14 model with 1% capitation withhold and the following changes: Minimum 10% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

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CYE 15 Payment Reform Initiatives

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  1. CYE 15 Payment Reform Initiatives Acute Care • Continue CYE 14 model with 1% capitation withhold and the following changes: • Minimum 10% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted • AHCCCS considering limiting portion of shared savings with owner systems – 33% of total maximum? • AHCCCS considering adding geographic requirements – e.g. 80% maximum in any one GSA for multiple GSA plans?

  2. CYE 15 Payment Reform Initiatives ALTCS EPD • Implement initiative similar to Acute Care CYE 14 model: • Minimum 5% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted • Minimum 2% of total Acute Care service payments • Minimum 2% of total LTC service payments • Remaining 3% of total spend at MCO discretion

  3. CYE 15 Payment Reform Initiatives ALTCS EPD • Minimum 1.5% of Medicare DSNP total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted • 1% capitation withhold • Distribution based on existing performance measures • Would prefer mix of Acute Care and LTC services • Input on performance measures welcome

  4. CYE 15 Payment Reform Initiatives ALTCS DDD • LTC Services • DES/DDD submit plan regarding value-based purchasing to AHCCCS by April 2015 for CYE 16 implementation • Acute Care Services • Implement initiative similar to Acute Care CYE 14 model: • Minimum 5% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted • Consider 1% capitation withhold • Input on performance measures welcome

  5. CYE 15 Payment Reform Initiatives CRS • Implement initiative similar to Acute Care CYE 14 model: • Minimum 5% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts/block purchasing counted • No capitation withhold due to single Contractor • Consider sanction for non-compliance

  6. CYE 15 Payment Reform Initiatives BHS • Implement initiative for integrated RBHA • Minimum 1% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts/block purchasing counted • No capitation withhold due to single Integrated RBHA • Consider sanction for non-compliance

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