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Operations Update. Dr. Kim Elliott, Clinical Quality Management Diana Alvarez, Operations Jami Snyder, Operations Division of Health Care Management September 19, 2012. Community First Choice Long Term Care .
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Operations Update Dr. Kim Elliott, Clinical Quality Management Diana Alvarez, Operations Jami Snyder, Operations Division of Health Care Management September 19, 2012
Community First ChoiceLong Term Care • Option under the Affordable Care Act aimed at enhancing the member-directed service options • AHCCCS will use CFC to implement the Agency with Choice model • Co-employer model, in which the member and provider share employer-based responsibilities for the paid caregiver (attendant care, personal care, homemaker, habilitation) Our first care is your health care Arizona Health Care Cost Containment System
Community First ChoiceLong Term Care • Implementation Date: January 1, 2013 • Next Steps • Public hearing – Arizona CFC regulations • September 24, 2012, 10 a.m. • Submission of State Plan Amendment to CMS • Finalize necessary policy changes • Outreach and training • ALTCS case manager training, community stakeholder training/outreach, provider forums Our first care is your health care Arizona Health Care Cost Containment System
Direct Care Worker Training and Testing InitiativeLong Term Care • Training and testing program, requiring that direct care workers (attendant care, personal care, homemaker) demonstrate proficiency in a core set of competencies needed to serve ALTCS members • Implementation Date: October 1, 2012 • Next Steps • Work with MCOs to ensure all affected providers have a plan to train workers • Finalize database to track test scores of trained workers • Begin conducting audits of approved training programs Our first care is your health care Arizona Health Care Cost Containment System
Provider Affiliation Transmission RevisionsAcute Care and Long Term Care • Quarterly reporting requirement for Acute and ALTCS plans • New requirement for ALTCS plans (replaces biannual network summary report) • Additional fields added to meet Insure Kids Now Requirement (IKN) • October submission suspended • Next submission Date: January 15, 2013 Our first care is your health care Arizona Health Care Cost Containment System
Dental Audit– Access to CareAcute Care • Conducted to address access to care concerns, specifically related to dental providers • Random phone survey • Approximately 300 calls • Surveyed availability of urgent and routine appointments, if accepting new patients, provider speaks another language or serves special needs population as identified on website Our first care is your health care Arizona Health Care Cost Containment System
Dental Audit– Access to CareAcute Care Results 91 percent of all providers actually contacted for appointment were able to meet appointment timeframes. Most that were unable to make an appointment provided a referral Percent of providers from pool of all providers in the sample that we were unable to schedule an appointment ranged from 3 percent to 40 percent among AHCCCS acute care health plans. Denominator includes providers not reached, providers that did not speak Spanish, providers that had disconnected numbers and providers that had terminated contracts or registration with AHCCCS.
Dental Audit– Access to CareAcute Care • Results (continued) • 29 providers called to assess ability to accommodate Spanish speaking members • 20 percent of providers were unable to schedule an appointment • 4 providers did not have a Spanish speaking staff member available to schedule an appointment • 2 providers had wait times of 15 and 20 minutes
Dental Audit– Access to CareAcute Care • AHCCCS expectation going forward • AHCCCS to share detailed results with MCOs • MCOs do similar type audits or surveys • Track and trend data to ensure adequate network Our first care is your health care Arizona Health Care Cost Containment System
Questions Our first care is your health care Arizona Health Care Cost Containment System
