April 10, 2013 - AHCCCS

State Medicaid Advisory Committee (SMAC) 

Wednesday, April 10, 2013 

AHCCCS 

Gold Room - 3rd Floor 

701 E. Jefferson Street 

1 p.m. – 3p.m. 

Agenda 

I. Welcome Deputy Director Beth Lazare 

II. Introductions of Members ALL 

III. Approval of February 1, 2013 meeting summary ALL 

Agency Updates 

IV. Legislative Update Jennifer Carusetta, 

Office of Intergovernmental Relations 

V. CMS Update-State Plan Amendments; Waivers Theresa Gonzales, 

Office of Intergovernmental Relations 

VI. RFP Announcements Kari Price, 

Division of Health Care Management 

VII. DHS Update – Maricopa RBHA RFP Will Humble, 

Director of AZ Dept. of Health Services 

VIII. 

AHCCCS Update – Medicaid Coverage Plan 

IX. Call to the Public 

Discussion 

Beth Lazare, 

Deputy Director 

Deputy Director Beth Lazare 

X. Adjourn at 3:00 p.m. ALL 

2013 SMAC Meetings 

Per SMAC Bylaws, meetings are to be held the 2nd Wednesday of January, April, July and October. 

All meetings will be held from 1 p.m.- 3 p.m. at the AHCCCS Administration 

701 E. Jefferson, Phoenix, AZ 85034, 3rd Floor in the Gold Room: 

February 1, 2013 

April 10, 2013 

July 10, 2013 

October 9, 2013 

For more information or assistance, please contact Theresa Gonzales at (602) 417-4732 or theresa.gonzales@azahcccs.gov

February 2013 Meeting Summary

Janice K. Brewer, Governor 

Thomas J. Betlach, Director 

801 East Jefferson, Phoenix, AZ 85034 

PO Box 25520, Phoenix, AZ 85002 

Phone: 602-417-4000 

www.azahcccs.gov 

Our first care is your health care 

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM 

Members in attendance: 

Tom Betlach 

Will Humble 

Kathy Waite 

Kathy Byrne 

Tara McCollum Plese 

Kathleen Collins Pagels 

State Medicaid Advisory Committee (SMAC) Meeting Summary 

Friday, February 1, 2013, AHCCCS, 701 E. Jefferson, Gold Room 

1:00 p.m. – 3:00 p.m. 

Members Absent: Kevin Earle, & Kim VanPelt 

Elena Rodriguez for Amanda Aguirre 

Sue Braga for Peggy Stemmler 

Leonard Kirschner 

Phil Pangrazio 

David Mitchell 

Vernice Sampson 

Tomas Leon 

Staff and public in attendance: 

Theresa Gonzales, Exe Const. III, AHCCCS 

Stephen Jennings, Assoc. State Director, AARP 

Lourdes Encinas, Outreach ED, RCBH/SWIC 

Gloria Knoblock, Supervisor, TAPI 

Jennifer Tinney, Program Director, TAPI 

Chris Sampson, Member/Assoc. Pastor, Salt River 

Assembly of God 

Marcus Wilson, Policy & Planning, DES 

Scott Larson, State Gov’t OPC, BMS 

Lori Howarth, Corp. Alliance Director, Bayer 

Eric Rouse, Acct. Mngr., Eli Lilly 

AGENDA 

I. Welcome & Introductions Director Thomas Betlach 

II. Introductions of Members and Audience All 

• New Members Vernice Sampson & Tomas Leon 

III. Approval of October 10, 2012 Meeting Summary/Minutes Unanimous 

AGENCY UPDATES 

IV. AHCCCS Updates 

Thomas Betlach 

• Trends 

• Governor’s Medicaid Coverage Proposal 

• RFP Update 

o Summary of ACUTE/CRS RFP Proposals 

• Other Issues 

o NF Assessment – In progress 

o HIT payment – Exceed $100m to date 

o KidsCare II > 25,000 

o State Trainings 

Page 1 of 3

V. Legislative Update (no handouts) Jennifer Carusetta 

• HB2044 Continuation Bill 

• HB2045 Hospital Reimbursement Methodology Bill 

• HB2046 Omnibus Bill 

• HB2089 Chronically ill Children 

• HB2090 Peace Officers Bill 

VI. CMS Update – State Plan Amendments; Waivers 

Theresa Gonzales 

• AZ Medicaid State Plan Amendments 

• 1115 Waiver Status 

VII. Rates for Primary Care Services 

Dr. Marc Leib 

• Overview 

• CMS Final Rule 

• Additional Information for Providers 

• Regulatory Updates 

VIII. Quality Measures Overview 

Jakenna Lebsock 

• CYE 2014 Performance Measure Crosswalk 

IX. Arizona Bridge to Independent Living (ABIL) 

Phil Pangrazio 

• ABIL’s Mission Statement 

• Purpose of a Continue Independent Lifestyles (CIL) 

• Independent Living Principles 

• Philosophies: Medical vs. Independent Living 

• Four Core Services 

• ABIL Programs 

• Advocacy 

• AZ Freedom to Work (WIPA) 

• ABIL Employment Services 

• Empowering Youth in Transition 

• Home Modifications 

• Outreach/Early Intervention 

• Personal Assistance Services 

Page 2 of 3

DISCUSSION 

X. Call to the Public Director Thomas Betlach 

XI. Adjourn at 3:00 p.m. All 

Page 3 of 3

Legislative Update 

(no handouts)

CMS Update

State Plan Activity 

CMS Update 

The State Plan is a comprehensive written contract (677 pages) between AHCCCS and 

the Centers for Medicare and Medicaid Services (CMS) that describes the nature and 

scope of Arizona’s Medicaid program and assures that Arizona will administer its 

programs according to federal requirements under the provisions of the Social Security 

Act (SSA). The State Plan also provides a basis for Federal Financial Participation 

(FFP). 

AHCCCS submits State Plan Amendments (SPAs) for CMS approval to reflect changes 

in federal and state laws, regulations, policy, or court decisions. The following is a 

summary of Arizona’s SPA activity over the past 3 years: 

2013: 4 SPA submitted; 2 approved; 2 pending; 

2012: 15 SPAs submitted; 10 approved; 5 pending; 1 withdrawn 

2011: 25 SPAs submitted; 23 approved; 2 pending 

2010: 17 SPAs submitted; 16 approved; 1 withdrawn 

2009: 6 SPAs submitted; 5 approved; 1 denied 

More information can be found at: 

http://www.azahcccs.gov/reporting/PoliciesPlans/StatePlanAmendments.aspx 

Waiver Activity 

The 1115 Waiver refers to section 1115 of the Social Security Act. AHCCCS has been 

exempt from specific provisions of the SSA, under an 1115 Waiver since Arizona first 

began participating in Medicaid on October 1, 1982. Arizona’s 1115 Waiver includes 

provisions in the SSA and corresponding regulations AHCCCS is exempt from; terms 

and conditions that AHCCCS must fulfill; approved federal budget amounts. AHCCCS 

submits waiver amendments to reflect changes in federal and state laws, regulations, 

policy, and court decisions. The following is a summary of Arizona’s Waiver activity over 

recent years: 

2013: 1 submitted; 0 approved; 1 pending; 

The pending amendment was submitted to CMS on January 29, 2013 and would allow 

the City of Phoenix to charge an assessment on designated acute care hospitals for 

AHCCCS to draw down additional federal matching funds. 

On January 31, 2013, CMS approved Arizona’s requests to: Integrate physical and 

behavioral health services provided to children enrolled in the Children’s Rehabilitative 

Services program and to adults residing in Maricopa County who are diagnosed with a 

serious mental illness; Clarify language to the KidsCare II program wait list procedures; 

Update 2013 DSH amounts; and Revise the SNCP protocols to include three new 

hospitals and mid-level practitioner costs. 

More information about waivers can be found at: 

http://www.azahcccs.gov/reporting/federal/waiver.aspx 

1

2013 Amendments 

*SPA 13-004 Drug Coverage 

Updates the State Plan to exclude the coverage of barbiturates and benzodiazepines for 

dual eligibles as Part D covers them effective January 1, 2013. 

Submitted 3/28/13 

*SPA 13-003 Primary Care Service Payments 

Updates the State Plan to reflect that reimbursements for certain Primary Care Services 

will comply with the Affordable Care Act. 


SPA 13-002 Technical Correction 

Updates the State Plan to make technical correction that incorporates the changes 

approved in SPA #11-017A. 

Approved 4/3/13 


SPA 13-001 Tobacco Cessation Services for Pregnant Women 

Updates the State Plan to include Tobacco Cessation Counseling Services for Pregnant 

Women effective January 1, 2013. 


2012 Amendments 

SPA 12-011 Community First Choice Option 

Updates the State Plan to describe the Community First Choice Option effective January 

1, 2013. 

Submitted 10/5/12 

SPA 12-010 NF Tax and Supplement Payment Structure 

Updates the State Plan to describe the Nursing Facility Tax and Supplemental Payment 

structure effective October 1, 2012. 


Submitted 10/4/12 

SPA 12-009 GME 2013 

Updates GME funding for the service period July 1, 2012 through June 30, 2013 for 

programs with submitted IGAs. 


SPA 12-008 Nursing Facilities Provider Tax 

Updates the State Plan to describe the Nursing Facility Tax and Supplemental Payment 

structure effective October 1, 2012. (Note: This SPA has been withdrawn and replaced 

with #12-010.) 

Withdrawn 10/4/12 


2

SPA 12-007 Outliers 

Updates the State Plan regarding Outliers for the time period beginning October 1, 2012. 


Submitted 7/17/12 [38KB] 

SPA 12-006D Nursing Facility Rates 

Continues current reimbursement rates for nursing facilities during the period October 1, 

2012 to September 30, 2013. 



SPA 12-006C Provider Reimbursement Rates 

Continues current reimbursement rates for other providers during the period October 1, 




SPA 12-006B Outpatient Hospital Reimbursement Rates 

Continues current outpatient hospital reimbursement rates for the period October 1, 




SPA 12-006A Inpatient Hospital Reimbursement Rates 

Continues current inpatient hospital reimbursement rates for the period October 1, 2012 

to September 30, 2013. 



SPA 12-005 Reimbursement of Transportation Services 

Updates the State Plan to include pages that describe reimbursement for transportation 

services. 


SPA 12-004 Asset Verification System 

Clarifies the process for establishing an Asset Verification System to verify the assets of 

aged, blind, or disabled Medicaid applicants or recipients. 



SPA 12-003 IHS 638 Tables 

This SPA has been separated into two related SPAs for timing purposes. Further 

information is below: 


3

SPA 12-003A- Encounter/visit limit 

Updates the State Plan to reflect a 5 encounter/visit per day limit for services at Indian 

Health Services and Tribal 638 Health Facilities. 



12-003B- Reimbursement Methodologies 

Updates the State Plan regarding reimbursement methodologies at Indian Health 

Services and Tribal 638 Health Facilities. 

SPA 12-002 Provider Screening and Enrollment 

Provides assurance that the State complies with federal requirements related to Provider 

Screening and Enrollment. 



SPA 12-001 Services Clarification 

Updates the State Plan pages regarding targeted case management, extended care for 

pregnant women and transportation services. 


2011 State Plan Amendments 

SPA 11-018 Fee Schedule Update 

Updates the State Plan pages regarding the effective dates for fee for service rates. 

*Approved 01/04/13 


SPA 11-017 GME 

Updates GME funding for the service period July 1, 2010 through June 30, 2011 for 

programs with submitted IGAs. This SPA has been separated into two related SPAs for 

timing purposes.) 


SPA 11-017A GME 

Updates GME funding for hospital payments made before 9/30/12. 

Approved 10/3/12 [831KB] 


SPA 11-017B GME 

Updates GME funding for hospital payments made before 9/30/12. 


SPA 11-016 Healthcare Acquired Conditions 

Updates the State Plan to include standards of payment for healthcare acquired 

conditions. 



4

SPA 11-015 340 B Drug Pricing 

Updates the State Plan to include standards of pricing and payment for 340B drugs. 



SPA 11-014 Hospice Restoration 

Updates the State Plan to indicate Hospice Care is a provided service, effective July 20, 

2011. 

Approved 10/12/11 

Companion Letter 10/12/11 


SPA 11-013 Freestanding Birth Centers 

Documents compliance with the Affordable Care Act, Section 2301, regarding Medicaid 

coverage and separate payments for freestanding birth center services. 

Approved 9/22/11 [816KB] 


SPA 11-012 Inpatient Hospital Limit 

Limits the number of inpatient hospital days for adult members. 



SPA 11-011 Outlier 

Updates the methodology for qualifying and paying claims for inpatient hospital services 

with extraordinary operating costs per day. 



SPA 11-010 Outpatient Hospital Rate Rebase 

Rebases the outpatient hospital fee schedule using the most current available Medicare 

cost data. 



SPA 11-009D Nursing Facility Rate Reductions 

Updates nursing facility reimbursement rates to reflect a 5% reduction from October 1, 

2011 to September 30, 2012. 



5

SPA 11-009C Rate Reductions 

Updates reimbursement rates for various services to reflect a 5% reduction from October 

1, 2011 to September 30, 2012. 



SPA 11-009B Outpatient Hospital Rate Reduction 

Updating reimbursement rates for outpatient hospital services to reflect a 5% reduction 

from October 1, 2011 to September 30, 2012. 



SPA 11-009A 5% Inpatient Hospital Rate Reduction 

Updating reimbursement rates for inpatient hospital services to reflect a 5% reduction 

from October 1, 2011 to September 30, 2012. 



SPA 11-008 Behavioral Health Practitioners 

Clarifies the list of state-licensed behavioral health practitioners. 



SPA 11-007 School Based Claims 

Updating the reimbursement methodology for School Based Claiming. 



SPA 11-006 Home Health Services 

Clarifyies the services of home health, private duty nursing and therapies in the State 

Plan. 



SPA 11-005 Transplant Restoration 

Updates Arizona’s State Plan to restore transplants previously covered by AHCCCS, 

and clarifies transplants covered as of April 1, 2010. 



SPA 11-004 Public Assistance Reporting Information System (PARIS) 

Documents maintenance of an eligibility determination system that provides for data 

matching through PARIS or other successor systems. 



6

SPA 11-003 Prohibition on Payments Outside the US 

Updates Arizona’s State Plan to include a statement of compliance with Section 6505 of 

the Affordable Care Act that prohibits payments to any financial institution or entity 

located outside of the U.S. 



SPA 11-002 Hospice 

Describes hospice services provided under EPSDT. 



SPA 11-001 GME Updates 

This SPA has been separated into two related SPAs for timing purposes. Further 

information is below: 

SPA 11-001A GME 

Updates GME funding for hospital payments made by 6/30/11. 



SPA 11-001B GME Updates 

Updates GME funding for hospital payments made after 6/30/11. 



SPA 11-001C GME Updates 


programs with pending IGAs. 



SPA 11-001D GME Updates 


programs with pending IGAs. 


Original GME SPA 11-001 Submission 

Updates GME funding for the service period July 1, 2010 through June 30, 2011. 


7

RFP Announcements

Janice K. Brewer, Governor 

Thomas J. Betlach, Director 

801 East Jefferson, Phoenix, AZ 85034 

PO Box 25520, Phoenix, AZ 85002 

Phone: 602-417-4000 

www.azahcccs.gov 


ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM 

Arizona Health Care Cost Containment System (AHCCCS) 

Announces Award of Contracts for its Acute Care Program and 

Children’s Rehabilitative Services Program (CRS) 

April 2, 2013 – On March 22, 2013, the Arizona Health Care Cost Containment System (AHCCCS) awarded 

contracts to seven successful managed care companies that will provide services to over one million lowincome 

Arizonans enrolled in the Acute Care Program. On April 1, 2013, AHCCCS awarded a contract to an 

eighth company. 1 Acute care members are covered for medical care, including doctor's office visits, 

hospitalization, prescriptions, lab work, and other physical health services. Ten managed care organizations bid 

to be contractors, resulting in a competitive process that drove down per member program costs by 2.8% or 

roughly $100 million in the first year. 

AHCCCS also awarded one statewide Children’s Rehabilitative Services (CRS) contract to one managed care 

company to provide integrated physical and behavioral health services to 24,000 AHCCCS enrolled children 

with CRS-qualifying conditions. Two managed care organizations bid to be contractors for CRS. 

Contracts are awarded for up to five years for the Acute Care Program and up to four years for the CRS 

Program beginning October 1, 2013. 

• Maricopa County – Care1st Arizona, Health Choice Arizona, Health Net of Arizona, Maricopa Health 

Plan, Mercy Care Plan and United Health Care Community Plan, Phoenix Health Plan. 

• Pima County – Care1st Arizona, Health Choice Arizona, Mercy Care Plan, United Health Care 

Community Plan, University of Arizona Health Plans University Family Care 

• Santa Cruz County - United Health Care Community Plan, University of Arizona Health Plans 

University Family Care 

• Cochise/Graham/Greenlee Counties – United Health Care Community Plan, University of Arizona 

Health Plan’s University Family Care 

• Yuma/La Paz Counties - United Health Care Community Plan, University of Arizona Health Plan’s 


• Mohave/Coconino/Apache/Navajo Counties – Health Choice Arizona, United Health Care 

Community Plan 

• Yavapai County - United Health Care Community Plan, University of Arizona Health Plan’s 


• Pinal/Gila Counties – Health Choice Arizona, University of Arizona Health Plan’s University Family 

Care 

1 AHCCCS exercised its contractual authority to offer a capped contract to Phoenix Health Plan, an unsuccessful incumbent Contractor in Maricopa 

County.

• Statewide CRS Contract – United Health Care Community Plan 

The new contractor awards impact approximately 130,000 members that will be transitioning to a new health 

plan. The AHCCCS Administration has a proven process for the transition of members to new health plans. 

The AHCCCS Administration will work with all health plans, both relinquishing health plans and new health 

plans, to ensure members are transitioned to their new health plan without disruption in health care services. 

This process ensures that members who are in the middle of a course of treatment, e.g. cancer, or who have 

ongoing healthcare needs, like pregnancy or chronic disease, will not have their care disrupted. 

All members transitioning to a new health plan will receive a notice from AHCCCS with their new health plan 

assignment in July 2013. The new health plan assignment will be effective October 1, 2013. Members enrolled 

in a health plan that is no longer serving their county will be assigned to an available health plan in their county 

by AHCCCS. These members can stay with that health plan or choose a different one by a designated date. 

Members will also have a chance to change health plans (if desired) during another enrollment choice period 

after October 1, 2013. Meanwhile, all current health plans will continue to serve their membership until the 

current contract expires on September 30, 2013. 

The following table provides a detailed account of the AHCCCS Acute Program and CRS Program contract 

awards granted in response to Request for Proposal YH14-0001.

Summary of ACUTE/CRS RFP Awards 

Bridgeway Health 

Solutions of Arizona, 

LLC 

Care 1 st 

Health Plan Arizona 

Health Choice 

Arizona 

GSA 2 GSA 4 GSA 6 GSA 8 GSA 10 GSA 12 GSA 14 CRS 

Yuma, 

LaPaz 

Apache, 

Coconino, 

Mohave, 

Navajo 

Yavapai 

Gila, 

Pinal 

Pima, 

Santa 

Cruz 

Maricopa 

Cochise 

Graham 

Greenlee 

S S *S S S S S 

S S S S(1) *S S 

*S *S S S *S(1) *S S 

Health Net of 

Arizona 

Maricopa Health 

Plan managed by 

University of 

Arizona Health 

Plans 

Blue Cross Blue 

Shield of Arizona / 

Medisun Community 

Care Inc. dba 

Community Care 

Southwest Catholic 

Health Network dba 

Mercy Care Plan 

S S S *S(1) *S *S S 

Phoenix Health Plan *S *S *S *S *S 

United Health Care 

Community Plan 

University of 

Arizona Health 

Plans, University 

Family Care 

*S S S S *S *S S *S 

S S *S *S *S 

Total Bids Received 6 5 7 6 8 9 6 2 

* = Current Contractor 

S = Submitted a Proposal 

(1) = Award in Pima County Only 

= Contract Awarded 

Note: Per Section H, Paragraph 9, Award of Contract, of the RFP, AHCCCS granted Phoenix Health Plan a capped 

contract in the Maricopa GSA. 

Revised April 2, 2013 

S 

S 

*S 

S

To access RFP award information, click the Procurement File link below. 

Procurement File Page - YH14-0001

DHS Update

Mercy Maricopa Integrated Care 

RBHA Overview 

March 2013 

Health and Wellness for all Arizonans 

azdhs.gov

Mercy Maricopa Integrated Care - - Facts 

• Offeror will utilize the majority of the existing provider network 

• By October 1 st bidder would have eight (8) SMI clinics that offer integrated 

care – (4 are currently used as co-location sites in the existing contract) 

• SMI clinics offering integrated services will be increased to 20 sites over 

the course of the contract 

• Management Team (CEO, CMO, CFO, COO) all come from behavioral health 

• Mercy Care Experience Serving Populations with Complex Care Needs 

– 2400 SMI in the ALTCS program – (Fully integrated BH services) 

– 6200 SMI in the Acute program 

– 9300 in the DDD program 

• Have held community outreach and development planning with 51 

different stakeholders including providers, peer runs and community 

organizations 

• Have shaped a Community Proposal versus a single organization approach 


azdhs.gov

What Does MMIC Bring 

Recognition of what needs to improve the system – 

• Utilizes the existing network and enhances access to care 

• Member and family focused 

• Recovery and resiliency throughout the system 

• Already serving nearly half of the SMI population in acute plans 

• Extensive experience serving individuals with very complicated 

care needs (Operate integrated BH models in Illinois, Florida, Delaware, Missouri, 

Texas) 

• Two years of outreach to the community stakeholders with 

identified opportunities 

• Builds on the existing crisis system and enhances through 

specialty crisis and ACT teams 

Crisis 

Children & Youth 

School Based 

DDD 

ACT 

Homeless ACT 

Forensic ACT 

Peer Support ACT 


azdhs.gov

MMIC Response to Stakeholder Meetings 

Feedback Summary 

“The meetings described above have produced a wealth of information about 

what works in the current system and what could use improvement. We left 

our sessions with two major realizations: 

(1) There are many people and providers working in the RBHA system who 

care and seek to serve people in need and use resources well; and 

(2) Many of the issues they have encountered in trying to fulfill their 

missions will be greatly helped by integrating the acute, behavioral and 

Medicare programs, if the integration is done well”. 


azdhs.gov

To address the concern that physical health practice will 

overwhelm and/or dominate BH practice. 

“Maintaining access to a robust array of services and providers of behavioral 

health specialty care, while assuming responsibility for integrating these 

services within physical health care, is just one of many strategies in 

maintaining a focus on the behavioral health needs of Maricopa County 

residents. While this will be a major focus of RBHA integration efforts, 

assisting adults with SMI in accessing needed preventative and specialty 

physical health care should not disrupt the active and often successful 

treatment of the co-occurring behavioral health disorders. While the location 

and focus of care may be expanding for some individuals, access to needed 

behavioral health services will remain. For some this can occur within a single 

setting, for others it will require an expanded treatment team. As treatment 

teams expand, Care Coordinators and Case Managers will be responsible for 

making sure Individualized Care Plans are addressing the whole health needs 

of members”. 


azdhs.gov

How the System Operates Today - Most 

• Member visits provider for immediate issue 

• Immediate issue treated 

• Limited delivery of other services 

• Member leaves 

• Member may or may not access care for secondary 

issues 

• The RBHA may not know about any of the service 

• May be up to three different payor sources 

• Potential for bad outcomes even if the member 

does everything right 

• Medication interactions; family is left trying to navigate multiple 

issues; patient accesses higher levels of care for preventable issues; 

unnecessary funds are expended 


azdhs.gov

How the System Operates Today - Some 

• Same as most experience except— 

• Four clinics with co-location partnership 

• Co-location is better but still does not meet the needs of the 

whole person 

• Still limited sharing of information on diagnosis and 

treatment 

• Members are limited on accessing these providers due to 

proximity and transportation 

• Still have multiple streams of funding not communicating on 

outcomes 

• Families may be left coordinating care and communication 


azdhs.gov

How the System Would Operate With MMIC 

• Member accesses the system for care 

• Seen by provider for presenting issue 

• Provider considers full treatment history 

-Behavioral, Physical, Medication, Case Management 

• Member/family discuss whole health issue, receive treatment and 

develop treatment plan adjustments in one step 

• Improve BH outcomes by welcoming person for whatever reason 

• Reduce morbidity by treating preventable illnesses and supporting 

recovery with a whole person approach 

• Wherever you go Care Coordination will be there 

• RBHA involved in care coordination throughout entire experience 


azdhs.gov

MMIC Integrated Care Sites 

• Member Centered 

• Family Support 

• Coordination of Care 

• Accountability 

• Whole health service delivery 

1. East Valley 4330 E. University Dr. Mesa 

2. Hampton 1440 S. Country Club Dr., Mesa 

3. Centro Esperanza 310 S. Extension Mesa 

4. San Tan 1465 W. Chandler Blvd., Chandler 

5. Enclave 1642 S. Priest Dr., Tempe 

6. Arcadia 3311 N. 44th St., Phoenix 

7. Communidad 1035 E. Jefferson St., Phoenix 

8. South Central 1616 E. Roeser Rd., Phoenix 

9. Highland 4707 N. 12th St. Phoenix 

10. Midtown 3333 N. 7th Ave. Phoenix 

11. Capitol Center 1540 W. Van Buren St. Phoenix 

12. Saguaro 3227 E. Bell Rd., Phoenix 

13. Townley 8836 N. 23rd Ave., Phoenix 

14. Osborn 3640 W. Osborn Rd., Phoenix 

15. West McDowell 5030 W. McDowell Rd., Phoenix 

16. Metro Center 10240 N. 31st Ave., Phoenix 

17. Bethany Village 4210 W. Bethany Home Rd. Glendale 

18. Garden Lakes 4170 N. 108th Ave. Phoenix 

19. West Valley 11361 N. 99th Ave., Peoria 

20. Hassayampa Campus 811 N. Tegner, Wickenburg 

Note: 

Sites 5, 7, 8 & 16 are existing SMI co-located clinics used by Magellan 

Sites 2, 10, 11 & 14 are anticipated opening by 10-01-13 

Choices (5,6,8,10,13,15); People of Color (3,7,11) 

Partners in Recovery (1,16,19,20); Southwest Network 

(2,4,9,12,14,17,18) 


azdhs.gov

MMIC System Entry Points 


azdhs.gov

So what is Care Coordination 

Community based system wrapped around members and families 

Single accountable entity 

Care management function ensures accountability, transparency, seamless service delivery, minimizes possible 

gaps in care 

Care manager (administrative level) 

Big picture trends; systemic issues; real time 

Exp. - Notices member went to ED over 5 times…identifies possible issues… communicates issue and opportunity 

to treatment team through Care Coordinator 

Care coordinator (team focus) 

Treatment team management; views the whole person; bridges communication gaps; develops team approach to 

problem resolution 

Case manager (member and family single point contact) 

High touch with member and family 

Carries out the plan at the service level 

Peer navigator (member educator/advocate) 

Helps members and families understand and communicate throughout the process 

Member 

Engaged with the team to utilize strengths in plan development 

Health Record 

Wrapped around the member at all points of contact to facilitate coordinated care 


azdhs.gov

Members and Families First 

“Our Care Management approach will weave together physical, behavioral 

health, and psychosocial support needs in a holistic manner. 

• Taking a holistic person-centered focus: We will focus on members’ life 

goals, not their diagnoses, while incorporating their strengths, 

preferences and needs in a culturally and linguistically appropriate 

manner. 

• Maintaining and supporting the current behavioral health system and 

adding supports that strengthen it:” – Mercy Maricopa Integrated Care 


azdhs.gov

Member Transition 

Members 

• Over 40% SMI currently receive services with successful bidder 

• Have up to ninety days after contract start day to select a PCP 

• Option to use single case agreement if member chooses to keep current PCP 

• Successful bidder already has letter of agreements with behavioral health providers 

ADHS Transition 

Plan & Coordination 

• ADHS, Successful Bidder & Magellan work together to ensure seamless transition 

• ADHS coordinates activities with AHCCCS & Health Plans to ensure continuity of care during 

transition 

• Community Engagement Team is ready as of March 6, 2013 

• Member Transition activities required to start 10 days post contract award 

ADHS 

Monitoring 

• ADHS Comprehensive Member Transition Plan is in place 

• Member Transition Team has been identified 

• Real-time data monitoring tools and strategies have been developed 

• Community Engagement Team members have been trained 

• ADHS will use enterprise system to work interactively with Magellan, AHCCCS, Health Plans and 

Successful bidder during member transition period 


azdhs.gov

MMIC RBHA Summary 

• Supports the whole person vision for behavioral health 

services 

– Reduces stigma 

– Delivers services where the person wants 

– Supports families 

– Closes gaps in care 

– Improves quality of life 

• Have experience in delivering high quality service in 

behavioral health 

• Utilizes the existing provider network and grows 

• Provides full coordination of care 

• Member and family focused 


azdhs.gov


azdhs.gov

Recovery through Whole Health: 

the Administrative Level 

Medicaid Funds Federal Grant Funds State General Funds Other Funds (e.g. County, City funds) 

From AHCCCS 

From HHS 

From OSPB, 

Legislature 

From Maricopa County , City 

of Phoenix, Dept of Housing 

ADHS/DBHS 

Medicare Funds 

From CMS since RBHA will be 

Medicare Special Needs Plan 

One contract = one accountable entity for TXIX SMI members; 

Responsible for whole health outcomes and for the whole person’s 

healthcare needs 

Maricopa County RBHA 

Behavioral health network 

Serves TXIX and non-TXIX adults with SMI, 

adults without SMI, and children/adolescents; 

Also provides crisis services to anyone in need 

Physical health network 

Serves TXIX adults with SMI only 


azdhs.gov

Recovery through Whole Health: the service provider level 

Behavioral Health 

•Use of evidenced based practices 

• Routine screening, prevention, whole health, wellness AND RECOVERY focus 

• Care management, chronic disease management AND RECOVERY programs 

• Shared medical records 

Primary Care 

Multidisciplinary 

team 

Housing Support 

Specialty Care 

Employment Support 

Peer Support 

Community & Social Support 


azdhs.gov

Anticipated Benefits 

• Lengthen the lifespan and improve healthcare outcomes 

– Overcome disparities through integrated care 

• Strengthen the focus on screening, prevention, early 

intervention, care management, patient education, wellness, 

AND RECOVERY FROM MENTAL ILLNESS AND SUBSTANCE 

ABUSE 

• Control costs 

– 60% of Medicaid’s highest cost beneficiaries with 

disabilities have co-occurring physical and behavioral 

health conditions 

– Current healthcare system is unsustainable 


azdhs.gov

AHCCCS Update

AHCCCS Update 

30 Years of Medicaid Innovation 


Arizona Health Care Cost Containment System 

“Reaching across Arizona to provide comprehensive quality 

health care for those in need”

AHCCCS Population as of July 1 

1,400,000 

1985 – 2012 

1,200,000 

1,000,000 

1,047,982 

800,000 

600,000 

456,385 508,917 

400,000 

318,383 

200,000 

144,450 




2 


health care for those in need” 

.

AHCCCS Population 

2,000,000 

1,800,000 

1,600,000 

1,400,000 

1,200,000 

1,000,000 

800,000 

600,000 

400,000 

200,000 

0 

FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY 2010FY 2011 

June 30 Enrollment 

FY Unduplicated Count 




3 



AHCCCS Growth of GF 

 

 

 

Since 2007 Medicaid costs 

have grown by 35% 

Includes $2.5 billion in total 

fund cuts 

At full implementation the 

Prop. 204 expansion’s 

unfunded costs are $256.0 

million 




4 



Growth in National Health Expenditures and 

Gross Domestic Product (GDP), 1985-2011 

Annual Percent change 

12.0 

10.0 

8.0 

6.0 

4.0 

2.0 

July 1990- 

March 1991 

Recession 

March 2001- 

November 2001 

Recession 

December 

2007-June 

2009 

Recession 

0.0 

-2.0 

1985 

1987 

1989 

1991 

1993 

1995 

1997 

1999 

Calendar Years 

2001 

2003 

2005 

2007 

2009 

-4.0 

NHE 

GDP 

SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, U.S Department of Commerce, Bureau of Economic Analysis and 

National Bureau of Economic Research, Inc. 




5 



10% 

8% 

6% 

4% 

2% 

0% 

-2% 

15% 

Medicaid: Growth in Enrollment and Total, Federal, 

and State & Local Expenditures, 2007 – 2011 

Total Medicaid 

Expenditures and 

Enrollment 

6.2% 

2.2% 

1.4% 

1.0% 

-0.7% 

2007 2008 2009 2010 2011 

Enrollment Spending Per enrollee 

2007 

2008 

2009 

2010 

2011 

Federal and State & Local 

Medicaid Expenditures 

-10.0% 

-7.1% 

6.3% 

6.7% 

5.7% 

5.8% 

9.6% 

0.7% 

8.8% 

5.9% 

7.7% 

2.5% 

2.5% 

SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. 

21.9% 

22.2% 

Total Federal State/local 




6 



Childless Adult Population 

300,000 

250,000 

200,000 

150,000 

100,000 

50,000 

Mar May July Sept Nov Jan April July Oct Jan April 




7 



Regardless of ACA Decisions- 

Unsustainable System 

 

 

Institute of Medicine - $750 Billion in “Waste” 

• $210 B Unnecessary Procedures 

• $130 B Inefficient Care 

• $190 B Excess Admin 

• $105 B Inflated Prices 

• $55 B Prevention Failures 

• $75 B Fraud 

IOM Solutions – Science and Informatics – Engage and 

Empower Patients – Align Incentives – Transparency – 

Culture of Leadership and Learning 




8 



AHCCCS Strategies 

 

 

 

 

 

 

Leverage Triple Crown of Contracting – Integration 

and Modernization 

Dual Eligible Members 

Program Integrity Efforts 

Payment Reform 

Leverage Health Information Technology 

Improve American Indian Health Care delivery 




9 



Triple Crown Procurements 

October 1, 2013 start date for potentially 5 years 

Maricopa RBHA – $5 billion plus 

Statewide Acute Care – roughly $33 billion 

(with expansion) 

CRS Program - $1.0 billion – Integrate 

program 




10 



Results 

 

 

Competition 

• Rates down 2.8% - roughly $100 m in year 1 

Transition 

• 135,000 Acute members – Managing transitions in all 

GSAs 

• RBHA Contract – AHCCCS working closely with ADHS 

• Mercy Maricopa has very broad network – working to 

make seamless to members and families 

• CRS – working to transition services 




11 



Acute Bids (S = submitted - * = incumbent – shade = 

award – PHP = capped contract Maricopa) 

Yuma, 

LaPaz 

Apache, 

Coconino, 

Mohave, 

Navajo 

Yavapai 

Gila, 

Pinal 

Pima, 

Santa 

Cruz 

Maricopa 

Cochise 

Graham 

Greenlee 

CRS 

Bridgeway S S *S S S S S 

Care 1 st S S S S(1) *S S 

Health Choice *S *S S S *S(1) *S S 

Health Net S S 

Maricopa Health *S 

BCBS 

S 

Mercy Care Plan S S S *S(1) *S *S S 

Phoenix Health Plan *S *S *S *S *S 

United Community *S S S S *S *S S *S 

UA Health Plans S S *S *S *S 

Total Bids Received 6 5 7 6 8 9 6 2 




12 



Duals Demonstration Update 

 

 

 

 

 

 

AHCCCS submitted Demonstration Proposal to CMS for: 

• ALTCS EPD –1-1-14 – Existing Contractors – Statewide 

• Maricopa Members with SMI – 1-1-14 

• Acute Care Members – 1-1-14 – Statewide 

GOAL: 1-1-14 - 100,000 dual eligible in an integrated plan 

AHCCCS on Dual Track for Duals – If no Demo plans must be SNPs 

Recent Letter on web to CMS stating concerns – decision by April 

• January 1, 2014 cannot slip 

• What happens in 3 years – path forward 

• Capitation Rates 

Recently decided that State will not pursue full demonstration at this 

time 

State will pursue other alignment initiatives 




13 



AHCCCS Program Integrity 

Agency created central Office of Inspector General 

Even with 33% reduction in agency staff, resources dedicated to program 

integrity have increased 

Signed contract with Data analytics vendor 

Had 3rd lowest error rate of 17 states in national study 

Conducted two significant date of death analysis - minimal findings 

Developed and distributed 3 training modules staff – plans – members and 

providers 

Established match process with county jails 

Match with MVD photos – 1 million images per month 

Audit of $3.2 billion in payments – outside vendor - $2,200 recovered 

Program Integrity Results – FY 2012 

• Total Convictions – 25 

• Total Recoveries and avoidances - $960 million 

Need to leverage CMS 




14 



AHCCCS Payment Modernization 

Plan Integration – 

 

 

 

 

 

ALTCS Shared Savings Proposals 

Acute Plans – Shared Savings RFP Requirements 

Inpatient APR DRG 

Stakeholder input 

RFP questions on payment strategies 

Resources – CPR – Executive Team - 




15 



Health Information Technology 

What is the number 1 method medical information is 

communicated 

Medicaid Incentive Payment Systems 

HIT Payments – estimating $500 m over 7 years 

• 1,265 Eligible providers - $26.7 m 

• 56 hospitals $68 m 

Health Information Network of AZ 

Integration Opportunities require increase HIT 




16 



American Indian Care Coordination 

Strategies 

Care Management Coordinator Goal - Improve health 

outcomes by reducing readmissions and increase use of 

primary care services 

AHCCCS working with 3 populations Post IP stay 

Long Term Care – contacting tribal case manager (1,053 in 

non I.H.S/638 facility last year) 

Newborns – contacting moms to coordinate pediatric visit 

(1,213 born in 9 non I.H.S/638 facilities last year) 

Diabetic Patients – connecting member back to I.H.S & 638 

system 




17 



Jurassic Park 

Coverage Issue – Restore Prop 204 

ACA Requirements 

Exchange Issue 

Duals Demo 

Payment Reform 

Systems Issues 

Triple Crown Procurement 

Agency Sunset Process 




18

April 10, 2013 - AHCCCS

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