AHCCCS, Division of Health Care Management SNP Leadership Forum The View from States Advancing Financial Alignment Demonstrations: Program Administration and Oversight, Plan Selection and Financial Viability ARIZONA Katrina Cope AHCCCS, Division of Health Care Management November 2, 2012 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

AHCCCS Milestones 1965 – Congress enacts Medicaid Arizona County Based Indigent System 1982 – Arizona was the last state to join Medicaid – Created Arizona Health Care Cost Containment System (AHCCCS) Established Mandatory Managed Care 1989 – Long Term Care Added: Arizona Long Term Care System (ALTCS) 2013 – Integrated physical and behavioral health for individuals with serious mental illness (SMI) 2014 – Integration for dual eligible members 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Arizona Managed Care Principles Promote competition and choice in marketplace RFPs strong plan competition Establish proper infrastructure for oversight Staff of 75 to oversee plans Very good data used for rate setting and quality measures Demand improved member outcomes and plan performance Track quality measures – sanctions for poor results Establish broad networks that ensure member access Regular monitoring Be a competitive payer that attracts providers Professional/OP rates typically at Medicare 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Medicare Coordination Long-standing issue for AHCCCS and AHCCCS Contractors Part D implementation presented unique opportunity Many AHCCCS Contractors expanded to Medicare CMS allowed a one-time passive enrollment to allow for smooth transition of prescription drugs from AHCCCS to Medicare 38,000 members were passively enrolled in a Medicare plan where they were currently enrolled for AHCCCS benefits Over the years plans have become more sophisticated Level of supplemental benefits offered Improved care coordination strategies Increased understanding of Medicare 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Medicare Coordination Currently all AHCCCS Plans are also Medicare D-SNPs AHCCCS is very committed to strategies to improve the system for dual eligible beneficiaries Requiring all plans to be Demonstration plans or offer a D-SNP in all Medicaid service areas Policy effective where AHCCCS will not sign MIPPA contracts with D-SNPs who do not have AHCCCS contract Pursuing Demonstration Having a plan B if CMS and AHCCCS do not enter into MOU – D-SNP Track Focus on special needs populations for total integration ALTCS Members with SMI in Maricopa County 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

AHCCCS Duals – Medicare Enrollment August 2012 Acute and ALTCS full benefit duals Excludes duals without A, B, and D 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Avalere Study of Mercy Care Plan Duals Alignment Outcomes Avalere Study of Mercy Care Plan Duals 31% lower rate hospitalization 21% lower readmissions 43% lower rate of days spent in hospital 9% lower ED use 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Arizona Long Term Care System 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Maricopa RBHA Regional Behavioral Health Authorities provide behavioral health to non-long term care members Beginning 10/1/13 the Maricopa County (Phoenix metro) RBHA will also be responsible for physical health for members with Serious Mental Illness Over 50% of individuals who will be enrolled are dual eligible Important that the RBHA also offer Medicare for total coordination 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Arizona Financial Alignment Demonstration Model January 1, 2014 Statewide Implementation Passive enrollment with opt-out into current AHCCCS plan 3 Populations ALTCS E/PD: 20,000 Acute members with Serious Mental Illness in Maricopa County: 6,500 Acute: 72,000 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Arizona Financial Alignment Demonstration Model ALTCS E/PD: Use existing ALTCS contractors Members with Serious Mental Illness in Maricopa County: Maricopa RBHA required to be demonstration plan or D-SNP Acute: Plan selection through upcoming RFP issued November 2012 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Arizona Financial Alignment Demonstration Model Build on current Medicaid MCO/D-SNP Structure Increase alignment Ongoing opportunity for alignment for new members/members changing plans Alignment with new AHCCCS contracts 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Arizona Financial Alignment Demonstration Model Success of the Demonstration will depend on: Flexibility to build on state structure Adequate reimbursement/rate methodology Current market considerations – supplemental benefits Timely CMS involvement and decisions 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

AHCCCS Resources AHCCCS www.azahcccs.gov AHCCCS Duals Page http://www.azahcccs.gov/reporting/legislation/integration/Duals.aspx Acute RFP http://www.azahcccs.gov/commercial/Purchasing/RFPInfo.aspx Maricopa RBHA http://www.azdhs.gov/diro/integrated/ Katrina.Cope@azahcccs.gov 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System