Arizona PERM Pilot Round 1 Kim Sanchez Quality Compliance Administrator Phone: (602)

AZ Organization Background 2 Reaching across Arizona to provide comprehensive quality health care for those in need AHCCCS Arizona Medicaid Determines Eligibility for SSI MAO and Long Term Care Department Of Economic Security (DES) Determines eligibility for SNAP, TANF and Medicaid for non-disabled adults and children MMIS

Systems 3 Reaching across Arizona to provide comprehensive quality health care for those in need

PERM Pilot Round 1 Sample 200 Medicaid, 0 CHIP Pull at the individual level Pull weekly samples (calendar week) Review at the household level Reviews pulled from December and February 4 Reaching across Arizona to provide comprehensive quality health care for those in need

Resources Social Interest Solutions – Developed HEAplus and our sampling programming AHCCCS Medicaid QC staff – completed the reviews 5 Reaching across Arizona to provide comprehensive quality health care for those in need

Challenges and Resolutions Universes inconsistent Eligibility “work arounds” developed after pilot proposal was submitted Revisions to pilot proposal 6 Reaching across Arizona to provide comprehensive quality health care for those in need

Universes inconsistent Universe totals did not align o Majority of samples pulled in April o Quality control check the samples o Clerical pulled system screens for reviewers o Assigned to staff in May o Had May and June to complete the reviews Result: Limited time to complete reviews 7 Reaching across Arizona to provide comprehensive quality health care for those in need

Eligibility “work arounds” developed after pilot proposal was submitted Eligibility workers not all in the new system o Eligibility determined in the old system o Some determinations in our universes were a preliminary denial decision Result: Had to re-evaluate our review process, re-write our internal policy and re-train staff 8 Reaching across Arizona to provide comprehensive quality health care for those in need

Revisions to Pilot Proposal Proposal –stratification by submission method, including transfers from the FFM. o Revision 1 – no FFM referrals Proposal – We proposed to complete 160 positive reviews and 40 negative reviews. o Revision 2 – 167 positive reviews, 33 negative reviews 9 Reaching across Arizona to provide comprehensive quality health care for those in need

Pilot Results Medicaid Active – 6 Income not budgeted 5 No valid signed application 4 budget unit established incorrectly 2 in receipt of Medicare 2 applied old budgeting rules 1 Relationship incorrectly coded 1 Income used was not reasonably compatible 10 Reaching across Arizona to provide comprehensive quality health care for those in need

Pilot Results Medicaid Negative – 2 Notice not sent 3 Eligible for MAGI  Client double entered self-employment  Incorrectly denied  Denied when eligible for Emergency Services 11 Reaching across Arizona to provide comprehensive quality health care for those in need

Preparation for 2nd Round Pilot Stabilization of universes Complete reviews of a State samples of cases transferred from the FFM Revise our written procedures with more detail for reviewers to take into consideration eligibility “work arounds” established Conduct additional staff training 12 Reaching across Arizona to provide comprehensive quality health care for those in need

Questions? 13 Reaching across Arizona to provide comprehensive quality health care for those in need

Thank You. 14 Reaching across Arizona to provide comprehensive quality health care for those in need