“Reaching across Arizona to provide comprehensive quality health care for those in need” Arizona Health Care Cost Containment System Administrator Meeting Quality Update January 2014

“Reaching across Arizona to provide comprehensive quality health care for those in need” Maternal and Child Health Updates  Significant revisions to the AHCCCS Medical Policy Chapter 400 Clarifications to what constitutes an EPSDT visit More clearly indicates what is included in the EPSDT visit fee Identifies what can be billed separately from the EPSDT visit (if done during an EPSDT visit)  What circumstances  By whom and the qualifications, if any, that must be met by the provider or staff  Any specific tools or equipment that must be utilized in order to be reimbursed in addition to the EPSDT visit fee American Academy of Pediatrics, Contractor staff, AHCCCS Office of the Inspector General staff provided input and review of the revisions Modifies the approved developmental screening tools and ages for screening Adds PCP varnish application during EPSDT visits Adds dental home requirements EPSDT forms have been updated Requires obstetrical claims, regardless of method of payment (global or by service) to include all dates of service

“Reaching across Arizona to provide comprehensive quality health care for those in need” Maternal and Child Health Updates  Newborn Screening Program ADHS statute changes in 2013 to allow changes in the fee charged for newborn screening Rulemaking has been underway to raise the price of the second newborn screening test from $40 to $65 Contractors will be informed what the effective date of the increase is as soon as it is confirmed The second screening is performed in the PCP’s office and is paid for by the health plan Additional Rulemaking will begin around April for the purpose of discussing adding two new tests to the newborn screening panel and raising the second screening fee another $15 –AHCCCS will inform you of any future changes  CCHD – completed within 24 hours of birth in facility  SCID – included in the blood spot panel

“Reaching across Arizona to provide comprehensive quality health care for those in need” Maternal and Child Health Updates  Baby Arizona Program Program ended on December 31, 2013 Affordable Care Act requires  Use of one enrollment and eligibility process  Those individuals that would qualify for coverage through Baby Arizona will qualify for either AHCCCS or an Exchange Plan AHCCCS and ADHS have worked with ArMA and the Baby Arizona providers to determine which providers would still be willing to receive ADHS Hot Line referrals for sliding fee scale individuals that are not eligible for AHCCCS or an Exchange Plan

“Reaching across Arizona to provide comprehensive quality health care for those in need” Maternal and Child Health Updates  SOBRA Family Planning Extension Program Program ended on December 31, 2013 AHCCCS SOBRA members that have delivered will now either qualify for AHCCCS or an Exchange Plan  As a result, sterilization reporting requirements have changed Under age 21 only Purpose: to confirm that the sterilization was medically necessary (otherwise not covered until 21 years of age)

“Reaching across Arizona to provide comprehensive quality health care for those in need” Maternal and Child Health Updates  Primary Care Provider – Fluoride Varnish Effective April 1, 2014 Allows Primary Care Providers to apply fluoride varnish during EPSDT visits beginning at first tooth eruption up to age 2 years (no more frequent than every six months) Includes PCP education or discussion with parent of the need for oral health care and referral to a dental home Additional payment outside of the EPSDT visit fee PCP should verify that they have received training on applying fluoride varnish Office staff not eligible to apply fluoride varnish

“Reaching across Arizona to provide comprehensive quality health care for those in need” Maternal and Child Health Updates  Dental Home Not to be confused with requirements or description of a “medical home” Dental Home  Allows members to select or be assigned to an oral health professional that they are established with, or if not established to an oral health professional within the Contractor’s network  Provides a “panel” of patients for outreach purposes so that the oral health professional can deliver services, send reminder notifications, etc. Purpose/Goal: To increase utilization of EPSDT oral health services to the level/rate mandated by CMS (the 10% increase by 2015) Contractors should begin implementation. Mandatory effective date will be discussed with Contractors in the near future

“Reaching across Arizona to provide comprehensive quality health care for those in need” Quality Management Update  Behavioral Health credentialing requirements added to Chapter 900 Initial requirements that will be strengthened over time  HCBS annual quality monitoring/site visit tool completed and will be fully implemented by Contractors by April 1, 2014

“Reaching across Arizona to provide comprehensive quality health care for those in need” Quality Improvement  New Performance Improvement Project  Topic: Increasing the use of e-prescribing Number or percent of prescriptions filled that were e-prescribed Number or percent of providers that submit prescriptions utilizing e- prescribing Methodology will be available soon

“Reaching across Arizona to provide comprehensive quality health care for those in need” Performance Measure Transition Status  Vendor status Contract has been signed with Optum to calculate AHCCCS Performance Measures beginning with the 2014 measurement year The contract includes:  HEDIS measures  CMS Measures Sets (including Core Measure Sets)  Development of new measure sets included in federal measures sets  File returned to AHCCCS for additional stratification for quality improvement purposes Development and implementation of Performance Measure requirements will begin in February 2014

“Reaching across Arizona to provide comprehensive quality health care for those in need” CYE 2013 Performance Measures AHCCCS may utilize the EQRO to run the CYE 13 performance measures AHCCCS anticipates also reporting a limited number of measures for CYE 13 Ensure the encounter data is accurate and complete – it does impact final performance measure rates

“Reaching across Arizona to provide comprehensive quality health care for those in need” Table Slides - KEY  Highlighted in RED print – the rate declined in the CYE 2012 Performance Measure  Highlighted in ITALICS – the rate is below the AHCCCS Minimum Performance Standard (MPS)  Important to note that the size of the Contractor’s population is important when reviewing declining rates or those below MPS as these may impact the state wide aggregate performance

“Reaching across Arizona to provide comprehensive quality health care for those in need” CYE 2012 Aggregate Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 96.8%97.0%0.2% %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 86.9%87.7%0.8%< %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 89.3%89.9%6.9%< %97%89.9%92.2% Children’s Access to PCPs Years 87.2%87.7%3.9% %97%88.4%89.7% Well-Child Visits – First 15 Months of Life 64.1%67.8%5.8%< %90%63.6%78.2% Well-Child Visits 3-6 Years 67.7%66.8%-1.3%< %80%72.0%72.9% Adolescent Well Care Visits 42.1%38.0%-9.7%< %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” CYE 2012 Aggregate Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 64.7%61.8%-4.5%< % NA EPSDT Participation 63.6%65.7%3.3%< %80%NA EPSDT Dental Participation 46.0%44.1%-4.1%< %54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” United Healthcare Community Plan (Acute)CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 96.9%97.2%0.3% %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 86.3%87.1%1.0% %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 89.6%89.9%0.3% %97%89.9%92.2% Children’s Access to PCPs Years 88.1%87.8%-0.4% %97%88.4%89.7% Well-Child Visits – First 15 Months of Life 53.9%51.9%-3.8% %90%63.6%78.2% Well-Child Visits 3-6 Years 59.3%62.5%5.3%< %80%72.0%72.9% Adolescent Well Care Visits 32.5%33.8%4.0%< %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” United Healthcare Community Plan (Acute) CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 63.5%57.6%-9.3%< % NA EPSDT Participation 62.5%62.8%0.5% %80%NA EPSDT Dental Participation 48.3%41.3%-14.5%< %54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” Care 1 st CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 97.2%97.8%0.7% %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 87.5% 0.0% %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 87.8%89.4%1.8% %97%89.9%92.2% Children’s Access to PCPs Years 84.4%85.8%1.6% %97%88.4%89.7% Well-Child Visits – First 15 Months of Life 78.4%80.4%2.5% %90%63.6%78.2% Well-Child Visits 3-6 Years 65.3%66.9%2.4% %80%72.0%72.9% Adolescent Well Care Visits 33.1%34.9%5.6% %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” Care 1 st CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 62.2%62.9%1.1% % NA EPSDT Participation 67.4%65.7%-2.5%< %80%NA EPSDT Dental Participation 43.4%43.6%0.4% %54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” CMDP CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 96.5%99.7%3.3%< %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 91.3%91.1%-0.2% %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 94.4%94.8%0.5% %97%89.9%92.2% Children’s Access to PCPs Years 95.9%96.8%1.0% %97%88.4%89.7% Well-Child Visits 3-6 Years 64.8%63.7%-1.6% %80%72.0%72.9% Adolescent Well Care Visits 64.0%63.9%-0.2% %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” CMDP CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 80.3%82.7%2.9% % NA EPSDT Participation 97.8% 100% 2.2%< %80%NA EPSDT Dental Participation 68.3%79.0%15.7%< %54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” Health Choice Arizona CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 96.2%95.7%-0.5% %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 83.4%84.4%1.2% %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 86.3%87.2%1.1% %97%89.9%92.2% Children’s Access to PCPs Years 83.5%83.9%0.5% %97%88.4%89.7% Well-Child Visits – First 15 Months of Life 48.6%52.2%7.4% %90%63.6%78.2% Well-Child Visits 3-6 Years 59.1%60.9%3.0%< %80%72.0%72.9% Adolescent Well Care Visits 30.3%32.3%6.3%< %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” Health Choice Arizona CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 64.2%65.3%1.7%< % NA EPSDT Participation 59.8%58.2%-2.7%< %80%NA EPSDT Dental Participation 45.9%46.8%2.0%< %54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” Maricopa Health Plan CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 95.8%95.6%-0.2% %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 80.8%86.3%6.8%< %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 84.7%86.1%1.6% %97%89.9%92.2% Children’s Access to PCPs Years 79.0%82.9%4.9%< %97%88.4%89.7% Well-Child Visits – First 15 Months of Life 90.3%78.8%-12.7%< %90%63.6%78.2% Well-Child Visits 3-6 Years 55.7%72.6%30.3%< %80%72.0%72.9% Adolescent Well Care Visits 28.4%40.3%42.0%< %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” Maricopa Health Plan CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 60.3%59.8%-0.8% % NA EPSDT Participation 59.9%63.7%6.3%< %80%NA EPSDT Dental Participation 25.3%24.7%-2.5% %54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” Mercy Care Plan CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 97.4%97.6%0.2% %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 89.2%88.9%-0.3% %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 90.8%91.0%0.3% %97%89.9%92.2% Children’s Access to PCPs Years 88.2%88.6%0.4% %97%88.4%89.7% Well-Child Visits – First 15 Months of Life 87.2%77.9%-10.7%< %90%63.6%78.2% Well-Child Visits 3-6 Years 68.8%68.0%-1.0%0.0466%80%72.0%72.9% Adolescent Well Care Visits 35.7%38.5%7.8%< %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” Mercy Care Plan CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 63.6%63.7%0.2% % NA EPSDT Participation 68.4%67.0%-2.0%< %80%NA EPSDT Dental Participation 48.9% 0.0%146%54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” Phoenix Health Plan CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 96.9%96.6%-0.3% %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 89.3%89.5%0.3% %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 91.3%92.3%1.1% %97%89.9%92.2% Children’s Access to PCPs Years 89.5%90.0%0.6% %97%88.4%89.7% Well-Child Visits – First 15 Months of Life 72.5%78.2%7.9%< %90%63.6%78.2% Well-Child Visits 3-6 Years 73.6%74.2%0.7% %80%72.0%72.9% Adolescent Well Care Visits 44.8%46.9%4.8%< %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” Phoenix Health Plan CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 61.6%62.6%1.7%< % NA EPSDT Participation 72.3%72.8%0.7% %80%NA EPSDT Dental Participation 45.5%45.8%0.6% %54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” University Family Care CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children’s Access to PCPs Months 96.0%97.9%1.9% %97%96.0%97.9% Children’s Access to PCPs 25 Mo.- 6 Years 84.3%87.6%3.9%< %97%88.3%91.6% Children’s Access to PCPs 7-11 Years 87.5%88.6%1.3% %97%89.9%92.2% Children’s Access to PCPs Years 88.4%89.1%0.7% %97%88.4%89.7% Well-Child Visits – First 15 Months of Life 81.1%67.1%-17.3%< %90%63.6%78.2% Well-Child Visits 3-6 Years 55.4%68.7%24.0%< %80%72.0%72.9% Adolescent Well Care Visits 32.2%39.5%22.8%< %50%49.7%43.3%

“Reaching across Arizona to provide comprehensive quality health care for those in need” University Family Care CYE 2012 Performance Measure Results Performance Measure CYE 2011 Results CYE 2012 Results Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Annual Dental Visits 58.5%53.6%-8.4%< % NA EPSDT Participation 57.9%61.8%6.7%< %80%NA EPSDT Dental Participation 42.3%23.0%-45.5%< %54%NA

“Reaching across Arizona to provide comprehensive quality health care for those in need” Contractor Summary CYE 2012 Performance Measure Results ContractorPerformance Measures Meeting Minimum Performance Standard Performance Measures Meeting AHCCCS Goal Performance Measures Meeting NCQA Medicaid Mean (3 measures do not have an NCQA rate) Performance Measures Meeting NCQA Commercial Mean (3 measures do not have an NCQA rate) United Healthcare Community Plan (Acute) 5 or 50%2 or 20%2 or 29%0 or 0% Care 1st 7 or 70%2 or 20%2 or 29%1 or 14% Comprehensive Medical and Dental Program (CMDP) 8 or 89%5 or 56%5 or 83%4 or 67% Health Choice Arizona 6 or 60%1 or 10%0 or 0% Maricopa Health Plan 7or 70%1 or 10%2 or 29%1 or 14 % Mercy Care Plan 8 or 80%2 or 20%5 or 71%0 or 0% Phoenix Health Plan 9 or 90%1 or 10%6 or 86%5 or 71% University Family Care 6 or 60%1 or 10%3 or 43%1 or 14%

“Reaching across Arizona to provide comprehensive quality health care for those in need” Contractor Summary CYE 2012 Performance Measure Results ContractorPerformance Measures That Met the AHCCCS Minimum Performance Standard Performance Measure Rates that Maintained or Improved United Healthcare Community Plan (Acute) 5 6 Care 1st 7 9 Comprehensive Medical and Dental Program (CMDP) 8 6 Health Choice Arizona 68 Maricopa Health Plan 7 6 Mercy Care Plan 86 Phoenix Health Plan 9 9 University Family Care 6 7

“Reaching across Arizona to provide comprehensive quality health care for those in need” Application of Sanctions  AHCCCS will be applying Contractor sanctions to performance measures results  Factors AHCCCS considers in determining Contractor sanctions (not an exhaustive list): Contractor did not meet the contractual minimum performance standards for the Performance Measure; and/or Contractor’s performance rate is declining; and/or Contractor’s performance may be negatively driving the aggregate rates; and/or Past performance or corrective actions taken

“Reaching across Arizona to provide comprehensive quality health care for those in need” Factors to Consider for Performance Improvement  Quality Improvement staffing levels (current number of GSA’s, population changes), skill set, experience  How many “hats” do the QI staff wear (all lines of business)  Organizational structure related to quality improvement  Local authority to implement interventions and/or activities to improve outcomes  How is data stored and how accessible is it: If multiple lines of business is it combined or separate Local ability to run stratifying reports, analyze data

“Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Assistance  AHCCCS requested quality improvement resource information from Contractors (due 1/17/14)  QI resource information will be used with Contractor performance results and other available information for discussions with Contractors that have opportunities to improve  Technical assistance meetings with Contractor QI staff will continue in 2014  Work group meetings will continue in 2014