AHCCCS Update. Prop 204 + Expansion 2 Reaching across Arizona to provide comprehensive quality health care for those in need.

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Presentation transcript:

AHCCCS Update

Prop Expansion 2 Reaching across Arizona to provide comprehensive quality health care for those in need

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

No Response Redes - % of Total 4 Reaching across Arizona to provide comprehensive quality health care for those in need

Prop 204 and Expansion Ages (CY 14) 5 Reaching across Arizona to provide comprehensive quality health care for those in need

GAO Medicaid Spending Report Duals excluded – (No Expansion) 1% of Population = 25% of spend 5% = 50% of spend 25%= 75% of spend Bottom 50% = 8% of spend 6 Reaching across Arizona to provide comprehensive quality health care for those in need

GAO - Conditions of Members (%) ConditionAsthmaDiabetesHIV/AIDSMHSUDDeliveryLTCNone Asthma Diabetes HIV/AIDS MH SUD Delivery LTC Reaching across Arizona to provide comprehensive quality health care for those in need

1332 Waivers Part of ACA Allows States to waive 1. QHP and EHB Statutes 2. Marketplace Requirements 3. Tax Credits – QHP Cost Sharing – Requires Legislation Statutory Principles o At least as comprehensive benefits – Affordable – offered to comparable number of residents 8 Reaching across Arizona to provide comprehensive quality health care for those in need

Overkill – by Atul Gwande Medicare Study on 26 low/no value Tests – 25-42% of Population received Example of Walmart Spine Centers of Excellence Transparency McAllen Texas - $3,000 per person reduction Premise – Unnecessary Care crowding out important care 20% of physicians in alternative payment models Focus on importance of primary care and PCMH 9 Reaching across Arizona to provide comprehensive quality health care for those in need

DD Acute RFI Questions 1.BH Integration 2.Support Payment Reform 3.Geographic Coverage 4.CRS Integration Long Term Future Discussions (Not for current RFI/RFP) – Fully Integrated Opportunities 10 Reaching across Arizona to provide comprehensive quality health care for those in need

Administrative Simplification 11 Reaching across Arizona to provide comprehensive quality health care for those in need

AHCCCS – DBHS Merger Staffing o Communicated with over 50 DBHS Staff about transitioning to AHCCCS o Goal of developing new Organization by Other Areas of Focus o IT o Legal o Grants o Stakeholder Communication 12 Reaching across Arizona to provide comprehensive quality health care for those in need

Provider Rates 230 pages of public comments Wide variety of provider types Timeline o Week of June 8 th - Publish Draft Rates o June 17 th – Tribal Consultation o July 1 st – Submit SPAs to CMS o October 1 st - Implement 13 Reaching across Arizona to provide comprehensive quality health care for those in need

GMH/SA Duals Transition May 28 th Plan Specific Meetings 1.Network Status – Analysis – Contracting 2.Staffing 3.Data transfers – AHCCCS historical data – DEF Files 4.High risk populations 5.Provider – Member Communication 14 Reaching across Arizona to provide comprehensive quality health care for those in need

Legislative Implementation Update Teledentistry Orthotics MCO Prescription Drug Utilization Management MCO ED Utilization Management AHCCCS Waiver Submittal Requirements o Work – 5 Year limits – Cost Sharing NF Assessment Continuation 15 Reaching across Arizona to provide comprehensive quality health care for those in need