1. “Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Update 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

2. “Reaching across Arizona to provide comprehensive quality health care for those in need” 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 2

3. “Reaching across Arizona to provide comprehensive quality health care for those in need” Final Legislation  Authorizes Prop 204 Restoration and Expansion  Provides AHCCCS Director with ability to levy an assessment against hospitals – includes ability to exempt  Includes circuit breakers Governor had requested in case federal funding is reduced  Restores Well-exams 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 3

4. “Reaching across Arizona to provide comprehensive quality health care for those in need” Budget and Legislation  Assumes 3% capitation rate for AHCCCS  Assumes 3% provider rate increase for BH and DD providers 10-1-13  Increases ambulance rates beginning 10-1-14  Repeals HCG 1-1-14 – stops enrollment 8-1-13  Increases cost sharing above federal limits 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 4

5. “Reaching across Arizona to provide comprehensive quality health care for those in need” Legislation continued  Continues AHCCCS for 10 years  AHCCCS Medically preferred treatment options; report  AHCCCS may provider services if the services are Medically recognized as the preferred treatment option consistent with Medicare Are less expensive than all other treatment options AHCCCS and contractors shall report on services and alternative treatments that would have been employed  Legislation was enacted establishing APR-DRGs as new IP system for 10-1-14 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 5

6. “Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Reports  12/1/13 - Non-emergency use of the ED  12/31/13 – Air Ambulance – 5 year history and consistency with rules  1/1/14 – Hospital Transparency – Charge-master Report – recommendations  10/1/13 - Hospital Uncompensated Costs – change in uncomp costs and profitability  8/1/14 – Hospital Assessment paid – coverage  10/1/14 – Legislative circuit breaker and outcomes study committee – impact of decreased federal funds 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 6

7. “Reaching across Arizona to provide comprehensive quality health care for those in need” Phase II  Lawsuits Referral – Constitution exempts laws necessary for the support and maintenance of the departments of the state government” Prop 108 – does not apply to “fees and assessments that are authorized by statute, but are not prescribed by formula, amount or limit, and are set by a state officer or agency.” 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 7

8. “Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Childless Adult Population 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 8

9. “Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Prop 204 Parents 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 9

10. “Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Adult Expansion 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 10

11. “Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS SOBRA Kids (Expansion Included) 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 11

12. “Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Traditional TANF Pop. 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 12

13. “Reaching across Arizona to provide comprehensive quality health care for those in need” AHCCCS Cumulative Growth (Prop 204 + Expansion) 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 13

14. “Reaching across Arizona to provide comprehensive quality health care for those in need” Health E Arizona Plus  On schedule to bring up on 10-1-13  Considerable challenges remain Lack of live testing to federal marketplace CMS has not finalized regulations Efforts to consolidate Medicaid call center support Training materials for staff and public Size – Scope – Timeframe – issues unknown 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 14

15. “Reaching across Arizona to provide comprehensive quality health care for those in need” ACA Update  Received very positive system review by CMS as part of 10-1-13 implementation  Arizona has worked diligently to ensure that the Health-e-Arizona Plus system is compliant with Federal law and regulation and that it meets the needs and requirements of the state of Arizona and its beneficiaries.  They consistently look for and offer work for reuse; the Health-e Arizona system will be interoperable with the FFM and the FDSH. Arizona is very proactive and engaged in analyzing and inquiring clarification on CMS IT Guidance.  Arizona is has been an invaluable resource to several states including sharing of ideas, hosting on-site visits, and providing demonstrations of their system. 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 15

16. “Reaching across Arizona to provide comprehensive quality health care for those in need” Maricopa RBHA Transition  Magellan protesting award  5-21 Stay issued by ADOA on transition related activitiy  8-12-13 hearing date set for OAH  DHS has stated that given the stay and this timeframe October 1 st is not achievable  AHCCCS working with DHS on Plan B – current structure – updating contracts/cap rates  Stay Tuned 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 16

17. “Reaching across Arizona to provide comprehensive quality health care for those in need” Blind Spots Update  AHCCCS working to make data available for care coordination purposes  BH data to acute plans – PH data to RBHAs – I.H.S/638 date etc..  Recently received approval to provide Medicare Parts A, B and D data  January 1, 2014 implementation 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 17

18. “Reaching across Arizona to provide comprehensive quality health care for those in need” Reinsurance YOY change FY 10 -5.44% - FY 11 3.34% - FY 12 -17.5%  Plan A -15.71%  Plan B -61.4%  Plan C -48%  Plan D -44%  Plan E -44%  Plan F -36%  Plan G -58%  Plan H -58% 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System 18