Presentation is loading. Please wait.

Presentation is loading. Please wait.

AHCCCS, Division of Health Care Management

Published byBriana McDaniel Modified over 6 years ago

Similar presentations

Presentation on theme: "AHCCCS, Division of Health Care Management"— Presentation transcript:

1 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

2 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

3 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

4 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

5 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

6 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

7 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

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

9 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

10 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

11 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

12 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

13 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

14 AHCCCS Resources AHCCCS www.azahcccs.gov
AHCCCS Duals Page Acute RFP Maricopa RBHA 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

Download ppt "AHCCCS, Division of Health Care Management"

Similar presentations

Introduction to Dual Eligible Integration National Senior Citizens Law Center and Families USA Webinar July 13, 2011.

Introduction to Dual Eligible Integration National Senior Citizens Law Center and Families USA Webinar July 13, 2011.
Scott Leitz Assistant Commissioner for Health Care Minnesota Department of Human Services Minnesotas Approach: Integrated Medicare & Medicaid Programs.

Scott Leitz Assistant Commissioner for Health Care Minnesota Department of Human Services Minnesotas Approach: Integrated Medicare & Medicaid Programs.
Medicaid Division of Medicaid and Long-Term Care Department of Health and Human Services Managed Long-Term Services and Supports.

Medicaid Division of Medicaid and Long-Term Care Department of Health and Human Services Managed Long-Term Services and Supports.
Integrating Care for Medicare- Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 2011.

Integrating Care for Medicare- Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 2011.
DataBrief: Did you know… DataBrief Series ● February 2011 ● No. 12 Dual Eligibles Across the States In 2008, dual eligibles as a percent of the total Medicare.

DataBrief: Did you know… DataBrief Series ● February 2011 ● No. 12 Dual Eligibles Across the States In 2008, dual eligibles as a percent of the total Medicare.
A Brief History of the Program.  Behavioral health services were provided in a variety of un-coordinated ways ◦ County government was responsible for.

A Brief History of the Program.  Behavioral health services were provided in a variety of un-coordinated ways ◦ County government was responsible for.
MEDICAID – CONTEXT FOR CHANGE Mike Cheek Vice President, Medicaid and Long Term Care Policy.

MEDICAID – CONTEXT FOR CHANGE Mike Cheek Vice President, Medicaid and Long Term Care Policy.
GMH/SA Benefit for Acute Duals Integration Update Kijuana Wright March 18, 2015.

GMH/SA Benefit for Acute Duals Integration Update Kijuana Wright March 18, 2015.
National Academy for State Health Policy 24 th Annual State Health Policy Conference KRISTIN FROUNFELKER Behavioral Health Administrator Arizona Health.

National Academy for State Health Policy 24 th Annual State Health Policy Conference KRISTIN FROUNFELKER Behavioral Health Administrator Arizona Health.
It’s All About MME Tasia Sinn September 18, 2014 Understanding Colorado’s New Medicare- Medicaid Enrollee (MME) Program.

It’s All About MME Tasia Sinn September 18, 2014 Understanding Colorado’s New Medicare- Medicaid Enrollee (MME) Program.
00 University Family Care Proposed Change of Ownership Community Forum August 25, 2014.

00 University Family Care Proposed Change of Ownership Community Forum August 25, 2014.
Mercy Care Advantage HMO SNP

Mercy Care Advantage HMO SNP
Cal MediConnect Martha Smith

Cal MediConnect Martha Smith
MEDICARE ADVANTAGE SPECIAL NEEDS PLAN AN OVERVIEW.

MEDICARE ADVANTAGE SPECIAL NEEDS PLAN AN OVERVIEW.
Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible.

Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible.
Duals Update Kijuana Wright May 21, 2014. Arizona Dual Eligible Enrollment 2 Reaching across Arizona to provide comprehensive quality health care for.

Duals Update Kijuana Wright May 21, Arizona Dual Eligible Enrollment 2 Reaching across Arizona to provide comprehensive quality health care for.
1 University of Maryland Center on Aging Medicare/Medicaid Integration Program July 8, 2004 University of Maryland Center on Aging Medicare/Medicaid Integration.

1 University of Maryland Center on Aging Medicare/Medicaid Integration Program July 8, 2004 University of Maryland Center on Aging Medicare/Medicaid Integration.
“Reaching across Arizona to provide comprehensive quality health care for those in need” CYE 2014 Transition Update AHCCCS Contractor Update Meeting June.

“Reaching across Arizona to provide comprehensive quality health care for those in need” CYE 2014 Transition Update AHCCCS Contractor Update Meeting June.
Medicaid Managed Care Basics Presentation to the Specialized Services Subcommittee September 13, 2010 1.

Medicaid Managed Care Basics Presentation to the Specialized Services Subcommittee September 13,
Tony Rodgers, Director Arizona Health Care Cost Containment System Tony Rodgers, Director Arizona Health Care Cost Containment System The Perfect Storm.

Tony Rodgers, Director Arizona Health Care Cost Containment System Tony Rodgers, Director Arizona Health Care Cost Containment System The Perfect Storm.

Similar presentations

Ads by Google