1. AHCCCS Update

2. Medicaid by the numbers
Lives Covered
1 in 3
Kids (33 m)
1 in 7
Elderly (6 m)
10 m
Ind. with Disabilities
25%
% of Total BH Spending
50%
Births
600 B
Total Cost
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3. AHCCCS by the Numbers 1,849,500 27% >70,000 $33.0 million 52%
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4. MACStats Data Medicaid National per enrollee spend $7,248 Arizona
$5,867 – second lowest for expansion states
National Generic Rate %
Arizona – 86.1% - second highest to RI
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5. Medicaid Challenge: Sustainability Enrollment and Spending
Source: MPACStats December 2016
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6. Political Uncertainty
Medicaid Challenge
Political Uncertainty

7. Medicaid Challenge: New Populations
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8. Medicaid Challenge: Complex Member
Condition
Asthma
Diabetes
HIV/AIDS MH
SUD
Delivery
LTC
None
24.5
3.9
65.1
29.1
6.5
7.3 17
18.5
2.6
52.4
23.9
3.1
12.7
29.7
17.9
15.6
48.1
39.4
2.1
7.2 29
17.6
18.7
2.8
26.7
4.0
11.9
42.9
20.8
22.6
6.0
70.8
4.5
10.2
9.3
5.9
0.7
21.3
9.0
0.5 66
12.5
28.6
74.7
24.4
0.6
14.1
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9. Medicaid Challenge: Dual Eligible Fragmentation
Medicare and Medicaid spending on dual-eligible beneficiaries by age and type of benefit, CY 2011
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10. Provider Compensation - Provider Rate Changes (2009-17)
Hospital IP
(16-20)%
Emergency
29.5%
Hospital OP
(8.7)%
NEMT
(11.3)%
NF (EPD)
2.3%
ASC
5.6%
Behavioral Health OP
(4.6)%
Dental
(12.5)%
Physician
(13.2)%
FQHC
50%
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11. Medicaid Challenge: Leadership Director Tenure
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12. AHCCCS Strategic Plan
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Bend the cost curve while improving the member’s health outcomes
Pursue continuous quality improvement
Reduce fragmentation driving towards an integrated healthcare system
Maintain core organizational capacity, infrastructure and workforce.
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13. Vision - Integration at all 3 Levels
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14. Integration for Complex Members
MCO
Medicaid Behavioral Health
MLTSS
Care Mgmt.
Medicaid Physical Health
Medicare A , B & D
Housing
& Employment
Crisis System

15. Integration Progress To Date
ALTCS /EPD 29,200
CRS 17,000
SMI Maricopa 18,000
SMI Greater AZ 17,000
AIHP/TRBHA 80,000
GMH/SA Duals 80,000
GMH/SA Adults & Non CMDP Children
Approximately 1.5 million
95%
40%
20%
Look at all the numbers… 250k, 17k, 18k, 17k, 80k… this is out of the 1.9 million.
ALTCS was always integrated… that is just where we started our steps. Since the inception of long term care 1989.
If you are in a plan with a check mark you are already in an integrated plan.
If you or your loved one is on ALTCS or an adult with an SMI determination, you are not affected by this RFP. Your health plans will not change as a result.
** small exception if your loved one is SMI with CRS they will move to a RBHA
Also Foster Child receiving services through CMDP, your health plans will not change on 10/1/2018.
(CRS IS EXCEPTION FOR CMPD
We will discuss later future efforts that may affect your services.
**Can loop back that the 1.5 million was the maroon in the chart just shown. ‘the upper left corner’
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16. Care Delivery System as of Oct. 1, 2018
New ACC Plan names and affiliated RBHAS, as of 10/1/18

17. ACC Plan Geographic Service Areas
North: Care 1st and Steward Health Choice Arizona
Central: Banner University Family Care, Care 1st, Steward Health Choice Arizona, Arizona Complete Health, Magellan Complete Care, Mercy Care, UnitedHealthcare Community Plan
South: Banner University Family Care, Arizona Complete Health, UnitedHealthcare Community Plan (Pima county only)
Note alignment with 2017 altcs contracts – also note san carlos if applicable – biggest change is to pinal gila with maricopa
Zip codes 85542, 85192, representing mostly San Carlos Tribal area is excluded from Gila county in the Central GSA and included in the South GSA.
Visual for the GMHSA and non CMDP
RBHA still puts Gila north and Pinal south.
If ask for RBHA future GSA – we may look to align
AIHP covers statewide – no GSA.
TEXT REMOVED FROM SCREEN PER KARI 3/7: Additional zip code exceptions may be considered to allow for further alignment with certain tribal lands.

18. Awarded AHCCCS Complete Care (ACC) Plans
GSA
Awarded AHCCCS Complete Care (ACC) Plans
Banner University Family Care
Care1st
Steward Health Choice Arizona
Arizona Complete Health
Magellan Complete Care
Mercy Care
UnitedHealth care Community Plan
Central
A**
A*** A
A/N
South E A*
North
Note that with the change to the Central GSA to include Pinal and Gila, the four current plans (excluding United) are all new to Pinal/Gila only in the Central GSA which is not highlighted above. The N’s in Central represent new to whole GSA or to Maricopa.
ONLY ONE BRAND NEW PLAN – MAGELLAN IF THEY ACCEPT
BANNER IS NEW TO THE LARGEST AREA OF GSA (MARICOPA)
4 OTHERS ARE NEW TO PINAL/GILA (SMALLER PORTION OF THE CENTRAL GSA)
HEALTH CHOICE CURRENTLY EXISTS IN ALL THREE AREAS OF THE CENTRAL GSA
No awardee is statewide.
**Maybe with Heidi make As different color
UNITED WILL NOW BE IN PIMA ONLY – LOSING CONTRACT
A = Awarded N = New E = Exiting
*Pima county award only
**New in Maricopa county only
***Only new Pinal/Gila counties

19. Projected Membership Transition
GSA
Estimated Members
Central
10,400
South
199,575
North
83,445
Total
293,420
From learned experience managing previous health care plan transitions, AHCCCS has proven processes in place to ensure continuity of care for members. These members will be notified of their health plan assignment in June and can make changes to their assignment during the month of July.
Clearly a transition this large lends to some member movement… we roughly estimate 300,000. This slide shows by region the approximation of member movement.
Most awardees have current membership.
The estimated membership movement for 10/1 – not taking into account movement based on members Choosing in July…
Big exception here that we cannot predict – how members are choosing.
IF ASKED ONLY – DOES NOT take into account bh utilizers
If asked who is changing in central… The only ones we will have to assign in June in Central are CRS Members and bh utilizers.
Approximately 300K members will transition to new MCOs as a result of ACC.
Based on February 2018 enrollment.
Pima county projection – 105,200
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20. Who Is Affected and When?
Affects most adults and children on AHCCCS
Members enrolled in Children’s Rehabilitative Services (CRS)
It does not affect:
Members on ALTCS (EPD and DES/DD);
Adult members with a serious mental illness (SMI); and
Most CMDP
Starts on October 1, 2018!
If asked: Why aren’t foster care children enrolled with CMDP included? Because it is a Federal Program and it would require legislative action to integrate.
(Because CMDP has to be the provider of physical health services for foster children per statute) 
**The exception is if a CMDP child is getting services in CRS (currently united).
Why not adults with a SMI? They are already on an integrated plan.
More to come later… Future Integration Efforts for Foster Children Enrolled with CMDP
Again, this starts 10/1/ There will not be a phased-in approach to transition.
If asked – “most adults” was previously referred to as GMHSA (general mental health and substance abuse). For those of you that have been around behavioral health for awhile you may assume this is someone receiving mental health treatment or substance abuse treatment… however this actually refers to adults that have the OPTION to engage in mental health treatment or substance abuse treatment (may or may not be)…. Ultimately this population is huge….

21. CRS Members CRS members will have choice of ACC Plan
CRS members will continue to be identified and designated by AHCCCS.
CRS members in DDD program will have CRS services transitioned to DDD United contract - seamless
Contract requires ACC plans to continue to have MSIC in network
REVIEW NO LONGER STATEWIDE SINGLE PLAN CHOICE.
Members that are currently getting their physical health services (for all conditions including CRS) will be the ones moving to ACC Plans. Ones that are in CRS and getting physical health services somewhere else...like AIHP or through DD are not going to ACC Plan.
If asked…Took out no more unique identifier numbers assigned. The plan will still have access to those historical numbers for claims purposes.
Designated by AHCCCS UNTIL AGE 21
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22. Most AHCCCS Members Timeline:
June: letters sent to affected AHCCCS members with assigned health plans
July: AHCCCS assigns members to an ACC plan, members make plan changes during the month of July
Members in acute plans not awarded an ACC plan
Members in CRS for CRS and physical health
Members in CRS for all services
Members in RBHAs meeting a threshold (?) that are in a continuing plan not affiliated with a RBHA
Oct. 1: ACC health plans begin delivering service
What happens to CRS populations:
GMHSA adults and GMHSA Kids = go to ACC
DDD Adults and kids = stay with United per DDD
CMPD Adults and kids = stay with DCS/RBHA
SMI Adults = stay with RBHA
GMHSA duals will see no change.

23. Members who are American Indians with CRS conditions
American Indians continue to have choice of ACC for all services or AIHP (TRBHA if available).
American Indians receiving CRS only (AIHP/RBHA) = will change to BH/CRS to AIHP and receive all services from AIHP.
American Indians receiving CRS only (AIHP/TRBHA) = will change CRS to AIHP and receive all services from choice of ACC or AIHP.
AI receiving partial CRS = will change to ACC (or could they also stay with AIHP?)

24. Children in Foster Care with CRS conditions
No change in service for this population. Future plans include an integrated contract with Dept. of Child Safety.

25. ALTCS members with developmental disabilities and CRS conditions
Members will see no change to current service options.
UHC will contract directly with DES instead of with AHCCCS.
Note for providers: you will see a change in member verification. Members will see no change to plan or services.)

26. What if I already get services with a RBHA and want to stay?
Certain members previously receiving services with a RBHA will have a one time choice for 10/1/18 to elect to stay with the “RBHA-affiliated” ACC Contractor
Members given this choice must:
not already be enrolled in a RBHA-affiliated Plan that will be an ACC Plan; or
not already be getting choice of all ACC Plans (including RBHA-affiliated ACC Plan) due to current enrollment in exiting plan
If you want to stay with RBHA HEALTH PLAN organization, you need to get in the RBHA Affiliated ACC Plan and you have to say you want to be moved to that plan.
E.G. CARE FIRST MEMBERS (A PORTION OF THOSE MEMBERS GETTING BH FROM MMIC) – WE WILL FIND THEM IN CARE 1ST – DO YOU WANT ONE TIME CHOICE TO MOVE TO Mercy?
LAST BULLET E.G. THERE IS A PLAN GOING AWAY THEREFORE THEY ARE ALREADY SUBJECTED TO SOME CHANGE
**NOT ALREADY HAVING CHOICE BC THEIR PLAN WENT AWAY.
Threshold is $1,000 of bh services in 2017 with the RBHA - YOU WILL KNOW WHEN YOU RECEIVE NOTICE FOR OPTION OF CHANGE
(WHAT IF USING IN 2018 AND WANTING TO STAY… THEY NEED TO CALL AHCCCS IN THE MONTH OF JULY AND EXPLAIN THEIR SITUATION)
“I want to remain with the plan that I am currently getting my BH services from that is now affiliated with an ACC Plan and will have a contract with AHCCCS for both ACC and RBHA services.” Next slide shows affiliations...
IN FUTURE ONE ORGANIZATION WILL HAVE TWO CONTRACTS WITH US (RBHA AND ACC)
In addition, members may select the RBHA-affiliated ACC plan during annual enrollment choice....

27. AHCCCS Complete Care Timeline
Note where we are “spring 2018”
Review passive assignment and bh utilizers are ones getting letters.
Screen shot of making address correct next - note importance.
Over 30 days for choice.
Keep in mind entire timeline includes all the behind the scenes readiness of the contractor and AHCCCS working collaboratively
**discuss with Lori what providers may want to hear and maybe some readiness high level overview

28. You can find more info about ACC and integration plans on our website at including a list of Frequently Asked Questions.

29. AHCCCS Contract Timeline
Once RBHA contracts expire, successfully awarded ACC Plans may have the opportunity to compete for expansion of services to include members with SMI and Non TXIX/XXI (non AHCCCS eligible members). WE may do an RFP…
A limited number of integrated contracts will be permitted to expand these services in each GSA.

30. Estimated Distribution of Funds Across Each Strategic Focus Area per Year
TI Overall
6.7%
$19 M
23.3%
$66.5 M
30.0%
$85.5 M
22.3%
$66.5M
16.7%
$47.5M
Ambulatory
(Primary Care & BH Services)
92%
$17.5 M
$61. 2 M
$78.7 M
$61.8 M
$43.7 M
Justice 5%
$950,000
$3,325,000
$4,275,000 3%
$2,321,000
Hospital
$570,000
$1,995,000
$2,565,000
$1,425,000
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31. Children in Foster Care PMPM
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32. MMIC Penetration Rate for CMDP Members
RBHA Self Reported Data
For penetration – Are you counting by any service? Or a different way? We are counting the total number of units for services for each category within this report as follows:
a.       BH Screening/Assessments: HCPCS Codes H0001, H0002, H0031 with all modifiers.
b.      Case Management: HCPCS Code T1016 with all modifiers.
c.       HCTC Services: HCPCS Code S5109 with all modifiers.
d.      Rehabilitative and Support Services: HCPCS Codes S5150, S5151, H2014, H2017, H0025, H0034, T1019, T1020, H0038, T1013 with all modifiers.
e.      Individual/Group Services: HCPCS Codes H0004 and H2033
f.        Physician/Nursing Services: HCPCS Codes T1002 and T1003 with all modifiers.
g.       Crisis Services: HCPCS Codes H2011, S9484, S9485 (this last HCPCS code to be added this week) with all modifiers.
h.      OOH Services: Revenue Codes 0114, 0124, 0134, 0154 and new Revenue Codes to be added this week of 0116, 0126, 0136 and 0156 (Detox IP Hospital Codes).  
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RBHA Self Reported Data

33. HCIC Penetration Rate for CMDP Members
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RBHA Self Reported Data

34. CIC Penetration Rate for CMDP Members
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RBHA Self Reported Data

35. Statewide HIE Participation
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37. AHCCCS Staffing Levels
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38. Employee Engagement
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39. AHCCCS Generations in workplace (2013)
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40. AHCCCS Generations in the Workplace 2017
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