1. February 13, 2006 AHCCCS Offerors’ Orientation ARIZONA LONG TERM CARE SYSTEM (ALTCS) RFP YH07-0001

2. February 13, 2006 Contracting Process MICHAEL VEIT Contracting Officer

3. 3 February 13, 2006 Contracting Process Purpose Materials Timetable –Submission Deadline – 3/31/06 Website Navigation Questions/Answers Contracting Process

4. February 13, 2006 AHCCCS Overview KATE AURELIUS Assistant Director

5. 5 February 13, 2006 AHCCCS Mission: Reaching across Arizona to provide comprehensive, quality health care for those in need. Vision: Shaping tomorrow’s managed health care…from today’s experience, quality and innovation. AHCCCS Overview

6. 6 February 13, 2006 Introduction to AHCCCS AHCCCS Administration Product Lines - Acute Care (Medicaid & KidsCare) - Long Term Care - Healthcare Group - Premium Sharing Acute Health Plans LTC Program Contractors State Agencies  DHS ·Behavioral Health & CRS  DES ·Eligibility Fee-For-Service  Native Americans  Non-Qualified Persons Policy Eligibility (Special Populations) Monitor Care and Financial Viability Information Services Budget and Claims Processing Legal Intergovernmental Relations Contract for Care Funding Federal State County Private  Premiums AHCCCS Overview

7. 7 February 13, 2006 AHCCCS Organizational Structure Division of Health Care Management (DHCM) Office of Intergovernmental Relations (OIR) Division of Member Services (DMS) Division of Business and Finance (DBF) Information Service Division (ISD) Office of the Director (OOD) Office of Legal Assistance (OLA) The Division of Fee For Service Management (DFSM) Office of Program Integrity (OPI) AHCCCS Overview

8. 8 February 13, 2006 Who Does AHCCCS Serve? AHCCCS Overview

9. 9 February 13, 2006 ALTCS Elderly and Physically Disable Enrollment As of January 1, 2006 Total Program Contractor Enrollment = 22,853 COCONINO 190 NAVAJO 219 APACHE 78 MOHAV E 802 LA PAZ 72 YUMA 605 MARICOPA 13,747 PINAL 967 GRAHAM 121 GILA 265 PIMA 3,732 COCHISE 781 YAVAPAI 1,014 SANTA CRUZ 245 1,289 1,014 677 13,747 3,977 1,232 917 GSA Enrollment GSA Number 44 48 42 52 50 40 46 Pinal, Gila GSA Counties La Paz, Yuma Apache, Coconino, Mohave, Navajo Cochise, Graham, Greenlee Yavapai Pima, Santa Cruz Maricopa GREENLEE 15 AHCCCS Overview

10. 10 February 13, 2006 ALTCS Elderly and Physically Disabled (EPD) Only (Excludes DDD & Tribal Enrollment) Total: 22, 728 NF: 36.4% Own Home: 44.4% Alt. Res.: 17.0% Other: 2.2% AHCCCS Overview

11. 11 February 13, 2006 ALTCS Guiding Principles Member-centered case management Consistency of services Accessibility of network Most integrated setting Collaboration with stakeholders AHCCCS Overview

12. 12 February 13, 2006 ALTCS Program Contractors DES-DDD EPD Contractors Cochise Health System Evercare Select Mercy Care Pima Health System Pinal/Gila LTC Yavapai County LTC ALTCS FFS – Tribal CM Financial/Medical Eligibility 1.Citizen/Qualified Alien 2.AZ Resident 3.$2,000/$3,000 Resources 4.$1,809 Income Maximum 1 5.Transfer of Resources 6.SSN 7.Medical Eligibility/PAS PCP/ CASE MANAGER Covered Services Acute Care Services Nursing Facility ICF/MR Hospice Behavioral Health HCBS - Homemaker- Transportation - Personal Care- Adult Day Health - Respite Care- Home Delivered Meals - Attendant Care- DD Day Care - Home Health Nurse- Habilitation - Home Health Aide- Assisted Living Facilities Potential ALTCS Member 2,500 Applications/Month KEY EPD -Elderly & Physically Disabled (Age 65+, Blind or Disabled) DES/DDD Dept. of Economic Security, Div. Of Developmental Disabilities ICF/MR -Intermediate Care Facility for Mental Retarded NF -Nursing Facility PAS -Pre Admission Screening 1 Income Limit is 300% of SSI maximum and increases annually in January ALTCS Model Current System AHCCCS Overview

13. 13 February 13, 2006 AHCCCS Oversight Responsibilities On-site Operational and Financial Review (OFR) Financial Quality Management/Improvement Plan Performance Measures Performance Improvement Projects (PIPs) Provider network Case management Claims payment / Encounters Grievance and appeal Technical assistance AHCCCS Overview

14. 14 February 13, 2006 Program Contractor Responsibilities Contract for Services Develop and Ensure Adequate Network Active Monitoring and Oversight Case Management Member and Family Support Quality & Medical Management Integration of Medical Care Pay Claims and Process Encounters Grievance and Appeals AHCCCS Overview

15. February 13, 2006 Division of Member Services LINDA SKINNER Acting Assistant Director See Separate Handout

16. February 13, 2006 Program ALAN SCHAFER ALTCS Manager

17. 17 February 13, 2006 Program Services Operations Case Management Quality Management Medical Management Grievance and Appeals Finance Program

18. 18 February 13, 2006 ALTCS Covered Services Acute Care ServicesBehavioral Health Nursing FacilityHospice ICF/MR HomemakerTransportation Personal CareAdult Day Health Respite CareHome Delivered Meals Attendant CareDD Day Care Home Health NurseHabilitation Home Health AideAssisted Living Facilities Home Modifications HCBS Program

19. 19 February 13, 2006 Operations Contract Development Network Monitoring Day to Day Operations Claims/Encounters Member/Provider Council Program

20. 20 February 13, 2006 Case Management Service Assessment, Planning and Coordination Cost Effectiveness Study (CES) Brokering of Services Facilitation/Advocacy Monitoring and Reassessment Gatekeeping Case Manager Ratios Program AMPM Chapter 1600

21. 21 February 13, 2006 Quality Management Monitoring and Evaluation Quality of Care (QOC) Performance Measures Performance Improvement Projects (PIPs) Credentialing Program AMPM Chapter 900

22. 22 February 13, 2006 Medical Management Prior Authorization and Referral Management Concurrent Review Practice Guidelines Disease Management Over/Under Utilization Data Analysis AMPM Chapter 1000 Program

23. 23 February 13, 2006 Grievance System Grievances Appeals Claims Disputes Contract Section F Attachments B(1) & (2) ACOM Program

24. 24 February 13, 2006 Finance Categories of Reimbursement  Prospective  Prior Period Coverage (PPC)  HIV/AIDS Supplement Program Contract Section D, ¶56

25. 25 February 13, 2006 Finance Financial Standards Performance Bond Minimum Capitalization Financial Viability Standards and Performance Guidelines Program Contract Section D, ¶45, 46, 52, 56

26. 26 February 13, 2006 Reinsurance Statewide Plan Enrollment Deductible With Medicare Part A Deductible Without Part A Coinsurance 0-1,999$10,000$20,00075% 2,000+$20,000$30,00075% Reinsurance (Inpatient/Outpatient) Reinsurance (Inpatient/Outpatient) Program Catastrophic (including Behavioral Health) and Transplant 85%, No Deductible Contract Section D, ¶58 $650,000

27. February 13, 2006 ALTCS RFP ALAN SCHAFER ALTCS Manager

28. 28 February 13, 2006 RFP Milestone Dates ActivityDate RFP IssuedFebruary 8, 2006 Technical Assistance & RFP Questions DueFebruary 10, 2006 New Offerors, Prospective Offerors Conference and Technical Assistance Session February 13, 2006 Technical Assistance and RFP Questions DueFebruary 16, 2006 1 st RFP Amendment and Formal Response to Questions February 28, 2006 Second Set of Technical Assistance and RFP Questions Due March 7, 2006 RFP

29. 29 February 13, 2006 RFP Milestone Dates – cont. ActivityDate 2 nd RFP Amendment and Formal Response to Questions March 14, 2006 Proposals Due by 3:00 P.M. March 31, 2006 Contracts Awarded On or About May 1, 2006 Readiness Reviews Begin July 1, 2006 New Contracts Effective October 1, 2006 RFP

30. 30 February 13, 2006 Contracts To Be Awarded GSA #County or CountiesNumber of Awards 40Pinal, Gila1 42Yuma, LaPaz1 44Apache, Coconino, Mohave, Navajo1 46Cochise, Graham, Greenlee1 48Yavapai1 50Pima, Santa CruzUp to 2 52MaricopaAt least 2, no more than 3 RFP

31. 31 February 13, 2006 Enrollment If New PCs  Outside Maricopa County  New PC in non-Choice County  New PC & Existing PC in Choice County  2 New PCs, Existing Not Awarded  Maricopa County  1 Existing Not Awarded & 1 to 2 New PCs  New PC & Existing PCs Remain  All New PCs, No Existing PCs RFP

32. 32 February 13, 2006 Enrollment Growth Opportunities New Enrollment Open Enrollment Limited Annual Enrollment Choice (AEC) Limited Auto-Assignment RFP

33. 33 February 13, 2006 Member Newsletters 2 x per Year Types of Information to Include RFP

34. 34 February 13, 2006 Community Involvement Local LTC Organizations/Providers (e.g., aging, disabilities) Understanding the Community's LTC Issues RFP

35. 35 February 13, 2006 Quality Management HCBS Monitoring & Oversight Collaboration with QM & CM RFP

36. 36 February 13, 2006 Network Development Promoting Member-Centered Approach Supporting Member Informal Supports HCBS – Specialized Populations Paraprofessional Workforce Involvement Citizens Workgroup on the LTC Workforce Report RFP

37. 37 February 13, 2006 Transitional Services Implement 10/01/07 NF to In-Home Workgroup – Members, Advocates, Providers, PCs and AHCCCS RFP

38. 38 February 13, 2006 Consumer Directed Care Implement 10/01/07 PC(s) to Lead Development Administrative Adjustment Workgroup – Members, Advocates, Providers, PCs and AHCCCS Not Evaluated as Part of Contract Award for ALTCS RFP RFP

39. 39 February 13, 2006 Dual Eligibles Improve Care Coordination Become a MA SNP Formal Relationship with a MA or MA SNP RFP

40. 40 February 13, 2006 Contract Terms and Conditions Federal Immigration and Nationality Act (47) IRS W9 Form (48) Continuation of Performance Through Termination (49) RFP

41. 41 February 13, 2006 Network Rosters Formatted Rosters in Bidders Library Submit Disc and Hard Copy Sorting Do Not Include LOIs RFP Contract Section J, Exhibit C

42. 42 February 13, 2006 Contracts and LOIs Receive equal weight Contract must include AHCCCS ALTCS line of business to be considered One LOI per provider with multiple service sites One LOI per group when proof of signatory authority available RFP

43. February 13, 2006 ALTCS RFP - Finance PATRICE SPENCER ALTCS Financial Consultant

44. 44 February 13, 2006 Capitation Rates  N ew in the RFP Ventilator Capitation Rates Eliminated Dual & Non Dual Rates Established  Pending Changes Regular Reinsurance Behavioral Health  Capitation Rate Submission RFP

45. 45 February 13, 2006 Ventilator Dependent Ventilator Dependent Capitation Rates Eliminated Less than 200 total ALTCS Ventilator Dependent Members Decreased differentiation of medically necessary services available to Ventilator Dependent and Non-Ventilator Dependent members Ventilator Dependent data has been combined with Non- Ventilator Dependent data for capitation rate and capitation rate range development A Ventilator Dependent Databook is currently under development RFP

46. 46 February 13, 2006 Dual/Non-Dual Rates Dual and Non-Dual Risk Groups Alignment with CMS description of risk groups (42 CFR § 438.6 ©(3)(iii)) RFP

47. 47 February 13, 2006 Pending Reinsurance Changes Pending Reinsurance Changes Potential increase in Reinsurance Deductibles Discontinuance of High Cost Behavioral Health (TBI) reinsurance. Prospective Reinsurance Annual Deductible – Statewide Enrollment Less than or equal to 1999 members Annual Deductible – Statewide Enrollment 2,000+ members Coinsurance With Medicare Part A $30,000$40,00075% Without Medicare Part A $30,000$40,00075% RFP

48. 48 February 13, 2006 Financial Standards  Minimum Capitalization  Performance Bond  Financial Viability Standards and Performance Guidelines RFP

49. 49 February 13, 2006 Minimum Capitalization Geographic Service Area (GSA) # Members as of January 1, 2006 Potential Awards Proposed Capitalization Requirement Per Contractor (rounded) Maricopa (52)13,7053$4,500,000 Mohave/Coconino/ Apache/Navajo (44) 1,2961$1,300,000 La Paz/Yuma (42)4651$ 500,000 Pima/Santa Cruz (50)3,9362$2,000,000 Cochise/Graham/ Greenlee (46) 9081$1,000,000 Pinal/Gila (40)1,2271$1,300,000 Yavapai (48)9941$1,000,000 RFP

50. 50 February 13, 2006 Minimum Capitalization $5,000,000 Statewide ceiling Required in addition to Performance Bond Requirements May be applied to meeting the equity per member requirement Existing Contractors must be meeting their contractual equity per member requirement RFP Minimum Capitalization

51. 51 February 13, 2006 Performance Bond Initial amount of the performance bond must be 80% of the total capitation payment expected to be paid to the contractor in the first month of the contract year, or as determined by AHCCCS. This requirement must be satisfied by the Program Contractor no later than 30 days after notification by AHCCCS of the amount required. RFP

52. 52 February 13, 2006 Financial Viability Standards and Performance Guidelines Current Ratio: 1.00 Equity per Member: At Least $2,000 Medical Expense Ratio: At least 85% Total Administrative Cost Percentage: No more than 8% Received But Unpaid Claims Days Outstanding: No more than 30 days RFP

53. February 13, 2006 Proposal Submission

54. 54 February 13, 2006 Capitation Rate Submission Capitation Rate Submission CountyGSABid OnlyChoiceAccept Published Rates Pinal40X Gila40X La Paz42X Yuma42X Apache44X Coconino44X Mohave44X Navajo44X Cochise46X Graham46X Greenlee46X Yavapai48X Pima50X Santa Cruz50X Maricopa52X Proposal Submission

55. 55 February 13, 2006 ALTCS Capitation Rate Submission Section J, Exhibit D published rates and HCBS mix percentages Rate components  Nursing Facility  HCBS Home  HCBS Community  Case Management  Acute Care  Administration  Risk Contingency  Premium Tax Proposal Submission

56. 56 February 13, 2006 ALTCS Capitation Rate Submission Attestation Submission Requirement –Each County for which the Offeror has submitted a proposal ALTCS Capitation Rate Submission CD and instruction will be available by March 1. –Acceptance of published rates –Submission of proposed capitation rate bids Proposal Submission

57. 57 February 13, 2006 ALTCS Capitation Rate Submission Adjustments to final rates include, but are not limited to: –HCBS placement –Number of Contract Awards for a GSA –Changes in the AHCCCS Waiver –Changes in trend due to AHCCCS FFS rate updates –Legislative changes and/or program changes –Pending reinsurance changes Proposal Submission

58. 58 February 13, 2006 Bidder’s Library RFP Data Supplement for Offeror’s Forms & Exhibits References Proposal Submission

59. 59 February 13, 2006 Contents of Offeror’s Proposal All Pages Numbered Sequentially Page Limit – 3 (unless otherwise noted) Page Size 8 1/2” by 11” Single Spaced, Typewritten 10 font, Borders no less than ½ “ 3”, 3-ring Binders Original, Plus 7 Copies Disc of Network Roster Proposal Submission

60. 60 February 13, 2006 Evaluation Areas Capitation Organization Program Provider Network Proposal Submission

61. 61 February 13, 2006 Negligible Difference Incumbent PC Other AHCCCS Lines of Business Past Performance w/ AHCCCS Medicare Formal Relationships Diversity of PC Network Proposal Submission

62. 62 February 13, 2006 Scoring Capitation and Network Development scored by Geographic Service Area Network Management, Program, and Organization will receive a statewide score Proposal Submission

63. February 13, 2006 Questions Kate Aurelius Assistant Director Questions