1. Arizona PERM Pilot Round 1 Kim Sanchez Quality Compliance Administrator Phone: (602) 417-4563 Email: kim.a.sanchez@azahcccs.gov

2. AZ Organization Background 2 Reaching across Arizona to provide comprehensive quality health care for those in need AHCCCS Arizona Medicaid Determines Eligibility for SSI MAO and Long Term Care Department Of Economic Security (DES) Determines eligibility for SNAP, TANF and Medicaid for non-disabled adults and children MMIS

3. Systems 3 Reaching across Arizona to provide comprehensive quality health care for those in need

4. PERM Pilot Round 1 Sample 200 Medicaid, 0 CHIP Pull at the individual level Pull weekly samples (calendar week) Review at the household level Reviews pulled from December and February 4 Reaching across Arizona to provide comprehensive quality health care for those in need

5. Resources Social Interest Solutions – Developed HEAplus and our sampling programming AHCCCS Medicaid QC staff – completed the reviews 5 Reaching across Arizona to provide comprehensive quality health care for those in need

6. Challenges and Resolutions Universes inconsistent Eligibility “work arounds” developed after pilot proposal was submitted Revisions to pilot proposal 6 Reaching across Arizona to provide comprehensive quality health care for those in need

7. Universes inconsistent Universe totals did not align o Majority of samples pulled in April o Quality control check the samples o Clerical pulled system screens for reviewers o Assigned to staff in May o Had May and June to complete the reviews Result: Limited time to complete reviews 7 Reaching across Arizona to provide comprehensive quality health care for those in need

8. Eligibility “work arounds” developed after pilot proposal was submitted Eligibility workers not all in the new system o Eligibility determined in the old system o Some determinations in our universes were a preliminary denial decision Result: Had to re-evaluate our review process, re-write our internal policy and re-train staff 8 Reaching across Arizona to provide comprehensive quality health care for those in need

9. Revisions to Pilot Proposal Proposal –stratification by submission method, including transfers from the FFM. o Revision 1 – no FFM referrals Proposal – We proposed to complete 160 positive reviews and 40 negative reviews. o Revision 2 – 167 positive reviews, 33 negative reviews 9 Reaching across Arizona to provide comprehensive quality health care for those in need

10. Pilot Results Medicaid Active – 6 Income not budgeted 5 No valid signed application 4 budget unit established incorrectly 2 in receipt of Medicare 2 applied old budgeting rules 1 Relationship incorrectly coded 1 Income used was not reasonably compatible 10 Reaching across Arizona to provide comprehensive quality health care for those in need

11. Pilot Results Medicaid Negative – 2 Notice not sent 3 Eligible for MAGI  Client double entered self-employment  Incorrectly denied  Denied when eligible for Emergency Services 11 Reaching across Arizona to provide comprehensive quality health care for those in need

12. Preparation for 2nd Round Pilot Stabilization of universes Complete reviews of a State samples of cases transferred from the FFM Revise our written procedures with more detail for reviewers to take into consideration eligibility “work arounds” established Conduct additional staff training 12 Reaching across Arizona to provide comprehensive quality health care for those in need

13. Questions? 13 Reaching across Arizona to provide comprehensive quality health care for those in need

14. Thank You. 14 Reaching across Arizona to provide comprehensive quality health care for those in need