April 10, 2013 - AHCCCS

State Medicaid Advisory Committee (SMAC)
Wednesday, April 10, 2013
AHCCCS
Gold Room - 3rd Floor
701 E. Jefferson Street
1 p.m. – 3p.m.
Agenda
I. Welcome Deputy Director Beth Lazare
II. Introductions of Members ALL
III. Approval of February 1, 2013 meeting summary ALL
Agency Updates
IV. Legislative Update Jennifer Carusetta,
Office of Intergovernmental Relations
V. CMS Update-State Plan Amendments; Waivers Theresa Gonzales,
Office of Intergovernmental Relations
VI. RFP Announcements Kari Price,
Division of Health Care Management
VII. DHS Update – Maricopa RBHA RFP Will Humble,
Director of AZ Dept. of Health Services
VIII.
AHCCCS Update – Medicaid Coverage Plan
IX. Call to the Public
Discussion
Beth Lazare,
Deputy Director
Deputy Director Beth Lazare
X. Adjourn at 3:00 p.m. ALL
2013 SMAC Meetings
Per SMAC Bylaws, meetings are to be held the 2nd Wednesday of January, April, July and October.
All meetings will be held from 1 p.m.- 3 p.m. at the AHCCCS Administration
701 E. Jefferson, Phoenix, AZ 85034, 3rd Floor in the Gold Room:
February 1, 2013
April 10, 2013
July 10, 2013
October 9, 2013
For more information or assistance, please contact Theresa Gonzales at (602) 417-4732 or theresa.gonzales@azahcccs.gov

February 2013 Meeting Summary

Janice K. Brewer, Governor
Thomas J. Betlach, Director
801 East Jefferson, Phoenix, AZ 85034
PO Box 25520, Phoenix, AZ 85002
Phone: 602-417-4000
www.azahcccs.gov
Our first care is your health care
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
Members in attendance:
Tom Betlach
Will Humble
Kathy Waite
Kathy Byrne
Tara McCollum Plese
Kathleen Collins Pagels
State Medicaid Advisory Committee (SMAC) Meeting Summary
Friday, February 1, 2013, AHCCCS, 701 E. Jefferson, Gold Room
1:00 p.m. – 3:00 p.m.
Members Absent: Kevin Earle, & Kim VanPelt
Elena Rodriguez for Amanda Aguirre
Sue Braga for Peggy Stemmler
Leonard Kirschner
Phil Pangrazio
David Mitchell
Vernice Sampson
Tomas Leon
Staff and public in attendance:
Theresa Gonzales, Exe Const. III, AHCCCS
Stephen Jennings, Assoc. State Director, AARP
Lourdes Encinas, Outreach ED, RCBH/SWIC
Gloria Knoblock, Supervisor, TAPI
Jennifer Tinney, Program Director, TAPI
Chris Sampson, Member/Assoc. Pastor, Salt River
Assembly of God
Marcus Wilson, Policy & Planning, DES
Scott Larson, State Gov’t OPC, BMS
Lori Howarth, Corp. Alliance Director, Bayer
Eric Rouse, Acct. Mngr., Eli Lilly
AGENDA
I. Welcome & Introductions Director Thomas Betlach
II. Introductions of Members and Audience All
• New Members Vernice Sampson & Tomas Leon
III. Approval of October 10, 2012 Meeting Summary/Minutes Unanimous
AGENCY UPDATES
IV. AHCCCS Updates
Thomas Betlach
• Trends
• Governor’s Medicaid Coverage Proposal
• RFP Update
o Summary of ACUTE/CRS RFP Proposals
• Other Issues
o NF Assessment – In progress
o HIT payment – Exceed $100m to date
o KidsCare II > 25,000
o State Trainings
Page 1 of 3

V. Legislative Update (no handouts) Jennifer Carusetta
• HB2044 Continuation Bill
• HB2045 Hospital Reimbursement Methodology Bill
• HB2046 Omnibus Bill
• HB2089 Chronically ill Children
• HB2090 Peace Officers Bill
VI. CMS Update – State Plan Amendments; Waivers
Theresa Gonzales
• AZ Medicaid State Plan Amendments
• 1115 Waiver Status
VII. Rates for Primary Care Services
Dr. Marc Leib
• Overview
• CMS Final Rule
• Additional Information for Providers
• Regulatory Updates
VIII. Quality Measures Overview
Jakenna Lebsock
• CYE 2014 Performance Measure Crosswalk
IX. Arizona Bridge to Independent Living (ABIL)
Phil Pangrazio
• ABIL’s Mission Statement
• Purpose of a Continue Independent Lifestyles (CIL)
• Independent Living Principles
• Philosophies: Medical vs. Independent Living
• Four Core Services
• ABIL Programs
• Advocacy
• AZ Freedom to Work (WIPA)
• ABIL Employment Services
• Empowering Youth in Transition
• Home Modifications
• Outreach/Early Intervention
• Personal Assistance Services
Page 2 of 3

DISCUSSION
X. Call to the Public Director Thomas Betlach
XI. Adjourn at 3:00 p.m. All
Page 3 of 3

Legislative Update
(no handouts)

CMS Update

State Plan Activity
CMS Update
The State Plan is a comprehensive written contract (677 pages) between AHCCCS and
the Centers for Medicare and Medicaid Services (CMS) that describes the nature and
scope of Arizona’s Medicaid program and assures that Arizona will administer its
programs according to federal requirements under the provisions of the Social Security
Act (SSA). The State Plan also provides a basis for Federal Financial Participation
(FFP).
AHCCCS submits State Plan Amendments (SPAs) for CMS approval to reflect changes
in federal and state laws, regulations, policy, or court decisions. The following is a
summary of Arizona’s SPA activity over the past 3 years:
2013: 4 SPA submitted; 2 approved; 2 pending;
2012: 15 SPAs submitted; 10 approved; 5 pending; 1 withdrawn
2011: 25 SPAs submitted; 23 approved; 2 pending
2010: 17 SPAs submitted; 16 approved; 1 withdrawn
2009: 6 SPAs submitted; 5 approved; 1 denied
More information can be found at:
http://www.azahcccs.gov/reporting/PoliciesPlans/StatePlanAmendments.aspx
Waiver Activity
The 1115 Waiver refers to section 1115 of the Social Security Act. AHCCCS has been
exempt from specific provisions of the SSA, under an 1115 Waiver since Arizona first
began participating in Medicaid on October 1, 1982. Arizona’s 1115 Waiver includes
provisions in the SSA and corresponding regulations AHCCCS is exempt from; terms
and conditions that AHCCCS must fulfill; approved federal budget amounts. AHCCCS
submits waiver amendments to reflect changes in federal and state laws, regulations,
policy, and court decisions. The following is a summary of Arizona’s Waiver activity over
recent years:
2013: 1 submitted; 0 approved; 1 pending;
The pending amendment was submitted to CMS on January 29, 2013 and would allow
the City of Phoenix to charge an assessment on designated acute care hospitals for
AHCCCS to draw down additional federal matching funds.
On January 31, 2013, CMS approved Arizona’s requests to: Integrate physical and
behavioral health services provided to children enrolled in the Children’s Rehabilitative
Services program and to adults residing in Maricopa County who are diagnosed with a
serious mental illness; Clarify language to the KidsCare II program wait list procedures;
Update 2013 DSH amounts; and Revise the SNCP protocols to include three new
hospitals and mid-level practitioner costs.
More information about waivers can be found at:
http://www.azahcccs.gov/reporting/federal/waiver.aspx
1

2013 Amendments
*SPA 13-004 Drug Coverage
Updates the State Plan to exclude the coverage of barbiturates and benzodiazepines for
dual eligibles as Part D covers them effective January 1, 2013.
Submitted 3/28/13
*SPA 13-003 Primary Care Service Payments
Updates the State Plan to reflect that reimbursements for certain Primary Care Services
will comply with the Affordable Care Act.
Submitted 3/18/13
SPA 13-002 Technical Correction
Updates the State Plan to make technical correction that incorporates the changes
approved in SPA #11-017A.
Approved 4/3/13
Submitted 3/18/13
SPA 13-001 Tobacco Cessation Services for Pregnant Women
Updates the State Plan to include Tobacco Cessation Counseling Services for Pregnant
Women effective January 1, 2013.
Submitted 1/11/13
2012 Amendments
SPA 12-011 Community First Choice Option
Updates the State Plan to describe the Community First Choice Option effective January
1, 2013.
Submitted 10/5/12
SPA 12-010 NF Tax and Supplement Payment Structure
Updates the State Plan to describe the Nursing Facility Tax and Supplemental Payment
structure effective October 1, 2012.
Approved 11/1/12
Submitted 10/4/12
SPA 12-009 GME 2013
Updates GME funding for the service period July 1, 2012 through June 30, 2013 for
programs with submitted IGAs.
Submitted 9/28/12
SPA 12-008 Nursing Facilities Provider Tax
Updates the State Plan to describe the Nursing Facility Tax and Supplemental Payment
structure effective October 1, 2012. (Note: This SPA has been withdrawn and replaced
with #12-010.)
Withdrawn 10/4/12
Submitted 7/25/12
2

SPA 12-007 Outliers
Updates the State Plan regarding Outliers for the time period beginning October 1, 2012.
Approved 1/3/13
Submitted 7/17/12 [38KB]
SPA 12-006D Nursing Facility Rates
Continues current reimbursement rates for nursing facilities during the period October 1,
2012 to September 30, 2013.
Approved 1/3/13
Submitted 7/19/12 [43KB]
SPA 12-006C Provider Reimbursement Rates
Continues current reimbursement rates for other providers during the period October 1,
2012 to September 30, 2013.
Approved 2/6/13
Submitted 7/13/12
SPA 12-006B Outpatient Hospital Reimbursement Rates
Continues current outpatient hospital reimbursement rates for the period October 1,
2012 to September 30, 2013.
Approved 2/6/13
Submitted 7/9/12
SPA 12-006A Inpatient Hospital Reimbursement Rates
Continues current inpatient hospital reimbursement rates for the period October 1, 2012
to September 30, 2013.
Approved 1/3/13
Submitted 7/9/12
SPA 12-005 Reimbursement of Transportation Services
Updates the State Plan to include pages that describe reimbursement for transportation
services.
Submitted 6/4/12
SPA 12-004 Asset Verification System
Clarifies the process for establishing an Asset Verification System to verify the assets of
aged, blind, or disabled Medicaid applicants or recipients.
Approved 5/30/12
Submitted 3/30/12
SPA 12-003 IHS 638 Tables
This SPA has been separated into two related SPAs for timing purposes. Further
information is below:
Submitted 3/1/12
3

SPA 12-003A- Encounter/visit limit
Updates the State Plan to reflect a 5 encounter/visit per day limit for services at Indian
Health Services and Tribal 638 Health Facilities.
Approved 8/20/12
Submitted 7/11/12
12-003B- Reimbursement Methodologies
Updates the State Plan regarding reimbursement methodologies at Indian Health
Services and Tribal 638 Health Facilities.
SPA 12-002 Provider Screening and Enrollment
Provides assurance that the State complies with federal requirements related to Provider
Screening and Enrollment.
Approved 5/3/12
Submitted 2/9/12
SPA 12-001 Services Clarification
Updates the State Plan pages regarding targeted case management, extended care for
pregnant women and transportation services.
Submitted 1/12/12 [55KB]
2011 State Plan Amendments
SPA 11-018 Fee Schedule Update
Updates the State Plan pages regarding the effective dates for fee for service rates.
*Approved 01/04/13
Submitted 12/29/11
SPA 11-017 GME
Updates GME funding for the service period July 1, 2010 through June 30, 2011 for
programs with submitted IGAs. This SPA has been separated into two related SPAs for
timing purposes.)
Submitted 11/23/11
SPA 11-017A GME
Updates GME funding for hospital payments made before 9/30/12.
Approved 10/3/12 [831KB]
Submitted 11/23/11 [40KB]
SPA 11-017B GME
Updates GME funding for hospital payments made before 9/30/12.
Submitted 11/23/11 [59KB]
SPA 11-016 Healthcare Acquired Conditions
Updates the State Plan to include standards of payment for healthcare acquired
conditions.
Approved 7/18/12
Submitted 8/31/11
4

SPA 11-015 340 B Drug Pricing
Updates the State Plan to include standards of pricing and payment for 340B drugs.
Approved 3/9/12
Submitted 8/31/11
SPA 11-014 Hospice Restoration
Updates the State Plan to indicate Hospice Care is a provided service, effective July 20,
2011.
Approved 10/12/11
Companion Letter 10/12/11
Submitted 7/15/11
SPA 11-013 Freestanding Birth Centers
Documents compliance with the Affordable Care Act, Section 2301, regarding Medicaid
coverage and separate payments for freestanding birth center services.
Approved 9/22/11 [816KB]
Submitted 6/30/11 [117KB]
SPA 11-012 Inpatient Hospital Limit
Limits the number of inpatient hospital days for adult members.
Approved 4/13/12
Submitted 6/24/11
SPA 11-011 Outlier
Updates the methodology for qualifying and paying claims for inpatient hospital services
with extraordinary operating costs per day.
Approved 11/18/11
Submitted 6/24/11
SPA 11-010 Outpatient Hospital Rate Rebase
Rebases the outpatient hospital fee schedule using the most current available Medicare
cost data.
Approved 9/22/11 [886KB]
Submitted 6/24/11
SPA 11-009D Nursing Facility Rate Reductions
Updates nursing facility reimbursement rates to reflect a 5% reduction from October 1,
2011 to September 30, 2012.
Approved 11/18/11
Submitted 6/23/11
5

SPA 11-009C Rate Reductions
Updates reimbursement rates for various services to reflect a 5% reduction from October
1, 2011 to September 30, 2012.
Approved 11/21/11
Submitted 6/23/11
SPA 11-009B Outpatient Hospital Rate Reduction
Updating reimbursement rates for outpatient hospital services to reflect a 5% reduction
from October 1, 2011 to September 30, 2012.
Approved 11/21/11
Submitted 6/23/11
SPA 11-009A 5% Inpatient Hospital Rate Reduction
Updating reimbursement rates for inpatient hospital services to reflect a 5% reduction
from October 1, 2011 to September 30, 2012.
Approved 11/18/11
Submitted 6/23/11
SPA 11-008 Behavioral Health Practitioners
Clarifies the list of state-licensed behavioral health practitioners.
Approved 9/9/11 [679KB]
Submitted 6/20/11
SPA 11-007 School Based Claims
Updating the reimbursement methodology for School Based Claiming.
Approved 12/16/11
Submitted 6/20/11
SPA 11-006 Home Health Services
Clarifyies the services of home health, private duty nursing and therapies in the State
Plan.
Approved 2/17/12
Submitted 6/3/11
SPA 11-005 Transplant Restoration
Updates Arizona’s State Plan to restore transplants previously covered by AHCCCS,
and clarifies transplants covered as of April 1, 2010.
Approved 7/14/11
Submitted 4/21/11
SPA 11-004 Public Assistance Reporting Information System (PARIS)
Documents maintenance of an eligibility determination system that provides for data
matching through PARIS or other successor systems.
Approved 5/27/11
Submitted 4/11/11
6

SPA 11-003 Prohibition on Payments Outside the US
Updates Arizona’s State Plan to include a statement of compliance with Section 6505 of
the Affordable Care Act that prohibits payments to any financial institution or entity
located outside of the U.S.
Approved 3/31/11
Submitted 2/23/11
SPA 11-002 Hospice
Describes hospice services provided under EPSDT.
Approved 5/12/11
Submitted 2/23/11
SPA 11-001 GME Updates
This SPA has been separated into two related SPAs for timing purposes. Further
information is below:
SPA 11-001A GME
Updates GME funding for hospital payments made by 6/30/11.
Approved 6/9/11
Submitted 5/31/11
SPA 11-001B GME Updates
Updates GME funding for hospital payments made after 6/30/11.
Approved 1/23/12
Submitted 5/31/11
SPA 11-001C GME Updates
Updates GME funding for the service period July 1, 2010 through June 30, 2011 for
programs with pending IGAs.
Approved 9/26/12
Submitted 12/7/11
SPA 11-001D GME Updates
Updates GME funding for the service period July 1, 2010 through June 30, 2011 for
programs with pending IGAs.
Submitted 2/15/11 [37KB]
Original GME SPA 11-001 Submission
Updates GME funding for the service period July 1, 2010 through June 30, 2011.
Submitted 2/15/11
7

RFP Announcements

Janice K. Brewer, Governor
Thomas J. Betlach, Director
801 East Jefferson, Phoenix, AZ 85034
PO Box 25520, Phoenix, AZ 85002
Phone: 602-417-4000
www.azahcccs.gov
Our first care is your health care
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
Arizona Health Care Cost Containment System (AHCCCS)
Announces Award of Contracts for its Acute Care Program and
Children’s Rehabilitative Services Program (CRS)
April 2, 2013 – On March 22, 2013, the Arizona Health Care Cost Containment System (AHCCCS) awarded
contracts to seven successful managed care companies that will provide services to over one million lowincome
Arizonans enrolled in the Acute Care Program. On April 1, 2013, AHCCCS awarded a contract to an
eighth company. 1 Acute care members are covered for medical care, including doctor's office visits,
hospitalization, prescriptions, lab work, and other physical health services. Ten managed care organizations bid
to be contractors, resulting in a competitive process that drove down per member program costs by 2.8% or
roughly $100 million in the first year.
AHCCCS also awarded one statewide Children’s Rehabilitative Services (CRS) contract to one managed care
company to provide integrated physical and behavioral health services to 24,000 AHCCCS enrolled children
with CRS-qualifying conditions. Two managed care organizations bid to be contractors for CRS.
Contracts are awarded for up to five years for the Acute Care Program and up to four years for the CRS
Program beginning October 1, 2013.
• Maricopa County – Care1st Arizona, Health Choice Arizona, Health Net of Arizona, Maricopa Health
Plan, Mercy Care Plan and United Health Care Community Plan, Phoenix Health Plan.
• Pima County – Care1st Arizona, Health Choice Arizona, Mercy Care Plan, United Health Care
Community Plan, University of Arizona Health Plans University Family Care
• Santa Cruz County - United Health Care Community Plan, University of Arizona Health Plans
University Family Care
• Cochise/Graham/Greenlee Counties – United Health Care Community Plan, University of Arizona
Health Plan’s University Family Care
• Yuma/La Paz Counties - United Health Care Community Plan, University of Arizona Health Plan’s
University Family Care
• Mohave/Coconino/Apache/Navajo Counties – Health Choice Arizona, United Health Care
Community Plan
• Yavapai County - United Health Care Community Plan, University of Arizona Health Plan’s
University Family Care
• Pinal/Gila Counties – Health Choice Arizona, University of Arizona Health Plan’s University Family
Care
1 AHCCCS exercised its contractual authority to offer a capped contract to Phoenix Health Plan, an unsuccessful incumbent Contractor in Maricopa
County.

• Statewide CRS Contract – United Health Care Community Plan
The new contractor awards impact approximately 130,000 members that will be transitioning to a new health
plan. The AHCCCS Administration has a proven process for the transition of members to new health plans.
The AHCCCS Administration will work with all health plans, both relinquishing health plans and new health
plans, to ensure members are transitioned to their new health plan without disruption in health care services.
This process ensures that members who are in the middle of a course of treatment, e.g. cancer, or who have
ongoing healthcare needs, like pregnancy or chronic disease, will not have their care disrupted.
All members transitioning to a new health plan will receive a notice from AHCCCS with their new health plan
assignment in July 2013. The new health plan assignment will be effective October 1, 2013. Members enrolled
in a health plan that is no longer serving their county will be assigned to an available health plan in their county
by AHCCCS. These members can stay with that health plan or choose a different one by a designated date.
Members will also have a chance to change health plans (if desired) during another enrollment choice period
after October 1, 2013. Meanwhile, all current health plans will continue to serve their membership until the
current contract expires on September 30, 2013.
The following table provides a detailed account of the AHCCCS Acute Program and CRS Program contract
awards granted in response to Request for Proposal YH14-0001.

Summary of ACUTE/CRS RFP Awards
Bridgeway Health
Solutions of Arizona,
LLC
Care 1 st
Health Plan Arizona
Health Choice
Arizona
GSA 2 GSA 4 GSA 6 GSA 8 GSA 10 GSA 12 GSA 14 CRS
Yuma,
LaPaz
Apache,
Coconino,
Mohave,
Navajo
Yavapai
Gila,
Pinal
Pima,
Santa
Cruz
Maricopa
Cochise
Graham
Greenlee
S S *S S S S S
S S S S(1) *S S
*S *S S S *S(1) *S S
Health Net of
Arizona
Maricopa Health
Plan managed by
University of
Arizona Health
Plans
Blue Cross Blue
Shield of Arizona /
Medisun Community
Care Inc. dba
Community Care
Southwest Catholic
Health Network dba
Mercy Care Plan
S S S *S(1) *S *S S
Phoenix Health Plan *S *S *S *S *S
United Health Care
Community Plan
University of
Arizona Health
Plans, University
Family Care
*S S S S *S *S S *S
S S *S *S *S
Total Bids Received 6 5 7 6 8 9 6 2
* = Current Contractor
S = Submitted a Proposal
(1) = Award in Pima County Only
= Contract Awarded
Note: Per Section H, Paragraph 9, Award of Contract, of the RFP, AHCCCS granted Phoenix Health Plan a capped
contract in the Maricopa GSA.
Revised April 2, 2013
S
S
*S
S

To access RFP award information, click the Procurement File link below.
Procurement File Page - YH14-0001

DHS Update

Mercy Maricopa Integrated Care
RBHA Overview
March 2013
Health and Wellness for all Arizonans
azdhs.gov

Mercy Maricopa Integrated Care - - Facts
• Offeror will utilize the majority of the existing provider network
• By October 1 st bidder would have eight (8) SMI clinics that offer integrated
care – (4 are currently used as co-location sites in the existing contract)
• SMI clinics offering integrated services will be increased to 20 sites over
the course of the contract
• Management Team (CEO, CMO, CFO, COO) all come from behavioral health
• Mercy Care Experience Serving Populations with Complex Care Needs
– 2400 SMI in the ALTCS program – (Fully integrated BH services)
– 6200 SMI in the Acute program
– 9300 in the DDD program
• Have held community outreach and development planning with 51
different stakeholders including providers, peer runs and community
organizations
• Have shaped a Community Proposal versus a single organization approach
Health and Wellness for all Arizonans
azdhs.gov

What Does MMIC Bring
Recognition of what needs to improve the system –
• Utilizes the existing network and enhances access to care
• Member and family focused
• Recovery and resiliency throughout the system
• Already serving nearly half of the SMI population in acute plans
• Extensive experience serving individuals with very complicated
care needs (Operate integrated BH models in Illinois, Florida, Delaware, Missouri,
Texas)
• Two years of outreach to the community stakeholders with
identified opportunities
• Builds on the existing crisis system and enhances through
specialty crisis and ACT teams
Crisis
Children & Youth
School Based
DDD
ACT
Homeless ACT
Forensic ACT
Peer Support ACT
Health and Wellness for all Arizonans
azdhs.gov

MMIC Response to Stakeholder Meetings
Feedback Summary
“The meetings described above have produced a wealth of information about
what works in the current system and what could use improvement. We left
our sessions with two major realizations:
(1) There are many people and providers working in the RBHA system who
care and seek to serve people in need and use resources well; and
(2) Many of the issues they have encountered in trying to fulfill their
missions will be greatly helped by integrating the acute, behavioral and
Medicare programs, if the integration is done well”.
Health and Wellness for all Arizonans
azdhs.gov

To address the concern that physical health practice will
overwhelm and/or dominate BH practice.
“Maintaining access to a robust array of services and providers of behavioral
health specialty care, while assuming responsibility for integrating these
services within physical health care, is just one of many strategies in
maintaining a focus on the behavioral health needs of Maricopa County
residents. While this will be a major focus of RBHA integration efforts,
assisting adults with SMI in accessing needed preventative and specialty
physical health care should not disrupt the active and often successful
treatment of the co-occurring behavioral health disorders. While the location
and focus of care may be expanding for some individuals, access to needed
behavioral health services will remain. For some this can occur within a single
setting, for others it will require an expanded treatment team. As treatment
teams expand, Care Coordinators and Case Managers will be responsible for
making sure Individualized Care Plans are addressing the whole health needs
of members”.
Health and Wellness for all Arizonans
azdhs.gov

How the System Operates Today - Most
• Member visits provider for immediate issue
• Immediate issue treated
• Limited delivery of other services
• Member leaves
• Member may or may not access care for secondary
issues
• The RBHA may not know about any of the service
• May be up to three different payor sources
• Potential for bad outcomes even if the member
does everything right
• Medication interactions; family is left trying to navigate multiple
issues; patient accesses higher levels of care for preventable issues;
unnecessary funds are expended
Health and Wellness for all Arizonans
azdhs.gov

How the System Operates Today - Some
• Same as most experience except—
• Four clinics with co-location partnership
• Co-location is better but still does not meet the needs of the
whole person
• Still limited sharing of information on diagnosis and
treatment
• Members are limited on accessing these providers due to
proximity and transportation
• Still have multiple streams of funding not communicating on
outcomes
• Families may be left coordinating care and communication
Health and Wellness for all Arizonans
azdhs.gov

How the System Would Operate With MMIC
• Member accesses the system for care
• Seen by provider for presenting issue
• Provider considers full treatment history
-Behavioral, Physical, Medication, Case Management
• Member/family discuss whole health issue, receive treatment and
develop treatment plan adjustments in one step
• Improve BH outcomes by welcoming person for whatever reason
• Reduce morbidity by treating preventable illnesses and supporting
recovery with a whole person approach
• Wherever you go Care Coordination will be there
• RBHA involved in care coordination throughout entire experience
Health and Wellness for all Arizonans
azdhs.gov

MMIC Integrated Care Sites
• Member Centered
• Family Support
• Coordination of Care
• Accountability
• Whole health service delivery
1. East Valley 4330 E. University Dr. Mesa
2. Hampton 1440 S. Country Club Dr., Mesa
3. Centro Esperanza 310 S. Extension Mesa
4. San Tan 1465 W. Chandler Blvd., Chandler
5. Enclave 1642 S. Priest Dr., Tempe
6. Arcadia 3311 N. 44th St., Phoenix
7. Communidad 1035 E. Jefferson St., Phoenix
8. South Central 1616 E. Roeser Rd., Phoenix
9. Highland 4707 N. 12th St. Phoenix
10. Midtown 3333 N. 7th Ave. Phoenix
11. Capitol Center 1540 W. Van Buren St. Phoenix
12. Saguaro 3227 E. Bell Rd., Phoenix
13. Townley 8836 N. 23rd Ave., Phoenix
14. Osborn 3640 W. Osborn Rd., Phoenix
15. West McDowell 5030 W. McDowell Rd., Phoenix
16. Metro Center 10240 N. 31st Ave., Phoenix
17. Bethany Village 4210 W. Bethany Home Rd. Glendale
18. Garden Lakes 4170 N. 108th Ave. Phoenix
19. West Valley 11361 N. 99th Ave., Peoria
20. Hassayampa Campus 811 N. Tegner, Wickenburg
Note:
Sites 5, 7, 8 & 16 are existing SMI co-located clinics used by Magellan
Sites 2, 10, 11 & 14 are anticipated opening by 10-01-13
Choices (5,6,8,10,13,15); People of Color (3,7,11)
Partners in Recovery (1,16,19,20); Southwest Network
(2,4,9,12,14,17,18)
Health and Wellness for all Arizonans
azdhs.gov

MMIC System Entry Points
Health and Wellness for all Arizonans
azdhs.gov

So what is Care Coordination
Community based system wrapped around members and families
Single accountable entity
Care management function ensures accountability, transparency, seamless service delivery, minimizes possible
gaps in care
Care manager (administrative level)
Big picture trends; systemic issues; real time
Exp. - Notices member went to ED over 5 times…identifies possible issues… communicates issue and opportunity
to treatment team through Care Coordinator
Care coordinator (team focus)
Treatment team management; views the whole person; bridges communication gaps; develops team approach to
problem resolution
Case manager (member and family single point contact)
High touch with member and family
Carries out the plan at the service level
Peer navigator (member educator/advocate)
Helps members and families understand and communicate throughout the process
Member
Engaged with the team to utilize strengths in plan development
Health Record
Wrapped around the member at all points of contact to facilitate coordinated care
Health and Wellness for all Arizonans
azdhs.gov

Members and Families First
“Our Care Management approach will weave together physical, behavioral
health, and psychosocial support needs in a holistic manner.
• Taking a holistic person-centered focus: We will focus on members’ life
goals, not their diagnoses, while incorporating their strengths,
preferences and needs in a culturally and linguistically appropriate
manner.
• Maintaining and supporting the current behavioral health system and
adding supports that strengthen it:” – Mercy Maricopa Integrated Care
Health and Wellness for all Arizonans
azdhs.gov

Member Transition
Members
• Over 40% SMI currently receive services with successful bidder
• Have up to ninety days after contract start day to select a PCP
• Option to use single case agreement if member chooses to keep current PCP
• Successful bidder already has letter of agreements with behavioral health providers
ADHS Transition
Plan & Coordination
• ADHS, Successful Bidder & Magellan work together to ensure seamless transition
• ADHS coordinates activities with AHCCCS & Health Plans to ensure continuity of care during
transition
• Community Engagement Team is ready as of March 6, 2013
• Member Transition activities required to start 10 days post contract award
ADHS
Monitoring
• ADHS Comprehensive Member Transition Plan is in place
• Member Transition Team has been identified
• Real-time data monitoring tools and strategies have been developed
• Community Engagement Team members have been trained
• ADHS will use enterprise system to work interactively with Magellan, AHCCCS, Health Plans and
Successful bidder during member transition period
Health and Wellness for all Arizonans
azdhs.gov

MMIC RBHA Summary
• Supports the whole person vision for behavioral health
services
– Reduces stigma
– Delivers services where the person wants
– Supports families
– Closes gaps in care
– Improves quality of life
• Have experience in delivering high quality service in
behavioral health
• Utilizes the existing provider network and grows
• Provides full coordination of care
• Member and family focused
Health and Wellness for all Arizonans
azdhs.gov

Health and Wellness for all Arizonans
azdhs.gov

Recovery through Whole Health:
the Administrative Level
Medicaid Funds Federal Grant Funds State General Funds Other Funds (e.g. County, City funds)
From AHCCCS
From HHS
From OSPB,
Legislature
From Maricopa County , City
of Phoenix, Dept of Housing
ADHS/DBHS
Medicare Funds
From CMS since RBHA will be
Medicare Special Needs Plan
One contract = one accountable entity for TXIX SMI members;
Responsible for whole health outcomes and for the whole person’s
healthcare needs
Maricopa County RBHA
Behavioral health network
Serves TXIX and non-TXIX adults with SMI,
adults without SMI, and children/adolescents;
Also provides crisis services to anyone in need
Physical health network
Serves TXIX adults with SMI only
Health and Wellness for all Arizonans
azdhs.gov

Recovery through Whole Health: the service provider level
Behavioral Health
•Use of evidenced based practices
• Routine screening, prevention, whole health, wellness AND RECOVERY focus
• Care management, chronic disease management AND RECOVERY programs
• Shared medical records
Primary Care
Multidisciplinary
team
Housing Support
Specialty Care
Employment Support
Peer Support
Community & Social Support
Health and Wellness for all Arizonans
azdhs.gov

Anticipated Benefits
• Lengthen the lifespan and improve healthcare outcomes
– Overcome disparities through integrated care
• Strengthen the focus on screening, prevention, early
intervention, care management, patient education, wellness,
AND RECOVERY FROM MENTAL ILLNESS AND SUBSTANCE
ABUSE
• Control costs
– 60% of Medicaid’s highest cost beneficiaries with
disabilities have co-occurring physical and behavioral
health conditions
– Current healthcare system is unsustainable
Health and Wellness for all Arizonans
azdhs.gov

AHCCCS Update

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

AHCCCS Population as of July 1
1,400,000
1985 – 2012
1,200,000
1,000,000
1,047,982
800,000
600,000
456,385 508,917
400,000
318,383
200,000
144,450
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”
.

AHCCCS Population
2,000,000
1,800,000
1,600,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY 2010FY 2011
June 30 Enrollment
FY Unduplicated Count
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
3
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

AHCCCS Growth of GF
Since 2007 Medicaid costs
have grown by 35%
Includes $2.5 billion in total
fund cuts
At full implementation the
Prop. 204 expansion’s
unfunded costs are $256.0
million
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
4
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Growth in National Health Expenditures and
Gross Domestic Product (GDP), 1985-2011
Annual Percent change
12.0
10.0
8.0
6.0
4.0
2.0
July 1990-
March 1991
Recession
March 2001-
November 2001
Recession
December
2007-June
2009
Recession
0.0
-2.0
1985
1987
1989
1991
1993
1995
1997
1999
Calendar Years
2001
2003
2005
2007
2009
-4.0
NHE
GDP
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, U.S Department of Commerce, Bureau of Economic Analysis and
National Bureau of Economic Research, Inc.
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
5
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

10%
8%
6%
4%
2%
0%
-2%
15%
Medicaid: Growth in Enrollment and Total, Federal,
and State & Local Expenditures, 2007 – 2011
Total Medicaid
Expenditures and
Enrollment
6.2%
2.2%
1.4%
1.0%
-0.7%
2007 2008 2009 2010 2011
Enrollment Spending Per enrollee
2007
2008
2009
2010
2011
Federal and State & Local
Medicaid Expenditures
-10.0%
-7.1%
6.3%
6.7%
5.7%
5.8%
9.6%
0.7%
8.8%
5.9%
7.7%
2.5%
2.5%
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
21.9%
22.2%
Total Federal State/local
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
6
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Childless Adult Population
300,000
250,000
200,000
150,000
100,000
50,000
Mar May July Sept Nov Jan April July Oct Jan April
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
7
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Regardless of ACA Decisions-
Unsustainable System
Institute of Medicine - $750 Billion in “Waste”
• $210 B Unnecessary Procedures
• $130 B Inefficient Care
• $190 B Excess Admin
• $105 B Inflated Prices
• $55 B Prevention Failures
• $75 B Fraud
IOM Solutions – Science and Informatics – Engage and
Empower Patients – Align Incentives – Transparency –
Culture of Leadership and Learning
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
8
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

AHCCCS Strategies
Leverage Triple Crown of Contracting – Integration
and Modernization
Dual Eligible Members
Program Integrity Efforts
Payment Reform
Leverage Health Information Technology
Improve American Indian Health Care delivery
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
9
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Triple Crown Procurements
October 1, 2013 start date for potentially 5 years
Maricopa RBHA – $5 billion plus
Statewide Acute Care – roughly $33 billion
(with expansion)
CRS Program - $1.0 billion – Integrate
program
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
10
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Results
Competition
• Rates down 2.8% - roughly $100 m in year 1
Transition
• 135,000 Acute members – Managing transitions in all
GSAs
• RBHA Contract – AHCCCS working closely with ADHS
• Mercy Maricopa has very broad network – working to
make seamless to members and families
• CRS – working to transition services
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
11
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Acute Bids (S = submitted - * = incumbent – shade =
award – PHP = capped contract Maricopa)
Yuma,
LaPaz
Apache,
Coconino,
Mohave,
Navajo
Yavapai
Gila,
Pinal
Pima,
Santa
Cruz
Maricopa
Cochise
Graham
Greenlee
CRS
Bridgeway S S *S S S S S
Care 1 st S S S S(1) *S S
Health Choice *S *S S S *S(1) *S S
Health Net S S
Maricopa Health *S
BCBS
S
Mercy Care Plan S S S *S(1) *S *S S
Phoenix Health Plan *S *S *S *S *S
United Community *S S S S *S *S S *S
UA Health Plans S S *S *S *S
Total Bids Received 6 5 7 6 8 9 6 2
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
12
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Duals Demonstration Update
AHCCCS submitted Demonstration Proposal to CMS for:
• ALTCS EPD –1-1-14 – Existing Contractors – Statewide
• Maricopa Members with SMI – 1-1-14
• Acute Care Members – 1-1-14 – Statewide
GOAL: 1-1-14 - 100,000 dual eligible in an integrated plan
AHCCCS on Dual Track for Duals – If no Demo plans must be SNPs
Recent Letter on web to CMS stating concerns – decision by April
• January 1, 2014 cannot slip
• What happens in 3 years – path forward
• Capitation Rates
Recently decided that State will not pursue full demonstration at this
time
State will pursue other alignment initiatives
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
13
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

AHCCCS Program Integrity
Agency created central Office of Inspector General
Even with 33% reduction in agency staff, resources dedicated to program
integrity have increased
Signed contract with Data analytics vendor
Had 3rd lowest error rate of 17 states in national study
Conducted two significant date of death analysis - minimal findings
Developed and distributed 3 training modules staff – plans – members and
providers
Established match process with county jails
Match with MVD photos – 1 million images per month
Audit of $3.2 billion in payments – outside vendor - $2,200 recovered
Program Integrity Results – FY 2012
• Total Convictions – 25
• Total Recoveries and avoidances - $960 million
Need to leverage CMS
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
14
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

AHCCCS Payment Modernization
Plan Integration –
ALTCS Shared Savings Proposals
Acute Plans – Shared Savings RFP Requirements
Inpatient APR DRG
Stakeholder input
RFP questions on payment strategies
Resources – CPR – Executive Team -
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
15
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Health Information Technology
What is the number 1 method medical information is
communicated
Medicaid Incentive Payment Systems
HIT Payments – estimating $500 m over 7 years
• 1,265 Eligible providers - $26.7 m
• 56 hospitals $68 m
Health Information Network of AZ
Integration Opportunities require increase HIT
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
16
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

American Indian Care Coordination
Strategies
Care Management Coordinator Goal - Improve health
outcomes by reducing readmissions and increase use of
primary care services
AHCCCS working with 3 populations Post IP stay
Long Term Care – contacting tribal case manager (1,053 in
non I.H.S/638 facility last year)
Newborns – contacting moms to coordinate pediatric visit
(1,213 born in 9 non I.H.S/638 facilities last year)
Diabetic Patients – connecting member back to I.H.S & 638
system
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
17
“Reaching across Arizona to provide comprehensive quality
health care for those in need”

Jurassic Park
Coverage Issue – Restore Prop 204
ACA Requirements
Exchange Issue
Duals Demo
Payment Reform
Systems Issues
Triple Crown Procurement
Agency Sunset Process
30 Years of Medicaid Innovation
Our first care is your health care
Arizona Health Care Cost Containment System
18
“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
“Reaching across Arizona to provide comprehensive quality
health care for those in need”