AHCCCS Update September 19, 2012

“Reaching across Arizona to provide comprehensive quality health care for those in need”

Our first care is your health care Arizona Health Care Cost Containment System

AHCCCS Update September 19, 2012


Our first care is your health care arizona health care cost containment system

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Health Care Reform PPACA expanded Medicaid to 133% of the federal poverty

limit on January 1, 2014. Nationally Medicaid is estimated to grow by 16 million

lives Create Health Exchange

provide tax credit subsidy for individuals from 100% to 400%

Nationally Exchanges are expected to cover 24 million lives by 2019

State needs to determine who will operate Exchange Made a number of commercial insurance reforms Established Individual Mandate


Supreme Court Ruling Surprise – Individual Mandate – stands Medicaid – Justice Roberts“We disagree. The court today limits the financial

pressure the Secretary may apply to induce States to accept the terms of the Medicaid expansion. As a practical matter, that means States may now choose to reject the expansion; that is the whole point. But that does not mean all or any will.”


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What does this mean for Arizona?It is complicatedProposition 204 voter mandateCurrent freeze due to limited resourcesFederal waivers that expire on January 1, 2014 that provided temporary assistance for uncompensated careExecutive seeking input on important decisions re: Medicaid and Exchange


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Population Fiscal SummaryPopulation FPL Est. # State Cost Total

Children 6-18 100-133 44,000 $33 m $124 m

Eligible not enrolled 0-133 137,000 $225 m $656 m

Childless Adult Restoration

0-100 154,000 $170 m $1.4 B

Childless Adult not previously enrolled

0-100 33,600 $37 m $306 m

Optional Parent Expansion

100-133 42,000 $0 $289 m

Optional Childless Adult Expansion

100-133 18,000 $0 $165 m


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Public ForumsOutlining Executive principles, facilitating stakeholder discussions and gathering input on community perspectives re: ACAFlagstaffPhoenixYumaTucson


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Process and Timeline for Deliberations Ongoing: Submit clarifying questions to Federal

Government and await further guidance on Federal interpretation of Supreme Court ruling for Medicaid.

August 2012: Update fiscal estimates on State options.

July – November 2012: Engage stakeholders and obtain public input.

November – December 2012: Incorporate final decisions into normal policy-making process.


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1010

Total AHCCCS Population



1111

80,000

130,000

180,000

230,000

280,000

Mar May July Sept Nov Jan March May July

Childless Adult Population



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AHCCCS AIHP Enrollment

60,000

65,000

70,000

75,000

80,000

85,000

90,000

95,000

100,000

105,000


AHCCCS Coverage Solutions: Current Status of the AHCCCS Program Current Waivers that end Jan. 2014:

Freeze and coverage for Childless Adults Safety Net Care Pool using local dollars to cover

uncompensated hospitals costs ($332 M program - $150 M paid to date).

KidsCare II allowing coverage for 22,000 children using local dollars.

First-ever funding program to support uncompensated care costs for Indian Health Services and Tribally Operated facilities ($17 M paid to date).


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AHCCCS Coverage Solutions: Building on a Tradition of Flexibility, Partnership Flexibility, partnership are cornerstone of AHCCCS success,

mainly through 1115 Waiver, which: Created first statewide, mandatory Medicaid Managed Care program

(1982); Permitted Home and Community Based Services to allow elderly and

individuals with disabilities to stay at home instead of being placed in institutions for their care (1989).

Allowed coverage for Childless Adults in response to Prop. 204 (2001);

Supported personal responsibility through mandatory copays for Childless Adults (2003); and

Provides State ability to manage program during fiscal crisis.


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Opportunities for Operational Efficiencies Currently, multiple agencies across state government are

performing the same function of purchasing healthcare services for the State.

Modernizing Arizona’s healthcare infrastructure presents opportunities to consolidate some of these functions.

Streamlining government functions supports best practices, leverages existing capacity and achieves greater efficiencies.

The State could better focus on reform initiatives to align incentives in healthcare, pay for quality of care and not quantity of services, modernize reimbursement strategies (e.g., use of APR-DRGs), and pursue innovation grants.


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Medicaid Policy Questions What is available in resources to restore Proposition

204? What flexibility will the federal government provide

to the state going forward for this population? What match rate will the state receive for Prop 204 –

standard or enhanced - $1.5 B difference (4 years) What should the state do regarding the adult

population between 100-133% - Exchange or Medicaid?


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Health Insurance Exchange Timeframes September 2012: Essential Benefits decision November 2012: Submit State’s Intent

regarding Exchange to HHS Secretary January 2013: HHS Secretary Certifies Exchange July 2013: Systems Readiness Testing October 2013: Exchange enrollment begins January 2014: Exchange coverage begins January 2015: Exchange must be self-sustaining

through user fees, assessments or other funding sources


Exchange Tax Credits Law provides for refundable, advanceable

Credits Up to 133% FPL – 2% of income 133-150% FPL – 3-4% of income 150-200% FPL – 4-4.63% of income 200-250% FPL – 6.3-8.05% of income 250-300 FPL – 8.05-9.5% 300% + - 9.5%


Health Insurance Exchange: Funding State v. Federal Exchange operation

considerations: Customer Support Competition and Choice AHCCCS eligibility determination Start-up Funding


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Other Issues


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Dual Members DemonstrationUnprecedented historical opportunity to improve care April – Presentation to CMS and OMBMay - Meetings with

1. CMS Administration 2. Congressional Staff3. MEDPAC/MACPAC

June – Hosted California Staff July – Congressional TestimonyConcerns expressed include (non CMS)

Speed – Size – Health Plan Capacity – Unresolved Issues – Medicare Principles

Current model is fragmented, unsustainable and results in lack of accountability and sub-optimum outcomes



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Arizona Dual Eligible Demonstration Proposal Arizona 1 of over 20 states to submit proposal Arizona has proven success of alignment Submitted to CMS on May 31, 2012 3 Year Demonstration Goal – Statewide move from 40,000 integrated

members to 100,000 3 way contract – CMS – State – Plans Still unanswered questions –requires flexibility



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KidsCare Program KidsCare II

Originally 21,000 slots Slow startup allowed for additional enrollment – 22,200 currently

enrolled Cap instituted September 7 1-1-14 end date

New Prop 204 Sales Tax Directs $25 million to KidsCare (potentially a “KidsCare III

program) Additional funding not really needed, since ACA provides 99%

federal match for KidsCare


Care Coordination Strategies Care Management Coordinator AHCCCS working with 3 populations with Inpatient

stay Long Term Care – contacting tribal case manager Newborns – contacting moms to coordinate pediatric

visit Diabetic Patients – connecting member back to I.H.S

& 638 system


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Implementing Legislative Changes Breast and Cervical Cancer program

Allows screening by a broader array of providers Expected to increase program enrollment

Ambulance Rates CY 2013 rates at 68.59% of ADHS as of Aug 2 (proposed

rule) Future rates determined through collaborative stakeholder

process that includes: Predictability Limited annual impact Potential acknowledgement of changes in uncompensated care


Outstanding Waivers Integration Waivers

CRS members Individuals with SMI – Maricopa RBHA to

provide physical health and behavioral health Nursing Facility assessment


Hearings OALS and OAH implementing plan to reduce

backlog Of 1237 cases:

340 vacated 403 withdrawn 442 set for prehearing 52 received hearing


Other Issues Managed Care RAC RFI – closed Sept 5,

2013 - 7 responses received – currently under review

State Innovation Models (SIM) grant Governor’s Office would lead application Concerns regarding:

Resource diversion from priority projects Coordinating various stakeholders/players Breadth of scope


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Other Issues Numerous federal efforts around updating and

improving quality measures CHIPRA Core – Comprehensive Well Child Core – Adult

Core - Dual Eligible – Multiple Chronic Disease – Meaningful Use – CMS Access Measures

HIT – looking to leverage ARRA investment 986 EP - $20 m – 47 Hospitals - $56 m

New IP Payment methodology – All Payer Refined – Diagnosis Related Groups (APR-DRGs)



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Other Issues Audits and Reviews

Sunset Audit – 2 of 4 reports complete Eligibility 1.1% Error Rate – see attachment

Medicare Part B Payments – Disallowance PERM Review RAS Recovery Audit CMS ALTCS Review – GAO Managed Care Review

Nursing Facility Assessment Fee Legislation


NAMD 501(c)(3) entity to facilitate dialogue among

states, develop consensus on critical issues, represent Medicaid directors in national policy debates, and provide technical assistance to states.

Medicaiddirectors.org


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State Personnel Reform Modernized state management of employees

to increase productivity, attract talent and retain high performing employees.

Certain current employees and all new employees will have “uncovered” status.

State agencies are implementing over the next year.


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AHCCCS Update September 19, 2012

Documents

Transcript of AHCCCS Update September 19, 2012