Rate Update - azahcccs.gov · Shelli Silver May 16, 2018 . MSIC Fee Schedule •Not really a Fee...
Transcript of Rate Update - azahcccs.gov · Shelli Silver May 16, 2018 . MSIC Fee Schedule •Not really a Fee...
Rate Update
Shelli Silver
May 16, 2018
MSIC Fee Schedule
• Not really a Fee Schedule – will be reflected as provider specific rates in PMMIS for each of the four MSICs
• This is a change from Consortium
• MSIC Fee Schedule will only apply to:
o Members with CRS Designation
o Members with “Former CRS” Indicator (21 and over but could also be under 21)
2 Reaching across Arizona to provide comprehensive
quality health care for those in need
MSIC Fee Schedule – cont.
• Will include unique rates for T1015 specific to each provider
o Only payable to these four providers
o Only payable for CRS/Former CRS members
• AHCCCS developing billing rules – will publish in Fee For Service Provider Manual
3 Reaching across Arizona to provide comprehensive quality health care for those in need
MSIC Fee Schedule – cont.
• Today the four MSICs are registered as one of the following:
o PT 02
o PT 05
o PT IC
• Considering an MSIC Provider Type post-10/1/18
4 Reaching across Arizona to provide comprehensive quality health care for those in need
MSIC Fee Schedule – cont.
• Draft Rates effective 10/1/18 (subject to change)
5 Reaching across Arizona to provide comprehensive quality health care for those in need
Phoenix Tucson Flagstaff Yuma
T1015 $270.00 $276.96 $558.00 $441.00
All Other Codes 115% 120% 115% 115%
ACC/RBHA Capitation Rates
6
• Timeline Reminder
o Preliminary rates released in July
o Final RBHA rates released mid-August
o Final ACC rates released in September – released later due to risk adjustment
Reaching across Arizona to provide comprehensive quality health care for those in need
Non-diagnostic Based Population Risk Adjustment
• Uses payment data for assigned members
o Payment data uses AHCCCS Allowed Amount to address CMS concerns
• Uses historical encounter data – all services – for every assigned member
o 6 month lag
o Up to 12 months of data
• Budget Neutral
7 Reaching across Arizona to provide comprehensive quality health care for those in need
Questions?
8 Reaching across Arizona to provide comprehensive quality health care for those in need