State Medicaid Advisory Committee (SMAC) Info...Jul 09, 2014 · 2014 SMAC Meetings Per SMAC...

State Medicaid Advisory Committee (SMAC) Wednesday, July 9, 2014

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 and Chief Medical Officer • Dr. Sara Salek

ALL

III. Approval of April 9, 2014 meeting summary

ALL

Agency Updates

IV. AHCCCS Update • SIM Grant Announcement


V. Transition and Coordination with the Justice System

Michal Rudnick Office of the Director

VI. CMS Update

• SNCP and I.H.S./638 Extension Waiver Amendment Requests

• Benefits Discussion

Theresa Gonzales

Office of Intergovernmental Relations

Discussion

VII. Call to the Public


VIII. Adjourn at 3:00 p.m.

ALL

2014 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: January 8, 2014

April 9, 2014 July 9, 2014

October 8, 2014

For more information or assistance, please contact Theresa Gonzales at (602) 417-4732 or [email protected]

April 2014 Meeting Summary

Janice K. Brewer, Governor Thomas J. Betlach, Director

801 East Jefferson, Phoenix, AZ 85034 • PO Box 25520, Phoenix, AZ 85002 • 602-417-4000 • www.azahcccs.gov

State Medicaid Advisory Committee (SMAC) Meeting Summary

Wednesday, April 9, 2014, AHCCCS, 701 E. Jefferson, Gold Room 1:00 p.m. – 3:00 p.m.

Members in attendance: Tom Betlach Will Humble Kathy Waite Tara McCollum Plese Kevin Earle Phil Pangrazio Tomas Leon

Elena Rodriguez behalf of Amanda Aguirre by phone Brittany Carter behalf of Kathleen Collins Pagels Leonard Kirschner by phone Kathy Byrne by phone Peggy Stemmler Kim VanPelt David Mitchell

Members Absent: Vernice Sampson Staff and public in attendance: Theresa Gonzales, Exe Const. III, AHCCCS Elizabeth Carpio, Strategic Planning, AHCCCS Camille Kerr, Health Policy Mgr., Allergam Joe Fu, Director Health Policy, CAA Barb Fanning, Director, AzHHA Marcus Wilson, Policy & Planning, DES

Laura Hartgroves, Director of Network/System Develop Eddie Sissons, MHA Arizona Carrie Senseman, Policy Chief, DES Anna Gulotta, Legal Fellow, CLS Lisa Gomez, Pres./CEO, PCN Health

AGENDA

I. Welcome & Introductions Tom Betlach II. Introductions of Members All

III. Approval of January 8, 2014 Meeting Summary/Minutes Unanimous

AGENCY UPDATES

IV. AHCCCS Updates Tom Betlach

• AHCCCS Population • HEAplus Update • Medicaid Restoration • KidsCare Update • Prop 204 Childless Adult Restoration • AHCCCS Adult Expansion • Hospital Assessment & Litigation • Reports to Legislature • AHCCCS Budget Update • AHCCCS Capitation Trends • AHCCCS Strategic Goals

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AHCCCS Updates (continued)

• Growth in National Health Exp. • Payment Modernization Progression • States with Medicaid MLTSS • AHCCCS Dual Eligible Members Medicare Enrollment • Dual Delivery System • CAHPS Results • Maricopa Integration for Members with Serious Mental Illness • RBHA Update • DHS Greater AZ Guidance • American Indian Health Plan Care Coordination- Comment from SMAC member:

Commend AHCCCS for its work on this important issue and being a national leader in improving access to care for those in need.

• NEMT Changes • FQHC Payments • Hospital Presumptive Eligibility • HIT Update

V. Legislative and Benefits Update Jennifer Carusetta

• Bills o HB2367 – Annual Waiver Submittals o HB2007 – Technical Correction; DES o HB2101 – Vaccines; Study Committee o HB2531 – Court ordered Evaluation Services; Payment o SB1124 – Controlled Substances Prescription Monitoring Program

VI. CMS Update and Tuba City Waiver Request Theresa Gonzales

• AZ Medicaid State Plan Amendments • Tuba City Regional Health Care Corporation Request • 1115 Waiver Status

o Update on I.H.S./638 Extension: AHCCCS will request an extension of the I.H.S. 638 Uncompensated Care Payments.

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VII. Overview on Care Coordination – Elizabeth Carpio American Indian Medical Home

• Background and History • The four strategic area of focus

o Staff o Relationships o Data o The Model

• Accomplishments

o Established an Internal AHCCCS Tribal Care Coordination Workgroup

o Increased AHCCCS Tribal Care Coordination Staff o Identified Target Populations o Quarterly Data Sharing-Statewide Outreach o Coordination with the Behavior Health System o Tribal Care Coordination Work Session

• Next Steps o Expand outreach for data sharing to additional HIS/638

facilities. o Begin outreach to non-HIS/638 facilities regarding the AIHP

population o Establish statewide partnerships with the RBHAs/TRBHAs o Refine Data that is shared o Establish Care Coordination Staffing meetings with HIS/638,

non-HIS/638 facilities and RBHAs/TRBHAs • Achieving Goals Together

o Improving health of individuals o Improving health outcomes in Native Communities o Lowering per capita health care costs

DISCUSSION VIII. Call to the Public Tom Betlach

IX. Adjourn at 3:00 p.m. All

AHCCCS Update

Medicaid Restoration

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

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12/1/2013 6/1/2014 Change

Prop 204 Restoration 67,770 235,478 167,708

Adult Expansion 0 24,560 24,560

KidsCare 46,761 2,012 ‐44,749

Family Planning 5,105 0 ‐5,105

AHCCCS for Families & Children (1931) 672,135 723,369 51,234

All Other 505,379 566,767 61,388

Total Enrollment 1,297,150 1,552,186 255,036

HEAplus Update• HEAplus went live to public on 10-19-13• Started pilot for roll out to eligibility workers• Processing Account Transfers• Marketplace Enrollment – AZ – 120,071 (4-19-14)• HHS OIG Review starting already• Performance Evaluation ongoing


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Prop 204 Adult Restoration

4Reaching across Arizona to provide comprehensive quality health care for those in need

‐

50,000

100,000

150,000

200,000

250,000

Actual Forecast

Total Prop 204 Population


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‐

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

Actual Forecast

AHCCCS Adult Expansion


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‐

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Actual Forecast

AHCCCS Traditional Families


‐

100,000

200,000

300,000

400,000

500,000

600,000

Actual Forecast

Total AHCCCS Acute


0

200000

400000

600000

800000

1000000

1200000

1400000

1600000

1800000

Actual Forecast

AIHP – Adults Restored Coverage


‐

5,000

10,000

15,000

20,000

25,000

Actual 07/13 Forecast

AIHP Enrollment


‐

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Actual 07/13 Forecast

Hospital Assessment & LitigationAssessment• AHCCCS worked with consultant and hospital stakeholders• Assessed $75 m in FY 2014 • Model shows no systems negatively impacted• Finalized new rate for 7-1-14 – $233 million

Litigation• Lawsuit brought by 36 Republican Legislators• Hearing held on Dec. 13th to determine standing• Won at Superior Court – Standing• Lost Standing at Court of Appeals • Supreme Court Review to hear case August 26th


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Legislative Session• AHCCCS Budget had savings ($60 m)• Assumes 3% cap rate growth• No new funding for employee

compensation• NF – BH – DD provider rate increases• Insulin Pumps only benefit added


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DHS Procurements


North includes San Carlos Apache Tribe in Graham county with zip codes 85530 and 85550

DHS Greater AZ Guidance1. Serious Mental Illness (SMI) Eligibility Determination will not be a

Regional Behavioral Health Authority (RBHA) function. 2. GMH/SA Duals will have behavioral health services integrated into

AHCCCS acute plans.3. The Greater Arizona RFP will include integration of behavioral and

physical health for the SMI population similar to the Geographical Service Area (GSA) 6 Contract.

4. The preferred GSA model will be a north/south split. The north/south split is contingent upon a waiver being granted by the Centers for Medicare and Medicaid Services (CMS) concerning choice of plans for acute care. If a waiver is not granted the GSA model will provide for member choice within the defined GSA(s).


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DHS Greater AZ Guidance Cont.5. It is the intent of the ADHS to make every attempt to align GSA’s so

that tribal nations will be kept whole in the assignment to a RB6. Delivery of Crisis Services within Greater Arizona is dependent upon

the CMS waiver determination. If a waiver is granted the crisis system will be the responsibility of each individual RBHA awarded a contract. If a waiver is not granted the RBHAs that are awarded contracts may be required to jointly create and manage a crisis system through a joint governance agreement as delineated within the RFP.

7. A RBHA will not be allowed to be awarded or hold a contract in more than one (1) GSA. For the purposes of this section a RBHA includes any entity holding a substantial financial, operational or organizational attachment to another entity operating as a RBHA within Arizon

8. Decisions around Dual Eligible-Special Needs Plan D-SNP. See Attachment


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SIM Overview• CMS established State Innovation Model (SIM)

Initiative for multi-payer efforts around payment reform and health system transformation.

• Goal is to achieve statewide transformation for the proponderance of care delivered within the state and:o Improve healtho Transform delivery systemo Lower costs


SIM Overview – Delivery System Reform• CMS has identified goals for delivery system transformation – states

must work toward engaging providers in:


Delivery System Transformation

Providers participate in integrated or virtually integrated delivery models Providers use HIT to improve quality

>80% of provider payments from all payers are value based, non‐FFS structures Adequate healthcare workforce

Every state resident has accountable (quality and cost) PCP

Providers perform at top of license and board certification

Care coordinated across providers and settings

Consistently high performance in quality and cost measures

High level of patient engagement (with quantifiable results)

Population health measures integrated into delivery system

Data used to drive health system processes

SIM Round 2 • Round 2 applications due July 21, 2014 –

Model Test award period of 48 months• Model Design: Up to $30 million for up to

15 states ($1-$3 million per state)• Model Test: Up to $700 million for up to 12

states ($20-$100 million per state based on state population and scope of proposal)


Proposed Arizona Strategy• Arizona well-positioned to focused on driving

innovation by expanding successful public private partnership

• Proposal would build on numerous existing initiatives to:o Reduce fragmentationo Integrate the delivery systemo Align incentives to reduce costs and improve quality

• Align with (without duplicating) other efforts such as Medicare initiatives, where possible


Proposed Arizona Strategy (ctd.)Focus Areas

Integration and Coordination for AHCCCS members and Dual

EligiblesJustice System Transitions

Superutilizers Workforce Strategies

QHP Coordination Alignment with Public Health Efforts

American Indian Care Coordination Evaluation


Proposed Arizona Strategy (ctd.)Examples of Potential Funding Targets

HIT for BH Providers Build upon SHIP strategies

Grants to major providers who partner with BH providers on integration and data

sharing

Evaluation of effective provider practices and clinical training for integrated delivery

system.

Funding for plans that partner with RBHAs on VBP

Care Coordination Efforts between QHPs,AHCCCS plans, RBHAs, other?

American Indian Care Coordination Infrastructure – sharing between key I.H.S.

638 and non‐tribal providersEvaluation


Sovaldi• Have had 18,000 Hep C members past 2

years• 25% Duals• Need national dialogue on pricing and

medical management policies• NGA/NAMD hosting session in June• Have 127 members authorized• Policy update


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Sovaldi Con’t.Low High

Treatment Cost –post Rebate

$52,500 $112,500

20% of Known HepC Population

117,119,520 250,970,400

Entire Known HepC population

585,597,600 1,254,852,000


Average spending on health per capita ($US PPP)


Top expenditures on health as percent of GDP


America has the least efficient health care system


Percent of patients who reported spending “a lot of time on paperwork or disputes related to medical bills

America ranks worst on cost-related problems


Percent of residents who “did not fill a prescription; skipped recommended medical test, treatment or follow-up, or had a medical problem but did not visit a doctor or clinic in the past year because of cost.”

America ranks third on effective care


Percent of doctors or clinical staff talking with patients about exercise or physical activity

Infant mortality rates


Deaths per 1,000 live births

America’s health care system is the least equalPercent of patients who “did not get recommended test, treatment, or follow-up because of cost in the past year.”



Projected Medicare, Medicaid and private insurance growth per enrollee (2012-2022)

Transition and Coordination with the Justice System

Transition and Coordination with the Justice SystemMichal RudnickProject Manager

Background• Over 18,000 people released from

Department of Corrections annually• Combined, over 100,000 released from

County Jails annually• Over half of the people released into the

community require treatment for mental health/substance abuse


Background cont’d• Medicaid unavailable to people when

incarcerated• Medicaid restoration and expansion allow

for higher enrollment upon release


Eligibility and Enrollment• Enrollment suspense/reinstate process

established for 6 Counties, including Maricopa

• Department of Corrections - for those with less than 12 months


Pre-release Application Process• Department of Corrections • Maricopa County Jail• Yavapai County Jail• High risk, high need; for example:

o Substance abuseo SMIo Terminal Illnesso Long-term care


Pre-release Application Process, cont’d• Prior to release, correctional staff submit

applications to AHCCCS and DES• AHCCCS and DES staff process within 48

hours of release• Medicaid also available to qualified

detainees who are released temporarily to an inpatient hospital setting


Care Coordination• Correctional staff provide clinical

information needed to coordinate care• Member contact information and timing

critical• Upon approval of pre-release applications,

AHCCCS team contacts health plan


Future Efforts• HEAplus enhancements to eliminate manual

application• Increase number of Counties using the

enrollment suspense/reinstate process• Increase use of Community Partners/Navigators

to assist with applications and coordination• Expand upon and learn from existing models

(e.g. Pima County)• Explore options for improving data sharing


Questions?


Thank You.


CMS Update

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CMS Update State Plan Activity

The State Plan is a comprehensive written contract 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: 2014: 8 SPAs submitted; 4 approved; 4 pending 2013: 19 SPAs submitted; 18 approved; 1 pending; 2012: 15 SPAs submitted; 11 approved; 2 pending; 2 withdrawn 2011: 25 SPAs submitted; 24 approved; 0 pending; 1 withdrawn 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:

- Phoenix Children’s Hospital SNCP Extension and Uncompensated Care Payments to I.H.S. and 638s Extension AHCCCS will submit a request to amend the waiver to extend the Phoenix Children’s Hospital SNCP and Uncompensated Care Payments initiatives for an additional year through December 31, 2015. For more background information on these requests, can be found on the AHCCCS website.

- Tuba City Regional Health Care Corporation One of the largest 638 facilities, Tuba City Regional Health Care Corporation located on Navajo Nation, has recently had to absorb the cost of care for the population incarcerated within the Navajo Detention Facility at Tuba City, even though these patients are federal trustees for whom the facility would otherwise be receiving reimbursement from Medicaid. Lack of availability of Medicaid funding for the care provided to these inmates is proving unsustainable for the Tuba City Regional Health Care Corporation, one of the most critical providers of care to the American Indian Medicaid enrolled population in Arizona. AHCCCS is proposing to preserve access to care for a critical Medicaid population that is largely American Indian living in rural and frontier areas; and collect data to establish a line item within the Indian Health Services budget as more of these

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facilities are built on reservation. AHCCCS is accepting public comments on this DRAFT proposal through June 27, 2014. See the Public Comment section below for instructions on how to send comments on this proposal. Tuba City Regional Health Care Corp. DRAFT 5/29/14 [PDF]

- Cost Sharing At the direction of the Arizona State Legislature and upon CMS approval, AHCCCS is proposing to impose mandatory cost sharing on the Expansion Population of:

o A premium of not more than two percent of the person's household income.

o A copayment of two hundred dollars for nonemergency use of an emergency room if the person is not admitted to the hospital.

o A copayment of two hundred dollars for nonemergency use of an emergency room if there is a community health center, rural health center or urgent care center within twenty miles of the hospital.

Cost Sharing Proposal DRAFT 2/11/14

- Behavioral Health Integration AHCCCS is proposing to expand integrated health care service delivery by allowing the Greater Arizona RBHAs to provide physical and behavioral health care services to individuals with Serious Mental Illness in order to maximize care coordination statewide. AHCCCS is accepting public comments through March 24, 2014 on the proposal at the link below. See the Public Comment section below for instructions on how to send comments on this proposal. Greater AZ RBHA DRAFT 2/20/14

- Medical Homes at I.H.S. and 638 facilities AHCCCS is requesting authority to support a Medical Home Program for the FFS population receiving services at Indian Health Services and 638 facilities. More information is included in the proposal below. Medical Home Proposal to CMS 8-11-11

- Tuba City Regional Health Care Corporation Request

A request to submit a waiver amendment to CMS to allow AHCCCS to provide primary outpatient health care services to American Indians below 100% FPL who are transferred from the Navajo Detention Facility to TCRHCC.

More information about waivers can be found at: http://www.azahcccs.gov/reporting/federal/waiver.aspx

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2014 Amendments SPA 14-008 – Presumptive Eligibility Describes Presumptive Eligibility by Hospitals in Arizona. Submitted 3/28/14 Presumptive Eligibility in Arizona SPA 14-007 – Barbiturates, Benzodiazepines and Tobacco Cessation Updates the State Plan to remove barbiturates, benzodiazepines and agents used to promote tobacco cessation otherwise covered by Medicare Part D. Approved 4/15/14 Submitted 3/17/14 SPA 14-006 – Alternative Benefit Plan (ABP) Aligns the ABP benefits for individuals enrolled in the new Adult Group with the current State Plan. In Arizona, the new Adult Group includes childless adults 0-100% FPL and adults without Medicare that are 100-133% FPL. Approved 4/1/14 Submitted 3/17/14 DRAFT 2/21/14 SPA 14-005 – Medicaid Administration Addresses single state agencies delegation of appeals and determinations. Approved 6/6/14 Submitted 3/11/14 SPA 14-004 – Therapies Revises the State Plan to reflect updates to therapies covered under the State Plan. Submitted 2/20/14 SPA 14-003 – Medically Preferred Treatment Options Revises the State Plan to reflect updates to the orthotic benefit. Submitted 1/31/14 SPA 14-002 – Coverage for over-the-counter or non-prescription medication Updates the State Plan to comprehensively describe coverage for over-the-counter or non-prescription medication. Approved 2/24/14 Submitted 1/29/14 SPA 14-001 – ADHS Licensure Changes Revises the State Plan to reflect updates to the licensing of health programs. Submitted 1/10/14

State Medicaid Advisory Committee (SMAC) Info...Jul 09, 2014 · 2014 SMAC Meetings Per SMAC...

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Transcript of State Medicaid Advisory Committee (SMAC) Info...Jul 09, 2014 · 2014 SMAC Meetings Per SMAC...