State Medicaid Advisory Committee (SMAC) Info...Oct 10, 2012 · 2012 SMAC Meetings Per SMAC...

State Medicaid Advisory Committee (SMAC)

Wednesday, October 10, 2012 AHCCCS

Gold Room - 3rd Floor 701 E. Jefferson Street

1 p.m. – 3p.m. Agenda

I. Welcome Director Thomas Betlach

II. Introductions of members and audience

ALL

III. Approval of July 11, 2012 meeting summary ALL

Agency Updates IV. 30th Anniversary

Director Thomas Betlach

V. AHCCCS Update


VI. CMS Update-State Plan Amendments; Waivers

Theresa Gonzales Office of Intergovernmental Relations

VII. Childless Adult DRAFT Waiver

Monica Coury Office of Intergovernmental Relations

VIII. Public Meetings Summary

Theresa Gonzales Office of Intergovernmental Relations

IX. Quality Strategy

Jakenna Lebsock DHCM/Clinical Quality Management

X. Arizona Mission of Mercy

Kevin Earle, Executive Director Arizona Dental Association

Discussion XI. Call to the Public


XII. Adjourn at 3:00 p.m.

ALL

2012 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 11, 2012 April 11, 2012 July 11, 2012

October 10, 2012 For more information or assistance, please contact Theresa Gonzales at (602) 417-4732 or [email protected]

July 2012 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

Page 1 of 2

Our first care is your health care ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

State Medicaid Advisory Committee (SMAC) Meeting Summary

Wednesday, July 11, 2012, AHCCCS, 701 E. Jefferson, Gold Room 1:00 p.m. – 3:00 p.m.

Members in attendance: Tom Betlach Peggy Stemmler Kim VanPelt Phil Pangrazio Leonard Kirschner

Kathy Waite Tara McCollum Plese Stephen M. Jennings for David Mitchell Amanda Aguirre Kathleen Pagels Kathy Byrne Kevin Earle

Members Absent: Pamela Thompson, Dr. Sundin Applegate Staff and public in attendance: Theresa Gonzales, Exe Const. III, AHCCCS Eric Rouse, Acct. Mngr., Eli Lilly Sabrina Aery, OPS, Bristol-Myers Ann Kuhns, State Gov’t Affairs, BMS Scott Larson, State Gov’t OPC, BMS Jill Kennedy, Contract Admin., NARBHA Eddie Aines, ED, AFBH

Lori Howarth, Corporate Alliance Director, Bayer Marcus Wilson, Policy & Planning, DES Matt Jewett, Director of Health Policy, CAA Michelle PaBis, Director, SHC Elena Rodriquez, Clinic Manager, SLWIC Nancy Arroyo, Switchboard, SLWIC Shawn McDonough, Senior Acct Manager, Covidien

AGENDA

I. Welcome & Introductions Director Thomas Betlach

II. Approval of April 11, 2012 Meeting Summary/Minutes Unanimous AGENCY UPDATES

III. AHCCCS Updates Thomas Betlach

• Supreme Court Ruling o Individual Mandate – Stands o Medicaid – Justice Roberts o SCOTUS – CMS Post Decision Questions & Factors o SCOTUS – Arizona Approach

AZ Republic Article o Health Care Reform Timeframes

• Enrollment Update

o AHCCCS Population o Waiver Population o Dual Members Demonstration o AZ Dual Eligible Demonstration Proposal o Waiver

of 2

• Other Issues

o Updating and Improving Quality Measures o HIT o New IP Payment Methodology – APR-DRGs o Audits and Reviews o Care Management – DFSM efforts o SCAN Transition Maricopa County 2,700 members o Nursing Facility Assessment Fee Legislation

IV. CMS Update – State Plan Amendments; Waivers Theresa Gonzales

• AZ Medicaid State Plan Amendments • 1115 Waiver Status

V. Community Health Centers and ACA Tara McCollum Plese

• Primary and Preventative Healthcare • Access to Healthcare • Quality Healthcare • Affordable Healthcare

VI. Nursing Facility Assessment Kathleen Collins Pagels

VII. Overview – Quality Measure Sets Kim Elliott

• Handout

DISCUSSION VIII. Call to the Public Director Thomas Betlach

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

AHCCCS Update

“Reaching across Arizona to provide comprehensive quality

health care for those in need”

AHCCCS Update

October 10, 2012

30 Years of Medicaid Innovation

Our first care is your health care

Arizona Health Care Cost Containment System


health care for those in need”2

Topics to Cover

� Economy

� Budget Picture

� AHCCCS Decisions

� Insurance Exchange Decisions

� Other Issues









3






4



-6 5 %

-6 0 %

-5 5 %

-5 0 %

-4 5 %

-4 0 %

-3 5 %

-3 0 %

-2 5 %

-2 0 %

-1 5 %

-1 0 %

-5 %

0 %

5 %

0 1 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 0 1 0 0 1 1 0 1 2 0 1 3 0 1 4 0 1 5 0 1 6 0

Percent Change from Peak Employment

Nu m b er o f M o n th s A fter Peak Em p lo y m en t

A Z Dep ressio n vs. Recessio n

N u m b er o f M o n th s n eed ed to su rp ass a p eak in em p lo ym en t

A Z 1 9 2 9 A Z 2 0 0 7




5



Federal Spending - Sequester

� 7.8% percentage decrease applied to all covered non-

defense discretionary and mandatory programs (FY

13 AZ Impact $132 million)

� 10% sequester percentage decrease applied across

the board for defense programs (AZ Impact $1.3

billion)

� Arizona is projected to lose 35,248 jobs to DOD cuts

and 13,941 to Non-DOD cuts, according to a

Aerospace Industries Association report




6



Impact of Expiration of Tax Cuts

� Expiration of Title I of the Tax Relief Act,

Unemployment Insurance Reauthorization,

2010 Job Creation Act, and Title III (gift and

estate tax) will lead to an increased tax burden

of $3.2 trillion between 2013-2022.




7



State Budget Outlook




8



FY 2014 Fiscal Challenges

� Prop 100 Revenue

� AHCCCS Decisions

� DES Funding –

� K12 growth and capital

� Universities

� State infrastructure – employee compensation

� Multi-year planning






AHCCCS FY 2014 Request

� Total General Fund Increase - $81 million

� Assumptions

� Prop 204 Freeze through 12-31-13

� Enrollment Resumes 1-1-14 at enhanced FMAP

� Traditional Acute Growth – 18%

� KidsCare II – 50% to Medicaid

� 3% cap rate current year and FY 2014

� Require Legislation – Outlier – IP – Transplant

� No impact from sales tax initiative – update later1030 Years of Medicaid Innovation





FY 2014 ACA Summary

Fiscal Year 2014

Issue (Eff Date) Total Fund Federal Fund State Match

Child Expansion (1/1/14) 28,634,800 20,263,100 8,371,700

Categorical Woodwork (7/1/13) 129,164,400 84,835,200 44,329,200

Streamlined Redeterminations (1/1/14) 67,338,300 44,227,900 23,110,400

Federal Emergency Services for Childless

Adults (1/1/14) 12,307,800 10,195,900 2,111,900

Primary Care Physician Rates (1/1/13) 159,964,000 118,935,200 41,028,800

Health Insurer Fee (1/1/14) 35,018,600 23,767,900 11,250,700

Grand Total 432,427,900 302,225,200 130,202,700






ACA - AHCCCS




12



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.”1430 Years of Medicaid Innovation





What does this mean for Arizona?

It is complicated

�Proposition 204 voter mandate

�Current freeze due to limited resources

�Federal waivers that expire on January 1, 2014

that provided temporary assistance for

uncompensated care

�Executive seeking input on important decisions





health care for those in need”1630 Years of Medicaid Innovation





Process and Timeline for Deliberations

� Ongoing: Submit clarifying questions to Federal

Government and await further guidance

� August 2012: Update fiscal estimates on State options.

� July – November 2012: Engage stakeholders and

conduct public hearings.

� September – Post 1115 waiver seeking enhanced

funding for Prop 204 population

� October – submit waiver to CMS

� November – December 2012: Incorporate final decisions

into normal policy-making process.1730 Years of Medicaid Innovation





1115 Waiver Proposal

� Does not reflect any “decision” on AHCCCS

coverage issues

� Agency has authority to seek waiver because

of Prop 204 (2000) – Seeks Medicaid

coverage beyond 1-1-14

� Waiver seeks enhanced funding levels and

flexibility to manage within available

resources






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?






State Match Costs (FY 14-17)Comparison In Millions






Total AHCCCS Population






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.2230 Years of Medicaid Innovation





Population Fiscal Summary (FY 16)Population 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






Stakeholder Sessions

Tribal Consultation – ongoing

�Tribal Forum – Gila River 10-12 or 10-17

Community Forums

�Flagstaff – Phoenix – Yuma – Tucson – Sierra

Vista – Gila River

Stakeholder discussions

�Providers – plans – advocates – business

groups - universities2430 Years of Medicaid Innovation





AHCCCS Summary

� Are there available resources to restore

Proposition 204?

� Will the state pursue Medicaid coverage

above 100?






ACA - Exchange




26



Health Insurance Exchange:

Principles for an Arizona Exchange

� Build on Arizona’s Strong Health Insurance

Market.

� Support Market Facilitator Approach.

� Maximize Choice and Competition.

� Impose Minimal Regulations and Reporting

Requirements.






Health Insurance Exchange: Funding

� Federal grants fund all planning, design and

start-up costs through December 31, 2014.

� Arizona received a one-year planning grant

for $1 million on September 30, 2010.

� Arizona received a one-year grant for $29.8

million on November 28, 2011.






Health Insurance Exchange:

State vs. Federal






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 Decisions

� State or Federal Exchange?

� If State Exchange – where does it live?






AHCCCS Issues

� Primary Care Increase – 1-1-13 – up to

Medicare – information on AHCCCS website

� HIT Payments

� 1,265 Eligible providers - $26.7 m

� 56 hospitals $68 m

� Triple Crown Procurement –

� Maricopa RBHA – On Street

� Acute – CRS – November3230 Years of Medicaid Innovation





Arizona Duals Demonstration

� AHCCCS would like to pursue a Demonstration for: � ALTCS EPD –1-1-14 – Existing Contractors – Statewide

� Maricopa Members with SMI – 1-1-14

� Required as part of RFP - Demo or SNP

� Acute Care Members – 1-1-14 – Statewide

� Handle as part of RFP

� GOAL: 1-1-14 - 100,000 dual eligible individuals will be in an integrated plan

� Members will retain choice to opt out to Traditional Medicare

� 1-1-14 and Beyond would not “contract” with SNPs not involved in Demo

� If Demo not viable pursuing alternative path leveraging SNP30 Years of Medicaid Innovation





� July 2011 – CMS released State Medicaid Director Letter with opportunities for Dual Demonstration

� July 2011 – AHCCCS submitted Letter of Intent to explore dual opportunities for the Maricopa SMI population

� February – April 2012 – Extensive Stakeholder Engagement

� April 2012 – Draft proposal made available on web for 30 day public comment period

� May 2012 – Proposal submitted to CMS

� June 2012 – Proposal available for 30 day comment period on CMS website

AHCCCS Demonstration To Date






Next Steps� Continue discussions with CMS around key issues

� Winter 2012 - Begin negotiations for contract between State and CMS (MOU)

� Spring 2013 – Decision to pursue Demo or continue leveraging SNP model

� Spring 2013 – If Demo 3-way contracts signed between State, CMS, and health plans

� Summer 2013 – Readiness reviews conducted

� Fall 2013 – Member/provider education and outreach

� January 1, 2014 - Implementation30 Years of Medicaid Innovation





AHCCCS Results

Avalere Study of Mercy Care Plan Duals

�31% lower rate hospitalization

�21% lower readmissions

�43% lower rate of days spent in hospital

�9% lower ED use

Awaiting Mathematica study of Arizona Data






Outstanding Issues Arizona Demo

� Capitation Rates

� Frequency of Medicaid enrollment (monthly

verse annually)

� Supplemental Benefits – big deal for members

� Capitation Rate Setting

� Administrative Efficiencies






AHCCCS Sunset� Sunset Audit Process

� 3 Audits

� TPL/COB – “AHCCCS processes help meet federal and state

requirements…” - minimal findings

� Eligibility – “findings of a 1.1% error rate are commendable

…particularly when compared to the …national eligibility error

rate of 6.7%” (AHCCCS response)

� Medicaid Fraud – “AHCCCS has processes in place to detect

Medicaid fraud and abuse but should continue to enhance its

training and data analysis”

� Sunset Factors – “Auditors’ analysis of the sunset factors found

strong performance by AHCCCS with regard to many of these

factors”

� Next Step - Legislation 3830 Years of Medicaid Innovation





AHCCCS Safety Net Waiver Update

� KidsCare II – 23,000 approved

� SNCP Hospital Payments - $150 m paid

� $13 m more in ED funding

� I.H.S/638 Payments

� Option 1- 22 facilities - $15.2 m paid

� Option 2 – 25 facilities - $7.7 m paid

� City of Phoenix Provider Tax????






DFSM 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






Other Issues

� Personnel Reform – 280 uncovered to 760 out

of 950 staff

� NF Provider Tax

� Ambulance Rates – 10-1-13 – DHS link

� NAMD Managed LTC Training

� IT Upgrades

� 5010 -Data warehouse - desktop infrastructure

� ICD 10 – 10-1-14 starts now4130 Years of Medicaid Innovation








42

CMS Update-State Plan Amendments; Waivers

As of 10/9/12

1

CMS Update State Plan Activity

The State Plan is a comprehensive written contract (628 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: 2012: 15 SPAs submitted; 2 approved; 12 pending; 1 withdrawn 2011: 23 SPAs submitted; 19 approved; 4 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 AHCCCS is operating under the 1115 Waiver that was approved by CMS on 10/21/11. On September 18, 2012, AHCCCS posted information about a DRAFT waiver amendment to CMS to maintain its current authority to offer coverage to childless adults at an enhanced federal medical assistance percentage (FMAP), within available resources. Without CMS approval, AHCCCS will no longer have the federal authority to cover childless adults in its program beginning January 1, 2014. If the waiver is not approved, and no other action is taken, AHCCCS will have to eliminate coverage for all remaining childless adults enrolled in AHCCCS beginning January 1, 2014. More information about this request, including how to submit public comments (due by October 19, 2012) can be found on the link below. http://www.azahcccs.gov/reporting/federal/childlessAdults.aspx More information about other waivers can be found at: http://www.azahcccs.gov/reporting/federal/waiver.aspx

As of 10/9/12

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 [72KB]

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. Submitted 10/4/12 [95KB]

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 [125KB]

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 [42KB]

SPA 12-007 Outliers Updates the State Plan regarding Outliers for the time period beginning October 1, 2012. 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. 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. Submitted 7/13/12 [58KB]

SPA 12-006B Outpatient Hospital Reimbursement Rates Continues current outpatient hospital reimbursement rates for the period October 1, 2012 to September 30, 2013. 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. Submitted 7/9/12

As of 10/9/12

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 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.


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]

As of 10/9/12

2011 State Plan Amendments SPA 11-018 Fee Schedule Update Updates the State Plan pages regarding the effective dates for fee for service rates.

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.


SPA 11-016 Healthcare Acquired Conditions Updates the State Plan to include standards of payment for healthcare acquired conditions.


SPA 11-015 340 B Drug Pricing Updates the State Plan to include standards of pricing and payment for 340B drugs.


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]

As of 10/9/12

SPA 11-012 Inpatient Hospital Limit Limits the number of inpatient hospital days for adult members.


SPA 11-011 Outlier Updates the methodology for qualifying and paying claims for inpatient hospital services with extraordinary operating costs per day.


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.


SPA 11-009C Rate Reductions Updates reimbursement rates for various services to reflect a 5% reduction from October 1, 2011 to September 30, 2012.


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.


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.


SPA 11-008 Behavioral Health Practitioners Clarifies the list of state-licensed behavioral health practitioners. Approved 9/9/11 [679KB] Submitted 6/20/11

As of 10/9/12

SPA 11-007 School Based Claims Updating the reimbursement methodology for School Based Claiming.


SPA 11-006 Home Health Services Clarifyies the services of home health, private duty nursing and therapies in the State Plan.


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.


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.


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.


SPA 11-002 Hospice Describes hospice services provided under EPSDT.


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.


SPA 11-001B GME Updates Updates GME funding for hospital payments made after 6/30/11. Approved 1/23/12 Submitted 5/31/11

As of 10/9/12

SPA 11-001C GME Updates Updates GME funding for the service period July 1, 2010 through June 30, 2011 for programs with pending IGAs.


SPA 11-001D GME Updates Updates GME funding for the service period July 1, 2010 through June 30, 2011 for programs with pending IGAs.


Original GME SPA 11-001 Submission Updates GME funding for the service period July 1, 2010 through June 30, 2011.

Submitted 2/15/11

Childless Adults DRAFT Waiver Amendment

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

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

Childless Adults DRAFT Waiver Amendment

October 1, 2012


Our first care is your health careArizona Health Care Cost Containment System 2

Topics to Cover

OverviewFMAPProcess and Timeline


OverviewAHCCCS currently covers adults without deprived children (“Childless Adults”) through its 1115 Waiver because Childless Adults are not otherwise eligible for Medicaid.Arizona is one of only six states in the country to provide Medicaid coverage to Childless Adults.The authority to cover Childless Adults under the Waiver expires December 31, 2013. The purpose is to continue the State’s existing authority to cover childless adults in AHCCCS beyond 2013.Waiver request attempts to eliminate the possibility of having to drop childless adults from coverage January 1, 2014.



Overview Con’t

As the State evaluates coverage options for the future, Governor Brewer has underscored the need to identify enhanced federal match rate opportunities for the restoration of coverage for Childless Adults. This amendment request does not reflect any decision on the part of Governor Brewer about the future of Arizona’s Medicaid program.



FMAPAs part of the request, AHCCCS will seek clarification on the applicable FMAP. FMAP is the federal share of expenditures for the Medicaid program. At this time, it is unknown which FMAP will apply to Arizona.States that have never covered childless adults can obtain 100% federal funding for this population in 2014.Because Arizona already covers childless adults, Arizona is not eligible for the 100% FMAP for childless adults.Restoring coverage for childless adults at enhanced versus regular FMAP is an additional cost of $1.5 billion to State.



FMAP Con’tSummary of AZ’s Estimated Costs

FMAP % Cost to Arizona Description Status

Enhanced FMAP @ 83‐90%

$928 million FMAP % and cost if CMS approves enhanced FMAP for childless adults.

DRAFT request to CMS open for public comment.

Regular FMAP @ 66%

$2.5 billion FMAP % and cost if CMS does not approve enhanced FMAP.

If CMS does not approve enhanced FMAP, the Legislature will need to determine if there are available funds to cover childless adults.

Full FMAP@ 100%

$57 million FMAP % and cost if Arizona had not previously covered childless adults.

Arizona is not eligible for 100% FMAP to cover childless adults.



Process and Timeline

October 19, 2012: Deadline for public comments on DRAFT Waiver Request.Submit Waiver Request to CMSNegotiate details with CMSObtain CMS approvalGoal: Approval in time for policymakers to act (legislative session begins January 2013)


Public Meetings Summary

Dear Stakeholder:

The recent U.S. Supreme Court decision offers states unique opportunities to reform their Medicaid programs. AHCCCS is hosting community meetings across the state to provide the public with information about some of the potential options regarding the future of Arizona’s Medicaid program. These sessions will also provide the opportunity for AHCCCS to hear from stakeholders, including members and their families, advocates and providers. If you can’t attend one of the meetings listed below, you can still provide input by e-mailing AHCCCS at: [email protected]. More information is available on the website at:

http://www.azahcccs.gov/shared/news.aspx?ID=reporting#ACA_News

AHCCCS Community Forums

Date Location Wednesday, September 5, 2012 1p.m. - 3p.m.

Joe C. Montoya Adult Center 245 N. Thorpe Rd Flagstaff, AZ 86001

Session 1: Monday, September 10, 2012 2p.m. - 4p.m. Session 2: Monday, September 10, 2012 4p.m.- 5:30p.m.

The Disability Empowerment Center 5025 E. Washington St., 200 Phoenix, AZ 85034 The Disability Empowerment Center 5025 E. Washington St., 200 Phoenix, AZ 85034

Friday, September 14, 2012 1p.m.- 3p.m.

Yuma County Public Library 2951 S. 21st Dr. Yuma, AZ 85364

Tuesday September 18, 2012 1p.m. - 3p.m.

United Way Community Resource Campus330 N. Commerce Park Loop Tucson, AZ 85745

Wednesday, October 17, 2012 1p.m. – 3p.m.

Service Center Building 31 N. Church Street Sacaton, AZ 85147

Thursday, October 18, 2012 11a.m.- 12:30 p.m.

Sierra Vista City Library 2600 East Tacoma StreetSierra Vista, AZ 85635

Quality Strategy

AHCCCS Quality Assessment and Performance Improvement Strategy

Strategy Summary: The Quality Strategy, developed in compliance with 42 CFR 438.200 et. seq., has been a working AHCCCS document since 2003. It is a coordinated, comprehensive, and pro-active approach to drive quality throughout the AHCCCS system by utilizing creative initiatives, monitoring, assessment, and outcome-based performance improvement and is designed to ensure that services provided to members meet or exceed established standards for access to care, clinical quality of care, and quality of service. The document aligns with CMS requirements and is frequently referenced in CMS reporting. Reason for Update:

• Strategy was last updated in 2010 • Included new Agency activities/initiatives • Removed outdated information

Update Process:

• Initiated and initially updated by the Clinical Quality Management Unit • Update process managed by Heidi Oliver in Medical Policy

o Although not a formal policy, the document went through the policy revision process

o After initial review, was sent to all APC members and other identified staff for review

• All changes are outlined in a change matrix Summary of Major Changes:

• Changes to program references such as the freeze on services for childless adults • Added summaries of the Direct Care Worker Program and Community First Choice

option as a new program highlight, which replaced the Spouses as Paid Caregiver and Self-Directed Attendant Care summaries

• Removed reference to preventive/well-care visits for adults as they are not currently a covered benefit

• Updated Health Information Exchange (HIE), Health Information Technology (HIT), and Electronic Medical Record (HER) Program references

• Removed reference to the Adolescent Well Care PIP; replaced with a more current summary of the Advance Directive PIP

• Updated program data as necessary – such as the number of members who have utilized the Spouses as Paid Caregivers option

• Described the performance measure transition process and expected outcomes related to the transition

Summary of Minor Changes:

• Transitioned from AHCCCS Administration to AHCCCS • Language revisions for clarification • Acronyms spelled out • Updated reference links • Clarified timeframes, such as quarterly meetings

Arizona Mission of Mercy

Central Arizona Dental Society Foundation Arizona Dental Mission of Mercy

Veteran’s Coliseum, Arizona State Fairgrounds, Dec. 6th-9th, 2012

• The largest charitable dental event ever held in Arizona. An estimated $1.2MM in free dental care delivered to over 2000 patients.

• 1500 volunteers, including over 300 dentists are required.

• Provides for the immediate dental needs of underserved people who would otherwise go without care, or utilize emergency rooms.

• Patients mix includes children, low‐income people, and the homeless. Translation services provided for Native American & Hispanic communities

What is a Dental Mission of Mercy?

The Challenge

• Arizona residents suffer from higher rates ofdental disease and benefit less from provenpreventive methods than other states.

• 21% of Arizona adults and 31% of Arizona children have never had a dental check‐up!

• In Arizona, 44% of adults and 38% of children lack dental insurance.

The Process• Site: Veteran’s Coliseum‐ State

Fairgrounds• Set Up: December 6• Treatment Days: December 7 & 8• Clinic hours: 6 AM to 6 PM• Tear down: December 9• Line Up: Patients line up as early

as 24 hours in advance• Service: First come, first served

The Process (cont.)• Patients are always accompanied by volunteer patient

escorts.• Patients undergo Medical and Dental screening• Patients awaiting treatment receive oral hygiene

instruction and may get free flu and hepatitis vaccines• X‐rays are performed• Volunteer dentist determines what procedures are

required.• Pain and infection take priority over other treatments.• Dental cleanings performed by Hygiene Section• Treatments typically include extractions and fillings.• Some patients missing front teeth may get partial

dentures (aka “flippers”)• Patients are given post operative instructions and may

receive medication (limited to non‐narcotic painmedication and antibiotics).

• Patient education an important element.• Dental disease is preventable!• The bacteria that causes dental decay is

transmissible!• Promote daily oral hygiene practices• Healthy Diets – Learn about effects of

soda and sugary beverages• The negative effects of tobacco use • Routine preventive dental care

Promoting Oral Health Literacy

• The AZ Dental Mission of Mercy requires 1500 volunteers to make this event successful

• Please volunteer today!• All clinical providers who render treatment

services to MOM patients must have all current licenses issued by the appropriate licensing authority (e.g. BODEX).

• Out of state dentists may obtain a Restricted Permit from BODEX

• All other volunteers are screened forexperience in their area of service.

• Sign up at www.azmom.org

Volunteer and Make a Difference!

• Dentists (300 needed)• Dental Hygienists (150 needed)• Dental Assistants (300 needed)• Patient Escorts• Patient Educators• Patient Registration• Dental Lab Technicians• Translators• Parking attendants• Hospitality (feed volunteers)• Set up and Tear down

How many and what type of volunteers are needed?

• Thursday, December 6, 10 am ‐ 5 pm: Clinic Set Up (no patients)

• Friday, December 7 ‐ 6 am ‐ 6 pmDental Clinic (patients)

• Saturday, December 8, 6 am ‐ 6 pm Dental Clinic (patients)

• Saturday, December 8, 6 ‐ 9 pm:Clinic Tear Down (no patients)

• Sunday, December 9 (as needed) 8 am ‐12 pm: Clinic Tear Down and Pack‐up

Schedule

Funded 100% by private donations.Central Arizona Dental Society Foundation is recognized as a charitable organization under Section 501 C‐3 of the Internal

Revenue Code. All contributions are tax deductible.

Financial donations are used to purchase equipment and supplies for this event.

For every $1 received, AZMOM is able to provide $5 to$7 of care.

Please send your donation to:

Central Arizona Dental Society FoundationAttn: Arizona MOM3193 N Drinkwater BlvdScottsdale, AZ 85251‐6491Or donate online at: www.azmom.org

Contribute!

Contact Information:Jacqueline S. Allen, D.D.S., M.S.

Event Coordinator602-242-4745

Arizona Dental Association480-344-5777 ext [email protected]

www.azmom.org

Thank You!

State Medicaid Advisory Committee (SMAC) Info...Oct 10, 2012 · 2012 SMAC Meetings Per SMAC...

Documents

Transcript of State Medicaid Advisory Committee (SMAC) Info...Oct 10, 2012 · 2012 SMAC Meetings Per SMAC...