arizona perm pilot round 1
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Arizona PERM Pilot Round 1. Kim Sanchez Quality Compliance Administrator Phone: (602) 417-4563 Email: [email protected]. AZ Organization Background. AHCCCS Arizona Medicaid Determines Eligibility for SSI MAO and Long Term Care. Department Of Economic Security (DES) - PowerPoint PPT PresentationTRANSCRIPT
Arizona PERM PilotRound 1
Kim SanchezQuality Compliance AdministratorPhone: (602) 417-4563Email: [email protected]
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AZ Organization Background
Reaching across Arizona to provide comprehensive quality health care for those in need
AHCCCSArizona Medicaid
Determines Eligibility for SSI MAO and Long Term Care
Department Of Economic Security (DES)
Determines eligibility for SNAP, TANF and Medicaid for
non-disabled adults and children
MMIS
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Systems
Reaching across Arizona to provide comprehensive quality health care for those in need
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PERM Pilot Round 1
• Sample 200 Medicaid, 0 CHIP
• Pull at the individual level
• Pull weekly samples (calendar week)
• Review at the household level
• Reviews pulled from December and February
Reaching across Arizona to provide comprehensive quality health care for those in need
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Resources• Social Interest Solutions – Developed
HEAplus and our sampling programming
• AHCCCS Medicaid QC staff – completed the reviews
Reaching across Arizona to provide comprehensive quality health care for those in need
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Challenges and Resolutions• Universes inconsistent
• Eligibility “work arounds” developed after pilot proposal was submitted
• Revisions to pilot proposal
Reaching across Arizona to provide comprehensive quality health care for those in need
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Universes inconsistent• Universe totals did not align
o Majority of samples pulled in Aprilo Quality control check the sampleso Clerical pulled system screens for
reviewerso Assigned to staff in Mayo Had May and June to complete the
reviews
• Result: Limited time to complete reviews
Reaching across Arizona to provide comprehensive quality health care for those in need
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Eligibility “work arounds” developed after pilot proposal was submitted• Eligibility workers not all in the new system
o Eligibility determined in the old system o Some determinations in our universes were a
preliminary denial decision
• Result: Had to re-evaluate our review process, re-write our internal policy and re-train staff
Reaching across Arizona to provide comprehensive quality health care for those in need
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Revisions to Pilot Proposal
• Proposal –stratification by submission method, including transfers from the FFM. o Revision 1 – no FFM referrals
• Proposal – We proposed to complete 160 positive reviews and 40 negative reviews. o Revision 2 – 167 positive reviews, 33 negative
reviews
Reaching across Arizona to provide comprehensive quality health care for those in need
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Pilot Results• Medicaid Active –
6 Income not budgeted
5 No valid signed application
4 budget unit established incorrectly
2 in receipt of Medicare
2 applied old budgeting rules
1 Relationship incorrectly coded
1 Income used was not reasonably compatible
Reaching across Arizona to provide comprehensive quality health care for those in need
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Pilot Results
• Medicaid Negative – 2 Notice not sent3 Eligible for MAGI
Client double entered self-employment Incorrectly denied Denied when eligible for Emergency Services
Reaching across Arizona to provide comprehensive quality health care for those in need
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Preparation for 2nd Round Pilot• Stabilization of universes
• Complete reviews of a State samples of cases transferred from the FFM
• Revise our written procedures with more detail for reviewers to take into consideration eligibility “work arounds” established
• Conduct additional staff trainingReaching across Arizona to provide comprehensive
quality health care for those in need
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Questions?
Reaching across Arizona to provide comprehensive quality health care for those in need
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Thank You.
Reaching across Arizona to provide comprehensive quality health care for those in need