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

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

CYE 2014 Transition Process Overview

AHCCCS Contractor Update MeetingMay 1, 2013

30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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

Key Components

Readiness assessment Acute care Children’s Rehabilitative Services (CRS) Integrated RBHA – Mercy Maricopa Integrated Care (MMIC;

conducted by ADHS/DBHS)

Transition of member data Other planning issues and efforts

30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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

Readiness Assessment Initial meetings held with Acute Care Contractors and UnitedHealthcare

Community Plan/CRS (UHC/CRS) in April Assessing all new Contractors (Health Net), incumbent Contractors

assuming new geographic service areas and UHC/CRS Monthly reports due to AHCCCS containing documentation

demonstrating Health Plan readiness in 10 areas On site visits will occur, as necessary, in July 2013 Focusing on attestation elements from the RFP and areas critical to

Contractor readiness

****ADHS/DBHS conducting readiness assessment of Mercy Maricopa Integrated Care with support from AHCCCS, as needed****

30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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

Readiness Assessment Programmatic areas under review

Administration and management, delivery system, medical management, quality – management and improvement, quality – EPSDT, maternal and child health, behavioral health, financial reporting, claims processing and provider support, encounter reporting, management information systems, member services

Particular areas of focus Staffing enhancements Network enhancements/build up Policy/procedure development/revision Systems capabilities Care coordination processes

30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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

Transition of Member Data Approximately 170,000 members will be transitioned on 10/01/13 Transition of member data will begin on 07/05/13 and continue through December

2013 File format for the transition of member data from Acute Care Contractors to

“receiving” Acute Care Contractors, CRS and MMIC sent to Contractors for review and comment on 04/26/13 Input is due by 05/03/13; file format will be finalized by 05/31/13

File format for transition of member data from RBHAs/DBHS to UHC/CRS and from UHC/CRS to ALTCS E/PD Contractors will be sent out by 05/15/13 for review and comment and finalized by 06/15/13

AHCCCS will initiate meetings in June 2013 with all relinquishing and receiving Contractors to assist in transition of member information Meetings will be held monthly, at a minimum, through 10/01/13 Separate meetings will be held for the transition of member data to MMIC, CRS,

ALTCS E/PD 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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

Transition of Member Data

30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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Transferring Parties Summary Initiation DateACUTE Transition

Acute Plans → Acute PlansRelinquishing Acute plans transfer physical health

member data to receiving Acute plans09/05/13

Maricopa RBHA Transition

Acute Plans → MMICAll Acute plans (relinquishing and incumbent) in

Maricopa County transfer physical health member data for members with SMI to MMIC

07/05/13

Magellan → MMICMagellan transfers behavioral health member data to

MMIC07/05/13

CRS Transition

Acute Plans → UHC/CRSAll Acute plans (relinquishing and incumbent) statewide

transfer physical health member data to UHC/CRS07/05/13

RBHAs/DBHS → UHC/CRS

All RBHAs (relinquishing and incumbent) statewide transfer behavioral health member data to UHC/CRS (including data for CRS members served by DDD and

CMDP)

07/05/13

UHC/CRS → ALTCS E/PD ContractorsUHC/CRS statewide transfers CRS member data to

ALTCS E/PD Contractors07/05/13

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

Other Planning Issues and Efforts

ALTCS E/PD Contractor readiness to serve CRS members for CRS-related conditions

Outstanding CRS issues/efforts Transition of eligibility determination process Systems challenges related to 4 coverage types Policy revisions Community outreach and engagement

Community forums in Phoenix on 05/07/13 and in Tucson on 05/09/13

Monitoring for adherence to requirements related to continuation of member services post 10/01/13

30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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