Posts Tagged ‘AHCCCS’

American Indian Healthcare Matrix (Part III)

May 20th, 2014

In addition to services provided by the Indian Health Service and the 638’s administered by tribes and tribal organizations, American Indians are eligible to apply for and receive Medicare, Medicaid, and  Children’s Health Insurance Plan.  American Indians applying for Medicaid services in Arizona need to meet the same income requirements as all other applicants.  Unearned Per Capita income via Tribal Gaming Payments is counted in determining AHCCCS eligibility… which may make them ineligible to receive or continue receiving Medicaid services.  American Indians are exempt from cost sharing requirements in the AHCCCS (Medicaid) and KidsCare programs.

Native Americans are also exempt from the managed care requirement used by AHCCCS, so they have the option to receive their healthcare benefits through an AHCCCS health plan or through the American Indian Health Program, which is a fee-for-service program (rather than a capitated managed care program).   People that sign up with the American Indian Health Program have access to a comprehensive benefit package but some services may require prior authorization from AHCCCS.  Services must be medically necessary and delivered by an AHCCCS contracted provider (subject to exclusions and limitations).

Long-term care services are also available to American Indians living on or off a reservation via the Arizona Long Term Care System, Tribal Case Management Program. Even when American Indian members sign up with an AHCCCS health plan, they can always go to Indian Health Services or 638 facilities for their care.  AHCCCS provides a Tribal Relations Liaison to assist Arizona’s tribes with issues and concerns tribal members may have with enrolling in and/or accessing services.

Native Americans can also qualify for Medicare benefits.  The federal government partners with tribes to assist them with Medicare plan enrollment, plan service delivery, and billing questions under guidance from the CMS American Indian/Alaska Native Center.  Special content-specific groups have been created within the American Indian Alaska Native Center at CMS to guide beneficiaries including the CMS Tribal Affairs Group and the Tribal Technical Advisory Group.

5 Years of Behavioral Health Innovation Paying Dividends (Part I)

April 15th, 2014

MPeople with a serious mental illness die more than 30 years earlier than people without those challenges.  Over the next few weeks, I’ll be reflecting about some of the innovative strategies that we’ve implemented with our behavioral health community partners over the last several years to improve the health status of folks with a serious mental illness.

I’ll start with a project that began with modest funding from SAMHSA, through a grant meant for small pilots to test concepts in our community.  In 2009, we and AHCCCS jointly applied for and got a Transformation Transfer Initiative grant which was used to initiate a peer-based whole health program Maricopa and Pima Counties.  The goal of the program was to help transform the behavioral health system into one that applies a holistic approach to consumer health.

Magellan Health Services of Arizona launched the first phase of Integrated Health Homes as part of this initiative- bringing together mental health and physical health care.  The model was a partnership between Magellan, Maricopa Integrated Health System, and CHOICES Network, Partners in Recovery, People of Color Network and Southwest Network.  By 2013, there were 10 Integrated Health Homes in Maricopa County that have been providing coordinated care for members.  Thousands of people have received coordinated care and achieved better outcomes through these health homes.  Here are some additional typical health home participant vignettes that profile service recipients who can benefit from the initiative.

In the coming weeks, I’ll cover improvements in the Crisis Response System, the kids system of care, children’s substance abuse, coordination with the correctional system, and performance dashboards.

And Now, the Rest of the State

April 7th, 2014

Now that the transition to a new Behavioral Health Authority in Maricopa County is underway- we’re turning our attention to bringing integrated care to the rest of the state.  We’ll be working hard throughout 2014 to set the course for integrating behavioral health and physical health for folks with a serious mental illness as we select behavioral health authorities in the rest of Arizona – it’s called the “Greater Arizona RFP.

We’ve decided that the Greater Arizona RFP will include integration of behavioral and physical health for folks with a serious mental illness- much like the Maricopa County contract.  People in the general mental health or substance abuse categories will get behavioral health services from the RBHA and their physical health care from an AHCCCS acute care health plan.

We’re also planning to consolidate several of the current Geographic Service Areas (GSAs).  We’re likely to have a total of 3 service zones (North, South, & Maricopa)- rather than the current 6.  We’re also going to ensure that tribal land aligns with the GSAs.  Of course- tribes wishing to continue as a Tribal Behavioral Health Authority would continue as-is. Finally, we’re inclined to include a provision in the solicitation that makes it clear awardees will only be able to hold a contract in 1 GSA.  We’ve also made some decisions regarding how we’ll be dealing with Medicare issues.

We plan on issuing the Request for Proposal (RFP) in July, review the proposals from October through December, and award the contracts just before the New Year- with an October 1, 2015 start date.  Stay tuned.  There’s still more work to be done- and some decisions to be made before we put the procurement on the street this Summer.

Opening Day: Mercy Maricopa Integrated Care

April 4th, 2014

openingdayThis was a milestone week for our behavioral health program.  Tuesday marked the start of our contract with Mercy Maricopa Integrated Care as the regional behavioral health authority in Maricopa County.  The transition has gone well this week.  Literally 100s of things had to go right in order to have a smooth transition- including Information Technology, eligibility, pharmacy, medical records, claims management, network capacity and a host of other things.  A big thanks go out to the folks at Magellan, MMIC, AHCCCS and our DBHS, IT, and procurement teams for the weeks and weeks of hard work that it took to have a smooth transition for our members.  Well done!

Mercy Maricopa’s core mission is dedicated to providing its members access to care for their behavioral and medical health needs — focusing on the whole person, taking a holistic approach and empowering members to take charge of their health care. A new, secure health information exchange will help physical and behavioral health care providers to share information- leading to better care coordination, improved health outcomes, and reduced costs. Folks interested in learning more about Mercy Maricopa Integrated Care can visit their website, which has a host of resources for members and health care providers.

We’re optimistic that our collective hard work over the last couple of years to develop this new system of care will continue to result in better public health outcomes consistent with our Vision of Health and Wellness for all Arizonans.

Behavioral Health Efficiency Moves

January 9th, 2014

This week we’re making 3 efficiency changes in our behavioral health system.  Instead of having providers bill us and AHCCCS for different services, all the bills will go to AHCCCS- and we’ll get statements from them.  It’ll be the same with enrollment- all paperwork is processed through AHCCCS and we’ll get a standard report that will keep the system up-to-date.  The 3rd change should make it more efficient for determining whether someone has a Serious Mental Illness in the greater Phoenix area.  The Crisis Response Network will evaluate the information based on our standards. 

Once again – thanks to the amazing number of people who came together from IT and Behavioral Health to make these changes a reality including Ravi Pitti, Geetanjali Bandi, Nasrin Akhter, Laxma Veeravelly, Desi Grosso, and Vickie Kropp, Kumar Mani and Serghei Scafaru.


Request for Information (RFI) for the Greater Arizona “RFP”

December 9th, 2013

Now that we’re on the road to transitioning to a new system of behavioral health care in Maricopa County, it’s time to move our sights toward taking our reform initiative to the rest of the State.  Our first objective is to get input from the public and other Stakeholders. 

That’s why we, in coordination with AHCCCS, released a Request for Information (RFI) this week.  We’re exploring the feasibility of contracting with more than one at-risk managed care organization to act as a Regional Behavioral Health Authority to create an integrated health care service delivery system to provide physical and behavioral health care services, and to maximize care coordination statewide (we’ve already started the transition in Maricopa County).  

The purpose of RFI is to seek input on the design of the service delivery system to be implemented in Greater Arizona and be fully operational by October 1, 2015.  The Request for Information asks a series of 15 key questions that will impact on how we formulate our next procurement solicitation for behavioral health services.  Folks can submit comments to Elena Beeman in our Procurement shop through January 22, 2014 to weigh in.


Introducing Health-e-Arizona Plus

December 6th, 2013

AHCCCS and ADES have rolled out a new website that makes it easier than ever to enroll for Medicaid and other benefits.  It’s called Health-e-Arizona Plus… and it’s Arizona’s one-stop-shop for easy Medicaid enrollment.  Health-e-Arizona Plus provides an easy pathway to apply for a full range of AHCCCS and ADES benefits and local health access programs like the Supplemental Nutrition Assistance Program (Food Stamps) and Cash Assistance benefits.  This easy-to-use new website has modules for connecting individuals and families to coverage, benefits, and services as well as tools for state workers and community assistors.

Leveraging Medicaid to Help Arizonans “Kick the Habit”

September 19th, 2013

Many of the health disparities in the US are linked to income.  In general… the lower a family’s income the greater the prevalence of health disparities.  Health impacts from smoking cigarettes are no exception.  Arizonans below the poverty line (100% of FPL) are 40% more likely to smoke than those with more money… and about 34% of Arizona folks who receive their health insurance through Medicaid smoke.  This higher smoking rate results in a cascade of negative health impacts over the course of a lifetime.  BTW…  less than 7% of Arizonans that make over $75K smoke. 

For the last few months our Tobacco and Chronic Disease team has been working with AHCCCS to get the Centers for Medicare and Medicaid Services (CMS) to allow us to claim the 50% federal administrative match rate for the Arizona Smokers Helpline (the ASHLine) for the smoking cessation services that we provide to AZ Medicaid beneficiaries. 

Last month we were successful!  CMS approved the reimbursement for Federal Financial Participation for our Quitline Administrative Expenditures.  The reimbursement will come from CMS to AHCCCS and then back to us and then back to the ASHLine.  Arizona is only the 10th state to receive approval to reimburse Quitline services for Medicaid folks.  A shout out to Courtney Ward for making this happen! 

Establishing this public-public partnership with Medicaid is critical to ensuring access to evidence-based cessation treatments for a population disparately impacted by tobacco’s harm. This financial match coupled with our efforts to entice new partnerships with health plans and employers will help to address and provide tobacco cessation services for this AZ Winnable Battle


What’s Meaningful Use, Anyway?

June 26th, 2013

You’ve probably heard the words “meaningful use” thrown around…  but what is it?  Basically, it’s using electronic health record technology to: 1) Improve quality, safety, efficiency, and reduce health disparities; 2) Engage patients and family; 3) Improve care coordination, and population and public health; and 4) Maintain privacy and security of patient health information.  

Using electronic health records in a meaningful way will result in better clinical and public/population health outcomes, increased transparency and efficiency, and more robust research data on health systems that can be used to improve efficiency and reduce costs.  Meaningful use sets specific objectives that eligible professionals and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services Incentive Programs

A few years ago, Congress authorized about $25B in incentive payments to hospitals and healthcare providers to encourage them to electronically exchange health information in a meaningful way. The project is called Meaningful Use. There are several criteria that folks need to meet, some of which are related to public and population health. These include the capability to electronically transfer information into immunization registries, cancer registries, and other specialized registries; the electronic transmission of laboratory reports to the public health surveillance system; and rapid electronic transmission of sentinel indicators to monitor for public health events prior to formal diagnosis.   

Over the past few years, we’ve been working with our partners at Arizona Strategic Enterprise Technology, Arizona Health-e Connection, and AHCCCS to develop our infrastructure to receive these messages and support providers in the community to meet the Meaningful Use criteria.  Earlier this month we helped to put on a full-day workshop for 90 hospital and vendor participants to introduce the required standards, tools and processes to fulfill the Meaningful Use objective related to electronic laboratory reporting. There were also short sessions on other public health Meaningful Use topics. 

This workshop provided valuable resources to providers in the community and demonstrated great collaborations across multiple agencies in Arizona. Materials from the workshop and more information about our efforts to assist providers in achieving Meaningful Use are posted on our website.

Budget Squared Away

June 20th, 2013

As you’ve probably seen, the Legislature went into a special session and worked some long hours to pass a FY 2014 budget.  While we’re still analyzing everything, here are some key provisions of the budget bill as it was sent to the Governor. 

Medicaid (AHCCCS) will be restored and expanded.  This will be a big bonus for our behavioral health system.  This change in Medicaid eligibility will provide health coverage to an additional 300,000 low-income Arizonans (everyone that makes less than 133% of the federal poverty level) starting January 1, 2014.  There’s also a new line item of $250,000 to fund Mental Health First Aid in the budget that passed.   The bill approved by both houses also appropriates $300,000 to fund dental care and nutrition supplements for certain folks with kidney disease and provides funding for electronic health records at the State Hospital

The 5% employee retention bonus for uncovered employees will be continued and made permanent.  The budget bill also repeals the requirement that state employees work for at least 90 days before becoming eligible for state employee benefits.  There will be much more to write about in future updates as we sift through the final budget.