AHCCCS Update Meeting Systems Update November 2015
Stay informed about the latest updates from AHCCCS meeting in November 2015, including ICD10 project close-out, Greater AZ SMI integration, PCP rate parity project updates, and more. Learn about the successful implementations, issues resolved, and future plans for comprehensive healthcare in Arizona.
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Presentation Transcript
AHCCCS Update Meeting Systems Update November 2015
Topics: ICD10 Project Close-out Greater AZ SMI Integration and GMH/SA Duals Integration Wrap-up PCP Rate Parity Project Updates AHCCCS CRN Expansion Project (999 Lines) Updates Hospice Rate Change Update Value Based Purchasing (VBP) Differential Adjusted Payments Update Reaching across Arizona to provide comprehensive quality health care for those in need 2
ICD10 Project Close-out Congratulations to everyone on a smooth implementation A few issues have been identified with minimal impacts and all were quickly resolved We will continue to maintain and monitor the ICD10 mailbox through at least the end of calendar year AHCCCS will be running a standard set of monitoring reports for a few months for Claims and Encounters to assess and make early identification of any areas of issue Beginning 10/1/15 MCO s were asked to supply a limited set of every other week updates on key areas, through at least the end of the calendar year Reaching across Arizona to provide comprehensive quality health care for those in need 3
Greater AZ SMI/GMH/SA Duals Integrations Close-out Again an overall successful implementation of both projects Minimal conversion, member record issues that either have been or in the process of being addressed Related to Lessons Learned from this implementation, a new process will be implemented to facilitate Contractor reporting of member questions, data issues, etc. on an ongoing basis; additional information to be sent shortly outlining the process Reaching across Arizona to provide comprehensive quality health care for those in need 4
PCP Rate Parity Project Updates Adjudication Dates Run Date August - December 2013 Completed January - March 2014 Completed April - June 2014 Completed July - September 2014 * Completed October 2014 Completed November 2014 Completed December 2014 Completed January - March 2015 Completed April June 2015 (includes July 2014 June 2015 Void/Replace) Initially Distributed July 21, 2015; with a follow-up correction in August; final reports to go out this ASAP July August 2015; include only dates of service on and after 10/1/13 other than by specific exception Run in progress for distribution ASAP Reaching across Arizona to provide comprehensive quality health care for those in need 5
PCP Rate Parity Project Updates, Cont. Reminder - Contractor Error Reports, sample or full reports may be made available to plans as requested Reminder - In the event that a provider is subsequently decertified for enhanced payments as result of required audits or other changes to providers: o Contractors will be required to reprocess all impacted claims for recoupment of enhanced payment amounts and replace encounters for the reprocessed claims o Contractors will be required to refund payments to AHCCCS for any reduced claim payments Reaching across Arizona to provide comprehensive quality health care for those in need 6
PCP Rate Parity Project Updates, Cont. The first of the required audits of eligible providers is currently nearing completion; pending receipt of a few identified outstanding records and final assessment of providers Reaching across Arizona to provide comprehensive quality health care for those in need 7
AHCCCS CRN Expansion Project Updates (999 Lines) AHCCCS 999 line claims HIPAA compliance changes Targeted for a March 2016 Implementation Approach - fully remediated the PMMIS system to expand the CRN by 1 additional digit for all form types; i.e. AHCCCS CRN s will go from 14 digits to 15 digits in length Impacts all history processes, reporting, PMMIS screens, etc that utilize CRN s from the implementation date forward Will impact and require testing with Contractors and Trading Partners Overview of impacts in process Reaching across Arizona to provide comprehensive quality health care for those in need 8
AHCCCS CRN Expansion Project Updates (999 Lines), cont. Testing to begin mid to late December with external Trading Partners CRN expansion is current in place in the AHCCCS PMMIS Test Systems Technical Workgroup scheduled for 12/3/2015 Reaching across Arizona to provide comprehensive quality health care for those in need 9
Hospice Rate Change Update AHCCCS was recently notified of an upcoming Hospice Rate Change effective 1/1/2016 that we and all MCO s need to comply with. Notice sent to all MCO s last week Effective January 1, 2016 Hospice Final Rule replaces the single Routine Home Care (RHC) per diem rate with two different RHC payment rates o A higher payment rate for the first 60 days of hospice care o A reduced payment rate for 61 days and over of hospice care Reaching across Arizona to provide comprehensive quality health care for those in need 10
Hospice Rate Change Update, Cont. Medicaid follows the Medicare methodology, therefore State Medicaid agencies must make conforming changes to their payments. Additionally the Rule identifies a Service Intensity Add-on (SIA) payment is in addition to the per diem RHC rate when all of the following criteria are met: o The day is an RHC level of care day o The day occurs during the last 7 days of the patient s life, and the patient is discharged expired o Direct patient care is furnished by a registered nurse (RN) or social worker that day Reaching across Arizona to provide comprehensive quality health care for those in need 11
Hospice Rate Change Update, Cont. New G-codes will be used to identify RN versus LPN visits for the SIA AHCCCS is in the process of finalizing our approach to remediation of our systems and will share this information for those interested in our approach as soon as it is available Reaching across Arizona to provide comprehensive quality health care for those in need 12
Value Based Purchasing (VBP) Differential Adjusted Payments Update Effective 10/1/16 9/30/17 Positive adjustment to AHCCCS FFS rates for: o Hospitals (for inpatient and outpatient services) o Nursing Facilities Reaching across Arizona to provide comprehensive quality health care for those in need 13
VBP Differential Adjusted Payments Update, Cont. Based on criteria established by AHCCCS Determined at a point in time preceding 10/1/16 (thus no provider being added/subtracted during year) MCOs will be mandated via contract language to make same adjustments to payments for providers meeting criteria Reaching across Arizona to provide comprehensive quality health care for those in need 14
VBP Differential Adjusted Payments Updates, Cont. Public Notice will post this week with more details, seeking public comment Proposal includes: o 0.5% increase for hospitals o 1.0% increase for NFs Anticipate expansion of this proposal for 10/1/17 -9/30/18 Reaching across Arizona to provide comprehensive quality health care for those in need 15
Questions? Reaching across Arizona to provide comprehensive quality health care for those in need 16
Thank You. Reaching across Arizona to provide comprehensive quality health care for those in need 17
