Quality Healthcare Initiatives in Arizona
Discover the various provider rate initiatives, recognition programs, and new methodologies aimed at improving healthcare services in Arizona. Learn about Treat and Refer services, Free-Standing Emergency Departments, and Value-Based Payment differentials effective from 10/1/16. Explore the commitment to enhancing patient care, member health, and reducing healthcare costs across Arizona.
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Presentation Transcript
10/1/16 Provider/Rate Initiatives Shelli Silver May 18, 2016
Treat and Refer Purpose: recognize EMS agencies that demonstrate optimal patient safety and quality of care by matching treatment, transport, and care destination options to the needs of members via payments for Treat and Refer services Definition: a healthcare event with a member who has accessed 9-1-1 or a similar emergency number, but whose illness or injury does not require ambulance transport to an ED Reaching across Arizona to provide comprehensive quality health care for those in need 2
Treat and Refer ADHS/Bureau of EMS and Trauma System will recognize Treat and Refer providers via an application process o Recognition status may be revoked New Provider Type effective 10/1/16 Assigned codes/rates (TBD) effective 10/1/16 Should result in program savings but no capitation impact until evidence available Reaching across Arizona to provide comprehensive quality health care for those in need 3
Free-Standing Emergency Departments (FrEDs) Draft definition: services provided by an OTC that (1) provides emergency room services under R9- 10-1019, (2) is subject to the requirements of 42 CFR 489.24, and (3) has common ownership with a hospital, regardless of whether the OTC operates under a hospital s single group license New Provider Type effective 10/1/16 Reaching across Arizona to provide comprehensive quality health care for those in need 4
Free-Standing Emergency Departments (FrEDs) New rate methodology effective 1/1/17 AHCCCS to post a proposed Rule no later than mid-July o Will consider access to care in rural areas versus access to care in urban settings Reaching across Arizona to provide comprehensive quality health care for those in need 5
VBP Differential Adjusted Rates Purpose: to distinguish providers which have committed to supporting designated actions that improve patients care experience, improve members health, and reduce cost of care growth Effective for dates of service 10/1/16 - 9/30/17 o Inpatient/outpatient hospital services increased by 0.5% o Nursing facility services increased by 1% o Select physical health services (TBD) for Integrated Clinics increased by 10% Reaching across Arizona to provide comprehensive quality health care for those in need 6
VBP Differential Adjusted Rates, cont. Qualifying hospitals and NFs will be determined prior to 10/1/16 ICs can qualify throughout CYE 2017 for dates of service that coincide with IC registration MCOs will be mandated to pass-through differential adjustments on MCOs rates Reaching across Arizona to provide comprehensive quality health care for those in need 7
Long-Acting Reversible Contraception Many repeat births could be prevented through postpartum use of LARC Medicaid mean for postpartum care was 63% in 2013 Offering women LARC in the hospital after delivery makes it easier for women to avoid unintended pregnancy But currently no ICD-10 PCS code for device for inpatient hospital use Reaching across Arizona to provide comprehensive quality health care for those in need 8
LARC, cont. With no code available, DRG assignment and payment does not reflect provision of LARC Effective 10/1/16 or 1/1/17 (TBD), AHCCCS will pay hospitals for LARC device in addition to DRG o Will be eliminated in future, if and when ICD-10 PCS code is established and DRG Grouper updated Billing requirements will direct hospitals to bill the device on Form 1500 Codes/rates TBD Reaching across Arizona to provide comprehensive quality health care for those in need 9
Behavioral Heath Outpatient Rates AHCCCS performing deep dive on BH outpatient fee-for-service rates Identifying a sustainable methodology for computing and updating rates o Researching another state s methodology Analyzing current RBHA rates Consider contracting terms Reaching across Arizona to provide comprehensive quality health care for those in need 10
Other Rate Issues HCBS rates 1% increase minimum 10/1/16 Air Ambulance realignment 10/1/16 Dental realignment 10/1/16 Speech therapy? (AzEIP concerns) NF rebase? Specialty/add-on rates? 10/1/17 earliest Reaching across Arizona to provide comprehensive quality health care for those in need 11
Thank You. Reaching across Arizona to provide comprehensive quality health care for those in need 12
