ahcccs update meeting – systems update november 2015

AHCCCS Update Meeting – Systems UpdateNovember 2015

2

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

3

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


4

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


5

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

6

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


7

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


8

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 processReaching across Arizona to provide comprehensive

quality health care for those in need

9

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


10

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 rateso A higher payment rate for the first 60 days of hospice

care o A reduced payment rate for 61 days and over of hospice

careReaching across Arizona to provide comprehensive

quality health care for those in need

11

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 dayo The day occurs during the last 7 days of the patient’s life,

and the patient is discharged expiredo 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

12

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


13

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


14

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


15

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 hospitalso 1.0% increase for NFs

• Anticipate expansion of this proposal for 10/1/17 -9/30/18


16

Questions?


17

Thank You.


ahcccs update meeting – systems update november 2015

Documents

final reports

enhanced payments

result of required audits

week updates

data issues

final assessment of

member record issues

end of calendar yearahcccs