cye 2021 dap update - health current · the program began in contract year end (cye) 2017 • dap...

CYE 2021 DAP Update

Final Public Notice & Requirements

June 2020

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AHCCCS Differential Adjusted Payment (DAP) Update on CYE 2021 Final Public Notice

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1. DAP Basics2. Final Public Notice & Changes from Preliminary Notice

• Changes for Hospitals, Inpatient Facilities & IHS/638 providers- Participation Track – New to DAP for 2021- Performance Track – Returning to DAP for 2021

• Critical Access Hospitals – Performance Track• Changes for Behavioral Health Outpatient Clinics & Integrated Clinics• COVID Requirements (NEW) – All Providers• Clinical Lab Results (NEW) – All Providers

3. Next Steps4. Q & A

Agenda

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DAP Basics

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What is DAP?DAP Program and Health Information Exchange• DAP aims to distinguish providers that have committed

to supporting designated actions that improve patients’ care experience, improve members’ health and reduce cost of care growth.

• An integral part of the DAP program includes HIE data access and connectivity

• DAP includes various other requirements besides HIE:• sepsis care• peer support for substance use

disorders• medication assisted treatment• quality reporting & awards• pressure ulcers

• urinary tract infections• partnerships with schools to

provide behavioral health• autism centers of excellence• e-prescribing• and more!

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DAP Basics

• Differential Adjusted Payment (DAP) policy is a means for AHCCCS to offer and pay incentives to its provider network based on meeting various requirements

• Part of AHCCCS’ value-based payment strategy

• HIE requirements have been a key component of DAP policies since the program began in contract year end (CYE) 2017

• DAP is scheduled based on CYE schedule, based on contract year for AHCCCS and its MCOs – which is equivalent to federal fiscal year (FFY) schedule• CYE 2020 = October 1, 2019 to September 30, 2020• CYE 2021 = October 1, 2020 to September 30, 2021

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DAP Basics

• Final Public Notice posted to AHCCCS website May 27, 2020

The DAP CYE 2021 Final Public Notice is available here: https://azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/DAP_FinalNotice-CYE2021.pdf

Information about HIE requirements for DAP CYE 2021 is available here:https://healthcurrent.org/ahcccs-programs/differential-adjusted-payment-program/

https://azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/DAP_FinalNotice-CYE2021.pdf

https://healthcurrent.org/programs/ahcccs-programs/differential-adjusted-payment-dap-program/

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Differential Adjusted Payment (DAP) Preliminary Public Notice

• HIE Requirements in CYE2021 for following entities:

Provider Type HIE Incentive

Hospitals Subject to APR-DRG Reimbursement, excluding Critical Access Hospitals 2.5%*

Critical Access Hospitals 10%*

Other Hospitals and Inpatient Facilities 2.5%*

IHS and 638 Tribally Owned and/or Operated Facilities 2.5%

Integrated Clinics 10%

Behavioral Health Outpatient Clinics 1%

*Hospitals Subject to APR-DRG Reimbursement (excluding Critical Access Hospitals) as well as Other Hospitals and Inpatient Facilities are eligible to either participate in the HIE Participation program or the HIE Performance option. Critical Access Hospitals are only eligible to participate in the HIE Performance option. See Preliminary Public Notice for performance criteria details.

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DAP Provider CategoriesWho is Included in which DAP categories?

Source: https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/DAP_Preliminary_NoticeCYE2021.pdf

DAP HIE Categories Provider Type Hospitals Subject to APR-DRG Reimbursement 02 Critical Access Hospitals (designated CAH by 5/1/2020) 02 Other Hospitals and Inpatient Facilities:

Psychiatric Hospitals, with the exception of public hospitals 71 Secure Residential Treatment Centers (17+ beds) B1 Non-Secure Residential Treatment Centers (17+ beds) B3 Subacute Facilities (1-16 Beds) B5 Subacute Facilities (17+ beds) B6 Rehabilitation Hospitals C4 Long Term Acute Care Hospitals C4

IHS & 638 Tribally Owned and/or Operated Facilities (Hospitals owned and/or operated by HIS or under Tribal authority by 5/1/2020) See Notice

Integrated Clinics IC Behavioral Health Outpatient Clinics 77

https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/DAP_Preliminary_NoticeCYE2021.pdf

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Changes in the Final Public Notice

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General Updates & Changes

AHCCCS’ goal was to lighten the load where possible on milestone dates for DAP participating agencies• Many milestone due dates in the Final Notice are extended by 30 days or more• Flexibility provided for outpatient providers in the process of implementing a

new Electronic Medical Record (EMR) or Electronic Health Record (EHR)• Certain COVID 19 clinical lab result data milestones added for all provider

types (except IHS/638 providers) if the provider conducts COVID 19 testing, antibody testing or performs immunizations

• All providers (including IHS/638) that utilize external reference labs for any lab result processing must submit necessary provider authorization forms to the qualifying HIE, if required by the external reference lab, to have all outsourced lab test results flow to the qualifying HIE on their behalf

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Changes for Hospitals (02) – Participation Track

Milestone Preliminary Notice3/6/2020

Final Notice5/27/2020

DAP Incentive 2.5% 2.5%Letter of Intent 5/1/2020 5/27/2020HIE Participation Agreement 5/1/2020 5/27/2020

ADT Submission 5/1/2020 6/1/2020PHI Submission 6/30/2020 8/1/2020Data Quality SOW 10/1/2020 11/1/2020Phase 1 Initial Quality Profile 12/1/2020 1/1/2021

Phase 1 Final Quality Profile 5/1/2021 5/1/2021

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Changes for Hospitals (02) – Performance Track




PHI Submission 5/1/2020 6/1/2020Data Quality SOW 10/1/2020 11/1/2020Phase 2 Initial Quality Profile 12/1/2020 1/1/2021Phase 2 Final Quality Profile 5/1/2021 5/1/2021

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COVID Requirements For All Hospitals (02) – If ApplicableMilestone Due Date

Submit all COVID-19 lab test codes and the associated LOINC codes to qualifying HIE

By 7/1/2020 or within 30 days of initiating COVID 19 lab testing

Submit all COVID-19 antibody test codes and the associated LOINC codes to the qualifying HIE

By 7/1/2020 or within 30 days of initiating COVID 19 antibody testing

Submit all COVID-19 immunization codes and the associated LOINC codes to the qualifying HIE

Within 30 days of initiating COVID 19 immunizations

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Changes for Critical Access Hospitals – Performance Track



DAP Incentive 10% 10%Letter of Intent 5/1/2020 5/27/2020HIE Participation Agreement 5/1/2020 5/27/2020

ADT & PHI Submission 5/1/2020 6/1/2020Data Quality SOW 10/1/2020 11/1/2020Phase 2 Initial Quality Profile 12/1/2020 1/1/2021Phase 2 Final Quality Profile 5/1/2021 5/1/2021

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COVID Requirements For Critical Access Hospitals – If Applicable

Milestone Due Date







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Changes for Inpatient Facilities (71, B1, B3, B5, B6, C4) –Participation TrackMilestone Preliminary Notice

3/6/2020Final Notice

5/27/2020DAP Incentive 2.5% 2.5%Letter of Intent 5/1/2020 5/27/2020HIE Participation Agreement 5/1/2020 5/27/2020

ADT Submission 5/1/2020 6/1/2020PHI Submission 6/30/2020 8/1/2020Data Quality SOW 10/1/2020 11/1/2020Phase 1 Initial Quality Profile 12/1/2020 1/1/2021

Phase 1 Final Quality Profile 5/1/2021 5/1/2021

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Changes for Inpatient Facilities (71, B1, B3, B5, B6, C4) ––Performance Track




ADT & PHI Submission 5/1/2020 5/27/2020Data Quality SOW 10/1/2020 11/1/2020Phase 2 Initial Quality Profile 12/1/2020 1/1/2021Phase 2 Final Quality Profile 5/1/2021 5/1/2021

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COVID Requirements For Inpatient Facilities – If ApplicableMilestone Due Date







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Changes for IHS/638 Hospitals (02) – Participation Track




Submit necessary provider authorization forms to the qualifying HIE, if required by the external reference lab

n/a 7/1/2020

Data Quality SOW 11/1/2020 12/1/2020ADT Submission 3/1/2021 4/1/2021

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Changes for IHS/638 Hospitals (02) – Participation TrackContinuedMilestone Preliminary Notice

3/6/2020Final Notice

5/27/2020PHI Submission 5/1/2020 6/1/2021If the facility has ambulatory and/or behavioral health practices, the facility must submit actual patient identifiable information to the production environment of a qualifying HIE, including registration, encounter summary, and SMI data elements as defined by the qualifying HIE organization.

5/1/2021 6/1/2021

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Changes for Integrated Clinics (IC) –– Returning ICs



DAP Incentive 10% (selected services) 10% (selected services)Letter of Intent 5/1/2020 5/27/2020HIE Participation Agreement 5/1/2020 5/27/2020

Submit Registration/Encounter 5/1/2020 5/27/2020Registration/Encounter - New EMR/EHR

1/1/2021 1/1/2021

HIE Data Access 5/1/2020 1/1/2021PHI Submission including SMI elements (if applicable)

4/1/2021 4/1/2021

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Changes for Integrated Clinics (IC) –– IC New to DAP



DAP Incentive 10% (selected services) 10% (selected services)Letter of Intent/Agreement 5/1/2020 5/27/2020HIE Participation Agreement 5/1/2020 8/1/2020

Submit Registration/Encounter 5/1/2020 1/1/2021HIE Data Access 5/1/2020 1/1/2020PHI Submission including SMI elements (if applicable)

4/1/2021 4/1/2021

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COVID Requirements For Integrated Clinics – If ApplicableMilestone Due Date







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Changes for Behavioral Health Outpatient Clinics (77)



DAP Incentive 1% 1%Letter of Intent 5/1/2020 5/27/2020HIE Participation Agreement 5/1/2020 8/1/2020

HIE Data Access 12/1/2020 1/1/2021

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Authorizations for External Lab ProcessingAll Provider Types & All Tracks

Milestone Due DateProviders that utilize external reference labs for any lab result processing must submit necessary provider authorization forms to the qualifying HIE, if required by the external reference lab, to have all outsourced lab test results flow to the qualifying HIE on their behalf

7/1/2020

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Next Steps

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Final Public Notice Milestones, Deadlines, Roles & ResponsibilitiesReview the Final CYE2021 DAP Public Notice.

Review the milestones that apply to your organization and the respective roles and responsibilities to determine what steps and activities must be completed to achieve the milestone.

If you have any questions: • Contact your Health Current Account Manager if you are an active HIE

Participant

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Future DAP HIE Requirement Progression

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Questions

cye 2021 dap update - health current · the program began in contract year end (cye) 2017 • dap...

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