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OPERATIONS UPDATE
oContract AmendmentsoAHCCCS Provider Claims Survey
Reaching across Arizona to provide comprehensive quality health care for those in need
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Upcoming Contract Amendments
Reaching across Arizona to provide comprehensive quality health care for those in need
Anticipated Effective Date Amendment Line of Business
April 1, 2015
FQHC/RHC PPS Rates All
Supplemental Rebates (language) All
Incontinence Briefs Rates Long Term Care (EPD & DDD)
Physical Health/Behavioral Health Rates ADHS/DBHS & Acute
April 13, 2015 Rural Hospital
Acute • Health Choice • UFC • UHCCP
(?) May 1, 2015 Risk Adjustment Acute
June 1, 2015 Health Insurer Fee (the sequel) All (Except for CMDP)
July 1, 2015 Renewals DDD & CMDP
January 1, 2015 April 1, 2015 July 1, 2015 Nursing Facility Quarterly Amendment ALTCS EPD
TBD 3% Provider Rate Adjustment All
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Provider Claims Survey
Reaching across Arizona to provide comprehensive quality health care for those in need
• Survey was developed using web-based provider of survey solutions, Survey Monkey
• Survey for Acute Care, CRS, and ALTCS EPD
• Made available on the web 10/16/2014 – 12/04/2014
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Survey Questions• How satisfied are you with this Health Plan’s
processing of your initial claims?
• How satisfied are you with this Health Plan’s resolution of your claims issues?
• How satisfied are you with this Health Plan’s timeliness of resolution of your claims issues?
• How satisfied are you with this Health Plan’s Claims Customer Service Department?
• How satisfied are you with this Health Plan’s Provider Services Staff?
Reaching across Arizona to provide comprehensive quality health care for those in need
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How Health Plans Compare
Reaching across Arizona to provide comprehensive quality health care for those in need
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How Health Plans Compare
Reaching across Arizona to provide comprehensive quality health care for those in need
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How Health Plans Compare
Reaching across Arizona to provide comprehensive quality health care for those in need
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How Health Plans Compare
Reaching across Arizona to provide comprehensive quality health care for those in need
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How Health Plans Compare
Reaching across Arizona to provide comprehensive quality health care for those in need
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• Most satisfaction o Health plan performance
with processing of initial claims, Claims Customer Service, and Provider Services Staff.
• Most dissatisfaction o Health plan performance
with resolution of claims issues and timeliness of resolution of claims issues.
• Comments• 728 total comments across all
health plans. o Provider satisfaction - 18.3%o Provider dissatisfaction -
81.7% o Dissatisfied responses
indicate a desire for health plan improvement in the efficiency and processes for resolution of claims issues, particularly related to timeliness of resolution and subsequent payment.
Overall Findings
Reaching across Arizona to provide comprehensive quality health care for those in need
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Follow-up Actions & Expectations• Contractors
o Discuss the survey results at their Quarterly Health Plan Update meeting with the Director.
o Include, at a minimum, an overview of the results, strengths and challenges, and a planned course of action to address needed improvements.
• AHCCCSo Survey Report posted to the AHCCCS web 02/2015
o Follow up survey early 2016
o Follow up survey early 2016
Reaching across Arizona to provide comprehensive quality health care for those in need
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OPERATIONS UPDATE - ALTCS
oAMPM 1240 PolicyoHCBS Rule
Reaching across Arizona to provide comprehensive quality health care for those in need
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OPERATIONS UPDATE - ALTCS
oAMPM 1240 Policy Update Contractor and Provider Notification
Provider Compliance SB 1241
Reaching across Arizona to provide comprehensive quality health care for those in need
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OPERATIONS UPDATE -ALTCS
Reaching across Arizona to provide comprehensive quality health care for those in need
o HCBS Rule Workgroup Workgroup is meeting regularly Completed assessment of residential
settings; beginning assessment of non residential settings
Adult Day Health and Day Treatment Programs Supportive Employment Programs
Member and Provider Survey ALTCS Advisory Council is developing the survey
questions
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Questions?
Reaching across Arizona to provide comprehensive quality health care for those in need