Arizona’s Medicaid agency reported numerous case management issues against the former provider of Arizona Long Term Care Services (ALTCS).
After working as an ALTCS provider since 2006, Bridgeway lost its bid to secure a new contract with the Arizona Health Care Cost Containment System (AHCCCS) in March 2017 and was responsible for transitioning about 5,000 ALTCS members to new ALTCS contractors by October 1, 2017. Winners of the ALTCS bid were Banner University Family Care, Mercy Care Plan and UHC Community Plan.
AHCCCS reported as an exiting contractor Bridgeway was obligated to provide services to enrolled ALTCS members through the term of its contract and failed to comply with all contractural provisions and policies – especially case management during the transition of its members to new ALTCS plans.
Specifically, Bridgeway failed to perform mandated case management reassessments for a total of 2,,033 ALTCS members. As stated by AHCCCS,
“The importance of performing reassessment visits according to the mandated schedule cannot be overstated. Failure to conduct required visits and reassessments delays prompt identification and resolution of member health care needs which may impair the member’s progress and restrict access to vital health care services. Member reassessment visits are crucial for timely identification and review of any change in a member’s condition as well as for monitoring and evaluation of the appropriateness of the member’s placement and services. Compliance with the procedural and substantive requirements of reassessment visits is fundamental to AL TCS guiding principles. ”
“AHCCCS determined that BWY CM management instructed the CM staff to complete upcoming reassessments ahead of the scheduled date of reassessment. In many cases these visits occurred as early as four weeks prior to the originally scheduled due date which, in turn, accelerated the next scheduled reassessment due date for these members to September 2017. Further, AHCCCS identified that CM staff had been instructed that it was not necessary to conduct reassessment visits in September 201 7, the final month of the AL TCS YH 12-0001-01 Contract.”
Read the AHCCCS letter to Bridgeway