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Phoenix Public Forum
The Arizona Health Care Cost Containment System (AHCCCS) is requesting a waiver of the requirement to provide three months of retroactive coverage to new AHCCCS members. AHCCCS is seeking the flexibility to limit retroactive coverage to the month of application, consistent with Arizona’s policy prior to passage of the Affordable Care Act.
Summary
Under current law, if a new AHCCCS member would have qualified for AHCCCS coverage during any portion of three months immediately preceding the month in which the member applied for AHCCCS coverage, AHCCCS is required to reimburse providers for any AHCCCS covered service received by the member during that period.1 To better align Medicaid policies with commercial health insurance coverage, AHCCCS is seeking the flexibility to limit retroactive coverage to the month of application, consistent with Arizona’s policy prior to passage of the Affordable Care Act. Under the proposed policy, individuals will continue to receive retroactive coverage effective as of the first day of the month in which the Medicaid application was filed.
This proposal to waive Prior Quarter Coverage promotes the objectives of the Medicaid program by (1) creating efficiencies that ensure Medicaid’s sustainability for members over the long term; (2) encouraging members to obtain and maintain health coverage, even when healthy; and (3) encouraging members to apply for Medicaid expeditiously when they believe they meet the criteria for eligibility.
Arizona will increase efforts to educate and encourage Arizona residents to apply for AHCCCS coverage.
Following the public forums, the Proposal to Waive Prior Quarter Coverage will be presented at the State Medicaid Advisory Committee (SMAC) meeting on February 7, 2018.
The public will have the opportunity to review and comment on the proposal in person at public forums throughout the State and in writing via e-mail to [email protected] or mail to:
AHCCCSc/o Office of Intergovernmental Relations
801 E. Jefferson Street, MD 4200
Phoenix, AZ 85034
All comments received by February 25, 2018, will be reviewed, considered and included in the final proposal sent to CMS.
Conference call-in number: 1-877-820-7831
Participant Passcode: 960711
Read more about this waiver amendment from AHCCCS
Tucson Public Forum
The Arizona Health Care Cost Containment System (AHCCCS) is requesting a waiver of the requirement to provide three months of retroactive coverage to new AHCCCS members. AHCCCS is seeking the flexibility to limit retroactive coverage to the month of application, consistent with Arizona’s policy prior to passage of the Affordable Care Act.
Summary
Under current law, if a new AHCCCS member would have qualified for AHCCCS coverage during any portion of three months immediately preceding the month in which the member applied for AHCCCS coverage, AHCCCS is required to reimburse providers for any AHCCCS covered service received by the member during that period.1 To better align Medicaid policies with commercial health insurance coverage, AHCCCS is seeking the flexibility to limit retroactive coverage to the month of application, consistent with Arizona’s policy prior to passage of the Affordable Care Act. Under the proposed policy, individuals will continue to receive retroactive coverage effective as of the first day of the month in which the Medicaid application was filed.
This proposal to waive Prior Quarter Coverage promotes the objectives of the Medicaid program by (1) creating efficiencies that ensure Medicaid’s sustainability for members over the long term; (2) encouraging members to obtain and maintain health coverage, even when healthy; and (3) encouraging members to apply for Medicaid expeditiously when they believe they meet the criteria for eligibility.
Arizona will increase efforts to educate and encourage Arizona residents to apply for AHCCCS coverage.
Following the public forums, the Proposal to Waive Prior Quarter Coverage will be presented at the State Medicaid Advisory Committee (SMAC) meeting on February 7, 2018.
The public will have the opportunity to review and comment on the proposal in person at public forums throughout the State and in writing via e-mail to [email protected] or mail to:
AHCCCSc/o Office of Intergovernmental Relations
801 E. Jefferson Street, MD 4200
Phoenix, AZ 85034
All comments received by February 25, 2018, will be reviewed, considered and included in the final proposal sent to CMS.
Conference call-in number: 1-877-820-7831
Participant Passcode: 960711
Read more about this waiver amendment from AHCCCS
As organizations prepare for participation in Direct Contracting or continue to assess their participation options, NAACOS is hosting a three-part webinar series that examines the implications of recent financial specifications released by the CMS Innovation Center. The first of this series will take a closer look at options for Standard Direct Contracting Entities (DCEs). Subsequent webinars will examine New Entrant and High Needs Population DCEs. Attendees will hear from policy and data experts as well as from newly forming DCEs. Participants should come away with a better understanding of the financial ramifications of Direct Contracting participation.
Speakers:David Ault, Andrew Webster
As organizations prepare for participation in Direct Contracting or continue to assess their participation options, NAACOS is hosting a three-part webinar series that examines the implications of recent financial specifications released by the CMS Innovation Center. The second of this series will take a closer look at options for New Entrant Direct Contracting Entities (DCEs). The third webinar will examine High Needs Population DCEs. Attendees will hear from policy and data experts as well as from newly forming DCEs. Participants should come away with a better understanding of the financial ramifications of Direct Contracting participation.
Speakers:David Ault, Andrew Webster, Allison Brennan
Cost for NAACOS Members and Business Partners: FREE
The cost for Non-Members is: $195
In an effort to help the Direct Contracting community, we are working to compile questions and corresponding answers submitted to the CMS Help Desk. These will be shared with others after any identifying information is stripped out in the interest of shared learning. Please send those questions and corresponding answers to [email protected] so we can compile them.
Webinar Title: Direct Contracting’s Financial Details: High Needs Population DCEs
Date / Time: Thursday, October 29th 2:00 PM – 3:15 PM (Eastern)
As organizations prepare for participation in Direct Contracting or continue to assess their participation options, NAACOS is hosting a three-part webinar series that examines the implications of recent financial specifications released by the CMS Innovation Center. The third and final installment of this series will take a closer look at options for High Needs Population Direct Contracting Entities (DCEs). Previous webinars focused on Standard and New Entrant DCEs. Attendees will hear from policy and data experts as well as from newly forming DCEs. Participants should come away with a better understanding of the financial ramifications of Direct Contracting participation.
Arizona’s Section 1115 Waiver Renewal Request (2021-2026)
With over 2 million Arizonans enrolled in AHCCCS, Medicaid has a huge responsibility for impacting population health in the state. Despite past innovation, AHCCCS says it has an opportunity and obligation to do more.
The goals of modernizing Arizona Medicaid are to:
- Engage Arizonans to take charge of their health
- Make Medicaid a temporary option
- Promote a quality product at the most affordable price
AHCCCS posted a draft of the Section 1115 Waiver, which allows Arizona to run its unique and successful managed care model and exempts Arizona from certain provisions of the Social Security Act. It also includes expenditure authority for costs not otherwise matched by the federal government. Waiver programs are required to be budget neutral for the federal government − such programs don’t require more federal dollars than without a waiver.
The Centers for Medicare and Medicaid Services’ (CMS) approval of Arizona’s Demonstration renewal application will extend authority for Arizona to implement programs including, but not limited to:
- Mandatory managed care
- Home and community-based services for individuals in the Arizona Long Term Care System (ALTCS)
- Administrative simplifications that reduce the inefficiencies in eligibility determination
- Integrated health plans for AHCCCS members
- Payments to providers participating in the Targeted Investments Program
- AHCCCS Works
- Waiver of Prior Quarter Coverage for specific populations
In addition to renewing current waiver and expenditure authorities, AHCCCS is seeking to implement the following:
-
- Authority to allow for verbal consent in lieu of written signature for up to 30 days for all care and treatment documentation for ALTCS members when included in the member’s record and when identity can be reliably established.
- Authority to reimburse traditional healing services provided in, at, or as part of services offered by facilities and clinics operated by the Indian Health Service (IHS), a tribe or tribal organization, or an Urban Indian health program.
- Authority to reimburse Indian Health Services and Tribal 638 facilities to cover the cost of adult dental services that are eligible for 100 percent FFP, that are in excess of the $1,000 emergency dental limit for adult members in Arizona’s State Plan and $1,000 dental limit for individuals age 21 or older enrolled in the ALTCS program.
On November 13, from 1:30-3:30 pm, AHCCCS will hold a waiver public forum meeting over Zoom.
Download the presentation slides for the public forum from AHCCCS
Join us for a virtual Winter State of the State conference including robust Arizona market discussions, full conference program, data reference pages and a directory to support post-conference networking.
HOST & MODERATOR
JIM HAMMOND
CEO & Publisher, The Hertel Report
Managing Consultant, Professional Healthcare Solutions
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In some kind of a return to normalcy, the 2023 Winter State of the State breakfast meeting will be held once again at the Hilton Phoenix Resort at the Peak, formerly known as the Hilton Squaw Peak Resort, it was the conference host for two decades from 2000 to 2020.
Join us Friday, February 17, 2023, and get up to speed on all things healthcare while networking with friends and colleagues in person. Don’t worry, we also have a virtual option for those who cannot be there with us.
Networking and Breakfast: 7am-8am
Conference: 8am-10:30am
Click HERE to register!
The annual conference is hosted and moderated by Jim Hammond, publisher of The Hertel Report and Professional Healthcare Solutions’ managing consultant. Jim will share his take on the news and big changes coming in healthcare; updating the audience on Arizona’s health insurance market, Medicare, Medicaid, ACOs, and more.
Joining Jim this year is Charlton Wilson, MD, former CMO at Mercy Care and a recent Robert Wood Johnson Policy fellow. Dr. Wilson will recap his year in Washington D.C. working with congressional committees and learning about the lawmaking and law-shaping process.
Chief Medical Officer Mark Stephan, MD and Seth Dubry, MD, Arizona Medical Director at Equality Health, will also join us to discuss how the value-based network prioritizes meeting people where they are, empowers primary care providers and acknowledges cultural competency in the delivery of care and support.
And, finally, Paul Rose, CEO of Western Asset Protection, is returning again by popular demand. Paul is an expert in all things Arizona Medicare, including supplements, Part D and Medicare Advantage. Paul will share an insider’s view into Arizona’s new plans, sales efforts and winners and losers from the current Medicare open enrollment period.
Click HERE to view and download the event flier!