Current Updates (as of 9/27/23)
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Managed Long-Term Services and Supports On August 1, the Arizona Health Care Cost Containment System (AHCCCS) released a Request for Proposals (RFP) for the Arizona Long Term Care System (ALTCS) Program for people who are elderly and/or have a physical disability. The selected Contractor(s) will be responsible for providing integrated care addressing physical and behavioral health needs and LTSS for older adults and people with physical disabilities, including adults and children with and without General Mental Health/Substance Use needs; adults with a Serious Mental Illness designation; children with a Serious Emotional Disturbance designation; and children with special health care needs; and excluding AHCCCS Complete Care; Department of Economic Security/Division of Developmental Disabilities; Department of Child Safety/Comprehensive Health Plan; and AHCCCS Complete Care-Regional Behavioral Health Agreement enrolled members. On December 1, AHCCCS announced contracts were awarded to two health plans, Health Net Access, Inc. (dba Arizona Complete Health-Complete Care Plan) and Arizona Physicians IPA, Inc. (dba UnitedHealthcare Community Plan), effective October 1, 2024. (Source: Arizona Health Care Cost Containment System Bidders Link; 8-1-2023 and AHCCCS News; 12-1-2023) On September 27, AHCCCS requested to amend its 1115 demonstration to allow parents of minor children eligible for the Arizona Long Term Care Services (ALTCS) to receive payment for personal care and habilitation services, which had been approved under an Appendix K amendment during the public health emergency. Under the 1115 demonstration, AHCCCS seeks to mitigate the direct care worker shortage, increase member satisfaction and promote positive health outcomes, extend an additional support to restore, enhance, and maintain family functioning to preserve effective care for the member, and ensure that members receive high-quality care while increasing timely accessibility to care providers. (Source: AHCCCS 1115 Demonstration Waiver Amendment Request; 9-27-2023) |
Past Updates
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Managed Long-Term Services and Supports On May 24, 2023 the Arizona Health Care Cost Containment System (AHCCCS) announced a delay in the planned start date of its federally approved Housing and Health Opportunities (H2O) demonstration project to complete operational and system integration planning. The planned start date is now October 1, 2024. The H2O demonstration aims to address health-related social needs for members with a Serious Mental Illness who are leaving a correctional setting or who have additional chronic health conditions. Once implemented, AHCCCS will be able to reimburse providers for up to six months of medically necessary transitional housing and services that support a member’s success in housing. (Source: Arizona Health Care Cost Containment System; 5-24-2023) |
On October 14, 2022, the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid agency, announced CMS approval of Arizona’s request for a five-year extension of its 1115 waiver. In addition to renewing authority for its integrated managed long-term services and supports system “Arizona Long Term Care System (ALTCS),” the 1115 will extend the Targeted Investments (TI) program. Through TI, managed care plans have provided financial incentives to eligible Medicaid providers who meet certain benchmarks for integrating and coordinating physical and behavioral health care. Under the waiver extension, TI 2.0, more providers will be made eligible, and incentives continued for further integration efforts, including a range of initiatives aimed at addressing social drivers of health (SDOH). Additionally, CMS approved the new Housing and Health Opportunities (H20) project to further address health-related social needs for vulnerable populations and ensure their access to health care. AHCCCS will be able to reimburse for up to six months of medically necessary transitional housing (for example, for individuals leaving health care or correctional settings, or emergency shelters who need supports to remain medically stable) and enhance those services that support a member’s success in housing, like tenant rights education, eviction prevention, and medically necessary home modifications.
(Source: AHCCCS General News; 10-14-22)
Medicare-Medicaid Integration
On January 2, 2020 Blue Cross Blue Shield of Arizona (BCBSAZ) announced that the health plan acquired Steward Health Choice Arizona, LLC. BCBSAZ will provide health coverage and LTSS services to Arizonans who are dually eligible for Medicare and Medicaid, including those in the Arizona Health Care Cost Containment System (AHCCCS).
(Source: Blue Cross Blue Shield of Arizona Press Release; 1-2-2020)
Medicaid Managed LTSS Program
Under Medicaid §1115 waiver authority, Arizona Health Care Cost Containment System (AHCCCS) provides health care services through a prepaid, capitated managed care delivery model that operates statewide for Medicaid State Plan groups, as well as demonstration expansion groups. The goal of the demonstration is to provide organized and coordinated health care for both acute and long-term care that includes pre-established provider networks; payment arrangements; administrative and clinical systems; patient and provider services; and health services management. Long-term care service beneficiaries receive additional benefits not provided through the Medicaid State Plan. (Source: Medicaid.gov)
State AHCCCS website
Fact Sheet
Current Approval Document (10/14/2022)
In August 2012, the state released a final ruling to maintain reimbursement reductions for inpatient and outpatient hospital services covered through the AHCCCS program as instituted in October 2011, and to eliminate inflation-based rate adjustments. (Source: BNA Register, August 17, 2012)
In October 2012, the state submitted a §1115 waiver amendment seeking to extend state authority to provide Medicaid coverage to adults without dependent children with incomes between 0% and 100% of the Federal Poverty Level (“Childless Adults”); and to obtain the enhanced federal medical assistance percentage (FMAP) for Childless Adults beginning January 1, 2014. (Source: Application for Amendment, 11/9/2012)
On July 19, 2014, Arizona submitted an application for CMS State Innovation Model Funding to accelerate the state’s delivery system transformation towards a value-based integrated model focusing on whole person health in all settings and regardless of coverage source. The state will undertake transformation of the health care delivery system using three overarching strategies: 1) Facilitating Integration and Decreasing System Fragmentation; 2) Improving Care Coordination; 3) Driving Payment Reform.
The Arizona SIM Initiative will begin by focusing on critical populations including individuals with serious mental illness (SMI) or other significant medical and behavioral health needs (super-utilizers); individuals dually eligible for Medicare and Medicaid; individuals transitioning from the justice system; members moving between Qualified Health Plans and Medicaid health plans; and the American Indian population. (Source: Arizona SIM Initiative website; CMS State Innovation Model Funding FAQs)
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On November 1, 2016, the Arizona Health Care Cost Containment System (AHCCCS) released a request for proposals (RFP) to reprocure contracts for the state’s managed long term services and supports (MLTSS) system, known as the Arizona Long Term Care System (ALTCS). The RFP will cover approximately 26,000 beneficiaries that are elderly or have a physical disability, and does not include individuals with intellectual or development disabilities (I/DD). Currently, three managed care organizations (MCOs)—Mercy Care Plan, UnitedHealthcare, and Bridgeway Health Solutions—operate across Arizona, receiving an average per-member-per-month (PMPM) capitated payment of $3,323. Key provisions of the RFP include:
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Bidder proposals will be evaluated on four areas: program, capitation, access to care/network, and administrative. (Source: RFP 11/1/2016; HMA Weekly Roundup 11/2/2016)
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On March 3, 2017, the Arizona Health Care Cost Containment System (AHCCCS) announced awards for the three managed care organizations (MCOs) that have been selected to provide all medical and long-term services and supports (LTSS) to Medicaid individuals that are elderly or have a physical disability through the Arizona Long Term Care System (ALTCS). Contracts break down by health plan and Geographic Service Area (GSA) as follows: Central GSA:
South GSA:
North GSA:
The new contracts become effective on October 1, 2017, and will include over 26,000 AHCCCS members. (Source: Award Announcement 3/3/2017) The Arizona Department of Economic Security (DES) Division of Developmental Disabilities (DDD) announced that UnitedHealthcare Community Plan and Mercy Care were awarded contracts to manage DDD Health Plans. DDD Health Plans will offer physical and behavioral health services as well as limited long-term services and supports to eligible members. DDD Health Plans will coordinate with other LTSS and related supports not covered by the health plan. Arizonans enrolled in the Arizona Long Term Care System (ALTCS), which include older adults with fixed incomes and individuals with disabilities, are eligible to enroll in DDD Health Plans. DDD Health Plans are expected to start October 1, 2019. (Source: DDD Health Plans, 3-21-2019)
On August 11, 2022, Arizona Health Care Cost Containment System (AHCCCS) announced development of new health plan contracts for the Arizona Long Term Care System for Elderly and Physically Disabled (ALTCS-EPD) program. Feedback was solicited from stakeholders in public listening sessions on August 23 and 24. |
State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)
In May 2012, the state submitted a proposal for a statewide participation in the Capitated Financial Alignment Demonstration model; the proposed implementation date was January 1, 2014. (Source: Demonstration Proposal)
In April 2013, the state withdrew its proposal to participate in the Capitated Financial Alignment Demonstration for members that have AHCCCS and Medicare. The state said it would continue working with CMS to improve care for dual eligibles within its current managed care model. (Source: MACPAC)
Section 1915(k) Community First Choice Option
(Withdrawn)
In October 2012, Arizona submitted an application to CMS to implement the Community First Choice Option. In June 2013, Arizona withdrew its 1915(k) application, opting instead to implement its CFC service model under the state’s §1115 waiver. (Source: National HCBS Conference Presentation, 9/11/2013; State Medicaid Integration Tracker 9/30/2013)
Health Homes
In March 2011, Arizona received a planning grant to explore the feasibility of a Regional Behavioral Health Authority (RBHA) model with expanded responsibility for Title XIX-eligible adults with SMI. This RBHA model is known as Recovery Through Whole Health. (Source: Recovery Through Whole Health)