Arizona Medicaid (AHCCCS)Commercial Clinical Policy

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Arizona%201115%20Waiver%20Tribal%20Workgroups%20presentation.Pdf

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(1) review the methodology and data used to create the existing PMPM 2) Evaluate requests to modify the methodology to reflect current costs, utilization and service delivery. 3 Reaching across Arizona to provide comprehensive quality health care for those in need 4 Tr Traditional Healing Chair Violet Skinner, Utilization Review Director, Tuba City Regional Health Care Corp., Co-Chair Terrilynn Chee, Director of Revenue Cycle Management, Reaching across Arizona to provide comprehensive quality health care for those in need Currently AHCCCS does not reimburse for Traditional Healing services and will need to obtain federal authorization to do so. A request to reimburse for these services has been added to the 1115 Waiver. AHCCCS will develop the service parameters in partnership through the tribal consultation process. The parameters will need to be provided to CMS as part of the final language in the 1115 Waiver. The purpose of the workgroup is to: 1) develop service parameters to include the following: a. what services will be included b. what services will be covered and not covered c. what kind of qualified providers will provide the services 5 Am American Indian Medical Home Chair Ronald Speakman, Supervisory Nurse Specialist & Acting Facility Dir. Tucson Area IHS, San Xavier Health Center, Sells Service Unit Co-Chair Violet Skinner, Utilization Review Director, Tuba City Regional Health Care Corp. Reaching across Arizona to provide comprehensive quality health care for those in need AHCCCS is proposing to align it efforts in Arizona with the efforts being made by IHS and the federal government to modernize and improve the health care delivery system for the AI/AN population through the development of a system of care called the Indian Health Medical Home Program (IHMHP). AHCCCS proposes an IHMHP that aligns with IHS’ Improving Patient Care (IPC) program in order to address some disparities and to support the ability of IHS, Tribal, and Urban Indian Health programs, as well as non-IHS facilities with high AI/AN patient volumes, to better manage the care of American Indians and Alaska Natives enrolled in the American Indian Health Program. AHCCCS is proposing to reimburse qualifying facilities for: -Primary Care Case Management -Diabetes education -After-hospital care coordination -24-hour call lines staffed by medical professionals The purpose of the workgroup is to: 1) develop further details regarding the proposal for the American Indian Medical Home, including oversight and implementation processes. Questions? 
(2) Questions? 

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Original Document

  Reference



Arizona 1115 Waiver Tribal Work Arizona 1115 Waiver Tribal Workgroups Presenter: Violet Skinner, RN
Utilization Review Director, Tuba City Regional Health Care Corporation

2 Tr Tribal Workgroup Development Reaching across Arizona to provide comprehensive
quality health care for those in need 8/21/15: AHCCCS Tribal Consultation & Community Forum RE: AZ 1115 Waiver -3 workgroups to be formed to provide tribal input on the waiver process 10/1/15: AZ 1115 Waiver submitted to CMS -Beginning of 1 year review process 10/7/15: Tribal workgroups letter from AHCCCS requesting tribal participation 10/22/15: AHCCCS Tribal Consultation
-Workgroup sign up 12/10/15: Initial Workgroup organizational meetings -Chair elections, meeting schedule development 1/20/16-1/21/16: First workgroup meetings April 2016: Timeline to complete

Uncompensated Care Chair Violet Skinner, Utilizatio Uncompensated Care Chair Violet Skinner, Utilization Review Director, Tuba City Regional Health Care Corp., Co-Chair Alida Montiel, Health Systems Director, Inter Tribal Council of Arizona, Inc.,
The State is authorized through September 30, 2016 under the expenditure authorities of the 1115 Waiver to make supplemental payments to IHS and tribal 638 health facilities that take into account their uncompensated costs in furnishing specified types of care to Medicaid-eligible individuals. The supplemental payments are for benefits that were reduced. The purpose of the workgroup is to: 1) review the methodology and data used to create the existing PMPM 2) Evaluate requests to modify the methodology to reflect current costs, utilization and service delivery.

3 Reaching across Arizona to provide comprehensive
quality health care for those in need

4 Tr Traditional Healing Chair Violet Skinner, Utilization Review Director, Tuba City Regional Health Care Corp., Co-Chair Terrilynn Chee, Director of Revenue Cycle Management,
Reaching across Arizona to provide comprehensive
quality health care for those in need Currently AHCCCS does not reimburse for Traditional Healing services and will need to obtain federal authorization to do so. A request to reimburse for these services has been added to the 1115 Waiver.
AHCCCS will develop the service parameters in partnership through the tribal consultation process. The parameters will need to be provided to CMS as part of the final language in the 1115 Waiver.

The purpose of the workgroup is to: 1) develop service parameters to include the following: a. what services will be included b. what services will be covered and not covered c. what kind of qualified providers will provide the services

5 Am American Indian Medical Home Chair Ronald Speakman, Supervisory Nurse Specialist & Acting Facility Dir. Tucson Area IHS, San Xavier Health Center, Sells Service Unit Co-Chair Violet Skinner, Utilization Review Director, Tuba City Regional Health Care Corp. Reaching across Arizona to provide comprehensive
quality health care for those in need AHCCCS is proposing to align it efforts in Arizona with the efforts being made by IHS and the federal government to modernize and improve the health care delivery system for the AI/AN population through the development of a system of care called the Indian Health Medical Home Program (IHMHP). AHCCCS proposes an IHMHP that aligns with IHS’ Improving Patient Care (IPC) program in order to address some disparities and to support the ability of IHS, Tribal, and Urban Indian Health programs, as well as non-IHS facilities with high AI/AN patient volumes, to better manage the care of American Indians and Alaska Natives enrolled in the American Indian Health Program.

AHCCCS is proposing to reimburse qualifying facilities for: -Primary Care Case Management -Diabetes education -After-hospital care coordination -24-hour call lines staffed by medical professionals

The purpose of the workgroup is to: 1) develop further details regarding the proposal for the American Indian Medical Home, including oversight and implementation processes.

Questions? Questions? 6 Reaching across Arizona to provide comprehensive
quality health care for those in need

Thank You. Thank You. 7 Reaching across Arizona to provide comprehensive
quality health care for those in need violet.skinner@tchealth.org (928) 283-1387 office

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