University of Maryland Center on Aging

1
The Arizona Long Term Care System (ALTCS)
University of Maryland Center on
Aging Medicare/Medicaid Integration Program July
8, 2004
2
AHCCCS Mission and Vision

• Mission
• Reaching across Arizona to provide comprehensive,
  quality health care for those in need.
• Vision
• Shaping tomorrow's managed health care from
  today's experience, quality, and innovation.

3
The Arizona Long Term Care System
History
Current System
Future
4
History

• July 13, 1982 The Health Care Financing
  Administration (HCFA), which is now the Centers
  for Medicare Medicaid Services (CMS) granted
  Arizona an 1115 Research Waiver.
• October 1, 1982 The Arizona Health Care Cost
  Containment System (AHCCCS) began serving people
  in its acute care program.
• Arizona was the first state to implement a
  statewide, Medicaid managed care system, based on
  prepaid, capitated arrangements with health plans.

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History

• The following long term care services were
  excluded with approval of the 1115 Waiver
• Skilled Nursing Facility Services to certain
  categorically needy individuals
• Home Health Care
• Why wasnt long term care covered in the initial
  Arizona 1115 Waiver?
• Acute care was the main concern
• Needed to stabilize acute care program first

6
History

• Arizona in December 1986
• New Governor
• Feds requested that AHCCCS add long term care or
  behavioral health services
• Long term care was a responsibility of the
  counties
• Home and community based programs existed
• Opportunity to refinance

7
History

• December 1988 AHCCCS began phasing-in long term
  care services for persons who were
  Developmentally Disabled (DD)
• January 1989 AHCCCS began serving the Elderly
  and Physically Disabled (E/PD)
• Home and community based services were limited to
  a maximum expenditure of 5 of the States long
  term care expenditures for long term care
  services.

8
History
County Involvement Then and Now

• In the Beginning
• Maricopa County
• Pima County
• A Few Years Later
• Yavapai County
• Pinal County
• Cochise County
• 1 Plan per County, except

• Today
• Maricopa Long Term Care Plan
• Pima Health System
• Yavapai County Long Term Care
• Cochise Health Systems
• Pinal/Gila Long Term Care
• Evercare Select
• Mercy Care Plan
• 3 Plans in Maricopa County

9
Current System

Delivery System
Payors (2 Billion)

• Payors
• 2.8 Billion (Appropriated)
• 3.4 Billion (Appropriated Non-Appropriated)

Single State Agency

• Product Lines
• Acute Care
• KidsCare
• Long Term Care
• Healthcare Group
• Premium Sharing

• HCFA
• State
• County
• Private
• Foundation
• Premiums

AHCCCS Administration

• Acute health plans
• LTC program contractors

• Policy
• Eligibility
• (Special Populations)
• Contract for Care
• Monitor Care and
• Financial Viability
• Information Services
• Budget and Claims Processing
• Legal
• Intergovernmental
• Relations

• State Agencies
• DHS
• Behavioral Health
• CRS
• DES
• DDD
• Foster Children
• Eligibility

• FFS
• Indian Health Services
• Emergency Services
• (non-qualified immigrants)
• LTCS members enrolled
• with Tribes/NACH

10
Current System
Who Does AHCCCS Serve?
11
Current System
ALTCS Elderly and Physically Disabled (EPD)
Only (3/01/2003) (Excludes Tribal
Enrollment)
Total 21,969 NF 38.6 Own Home
44.7 Alt. Res. 14.7 Other 2.0
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Current System

• ALTCS Principles
• Prepaid, capitated approach through
  public/private partnerships.
• Integrate all long term care services by bundling
  acute care, long term care, case management, and
  behavioral health services.
• Pre-admission screening process to identify those
  at risk for institutionalization.
• Full continuum of services to ensure members are
  placed in least restrictive, most cost-effective
  care.
• Primary care physicians/case managers serve as
  gatekeepers to coordinate care.

13
Current System

• AHCCCS Health Plan Responsibilities
• Contract for Services
• Develop and Ensure Adequate Network
• Active Monitoring and Oversight
• Case Management
• Quality and Utilization Management
• Integration of Medical Care
• Member and Family Support
• Pay Claims and Process Encounters
• Grievance and Appeals

14
Current System

• What Makes ALTCS Work
• Pre-admission screening (PAS)
• Integrated continuum of care / choice of
  community settings
• Network standards
• Ability for members to move between settings
  without interruption in services
• Case management standards
• HCBS financial incentives to health plans
• State oversight (Contract, Network, Finance, QM,
  CM, Annual Reviews, Technical Assistance)
• Good communication between State and health plans

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Current System
ALTCS Model
Potential ALTCS Member 2,300 Applications/Month
ALTCS Health Plan DES-DDD EPD Contractors
Maricopa LTC Plan Pima Health
System Evercare Select Mercy Care
Tribes Yavapai County
LTC Pinal Gila LTC Cochise Health System
Financial/Medical Eligibility 1. Citiz
en/Qualified Alien2. AZ Resident3. 2,000/3,000
Resources4. 1,692 Income Maximum1 5. Transfer
of Resources6. SSN7. Medical Eligibility/PAS
Covered Services Acute Care Services Nursing
Facility ICF/MR Hospice Behavioral Health HCBS
- Homemaker - Transportation - Personal Care -
Adult Day Health - Respite Care - Home Delivered
Meals - Attendant Care - DD Day Care - Home
Health Nurse - Habilitation - Home Health Aide -
Assisted Living Facilities
PCP/ CASE MANAGER
KEY EPD - Elderly Physically Disabled (Age 65,
Blind or Disabled)DES/DDD Dept. of Economic
Security, Div. Of Developmental
DisabilitiesICF/MR - Intermediate Care Facility
for Mental RetardedNF - Nursing FacilityPAS
- Pre Admission Screening 1 Income Limit is 300
of SSI maximum and increases annually in January
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Future

• Future
• Coordination of care for dual eligibles.
• Revamping of the Medicare and Medicaid programs.
• A better system to help individuals understand
  and retrieve information on choices and options.
• Ability to continue expansion of HCBS. This will
  create a need for more monitoring by plans.
• Continued growth and impact on budget.
• Federal law allowing people to shelter income and
  create annuities.
• A closer look at including LTC insurance in
  employer benefit plans paid for by employees.