Arizona PERM PilotRound 1

Kim SanchezQuality Compliance AdministratorPhone: (602) 417-4563Email: kim.a.sanchez@azahcccs.gov

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AZ Organization Background

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AHCCCSArizona Medicaid

Determines Eligibility for SSI MAO and Long Term Care

Department Of Economic Security (DES)

Determines eligibility for SNAP, TANF and Medicaid for

non-disabled adults and children

MMIS

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Systems

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PERM Pilot Round 1

• Sample 200 Medicaid, 0 CHIP

• Pull at the individual level

• Pull weekly samples (calendar week)

• Review at the household level

• Reviews pulled from December and February

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Resources• Social Interest Solutions – Developed

HEAplus and our sampling programming

• AHCCCS Medicaid QC staff – completed the reviews

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

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Challenges and Resolutions• Universes inconsistent

• Eligibility “work arounds” developed after pilot proposal was submitted

• Revisions to pilot proposal

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Universes inconsistent• Universe totals did not align

o Majority of samples pulled in Aprilo Quality control check the sampleso Clerical pulled system screens for

reviewerso Assigned to staff in Mayo Had May and June to complete the

reviews

• Result: Limited time to complete reviews

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Eligibility “work arounds” developed after pilot proposal was submitted• Eligibility workers not all in the new system

o Eligibility determined in the old system o Some determinations in our universes were a

preliminary denial decision

• Result: Had to re-evaluate our review process, re-write our internal policy and re-train staff

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Revisions to Pilot Proposal

• Proposal –stratification by submission method, including transfers from the FFM. o Revision 1 – no FFM referrals

• Proposal – We proposed to complete 160 positive reviews and 40 negative reviews. o Revision 2 – 167 positive reviews, 33 negative

reviews

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Pilot Results• Medicaid Active –

6 Income not budgeted

5 No valid signed application

4 budget unit established incorrectly

2 in receipt of Medicare

2 applied old budgeting rules

1 Relationship incorrectly coded

1 Income used was not reasonably compatible

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Pilot Results

• Medicaid Negative – 2 Notice not sent3 Eligible for MAGI

Client double entered self-employment Incorrectly denied Denied when eligible for Emergency Services

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Preparation for 2nd Round Pilot• Stabilization of universes

• Complete reviews of a State samples of cases transferred from the FFM

• Revise our written procedures with more detail for reviewers to take into consideration eligibility “work arounds” established

• Conduct additional staff trainingReaching across Arizona to provide comprehensive

quality health care for those in need

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Questions?

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Thank You.

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