AHCCCS pays hospitals for inpatient and outpatient services to AHCCCS members. Additionally,
AHCCCS pays supplemental payments to hospitals for different purposes and activities.
A summary of all hospital payments (claims as well as supplemental payments) is
On March 29, 2012, Governor Brewer approved Laws 2012, Second Regular Session, Chapter
122 which, in part, ends the inpatient hospital tiered per diem methodology utilized
by AHCCCS and its Contractors effective September 30, 2013. The AHCCCS tiered per
diem methodology for the payment of acute care hospital inpatient claims has been
in place since 1993. This payment structure is the default methodology, as required
by Arizona State law, that must be used by AHCCCS' Managed Care Organizations (MCOs)
when no contract exists between an MCO and a hospital. Pursuant to the newly signed
law, AHCCCS is required to obtain legislative approval of an alternative reimbursement
methodology for inpatient dates of service on and after October 1, 2013. AHCCCS
is exploring the benefits of the APR-DRG payment methodology and will be establishing
workgroups to seek stakeholder input on such a methodology.
See more information here.
Information on the individual supplemental payment programs is provided below:
Critical Access Hospital Payments
Critical Access Hospitals (CAHs) are rural community hospitals that meet defined
criteria outlined in the Conditions of Participation, 432CFR-485 and subsequent
legislative refinements to the program through the BBA, BIPA, and Medicare Modernization
Act. The Arizona State Legislature has directed AHCCCS to allocate additional funds
appropriated in the annual state budget.
More information on Critical Access payments can be found
Rural Hospital Inpatient Fund Payments
The Rural Hospital Inpatient Fund was established by the Legislature in 2005 in
response to a 2002 hospital inpatient study that showed rural hospital inpatient
cost structures are higher than urban hospital cost structures for inpatient services.
This fund was designed to supplement rural hospital inpatient payments.
More information on Rural Hospital Inpatient Fund payments can be found
Proposition 202 Trauma & Emergency Services Fund Payments
In November 2002, Arizona voters approved Proposition 202, the Indian Gaming and
Self-Reliance Act. Among other things, the initiative established the Arizona Benefits
Fund, consisting of tribal gaming revenues paid to the State on a quarterly basis.
The Benefits Fund is administered by the Department of Gaming. To help offset the
readiness and costs of Level 1 Trauma Centers and the increasing volume in Emergency
Departments, a portion of these funds are transferred to AHCCCS for distribution.
More information on Proposition 202 payments can be found
- Hospitals must have
Prop 202 worksheets to AHCCCS by October
31 of each year in order to receive Prop 202 funds for that State fiscal
Graduate Medical Education Payments
Graduate Medical Education (GME) funds are distributed to hospitals that provide
training and education for medical school graduates. This training includes internships,
residencies and fellowships. GME funds are either designated to cover direct medical
education expenses or indirect medical education expenses.
More information on Graduate Medical Education payments can be found
Hospitals must have 2014 GME final IGAs to AHCCCS by
August 15, 2014 in order to receive allocated FY 2014 GME funds.
- Hospitals must have
2013 GME final IGAs to AHCCCS by
August 15, 2013 in order to receive allocated FY 2013 GME funds.
Hospitals must have 2012 GME final IGAs to AHCCCS by
September 30, 2013 in order to receive allocated FY 2012 GME funds.
Disproportionate Share Hospital Payments
Disproportionate Share Hospital (DSH) payments provide financial assistance to hospitals
that serve a large number of low-income patients such as people on Medicaid and
the uninsured. Medicaid DSH payments are the largest source of federal funding for
More information on Disproportionate Share Hospital payments can be found
DSH 2011 Pool 5 funds will be allocated on
October 5, 2012. All partnerships must notify
AHCCCS of the intent to receive distributions from this pool and have a template IGA on file
with AHCCCS by close of business, October 5, 2012.
DSH 2012 Pool 5 funds will be allocated on November 2, 2012
. All partnerships must notify AHCCCS of the intent to receive distributions from this
pool and have a template IGA on file with AHCCCS by close of business,
November 2, 2012.
Electronic Health Record Incentive Payments
Under the Health Information Technology for Economic and Clinical Health (HITECH)
Act, eligible health care professionals and hospitals can qualify for Medicare and
Medicaid incentive payments when they adopt certified EHR technology and use it
to achieve specified objectives.
More information on EHR Incentive payments can be found here.
- Hospitals must have complete
Federal Fiscal year 2012 EHR attestations in the AHCCCS ePIP system
by November 30, 2012.
Safety Net Care Pool Payments
The Safety Net Care Pool (SNCP) is a funding pool that uses monies from political subdivisions to
draw down federal matching dollars. The funds are then distributed to participating hospitals to help
defray the costs of uncompensated care provided to AHCCCS members and the uninsured.
More information on Safety Net Care Pool payments can be found here here.