YH14-0001 - Acute Care/CRS RFP Information

As of March 22, 2013, the Bidders’ Library will no longer be maintained. Refer to the corresponding section of the AHCCCS website for updates to the AHCCCS Contractor Guides & Manuals.


RSS FEED DISCLAIMER Acute/CRS Request for Proposal (RFP)

AHCCCS has established an RSS (Really Simple Syndication) feed as a courtesy to notify interested parties that information has been added to the Acute/CRS RFP Information page. Due to the numerous browsers and RSS Readers available for use, AHCCCS cannot guarantee whether, and to what extent, the RSS feed information will be viewed by the subscriber. Therefore, the RSS feed may not reliably provide the subscriber with RFP and Bidders' Library updates. In order to ensure that subscribers have access to all information pertaining to the RFP and Bidders' Library, it is the responsibility of the subscriber/interested party to regularly visit the AHCCCS Website, Acute/CRS RFP Information page.


Acute/CRS RFP YH14-0001

To access RFP award information, click the Procurement File link below.
Procurement File Page – YH14-0001


RFP BIDDERS' LIBRARY DISCLAIMER

The Bidders’ Library is a site to assist Offerors with information and resources regarding the Acute/CRS RFP. The information in the Bidders’ Library is not intended to be comprehensive. It is the responsibility of the Offeror to obtain and review all pertinent information relating to the Acute/CRS RFP.

This information may be downloaded in two ways:

Pre-Release Information

January 18, 2012 Public Meeting  
Fact Sheet  
Comment Form  
Public Meeting Presentation  
   
Items of Interest  
AHCCCS Acute Care/CRS RFP Schedule [PDF posted 11/27/12, 24KB]
Major Decisions as of October 9, 2012  
Medicare Major Decisions as of October 9, 2012  
Major Decisions as of August 27, 2012  
Major Decisions as of July 19th, 2012  
AHCCCS Hospital Inpatient Reimbursement Methodology
information located at: AHCCCS Hospital Payments
 

The Acute CYE’09, CYE’10 and CYE’11 risk adjustments white papers, documenting the risk adjustment approach, have been posted to the AHCCCS website at the following location: Acute Care Capitation Rates

 
   
Surveys  
Information on several topics regarding the Acute/CRS RFP.  
Acute/CRS RFP Results (Closed 07/30/12)  
Input from physical and behavioral health care
providers regarding care coordination for the non-Seriously
Mentally Ill population.
 
Coordination of Care Survey (Closed 08/07/12)  
   

Note: Information posted after the initial release of the Bidders’ Library will be noted with a  New Tag button and the date the information was added. After five days the New Tag button will be removed.


Acute Care/Children's Rehabilitative Services (CRS) Programs Request for Proposal (RFP)


Solicitation Amendments Solicitation Amendments  
Solicitation Amendment #1 Q & A [PDF posted 11/27/12, 267KB]
Signed Solicitation Amendment Signature Page [PDF posted 11/27/12, 39KB]
Solicitation Amendment #2 Q & A [PDF posted 12/19/12, 433KB]
Signed Solicitation Amendment Signature Page [PDF posted 12/20/12, 77KB]
Solicitation Amendment #3 Q & A [PDF posted 01/04/13, 111KB]
Signed Solicitation Amendment Signature Page [PDF posted 01/04/13, 79KB]
Solicitation Amendment #4 with Signature
Page
 
[PDF posted 01/10/13, 194KB]
Solicitation Amendment #5 with Signature
Page
[PDF posted 01/24/13, 104KB]
     
Sections
A, B and C:
 
Solicitation Page, Capitation Rates and Definitions  
  Solicitation Page, Capitation Rates and Definitions [PDF, 173KB]
     
Section D:     Program Requirements  
D1 Acute Care Program Requirements [PDF, 650KB]
D2 CRS Program Requirements [PDF, 645KB]
     
Section E:     Contract Terms and Conditions  
E1 Acute Care Program Contract Terms and
Conditions
[PDF, 141KB]
E2 CRS Program Contract Terms and Conditions [PDF, 140KB]
     
Section F:         Attachments  
Attachment A1 Enrollee Grievance System Standards [PDF, 49KB]
Attachment A2 Provider Claims Dispute Standards [PDF, 27KB]
Attachment B1 Acute Care Program Contractors’
Chart of Deliverables
[PDF, 99KB]
Attachment B2 CRS Program Contractor’s Chart of
Deliverables
[PDF, 90KB]
     
Section G:     Representations and Certifications of Offeror  
Representations and Certifications [WORD, 94KB]
Disclosure Information Templates [EXCEL, 39KB]
     
Section H: Instructions to Offerors  
Instructions to Offerors [PDF, 195KB]
     
Section I:         Exhibits  
Exhibit A Offeror's Checklist  [PDF, 45KB]
Exhibit B Minimum Subcontract Provisions  [PDF, 106KB]
Exhibit C Attestation Form [PDF, 58KB]
Exhibit D Medicare Requirements [PDF, 61KB]
Notification of Overdue Certifications [PDF posted 01/29/13, 18KB]
     


Information Technology (IT) Systems Demonstration


Introduction [PDF posted 11/27/12, 25KB]
Provisions [PDF updated 01/29/13, 28KB]
Calendar [PDF updated 12/19/12, 33KB]
Q & A Process Provisions [PDF posted 01/23/13, 28KB]
Q & A Template [Word posted 01/23/13, 24KB]


Daily Q & A


Q & A files are available for download on the AHCCCS SFTP server   [EFT updated 02/08/13]
Questions & Responses Summary  [PDF updated 02/08/13, 237KB]


General


Notification to Offerors regarding Oral Presentation: A memorandum notifying each Offeror of the date and time scheduled for the Oral Presentation has been emailed to the contact person & email listed on the Offeror’s Notice of Request for Proposal Solicitation Signature page. In addition, the notification memorandum is also available for download in the Offeror’s AHCCCS EFT/SFTP folder. [01/31/13]
List of RFP Offerors [PDF updated 01/31/13, 16KB]
Enrollment Map [PDF 32KB]
Instructions to Electronic File Transfer - Secured File Transfer Protocol [PDF reposted 11/14/12, 25KB]

Data provided to Offerors through the secure EFT/SFTP server is derived from protected health information that is not considered “de-identified” as that term is defined in the federal Health Information Privacy Rule. While the Rule allows release of this information to health plans that are also potential Offerors, it is not being made available to the general public. Offerors are advised to take appropriate steps to maintain the confidentiality of the information. The Instructions attached above notify Offerors of the process for accessing the secure server. The External User Affirmation Statement included in these Instructions clearly delineates appropriate use of the AHCCCS data.

[posted 11/08/12]

Prospective Offerors' Conference and Technical Interface Meeting


Conference Information   [PDF posted 11/06/12, 19KB]
Prospective Offerors' Conference Presentation Materials  
Prospective Offerors’ Conference Agenda [PDF posted 11/08/12, 60KB]
Prospective Offerors’ Conference Presentation
11/13/12 Note: Date correction made on slide 78, New Items Related
to Technology.
[PDF posted 11/08/12,1.8MB]
Prospective Offerors' Technical Interface Meeting Presentation Materials
Prospective Offerors' Technical Interface Meeting Agenda [PDF posted 11/09/12, 63KB]
Prospective Offerors' Technical Interface Meeting Presentation
[PDF posted 11/09/12, 387KB]
Conference Attendance  
Prospective Offerors' Conference Attendance [PDF posted 11/09/12, 1.4MB]
Prospective Offerors' Technical Interface Meeting Attendance [PDF posted 11/09/12, 673KB]

Forms


Questions and Responses Template [WORD, 107KB]
 

Medicare Duals


AHCCCS members who are also enrolled in Medicare are referred to as dual eligible. In an effort to improve care coordination for AHCCCS dual eligible members, AHCCCS will require all Acute plans to be organizations that manage and provide Medicare benefits to dual eligible members in all GSAs they hold a contract. Contractors will be required to meet the Medicare requirement either through the CMS Capitated Financial Alignment Demonstration or as Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) if AHCCCS does not finalize a Demonstration contract with CMS. Below is further information and resources.

AHCCCS Duals Page [WEB PAGE]
Acute/CRS RFP Medicare Major Decisions [PDF, 16KB]
CMS Memo Notice of Intent to Apply (NOIA) Information [PDF, 143KB]
AHCCCS Policy Contracting with Special Needs Plans [PDF, 62KB]
Acute Duals Enrollment by County [PDF posted 12/06/12, 12KB]
CMS Capitated Financial Alignment Demonstration Information [WEB PAGE]

The Financial Alignment Demonstration seeks to better serve people who are enrolled in both Medicare and Medicaid by testing a person-centered, integrated care model that provides a more easily navigable and seamless path to all Medicare and Medicaid services. Expected outcomes include: improved beneficiary experience of care, fewer avoidable hospitalizations and emergency room visits, and greater independence in the community and at home for seniors and people with disabilities.

 
Arizona's Demonstration Proposal [PDF, 830KB]
July 08, 2011 - State Medicaid Director Letter [PDF posted 11/14/12, 214KB]
January 25, 2012 - CMS Guidance [PDF posted 11/14/12, 323KB]
March 29, 2012 - CMS Guidance [PDF posted 11/14/12, 807KB]
CMS - 2013 Capitated Financial Alignment Demonstration Application [PDF posted 11/14/12, 1MB]
Joint Rate Setting Process Under the Capitated Financial Alignment Initiative [PDF posted 11/14/12, 300KB]
CMS Medicare Advantage Special Needs Plan Information [CMS link posted 11/14/12]

Dual Eligible SNPs (D-SNPs) enroll beneficiaries who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid.

 
CMS - 2013 Medicare Advantage Application Information [CMS link posted 11/14/12]
Medicare Managed Care Manuals [CMS link posted 11/14/12]
Medicare Managed Care Manual - Chapter 16B: Special Needs Plans [CMS PDF link posted 11/14/12]

Policies


Draft Policies (Watch for Updates to Draft Policies)

Note: Draft policies with an existing policy number will be effective as noted on the policy, and will replace current policies with the same number.

AMPM
Policy 310-B  - Behavioral Health Services [PDF, 439KB]
Policy 310-V - Prescription Medication/Pharmacy Services [PDF, 329KB]
Policy 330 - Covered Conditions and Services for the Children's
Rehabilitative Services (CRS) Program
[PDF, 655KB]
Policy 400 - Medical Policy for Maternal and Child Health -
Chapter Overview
[PDF, 3MB]
Policy 520 - Member Transitions [PDF, 466KB]
Policy 540 - Other Care Coordination Issues [PDF, 472KB]
Policy 560 - CRS Care Coordination and Service Plan (SP)
Management
[PDF, 197KB]
Policy 900 - Quality Management and Performance
Improvement Program - Chapter Overview
[PDF, 442KB]
   
ACOM

Note: Clean versions of the Draft Policies have been posted below replacing previously posted redline versions.

New Policy, Chapter 300 - Auto-Assignment Algorithm [PDF posted 11/20/12, 159KB]
New Policy, Chapter 300 - Acute Program Payment Reform
Initiative  
[PDF to be posted 04/01/13, 01/10/13]
New Policy, 302-I - Prior Period Coverage Reconciliation PDF posted 11/16/12, 177KB]
New Policy, 302-I - Prior Period Coverage Reconciliation - Attachment A   [PDF posted 11/16/12, 17KB]
Policy 304 - Premium Tax Reporting [PDF posted 11/16/12, 157KB]
Policy 304 - Premium Tax Reporting - Attachment A [PDF posted 11/16/12, 29KB]
Policy 305 - Performance Bond and Equity Per Member
Requirements
[PDF posted 11/16/12, 162KB]
Policy 306 - Performance Bond [PDF posted 11/16/12, 346KB]
Policy 311 - Acute Program Tiered Prospective Reconciliation [PDF posted 11/16/12, 184KB]
Policy 311 - Acute Program Tiered Prospective Reconciliation -
Attachment A
[PDF posted 11/16/12, 25KB]
Policy 312 - CRS Program Tiered Reconciliation   [PDF posted 11/16/12, 181KB]
Policy 312 - CRS Program Tiered Reconciliation -
Attachment A 
[PDF posted 11/16/12, 21KB]
New Policy, Chapter 400 - Acute Network Standards [PDF posted 11/16/12, 429KB]
New Policy, Chapter 400 - Coordination of Benefits/Third Party
Liability
 
[PDF updated 01/10/13, 185KB]
New Policy, Chapter 400 - Telephone Performance Standards
Measurement and Reporting
[PDF posted 11/16/12, 185KB]
New Policy, Chapter 400 - Telephone Performance Standards
Measurement and Reporting - Attachment A
[PDF posted 11/16/12, 17KB]
Policy 404 - Member Information   [PDF updated 02/07/13, 715KB]
Policy 412 - Claims Reprocessing [PDF posted 11/16/12, 210KB]
Policy 415 – Provider Network Development and Management
Plan
[PDF posted 11/16/12, 667KB]
Policy 417 - Appointment Availability Monitoring and Reporting [PDF posted 11/16/12, 316KB]
Policy 426 - Eligibility Reviews for CRS Applicants and
Referrals
[PDF updated 02/07/13, 215KB]
Policy 427 - CRS Contractor No-Show   [PDF posted 11/16/12, 78KB]
Policy 433 - Member Identification Cards [PDF posted 11/16/12, 178KB]
   

Current ACOM Policies Expiring as of October 1, 2013

Chapter 400  
Policy 409 - Intra-Agency Care Coordination for Services  
Policy 428 - CRS Service Authorization Process  
 

Current Policies

AHCCCS Contractors Operations Manual (ACOM) [WEB PAGE]
AHCCCS Medical Policy Manual (AMPM) [WEB PAGE]
   

Data Supplement for Offerors' - Acute Care/CRS


Section A: Data Supplement Instructions and Overview [PDF, 18KB]
     
Section B:   Program and Fee Schedule Changes  
Program and Fee Schedule Changes [PDF posted 11/07/12,  2.7MB.]
     
Section C:           Data Book Information  
Data Book Introduction [PDF, 39KB]
Data Book Layout/File Description   [PDF posted 11/16/12, 141KB]
Details of Updated CRS Data Book Files [PDF posted 11/29/12, 141KB]
Data Book Files [Acute Care Bid Files posted via EFT
11/16/12, CRS Bid Files updated via EFT 11/29/12]
Rate Setting Document [PDF posted 12/14/12, 228KB]
Supplemental Data Book Reports [PDF updated 12/20/12, 117KB]
Note: A new posting date will be noted whenever this document has been updated.
 
Section D: Service Matrix/Selection Criteria for Data Book  
Introduction [PDF, 20KB]
Acute Care/CRS Service Matrix [PDF updated 12/14/12, 40KB]
Behavioral Health Services Service Matrix [PDF, 35KB]
Crosswalk Acute Care Service Matrix to
Capitation Bid Template
[PDF posted 12/14/12, 185KB]
 
Section E: AHCCCS Category of Service, Form Types,
Provider Type List of Codes and Descriptions
Introduction [PDF, 10KB]
AHCCCS Categories of Service Codes [PDF, 23KB]
Definition of Form Types [PDF, 15KB]
AHCCCS Provider Types [PDF, 30KB]
     
Section F: Bid Submission Information
Note: See RFP Section H, Instructions to Offerors, Paragraph 16.C. Capitation
 
Bid Template Overview [PDF posted 11/19/12, 345KB]
Capitation Bid Templates [EFT posted 11/19/12]
Acute Care Medical Component Ranges
and CRS Rates
[PDF posted 12/14/12, 192KB]
     
Section G: Crosswalk from Service Matrix to Financial Statements  
Introduction [PDF, 14KB]
Crosswalk Acute Care/CRS-Service Matrix
to Financial Statements
[PDF, 27KB]
Crosswalk BHS Service Matrix to Financial
Statements
[PDF, 25KB]
     
Section H: Enrollment Information
Introduction [PDF, 24KB]
H-1 Enrollment by County by Contractor [EFT]
H-2 Report Acute Care Enrollment Activity [EFT]
H-3 Enrollment by Month
(Historical and Projected)
[EFT]
H-4 AHCCCS Members Count By Zip Code [EFT]
   
Section I: Risk Adjustment Information
Introduction [PDF posted 11/13/12, 77KB]
CYE 09 Risk Adjustment Whitepaper [PDF posted 11/13/12, 1MB]
CYE 10 through CYE13 Risk Adjustment
Methodologies
[PDF posted 11/13/12, 102KB]
Proposed CYE 14 and CYE 15 Risk
Adjustment Methodologies
[PDF posted 11/13/12, 77KB]
Risk Factors [PDF posted 11/13/12, 13KB]
Diagnosis Percentages by Form Type [PDF posted 11/13/12, 25KB]
     
Section J: Financial Information for Prospective Members  
Introduction [PDF, 19KB]
Acute Care Financial Information [EFT]
CRS Financial Information [EFT]
Section K:   Capitation Rates  
Capitation Rates [Web Page]
     
Section L: Birth to Member Month Analysis  
Introduction [PDF, 17KB]
Birth to Member Month Analysis [EFT]
   
Section M: Reinsurance Information  
Introduction [PDF, 21KB]
Reinsurance Payments [PDF, 40KB]
Reinsurance Offsets   [PDF, 23KB]
     
Section N: Hospital Rate Overview  
Introduction [PDF, 9KB] (contains link)
Outlier Cost Thresholds [PDF posted 12/18/12, 179KB]
     
Section O: Contractor Audited Financial Statements
Introduction [PDF, 13KB] (contains link)
     

List of Data Supplement Reports and Files available for download on the EFT/SFTP
(See Section A: Data Supplement Instructions and Overview for instructions to access)


Section C: Data Book Files [Acute Care Bid Files updated via EFT 12/20/12,
CRS Bid Files updated via EFT 12/20/12, 12/21/12]
Section F: Capitation Bid Templates [Posted 11/19/12 via EFT.]
Section H: H-1 Enrollment by County by Contractor  
H-2 Report Acute Care Enrollment Activity [EFT]
H-3 Enrollment by Month (Historical and Projected) [EFT]
H-4 AHCCCS Members Count By Zip Code [EFT]
   
Section J: Acute Care Financial Information [EFT]
CRS Financial Information [EFT]
     
Section L: Birth to Member Month Analysis [EFT]


Draft Reporting Guides and Manuals


Draft AHCCCS Financial Reporting Guides and Templates for CYE 14
 
Acute Care Contractors  
Draft Reporting Guide [PDF posted 12/14/12, 1.6MB]
Draft Reporting Template [PDF posted 12/14/12, 237KB]
   
CRS Contractor  
Reporting Guide [PDF posted 12/20/12, 2MB]
Reporting Template [PDF posted 12/20/12, 204KB]
Revenue and Expense Statement
Mapping Guidelines
[PDF posted 12/20/12, 43KB]
   
Draft Claims Dashboard Reporting Guide/Template-CYE 14 [To be revised after 10/01/13.
See existing Claims Dashboard Reporting Guide/Template 11/29/12.]
Draft Reinsurance Reporting Guide
(Effective 10/01/13)
[PDF posted 12/20/12, 2MB]
   

Current Reporting Guides and Manuals


Acute Health Care Contractors Financial Reporting Guidelines [WEB PAGE link posted 12/12/12]
Claims Dashboard Reporting Guide [PDF, 47KB]
Claims Dashboard Reporting Template [EXCEL, 243KB]
Encounter Data Validation Technical Document [PDF, 78KB]
Encounter Reporting User Manual [WEB PAGE]
Fee-for-Service Provider Manual   [WEB PAGE]

The Fee-For-Service Provider Manual is a publication of the Arizona Health Care Cost Containment System (AHCCCS), Claims Department, Division of Fee-for-Service Management. The Claims Department also publishes Claims Clues as a supplement to the manual.

The intent of this manual is to furnish providers’ billing staff and contracted billers with information about AHCCCS, coverage of specific services, and requirements for completion and submission of fee-for-service claims to the AHCCCS Administration.

This manual provides guidance for fee-for-service claims and it is not intended as a substitute or replacement for a Contractor’s billing manual.

 
Grievance System Reporting Guide [WEB PAGE]
Program Integrity Reporting Guide [PDF, 27KB]
Provider Affiliation Transmission (PAT) Manual [PDF, 121KB]
Technical Interface Guidelines (TIG) [WEB PAGE]

HIPAA Companion Documents


HIPAA Companion Documents [WEB PAGE]
HIPAA 5010 Consortiums and Documentation [WEB PAGE]

AHCCCS Regulatory Information


AHCCCS Laws, Regulations and Waivers [WEB PAGE]

Reference


Rate Codes to Risk Group Matrix [PDF, 121KB]
 

Rates


AHCCCS Fee-For-Service (FFS) Rates & Codes [WEB PAGE]
 


Contact

Questions about Solicitations, Contracts & Purchasing should be directed to Meggan Harley: