AHCCCS Rate Changes


Notification of Reimbursement Option for IHS-638 Facilities

Thur Mar 15, 2012
Reimbursement Option for IHS-638 Facilities Public Notice [PDF]


FFS Rate Update Effective February 1, 2012

FFS Rate Change Public Notice [PDF]


FFS Rate Update Effective October 1, 2011

FFS Rate Change Public Notice [PDF]


FFS Rate Update Effective April 1, 2011

FFS Rate Change Public Notice [PDF]


FFS Rate Update Effective October 1, 2010

FFS Rate Update Public Notice [PDF]


FFS Rate Update Effective October 1, 2009

On September 4, 2009, Governor Brewer signed into law HB 2013 of the 49th Legislature, Third Special Session. As noted in the Public Notice below, this action results in inpatient and outpatient hospital rates frozen at their October 1, 2008 levels, and ADHS-regulated emergency ground transportation rates reduced by 5% to 76% of ADHS rates.

FFS Rate Update Public Notice [PDF]


5% FFS Reduction Effective February 1, 2009

The State of Arizona is currently facing a projected budget deficit of $1.2 billion in State Fiscal Year 2009 and an estimated shortfall of at least twice that in State Fiscal Year 2010. As part of the Governor's Budget Management Plan, the Arizona Health Care Cost Containment System (AHCCCS) proposes to revise specified Fee-For-Service (FFS) payment rates for services provided to members enrolled in the AHCCCS FFS program, the Medicaid School Based Claiming (MSBC) program and the Comprehensive Medical and Dental Program (CMDP) for dates of service on and after February 1, 2009. AHCCCS has established the "FFS Program Capped Fee Schedule" and rates contained therein will be reduced by 5%.

5% FFS Rate Reduction Announcement [PDF]

  • Inpatient Hospital Tiered per Diem Rates and Outpatient Hospital Fee Schedule
    Pursuant to Laws 2008, Chapter 288, hospital inpatient and outpatient rates will remain frozen at the October 1, 2007 values from October 1, 2008 through September 30, 2009.
  • Nursing Facilities
    FFS nursing facility rates will be adjusted by component - direct, indirect, and capital.
    • The direct component will be inflated using the Global Insight estimate of the Employment Cost Index (ECI) for total compensation for nursing and residential care facilities.
    • The indirect component will be inflated by the Global Insight estimate of the Consumer Price Index (CPI) for medical services, with an additional adjustment based on prior year cost report data.
    • The capital component will be inflated by the Global Insight estimate of skilled nursing facility total market basket capital costs net of interest.

    The estimated impact of the increases in nursing facility FFS rates on AHCCCS' FFS expenditures for federal fiscal year 2009 is an increase of 4.0%.

  • Home and Community-Based Services
    FFS home and community based service rates will be inflated by the Global Insight forecast of the Consumer Price Index for medical services rounded to the nearest $0.05. The estimated impact on AHCCCS' FFS HCBS expenditures for federal fiscal year 2009 is an increase of 4.6%.
  • Physician Fee Schedule
    The physician fee schedule rates will be updated as follows:
    1. laboratory and pathology rates, and DMEPOS rates, will be updated based on Medicare's corresponding fee schedules;
    2. rates for drugs and injectibles will be updated based on Medicare's corresponding fee schedule, except that chemotherapy drugs will continue to be based on 85% of Average Wholesale Price;
    3. all other rates will be updated based on Medicare's Resource-Based Relative Value Schedule, using conversion factors that will produce AHCCCS claims budget neutral.

    The estimated impact on AHCCCS Fee-For-Service expenditures for the period October 1, 2008 - September 30, 2009 is 0%.

  • Transportation
    1. Emergency Ground Transportation: Base rates for emergency ground transportation providers not regulated by the Arizona Department of Health Services (ADHS) will be inflated by a composite of the Global Insight forecast of the Consumer Price Index (CPI) for medical care services and the Global Insight forecast of the CPI for medical services by other medical professionals. Mileage rates will be inflated by a composite of the Global Insight forecast of the CPI for medical services by other medical professionals and a fuel index based on the increases in gasoline prices in Arizona. The estimated impact of the inflated base and mileage rates on non-ADHS-regulated FFS emergency ground transportation services for federal fiscal year 2009 is an increase of 3.57%.
    2. Non-Emergency Ground Transportation: Base rates for non-emergency ground transportation providers not regulated by ADHS will be inflated by the Global Insight forecast of the CPI. Mileage rates for non-emergency ground transportation will be inflated by a composite of the Global Insight forecast of the ECI for transportation workers and a fuel index based on the increases in gasoline prices in Arizona. Mileage rates for Arizona Long Term Care Services (ALTCS) providers of home and community based services to Native Americans will be adjusted to the IRS business mileage allowance rate. The estimated impact of the inflated base and mileage rates on non-ADHS-regulated FFS non-emergency ground transportation services for federal fiscal year 2009 is an increase of 4.63%.
    3. Emergency Air Transportation Rates: Base rates for emergency air transportation providers not regulated by ADHS will be inflated by a composite of the Global Insight forecast of the CPI for transportation services and the Global Insight forecast of the CPI for medical services by other medical professionals. Mileage rates will be inflated by a composite of the Global Insight forecast of the CPI for transportation, the Global Insight forecast of the ECI for transportation workers and the Federal Aviation Administration forecast of jet fuel prices. The estimated impact of the inflated base and mileage rates on non-ADHS-regulated FFS emergency air transportation services for federal fiscal year 2009 is an increase of 3.91%.

 

Adobe Acrobat Reader is required to view PDF files. This is a free program available from the Adobe web site. Follow the download directions on the Adobe web site to get your copy of Adobe Acrobat Reader.