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AHCCCS October 1, 2011 Rate Reductions
Tues April 3, 2012
On April 2, 2012, the Arizona Hospital and Healthcare Association (AzHHA) withdrew the
lawsuit it filed against AHCCCS and the federal government challenging the 5% rate
reductions for hospitals which became effective October 1, 2011. AzHHA's decision
to end its litigation follows the District Court’s order denying AzHHA's motion for
Preliminary Injunction and granting, in part, AHCCCS' Motion to Dismiss some of
AzHHA's claims. The 5% rate reductions will remain in place. More information is provided below.
AzHHA Notice of Dismissal 4/2/11
District Court Order re Injunction 3/23/11
District Court Order re Motion to Dismiss 3/23/11
Wed February, 8, 2012
On November 29, 2011, a lawsuit was filed by the Arizona Hospital and Healthcare Association
(AzHHA) against AHCCCS and the federal government challenging the 5% rate reductions effective
October 1, 2011. The lawsuit is currently pending before the federal District Court. More
information is provided below and will be updated as new developments occur.
AzHAA Complaint
AzHHA’s
Complaint- 11/29/11
AHCCCS Motion to Dismiss
AHCCCS Motion to Dismiss- 12/19/11
AzHHA Response to AHCCCS Motion to Dismiss- 1/3/12
AHCCCS Reply to Motion to Dismiss- 1/10/12
AzHAA Motion for Preliminary Injunction
AzHHA Motion for Preliminary Injunction- 12/14/11
CMS Response to Motion for Preliminary Injunction 1/10/12
AHCCCS Response to Motion for Preliminary Injunction- 1/26/12
AzHHA Reply to Motion for Preliminary Injunction- 2/6/12
Declaration of AHCCCS Director (Exhibit to AHCCCS Response to Preliminary Injunction)
Declaration of AHCCCS Director- 1/26/12
Tues November 22, 2011
CMS has approved the State Plan Amendments to reduce Reimbursement Rates by
5%. CMS has also approved the State Plan Amendment update the payment methodology for
paying inpatient hospital claims with extraordinary operating costs. Click on the
links below to view the CMS approval letters:
SPA Approval 11-009A - Inpatient Hospital Rates
SPA Approval 11-009B - Outpatient Hospital Rates
SPA Approval 11-009C - Rate Reductions
SPA Approval 11-009D - Nursing Facility Rates
SPA Approval 11-011- Outlier
Wed October 19, 2011
AHCCCS is providing information on the status of the October 1, 2011, rate reductions.
Click on the link for additional information and continue to check the AHCCCS website for
updates.
AHCCCS Rate Update [10KB]
Tues. May 24, 2011
Laws 2011, Chapter 31, gives AHCCCS authority to reduce rates for all providers up
to 5%. Effective October 1, 2011, AHCCCS will reduce all provider reimbursements by 5%,
including all payment ratios utilized for provider reimbursement (e.g., all Cost-to-Charge
Ratios (CCRs), By Report Percentages (BR), etc.). The only exceptions are for:
- Drugs administered in a physician's office
- Hospice rates - AHCCCS matches Medicare rates as required by Federal law.
- Payments for services provided by the Indian Health Service or Tribal 638
facilities claimed at 100% FMAP.
For more detail regarding the Provider Rate Reductions, please click on the links provided below:
Outlier Proposed Rule [68KB]
State Plan Amendments
Access to Care Studies, Memos and Additional Information
AHCCCS Comments on CMS Access to Care Proposed Rule
Notice of Public Information
Materials from
Hospital Meeting 8/15
[166KB]
DDD Provider
Meeting 9/9* [60KB]
Info for DDD Families
[20KB]
Additional information, such as the Notice of Exempt
Proposed Rulemaking and State Plan Amendment to CMS will be posted
on the web as it becomes available.
*AHCCCS met with a small group representing providers of
services to AHCCCS members enrolled in the Division of Developmental
Disabilities (DDD) to learn more about their concerns regarding rate
reductions. This presentation was shared with the group.
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Proposal to Provide Funding Assistance to Hospitals
April 6, 2012
On Friday, April 6, 2012, AHCCCS received approval under Arizona's Section 1115 Waiver, to move
forward with two new programs critical to Arizona’s safety net healthcare delivery system – the
Safety Net Care Pool and the Indian Health Services/tribal 638 facilities supplemental payment
program. See the links below for additional information.
Governor's Announcement
Waiver Amendment Fact Sheet
SNCP Information
KidsCare II Information
I.H.S./638 Information
Prop 202 Options
Mon Nov 28, 2011
Governor Brewer and area hospitals propose to use local dollars to fund uncompensated care and
hospital improvements. The proposal is pending before CMS. Click on the link below for more
information (See item #15):
Funding Pools Proposal [1.09MB
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340B Pricing Update
March 12, 2012
Beginning April 11, 2012, AHCCCS is implementing changes to the reimbursement methodology
for FQHC and FQHC Look-Alike pharmacies. For additional information, please click on the
link below.
Pharmacy Updates
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Payment Reform Pilot Program
Wed November 16, 2011
AHCCCS is pleased to announce the Payment Reform Pilot Program. Under the program, AHCCCS
can reimburse for a specific service array that drives quality over quantity and furthers
cost control improvements. More information can be found in the link below:
Payment Reform Information [22KB]
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AHCCCS Integration
Mon Sept 26, 2011
As part of Arizona's Medicaid Reform Plan, AHCCCS is reviewing opportunities to further
integrate care. The link below has more information.
AHCCCS Integration Page
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2011 Benefit Changes
Tues April 17, 2012
CMS approved SPA #11-012, which establishes a 25-day annual inpatient limit effective
October 1, 2011. The limit applies to adults age 21 and older. See the link below for the
CMS approval package.
SPA 11-0012
Fri. Jul 22, 2011
As part of Arizona's Medicaid Reform Plan, AHCCCS will be making changes to the benefit
package, effective October 1, 2011, unless otherwise indicated. More information is provided below.
2011 Benefits
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Community Forums
Wed May 18, 2011
AHCCCS will hold a number of public meetings over the next few months to provide updates
on various aspects of
Arizona’s Medicaid Reform Plan. Specific information is provided in the link below.
Community Forums
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Revised Waiver Proposal
Thurs Mar 31, 2011
On March 31, 2011, AHCCCS submitted a revised Waiver Demonstration proposal to CMS incorporating
provisions of the Governor's Medicaid Reform Plan. Waivers from various federal requirements are
needed for flexibilities that will allow the State to manage its Medicaid program within budgetary
constraints. The links below have more information including the proposal, how to submit comments
about the proposal and public hearings about the proposal.
Waiver Information
Estimated Impact Data [17KB]
Public Meeting Notice
Tues Mar 15, 2011
In response to a number of requests, AHCCCS is providing details related to the medical
utilization and costs of the expansion groups- including Waiver and Proposition 204 populations.
Summary
Data Narrative and Detail
