AHCCCS Initiatives and Best Practices
AHCCCS has several initiatives and best practices underway aimed at building a more cohesive and effective health care system in Arizona by reducing fragmentation, structuring provider reimbursements to incentivize quality outcomes, leveraging health information technology and working with private sector partners to further innovation to the greatest extent. This page highlights ongoing initiatives and best practices with links to more detailed information and will be updated as more information becomes available.
Accessing Behavioral Health in Schools
AHCCCS is partnering with the Arizona Department of Education and others to ensure students who are Medicaid eligible can receive behavioral health services in school settings. For more information: BHS Webpage.
Building A Health Care System: Care Coordination and Integration
Today’s health care system is a series of parts not yet connected to each other. AHCCCS has various initiatives designed to improve care coordination and communication while reducing fragmentation to weave these series of parts together. Learn more about Care Coordination and Integration.
Electronic Visit Verification
Pursuant to Section 1903 of the Social Security Act (42 U.S.C. 1396b), AHCCCS mandated Electronic Visit Verification (EVV) for non-skilled (attendant care, personal care, homemaker, habilitation, respite) and in-home skilled nursing services (home health) services on January 1, 2021. In addition to the legislative intent of EVV to prevent, detect, and recover improper payments due to fraud, waste and abuse, AHCCCS is using EVV to help ensure, track, and monitor timely service delivery and access to care for members receiving services in their homes or community, including real-time service gap reporting and monitoring. For more information visit the EVV Webpage.
Emergency Triage, Treat and Transport to Transform EMS Delivery
The Emergency Triage, Treat and Transport initiative (ET3) is a voluntary, five-year CMS Innovation Center Payment Model designed to provide greater flexibility to ambulance care teams addressing emergency healthcare needs. The goal of this program is to decrease unnecessary transports to emergency departments and reduce hospital admissions while simultaneously connecting members with the appropriate level of care, at the right time and at the right place, in order to improve quality and reduce costs. AHCCCS began reimbursing qualified emergency transportation providers for providing ET3 services on and after October 1, 2021. Learn more about ET3.
AHCCCS Housing Programs
The AHCCCS’s Housing Programs (AHP) consists of the Permanent Supportive Housing and housing support programs. The majority of AHCCCS available housing funding is reserved for members with a designation of Serious Mental Illness (SMI), although limited housing is provided for some individuals without an SMI designation, but still considered having General Mental Health/Substance Abuse Disorder (GMH/SUD) needs. For persons with GMH/SUD needs, housing priority is focused on persons identified with increased service utilization including crisis or emergency services and/or services addressing complex chronic physical, developmental, or behavioral conditions. For a limited number of units within the program, eligibility is further based upon receipt of specific behavioral health services such as an Assertive Community Treatment (ACT) Team. Learn more about AHCCCS Housing Programs.
Health Equity Committee
Formally established in July 2020, the Health Equity Committee is tasked with understanding health disparities and developing strategies to ensure health equity for all AHCCCS-eligible individuals and members. This committee is responsible for overseeing and managing recommendations as they relate to policy, data, health plan oversight and emerging health care innovation strategies for over 2 million Arizonans. Learn more about Health Equity Committee.
Incentivizing Quality: Payment Modernization
Modernizing the way health care services are purchased means rethinking the end product. Today’s reimbursement structure favors the provider with higher production numbers. In order to bend the cost curve, there must be a paradigm shift such that reimbursement favors the provider who achieves a quality health outcome. Learn more about Payment Modernization.
Improving Communications: Health Information Technology
The State Medicaid Health Information Technology Plan (SMHP) describes the Agency’s historical, current, and future efforts to improve health outcomes by leveraging electronic health record (EHR) deployment, adoption, and use by providers. In addition, AHCCCS continues to be an active participant in the Health Information Network of Arizona (HINAz), Arizona’s Health Information Exchange. Learn more about Health Information Technology.
Connecting Communities: The Importance of Private Sector Partners
The AHCCCS program was founded upon a competitive, public/private partnership model. AHCCCS began in 1982 as the first statewide mandatory managed care program, placing all enrollees (except American Indians/Alaska Natives) in private health plans for acute care, long term care and behavioral health (known as Regional Behavioral Health Authorities). Medicaid managed care has evolved and answered the call toward continued innovation and population health strategies. Learn more about Private Sector Partners.
Delivering health care services through telehealth provides an alternative way for AHCCCS members to see their healthcare providers. AHCCCS covers all major forms of telehealth technologies and holds ongoing discussions with our contracted managed care health plans, providers including IHS/638 facilities, and members to determine how telehealth should be leveraged to serve our members and improve healthcare outcomes. Learn more about Telehealth Services.
Transforming Health Care Delivery: Targeted Investments Program
The Targeted Investments (TI) Program provides financial incentives to eligible AHCCCS providers to develop systems that integrate and coordinate physical and behavioral health care. The TI Program aims to reduce fragmentation that occurs between acute care and behavioral health care; increase efficiencies in service delivery for members with behavioral health needs, and improve health outcomes for the affected populations. Learn more about Targeted Investments.