ARP Provider Payment Information 2024 (Updated 02/21/2024)

In its American Rescue Plan (ARP) Act Home and Community Based Services (HCBS) spending plan, AHCCCS received federal approval to allocate almost $1.3 billion over three years in one-time provider payments to recruit and retain a knowledgeable and well-trained workforce. This amount is subject to change pending additional modifications made to the HCBS Spending Plan. These time-limited payments will be made in State Fiscal Years (SFY) 2022, 2023, and 2024. AHCCCS intends to conclude the time-limited ARP payments with a 2024 final payment in the spring of 2024.

The SFY 2024 provider payments total more than $387 million and will be paid by the AHCCCS managed care organizations (MCOs) and the fee-for-service (FFS) administration to providers serving members enrolled in all AHCCCS programs who are active providers in good standing. Of note, the Department of Economic Security/Division of Developmental Disabilities (DES/DDD) will make direct payments to its contracted providers using a methodology similar to that used by AHCCCS. Providers should also note that the SFY 2024 payments may be different from the SFY 2023 payments.

These payments outlined below are meant to be a FINAL one-time directed payment for HCBS and Rehabilitation providers. AHCCCS will not continue this funding in the future.

The AHCCCS managed care provider payments, called “directed payments,” will be computed by applying a flat percentage rate to eligible providers’ prior Title XIX Medicaid payments from a specified time period for select ARP qualifying codes. For SFY 2024, key components of calculations are included below:

  • The flat percentage is 15%,
  • The specified time period is dates of service from October 1, 2022 through March 31, 2023. The six months of data will be doubled to approximate a full year of payments, and
  • There are nearly 70 qualifying procedure codes summarized by category.

Approximately 1,900 AHCCCS managed care providers are expected to qualify for the final SFY 2024 payments. Based on this significant number of impacted providers, and the application of nearly 70 procedure codes, only approved and adjudicated encounters in the AHCCCS database will be utilized in the computations. AHCCCS will not consider any other data when computing payments, including validation or verification of provider computations. Provider payments may be made by multiple MCOs and involve multiple transactions in the same proportion that claims payments from the specified period were received.

Approximately 3,000 provider agencies will receive the final directed payments from DES/DDD utilizing a similar methodology, though the percentage rate applied to prior Medicaid payments will vary by service category.

Working within federal and state guidelines, AHCCCS has developed the methodology for making time- limited payments to fee-for-service (FFS) providers. FFS provider payments will utilize the same ARP qualifying services as those identified for the AHCCCS managed care Directed Payments for eligible providers. Both non-Indian Health Service /638 tribal (IHS/638) providers, and IHS/638 providers, could be eligible for payment.

ARP Directed Payment Provider Guidance 2024

Guidance regarding ARP provider payments as authorized by Laws 2022, Second Regular Session, Chapter 2 and the Centers for Medicare and Medicaid Services (CMS) through 438.6(c) is available at the links provided below. To the extent that CMS requires changes to the payment methodology and/or process, this guidance may be updated.

The SFY 2024 payments outlined below are meant to be a FINAL one-time directed payment for HCBS and Rehabilitation providers. AHCCCS will not continue this funding in the future.

The Provider Directed Payment Guidance available at the link below is for all lines of business, except ALTCS-DD. The DES/DDD issued its own guidance and requirements for ALTCS-DD providers, which can be found on the DDD ARP web page.

As outlined in this AHCCCS guidance, there are requirements regarding how the funds are to be utilized. Eligible providers must attest that they will follow these guidelines. The eligible providers included in the Individual Eligible Providers with NPI (Non-DDD and DDD Subcontracted Health Plan) list (link below) are providers contracted through the MCOs. Please note that providers AHCCCS determines are ineligible for payments will be excluded, either before or after attestation.

AHCCCS has developed a similar process for providers reimbursed through the FFS program. Providers who serve both MCO and FFS members will be required to complete two attestations. One related to MCO payments and a second related to FFS payments. For Fee-for-Service providers, AHCCCS intends to distribute the FINAL ARP SFY 2024 funds no later than May 31, 2024. Providers will be required to complete a SFY 2024 attestation prior to distribution of any FINAL SFY 2024 payments. The FFS attestation will be posted to the AHCCCS website in Quarter 2 of 2024. Guidance for FFS providers will be provided at a later date.

ARP Provider Payment Resources 2024

Provider questions about ARP Directed Payments can be emailed to: AHCCCSARPADIRECTEDPAYMENTS@mslc.com