Building an Integrated Health Care System and Improving Care Coordination
Today’s health care system is a series of parts not yet connected to each other. Improving care coordination and communication, while reducing fragmentation, weaves these parts together to create a health care system with more effective outcomes. AHCCCS continues to integrate the care delivery systems and align incentives that are designed to transform the structure of the Medicaid program, improve health outcomes, and better manage limited resources.
- 2021-2022 AHCCCS Integrated Delivery System Chart of Programs
- 2022-2023 AHCCCS Integrated Delivery System Chart of Programs (as of 10/01/2022)
The Department of Economic Security/Division of Developmental Disabilities (DES/DDD) provides health care to eligible DDD members through the Arizona Long Term Care System (ALTCS).
Starting October 1, 2019, behavioral health service responsibility for these enrolled members will transition from the Regional Behavioral Health Authorities (RBHAs) to integrated health plans contracted with DDD (DDD Health Plans). This transition will include members with a designation of Serious Mental Illness (SMI). These DDD Health Plans will also provide services for DDD members with qualifying Children’s Rehabilitative Services (CRS) conditions.
Improving Behavioral Health and Physical Health Care Coordination for Individuals with a Serious Mental Illness Designation
On October 1, 2022, AHCCCS is updating its contracts with Managed Care Organizations (MCOs) for health insurance coverage for individuals with a Serious Mental Illness (SMI) designation. Select AHCCCS Complete Care (ACC) Contractors will have expanded responsibilities as an ACC Contractor with a Regional Behavioral Health Agreement (ACC-RBHA). The ACC-RBHAs will be responsible for the provision of integrated care addressing physical health and behavioral health for members with an SMI designation. AHCCCS will continue to work collaboratively with the ACC-RBHAs to evaluate methods to reduce program complexity, administrative burden, and unnecessary administrative and medical costs; and to improve care coordination and disease/chronic care management. Learn more about these changes.
Medicare and Medicaid Alignment for Dual Eligibles: Alignment Makes a Difference
Medicare presents one of the greatest challenges to states serving individuals dually eligible for Medicaid and Medicare. Medicare is its own distinct, complex system of care operated by the federal government with little to no interface with state Medicaid programs. For the over 150,000 Arizonans that are eligible for both Medicare and Medicaid, navigating these two separate systems of care can be overwhelming. Under these circumstances, its more likely for people to fall through the cracks, receive inefficient care, and not achieve optimal health outcomes. See the Dual Eligible Members web page to learn how AHCCCS is aligning these systems.
Simplifying the System of Care for Children with Special Health Care Needs: Children’s Rehabilitative Services (CRS)
Children’s Rehabilitative Services (CRS) was started in 1929 to serve children with complex health care needs who require specialized services. Services for the treatment of CRS qualifying conditions were previously managed solely through the CRS program. Medicaid members would then have to access routine or other non-CRS specialty physical health care through their AHCCCS acute plan and behavioral health through the RBHA. For children that were Medicare eligible, the family had one additional hurdle. Arizona families attempting to care for their child with special health care needs was being asked to navigate up to four systems of care. See the CRS web page to learn how AHCCCS is aligning these systems.
AHCCCS has partnered with state and county governments to improve coordination within the justice system and create more cost effective and efficient ways to transition people leaving the criminal justice system. A significant number of men, women and children transitioning out of jail and prison into communities are in need of services for behavioral health and physical health conditions. Many of these individuals are eligible for Medicaid.
To facilitate this transition, AHCCCS is engaged with the Arizona Department of Corrections Rehabilitation and Reentry (ADCRR) and most Arizona counties covering the majority of the State’s population, including the two largest – Maricopa and Pima – in a data exchange process that allows AHCCCS to suspend eligibility upon incarceration, rather than terminate coverage. This exchange also allows ADOC and counties to electronically send discharge dates, which simplifies the process of transitioning directly into care. Through this enrollment suspension process, care can be coordinated by county jails or prisons upon discharge. To support this, all RBHAs are contractually required to have a justice systems contact that can ensure a connection to needed behavioral health services. In addition, AHCCCS medical management coordinates with counties to facilitate a transition to care into acute health plans for persons being discharged with serious physical illnesses, such as cancer or other illness, that present public health concerns or require immediate attention. More information will be posted soon.