YH14-0001 - Acute Care/CRS RFP Information

As of March 22, 2013, the Bidders’ Library will no longer be maintained. Refer to the corresponding section of the AHCCCS website for updates to the AHCCCS Contractor Guides & Manuals.
Acute/CRS RFP YH14-0001 To access RFP award information, click the Procurement File link below.
Procurement File Page – YH14-0001

The Bidders’ Library is a site to assist Offerors with information and resources regarding the Acute/CRS RFP. The information in the Bidders’ Library is not intended to be comprehensive. It is the responsibility of the Offeror to obtain and review all pertinent information relating to the Acute/CRS RFP.

This information may be downloaded in two ways:

  1. Download Entire YH14-0001 Library [25.7 MB]
  2. Download Individual Files from this page.
January 18, 2012 Public Meeting  
Fact Sheet  
Public Meeting Presentation  
Items of Interest  
AHCCCS Acute Care/CRS RFP Schedule [Posted 11/27/12, 24KB]
Major Decisions as of October 9, 2012  
Medicare Major Decisions as of October 9, 2012  
Major Decisions as of August 27, 2012  
Major Decisions as of July 19th, 2012  
AHCCCS Hospital Inpatient Reimbursement Methodology
information located at: AHCCCS Hospital Payments
 

The Acute CYE’09, CYE’10 and CYE’11 risk adjustments white papers, documenting the risk adjustment approach, have been posted to the AHCCCS website at the following location: Acute Care Capitation Rates

 
Surveys  
Information on several topics regarding the Acute/CRS RFP.  
Acute/CRS RFP Results (Closed 07/30/12)  
Input from physical and behavioral health care
providers regarding care coordination for the non-Seriously
Mentally Ill population.
 
Coordination of Care Survey (Closed 08/07/12)  

Note: Information posted after the initial release of the Bidders’ Library will be noted with a button and the date the information was added. After five days the button will be removed.

Solicitation Amendments Solicitation Amendments  
Solicitation Amendment #1 Q & A [Posted 11/27/12, 267KB]
Signed Solicitation Amendment Signature Page [Posted 11/27/12, 39KB]
Solicitation Amendment #2 Q & A [Posted 12/19/12, 433KB]
Signed Solicitation Amendment Signature Page [Posted 12/20/12, 77KB]
Solicitation Amendment #3 Q & A [Posted 01/04/13, 111KB]
Signed Solicitation Amendment Signature Page [Posted 01/04/13, 79KB]
Solicitation Amendment #4 with Signature
Page
 
[Posted 01/10/13, 194KB]
Solicitation Amendment #5 with Signature
Page
[Posted 01/24/13, 104KB]
     
Sections
A, B and C:
 
Solicitation Page, Capitation Rates and Definitions  
  Solicitation Page, Capitation Rates and Definitions [173KB]
     
Section D:     Program Requirements  
D1 Acute Care Program Requirements [650KB]
D2 CRS Program Requirements [645KB]
     
Section E:     Contract Terms and Conditions  
E1 Acute Care Program Contract Terms and
Conditions
[141KB]
E2 CRS Program Contract Terms and Conditions [140KB]
     
Section F:         Attachments  
Attachment A1 Enrollee Grievance System Standards [49KB]
Attachment A2 Provider Claims Dispute Standards [27KB]
Attachment B1 Acute Care Program Contractors’
Chart of Deliverables
[99KB]
Attachment B2 CRS Program Contractor’s Chart of
Deliverables
[90KB]
     
Section G:     Representations and Certifications of Offeror  
Representations and Certifications [94KB]
Disclosure Information Templates [39KB]
     
Section H: Instructions to Offerors  
Instructions to Offerors [195KB]
     
Section I:         Exhibits  
Exhibit A Offeror's Checklist  [45KB]
Exhibit B Minimum Subcontract Provisions  [106KB]
Exhibit C Attestation Form [58KB]
Exhibit D Medicare Requirements [61KB]
Notification of Overdue Certifications [Posted 01/29/13, 18KB]
     
Introduction [Posted 11/27/12, 25KB]
Provisions [Updated 01/29/13, 28KB]
Calendar [Updated 12/19/12, 33KB]
Q & A Process Provisions [Posted 01/23/13, 28KB]
Q & A Template [Posted 01/23/13, 24KB]
Q & A files are available for download on the AHCCCS SFTP server   [EFT updated 02/08/13]
Questions & Responses Summary  [Updated 02/08/13, 237KB]

Notification to Offerors regarding Oral Presentation: A memorandum notifying each Offeror of the date and time scheduled for the Oral Presentation has been emailed to the contact person & email listed on the Offeror’s Notice of Request for Proposal Solicitation Signature page. In addition, the notification memorandum is also available for download in the Offeror’s AHCCCS EFT/SFTP folder. [Posted 01/31/13]

List of RFP Offerors [Updated 01/31/13, 16KB]
Enrollment Map [32KB]
Instructions to Electronic File Transfer - Secured File Transfer Protocol [Reposted 11/14/12, 25KB]

Data provided to Offerors through the secure EFT/SFTP server is derived from protected health information that is not considered “de-identified” as that term is defined in the federal Health Information Privacy Rule. While the Rule allows release of this information to health plans that are also potential Offerors, it is not being made available to the general public. Offerors are advised to take appropriate steps to maintain the confidentiality of the information. The Instructions attached above notify Offerors of the process for accessing the secure server. The External User Affirmation Statement included in these Instructions clearly delineates appropriate use of the AHCCCS data.

[Posted 11/08/12]
Conference Information   [Posted 11/06/12, 19KB]
Prospective Offerors' Conference Presentation Materials  
Prospective Offerors’ Conference Agenda [Posted 11/08/12, 60KB]
Prospective Offerors’ Conference Presentation
11/13/12 Note: Date correction made on slide 78, New Items Related
to Technology.
[Posted 11/08/12,1.8MB]
Prospective Offerors' Technical Interface Meeting Presentation Materials
Prospective Offerors' Technical Interface Meeting Agenda [Posted 11/09/12, 63KB]
Prospective Offerors' Technical Interface Meeting Presentation
[Posted 11/09/12, 387KB]
Conference Attendance  
Prospective Offerors' Conference Attendance [Posted 11/09/12, 1.4MB]
Prospective Offerors' Technical Interface Meeting Attendance [Posted 11/09/12, 673KB]

AHCCCS members who are also enrolled in Medicare are referred to as dual eligible. In an effort to improve care coordination for AHCCCS dual eligible members, AHCCCS will require all Acute plans to be organizations that manage and provide Medicare benefits to dual eligible members in all GSAs they hold a contract. Contractors will be required to meet the Medicare requirement either through the CMS Capitated Financial Alignment Demonstration or as Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) if AHCCCS does not finalize a Demonstration contract with CMS. Below is further information and resources.

AHCCCS Duals Page
Acute/CRS RFP Medicare Major Decisions [16KB]
CMS Memo Notice of Intent to Apply (NOIA) Information [143KB]
AHCCCS Policy Contracting with Special Needs Plans [62KB]
Acute Duals Enrollment by County [Posted 12/06/12, 12KB]
CMS Capitated Financial Alignment Demonstration Information

The Financial Alignment Demonstration seeks to better serve people who are enrolled in both Medicare and Medicaid by testing a person-centered, integrated care model that provides a more easily navigable and seamless path to all Medicare and Medicaid services. Expected outcomes include: improved beneficiary experience of care, fewer avoidable hospitalizations and emergency room visits, and greater independence in the community and at home for seniors and people with disabilities.

 
Arizona's Demonstration Proposal [830KB]
July 08, 2011 - State Medicaid Director Letter [Posted 11/14/12, 214KB]
January 25, 2012 - CMS Guidance [Posted 11/14/12, 323KB]
March 29, 2012 - CMS Guidance [Posted 11/14/12, 807KB]
CMS - 2013 Capitated Financial Alignment Demonstration Application [Posted 11/14/12, 1MB]
Joint Rate Setting Process Under the Capitated Financial Alignment Initiative [Posted 11/14/12, 300KB]
CMS Medicare Advantage Special Needs Plan Information [CMS link posted 11/14/12]

Dual Eligible SNPs (D-SNPs) enroll beneficiaries who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid.

 
CMS - 2013 Medicare Advantage Application Information [CMS link posted 11/14/12]
Medicare Managed Care Manuals [CMS link posted 11/14/12]
Medicare Managed Care Manual - Chapter 16B: Special Needs Plans [CMS link posted 11/14/12]

Draft Policies (Watch for Updates to Draft Policies)

Note: Draft policies with an existing policy number will be effective as noted on the policy, and will replace current policies with the same number.

AMPM

Policy 310-B  - Behavioral Health Services [439KB]
Policy 310-V - Prescription Medication/Pharmacy Services [329KB]
Policy 330 - Covered Conditions and Services for the Children's
Rehabilitative Services (CRS) Program
[655KB]
Policy 400 - Medical Policy for Maternal and Child Health -
Chapter Overview
[3MB]
Policy 520 - Member Transitions [466KB]
Policy 540 - Other Care Coordination Issues [472KB]
Policy 560 - CRS Care Coordination and Service Plan (SP)
Management
[197KB]
Policy 900 - Quality Management and Performance
Improvement Program - Chapter Overview
[442KB]
   

ACOM

Note: Clean versions of the Draft Policies have been posted below replacing previously posted redline versions.

New Policy, Chapter 300 - Auto-Assignment Algorithm [Posted 11/20/12, 159KB]
New Policy, Chapter 300 - Acute Program Payment Reform
Initiative  
[To be posted 04/01/13, 01/10/13]
New Policy, 302-I - Prior Period Coverage Reconciliation [Posted 11/16/12, 177KB]
New Policy, 302-I - Prior Period Coverage Reconciliation - Attachment A   [Posted 11/16/12, 17KB]
Policy 304 - Premium Tax Reporting [Posted 11/16/12, 157KB]
Policy 304 - Premium Tax Reporting - Attachment A [Posted 11/16/12, 29KB]
Policy 305 - Performance Bond and Equity Per Member
Requirements
[Posted 11/16/12, 162KB]
Policy 306 - Performance Bond [Posted 11/16/12, 346KB]
Policy 311 - Acute Program Tiered Prospective Reconciliation [Posted 11/16/12, 184KB]
Policy 311 - Acute Program Tiered Prospective Reconciliation -
Attachment A
[Posted 11/16/12, 25KB]
Policy 312 - CRS Program Tiered Reconciliation   [11/16/12, 181KB]
Policy 312 - CRS Program Tiered Reconciliation -
Attachment A 
[11/16/12, 21KB]
New Policy, Chapter 400 - Acute Network Standards [Posted 11/16/12, 429KB]
New Policy, Chapter 400 - Coordination of Benefits/Third Party
Liability
 
[Updated 01/10/13, 185KB]
New Policy, Chapter 400 - Telephone Performance Standards
Measurement and Reporting
[Posted 11/16/12, 185KB]
New Policy, Chapter 400 - Telephone Performance Standards
Measurement and Reporting - Attachment A
[Posted 11/16/12, 17KB]
Policy 404 - Member Information   [Updated 02/07/13, 715KB]
Policy 412 - Claims Reprocessing [Posted 11/16/12, 210KB]
Policy 415 – Provider Network Development and Management
Plan
[Posted 11/16/12, 667KB]
Policy 417 - Appointment Availability Monitoring and Reporting [Posted 11/16/12, 316KB]
Policy 426 - Eligibility Reviews for CRS Applicants and
Referrals
[Updated 02/07/13, 215KB]
Policy 427 - CRS Contractor No-Show   [Posted 11/16/12, 78KB]
Policy 433 - Member Identification Cards [Posted 11/16/12, 178KB]
   

Current ACOM Policies Expiring as of October 1, 2013

Chapter 400  
Policy 409 - Intra-Agency Care Coordination for Services  
Policy 428 - CRS Service Authorization Process  

Current Policies

AHCCCS Contractors Operations Manual (ACOM)
AHCCCS Medical Policy Manual (AMPM)
Section A: Data Supplement Instructions and Overview [18KB]
     
Section B:   Program and Fee Schedule Changes  
Program and Fee Schedule Changes [Posted 11/07/12,  2.7MB.]
     
Section C:           Data Book Information  
Data Book Introduction [39KB]
Data Book Layout/File Description   [Posted 11/16/12, 141KB]
Details of Updated CRS Data Book Files [Posted 11/29/12, 141KB]
Data Book Files [Acute Care Bid Files posted via EFT
[11/16/12, CRS Bid Files updated via EFT 11/29/12]
Rate Setting Document [Posted 12/14/12, 228KB]
Supplemental Data Book Reports [Updated 12/20/12, 117KB]
Note: A new posting date will be noted whenever this document has been updated.
 
Section D: Service Matrix/Selection Criteria for Data Book  
Introduction [20KB]
Acute Care/CRS Service Matrix [Updated 12/14/12, 40KB]
Behavioral Health Services Service Matrix [35KB]
Crosswalk Acute Care Service Matrix to
Capitation Bid Template
[Posted 12/14/12, 185KB]
 
Section E: AHCCCS Category of Service, Form Types,
Provider Type List of Codes and Descriptions
Introduction [10KB]
AHCCCS Categories of Service Codes [23KB]
Definition of Form Types [15KB]
AHCCCS Provider Types [30KB]
     
Section F: Bid Submission Information
Note: See RFP Section H, Instructions to Offerors, Paragraph 16.C. Capitation
 
Bid Template Overview [Posted 11/19/12, 345KB]
Capitation Bid Templates [EFT posted 11/19/12]
Acute Care Medical Component Ranges
and CRS Rates
[Posted 12/14/12, 192KB]
     
Section G: Crosswalk from Service Matrix to Financial Statements  
Introduction [14KB]
Crosswalk Acute Care/CRS-Service Matrix
to Financial Statements
[27KB]
Crosswalk BHS Service Matrix to Financial
Statements
[25KB]
     
Section H: Enrollment Information
Introduction [24KB]
H-1 Enrollment by County by Contractor [EFT]
H-2 Report Acute Care Enrollment Activity [EFT]
H-3 Enrollment by Month
(Historical and Projected)
[EFT]
H-4 AHCCCS Members Count By Zip Code [EFT]
   
Section I: Risk Adjustment Information
Introduction [Posted 11/13/12, 77KB]
CYE 09 Risk Adjustment Whitepaper [Posted 11/13/12, 1MB]
CYE 10 through CYE13 Risk Adjustment
Methodologies
[Posted 11/13/12, 102KB]
Proposed CYE 14 and CYE 15 Risk
Adjustment Methodologies
[Posted 11/13/12, 77KB]
Risk Factors [Posted 11/13/12, 13KB]
Diagnosis Percentages by Form Type [Posted 11/13/12, 25KB]
     
Section J: Financial Information for Prospective Members  
Introduction [19KB]
Acute Care Financial Information [EFT]
CRS Financial Information [EFT]
Section K:   Capitation Rates  
Capitation Rates
     
Section L: Birth to Member Month Analysis  
Introduction [17KB]
Birth to Member Month Analysis [EFT]
   
Section M: Reinsurance Information  
Introduction [21KB]
Reinsurance Payments [40KB]
Reinsurance Offsets   [23KB]
     
Section N: Hospital Rate Overview  
Introduction [9KB] (contains link)
Outlier Cost Thresholds [Posted 12/18/12, 179KB]
     
Section O: Contractor Audited Financial Statements
Introduction [13KB] (contains link)
     
Section C: Data Book Files [Acute Care Bid Files updated via EFT 12/20/12,
CRS Bid Files updated via EFT 12/20/12, 12/21/12]
Section F: Capitation Bid Templates [Posted 11/19/12 via EFT.]
Section H: H-1 Enrollment by County by Contractor  
H-2 Report Acute Care Enrollment Activity [EFT]
H-3 Enrollment by Month (Historical and Projected) [EFT]
H-4 AHCCCS Members Count By Zip Code [EFT]
   
Section J: Acute Care Financial Information [EFT]
CRS Financial Information [EFT]
     
Section L: Birth to Member Month Analysis [EFT]
Draft AHCCCS Financial Reporting Guides and Templates for CYE 14
Acute Care Contractors  
Draft Reporting Guide [Posted 12/14/12, 1.6MB]
Draft Reporting Template [Posted 12/14/12, 237KB]
CRS Contractor  
Reporting Guide [12/20/12, 2MB]
Reporting Template [Posted 12/20/12, 204KB]
Revenue and Expense Statement
Mapping Guidelines
[Posted 12/20/12, 43KB]
Draft Claims Dashboard Reporting Guide/Template-CYE 14 [To be revised after 10/01/13.
See existing Claims Dashboard Reporting Guide/Template 11/29/12.]
Draft Reinsurance Reporting Guide
(Effective 10/01/13)
[Posted 12/20/12, 2MB]
   
Acute Health Care Contractors Financial Reporting Guidelines [WEB PAGE link posted 12/12/12]
Claims Dashboard Reporting Guide [47KB]
Claims Dashboard Reporting Template [243KB]
Encounter Data Validation Technical Document [78KB]
Encounter Reporting User Manual
Fee-for-Service Provider Manual  

The Fee-For-Service Provider Manual is a publication of the Arizona Health Care Cost Containment System (AHCCCS), Claims Department, Division of Fee-for-Service Management. The Claims Department also publishes Claims Clues as a supplement to the manual.

The intent of this manual is to furnish providers’ billing staff and contracted billers with information about AHCCCS, coverage of specific services, and requirements for completion and submission of fee-for-service claims to the AHCCCS Administration.

This manual provides guidance for fee-for-service claims and it is not intended as a substitute or replacement for a Contractor’s billing manual.

 
Grievance System Reporting Guide
Program Integrity Reporting Guide [27KB]
Provider Affiliation Transmission (PAT) Manual [121KB]
Technical Interface Guidelines (TIG)

Contact

Questions about Solicitations, Contracts & Purchasing should be directed to Meggan LaPorte: