Targeted Investments Program Overview
The Targeted Investments (TI) Program is AHCCCS’ strategy to provide financial incentives to eligible AHCCCS providers to develop systems for integrated care. In accordance with 42 CFR 438.6(c) and the 1115 Waiver, managed care plans will provide financial incentives to eligible Medicaid providers who meet certain benchmarks for integrating and coordinating physical and behavioral health care for Medicaid beneficiaries. The TI Program aims to:
Targeted Investments Program Requirements
Participants are responsible for notifying AHCCCS, Targeted Investments, and contracted Health Plans with any changes to their participating sites. AHCCCS is not responsible for a reduced TI incentive payment as a result of the participant’s failure to timely update these entities.
Participants can update AHCCCS Provider Enrollment through the new AHCCCS Provider Enrolment Portal (APEP).
Participants can notify Targeted Investments by completing this “Report A Change” form.
Participants must contact their provider representatives to ensure changes are communicated and processed for each contracted Health Plan. TI-PCP participants are encouraged to request assigned membership to be moved as appropriate.
The Targeted Investments team partnered with Arizona’s HIE (Contexture) to host a Town Hall on 10/15/2021. Please view the slide deck or watch the recording for brief updates on TI anticipated payment timelines, upcoming TI Year 6 requirements, the TI 2.0 Proposal, the latest HIE Service Releases (including Mental Illness Hospital Alerts) and HIE Data Availability!
- Primary Care Provider Eligibility Requirements: To participate in the TI Program, Primary Care Provider sites must have a minimum threshold of assigned AHCCCS members across all health plans with which they are contracted, must attest to a) having an Electronic Health Record (EHR) which has the ability to exchange and use electronic health information from other systems without special effort on part of the user and b) having completed a Behavioral Health integration assessment using one of the AHCCCS-specified tools (Pre-Application Self Assessment)
- Behavioral Health Provider Eligibility Requirements: To participate in the TI Program, Behavioral Health providers must have delivered an AHCCCS-defined minimum number of qualifying outpatient services to members during a recent 12-month period, must attest to a) having an Electronic Health Record (EHR) which has the ability to exchange and use electronic health information from other systems without special effort on part of the user and b) having completed a behavioral health integration assessment using one of the AHCCCS-specified tools (Pre-Application Self Assessment)
- Hospital Eligibility Requirements: To participate in the TI Program, hospitals must have at least have had an AHCCCS-defined minimum number of qualifying member discharges across all health plans during a recent 12-month period and must attest to having an Electronic Health Record (EHR) which has the ability to exchange and use electronic health information from other systems without special effort on part of the user.
**Federally Qualified Health Centers (FQHCs) & Rural Health Clinics (RHCs) have a federally mandated reimbursement mechanism that facilitates investment in system transformation activities. Additionally, the federally mandated cost-based reimbursement structure has led to significant increases for FQHCs/RHCs since 2009 while other providers in the AHCCCS system still have rates below 2009 levels. As a result, FQHCs/RHCs are not eligible to participate in TI. The only exception to this decision is related to FQHCs/RHCs that are selected to participate in the Adults Transitioning from the Criminal Justice System Area of Concentration. FQHCs/RHCs that are selected by RBHAs to participate in the Adults Transitioning from the Criminal Justice System Area of Concentration will also be instructed to participate in the Adult Ambulatory Project.
A Medicaid Provider Enrollment with the appropriate licensure & enrollment type(s) are required to determine Medicaid eligibility and TI Program eligibility.
BH Outpatient Clinics [Provider Type 77] whose services are limited to crisis line call centers do not provide the range of services necessary to meet the Targeted Investments requirements and are not eligible to participate in the TI Program.
Indian Health Service and 638 providers are not eligible to participate in the TI Program. Indian Health Service and 638 providers may be eligible to participate in a separate American Indian Medical Home program currently being developed by AHCCCS. [information available on the AHCCCS website]
Financial incentives will be paid on an annual basis to participating eligible primary care, behavioral health, and hospital providers based on requirements that vary over the five years of the Targeted Investments Program. For Year 1 of the TI Program, participating TI providers will receive payment following acceptance into the program. For Years 2 and 3 payment of directed incentive payments will be tied to completing Core Components and related Milestones [see section below that links to Core Components]. For Years 4, 5, and 6 payments will be based on meeting or exceeding performance improvement targets for specified quality measures. See more...
|Targeted Investments Program
Incentive Payment By Year
|TIY 1 (10/16-9/17)
Contingent upon acceptance into the program
|TIY 2 (10/17-9/18) and 3 (10/18-9/19)
Contingent upon successful completion of Core Components and Milestones for Ambulatory and Hospital Projects
|TIY 4 (10/19-9/20) and 5 (10/20-9/21) and 6 (10/21-9/22)
Contingent upon meeting or exceeding performance improvement targets
Primary care, behavioral health and hospital providers completing required Core Components within their chosen area of concentration for one of the two TI Program projects: 1. Ambulatory Project and 2. Hospital Project.
Ambulatory Project: The Ambulatory Project incentive dollars will be based on demonstrated performance for three focused populations: (i) adults with Behavioral Health needs, (ii) children and youth with Behavioral Health needs, including children and youth engaged in the child welfare system with Autism Spectrum Disorder (ASD); and (iii) adults who have transitioned from a criminal justice facility.
Within the Ambulatory Project, there are five Areas of Concentration, each of which contains Core Components that describe an action that help to further integrated primary care and behavioral health. The five Areas of Concentration are:
- Ambulatory Project for Primary Care Providers Treating Adults with Behavioral Health Needs
- Ambulatory Project for Behavioral Health Providers Treating Adults with Behavioral Health Needs
- Ambulatory Project for Pediatric Primary Care Providers Treating Children/Youth with Behavioral Health Needs
- Ambulatory Project for Behavioral Health Providers Treating Children/Youth with Behavioral Health Needs
- Ambulatory Project for Providers Serving Individuals Transitioning from the Justice System
Hospital Project: The Hospital Project incentive dollars will be based on demonstrated performance for adults with a primary diagnosis of mental illness or designated by AHCCCS as individuals with Serious Mental Illness (SMI).
Access to the TI Program Attestation Portal with this link to AHCCCS Online. The link will provide a prompt response to sign in. The Targeted Investments Attestation Portal link is located in the menu bar on the left side of the page in AHCCCS Online.
If you created an individual AHCCCS Online account, the master account holder for your provider number must activate your account before you can log in. The master account holder will also grant access to the Targeted Investments Program tab. If you created a master account for yourself, you must wait for your authentication code to be mailed to you via postal mail.
If you don't have an active AHCCCS Online account, access the AHCCCS Online website to register. Please keep documentation of completed Milestones in your records throughout the program.
AHCCCS uses Constant Contact to send out notifications and program updates to TI Providers. To make sure that these messages do not end up in your ‘Promotions Folder’ or spam, please add the Targeted Investments email address: email@example.com, to your email address contact list. If your IT systems do not allow emails from Constant Contact (marketing site), please notify us.
The Targeted Investments email address will continue to be available if you have questions or concerns.