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. AHCCCS will incorporate these payments into the actuarially-sound capitation rates. 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.
On June 9, 2017 an overview of the Targeted Investment Program was held at the AHCCCS offices and via webinar for interested providers and other stakeholders. The TI Program objectives, requirements, incentive payments, and application process were discussed.
TI Provider Eligibility Requirements **
- 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, 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 (Targeted Investments 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 (Targeted Investments 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.
Applicants must elect which project and Area(s) of Concentration they will participate in as part of the application process.
- Primary Care Provider applicants: Primary Care Providers must choose which population focus area they will participate in (e.g., adult with Behavioral Health needs and / or children/youth with Behavioral Health needs). Family and general practice providers may choose to participate in one or both population focus areas.
- Behavioral Health provider applicants: Behavioral Health care providers must choose which population focus area they will participate in (e.g., adult with Behavioral Health needs and / or children/youth with Behavioral Health needs).
- AHCCCS Registered Integrated Clinics or Providers that Meet the Functional Definition of Integrated Clinic (herein referred to as “integrated clinics”): Integrated clinics may participate in the primary care and/or Behavioral Health Areas of Concentration, and may choose whether to participate in the adult with Behavioral Health needs population focus area, the children/youth with Behavioral Health need focus area or both. To receive incentive payments for primary care, they must have members attributed to PCPs by MCO(s), complete the core components, milestones and associated reporting requirements.
- Hospital applicants: Hospital applicants will automatically participate in the Hospital Project.
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 and 5 payment will be based on meeting or exceeding performance improvement targets for specified quality measures [in development].
** Federally Qualified Health Centers (FQHCs) 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 since 2009 while other providers in the AHCCCS system still have rates below 2009 levels. As a result, FQHCs are not eligible to participate in TI. The only exception to this decision is related to FQHCs that are selected to participate in the Adults Transitioning from the Criminal Justice System Area of Concentration. FQHCs 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.
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.
|Targeted Investments Program
Incentive Payment By Year
Contigent upon acceptance into the program
TIY 2 and 3
Contigent upon successfull completion of Core Components and Milestones for Ambulatory and Hospital Projects
TIY 4 and 5
Contigent upon meeting or exceeding performance improvement targets
As mentioned, for Years 2 and 3 payment of the incentive dollars will be distributed based on 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. an Ambulatory Project and 2. a 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; and (iii) adults who have transitioned from a criminal justice facility.
Within the Ambulatory Project, there are five Areas of Concentration, each of which contain 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).
- Adult PCP Ambulatory Project
- Adult MH Ambulatory Project
- Pediatric PCP Ambulatory Project
- Pediatric MH Ambulatory Project
- Justice Ambulatory Project
- Hospital Project
IMPORTANT: The TI provider participation application will be available through the AHCCCS Targeted Investments webpage. Applicants MUST have an AHCCCS Online account in order to complete the TI application. It can take several weeks for the AHCCCS Online account registration process to be completed.
In preparation for completing an application, review all of the TI Program materials available on https://www.azahcccs.gov, including the TI Program Overview, the Core Components and Milestones descriptions, and the Performance Measures. Providers that are considering applying should fully understand the participation requirements, and the Core Components and milestones they will be required to meet based on their provider type, project selection or Areas of Concentration in order to receive incentive payments. In addition, primary care and Behavioral Health providers must complete one of the required Behavioral Health integration self-assessments to gauge where they stand at the outset of the TI Program.
Targeted Investments Self Assessment
Providers eligible to participate in the TI Program should ensure that their information is up to date with the Provider Registration Unit (PRU). If there are any discrepancies in the information that PRU has, providers may have a delay in receiving payment. As part of the application process, providers will be asked to provide their National Provider Identification (NPI) number and information on the practice site address that will be associated with their TI Program participation.
If you do not have an AHCCCS Online account, and are considering applying to participate in the Targeted Investments program, please use this link to create your account. https://azweb.statemedicaid.us/Help/LearnMore.aspx
In addition to these providers, there will be a limited number of Ambulatory providers that participate in the TI Program by completing Core Components focused on improving care for individuals who have transitioned from the justice system. These providers will be selected to participate in the TI Program by the Regional Behavioral Health Authorities (RBHAs). However, in order to participate in the Adults Transitioning from the Criminal Justice System Area of Concentration, they must also participate in the adult primary care Ambulatory Project and meet its Core Components in addition to those required through the Adults Transitioning from the Criminal Justice System Area of Concentration.
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]
Targeted Investments Program Provider Application
Please access the TI Program Application with this link to AHCCCS Online. The link will provide a prompt to sign in.
The Targeted Investments Application Link is located in the menu bar on the left side of the page.
Please refer to the Targeted Investments Program application instructions here.
Provider Payment Calculator
All provider types should review the payment calculator to understand an approximation of the incentive payments for which the provider may be eligible based on AHCCCS payment distribution rules.
Note: Providers selected to participate in the TI Adults Transitioning from the Criminal Justice System Area of Concentration will have a separate method for determining approximate incentive payments for which they may be eligible. More information will be shared with selected providers soon.
Targeted Investments Timeline
Future dates are approximate timeframes and are subject to change
- January 18, 2017: CMS Approval of the Targeted Investments Program
- April 24, 2017: Projects, Core Components, and Milestones posted
- June - July 2017: Provider Participants’ Applications Available
- June 9, 2017: Provider Participants Meeting and Webinar (11:30-1:30 at 801 E. Jefferson Street in Phoenix; webinar also available)
- August – September 2017: Participant Notification
- October 1, 2017: TI Performance Year 2 Begins
- December, 2017: TI Year 1 Participant Payments
On January 18, 2017, the Centers for Medicare and Medicaid Services (CMS) approved Arizona's request to begin a Targeted Investments Program that will make almost $300 million available over five years to Arizona providers who assist the State in promoting the integration of physical and Behavioral Health care, increasing efficiencies in care delivery, and improving health outcomes.
- The approval letter from CMS can be viewed here.
- Waiver and Expenditure Authorities and STCs 01/18/2017
Frequently Asked Questions and Definitions
For questions about the Targeted Investments Program, contact us at: TargetedInvestments@azahcccs.gov
NOTE: Emails submitted to this account prior to May 1st may need to be resubmitted as they didn’t reach AHCCCS due to a system glitch.