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September 22, 2023

AHCCCS Seeks Public Input on Setting Rates to Address Fraudulent Billing

Moving to set rates minimizes the possibility for fraudulent billing

PHOENIX – The Arizona Health Care Cost Containment System is accepting public comments on its annual fee schedule rate updates, including a proposal to establish set rate codes for Applied Behavior Analysis (ABA) services that currently pay a percentage of the billed amount.

Changing the payment methodology from the current “by report” method to a set rate minimizes the possibility of fraudulent Medicaid claims billing against these codes and further strengthens the agency’s ability to eliminate fraudulent providers from its system. On Oct. 1, 2022, and May 1, 2023, AHCCCS made similar changes to other “by report” rate codes.

The set rates proposed by AHCCCS are based on extensive analysis of rates paid by other states and insurers, and were developed using data from the Bureau of Labor Statistics to establish reasonable cost estimates for providers completing these services.

The rate changes will only apply to providers who bill the AHCCCS Fee for Service Program, the American Indian Health Program (AIHP). Providers billing contracted Managed Care Organizations (MCOs) are able to negotiate their own rates with the MCOs, however, per stipulations in the American Rescue Plan, MCOs may not pay lower rates for ABA providers until Oct. 1, 2024.

AHCCCS encourages public comment by email to FFSRates@azahcccs.gov and will consider all feedback it receives. The public comment period opened Sept. 1 and closes at 5:00 p.m. MST, Friday, Sept. 30, 2023.

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