AHCCCS Hospital Payments

AHCCCS pays hospitals for inpatient and outpatient services to AHCCCS members. Additionally, AHCCCS pays supplemental payments to hospitals for different purposes and activities. A summary of all hospital payments (claims as well as supplemental payments) is available here.

AHCCCS Hospital Inpatient Reimbursement Methodology

On March 29, 2012, Governor Brewer approved Laws 2012, Second Regular Session, Chapter 122 which, in part, ends the inpatient hospital tiered per diem methodology utilized by AHCCCS and its Contractors effective September 30, 2013. The AHCCCS tiered per diem methodology for the payment of acute care hospital inpatient claims has been in place since 1993. This payment structure is the default methodology, as required by Arizona State law, that must be used by AHCCCS' Managed Care Organizations (MCOs) when no contract exists between an MCO and a hospital. Pursuant to the newly signed law, AHCCCS is required to obtain legislative approval of an alternative reimbursement methodology for inpatient dates of service on and after October 1, 2013. AHCCCS is exploring the benefits of the APR-DRG payment methodology and will be establishing workgroups to seek stakeholder input on such a methodology. See more information here.

Hospital Supplement Payments

Information on the individual supplemental payment programs is provided below:

• Critical Access Hospital Payments

  Critical Access Hospitals (CAHs) are rural community hospitals that meet defined criteria outlined in the Conditions of Participation, 432CFR-485 and subsequent legislative refinements to the program through the BBA, BIPA, and Medicare Modernization Act. The Arizona State Legislature has directed AHCCCS to allocate additional funds appropriated in the annual state budget.

  More information on Critical Access payments can be found here.

• Rural Hospital Inpatient Fund Payments

  The Rural Hospital Inpatient Fund was established by the Legislature in 2005 in response to a 2002 hospital inpatient study that showed rural hospital inpatient cost structures are higher than urban hospital cost structures for inpatient services. This fund was designed to supplement rural hospital inpatient payments.

  More information on Rural Hospital Inpatient Fund payments can be found here.

• Proposition 202 Trauma & Emergency Services Fund Payments

  In November 2002, Arizona voters approved Proposition 202, the Indian Gaming and Self-Reliance Act. Among other things, the initiative established the Arizona Benefits Fund, consisting of tribal gaming revenues paid to the State on a quarterly basis. The Benefits Fund is administered by the Department of Gaming. To help offset the readiness and costs of Level 1 Trauma Centers and the increasing volume in Emergency Departments, a portion of these funds are transferred to AHCCCS for distribution.

  More information on Proposition 202 payments can be found here.

  Deadlines:

  • Hospitals must have Prop 202 worksheets to AHCCCS by October 31 of each year in order to receive Prop 202 funds for that State fiscal year.
  
  

• Graduate Medical Education Payments

  Graduate Medical Education (GME) funds are distributed to hospitals that provide training and education for medical school graduates. This training includes internships, residencies and fellowships. GME funds are either designated to cover direct medical education expenses or indirect medical education expenses.

  More information on Graduate Medical Education payments can be found here.

  Deadlines:

  • Hospitals must have 2013 GME final IGAs to AHCCCS by August 15, 2013 in order to receive allocated FY 2013 GME funds.
    
    
  • Hospitals must have 2011 GME final IGAs to AHCCCS by Feb 1, 2013 in order to receive allocated FY 2011 GME funds.
    
  
  

• Disproportionate Share Hospital Payments

  Disproportionate Share Hospital (DSH) payments provide financial assistance to hospitals that serve a large number of low-income patients such as people on Medicaid and the uninsured. Medicaid DSH payments are the largest source of federal funding for uncompensated care.

  More information on Disproportionate Share Hospital payments can be found here.

  Deadlines:

  • DSH 2011 Pool 5 funds will be allocated on October 5, 2012. All partnerships must notify AHCCCS of the intent to receive distributions from this pool and have a template IGA on file with AHCCCS by close of business, October 5, 2012.
    
    
  • DSH 2012 Pool 5 funds will be allocated on November 2, 2012 . All partnerships must notify AHCCCS of the intent to receive distributions from this pool and have a template IGA on file with AHCCCS by close of business, November 2, 2012.
  
  

• Electronic Health Record Incentive Payments

  Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives.

  More information on EHR Incentive payments can be found here.

  Deadlines:

  • Hospitals must have complete Federal Fiscal year 2012 EHR attestations in the AHCCCS ePIP system by November 30, 2012.
  
  

• Safety Net Care Pool Payments

  The Safety Net Care Pool (SNCP) is a funding pool that uses monies from political subdivisions to draw down federal matching dollars. The funds are then distributed to participating hospitals to help defray the costs of uncompensated care provided to AHCCCS members and the uninsured.

  More information on Safety Net Care Pool payments can be found here here.