104.01 The AHCCCS Administration (AHCCCSA)

 

A. Responsibilities

 

The AHCCCS Administration (AHCCCSA) supervises the planning, implementation, and continued operation of the Arizona Health Care Cost Containment System (AHCCCS).

 

The responsibilities of the AHCCCSA include:


 

B. Division of Member Services

 

The largest division within the AHCCCS Administration is the Division of Member Services (DMS).

 

DMS includes:

 


 

C. Administrative Services Office (ASO)

 

Administrative Services Office (ASO) is responsible for:

 

 


 

D. Employee Services and Organizational Management (ESOM)

 

Employee Services and Organizational Management (ESOM) is responsible for:

 


 

E. Quality Compliance Administration (QCA)

 

The Quality Compliance Administration (QCA) conducts a process required by Federal / State government to provide an accurate measurement of the accuracy of applications approved and denied for Medicaid and CHIP.

 

By reviewing a sample of eligibility determinations, the QCA review process establishes if medical assistance determinations meet the requirements of Federal regulations and waivers, state statutes, the state plan and intergovernmental agreements. Based on the elements of factual eligibility, QCA tracks error and deficiency trends and helps develop a corrective action plan.

 


 

F. Field Operations Administration (FOA)

 

The Field Operations Administration (FOA) has ALTCS staff located in 12 field offices statewide and the SSI MAO and KidsCare staff located in Phoenix. The Communications Center and the Office of Client Advocacy is also located in Phoenix.

 

The ALTCS staff determines eligibility for:

 

The KidsCare staff determines eligibility for:

 

The SSI-MAO staff determines eligibility for:

 

The Communications Center (CC):

 

The Office of Client Advocacy provides customer service to members that have complex AHCCCS issues that require research.

 

 


 

G. The Program Support Administration (PSA)

 

The Program Support Administration (PSA):

 

 


 

H. Office of Automation (OOA)

 

The Office of Automation (OOA):

 

 


 

I. Member Data Management Administration (MDMA)

 

The Member Data Management Administration (MDMA):

 


 

J. Health-e-Arizona (HEA)

 

Health-e-Arizona (HEA) is responsible for planning, organizing and administering operational activities related to Health-e-Arizona, a web-based application, including promoting the expanded use of Health-e-Arizona in the community.

 


 

K. Other AHCCCS Divisions

 

The table below lists the other divisions within the AHCCCSA and describes their functions.

 

Division

Function

Office of Strategic Planning & Projects

  • Develops the agency’s strategic plan and roadmap;

  • Conducts agency needs assessment;

  • Prioritizes projects;

  • Identifies collaborative opportunities; and

  • Serves as a liaison with other agencies and stakeholders to further agency objectives.

Office of Intergovernmental Relations

  • Functions as the primary liaison with the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicaid and KidsCare programs;

  • Responsible for the State Plan, 1115 and HIFA Waivers;

  • Coordinates the agency’s administrative rules and intergovernmental agreements;

  • Monitors and analyzes Federal and State legislation;

  • Tracks and monitors all AHCCCS related legislation; and

  • Serves as a liaison with legislature and staff.

Federal Projects & Grants

  • Procures and manages grants; and

  • Manages special agency projects.

Division of Business and Finance (DBF)

  • Develops and monitors the agency budget and manages agency funds;

  • Oversees the contractor responsible for third party liability (TPL) collections;

  • Oversees the contractor responsible for estate recovery; and

  • Collects premiums for the AHCCCS program

Information Services Division (ISD)

  • Develops and maintains all automation services necessary to support the functions of the agency; and

  • Supports the telephone, mainframe, and PC networks.

Office of Administrative Legal Services (OALS)

  • Accepts eligibility appeals;

  • Coordinates hearing dates and forwards all gathered information to the Arizona Office of Administrative Hearings (OAH):

  • Investigates member, provider, and contractor grievances and makes recommendations to the Director;

  • Reviews, approves, and oversees grievance procedures adopted by health plans, program contractors, and other agencies; and

  • Reviews trusts referred by the AEA and the ACEA staff.

Division of Health Care Management (DHCM)

  • Monitors contract performance of health plans and program contractors;

  • Develops rates for capitated plans and nursing homes; and

  • Develops and monitors the behavioral health program.

Division of Fee for Service Management (DFSM)

  • Develops medical policy for acute and long-term care programs;

  • Oversees utilization and quality management, case management services reviews, fee-for-service network development, transplants, and emergency services; and

  • Processes claims.

Office of the Inspector General (OIG)

  • Conducts criminal investigations relating to allegations of provider and member fraud;

  • Conducts program audits; and

  • Is responsible for internal investigations.

Human Resources & Development (HRD)

  • Provides hiring lists and oversees the hiring process and employee performance;

  • Oversees employee benefit programs including Employee Wellness, insurance, long and short term disability;

  • Maintains official employee records;

  • Promotes employee and organizational development through AHCCCS Overview, New Employee Workshop, personal computer classes; and the AHCCCS Leadership Academy (ALA).