Ari::ono. H1!ahh  Core Cosl Conlainmenl S.y rem

Thomas J. Betlach Director
801 E. Jefferson, MD 4100
Phoenix,llZ 85034

Arizona				
Department of		
Health Services		

JaniceK. Brewer, Governor		Will Humble Director
150 N 18th Ave
Suite, 500
Phoenix, AZ 85007

This letter is meant to serve as an update on a variety of enrollment issues associated with AHCCCS members and behavioral health services.  AHCCCS and the Department of Health Services Division of Behavioral Health Services (BHS) are committed to continued collaboration with stakeholders to ultimately get these issues resolved.

Issue One - Address Changes for RBHA Members
When  RBHA member  address updates  are received  by  AHCCCS  from the  eligibility  sources(SSI,
DES, HEAplus), AHCCCS enrollment processes look at both the member's physical health and behavioral health assignments to determine if the current enrolled Managed Care Organization and assigned RBHA are appropriate and consistent for the new address/zip code of the member. The AHCCCS system makes automatic adjustments to this enrollment/assignment if current enrollments are not appropriate. However, there are exceptions where the RBHA of record should not change. Examples include RBHA placements out of normal Geographic Service Areas and Arizona State Hospital placements. Historically, these issues have been manually corrected;  however,  the  State would like to implement an alternative to the manual process. Please note that this  issue does not impact TRBHA-enrolled members. These same address updates from the eligibility sources do not automatically impact TRBHA assignments.

Short Term Solution- AHCCCS  will continue to work  with BHS and RBHA's to manually correct RBHA and BHS identified members who fall into these exception categories through an existing referral process.

Long Term Solution- The State will be working to provide the ability for a manual as well as an automated (via the inbound 834 from BHS) "flag" with associated dates for exception members in PMMIS. This will allow for the RBHA's and BHS to execute timely designation and preservation of these members' RBHA assignments where appropriate. AHCCCS is working  with  BHS  on  the system changes necessary to implement this solution which is projected to be complete in the next year.

Issue two - TRBHA enrollment
Several years ago AHCCCS changed from episode of care enrollment in the behavioral health system to ensuring all AHCCCS members are enrolled with the T/RBHAs. As part of this process some refinements were made for TRBHA enrollment. If an American Indian moves off of Tribal lands system changes were made in 2012 to ensure that these members remain enrolled with the TRBHA. In fact the system also will do a look back so that if a member who is American Indian has moved and

has had a break in coverage, the enrollment system will look back and if that member was enrolled with a TRBHA prior to the break in coverage they will be re-enrolled with the TRBHA.
Members who are eligible for TRBHA assignment, but live off reservation and are initially assigned to a RBHA are not receiving timely reassignments when the member is actively receiving services from the TRBHA and/or desires TRBHA assignment. This process has historically been handled by BHS manually. This process has recently experienced lengthier delays in executing the manual change.

Short Term Solution- BHS has dedicated additional resources to resolve the issue in a more timely fashion.

Long Term Solution - AHCCCS and ADHS/BHS will continue to look for other opportunities and options to identify members who should be auto enrolled with TRBHA's. Ultimately full implementation of the HEAplus system will provide for the ability to offer choice but this option is will take greater than one year to implement.

We recognize that these are complex intricate issues. Hopefully this provides some clarity around the status of these issues. Should you have any questions please feel free to contact Paul Gladys, Assistant Director at 602-364-4566.

Sincerely,

Thomas J. Betlach Director
Arizona Healthcare Cost Containment System

Cory Nelson Deputy Director
Arizona Department of Health Services