TI 2.0 Program Overview

The Targeted Investments Program (TI 2.0) has been approved by the Centers for Medicare & Medicaid Services (CMS) for $250 million as part of Arizona’s Section 1115 Waiver. The program is active for 5 years from October 1, 2022 through September 30, 2027. See the AHCCCS news release,the CMS announcement and the Targeted Investments (TI 2.0) Proposal.

The TI application portal will be available through AHCCCS Online in the summer of 2023.

TI 2.0 Program Timeline and Structure

Year 1 (10/1/2022 - 9/30/2023)
Onboarding / Application / Required systems & processes

Year 2 (10/1/2023 - 9/30/2024)
Establish New Systems and Processes &
Performance / Outcome Measures

Year 3 (10/1/2024 - 9/30/2025)
Implementation and Evaluation of Systems and Processes &
Performance / Outcome Measures

Year 4 (10/1/2025 - 9/30/2026)
Performance / Outcome Measures

Year 5 (10/1/2026 - 9/30/2027)
Performance / Outcome Measures

Year 1- Onboarding/ Application: All interested PCP and BH organizations and ICs, regardless of TI 1.0 participation, have the opportunity to submit an application through an AHCCCS Online portal and upload specified documents to meet application requirements by 9/30/2023. Eligible provider applicants will earn Year 1 incentive payments for successfully completing the application requirements.

Year 2 & Year 3 Systems and Processes: TI 2.0 participants will be rewarded for establishing new and meaningful systems transformations and improving requirements to more comprehensively address health equity by providing whole person care as related to the new initiatives (below). These processes will be developed with minimum requirements met in Year 2 and demonstrated with a random sample review of members served in Year 3.

Year 2 - Year 5 Performance / Outcome Measures: Each performance target will have an incentive amount associated with it; participating providers will receive an incentive payment for each target that is met.

Primary Care (Adult and Peds)

• Integrated outpatient clinics enrolled with AHCCCS under the same Tax ID.
• Non-Integrated Primary Care outpatient clinics enrolled with AHCCCS under the same Tax ID.
• Non-facility PCP Providers working in the clinics enrolled with AHCCCS under the same Tax ID.

Example: Family practice MDs, DOs, OB/GYNs, NPs, and PAs working at primary care clinics enrolled with AHCCCS under the same TIN.

Behavioral Health (Adult and Peds)

• Integrated outpatient clinics enrolled with AHCCCS under the same Tax ID.
• 77-Behavioral Health outpatient clinics enrolled with AHCCCS under the same Tax ID.
• Non-facility BH providers working In the clinics enrolled with AHCCCS under the same Tax ID.

Justice

An application must be submitted for each licensed, AHCCCS-enrolled clinic in which PCP and BH services must be provided and readily accessible (i.e., not one afternoon a week) such as an IC, FQHC, RHC for justice-involved AHCCCS members. Telehealth services that are consistent with AHCCCS policy are allowable. Justice partnerships must include at least one county probation department and/or the Arizona Department of Corrections, Rehabilitation and Reentry (ADCRR). Clinics may partner with other diversion-related court programs, police departments, or criminal-justice agencies serving the unique needs of the community in addition to a justice partner administering probation or parole.

Partnerships, even if contingent upon TIP 2.0 Justice approval, must demonstrate collaboration as robust as co-location (i.e. clinics co-located with or adjacent-to probation and/or parole facilities, or probation and/or parole offices located within clinics). Clinics and justice partner(s) may suggest novel, innovative approaches that complement the justice-involved populations-needs, county layout, and justice provider’s resources and effectively engage justice-involved members to address whole-person care (i.e. primary care, behavioral health care, and health related social needs) as well as criminogenic risk factors to promote successful reentry to the community. AHCCCS and a separate panel of subject matter experts will review and approve blinded justice program applications that best meet the needs of the target population per the criteria below.

TI 2.0 Initiatives

TI 2.0 initiatives will build off TI 1.0 by furthering point-of-care integration achievements of original TI 1.0 providers. Like TI 1.0, ACC Contractors will be directed by AHCCCS to use program funding to make specific incentive payments to providers. Improving health equity for targeted populations through addressing health-related social needs (HRSN) is a primary goal of TI 2.0.

Over the demonstration period, providers will be incentivized to establish certain processes and meet outcomes-based metrics which will include but are not limited to the following activities

1. Implement national standards for Culturally and Linguistically Appropriate Services (CLAS);
2. Implement procedures to use a closed loop referral system to standardize HRSN referrals and coordination with community-based organizations;
3. Conduct population health analyses related to social determinants of health and health inequities, and implement a plan to identify and address them;
4. PCP only: Implement specialty-specific programs and processes such as: postpartum depression screening for parents;
5. Justice only: Tobacco cessation programs for patients transitioning from the criminal justice system.

Please refer to the TI website and the TI newsletter (sign up linked here) for the latest program news. Due to the high influx of interest and outreach, we recommend all interested parties refer to these resources first before contacting AHCCCS or TI team directly.