American Indian Initiatives
The two methodologies outlined in the waiver were requested for structuring a payment that will be made to IHS and 638 facilities that take into account their uncompensated costs in furnishing non-covered services by IHS and tribal 638 facilities, to AHCCCS enrolled individuals. The non-covered services include services that the State removed from the Medicaid state plan effective October 1, 2010. Some services have been restored since the end of the recession. Participating facilities must select one of the two possible options in determining these payments to the facilities. The facilities that choose Option1-Encounter Based Approach, will notify AHCCCS of their selection and will have the option to switch their methodology election only once. If a facility elects to switch to Option 2-Historical Data Approach, the methodology by which their uncompensated care payment is calculated, the facility must notify the State.
AHCCCS administers Medicaid to over 1.9 million members through a mandatory managed care delivery system. This system operates managed care insurance programs that establish each member with a Primary Care Physician (PCP) upon enrollment. Case management is provided as an administrative service to those members identified by their health plan to require care coordination or assistance in managing a chronic illness. Health plans also offer call lines staffed by medical professionals as an administrative service.
The AHCCCS model requires every Medicaid beneficiary to enroll with a managed care organization (MCO). An exception to this requirement is for the American Indian/Alaska Native (AI/AN) population, which has the option of enrolling with an MCO or receiving services in the AHCCCS fee-for-service (FFS) program, known as the American Indian Health Program (AIHP). American Indians and Alaska Natives who enroll in the American Indian Health Program receive their care largely through Indian Health Services (IHS) facilities and Tribal facilities operated under Public Law (PL) 93-638. IHS and Tribal facilities do not have the administrative dollars to support case management functions or call lines to assist members in coordinating their care. The clinical leadership of IHS recognizes that fundamental changes in their system are required in this time of fewer resources and health reform.
Arizona is proposing to offer services that support an Indian Health Medical Home Program – Primary Care Case Management, diabetes education and care coordination – to its acute care FFS Population. AIMHs will be charged with addressing health disparities between American Indians and other populations in Arizona, specifically by enhancing case management and care coordination. In tracking the successes of AIMHs across the state, Arizona expects to see trends indicating cost savings through the prevention of hospital readmissions and improved control of nonemergent use of the emergency department. Non-IHS/Tribal facilities will also share in those savings as critical players in addressing healthcare disparities for the AI/AN population.
AHCCCS is accepting public comments on the DRAFT State Plan Amendment to create the American Indian Medical Home program.
The AHCCCS 1115 Waiver application supports reimbursement for Traditional Healing Services provided in, at, or through facilities operated by the Indian Health Service, a Tribe or Tribal organization, or an Urban Indian health program (I/T/U) to Medicaid eligible American Indian/Alaska Natives (AI/AN). This assures that an AI/AN AHCCCS member that has requested such services obtains reimbursable traditional healing services that are coordinated through these facilities.
More information can be found in the pdf below: