Arizona PERM Pilot Round 1

Arizona PERM PilotRound 1

Kim SanchezQuality Compliance AdministratorPhone: (602) 417-4563Email: [email protected]

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AZ Organization Background

Reaching across Arizona to provide comprehensive quality health care for those in need

AHCCCSArizona Medicaid

Determines Eligibility for SSI MAO and Long Term Care

Department Of Economic Security (DES)

Determines eligibility for SNAP, TANF and Medicaid for

non-disabled adults and children

MMIS

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Systems

Reaching across Arizona to provide comprehensive quality health care for those in need

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PERM Pilot Round 1

• Sample 200 Medicaid, 0 CHIP

• Pull at the individual level

• Pull weekly samples (calendar week)

• Review at the household level

• Reviews pulled from December and February

Reaching across Arizona to provide comprehensive quality health care for those in need

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Resources• Social Interest Solutions – Developed

HEAplus and our sampling programming

• AHCCCS Medicaid QC staff – completed the reviews

Reaching across Arizona to provide comprehensive quality health care for those in need

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Challenges and Resolutions• Universes inconsistent

• Eligibility “work arounds” developed after pilot proposal was submitted

• Revisions to pilot proposal

Reaching across Arizona to provide comprehensive quality health care for those in need

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Universes inconsistent• Universe totals did not align

o Majority of samples pulled in Aprilo Quality control check the sampleso Clerical pulled system screens for

reviewerso Assigned to staff in Mayo Had May and June to complete the

reviews

• Result: Limited time to complete reviews

Reaching across Arizona to provide comprehensive quality health care for those in need

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Eligibility “work arounds” developed after pilot proposal was submitted• Eligibility workers not all in the new system

o Eligibility determined in the old system o Some determinations in our universes were a

preliminary denial decision

• Result: Had to re-evaluate our review process, re-write our internal policy and re-train staff

Reaching across Arizona to provide comprehensive quality health care for those in need

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Revisions to Pilot Proposal

• Proposal –stratification by submission method, including transfers from the FFM. o Revision 1 – no FFM referrals

• Proposal – We proposed to complete 160 positive reviews and 40 negative reviews. o Revision 2 – 167 positive reviews, 33 negative

reviews

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Pilot Results• Medicaid Active –

6 Income not budgeted

5 No valid signed application

4 budget unit established incorrectly

2 in receipt of Medicare

2 applied old budgeting rules

1 Relationship incorrectly coded

1 Income used was not reasonably compatible

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Pilot Results

• Medicaid Negative – 2 Notice not sent3 Eligible for MAGI

Client double entered self-employment Incorrectly denied Denied when eligible for Emergency Services

Reaching across Arizona to provide comprehensive quality health care for those in need

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Preparation for 2nd Round Pilot• Stabilization of universes

• Complete reviews of a State samples of cases transferred from the FFM

• Revise our written procedures with more detail for reviewers to take into consideration eligibility “work arounds” established

• Conduct additional staff trainingReaching across Arizona to provide comprehensive

quality health care for those in need

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Questions?

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Thank You.

Reaching across Arizona to provide comprehensive quality health care for those in need