SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION. The state is held to all reporting requirements outlined in the STCs; this schedule of deliverables should serve only as a tool for informational purposes only. Date Deliverable September 30, 2015 Complete Demonstration Extension Application (1115) and interim evaluation report March 31, 2016 Submit Interim Evaluation Report - Paragraph 30 August 1, 2016 Final Evaluation Report – Paragraph 31; Final Report - Paragraph 40. End of Demonstration Period. Monthly Deliverables Monthly call – Paragraph 36 Quarterly Deliverables Requirements for Quarterly Reports – Paragraph 37 Quarterly Budget Neutrality Reports – Paragraph 35 Expenditure Reports CMS 64 and CMS 21 - Paragraph 44 and Paragraph 54 Member Months Report – Paragraph 46 Annual Deliverables Requirement for Annual Report – Paragraph 38 Requirement for annual HCBS Report on March 31st – Paragraph 22 (h)(iii) Comparison of Costs for the DES Interagency Agreement, including how any excess revenues are spent, and for ADHS/BHS. Both reports will be due by January 15 – Paragraph 58 (b) Attachment A - Quarterly Report Guidelines As written in STC paragraph 37, the state is required to submit quarterly progress reports to CMS. The purpose of the quarterly report is to inform CMS of significant demonstration activity from the time of approval through completion of the demonstration. The reports are due to CMS 30 days after the end of each quarter. The following report guidelines are intended as a framework and can be modified when agreed upon by CMS and the state. A complete quarterly progress report must include the budget neutrality monitoring workbook. An electronic copy of the report narrative and the Microsoft Excel budget neutrality monitoring workbook is provided. NARRATIVE REPORT FORMAT: TITLE Title Line One – Arizona Health Care Cost Containment System -- AHCCCS, A statewide Approach of Cost Effective Health Care Financing Title Line Two - Section 1115 Quarterly Report Demonstration/Quarter Reporting Period: Example: Demonstration Year: 5 (5/01/04 - 4/30/05) Federal Fiscal Quarter: 4/2004 (7/04 - 9/04) INTRODUCTION: Information describing the goal of the demonstration, what it does, and key dates of approval /operation. (This should be the same for each report.) ENROLLMENTINFORMATION: Please complete the following table that outlines all enrollment activity under the demonstration. The state should indicate “N/A” where appropriate. If there was no activity under a particular enrollment category, the state should indicate that by “0”. Note: Enrollment counts should be person counts, not participant months. Population Groups (as hard coded in the CMS 64) Current Enrollees (to date) No. Voluntary Disenrolled in current Quarter No. Involuntary Disenrolled in current Quarter Population 1 – AFDC / SOBRA Population 2 - SSI Population 3 – ALTCS DD Etcetera Voluntary Disenrollments: Cumulative Number of Voluntary Disenrollments Within Current Demonstration Year: Reasons for Voluntary Disenrollments: Involuntary Disenrollments: Cumulative Number of Involuntary Disenrollments Within Current Demonstration Year: Reasons for Involuntary Disenrollments: Outreach/Innovative Activities: Summarize outreach activities and/or promising practices for the current quarter. Operational/Policy Developments/Issues: Identify all significant program developments/issues/problems that have occurred in the current quarter. Financial/Budget Neutrality Developments/Issues: Identify all significant developments/issues/problems with financial accounting, budget neutrality, and CMS 64 reporting for the current quarter. Identify the state’s actions to address these issues. Consumer Issues: A summary of the types of complaints or problems consumers identified about the program in the current quarter. Include any trends discovered, the resolution of complaints, and any actions taken, or to be taken, to prevent other occurrences. Quality Assurance/Monitoring Activity: Identify any quality assurance/monitoring activity in current quarter. Enclosures/Attachments: Identify by title any attachments along with a brief description of what information the document contains. State Contact(s): Identify individuals by name, title, phone, fax, and address that CMS may contact should any questions arise. The state may also add additional program headings as applicable. Date Submitted to CMS: Attachment B – Evaluation Guidelines Section 1115 demonstrations are valued for information on health services, health services delivery, health care delivery for uninsured populations, and other innovations that would not otherwise be part of Medicaid programs. CMS encourages states with demonstration programs to conduct or arrange for evaluations of the design, implementation, and/or outcomes of their demonstrations. The CMS also conducts evaluation activities. The CMS believes that all parties to demonstrations; states, Federal Government, and individuals benefit from state conducted self-evaluations that include process and case-study evaluations— these would include, but are not limited to: 1) studies that document the design, development, implementation, and operational features of the demonstration, and 2) studies that document participant and applicant experiences that are gathered through surveys, quality assurance activities, grievances and appeals, and in-depth investigations of groups of participants and applicants and/or providers (focus groups, interviews, other). These are generally studies of short-term experiences and they provide value for quality assurance and quality improvements programs (QA/QI) that are part of quality assurance activities and/or demonstration refinements and enhancements. Benefit also derives from studies of intermediate and longer-term investigations of the impact of the demonstration on health outcomes, self-assessments of health status, and/or quality of life. Studies such as these contribute to state and Federal formation and refinements of policies, statutes, and regulations. States are encouraged to conduct short-term studies that are useful for QA/QI that contribute to operating quality demonstration programs. Should states have resources available after conducting these studies, they are encouraged to conduct outcome studies. The following are criteria and content areas to be considered for inclusion in Evaluation Design Reports. • Evaluation Plan Development - Describe how plan was or will be developed and maintained: o Use of experts through technical contracts or advisory bodies; o Use of techniques for determining interest and concerns of stakeholders (funding entities, administrators, providers, clients); o Selection of existing indicators or development of innovative indicators; o Types of studies to be included, such as Process Evaluations, Case-Studies and Outcome investigations; o Types of data collection and tools that will be used – for instance, participant and provider surveys and focus groups; collection of health service utilization; employment data; or, participant purchases of other sources of health care coverage; and, whether the data collection instruments will be existing or newly developed tools; o Incorporation of results through QA/QI activities into improving health service delivery; and o Plans for implementation and consideration of ongoing refinement to the evaluation plan. • Study Questions – Discuss: o Hypothesis or research questions to be investigated; o Goals, such as: ▪ Increase Access ▪ Cost Effectiveness ▪ Improve Care Coordination ▪ Increase Family Satisfaction and Stability o Outcome Measures, Indicators, and Data Sources • Control Group and/or Sample Selection Discussion: o The type of research design(s) to be included - ▪ Pre/Post Methodology ▪ Quasi-Experimental ▪ Experimental o Plans for Base-line Measures and Documentation – time period, outcome measures, indicators, and data sources that were used or will be used • Data Collection Methods – Discuss the use of data sources such as: o Enrollment and outreach records; o Medicaid claims data; o Vital statistics data; o Provide record reviews; o School record reviews; and o Existing or custom surveys • Relationship of Evaluation to Quality Assessment and Quality Improvement Activities– Discuss: o How evaluation activities and findings are shared with program designers, administrators, providers, outreach workers, etc., in order to refine or redesign operations; o How findings will be incorporated into outreach, enrollment and education activities; o How findings will be incorporated into provider relations such as provider standards, retention, recruitment, and education; and o How findings will be incorporated into grievance and appeal proceedings. • Discuss additional points as merited by interest of the state and/or relevance to nuances of the demonstration intervention. ATTACHMENT C AHCCCS DISPROPORTIONATE SHARE HOSPITAL PROGRAM DSH 102 Congress established the Medicaid Disproportionate Share Hospital (DSH) program in 1981 to provide financial support to hospitals that serve a significant number of low-income patients with special needs. This document sets forth the criteria by which Arizona defines DSH hospitals and the methodology through which DSH payments are calculated and distributed. The document is divided into the following major topics: • Hospital eligibility requirements • Data on a State Plan Year Basis • Timing of eligibility determination • Medicaid Inpatient Utilization Rate (MIUR) calculation (Overall and Group 1 and 1A eligibility) • Low Income Utilization Rate (LIUR) calculation (Group 2 and 2A eligibility) • Governmentally-operated hospitals (Group 4 eligibility) • Obstetrician Requirements • Payment • Group 5 Eligibility Determination • Aggregate Limits • Reconciliations • Certified Public Expenditures (CPEs) • Grievances and appeals • Other provisions Hospital Eligibility Requirements In order to be considered a DSH hospital in Arizona, a hospital must be located in the state of Arizona, must submit the information required by AHCCCS by the specified due date, must satisfy one (1) of the conditions in Column A, AND must satisfy one (1) of the conditions in Column B, AND must satisfy the condition in Column C. COLUMN A COLUMN B COLUMN C
Appears in 2 contracts
Samples: Special Terms and Conditions, Special Terms and Conditions
SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION. The state is held to all reporting requirements outlined in the STCs; this schedule of deliverables should serve only as a tool for informational purposes only. Date Deliverable September 30, 2015 Written Notice of State’s Intent to Extend the Demonstration Under 1115 March 31, 2016 Complete Demonstration Extension Application (1115) and interim evaluation report March 31CRS and SMI Integration Evaluation Report (STC #28(f)) January 1, 2016 2017 Submit Interim Draft Evaluation Report - Paragraph 30 August STC # 29 March 1, 2016 2017 Final Evaluation Report – Paragraph 31; - STC #29. Final Report - Paragraph 40STC# 39. End of Demonstration Period. Monthly Deliverables Monthly call – Paragraph 36 - STC# 34 Quarterly Deliverables Requirements for Quarterly Reports – Paragraph 37 STC # 36 Quarterly Budget Neutrality Reports – Paragraph 35 STC # 33 Expenditure Reports CMS 64 and CMS 21 CMS21 - Paragraph STC# 44 and Paragraph 54 STC# 53 Member Months Report – Paragraph 46 - STC# 45 Annual Deliverables Requirement for Annual Report – Paragraph 38 - STC# 37 Requirement for annual HCBS Report on March 31st – Paragraph 22 - STC# 21 (h)(iii) Comparison of Costs for the DES Interagency Agreement, including how any excess revenues are spent, and for ADHS/BHS. Both reports will be due by January 15 – Paragraph 58 STC # 57 (b) Attachment A - Quarterly Report Guidelines As written in STC paragraph 3736, the state is required to submit quarterly progress reports to CMS. The purpose of the quarterly report is to inform CMS of significant demonstration activity from the time of approval through completion of the demonstration. The reports are due to CMS 30 days after the end of each quarter. The following report guidelines are intended as a framework and can be modified when agreed upon by CMS and the state. A complete quarterly progress report must include the budget neutrality monitoring workbook. An electronic copy of the report narrative and the Microsoft Excel budget neutrality monitoring workbook is provided. NARRATIVE REPORT FORMAT: TITLE Title Line One – Arizona Health Care Cost Containment System -- AHCCCS, A statewide Approach of Cost Effective Health Care Financing Title Line Two - Section 1115 Quarterly Report Demonstration/Quarter Reporting Period: Example: Demonstration Year: 5 (5/01/04 - 4/30/05) Federal Fiscal Quarter: 4/2004 (7/04 - 9/04) INTRODUCTION: Information describing the goal of the demonstration, what it does, and key dates of approval /operation. (This should be the same for each report.) ENROLLMENTINFORMATIONENROLLMENT INFORMATION: Please complete the following table that outlines all enrollment activity under the demonstration. The state should indicate “N/A” where appropriate. If there was no activity under a particular enrollment category, the state should indicate that by “0”. Note: Enrollment counts should be person counts, not participant months. Population Groups (as hard coded in the CMS 64) Current Enrollees (to date) No. Voluntary Disenrolled in current Quarter No. Involuntary Disenrolled in current Quarter Population 1 – AFDC / SOBRA Population 2 - SSI Population 3 – ALTCS DD Etcetera Voluntary Disenrollments: Cumulative Number of Voluntary Disenrollments Within Current Demonstration Year: Reasons for Voluntary Disenrollments: Involuntary Disenrollments: Cumulative Number of Involuntary Disenrollments Within Current Demonstration Year: Reasons for Involuntary Disenrollments: Outreach/Innovative Activities: Summarize outreach activities and/or promising practices for the current quarter. Operational/Policy Developments/Issues: Identify all significant program developments/issues/problems that have occurred in the current quarter. Financial/Budget Neutrality Developments/Issues: Identify all significant developments/issues/problems with financial accounting, budget neutrality, and CMS 64 reporting for the current quarter. Identify the state’s actions to address these issues. Consumer Issues: A summary of the types of complaints or problems consumers identified about the program in the current quarter. Include any trends discovered, the resolution of complaints, and any actions taken, or to be taken, to prevent other occurrences. Quality Assurance/Monitoring Activity: Identify any quality assurance/monitoring activity in current quarter. ESI Issues (through December 31, 2013): Identify all significant program developments/issues/problems that have occurred in the current quarter. Family Planning Extension Program (through December 31, 2013: Identify all significant program developments/issues/problems that have occurred in the current quarter, including the required data and information included in STC 34(d) and (e), including enrollment data requested that is not represented in the formatted tables. Enclosures/Attachments: Identify by title any attachments along with a brief description of what information the document contains. State Contact(s): Identify individuals by name, title, phone, fax, and address that CMS may contact should any questions arise. The state may also add additional program headings as applicable. Date Submitted to CMS: Attachment B – Evaluation Guidelines Section 1115 demonstrations are valued for information on health services, health services delivery, health care delivery for uninsured populations, and other innovations that would not otherwise be part of Medicaid programs. CMS encourages states with demonstration programs to conduct or arrange for evaluations of the design, implementation, and/or outcomes of their demonstrations. The CMS also conducts evaluation activities. The CMS believes that all parties to demonstrations; states, Federal Government, and individuals benefit from state conducted self-evaluations that include process and case-study evaluations— these would include, but are not limited to: 1) studies that document the design, development, implementation, and operational features of the demonstration, and 2) studies that document participant and applicant experiences that are gathered through surveys, quality assurance activities, grievances and appeals, and in-depth investigations of groups of participants and applicants and/or providers (focus groups, interviews, other). These are generally studies of short-term experiences and they provide value for quality assurance and quality improvements programs (QA/QI) that are part of quality assurance activities and/or demonstration refinements and enhancements. Benefit also derives from studies of intermediate and longer-term investigations of the impact of the demonstration on health outcomes, self-assessments of health status, and/or quality of life. Studies such as these contribute to state and Federal formation and refinements of policies, statutes, and regulations. States are encouraged to conduct short-term studies that are useful for QA/QI that contribute to operating quality demonstration programs. Should states have resources available after conducting these studies, they are encouraged to conduct outcome studies. The following are criteria and content areas to be considered for inclusion in Evaluation Design Reports. • Evaluation Plan Development - Describe how plan was or will be developed and maintained: o Use of experts through technical contracts or advisory bodies; o Use of techniques for determining interest and concerns of stakeholders (funding entities, administrators, providers, clients); o Selection of existing indicators or development of innovative indicators; o Types of studies to be included, such as Process Evaluations, Case-Studies and Outcome investigations; o Types of data collection and tools that will be used – for instance, participant and provider surveys and focus groups; collection of health service utilization; employment data; or, participant purchases of other sources of health care coverage; and, whether the data collection instruments will be existing or newly developed tools; o Incorporation of results through QA/QI activities into improving health service delivery; and o Plans for implementation and consideration of ongoing refinement to the evaluation plan. • Study Questions – Discuss: o Hypothesis or research questions to be investigated; o Goals, such as: ▪ Increase Access ▪ Cost Effectiveness ▪ Improve Care Coordination ▪ Increase Family Satisfaction and Stability o Outcome Measures, Indicators, and Data Sources • Control Group and/or Sample Selection Discussion: o The type of research design(s) to be included - ▪ Pre/Post Methodology ▪ Quasi-Experimental ▪ Experimental o Plans for Base-line Measures and Documentation – time period, outcome measures, indicators, and data sources that were used or will be used • Data Collection Methods – Discuss the use of data sources such as: o Enrollment and outreach records; o Medicaid claims data; o Vital statistics data; o Provide record reviews; o School record reviews; and o Existing or custom surveys • Relationship of Evaluation to Quality Assessment and Quality Improvement Activities– Discuss: o How evaluation activities and findings are shared with program designers, administrators, providers, outreach workers, etc., in order to refine or redesign operations; o How findings will be incorporated into outreach, enrollment and education activities; o How findings will be incorporated into provider relations such as provider standards, retention, recruitment, and education; and o How findings will be incorporated into grievance and appeal proceedings. • Discuss additional points as merited by interest of the state and/or relevance to nuances of the demonstration intervention. ATTACHMENT C AHCCCS DISPROPORTIONATE SHARE HOSPITAL PROGRAM DSH 102 Congress established the Medicaid Disproportionate Share Hospital (DSH) program in 1981 to provide financial support to hospitals that serve a significant number of low-income patients with special needs. This document sets forth the criteria by which Arizona defines DSH hospitals and the methodology through which DSH payments are calculated and distributed. The document is divided into the following major topics: • Hospital eligibility requirements • Data on a State Plan Year Basis • Timing of eligibility determination • Medicaid Inpatient Utilization Rate (MIUR) calculation (Overall and Group 1 and 1A eligibility) • Low Income Utilization Rate (LIUR) calculation (Group 2 and 2A eligibility) • Governmentally-operated hospitals (Group 4 eligibility) • Obstetrician Requirements • Payment • Group 5 Eligibility Determination • Aggregate Limits • Reconciliations • Certified Public Expenditures (CPEs) • Grievances and appeals • Other provisions Hospital Eligibility Requirements In order to be considered a DSH hospital in Arizona, a hospital must be located in the state of Arizona, must submit the information required by AHCCCS by the specified due date, must satisfy one (1) of the conditions in Column A, AND must satisfy one (1) of the conditions in Column B, AND must satisfy the condition in Column C. COLUMN A COLUMN B COLUMN C
Appears in 1 contract
Samples: Special Terms and Conditions
SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION. The state is held to all reporting requirements outlined in the STCs; this schedule of deliverables should serve only as a tool for informational purposes only. Date Deliverable September 30, 2015 Complete Demonstration Extension Application (1115) and interim evaluation report March 31, 2016 Submit Interim Evaluation Report - Paragraph 30 August 1, 2016 Final Evaluation Report – Paragraph 31; Final Report - Paragraph 40. End of Demonstration Period. Monthly Deliverables Monthly call – Paragraph 36 Quarterly Deliverables Requirements for Quarterly Reports – Paragraph 37 Quarterly Budget Neutrality Reports – Paragraph 35 Expenditure Reports CMS 64 and CMS 21 - Paragraph 44 and Paragraph 54 Member Months Report – Paragraph 46 Annual Deliverables Requirement for Annual Report – Paragraph 38 Requirement for annual HCBS Report on March 31st – Paragraph 22 (h)(iii) Comparison of Costs for the DES Interagency Agreement, including how any excess revenues are spent, and for ADHS/BHS. Both reports will be due by January 15 – Paragraph 58 (b) Attachment A - Quarterly Report Guidelines As written in STC paragraph 37, the state is required to submit quarterly progress reports to CMS. The purpose of the quarterly report is to inform CMS of significant demonstration activity from the time of approval through completion of the demonstration. The reports are due to CMS 30 days after the end of each quarter. The following report guidelines are intended as a framework and can be modified when agreed upon by CMS and the state. A complete quarterly progress report must include the budget neutrality monitoring workbook. An electronic copy of the report narrative and the Microsoft Excel budget neutrality monitoring workbook is provided. NARRATIVE REPORT FORMAT: TITLE Title Line One – Arizona Health Care Cost Containment System -- AHCCCS, A statewide Approach of Cost Effective Health Care Financing Title Line Two - Section 1115 Quarterly Report Demonstration/Quarter Reporting Period: Example: Demonstration Year: 5 (5/01/04 - 4/30/05) Federal Fiscal Quarter: 4/2004 (7/04 - 9/04) INTRODUCTION: Information describing the goal of the demonstration, what it does, and key dates of approval /operation. (This should be the same for each report.) ENROLLMENTINFORMATIONENROLLMENT INFORMATION: Please complete the following table that outlines all enrollment activity under the demonstration. The state should indicate “N/A” where appropriate. If there was no activity under a particular enrollment category, the state should indicate that by “0”. Note: Enrollment counts should be person counts, not participant months. Population Groups (as hard coded in the CMS 64) Current Enrollees (to date) No. Voluntary Disenrolled in current Quarter No. Involuntary Disenrolled in current Quarter Population 1 – AFDC / SOBRA Population 2 - SSI Population 3 – ALTCS DD Etcetera Voluntary Disenrollments: Cumulative Number of Voluntary Disenrollments Within Current Demonstration Year: Reasons for Voluntary Disenrollments: Involuntary Disenrollments: Cumulative Number of Involuntary Disenrollments Within Current Demonstration Year: Reasons for Involuntary Disenrollments: Outreach/Innovative Activities: Summarize outreach activities and/or promising practices for the current quarter. Operational/Policy Developments/Issues: Identify all significant program developments/issues/problems that have occurred in the current quarter. Financial/Budget Neutrality Developments/Issues: Identify all significant developments/issues/problems with financial accounting, budget neutrality, and CMS 64 reporting for the current quarter. Identify the state’s actions to address these issues. Consumer Issues: A summary of the types of complaints or problems consumers identified about the program in the current quarter. Include any trends discovered, the resolution of complaints, and any actions taken, or to be taken, to prevent other occurrences. Quality Assurance/Monitoring Activity: Identify any quality assurance/monitoring activity in current quarter. Enclosures/Attachments: Identify by title any attachments along with a brief description of what information the document contains. State Contact(s): Identify individuals by name, title, phone, fax, and address that CMS may contact should any questions arise. The state may also add additional program headings as applicable. Date Submitted to CMS: Attachment B – Evaluation Guidelines Section 1115 demonstrations are valued for information on health services, health services delivery, health care delivery for uninsured populations, and other innovations that would not otherwise be part of Medicaid programs. CMS encourages states with demonstration programs to conduct or arrange for evaluations of the design, implementation, and/or outcomes of their demonstrations. The CMS also conducts evaluation activities. The CMS believes that all parties to demonstrations; states, Federal Government, and individuals benefit from state conducted self-evaluations that include process and case-study evaluations— these would include, but are not limited to: 1) studies that document the design, development, implementation, and operational features of the demonstration, and 2) studies that document participant and applicant experiences that are gathered through surveys, quality assurance activities, grievances and appeals, and in-depth investigations of groups of participants and applicants and/or providers (focus groups, interviews, other). These are generally studies of short-term experiences and they provide value for quality assurance and quality improvements programs (QA/QI) that are part of quality assurance activities and/or demonstration refinements and enhancements. Benefit also derives from studies of intermediate and longer-term investigations of the impact of the demonstration on health outcomes, self-assessments of health status, and/or quality of life. Studies such as these contribute to state and Federal formation and refinements of policies, statutes, and regulations. States are encouraged to conduct short-term studies that are useful for QA/QI that contribute to operating quality demonstration programs. Should states have resources available after conducting these studies, they are encouraged to conduct outcome studies. The following are criteria and content areas to be considered for inclusion in Evaluation Design Reports. • Evaluation Plan Development - Describe how plan was or will be developed and maintained: o Use of experts through technical contracts or advisory bodies; o Use of techniques for determining interest and concerns of stakeholders (funding entities, administrators, providers, clients); o Selection of existing indicators or development of innovative indicators; o Types of studies to be included, such as Process Evaluations, Case-Studies and Outcome investigations; o Types of data collection and tools that will be used – for instance, participant and provider surveys and focus groups; collection of health service utilization; employment data; or, participant purchases of other sources of health care coverage; and, whether the data collection instruments will be existing or newly developed tools; o Incorporation of results through QA/QI activities into improving health service delivery; and o Plans for implementation and consideration of ongoing refinement to the evaluation plan. • Study Questions – Discuss: o Hypothesis or research questions to be investigated; o Goals, such as: ▪ Increase Access ▪ Cost Effectiveness ▪ Improve Care Coordination ▪ Increase Family Satisfaction and Stability o Outcome Measures, Indicators, and Data Sources • Control Group and/or Sample Selection Discussion: o The type of research design(s) to be included - ▪ Pre/Post Methodology ▪ Quasi-Experimental ▪ Experimental o Plans for Base-line Measures and Documentation – time period, outcome measures, indicators, and data sources that were used or will be used • Data Collection Methods – Discuss the use of data sources such as: o Enrollment and outreach records; o Medicaid claims data; o Vital statistics data; o Provide record reviews; o School record reviews; and o Existing or custom surveys • Relationship of Evaluation to Quality Assessment and Quality Improvement Activities– Discuss: o How evaluation activities and findings are shared with program designers, administrators, providers, outreach workers, etc., in order to refine or redesign operations; o How findings will be incorporated into outreach, enrollment and education activities; o How findings will be incorporated into provider relations such as provider standards, retention, recruitment, and education; and o How findings will be incorporated into grievance and appeal proceedings. • Discuss additional points as merited by interest of the state and/or relevance to nuances of the demonstration intervention. ATTACHMENT C AHCCCS DISPROPORTIONATE SHARE HOSPITAL PROGRAM DSH 102 Congress established the Medicaid Disproportionate Share Hospital (DSH) program in 1981 to provide financial support to hospitals that serve a significant number of low-income patients with special needs. This document sets forth the criteria by which Arizona defines DSH hospitals and the methodology through which DSH payments are calculated and distributed. The document is divided into the following major topics: • Hospital eligibility requirements • Data on a State Plan Year Basis • Timing of eligibility determination • Medicaid Inpatient Utilization Rate (MIUR) calculation (Overall and Group 1 and 1A eligibility) • Low Income Utilization Rate (LIUR) calculation (Group 2 and 2A eligibility) • Governmentally-operated hospitals (Group 4 eligibility) • Obstetrician Requirements • Payment • Group 5 Eligibility Determination • Aggregate Limits • Reconciliations • Certified Public Expenditures (CPEs) • Grievances and appeals • Other provisions Hospital Eligibility Requirements In order to be considered a DSH hospital in Arizona, a hospital must be located in the state of Arizona, must submit the information required by AHCCCS by the specified due date, must satisfy one (1) of the conditions in Column A, AND must satisfy one (1) of the conditions in Column B, AND must satisfy the condition in Column C. COLUMN A COLUMN B COLUMN C
Appears in 1 contract
Samples: Special Terms and Conditions
SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION. The state is held to all reporting requirements outlined in the STCs; this schedule of deliverables should serve only as a tool for informational purposes only. Date Deliverable September 30, 2015 Complete Demonstration Extension Application (1115) and interim evaluation report March 31, 2016 Submit Interim Evaluation Report - Paragraph 30 August 1, 2016 Final Evaluation Report – Paragraph 31; Final Report - Paragraph 40. End of Demonstration Period. Monthly Deliverables Monthly call – Paragraph 36 Quarterly Deliverables Requirements for Quarterly Reports – Paragraph 37 Quarterly Budget Neutrality Reports – Paragraph 35 Expenditure Reports CMS 64 and CMS 21 - Paragraph 44 and Paragraph 54 Member Months Report – Paragraph 46 Annual Deliverables Requirement for Annual Report – Paragraph 38 Requirement for annual HCBS Report on March 31st – Paragraph 22 (h)(iii) Comparison of Costs for the DES Interagency Agreement, including how any excess revenues are spent, and for ADHS/BHS. Both reports will be due by January 15 – Paragraph 58 (b) Attachment A - Quarterly Report Guidelines As written in STC paragraph 37, the state is required to submit quarterly progress reports to CMS. The purpose of the quarterly report is to inform CMS of significant demonstration activity from the time of approval through completion of the demonstration. The reports are due to CMS 30 days after the end of each quarter. The following report guidelines are intended as a framework and can be modified when agreed upon by CMS and the state. A complete quarterly progress report must include the budget neutrality monitoring workbook. An electronic copy of the report narrative and the Microsoft Excel budget neutrality monitoring workbook is provided. NARRATIVE REPORT FORMAT: TITLE Title Line One – Arizona Health Care Cost Containment System -- AHCCCS, A statewide Approach of Cost Effective Health Care Financing Title Line Two - Section 1115 Quarterly Report Demonstration/Quarter Reporting Period: Example: Demonstration Year: 5 (5/01/04 - 4/30/05) Federal Fiscal Quarter: 4/2004 (7/04 - 9/04) INTRODUCTION: Information describing the goal of the demonstration, what it does, and key dates of approval /operation. (This should be the same for each report.) ENROLLMENTINFORMATION: Please complete the following table that outlines all enrollment activity under the demonstration. The state should indicate “N/A” where appropriate. If there was no activity under a particular enrollment category, the state should indicate that by “0”. Note: Enrollment counts should be person counts, not participant months. Population Groups (as hard coded in the CMS 64) Current Enrollees (to date) No. Voluntary Disenrolled in current Quarter No. Involuntary Disenrolled in current Quarter Population 1 – AFDC / SOBRA Population 2 - SSI Population 3 – ALTCS DD Etcetera Voluntary Disenrollments: Cumulative Number of Voluntary Disenrollments Within Current Demonstration Year: Reasons for Voluntary Disenrollments: Involuntary Disenrollments: Cumulative Number of Involuntary Disenrollments Within Current Demonstration Year: Reasons for Involuntary Disenrollments: Outreach/Innovative Activities: Summarize outreach activities and/or promising practices for the current quarter. Operational/Policy Developments/Issues: Identify all significant program developments/issues/problems that have occurred in the current quarter. Financial/Budget Neutrality Developments/Issues: Identify all significant developments/issues/problems with financial accounting, budget neutrality, and CMS 64 reporting for the current quarter. Identify the state’s actions to address these issues. Consumer Issues: A summary of the types of complaints or problems consumers identified about the program in the current quarter. Include any trends discovered, the resolution of complaints, and any actions taken, or to be taken, to prevent other occurrences. Quality Assurance/Monitoring Activity: Identify any quality assurance/monitoring activity in current quarter. Enclosures/Attachments: Identify by title any attachments along with a brief description of what information the document contains. State Contact(s): Identify individuals by name, title, phone, fax, and address that CMS may contact should any questions arise. The state may also add additional program headings as applicable. Date Submitted to CMS: Attachment B – Evaluation Guidelines Section 1115 demonstrations are valued for information on health services, health services delivery, health care delivery for uninsured populations, and other innovations that would not otherwise be part of Medicaid programs. CMS encourages states with demonstration programs to conduct or arrange for evaluations of the design, implementation, and/or outcomes of their demonstrations. The CMS also conducts evaluation activities. The CMS believes that all parties to demonstrations; states, Federal Government, and individuals benefit from state conducted self-evaluations that include process and case-study evaluations— these would include, but are not limited to: 1) studies that document the design, development, implementation, and operational features of the demonstration, and 2) studies that document participant and applicant experiences that are gathered through surveys, quality assurance activities, grievances and appeals, and in-depth investigations of groups of participants and applicants and/or providers (focus groups, interviews, other). These are generally studies of short-term experiences and they provide value for quality assurance and quality improvements programs (QA/QI) that are part of quality assurance activities and/or demonstration refinements and enhancements. Benefit also derives from studies of intermediate and longer-term investigations of the impact of the demonstration on health outcomes, self-assessments of health status, and/or quality of life. Studies such as these contribute to state and Federal formation and refinements of policies, statutes, and regulations. States are encouraged to conduct short-term studies that are useful for QA/QI that contribute to operating quality demonstration programs. Should states have resources available after conducting these studies, they are encouraged to conduct outcome studies. The following are criteria and content areas to be considered for inclusion in Evaluation Design Reports. • Evaluation Plan Development - Describe how plan was or will be developed and maintained: o Use of experts through technical contracts or advisory bodies; o Use of techniques for determining interest and concerns of stakeholders (funding entities, administrators, providers, clients); o Selection of existing indicators or development of innovative indicators; o Types of studies to be included, such as Process Evaluations, Case-Studies and Outcome investigations; o Types of data collection and tools that will be used – for instance, participant and participantand provider surveys and focus groups; collection of health service utilization; employment data; or, participant purchases of other sources of health care coverage; and, whether the data collection instruments will be existing or newly developed tools; o Incorporation of results through QA/QI activities into improving health service delivery; and o Plans for implementation and consideration of ongoing refinement to the evaluation plan. • Study Questions – Discuss: o Hypothesis or research questions to be investigated; o Goals, such as: ▪ Increase Access ▪ Cost Effectiveness ▪ Improve Care Coordination ▪ Increase Family Satisfaction and Stability o Outcome Measures, Indicators, and Data Sources • Control Group and/or Sample Selection Discussion: o The type of research design(s) to be included - ▪ Pre/Post Methodology ▪ Quasi-Experimental ▪ Experimental o Plans for Base-line Measures and Documentation – time period, outcome measures, indicators, and data sources that were used or will be used • beused Data Collection Methods – Discuss the use of data sources such as: o Enrollment and outreach records; o Medicaid claims data; o Vital statistics data; o Provide record reviews; o School record reviews; and o Existing or custom surveys • Relationship of Evaluation to Quality Assessment and Quality Improvement Activities– Discuss: o How evaluation activities and findings are shared with program designers, administrators, providers, outreach workers, etc., in order to refine or redesign operations; o How findings will be incorporated into outreach, enrollment and education activities; o How findings will be incorporated into provider relations such as provider standards, retention, recruitment, and education; and o How findings will be incorporated into grievance and appeal proceedings. • Discuss additional points as merited by interest of the state and/or relevance to nuances of the demonstration intervention. ATTACHMENT C AHCCCS DISPROPORTIONATE SHARE HOSPITAL PROGRAM DSH 102 Congress established the Medicaid Disproportionate Share Hospital (DSH) program in 1981 to provide financial support to hospitals that serve a significant number of low-income patients with special needs. This document sets forth the criteria by which Arizona defines DSH hospitals and the methodology through which DSH payments are calculated and distributed. The document is divided into the following major topics: • Hospital eligibility requirements • Data on a State Plan Year Basis • Timing of eligibility determination • Medicaid Inpatient Utilization Rate (MIUR) calculation (Overall and Group 1 and 1A eligibility) • Low Income Utilization Rate (LIUR) calculation (Group 2 and 2A eligibility) • Governmentally-operated hospitals (Group 4 eligibility) • Obstetrician Requirements • Payment • Group 5 Eligibility Determination • Aggregate Limits • Reconciliations • Certified Public Expenditures (CPEsExpenditures(CPEs) • Grievances and appeals • Other provisions Hospital Eligibility Requirements In order to be considered a DSH hospital in Arizona, a hospital must be located in the state of Arizona, must submit the information required by AHCCCS by the specified due date, must satisfy one (1) of the conditions in Column A, AND must satisfy one (1) of the conditions in Column B, AND must satisfy the condition in Column C. COLUMN A COLUMN B COLUMN C
Appears in 1 contract
Samples: Special Terms and Conditions
