Written By: Heidi Capriotti, AHCCCS Public Information Officer
Today most of the 1.8 million AHCCCS members in Arizona are enrolled in at least two managed care health plans—one for physical health care services and the second plan for behavioral healthcare service. This traditional, fragmented delivery system is cumbersome for members and providers to navigate and does not reflect whole person health care.
Since 1989, AHCCCS has been gradually moving from fragmented health care delivery to a system that fully integrates physical and behavioral care into one plan for each member. On October 1, 2018, AHCCCS takes the largest step to date toward this strategic goal when 1.5 million members will transition to one of seven AHCCCS Complete Care (ACC) health plans.
Each ACC plan will select and manage its own provider network and will provide all covered physical and behavioral health services to its members. Concentrating accountability for a member’s care in one plan for physical and behavioral health will not only streamline processes for providers and members but also contribute to optimal health outcomes. The ACC plans will also provide services for members with Children’s Rehabilitative Services (CRS) conditions.
ACC plans by GSA
Seven health plans were awarded ACC contracts in three Geographic Service Areas (GSAs). No contractor was awarded in all three GSAs.
The North GSA includes Apache, Coconino, Mohave, Navajo and Yavapai Counties. The Central GSA includes Maricopa, Gila and Pinal Counties. The South GSA includes Pima, Cochise, Graham, Greenlee, La Paz, Santa Cruz, and Yuma Counties. Zip codes 85542, 85192, 85550 representing San Carlos Tribal area are included in the South GSA.
Arizona Complete Health-Complete Care Plan (Central and South)
Banner University Family Care (Central and South)
Care1st (Central and North)
Magellan Complete Care (Central)
Mercy Care (Central)
Steward Health Choice Arizona (Central and North)
UnitedHealthcare Community Plan (Central and Pima County)
ACC and RBHA members
Today, Regional Behavioral Health Authorities (RBHAs) provide behavioral health care services to most members. Beginning Oct. 1, ACC plans will provide these services. However, ACC will have no effect on members with a Serious Mental Illness (SMI) determination (who are not enrolled in CRS) as they will continue to receive integrated services from ACC-affiliated RBHAs. RBHAs will also continue to serve members with developmental disabilities who are enrolled with the Department of Economic Services/Division of Developmental Disabilities as well as foster care children enrolled in the Comprehensive Medical and Dental Program.
All AHCCCS registered providers are free to pursue a contract with any or all of the ACC plans. To ensure a smooth transition for members, if non-contracted providers agree to continue to serve an established patient, ACC plans must reimburse PCPs for services provided before January 1, 2019, or specialists before April 1, 2019.
ACC and American Indian members
American Indian members will have the choice of integrated care products: the statewide American Indian Health Program (AIHP) or an ACC health plan. AIHP and ACC plans provide integrated physical and behavioral health services for most eligible American Indian adults and children, as well as those members with a qualifying CRS condition. American Indian members can choose to switch enrollment between AIHP and ACC plan at any time, but may only change from one ACC plan to another once per year. AIHP members can choose to receive behavioral health care coordination from a Tribal Behavioral Health Authority (TRBHA) where available. Additionally, these members may continue to choose to receive services from at any time from an IHS facility or a tribally owned or operated facility.
American Indian members with SMI determinations will continue to receive behavioral health services from the RBHA or TRBHA. There is no change in service delivery or choice for these members.
Any AHCCCS registered provider, regardless of type, may choose to serve AIHP members. There is no separate contractual requirement.
Member Transition Communication
In June, AHCCCS sent written notification to approximately 300,000 members in the state whose current health plan will not be available as an ACC plan in their GSA. These members were assigned to an ACC plan and had the month of July to choose a different ACC Plan. In order for services provided to a Medicaid member on or after January 1, 2019 (or April 1, 2019 for specialists) to continue to be reimbursable by Medicaid, providers must contract with the member’s new plan.