Last week, the Arizona Health Care Cost Containment System (AHCCCS) announced the Centers for Medicare and Medicaid Services’s (CMS) approval of AHCCCS’s Home and Community-based Services (HCBS) Spending Plan, meaning the agency can now begin implementing the spending plan’s initiatives and programs upon approval from the Arizona State Legislature. Additionally, the agency announced they will receive a 10% increase to the federal medical assistance percentage (FMAP) for qualifying HCBS and behavioral health services.
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In the plan, AHCCCS emphasized the importance of expanding and improving the state’s existing HCBS programs and services for members of the Arizona Long Term Care System (ALTCS). The spending plan stated that allowing ALTCS members to reside in their own homes and community-based settings resulted in significant program savings while also enhancing members’ quality of life. Currently, 91% of ALTCS members are receiving services in their own homes or in community-based settings, generating over $2.2 billion in annual ALTCS program savings.
To strengthen and enhance Arizona’s HCBS system using extensive stakeholder feedback, the spending plan identifies various priorities that target key populations that access HCBS care, including Arizona’s seniors, individuals with disabilities, individuals living with serious mental illness, and children with behavioral health needs.
The spending plan would allocate $1.5 billion (primarily consisting of American Rescue Plan funds) over the next two years. The funding is set to end in March 2024.
Below is a breakdown of the plan’s focus areas and funding allocations.
Empowering parents and families to provide care and meet the needs of their children
AHCCCS has proposed $26.7 million in funding to support Parents as Paid Caregivers of Minors, and the Parent University Training and Support Program.
Parents as Paid Caregivers would allow parents to serve as paid caregivers of their ALTCS-enrolled children to address Direct Care Workforce (DCW) shortages. Parents would be required to be employed by an Attendant Care agency and meet all provider-specific and AHCCCS-specific criteria for employment, including passing standardized DCW competency tests.
Parent University would be a training program for parents and providers that would focus on everything from parenting basics to stress management within parenting roles.
Funding local initiatives and community-specific programming to improve member health
AHCCCS has proposed $62.5 million to fund grants that would allow for innovative HCBS programs, expanded or enhanced supports, and infrastructure development or modification. Grants would be targeted toward providers to assist in advancing workforce retention and development strategies including training and relationship-building with employment and education partners.
These grants would also be used to support community-building programs such as training classes on relationship communication and art therapy workshops to reduce social isolation. The grant dollars may be used to improve infrastructure, such as bathroom accessibility modifications and enhanced airflow for infection containment in HCBS settings.
Assessing member engagement and satisfaction to better understand needs, prevent abuse and neglect, and identify opportunities for improvement.
AHCCCS proposes $5.2 million to support implementation of the National Core Indicator (NCI) Survey, as well as other member and provider outreach strategies to ensure the highest quality of service delivery as possible.
The NCI Survey would provide AHCCCS with invaluable insight on member experiences and on opportunities for system improvement. AHCCCS stated:
“Data from the surveys would allow for national comparison of like-populations as well as benchmark setting to aid in year-over-year evaluation of the populations served. The routine administration of the survey would support the evolution of AHCCCS’ quality improvement program and reinforce AHCCCS’ commitment to continuous improvement and member-centric care.”
Expanding access to care from a well-trained, highly skilled workforce.
AHCCCS proposes $216.9 million to fund the expansion of a caregiver career pathway platform. The platform would provide individuals interested in starting a career in health care with an individually-tailored career map and connections to testing, job training, education resources and financial resources to help with career-long training costs. The funding would also support comprehensive training and career development programs for behavioral health workforce, as well as an online database to track and monitor workforce development.
AHCCCS explained how bolstering the HCBS workforce would benefit the HCBS delivery system as a whole.
“A key priority for AHCCCS is ensuring timely access to high quality care, regardless of whether a member resides in urban or rural parts of the state. Additionally, care and services should be delivered in a thoughtful, member-centric manner that meets individuals’ specific needs and care goals.
This funding would expand access to care from a well-trained and highly-skilled workforce through comprehensive training programs that incorporate Arizona-specific guiding principles, evidence based principles, and nationally-recognized best practices.”
Promoting stabilization, access to supportive services, and workforce retention/consistency to improve member outcomes
AHCCCS proposes $1 billion to incentivize HCBS providers to develop a comprehensive workforce development plan aimed at recruiting and retaining workforces, including workers with disabilities and lived experience.
The funding would also go toward an in-depth review of behavioral health providers across the state and their capacity to serve members, the development and implementation of a DCW credentialing process, home-delivered meals for the Division of Developmental Disabilities (DDD) population, and the extension of HCBS to aging members living with a serious mental illness who do not meet the institutional level of care criteria.
Utilizing new technology to promote care coordination and seamless communication
AHCCCS proposes $74.7 million to fund new and updated technologies and information systems that would improve care coordination and communication. These technologies include HCBS provider electronic medical records (notably for the Division of Developmental Disabilities), ALTCS health plan case manager hardware and software to convert planning processes into electronic format, an upgraded portal for AHCCCS-registered providers to include the Preadmission Screening and Resident Review (PASRR) for members, and an upgraded client assessment and tracking system.
Creating tools that strengthen quality monitoring and prevent abuse and neglect
AHCCCS proposes $3.2 million to support the development of an online dashboard that details the information about HCBS providers to assist members and families as they make decisions/choose providers for their HCBS care. Part of this would also go toward upgrading the AHCCCS quality improvement system to allow for more comprehensive monitoring of managed care organizations This would also provide greater efficiency for quality improvement and data teams, as well as the creation of a central employment repository to allow employers to screen their employees to reduce risk to the vulnerable populations they serve.
Supporting individual self-sufficiency by connecting members to technological tools and resources that promote independence
AHCCCS proposes $96.6 million to invest in HCBS telehealth delivery models that support members’ independence while ensuring appropriate supervision safeguards, such as activity sensors in the member’s home or wearable technology to remotely monitor health and activity, and assistive technology (i.e. medication administration, bed repositioning, etc.).
This funding would also support contracting with a vendor to assist the state in developing tools to assess which members are experiencing social isolation and evaluate efforts to reduce social isolation, as well as update preadmission screening (PAS) tools to ensure they are not creating barriers to long-term care in Arizona.