Arizona Health Care Cost Containment System
Arizona Long Term Care System (ALTCS) Performance Measure

Initiation of Home and Community Based Services
for Elderly and Physically Disabled Members
Measurement Period: October 1, 2004, through September 30, 2005
Prepared by the Division of Health Care Management
August 2006

Anthony D. Rodgers
Director, AHCCCS

For questions or comments about this report, contact:
Rochelle Tigner
Quality Improvement Manager, Clinical Quality Management
Division of Health Care Management, AHCCCS
(602) 417-4683

Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long Term Care System (ALTCS) Performance Measure:
INITIATION OF HOME AND COMMUNITY BASED SERVICES
FOR ELDERLY AND PHYSICALLY DISABLED MEMBERS
Measurement Period: October 1, 2004, through September 30, 2005

Overview …............................................................................................................................
Methodology …......................................................................................................................
Performance Standards ..........................................................................................................
Results and Analysis …..........................................................................................................
Conclusions and Recommendations.......................................................................................
References …………………………………………………………………………………..
Tables ……………………………………………………………………………………….
Appendix A: Methodology and Technical Specifications ………………………………….

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Arizona Health Care Cost Containment System
Arizona Long Term Care System Performance Measure:
INITIATION OF HOME AND COMMUNITY BASED SERVICES
FOR ELDERLY AND PHYSICALLY DISABLED MEMBERS
Measurement Period: October 1, 2004, through September 30, 2005

Overview
In a few years, the first “baby boomers”
will turn 65 years old, and people aged 65
and over are projected to represent 20
percent of the total U.S. population in
2030, compared with 12 percent in 2003.
The greatest increases in the elderly
population are occurring in the South and
in the West, particularly Mountain states
like Arizona.1

non-medical services to help meet the
health and personal needs of people with
chronic illness or disability, including
support services such as help with
activities of daily living (dressing and
bathing, for example). Long-term care can
be provided at home, in the community or
in nursing homes. However, most older
Americans are cared for at home, with
family and friends an integral part of care.2

While the health of older Americans is
improving overall, many are disabled and
suffer from chronic conditions, which
often lead to disability. About 80 percent
of seniors have at least one chronic health
condition, and 50 percent have at least two
chronic health conditions. Arthritis,
hypertension, heart disease, diabetes and
respiratory disorders are some of the
leading causes of activity limitations
among older people.

Medicaid pays the largest share of longterm care expenses, accounting for 40
percent in 2003.2 Home and communitybased services (HCBS) have become a
growing part of states’ Medicaid long-term
care programs, providing a cost-effective
alternative to institutional care for the
elderly and physically disabled (E/PD).
From 1992 to 2002, total Medicaid
expenditures on long-term care services
grew from $39 billion to $82 billion.
During that time, the proportion of
spending on home and community based
services rose from 15 percent to 30 percent
of
all
Medicaid
long-term
care
3
expenditures.

In addition, obesity poses additional threats
to the health and quality of life of older
Americans. Data shows a rise in the
percent of people age 65 to 74 who were
considered obese in 1999 and 2000,
compared with a decade before that: in
men, the proportion grew from about 24 to
33 percent and in women from about 27
percent to 39 percent.1

Fueling this growth are consumers’ desires
to reside in their own homes rather than in
nursing homes, and changes in federal and
state policy that support this option.
Research has shown a strong connection
with receiving services in the home to
improved consumer satisfaction and
overall quality of life.4

Nearly 10 million Americans of all ages
require long-term care, with the vast
majority over the age of 65.2 Long-term
care consists of a variety of medical and
1

where they live. Each member is assigned
The
Arizona
Health
Care
Cost
a case manager, who coordinates care with
Containment System (AHCCCS) has
the member’s primary care provider (PCP),
provided home and community-based
addresses any problems with service
services to long-term care beneficiaries
delivery and modifies the member’s care
through a waiver from the Centers for
plan based on changes in health status.
Medicare and Medicaid Services (CMS)
Case managers visit new members and, in
since 1989. Through its Arizona Long
conjunction with those members and their
Term Care System (ALTCS), AHCCCS
authorized representatives, assess needs to
provides comprehensive coverage for
determine the most appropriate services
HCBS members residing in their own
and
placement.
homes or approved
Services must be
alternative residential
initiated
within
settings,
such
as
timelines
to
meet
assisted
living
Services are initiated
members’ medical
facilities or group
promptly when the
needs, but no later
homes.
Covered
individual is determined
than 30 calendar
services include care
eligible and selects HCBS
days from their
such as home health
enrollment.
nursing, attendant or
Focus Area 1.B.4, Prompt Initiation,
personal care, and
Framework for Quality in HCBS,
from the Centers for Medicare and
The
ALTCS
home-delivered meals.
Medicaid
Services
program
has
a
Members
may
number
of
designate a relative or
mechanisms
to
friend
to
provide
ensure that people
attendant care; after
receive services that provide the proper
completion of training, these caregivers
level of care and that services are
may be paid by AHCCCS.
monitored. These include reassessment of
member needs at regular intervals by
By providing a variety of alternative
Contractors’ case managers, review of case
settings with differing levels of care,
management services by AHCCCS, and
ALTCS members are able to delay
monitoring of the timeliness of initiation of
institutionalization or, in some cases,
services after enrollment by both
transfer from nursing homes to home or
Contractors and AHCCCS.
other community-based settings. As of
Oct. 1, 2005, about 62 percent of the more
As part of its quality assessment and
than 22,000 elderly and physically disabled
performance
improvement
program,
Arizonans enrolled in ALTCS resided in
AHCCCS measures the percentage of
home and community-based settings. The
newly placed ALTCS members, by
proportion of HCBS members was slightly
Contractor, who receive specific HCBS
higher in urban counties, compared with
services within 30 days of enrollment.
rural areas.
These services include adult day health
care, attendant care, home-delivered meals,
Once eligibility for ALTCS is determined
home health nursing and homemaker
based on financial and medical criteria,
assistance (a complete list of services and
E/PD members enroll with a contracted
service codes is included in Appendix A).
health plan (Contractor), depending on

2

encounter data, Contractors were asked to
provide service delivery information from
medical or case management records or
their claims data.

It should be noted that this Performance
Measure does not include all covered home
and community-based services. For
example, emergency-alert and homemodification services are not included
because they are typically provided in
conjunction with nursing, personal care or
other
supportive
services.
This
measurement focuses on the health care
services that primarily allow members at
risk of institutionalization to remain in
their homes or the community.

In analyzing initiation of services,
AHCCCS did not include members who:
•
were residing in and receiving
services from an assisted living
facility,
•
were admitted to a hospital or
nursing home,
•
were receiving hospice services, or
•
refused services
when these situations were documented as
occurring within 30 days of enrollment.
Percentages of members in the sample who
fell into one of the above categories also
were analyzed.

Methodology
The methodology for this measurement is
based on two study questions:
•
What is the number and percentage
(overall, by urban and rural counties,
and by individual Contractor) of
sample members to whom a home and
community-based service was provided
within 30 days of enrollment?
•
For those members who did not receive
services within 30 days of enrollment,
what were the reasons?

To validate additional information
collected by Contractors, AHCCCS
required documentation of services
provided or reasons why a member did not
receive services (for example, the member
refused services while waiting for a family
member to become trained to provide
attendant care or was hospitalized during
all or part of the first 30 days of
enrollment). Documentation provided by
Contractors included copies of the
pertinent sections of case management
records, medical/service records from
providers, or verification of claims paid by
Contractors for qualifying services.

The measurement period for the study was
October 1, 2004, through September 30,
2005. The sample frame consisted of E/PD
members who:
•
were enrolled for 30 days or more with
an ALTCS Contractor during the
measurement period, and
•
were newly placed in a home or
community-based setting.
This study did not include ventilatordependent members, as Contractors are
required to initiate services for those
members within 14 days of enrollment.

Performance Standards
AHCCCS has established a Minimum
Performance Standard that Contractors
achieve a rate of at least 84 percent for this
measure. If Contractors are already
achieving the minimum standard, they
should strive for a rate of 85 percent or
higher. The AHCCCS long-range goal is
that all Contractors achieve a rate of at
least 98 percent for this measure.

A representative random sample was
selected for each Contractor. Data were
first collected from AHCCCS encounter
data (records of claims paid by
Contractors). If services within 30 days of
enrollment were not found in AHCCCS

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Conclusions and Recommendations
A large majority of new ALTCS members
who are placed in a home or community
based setting receive services within 30
days of enrollment. These services are
designed to help long-term care recipients
maintain or improve their health and
functional status, and enjoy a greater
degree of independence.

Results and Analysis
The study sample included 566 HCBS
members. Of those, 173 people were
residing in assisted living facilities, were
admitted to hospitals or nursing facilities,
were receiving hospice services, or refused
services within 30 days of enrollment
(Table 1).
Exclusions by Contractor
Cochise Health Systems
Evercare Select
Mercy Care LTC
Pima Health System LTC
Pinal/Gila LTC
Yavapai County LTC
TOTAL

In addition, all ALTCS E/PD Contractors
are meeting the AHCCCS Minimum
Performance Standard for this measure,
and most have achieved the Goal. It should
be noted that AHCCCS raised the
Performance Standards in ALTCS
contracts for the current measure.

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68
26
38
26
9
173

The option of having a relative, friend or
neighbor provide care appears to be a
popular choice among elderly and disabled
individuals. A recent study shows that
more than 60 percent of care for such
people nationally is provided by unpaid
“informal caregivers”: spouses, other
relatives and friends.5 Given the high
proportion of unpaid family and friends
who already provide care and support, it is
logical that these people would continue to
provide care under a paid arrangement.

Among the remaining 393 people, 350 or
89.1 percent received services within 30
days of enrollment (Table 2). The overall
rate of initiation of services was unchanged
from the previous measurement (p= .597).
There was no difference in the rate of
initiation of services between rural and
urban counties in this or the previous
measurement (p= .364).

Initiation of Services
Within 30 Days
10/1/04 - 9/30/05

In this study, AHCCCS did not include in
the analysis of rates those members whom
case managers documented were waiting
for a relative or friend to be trained as an
attendant caregiver, as these members
already were being cared for. In the current
measurement, 31 members or their
authorized representatives refused services
and/or were awaiting a designated
caregiver to complete training. The percent
of members who refused services and were
waiting for caregivers to be trained in the
current measurement was substantially less
than in the previous measurement, 17.9
percent compared to 32.1 percent.

Did Not
Receive
Services,
10.9%

n
Received
Services,
89.1%

Rates by Contractor ranged from 84.1
percent to 95.6 percent. All six Contractors
exceeded the AHCCCS Minimum
Performance Standard and five achieved
the current goal.

4

Given the variety and complexity of
members’ needs and personal situations
when they enroll in the ALTCS program,
Contractors’ case managers face distinct
challenges in ensuring that enrollees have
prompt access to home and community
based services that fit with their individual
choices.
Clearly,
some
AHCCCS
Contractors are effectively meeting this
challenge, with rates of initiation within 30
days of 90 percent or better.

•

Since much of the data for this indicator is
collected from case management records
when claims or encounters for services are
not available, Contractors must ensure that
case managers thoroughly and consistently
document when home and communitybased services are initiated for new
members or when members or authorized
representatives refuse services. Over the
past two years, AHCCCS has worked with
Contractors to improve documentation.

•

In October 2004, AHCCCS implemented a
new policy that ALTCS Program
Contractors should develop a standardized
system for verifying the delivery of
services with the member or representative
after authorization, in order to better
ensure that the services that have been
ordered are put in place in a timely
manner. Implementation of this policy may
help to further improve AHCCCS rates for
initiation of home and community based
services when they are measured in the
future.

enables case management staff to
better coordinate care and facilitate
communication and authorizations.
Communicating with providers through
secure electronic means. An HCBS
program in Ohio has implemented a
process that allows providers to
respond to a Request for Services and
advise case managers within 24 hours
if they are able to provide specific
services to a particular person. The
process safeguards the recipients’
privacy and reduces the amount of time
case managers spend on the phone or
faxing information to find a provider.
(Arizona
is
working
on
a
comprehensive initiative to create an
electronic
health
information
infrastructure that would increase
provider efficiency and improve care
coordination.)
Utilizing automated case management
systems. These systems can be used to
track timeliness of service initiation
and generate reports to evaluate overall
quality and outcomes. Reminders for
case managers may be built into the
systems.

Another key component of improving the
timeliness of health care service delivery is
the availability of performance information
by contracted health plan. Given that all
Contractors are meeting the Minimum
Performance Standard for this measure,
AHCCCS will consider raising the
minimum performance level in order to
encourage continued improvement toward
meeting the long-range goal.

Promising practices related to timely
provision of home and community-based
services have been identified through
programs in other states, including disease
management programs.6-10 These strategies
include:
•
Building ongoing relationships with
PCPs and other providers. This

5

10

References

MEDSTAT Group. Promising practices in home
and community-based services, Indiana’s quality
improvement process. Centers for Medicare and
Medicaid Services. Baltimore Md. Available at:
http://www.cms.hhs.gov/promisingpractices/datarea
dinessSC.pdf. Accessed June 21, 2004

1

Wan H, Sengupta M, Velkoff VA, DeBarros KA.
65+ in the United States: 2005. U.S. Census
Bureau, Current Population Reports, P23-209, U.S.
Government Printing Office, Washington, DC,
December
2005.
Available
at:
http://www.census.gov/population/www/socdemo/a
ge.html#elderly. Accessed June 12, 2006.
2
Kaiser Commission on Medicaid and the
Uninsured. Medicaid and long-term care. Kaiser
Family Foundation. Washington, DC. March 2005.
Available at:
http://www.kff.org/medicaid/loader.cfm?url=/com
monspot/security/getfile.cfm&PageID=36296.
Accessed June 21, 2005
3
Reester H, Missmar R, Tumlinson A. Recent
growth in medicaid home and community- based
service waivers. The Kaiser Commission on
Medicaid and the Uninsured. Kaiser Family
Foundation. Washington, DC. April 2004.
Available at:
http://www.kff.org/medicaid/loader.cfm?url=/com
monspot/security/getfile.cfm&PageID=36119.
Accessed June 21, 2005
4
Appelbaum R, Schneider B, Kunkel S, Davis S. A
guide to quality in consumer directed services.
Scripps Gerentology Center. Miami University.
May 2004. Available at:
http://www.hcbs.org/files/42/2099/Guidefront.pdf.
Accessed June 21, 2005
5
Center on an Aging Society. A decade of informal
caregiving. Georgetown Univeristy. Washington
DC. February 2005. Available at:
http://www.hcbs.org/files/65/3249/caregivers.pdf.
Accessed June 22, 2005
6
Brown R, Chen A. Disease management options:
Issues for state medicaid programs to consider.
Mathematica Policy Research Inc. Princeton, NJ.
April 2004. Available at: http://www.mathematicampr.com/publications/pdfs/diseaseman.pdf.
Accessed June 8, 2004
8
. MEDSTAT Group. Promising practices in home
and community-based services, Ohio – Increasing
timely access to services. Centers for Medicare and
Medicaid Services. Baltimore Md. Available at:
http://www.hcbs.org/promisingpractices/Ohio_increasingtimelyaccess.pdf.
Accessed February 10, 2004
9
MEDSTAT Group. Promising practices in home
and community-based services, South Carolina’s
case management system. Centers for Medicare and
Medicaid Services. Baltimore Md. Available at:
http://www.cms.hhs.gov/promisingpractices/datarea
dinessIN.pdf. Accessed June 21, 2005

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Table 1
AHCCCS ALTCS Performance Measure
INITIATION OF HOME AND COMMUNITY BASED SERVICES
Exclusions from Analysis of Initiation of Services, All Contractors
Measurement Period: October 1, 2004, through September 30, 2005

Reason
Member in Assisted Living Facility/Nursing
Facility

Member Recieving Hospice Services

Member Admitted to Hospital

Member Refused Services/Awaiting Designated
Caregiver to be Trained

Other

TOTAL

Number

Percent

Relative Percent
Change

111

64.16%

21.7%

85

52.70%

16

9.25%

17

8.20%

12

6.94%

6

3.70%

31

17.92%

57

32.10%

3

1.73%

6

3.30%

173

100.00%

171

100.00%

12.8%

87.5%

-44.2%

-47.5%

Shaded rows show results of the previous measurement period (Oct. 1, 2003, through Sept. 30, 2004). Data for Maricopa
Long Term Care Plan, which no longer is contracted with AHCCCS, was excluded from the results.

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Table 2
AHCCCS ALTCS Performance Measure
INITIATION OF HOME AND COMMUNITY BASED SERVICES
WITHIN 30 DAYS OF ENROLLMENT, BY ALTCS CONTRACTOR
Measurement Period: October 1, 2004, through September 30, 2005

Contractor
Cochise Health Systems *

Yavapai County LTC *

Pima Health System LTC *

Evercare Select *

Mercy Care LTC *

Pinal/Gila County LTC *

TOTAL

Number of
Members
Included

Number who
Received
Service Within
30 Days

Percent who
Received
Service Within
30 Days

Relative
Percent
Change

Statistical
Significance

45

43

95.6%

-2.7%

p=.584

56

55

98.2%

26

24

92.3%

2.6%

p = 1.000

30

27

90.0%

86

79

91.9%

-5.0%

p=.207

120

116

96.7%

60

54

90.0%

5.4%

p=.412

82

70

85.4%

132

113

85.6%

0.1%

p=.971

165

141

85.5%

44

37

84.1%

-5.6%

p =.450

64

57

89.1%

393

350

89.1%

-1.2%

p = .597

517

466

90.1%

* Denotes that the Contractor met or exceeded the AHCCCS Minimum Performance Standard.
Shaded rows show results of the previous measurement period (Oct. 1, 2003, through Sept. 30, 2004). Data for Maricopa
Long Term Care Plan, which no longer is contracted with AHCCCS, was excluded from the previous results.

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Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long Term Care System (ALTCS)
Performance Measure Methodology

Performance
Measure:

Initiation of Home and Community Based Services (HCBS)

Background:

Health care services and supports should be provided to members in the
Arizona Long Term Care System (ALTCS) who are residing in home and
community-based settings as quickly as possible after enrollment. These
services and supports include, but are not limited to: adult day health care,
attendant care, behavioral health services, habilitation services, homedelivered meals, home health aide services, home health nursing,
homemaker assistance, home infusion therapy and respiratory therapy.
Arizona Health Care Cost Containment System (AHCCCS) medical policy
requires that service be provided within the first 30 days after enrollment
to new ALTCS members who are placed in the Home and Community
Base Services (HCBS) program.

Purpose:

The purpose of this study is to evaluate ALTCS Contractor compliance
with AHCCCS medical policy in initiating services to newly enrolled elderly
and physically disabled (E/PD) members in the HCBS program.

Measurement
Periods:

October 1, 2004, through September 30, 2005

Study Questions:

1. What is the number and percentage (overall, by urban and rural
counties, and by individual Contractor) of sample members to whom a
service was provided within 30 days of enrollment?
2. For those members who did not receive services within 30 days of
enrollment, what were the reasons?

Population:

All newly enrolled E/PD members placed in the HCBS program

Sample Frame:

The sample frame consists of E/PD members who met the following
criteria:
•
Newly enrolled with an ALTCS Contractor during the measurement
period,
•
Enrolled in ALTCS for 30 or more days during the measurement
period, and
•
Placed in an ALTCS-authorized HCBS setting

Sample Frame
Exclusions:

•

•

This measure did not include members who were enrolled in the
Ventilator Dependent program. AHCCCS requires services for these
members to be implemented within 14 days of enrollment.
Members with Prior Period Coverage (PPC) were excluded from the
sample frame. PPC is a retroactive coverage period for which
Contractors are financially responsible for paying for covered services.

i

Sample Selection:

A statistical software package was used to select a random representative
sample by Contractor from the sample frame. The sample size was
determined using a confidence level of 95 percent and a 5-percent
confidence interval, plus oversampling that was based on the previous
year’s exclusions and missing record count.

Sample Strata:

The random sample was further stratified by urban and rural counties.

Data Sources:

AHCCCS recipient enrollment data were used to identify members who
met the sample frame criteria. AHCCCS encounter data, and member
medical records and/or case management files, and Contractor claims
data were used to identify services received by members in the sample
frame.

Data Collection:

Data were first collected from AHCCCS administrative (encounter) data. If
acceptable services were not identified as being provided within 30 days
of enrollment, AHCCCS requested that Contractors use medical records,
case management files or their own claims data to verify whether any of
the services measured in this study were provided to those members
within the first 30 days of enrollment. If services were not provided within
30 days, Contractors were to provide the reason and supporting
documentation for each case.
Contractors were required to collect data using the AHCCCS
standardized methodology in an electronic format provided by AHCCCS.
Each Contractor was provided an electronic file of its sample members for
whom encounters for services within 30 days of enrollment were not found
in the AHCCCS encounter system. After collection of data, Contractors
were required to return the data to AHCCCS in the predetermined
electronic format.

Confidentiality
Plan:

AHCCCS continues to work in collaboration with Contractors to develop,
implement and maintain compliance with Health Insurance Portability and
Accountability Act (HIPAA) requirements.
The Data Analysis & Research (DAR) Unit maintains the following security
and confidentiality protocols:
•
To prevent unauthorized access, the sample member file is
maintained on a secure, password-protected computer, by the DAR
project lead,
•
Only select Division of Health Care Management (DHCM) employees,
who enter or analyze data, have access to study data.
•
Sample files given to Contractors are tracked to ensure that all records
are returned.
•
All employees and Contractors are required to sign a confidentiality
agreement.
•
Member names are never identified or used in reporting.
•
Upon completion, all study information is removed from the computer
and placed on a compact disk, and stored in a secure location.

ii

Data Validation:

The sample frame was validated to ensure that members met criteria for
inclusion in the study.
Data files received back from Contractors were reviewed to ensure that:
•
all members included in the sample were listed in the returned data
file,
•
services met numerator criteria for this performance measure,
•
all requested information was provided.
Service data provided by Contractors must have been accompanied with
documentation of the source data (i.e., copy of the pertinent section of the
medical record or case management file and/or a copy of a paid claim),
including the date(s) of service. Contractor-supplied data were validated
by clinical staff of the AHCCCS ALTCS unit.

Indicators:

1. The number and percentage (overall, by urban and rural counties, and
by individual Contractor) of sample members who received at least
one acceptable home and community-based service within 30 days of
enrollment during the measurement periods.
2. The number and percentage of members who did not receive an
acceptable home and community-based service within 30 days of
enrollment, by reason category.

Denominators:

1. The number of members who met the sample frame criteria
2. The number of members who met the sample frame criteria and did
not receive a service within 30 days of enrollment

Numerators:

1. The number of sample members who received an acceptable service
within 30 days of enrollment in ALTCS
2. The number of sample members who did not receive an acceptable
service within 30 days of enrollment for one of the following reasons:
•
The number of members in denominator #2 who refused all
services (including those who refused other services while waiting
for a specific person to be trained as an attendant caregiver)
•
The number of members in denominator #2 who died within 30
days of enrollment
•
The number of members in denominator #2 who were admitted to
a hospital within 30 days of enrollment
•
The number of members in denominator #2 who were receiving
hospice services within 30 days of enrollment
•
The number of members in denominator #2 who were in an
assisted living facility or nursing facility within 30 days of
enrollment
•
The number of members in denominator #2 for whom no/other
reason was given

Analysis Plan:

•
•

The numerator was divided by the corresponding denominator for
each indicator (i.e., study question) to determine the indicator rate.
Data for services received within 30 days were analyzed as a
statewide aggregate, and by urban and rural counties, to determine
overall and urban- and rural- county rates.

iii

•

•
•

•

When calculating rates for initiation of services within 30 days of
enrollment (study question #1), members were excluded from the
denominator for the following reasons:
o refused all applicable services
o died within 30 days of enrollment
o admitted to a hospital within 30 days of enrollment
o received hospice services within 30 days of enrollment
o resided in an assisted living facility or nursing facility within
30 days of enrollment
No outliers were identified using standard deviations and patterns of
abnormal distribution of data.
Differences between the previous measurement results were analyzed
for statistical significance and relative change. Data for Maricopa Long
Term Care, which terminated its contract with AHCCCS effective Oct.
1, 2005, was removed from the results for the previous measurement
period.
The following assumptions were used to determine whether the
indicator criteria was met:
o Members included in the sample sent to Contractors for
which were not received back from the Contractor were
counted as having no service within 30 days;
o Any service documented by the Contractor that did not
include the date it was first delivered was counted as being
provided outside the 30-day requirement.

Comparative
Analysis:

•
•

Deviations from
HEDIS:

This Performance Measure is based on an AHCCCS contractual
requirement and is not based on any nationally recognized methodology,
such as the Health Plan Employer Data and Information Set (HEDIS).

Deviations from
Previous AHCCCS
Methodology:

There were no substantive deviations from the methodology used for the
previous measurement. Maricopa Long Term Care, which terminated its
contract with AHCCCS effective Oct. 1, 2005, was excluded from the
study.

Quality Control:

Overall rates for urban and rural counties were compared.
Individual Contractor rates were compared to each other and to the
AHCCCS Minimum Performance Standard and Goal.

To ensure consistency and reliability in data abstraction, AHCCCS:
provided each Contractor with the methodology for this measure
provided each Contractor with a data specification sheet, file layout,
and data dictionary for this measure
•
provided Contractors with detailed written instructions for data
collection
•
provided updates and ongoing technical assistance to Contractors
regarding data collection for this measure
•
•

iv

Acceptable HCBS Service Codes
The following services met the indicator criteria for the AHCCCS HCBS Performance
Measure for the measurement period of October 1, 2004, through September 30, 2005:
Adult Day Health

Personal Care

Z3000/S5100 Day care service; per 15 min.
Z3000/S5101 Day care service; per ½ day.
Z3000/S5102 Day care service; per diem.

Z3050/T1019 Personal care services; per 15 min.
Not for IP

Attendant Care

Respite

Z3725/S5125 Attendant care service; per 15 min.

Z3060/S5150 Unskilled, not hospice; per 15 min in
home respite care.

Z3080/S5125 Attendant care services; per diem.

Z3070/S5151 Unskilled, not hospice; per diem in
home respite care.
Z3061/S5150 Unskilled, not hospice; per 15 min
respite care.

Home-Delivered Meals
Z3010/S5170 Home-delivered meals; per meal
including preparation.

Homemaker
Z3040/S5130 Homemaker services, NOS; per 15
min.

Home Health Aide
Z3020/T1021 Home health aide or CNA; per visit.

Other
S5180 and S5181– applies to following:

Home Health Nursing – S9123 =RN, S9124=
LPN
Z3039/ S9123 Nursing Care in home by RN; per
hour. (Modifier TG)

W2404/S5180 Home health respiratory therapy,
initial evaluation.

Z3030/ S9123 or S9124 Nursing Care in home by
RN and LPN; per hour.

W2405/S5180 Home health respiratory therapy,
initial evaluation.

Z3038/ S9124 - Nursing Care in home by LPN;
per hour. (Modifier TG)

W2406/S5181 Home health respiratory therapy,
NOS; per diem.

Z3037/ S9124 Nursing Care in home by LPN per
hour.

Habilitation Services

Z3032/ S9123 Nursing Care in home by RN; per
hour (Modifier TG)

Z3132 /T2021 Day habilitation waiver; per 15 min.

Z3031/ S9123 and S9124 Nursing Care in home
by RN; per hour.

Z3133/T2016 Habilitation residential, waiver; per
diem.

Z3036/ S9123 Nursing Care in home by LPN; per
hour. (Modifier TG)

Z3134/T2017 Habilitation residential, waiver; per 15
minutes.

Z3035/ S9124 Nursing Care in home by LPN; per
hour. (Modifier TG)

T2020 Day Habilitation, waiver; per diem.

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Home Health Nursing (Con’t)

Behavioral Health

Z3034/ S9124 Nursing Care in home by RN; per
hour. (Modifier TG)

Z3050, /T1019 Personal care services; per hour.
W4044/T1019 Personal care services; per 15
minutes, up to 11 ¾ hours.
W4045/T1020 Personal care services; per diem.
W4006 /H2014 Skills training and development; per
15 minutes.
W4015/H2014 Group skills training and
development; per 15 minutes. (*Modifier HQ)
W4031/H2025 Ongoing support to maintain
employment; per 15 minutes

Home Infusion
Z3470/S9379 Home Infusion Therapy; per diem.
Not otherwise classified.

T2018 Habilitation, supported employment, waiver;
per diem.
Z3084/T2019 Habilitation, supported employment,
waiver; per 15 minutes.
W4071/H2012 Behavioral health day treatment
(supervised day program); per hour

Companion care

W4072/H2015 Comprehensive community support
services (supervised day program); per 15 minutes

S5135 Companion care adult; 15 minutes.

W4073 /H2019 Therapeutic behavioral services
(therapeutic day program); per 15 minutes.
W4074, W4077/H2019 Therapeutic behavioral
services (therapeutic day program); per diem.
(*Modifier TF)
W4075, W4078/H2020 Therapeutic behavioral
services (therapeutic day program); per diem.
W4079, W4082 /H0036 Community psychiatric
supportive treatment, Face to Face (medical day
program); per 15 minutes.
W4080, W4083/H0036 Community psychiatric
supportive treatment, Face to Face (medical day
program); per 15 minutes. (*Modifier TF)
W4081, W4084/H0037 Community psychiatric
supportive treatment program (medical day
program); per diem.
HIPAA Crosswalk for Codes: Use of the new codes was optional for dates of service on and after October
1, 2003. use of the new codes was required for dates of service after January 1,2004.
*Modifier HG – Modifier for group setting
*Modifier TF - Modifier for intermediate level of care
*Modifier TG - Modifier for complex/high level of care

vi