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, 2005, through September 30, 2006
Prepared by the Division of Health Care Management
August 2007

Anthony D. Rodgers
Director, AHCCCS

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, 2005, through September 30, 2006

Overview
It is estimated that the elderly population
will double by 2030, and that people 85
years and older, the group most likely to
have long-term care needs, will quadruple
by 2050.1

the health and personal needs of people
with chronic illness or disability. These
services range from skilled nursing care to
support services, such as help with
activities of daily living (dressing and
bathing, for example). Of Americans with
long-term care needs, 17 percent reside in
nursing homes, while the other 83 percent
live in the community, often cared for by
family members.1

The greatest increases in the elderly
population are occurring in the South and
in the West, particularly Mountain states
like Arizona.2 In less than 20 years, the
number of Arizonans age 65 and older is
expected to be almost 2 million, or about
20 percent of the state’s population.3

Estimates of total U.S. spending on longterm care services range from $158 billion
to $194 billion in 2004. Medicaid is the
largest financier of long-term care services,
with different studies estimating the
proportion at 42 to 49 percent of all longterm-care spending in 2004.1,4

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 two or
more chronic health conditions. Arthritis,
hypertension, heart disease, diabetes and
respiratory disorders are some of the
leading causes of activity limitations
among older people. 2

Home and community-based services
(HCBS) have become a growing part of
states’ Medicaid programs, providing a
cost-effective alternative to institutional
care for the elderly and physically disabled
(E/PD). From 1992 to 2002, HCBS
expenses rose from 15 percent to 30
percent of all long-term care expenditures.5

About 9.5 million Americans require longterm care services. But the elderly are not
the only users of long-term care: nearly
four in 10 (38 percent) are younger than
age 65 and have some sort of physical
and/or mental limitation.

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
between receiving services in the home
and improved consumer satisfaction and
overall quality of life.6

Long-term care consists of a variety of
medical and social services to help meet

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 members
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
October 2006, about 63.6 percent of the
As part of its quality assessment and
more than 22,000 elderly and physically
performance
improvement
program,
disabled Arizonans enrolled in ALTCS
AHCCCS measures the percentage of
resided in home and community-based
newly placed ALTCS members, by
settings. The proportion of HCBS
Contractor, who receive specific HCBS
members in rural counties was higher than
services within 30 days of enrollment.
in urban counties.
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 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-related
services that primarily allow ALTCS
members to remain in their homes longer.

In analyzing initiation of services,
AHCCCS did not include members who:
were residing in and receiving services
from an assisted living facility or nursing
home, were admitted to a hospital, were
receiving hospice services, or refused
services when these situations were
documented as occurring within 30 days of
enrollment. A small number of members
also were excluded for other reasons,
primarily because Medicare covered a
service for the member during the first 30
days. 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, 2005, through September 30,
2006. 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 (other than an
assisted living facility).
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
(MPS)
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

3

Rates by Contractor ranged from 79.3
percent to 97.7 percent. Five of six
Contractors exceeded both the AHCCCS
minimum standard and the current goal.
Two Contractors, Cochise Health Systems
and Pima Health System, achieved rates of
97.7 percent, just short of the AHCCCS
long-range goal of 98 percent.

Results and Analysis
The original study sample included 854
HCBS members. Of those, 284 people
were excluded because they were residing
in assisted living facilities or transferred to
nursing homes (171), were admitted to
hospitals (10), were receiving hospice
services (24), refused services while a
friend or family member was being trained
as a paid caregiver (66), or for other
reasons (13) in the first 30 days of
enrollment (Table 1).

Conclusions and Recommendations
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 and needs. However, the
overwhelming majority of new ALTCS
members placed in HCBS settings receive
services within 30 days of enrollment.

Exclusions by Contractor
Cochise Health Systems
Evercare Select
Mercy Care LTC
Pima Health System LTC
Pinal/Gila LTC
Yavapai County LTC
TOTAL

7
120
60
60
28
9
284

Among the remaining 570 people, 527 or
92.5 percent received services within 30
days of enrollment (Table 2). The overall
rate of initiation of services did not show a
statistically significant change, compared
with the previous measurement (p= .069).

Of the 284 people excluded from the study
in the current measurement, 66 members
or their authorized representatives refused
other services while awaiting a friend or
relative of the member to complete training
to become their paid caregiver. The
proportion of members/representatives
who refused services was 23.2 percent,
compared with 17.9 percent in the previous
measurement.

Initiation of Services
Within 30 Days
10/1/05 - 9/30/06
Did Not
Receive
Services,
7.5%

The option of having a relative or friend
provide care appears to be a popular choice
among elderly and disabled individuals.
One study showed that more than 60
percent of care for such people nationally
is provided by unpaid “informal
caregivers,” including relatives and
friends.7 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.

Received
Services,
92.5%

As was the case in the previous
measurement, there was no significant
difference in rates of initiation of services
between rural and urban counties in the
current period (p=.343).

4

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 few years, AHCCCS has worked with
Contractors to improve documentation.

•

In October 2004, AHCCCS implemented a
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 should help
to sustain high rates of initiation of home
and community based services.

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
nearly 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.8-11 These strategies
include:
•
Building ongoing relationships with
PCPs and other providers. This
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

References
1
Financing long-term care. The Henry J.
Kaiser Family Foundation. Washington, DC.
March 2007. Available at:
http://www.kaiseredu.org/topics_im.asp?id=68
0&imID=1&parentID=65. Accessed July 5,
2007.
2
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/socde
mo/age.html#elderly. Accessed June 12, 2006.
3
The state long-term care health sector 2005:
Characteristics, utilization and government
funding. American Health Care Association.
Washington, DC, August 2006. Available at:
http://www.ahca.org/research/index.html.
Accessed July 5, 2007.

5

4

11

Long-Term Care Financing Project. National
spending for long-term care fact sheet.
Georgetown University. Washington DC,
January 2007. Available at:
http://www.kaiseredu.org/topics_im.asp?id=68
0&imID=2&parentID=65. Accessed July 5,
2007.
5
Reester H, Missmar R, Tumlinson A. Recent
growth in medicaid home and communitybased 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=/c
ommonspot/security/getfile.cfm&PageID=361
19. Accessed June 21, 2005.
6
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.
7
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.p
df. Accessed June 22, 2005.
8
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.
9
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.
10
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/da
tareadinessIN.pdf. Accessed June 21, 2005.

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/da
tareadinessSC.pdf. Accessed June 21, 2004.

6

Table 1
AHCCCS ALTCS Perfromance Measure
INITIATION OF HOME AND COMMUNITY BASED SERVICES
Exclusions from Analysis of Initiation of Services, All Contractors
Measurement Periods: October 1, 2005, through September 30, 2006

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

n

Percent

Relative Percent
Change

171

60.2%

-6.2%

111

64.2%

24

8.5%

16

9.2%

10

3.5%

12

6.9%

66

23.2%

31

17.9%

13

4.6%

3

1.7%

284

100.0%

173

100.0%

Note:

Shaded rows show results of previous measurement, October 1, 2004, through September 30, 2005.

7

-8.6%

-49.2%

29.7%

164.0%

Table 2
AHCCCS ALTCS PERFORMANCE INDICATOR
INITIATION OF HOME AND COMMUNITY BASED SERVICES
WITHIN 30 DAYS OFENROLLMENT BY CONTRACTOR
Measurement Period: October 1, 2005, through September 30, 2006
Number who Percent who
Received
Received
Service Within Service Within
30 Days
30 Days

Contractor

n

Cochise Health Systems *

43

42

97.7%

45

43

95.6%

111

88

79.3%

60

54

90.0%

211

199

94.3%

132

113

85.6%

129

126

97.7%

86

79

91.9%

56

53

94.6%

44

37

84.1%

20

19

95.0%

26

24

92.3%

570

527

92.5%

393

350

89.1%

Evercare Select
Mercy Care LTC *
Pima Health System LTC *
Pinal/Gila County LTC *
Yavapai County LTC *

TOTAL

Relative
Percent
Change

Statistical
Significance

2.2%

1.000

-11.9%

0.075

10.2%

0.006

6.3%

0.093

12.5%

0.101

2.9%

1.000

3.8%

0.069

Notes:
* Indicates Contractor met or exceeded the AHCCCS Minimum Performance Standard.
Shaded rows show results of previous measurement, October 1, 2004, through September 30, 2005.

8

Appendix A: Acceptable Home and Community Based Services
Adult Day Health

Other
S5180 and S5181– applies to following:

S5100 Day Care service; per 15 minutes.
S5101 Day Care service; per ½ day.

S5180 Home health respiratory therapy, initial
evaluation.

S5102 Day Care service; per diem.

S5181 Home health respiratory therapy, NOS; per
diem.

Attendant Care
S5125 Attendant care service; per 15 minutes.

Habilitation Services
T2021 Day habilitation waiver; per 15 minutes

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

T2020 Day Habilitation, waiver; per diem.
T2017 Habilitation residential, waiver; per 15
minutes.

Home Health Aide
T1021 Home health aide or Certified Nurse
Assistant (CNA); per visit.

Behavioral Health
T1019 Personal care services; per 15 minutes.

Home Health Nursing – S9123 =RN, S9124= LPN
S9123 Nursing Care, in the home, by RN; per
hour (w or w/o *Modifier TG)

T1020 Personal care services, not for IP or
residential care facilities; per diem.

S9124 - Nursing Care in the home by LPN; per
hour. (w or w/o *Modifier TG)

H2014 Skills training and development; per 15
minutes. (w or w/o *Modifier HQ)
H2025 Ongoing support to maintain employment;
per 15 minutes.

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

T2018 Habilitation, supported employment,
waiver; per diem.
T2019 Habilitation, supported employment,
waiver; per 15 minutes.

Personal Care

H2019 Therapeutic behavioral services
(Behavioral Health Therapeutic Day Program);
per15 minutes. (w or w/o *Modifier TF)

T1019 Personal care services; per 15 minutes.

H2020 Therapeutic behavioral services
(Behavioral Health Therapeutic Day Program); per
diem.

Respite

i

S5150 Unskilled, not hospice; per 15 min in
home respite care.
Respite, cont.
S5151 Unskilled, not hospice; per diem in home
respite care.
S5150 Group, not hospice; per 15 min respite
care. (*Modifier HQ)
Homemaker

H0036 Community psychiatric supportive
treatment, Face to Face (Behavioral Health
Medical Day Program); per 15 minutes.
Behavioral Health
H0036 Community psychiatric supportive
treatment, Face to Face (Behavioral Health
Medical Day Program); per 15 minutes. (*Modifier
TF)
H0037 Community psychiatric supportive
treatment program (Behavioral Health Medical
Day Program); per diem.

S5130 Homemaker services, NOS; per 15 min.
*Modifier HQ – Modifier for group setting
*Modifier TF - Modifier for intermediate level of care
*Modifier TG - Modifier for complex/high level of care.

ii

Appendix B:
Arizona Long Term Care System (ALTCS)
Performance Measure Methodology

Project Title:

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
Period:

October 1, 2005, through September 30, 2006

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.

iii

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.
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 was 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 was 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.
iv

•

Data Validation:

Upon completion, all study information is removed from the computer
and placed on a compact disk, and stored in a secure location.

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 was 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 or nursing facility 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 within 30 days of enrollment
• The number of members in denominator #2 for whom no reason
was given

Analysis Plan:

•

The numerator was divided into the corresponding denominator for
each indicator (i.e., study question) to determine the indicator rate.
v

•

•

•
•
•

Data for services received within 30 days was analyzed as a statewide
aggregate, and by urban and rural counties, to determine overall and
urban- and rural- county rates.
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 or nursing facility within 30 days of
enrollment
o receiving hospice services within 30 days of enrollment
o residing in an assisted living facility within 30 days of
enrollment
Outliers were identified using standard deviations and patterns of
abnormal distribution of data.
Differences between prior study results were analyzed for statistical
significance and relative change.
The following assumptions were used to determine whether the
indicator criteria was met:
o Members included in the sample sent to Contractors for which
data was 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 indicator 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
Methodology:

There were no deviations from the methodology used for the previous
measurement.

Quality Control:

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.

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.

vi

Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long-Term Care System (ALTCS) Performance Indicator
Initiation of Home and Community (HCB) Services
Instructions for submission of data
Contractors can submit information in one of three ways: using an Excel spreadsheet provided by
AHCCCS, or a d-BASE IV file or a Text file. The data layout and instructions described must be
followed for submission to ensure accuracy of data translation and acceptance of data elements by
AHCCCS.
•

All variable fields must be left justified.

•

All variable fields are to be used exactly as indicated in the proceeding tables.

•

If information does NOT exist for any variable field, leave blank spaces in the columns.

•

Do not add any “new” variables that are not listed in the proceeding table.

•

Do not change variable names.

•

Do not change the order of the variable fields.

•

All dates should be formatted as mm/dd/yyyy. Thus, January 2, 2003 would be reported as
01/02/2003.

•

If submitting information in an Excel spreadsheet, use the file provided by AHCCCS. Do
not change the formatting.
The format has been designed for accurate importing of the data into AHCCCS software.
Any changes to the format could result in lost information and a request for the Contractor
to resubmit the data.
Do not change information provided by AHCCCS. Any discrepancy in provided
information, please provide AHCCCS with separate notation of difference and reason for
change.

•

•

•

If submitting the information in a d-BASE IV format, use the field layout provided below.
If no information exists for a variable field or your data does not fill the required field
length, use blank spaces in that column.

•

Data files must be formatted as fixed-width text files (*.txt).

•

Submit the data files using a CD-ROM. If file size is an issue, please compress the files into
a .zip file. If this does not solve the file size problem, please contact Sam S. Kim (e-mail:
sam.kim@azahcccs.gov).

vii

•

Put an external label on the CD-ROM indicating:
Contractor Name
Contact Name & Phone Number
Number of records in file(s) being provided

•

Send the CD to:
AHCCCS
Division of Health Care Management
701 East Jefferson, Mail Drop 6600
Phoenix, AZ 85034

•

The CD needs to arrive at AHCCCS by close of business April 16, 2006.

ANY DEVIATIONS FROM THE INSTRUCTIONS FOR SUBMISSION OF DATA WILL
NOT BE ACCEPTED AND RETURNED TO THE CONTRACTOR.
Contact information:
Technical questions related to the data request: should be directed to Sam S. Kim e-mail:
sam.kim@azahcccs.gov (preferred) or call (602) 417-4503
All other questions related to the project should be directed to Rochelle Tigner at (602) 417-4683
or e-mail: rochelle.tigner@azahcccs.gov
LAYOUT OF MEMBER IDENTIFIED FILE

Variable

Variable Name

Format

Length

Start Column

End Column

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

AHCCCS ID
Contractor
Last Name
First Name
Placement Code
Placement Begin Date
Placement End Date
ALTCS Enrollment Begin Date
ALTCS Enrollment End Date
Date Of Birth
Date Of Death
Gender
Fiscal County
Residential County
Service Code
Service Date

Text
Text
Text
Text
Text
Date
Date
Date
Date
Date
Date
Text
Text
Text
Text
Date

9
6
30
20
2
10
10
10
10
10
10
1
2
2
5
10

1
10
16
46
66
68
78
88
98
108
118
128
129
131
133
138

9
15
45
65
67
77
87
97
107
117
127
128
130
132
137
147

17

Exclusion Begin Date

Date

10

148

157

18

Exclusion End Date

Date

10

158

167

19

Reason For Exclusion

Text

10

168

177

20

Other

Text

50

178

227

21

Race

Text

1

228

228

viii

Description of Included Elements
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

AHCCCS ID
Contractor
Last Name
First Name
Placement Code
Placement Begin Date
Placement End Date
ALTCS Enrollment Begin Date
ALTCS Enrollment End Date
Date of Birth
Date of Death
Gender
Fiscal County
Residential County
Service Code
Service Date

17
18
19

Exclusion Begin Date
Exclusion End Date
Reason For Exclusion

20
21

Other
Race

9-digit alpha number assigned to a member upon enrollment into AHCCCS
6-digit number that tells what Contractor the member was enrolled with
Last name of member as listed in AHCCCS system
First name of member as listed in AHCCCS system
ALTCS placement code
Date that member became eligible for Home Community Based Services.
Date that member’s Home Community Based Services ended.
Date (not including prior period coverage) member was enrolled with the Contractor
Date that member’s ALTCS enrollment ended
Date that member was born as listed in AHCCCS system
Date that member expired as listed in AHCCCS system
Male or Female
County of financial responsibility
County in which the member resides
Five digit code that identifies specific service provided
Date that service was first provided to member (this is not the date that the case
manager authorized the service)
Date that a service began making a member eligible for exclusion
Date that a service ended making a member eligible for exclusion
Reason why service was not provided within 30 days of enrollment. (Drop-Down box
is provided that includes the acceptable exclusions.)
Other reason why service was not provided within 30 days of enrollment
Race of member as listed in AHCCCS system

ix