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, 2007, through September 30, 2008
Prepared by the Division of Health Care Management
August 2009

Anthony D. Rodgers
Director, AHCCCS

“Our first care is your health care”

Performance Measure Summary
Background: About 9.5 million Americans require long-term care services, ranging from skilled
nursing care to support services, such as help with activities of daily living (dressing and
bathing, for example).Estimates of total U.S. spending on long-term care services range from $158
billion to $194 billion. Medicaid is the largest financier of long-term care services, with studies
estimating the proportion at 42 to 49 percent of all long-term care spending.1,4
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.5 With the appropriate services, many people who would otherwise live in nursing facilities
are able to live in private homes or in community residential settings. Approximately 65 percent of the
more than 22,000 elderly and physically disabled Arizonans enrolled in the Arizona Long Term Care
System (ALTCS) reside in home and community-based settings.
Purpose:
AHCCCS annually measures the percentage of newly placed HCBS ALTCS members
who receive specific services within 30 days of enrollment, as required by AHCCCS medical policy.
This measure assesses Contractor performance in this area.
Goals:
AHCCCS has established a Minimum Performance Standard (MPS) for ALTCScontracted health plans (Contractors) that 92 percent of their members included in this measurement
will have a service within 30 days of enrollment. The AHCCCS goal for this measure is 98 percent.
Methodology: The measurement period for the current study is October 1, 2007, through September
30, 2008. A representative random sample was selected for each Contractor. The sample frame
consists of E/PD members who:
•
were enrolled for 30 days or more with an ALTCS Contractor during the measurement period,
•
were newly placed in an HCBS setting, other than an assisted living facility, and
•
were not ventilator-dependent, as Contractors are required to initiate services for those members
within 14 days of enrollment.
Some members also were excluded if they were hospitalized, receiving hospice services, or refused
services when these situations were documented as occurring within 30 days of enrollment.
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 encounter data, Contractors were
asked to provide information from medical or case management records or their claims data. Data
collected by Contractors were validated against documentation, such as copies of the pertinent sections
of case management records, medical/service records from providers, or verification of claims paid by
Contractors for qualifying services.
Results:
In the current measurement, 94.4 percent received services within 30 days of
enrollment, a statistically significant increase over the previous rate of 91.4 percent. There was no

significant difference in rates of initiation of services between rural and urban counties, or by
members’ race or ethnicity.
Rates by Contractor ranged from 80.9 percent to 100 percent. Six of the eight Contractors exceeded
the minimum standard and three achieved the AHCCCS goal. Contractors that did not meet the MPS
will be required to implement corrective action plans to bring their rates up to the standard.

Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long Term Care System (ALTCS)
PERFORMANCE MEASURE for INITIATION OF HOME AND
COMMUNITY BASED SERVICES
For the Measurement Period October 1, 2007, through September 30, 2008
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).

Introduction
It is estimated that the number of Americans
65 years and older will double by 2030, and
that the number of people 85 and older ―
the group most likely to have long-term care
needs ― will quadruple by 2050.1

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. 2

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.
Home and communityMedicaid is the largest
financier of long-term
based services provide a
care services, with
cost-effective
studies estimating the
alternative to
proportion at 42 to 49
percent of all long-term
institutional care for the
care
spending
in
elderly and physically
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
disabled.
chronic
health
Home and communitycondition,
and
50
― The Kaiser Commission on
based services (HCBS)
percent have two or
Medicaid and the Uninsured
have become a growing
more chronic health
part of states’ Medicaid
conditions.
Arthritis,
programs, providing a
hypertension,
heart
cost-effective alternative to institutional care
disease, diabetes and respiratory disorders
for the elderly and physically disabled
are some of the leading causes of activity
(E/PD).5 With the appropriate home and
limitations among older people. 2
community-based services, many people
who would otherwise live in nursing
Long-term care consists of a variety of
facilities are able to live in private homes or
medical and social services to help meet the
in community residential settings.
health and personal needs of people with

1

members may be able to transfer from
Research has shown a strong connection
nursing homes to home or other communitybetween receiving services in the home and
based settings or delay institutionalization
improved consumer satisfaction and overall
6
for a longer period of time.
quality of life. But people often face
challenges in accessing home and
Once eligibility for ALTCS is determined
community-based services, and some states
based on financial and medical criteria,
have waiting lists for HCBS programs that
E/PD members enroll
can result in longer
with a contracted
nursing facility stays.
health
plan
Arizona has developed
(Contractor).
Each
an HCBS program
Services are initiated
member
is
assigned
a
that allows long-term
promptly when the
case manager, who
care
members
to
individual is determined
coordinates care with
choose this option
eligible
and
selects
HCBS
the member’s primary
when appropriate, and
care provider (PCP)
requires
that
― Focus Area 1.B.4,
and other providers,
contracted
health
Prompt Initiation, CMS Framework
addresses
any
plans initiate services
for Quality in HCBS
problems with service
within timelines to
delivery, and modifies
meet
members’
the member’s care
medical needs, but no
plan based on changes
later than 30 calendar
in health status. Case managers visit new
days from their date of enrollment.
members and, in conjunction with those
members or their representatives, assess
The AHCCCS HCBS Program
needs to determine the most appropriate
The Arizona Health Care Cost Containment
services and placement.
System (AHCCCS) has provided home and
community-based services to long-term care
beneficiaries through a waiver from the
To ensure that member needs continue to be
Centers for Medicare and Medicaid Services
met in the most appropriate setting, case
(CMS) since 1989. Through its Arizona
managers reassess members’ physical and
Long Term Care System (ALTCS),
functional status at regular intervals and
AHCCCS provides comprehensive coverage
monitor the ongoing provision of services.
for HCBS members residing in their own
AHCCCS also monitors service provision
homes or approved alternative residential
through regular reviews of Contractor
settings, such as assisted living facilities or
operations.
group homes. Covered services include care
such as home health nursing, attendant or
Approximately 65 percent of the more than
personal care, and home-delivered meals.
22,000 elderly and physically disabled
Members may designate a family member or
Arizonans enrolled in ALTCS resided in
friend to provide attendant care; after
home and community-based settings by
completion of training, these caregivers can
October 2007 (when the measurement
be paid by AHCCCS.
period for this study began). AHCCCS
annually measures the percentage of newly
By providing a variety of alternative settings
placed HCBS members who receive specific
with differing levels of care, ALTCS
services within 30 days of enrollment.

2

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 who fell into one of
the above categories also were analyzed.

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 as long as possible (see
Appendix A, Methodology, for a complete
list of services and service codes included in
this measurement).

Data Quality and Reliability
AHCCCS conducts validation studies to
evaluate the completeness of encounter data.
The two most recent annual studies of
encounters submitted by ALTCS E/PD
Contractors show encounter-omission rates
of less than 5 percent for each year.

Methodology
The measurement period for the current
study is October 1, 2007, through September
30, 2008. A representative random sample
was selected for each Contractor. The
sample frame consists 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 an HCBS setting,
other than an assisted living facility.

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).
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. This documentation was reviewed
by AHCCCS staff with expertise in ALTCS
case management.

This study does not include ventilatordependent members, as Contractors are
required to initiate services for those
members within 14 days of enrollment.
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
encounter data, Contractors were asked to
provide information from medical or case
management records or their claims data.

Performance Standards
For this reporting period, AHCCCS raised
the Minimum Performance Standard (MPS)
that Contractors must achieve to 92 percent
for this measure. Contractors who do not
meet the MPS must develop and implement
corrective action plans, as approved by
AHCCCS. If Contractors are already
achieving the minimum standard, they
should strive for the AHCCCS goal of at
least 98 percent.

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

3

urban counties. There also were no
significant differences in rates for members
who identified themselves as Hispanic,
Native American, Black or “other”,
compared with non-Hispanic White
members.

Results and Analysis
The original study sample included 867
HCBS members enrolled with eight
Contractors serving ALTCS E/PD members.
Of those, 155 people were excluded because
they were residing in assisted living
facilities or transferred to nursing homes
(43), were admitted to hospitals (16), were
receiving hospice services (19), or refused
services while a friend or family member
was being trained as a paid caregiver (75) in
the first 30 days of enrollment (Table 1).
Members excluded by Contractor were:

Rates by Contractor ranged from 80.9
percent to 100 percent. Six of the eight
Contractors exceeded the Minimum
Performance Standard and three achieved
the AHCCCS goal.
Discussion
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. Despite these challenges,
the overwhelming majority of new ALTCS
members placed in HCBS settings receive
services within 30 days of enrollment.

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

19
14
7
9
42
22
37
5
155

The option of having a relative or friend
provide care appears to be a popular choice
among elderly and disabled individuals. Of
the 155 members excluded from the study in
the current measurement, nearly half of
them or their authorized representatives
refused HCBS services while awaiting a
friend or relative to complete training as a
caregiver. One study showed that more than
60 percent of care for elderly and disabled
people nationally is provided by unpaid
“informal caregivers,” including relatives
and friends.7 Many of these people continue
to provide care under a paid arrangement
once Medicaid eligibility has been
established.

Among the remaining 712 people, 672 or
94.4 percent received services within 30
days of enrollment (Table 2), which was a
statistically significant increase over the
previous rate of 91.4 percent (p= .030).
Initiation of Services <30 Days
Did Not
Receive
Services,
5.6%

Received
Services,
94.4%

As of October 1, 2007, a member’s spouse
also may be paid to prove provide a certain
amount of care under the HCBS program.

There was no significant difference in rates
of initiation of services between rural and
4

without having to leave their homes.
•
Some Contractors are developing multidisciplinary teams that combine case
management and medical management to
more closely monitor conditions and needs
of members in the HCBS program.
•
Monitoring service provision to HCBS
members within two weeks of enrollment, to
ensure services are received within the first
30 days. The use of automated case
management systems, which can be used to
track timeliness of service initiation and
generate reminders for case managers helps
support this monitoring.

Since much of the data for this measure 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 community-based
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.
Quality Improvement Initiatives
ALTCS
Program
Contractors
have
developed numerous initiatives over the
years to enhance the quality of life of HCBS
members, several of which facilitate timely
access to care. These include:
•
Coordinating
in-home
visits
by
physicians, nurse practitioners and/or
behavioral health professionals; this is
especially important for members who may
be adversely affected by having to travel to
see their primary care practitioners.
•
A rural Contractor sends a staff nurse to
members at home so they can get their
influenza and pneumococcal immunizations

Conclusions
Given that all or most Contractors met
AHCCCS Performance Standards for this
measure in the last few years, AHCCCS
raised the minimum performance level in
order to encourage continued improvement.
As a result, Contractors have implemented
interventions that have led to overall
improvement and continued progress toward
the long-range goal for ensuring timely
initiation of services for members in home
and community based settings.

Initiation of HCBS Services Performance Measure Trend
100
90
80
70
60
50
40
30
20
10
0
CYE 03

CYE 04

CYE05

CYE 06

Overall Rate

5

CYE 07

AHCCCS MPS

CYE 08

For questions or comments about this
report, please contact:
Rochelle Tigner,
Quality Improvement Manager
Clinical Quality Management Unit
Division of Health Care Management
MD 6700
701 E. Jefferson St.
Phoenix, AZ 85034
rochelle.tigner@azahcccs.gov

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=680
&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/socdem
o/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.
4
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=680
&imID=2&parentID=65.
Accessed July 5,
2007.
5
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=/co
mmonspot/security/getfile.cfm&PageID=36119.
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.p
df. 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.pd
f. Accessed June 22, 2005.

6

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, 2007, through September 30, 2008

Reason

n

Percent

Relative Percent
Change

Member in Assisted Living Facility/Nursing Facility

43

27.7%

-55.5%

182

62.3%

16

10.3%

22

7.5%

19

12.3%

23

7.9%

75

48.4%

65

22.3%

2

1.3%

0

0.0%

155

100.0%

292

100.0%

Member Admitted to Hospital

Member Recieving Hospice Services

Member Refused Services/Awaiting Designated
Caregiver to be Trained

Other

TOTAL

37.0%

55.6%

117.4%

N/A

0.0%

Note:

Shaded rows show results of previous measurement, October 1, 2006, through September 30, 2007.

7

Table 2
AHCCCS ALTCS PERFORMANCE MEASURE
INITIATION OF HOME AND COMMUNITY BASED SERVICES
WITHIN 30 DAYS OF ENROLLMENT, BY CONTRACTOR
Measurement Period: October 1, 2007, through September 30, 2008

Number who Percent who
Received
Received
Service Within Service Within
30 Days
30 Days

Contractor

n

Evercare Select *

68

68

100.0%

47

44

93.6%

131

129

98.5%

129

122

94.6%

51

50

98.0%

33

28

84.8%

38

37

97.4%

28

26

92.9%

177

172

97.2%

209

204

97.6%

70

68

97.1%

69

59

85.5%

88

76

86.4%

100

85

85.0%

89

72

80.9%

84

71

84.5%

712

672

94.4%

699

639

91.4%

Pima Long Term Care *

Cochise Health Systems *

Yavapai County LTC *

Mercy Care Plan *

Pinal/Gila Long Term Care *

SCAN Long Term Care

Bridgeway Health Solutions

TOTAL

Notes:
* Indicates Contractor met or exceeded the AHCCCS Minimum Performance Standard.
Shaded rows show results of previous measurement, October 1, 2006, through September 30, 2007.

8

Relative
Percent
Change

Statistical
Significance

6.8%

p=.066

4.1%

p=.101

15.5%

p=.033

4.9%

p=.570

-0.4%

p=1.000

13.6%

p=.015

1.6%

p=.790

-4.3%

p=.529

3.2%

p=.030

Arizona Health Care Cost Containment System (AHCCCS)
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, 2007, through September 30, 2008

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:

E/PD members

Sample Frame:

The sample frame consists of E/PD members who met the following
criteria:
• Newly placed in an HCBS setting during the measurement period,
• Enrolled in ALTCS for 30 or more days during the measurement
period, and
• Not placed in an ALTCS-authorized HCBS setting prior to this
measurement period.

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.

i

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.
ii

•
•

Data Validation:

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.

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

iii

Analysis Plan:

•
•

•

•
•
•

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

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.

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 m/dd/yyyy. Thus, January 2, 2008, would be reported as
1/02/2008.

•

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 Jessica Hauser (e-mail:
jessica.hauser@azahcccs.gov).

ANY DEVIATIONS FROM THE INSTRUCTIONS FOR SUBMISSION OF DATA WILL
NOT BE ACCEPTED AND RETURNED TO THE CONTRACTOR.
v

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
Race
Fiscal County
Residential County
Service Code

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

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

1
10
16
46
66
68
78
88
98
108
118
128
129
131
133
135

9
15
45
65
67
77
87
97
107
117
127
128
130
132
134
139

17

Service Date

Date

10

140

149

18

Exclusion Begin Date

Date

10

150

159

19

Exclusion End Date

Date

10

160

169

20

Reason For Exclusion

Text

10

170

179

21

Other

Text

50

180

229

vi

Description of Included Elements
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

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
Race
Fiscal County
Residential County
Service Code
Service Date

18
19
20

Exclusion Begin Date
Exclusion End Date
Reason For Exclusion

21

Other

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
Race of member as listed in AHCCCS system
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

vii

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

Other

S5100 Day Care service; per 15 minutes.

S5180 and S5181– applies to following:

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
Habilitation Services

S5125 Attendant care service; per 15 minutes.
Home-Delivered Meals

T2021 Day habilitation waiver; per 15 minutes

S5170 Home-delivered meals; per meal including
preparation.

T2020 Day Habilitation, waiver; per diem.

Home Health Aide

T2017 Habilitation residential, waiver; per 15 minutes.

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

Behavioral Health

Home Health Nursing

T1019 Personal care services; per 15 minutes.

G0154 Services of skilled nurse in home health setting,
each 15 minutes.

T1020 Personal care services, not for IP or residential care
facilities; per diem.
H2014 Skills training and development; per 15 minutes. (w
or w/o *Modifier HQ)

Home Infusion

H2025 Ongoing support to maintain employment; per 15
minutes.

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

T2018 Habilitation, supported employment, waiver; per diem.

Respite

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

T2019 Habilitation, supported employment, waiver; per 15
minutes.
home

H2019 Therapeutic behavioral services (Behavioral Health
Therapeutic Day Program); per15 minutes. (w or w/o
*Modifier TF)
H2020 Therapeutic behavioral services (Behavioral Health
Therapeutic Day Program); per diem.

S5151 Unskilled, not hospice; per diem in home respite
care.

Homemaker

S5130 Homemaker services, NOS; per 15 min.

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

Modifier HQ – Modifier for group setting
Modifier TF – Modifier for intermediate level of care

viii