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, 2009, through September 30, 2010
Prepared by the Division of Health Care Management
August 2011

Thomas J. Betlach
Director, AHCCCS

“Our first care is your health care”

Performance Measure Project Summary
Background:

More than 10 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
$194 billion to $280 billion. Medicaid is the largest financier of long-term care services, with studies
estimating the proportion at 40 percent or more 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 Almost half (45 percent) of the long-term services and supports financed by Medicaid in
2009 were community based.6 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.
More than 67 percent of elderly and physically disabled people enrolled in the Arizona Long Term
Care System (ALTCS) reside in home and community-based settings.
Purpose:
AHCCCS medical policy requires that services for HCBS members are initiated
within 30 days of enrollment, based on a personal visit and thorough assessment of service needs by a
case manager. This measurement assesses the percentage of newly placed HCBS ALTCS members
who received specific services within 30 days of enrollment, overall and by Contractor.
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, 2009, through September
30, 2010. A representative random sample was selected for each Contractor. The sample frame
consists of elderly and physically disabled (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.
Also excluded were members who died, 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, 97.1 percent of members received services within 30 days
of enrollment, which did not represent a statistically significant difference from the previous rate of
96.0 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 88.2 percent to 100 percent. Six of eight Contractors exceeded the
minimum standard and three achieved the AHCCCS goal.

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, 2009, through September 30, 2010

consists of a variety of medical and social
services to help meet 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).

Introduction
It is estimated that roughly two-thirds of
Americans age 65 and older today will
eventually need some type of long-term care
— ranging from personal care assistance for
managing daily activities at home to nursing
home care — for an average of three years. 1

Medicaid is the main source of long-term
At the same time, significant increases in the
care
coverage
and
elderly population are
financing in the U.S.,
occurring.2 In less
accounting for at least
than 20 years, the
Home and community$112
billion
in
number of Arizonans
1,4
expenditures.
More
age 65 and older is
based services provide a
expected to be over 2
than
half
of
all
Medicaid
cost-effective
million, or about 22.1
long-term care spending is
alternative to
for institutional care, but a
percent of the state’s
institutional care for the
growing share – 43
population.3
percent in 2007, up from
elderly and physically
30 percent in 2000 – went
While the health of
disabled.
older Americans is
to home and communityimproving
overall,
based services (HCBS). 1
― The Kaiser Commission on
More than $45 billion in
many are disabled and
Medicaid and the Uninsured
Medicaid dollars went to
suffer from chronic
home health, personal
conditions. About 80
care and other home and
percent of seniors
community-based services
have at least one
in federal fiscal year 2008.1
chronic health condition, and 50 percent
have two or more chronic health conditions,
These services provide a cost-effective
such as arthritis, hypertension, heart disease,
alternative to institutional care for the
diabetes and respiratory disorders. 2
elderly and physically disabled (E/PD). In
More than 10 million Americans, including
addition, research has shown a strong
about 6 million elderly and 4 million
connection between receiving services in the
children and working-age adults, need longhome and improved consumer satisfaction
term services and supports. Long-term care
and overall quality of life.4
1

provider (PCP) and other providers,
addresses any problems with service
delivery, and modifies the member’s care
plan based on changes in health status. Case
managers visit new members and, in
conjunction with those members or their
representatives, assess needs to determine
the most appropriate services and placement.
AHCCCS requires that contracted health
plans initiate home and community-based
services within timelines to meet members’
medical needs, but no later than 30 calendar
days from their date of enrollment.

Arizona has developed an HCBS program
that allows long-term care members to
choose this option when appropriate. People
receiving HCBS generally are more likely to
have family caregiver involvement and
assistance and have fewer needs resulting
from cognitive impairments.
The AHCCCS HCBS Program
The Arizona Health Care Cost Containment
System (AHCCCS) has provided home and
community-based services to long-term care
beneficiaries through a waiver from the
Centers for Medicare and Medicaid Services
(CMS) since 1989. Through its Arizona
Long Term Care System (ALTCS),
AHCCCS provides comprehensive coverage
for HCBS members residing in their own
homes or approved alternative residential
settings, such as assisted living facilities or
group homes. Covered services include care
such as home health nursing, attendant or
personal care, and home-delivered meals.
Members may designate a family member or
friend to provide attendant care; after
completion of training, these caregivers can
be paid by AHCCCS.

To ensure that member needs continue to be
met in the most appropriate setting, case
managers reassess members’ physical and
functional status at regular intervals and
monitor the ongoing provision of services.
AHCCCS also monitors service provision
through regular reviews of Contractor
operations.
AHCCCS annually measures the percentage
of newly placed HCBS members who
receive specific services within 30 days of
enrollment. This measurement is conducted
to
determine
individual
Contractor
compliance with performance standards in
contract, as well as to analyze overall rates
of initiation of services for HCBS members.

At the end September 2010, 64.3 percent of
the 27,547 elderly and physically disabled
Arizonans enrolled in ALTCS resided in
home and community-based settings.

It should be noted that this measurement
does not include all covered home and
community-based services. For example,
emergency-alert and home-modification
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).

By providing a variety of alternative settings
with differing levels of care, ALTCS
members may be able to transfer from
nursing homes to home or other communitybased settings or delay institutionalization
for a longer period of time.
Once eligibility for ALTCS is determined
based on financial and medical criteria,
E/PD members enroll with a contracted
health plan (Contractor). Each member is
assigned a case manager, who coordinates
care with the member’s primary care

2

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.

Methodology
The measurement period for the current
study is October 1, 2009, through September
30, 2010. 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.
This study does not include ventilatordependent members, as Contractors are
required to initiate services for those
members within 14 days of enrollment.

Performance Standards
For this reporting period, AHCCCS set the
Minimum Performance Standard (MPS) that
Contractors must achieve for this measure at
92 percent. 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.

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.
In analyzing initiation of services, AHCCCS
did not include members who: died, 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.
Percentages of members who fell into one of
the above categories are reported in Table 1.

Results and Analysis
The original study sample included 766
HCBS members enrolled with eight
Contractors serving ALTCS E/PD members.
Of those, 108 people were excluded; (20)
because they were residing in assisted living
facilities or transferred to nursing homes ,
(8) were admitted to hospitals, (8) were
receiving hospice services, (22) refused
services (50) were waiting for a family
member or friend to complete training as
their paid caregiver and did not want
someone else to provide services in the first
30 days of enrollment (Table 1).

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.

3

Member exclusions by Contractor were:

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

17
12
9
17
39
6
1
7
108

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.

Among the remaining 658 people, 639 or
97.1 percent received services within 30
days of enrollment (Table 2), not
statistically significant over the previous rate
of 96.0 percent (p= .304).
Initiation of Services <30 Days

Did Not
R eceive
Services,
2.9%

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:
•
Monitoring service provision to HCBS
members within one to two weeks of
enrollment. Reports are run at regular
intervals and provided to case managers.
•
The use of automated case management
systems, which can be used to track
timeliness of service initiation and generate
reminders for case managers to follow up.
•
The development of multi-disciplinary
teams that combine case management,
medical
management
and
quality
management staff to more closely monitor
needs of members in the HCBS program and
develop new ways to facilitate timely access
to care.

Received
Services,
97.1%

There was no significant difference in rates
of initiation of services between rural and
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.
Rates by Contractor ranged from 88.2
percent to 100 percent. Six of the eight
Contractors exceeded the Minimum
Performance Standard and three achieved
the AHCCCS goal.

4

Standard and three exceeded the AHCCCS
Goal.

Conclusions
AHCCCS raised the minimum performance
level two years ago in order to encourage
continued improvement. As a result,
Contractors have implemented interventions
that have continued to lead 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. Of the four
Contractors who will provide services to
Arizonans enrolled in the ALTCS program
with a start date of October 1, 2011, one
exceeded the Minimum Performance

Contractors that did not meet the MPS will
be required to implement corrective action
plans to bring their rates up to the standard.
In May of 2011, AHCCCS awarded
contracts to four Contractors to provide
services to Arizonans enrolled in the
Arizona Long Term Care System (ALTCS)
program with a start date of October 1,
2011. Previous Contractors not awarded and
not meeting the MPS are not required to
implement corrective action plans.

Initiation of HCBS Services Performance Measure Trend
120

100

80

60

40

20

0
CYE 03

CYE 04

CYE05

CYE 06

CYE 07

Overall Rate

5

CYE 08

AHCCCS MPS

CYE 09

CYE 10

References

For questions or comments about this
report, please contact:
Kim Elliott, PhD, CPHQ
Clinical Quality Administrator
Clinical Quality Management Unit
Division of Health Care Management
Kim.Elliott@azahcccs.gov

1

Engquist G, Johnson C, Lind A, Barnette LP.
Policy Brief: Medicaid-Funded Long-Term
Care: Toward More Home- and CommunityBased Options. Center for Health Care
Strategies. Hamilton, NJ. May 2010. Available
at:
http://www.chcs.org/publications3960/publicatio
ns_show.htm?doc_id=1253871. Accessed July
6, 2010.
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
Characteristics, utilization and government
funding: 2010. American Health Care
Association. Washington, DC, November 2010.
Available
at:
http://www.ahcancal.org/research_data/trends_st
atistics/Pages/default.aspx
Accessed June 27, 2010.
4
Medicaid: A primer. Kaiser Commission on
Medicaid and the Uninsured. Washington DC.
June 2010. Available at:
http://www.kff.org/medicaid/upload/733404.pdf. Accessed July 6, 2010.
5
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.
6
Eiken, S., K. Sredl, B. Burwell, L. Gold,
Medicaid Long-Term Care Expenditures in
FY2009, Thomson Reuters, August 2010.
Accessed June 27, 2011.

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, 2009, through September 30, 2010

Reason

n

Percent

Member in Assisted Living Facility/Nursing Facility

20

18.5%

Member Admitted to Hospital

8

7.4%

Member Receiving Hospice Services

8

7.4%

Member Refused Services

22

20.4%

Member Awaiting Designated Caregiver to be Trained

50

46.3%

Died

0

0.0%

Total

108

100.0%

7

Table 2
AHCCCS ALTCS PERFORMANCE MEASURE
INITIATION OF HOME AND COMMUNITY BASED SERVICES
WITHIN 30 DAYS OF ENRLLOMENT, BY CONTRACTOR
Measurement Period: October 1, 2009, through September 30, 2010
Minimum Performance Standard: 92%

Contractor

n

Number who
Received
Service Within
30 Days

Evercare Select

56

55

98.2%

62

61

98.4%

148

142

95.9%

144

140

97.2%

17

15

88.2%

33

33

100.0%

32

29

90.6%

43

41

95.3%

194

192

99.0%

174

173

99.4%

60

60

100.0%

70

63

90.0%

55

55

100.0%

103

97

94.2%

96

91

94.8%

99

91

91.9%

658

639

97.1%

728

699

96.0%

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

Percent who
Received
Service Within
30 Days

Relative
Percent
Change

Statistical
Significance

-0.2%

p=1.00

-1.3%

p=.750

-11.8%

p=.111

-5.0%

p=.645

-0.5%

p=1.00

11.1%

p=.015

6.2%

p=.093

3.1%

p=.568

1.1%

p=.304

Notes:
Statistically significant values are shown in bold (p< .05)
Shaded rows show results of previous measurement, Oct. 1, 2008 through Sept. 30, 2009

8

Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long Term Care System (ALTCS)
Performance Measure Methodology
2011

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, home-delivered 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 Based 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, 2009, through September 30, 2010

Study Questions:

1.

2.

Population:

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
calendar days of enrollment?
For those members who did not receive services within 30 calendar days of
enrollment, what were the reasons?

E/PD members in home and community based settings

Sample Frame:

The sample frame consists of E/PD members who met the following
criteria:
•

Enrolled in ALTCS with the same Contractor for 30 or more days during the
measurement period.
•
Enrolled on the last day of the measurement period.
•
Placed in an HCBS setting (H placement code) or temporary setting (Z placement
code) during the measurement period.

9

Sample Frame
Exclusions:

•

Sample Selection:

A statistical software package will be used to select a random
representative sample by Contractor from the sample frame. The sample
size will be determined using a confidence level of 95 percent and a 5percent confidence interval, plus oversampling to account for exclusions
and missing records.

Data Sources:

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

Data Collection:

Data will be first collected from AHCCCS administrative (encounter) data. If acceptable
services are not identified as being provided within 30 days of enrollment, AHCCCS will
request 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 will be instructed to provide the reason and any supporting
documentation for each case.

Members with Prior Period Coverage (PPC). PPC is a retroactive coverage period for
which Contractors are financially responsible for paying for covered services.
•
Members placed in settings other than H or Z any time during the first 30 days of
enrollment.
•
Members placed in Assisted Living Facilities (ALFs) any time during the first 30
days of enrollment, as they are receiving services on the first day of placement in such
facilities. Members residing in ALFs will be identified by the following Residence Codes
contained in the AHCCCS Prepaid Medical Management Information System (PMMIS)
Recipient Subsystem (CA 161): 5, 6, 8, 9, B, E, F, G, K, L, P and R.
•
Members with encounters for hospital, nursing facility or hospice services, as
identified by bill types 11X, 21X, 81X or 82X.
•
Members who died within 30 days of enrollment.
o
Members who are not in hospice and die in the first 30 days are in the death
category
o
Members who are in hospice in the first 30 days of enrollment (all or part of that
time) and who also die during that time (or any time after) are included in the hospice
category of exclusions in the table.

Contractors will be required to collect data using the AHCCCS standardized methodology
in an electronic format provided by AHCCCS. Each Contractor will be 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 will 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.

10

•
•

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.

Data Validation:

The sample frame will be validated to ensure that members meet criteria for inclusion in
the study.
Data files received back from Contractors will be reviewed to ensure that:
all members included in the sample are listed in the returned data file,
services meet numerator criteria for this performance measure,
all requested information is provided.
Service data provided by Contractors must be 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 will be validated by staff of the AHCCCS ALTCS unit

•
•
•

Indicators:

1.

2.

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.
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.

Denominator:

1.

The number of members who meet the sample frame criteria

Numerators:

1.

The number of sample members who receive an acceptable service within 30 days of
enrollment in ALTCS

Analysis Plan:

•
•

The numerator will be divided by the denominator to determine the indicator rate.
Data for services received within 30 days will be analyzed by Contractor, as a
statewide aggregate, and by urban and rural counties.
•
When calculating rates for initiation of services within 30 days of enrollment (study
question #1), members will be excluded from the denominator for the following reasons if
supported by appropriate Contractor documentation.
•

AHCCCS will report the number of sample members excluded from the denominator,
by Contractor, in the following categories:
o Refused all applicable services, including those who refused services while
waiting for a designated caregiver to be trained
o Members who were not in hospice and died within 30 days of enrollment
comprise the death category.
o Were admitted to a hospital or nursing facility within 30 days of enrollment.
o Received hospice services within the first 30 days of enrollment (all or part
of that time) and who also die during that time (or any time after) are
included in the hospice category.
o Were placed in an assisted living facility within 30 days of enrollment.
•
Outliers will be identified using standard deviations and patterns of abnormal
distribution of data.
•
Differences between prior study results will be analyzed for statistical significance
and relative change.
•
The following assumptions will be used to determine whether the indicator criteria
was met:
o Members included in the sample sent to Contractors for whom data was not
received back from the Contractor or for whom service data was not
supported by appropriate documentation will be 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 will be counted as being provided outside the 30-day

11

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 Healthcare Effectiveness Data and
Information Set (HEDIS).

Deviations from
Previous
Methodology:

AHCCCS excluded from the sample frame sent to Contractors members who were
hospitalized, or received nursing facility or hospice services during the first 30 days of
enrollment using Uniform Billing (UB) bill type codes associated with encounters:
•
11X – Hospital (inpatient)
•
21X – Nursing facility
•
81X – Hospice (nonhospital based)
•
82X – Hospice (hospital based)

Quality Control:

Overall rates for urban and rural counties will be compared.
Individual Contractor rates will be compared to the Contractor’s rate for the previous
measurement and to the AHCCCS Minimum Performance Standard and Goal.

In the current measurement, these members were excluded from Contractor samples prior
to sending samples for data collection to each Contractor. In previous measurements, bill
types were not used to exclude members from the sample frame prior to Contractor data
collection. Contractors provided documentation of these services within 30 days of
enrollment when appropriate, and such members were excluded from each Contractor’s
final sample prior to analysis.
To ensure consistency and reliability in data abstraction, AHCCCS:
•
provides each Contractor with the methodology for this measure,
•
provides each Contractor with a data specification sheet, file layout, and data
dictionary for this measure,
•
provides each Contractor with detailed written instructions for data collection,
•
provides updates and ongoing technical assistance to Contractors regarding data
collection for this measure.

12

Initiation of Home and Community (HCB) Services

Arizona Health Care Cost Containment System (AHCCCS)
Arizona Long-Term Care System (ALTCS) Performance Indicator

Instructions for submission of data
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, 2010, would be reported as 01/02/2010.

•

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.

•

Submit the data files using
lucy.valenzuela@azahcccs.gov).

•

Data must be submitted to AHCCCS by close of business May 2, 2011.

the

SFTP

server.

Contact

Lucy

Valenzuela

(e-mail:

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 Lucy Valenzuela at:
lucy.valenzuela@azahcccs.gov (preferred) or call (602) 417-4753.
All other questions related to the project should be directed to Rochelle Tigner at rochelle.tigner@azahcccs.gov
(preferred) or call (602) 417-4683.

13

LAYOUT OF MEMBER IDENTIFIED FILE

Variable
Variable Name
1
AHCCCS ID
2
3
4
5
6

Contractor
Last Name
First Name
Placement Code
Placement Begin Date

Placement End Date

Format

Length

Start Column

End Column

Text

9

1

9

Text
Text
Text
Text
Date

6
30
20
2
10

10
16
46
66
68

15
45
65
67
77

10
10
10
10
10
1
2
2
2
5

78
88
98
108
118
128
129
131
133
135

87
97
107
117
127
128
130
132
134
139

7
8
9
10
11
12
13
14
15
16

ALTCS Enrollment Begin Date
ALTCS Enrollment End Date
Date Of Birth
Date Of Death
Gender
Race
Fiscal County
Residential County
Service Code

Date
Date
Date
Date
Date
Text
Text
Text
Text
Text

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

14

Description of Included Elements
1
2
3
4
5
6
7
8

AHCCCS ID
Contractor
Last Name
First Name
Placement Code
Placement Begin Date
Placement End Date

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

ALTCS Enrollment
Begin Date
9
10
11
12
13
14
15
16
17

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

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

15

Appendix A: Acceptable Home and Community Based Services
Adult Day Health
S5100 Day Care service; per 15 minutes.

Other
S5180 and S5181– applies to following:

S5101 Day Care service; per ½ day.
S5102 Day Care service; per diem.
Attendant Care
S5125 Attendant care service; per 15 minutes.
Home-Delivered Meals
S5170 Home-delivered meals; per meal
including preparation.
Home Health Aide
T1021 Home health aide or Certified Nurse
Assistant (CNA); per visit.
Home Health Nursing
G0154 Nursing Care, in the home; per hour (w
or w/o *Modifier TG)
Home Infusion
S9379 Home Infusion Therapy; per diem. Not
otherwise classified.
Personal Care
T1019 Personal care services; per 15 minutes.

Respite

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

S5180 Home health respiratory therapy, initial
evaluation.
S5181 Home health respiratory therapy, NOS; per
diem.
Habilitation Services
T2021 Day habilitation waiver; per 15 minutes
T2020 Day Habilitation, waiver; per diem.
T2017 Habilitation residential, waiver; per 15
minutes.
Behavioral Health
T1019 Personal care services; per 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)
H2025 Ongoing support to maintain employment;
per 15 minutes.
T2018 Habilitation, supported employment,
waiver; per diem.
T2019 Habilitation, supported employment,
waiver; per 15 minutes.
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.

S5150 Group, not hospice; per 15 min respite
care. (*Modifier HQ)

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

S5151 Unskilled, not hospice; per diem in home Behavioral Health, cont.
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. (*Modifier
TF)
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
*Modifier TG - Modifier for complex/high level of care.