YH14-0001 - Acute Care/CRS RFP Information
Procurement File Page – YH14-0001
The Bidders’ Library is a site to assist Offerors with information and resources regarding the Acute/CRS RFP. The information in the Bidders’ Library is not intended to be comprehensive. It is the responsibility of the Offeror to obtain and review all pertinent information relating to the Acute/CRS RFP.
This information may be downloaded in two ways:
- Download Entire YH14-0001 Library [25.7 MB]
- Download Individual Files from this page.
| January 18, 2012 Public Meeting | |
| Fact Sheet | |
| Public Meeting Presentation | |
| Items of Interest | |
| AHCCCS Acute Care/CRS RFP Schedule | [Posted 11/27/12, 24KB] |
| Major Decisions as of October 9, 2012 | |
| Medicare Major Decisions as of October 9, 2012 | |
| Major Decisions as of August 27, 2012 | |
| Major Decisions as of July 19th, 2012 | |
| AHCCCS Hospital Inpatient Reimbursement Methodology information located at: AHCCCS Hospital Payments |
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The Acute CYE’09, CYE’10 and CYE’11 risk adjustments white papers, documenting the risk adjustment approach, have been posted to the AHCCCS website at the following location: Acute Care Capitation Rates |
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| Surveys | |
| Information on several topics regarding the Acute/CRS RFP. | |
| Acute/CRS RFP Results (Closed 07/30/12) | |
| Input from physical and behavioral health care providers regarding care coordination for the non-Seriously Mentally Ill population. |
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| Coordination of Care Survey (Closed 08/07/12) |
Note: Information posted after the initial release of the Bidders’ Library will be noted with a button and the date the information was added. After five days the button will be removed.
| Introduction | [Posted 11/27/12, 25KB] |
| Provisions | [Updated 01/29/13, 28KB] |
| Calendar | [Updated 12/19/12, 33KB] |
| Q & A Process Provisions | [Posted 01/23/13, 28KB] |
| Q & A Template | [Posted 01/23/13, 24KB] |
| Q & A files are available for download on the AHCCCS SFTP server | [EFT updated 02/08/13] |
| Questions & Responses Summary | [Updated 02/08/13, 237KB] |
Notification to Offerors regarding Oral Presentation: A memorandum notifying each Offeror of the date and time scheduled for the Oral Presentation has been emailed to the contact person & email listed on the Offeror’s Notice of Request for Proposal Solicitation Signature page. In addition, the notification memorandum is also available for download in the Offeror’s AHCCCS EFT/SFTP folder. [Posted 01/31/13]
| List of RFP Offerors | [Updated 01/31/13, 16KB] |
| Enrollment Map | [32KB] |
| Instructions to Electronic File Transfer - Secured File Transfer Protocol | [Reposted 11/14/12, 25KB] |
Data provided to Offerors through the secure EFT/SFTP server is derived from protected health information that is not considered “de-identified” as that term is defined in the federal Health Information Privacy Rule. While the Rule allows release of this information to health plans that are also potential Offerors, it is not being made available to the general public. Offerors are advised to take appropriate steps to maintain the confidentiality of the information. The Instructions attached above notify Offerors of the process for accessing the secure server. The External User Affirmation Statement included in these Instructions clearly delineates appropriate use of the AHCCCS data. |
[Posted 11/08/12] |
| Conference Information | [Posted 11/06/12, 19KB] |
| Prospective Offerors' Conference Presentation Materials | |
| Prospective Offerors’ Conference Agenda | [Posted 11/08/12, 60KB] |
| Prospective Offerors’ Conference Presentation 11/13/12 Note: Date correction made on slide 78, New Items Related to Technology. |
[Posted 11/08/12,1.8MB] |
| Prospective Offerors' Technical Interface Meeting Presentation Materials | |
| Prospective Offerors' Technical Interface Meeting Agenda | [Posted 11/09/12, 63KB] |
| Prospective Offerors' Technical Interface Meeting
Presentation |
[Posted 11/09/12, 387KB] |
| Conference Attendance | |
| Prospective Offerors' Conference Attendance | [Posted 11/09/12, 1.4MB] |
| Prospective Offerors' Technical Interface Meeting Attendance | [Posted 11/09/12, 673KB] |
AHCCCS members who are also enrolled in Medicare are referred to as dual eligible. In an effort to improve care coordination for AHCCCS dual eligible members, AHCCCS will require all Acute plans to be organizations that manage and provide Medicare benefits to dual eligible members in all GSAs they hold a contract. Contractors will be required to meet the Medicare requirement either through the CMS Capitated Financial Alignment Demonstration or as Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) if AHCCCS does not finalize a Demonstration contract with CMS. Below is further information and resources.
| AHCCCS Duals Page | |
| Acute/CRS RFP Medicare Major Decisions | [16KB] |
| CMS Memo Notice of Intent to Apply (NOIA) Information | [143KB] |
| AHCCCS Policy Contracting with Special Needs Plans | [62KB] |
| Acute Duals Enrollment by County | [Posted 12/06/12, 12KB] |
| CMS Capitated Financial Alignment Demonstration Information | |
The Financial Alignment Demonstration seeks to better serve people who are enrolled in both Medicare and Medicaid by testing a person-centered, integrated care model that provides a more easily navigable and seamless path to all Medicare and Medicaid services. Expected outcomes include: improved beneficiary experience of care, fewer avoidable hospitalizations and emergency room visits, and greater independence in the community and at home for seniors and people with disabilities. |
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| Arizona's Demonstration Proposal | [830KB] |
| July 08, 2011 - State Medicaid Director Letter | [Posted 11/14/12, 214KB] |
| January 25, 2012 - CMS Guidance | [Posted 11/14/12, 323KB] |
| March 29, 2012 - CMS Guidance | [Posted 11/14/12, 807KB] |
| CMS - 2013 Capitated Financial Alignment Demonstration Application | [Posted 11/14/12, 1MB] |
| Joint Rate Setting Process Under the Capitated Financial Alignment Initiative | [Posted 11/14/12, 300KB] |
| CMS Medicare Advantage Special Needs Plan Information | [CMS link posted 11/14/12] |
Dual Eligible SNPs (D-SNPs) enroll beneficiaries who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid. |
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| CMS - 2013 Medicare Advantage Application Information | [CMS link posted 11/14/12] |
| Medicare Managed Care Manuals | [CMS link posted 11/14/12] |
| Medicare Managed Care Manual - Chapter 16B: Special Needs Plans | [CMS link posted 11/14/12] |
Draft Policies (Watch for Updates to Draft Policies)
Note: Draft policies with an existing policy number will be effective as noted on the policy, and will replace current policies with the same number.
Current ACOM Policies Expiring as of October 1, 2013
| Chapter 400 | |
| Policy 409 - Intra-Agency Care Coordination for Services | |
| Policy 428 - CRS Service Authorization Process |
Current Policies
| AHCCCS Contractors Operations Manual (ACOM) | |
| AHCCCS Medical Policy Manual (AMPM) |
| Section A: | Data Supplement Instructions and Overview | [18KB] |
| Section B: | Program and Fee Schedule Changes | |
| Program and Fee Schedule Changes | [Posted 11/07/12, 2.7MB.] | |
| Section C: | Data Book Information | |
| Data Book Introduction | [39KB] | |
| Data Book Layout/File Description | [Posted 11/16/12, 141KB] | |
| Details of Updated CRS Data Book Files | [Posted 11/29/12, 141KB] | |
| Data Book Files | [Acute Care Bid Files posted via EFT [11/16/12, CRS Bid Files updated via EFT 11/29/12] |
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| Rate Setting Document | [Posted 12/14/12, 228KB] | |
| Supplemental Data Book Reports | [Updated 12/20/12, 117KB] | |
| Note: A new posting date will be noted whenever this document has been updated. | ||
| Section D: | Service Matrix/Selection Criteria for Data Book | |
| Introduction | [20KB] | |
| Acute Care/CRS Service Matrix | [Updated 12/14/12, 40KB] | |
| Behavioral Health Services Service Matrix | [35KB] | |
| Crosswalk Acute Care Service Matrix to Capitation Bid Template |
[Posted 12/14/12, 185KB] | |
| Section E: | AHCCCS Category of Service, Form Types, Provider Type List of Codes and Descriptions |
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| Introduction | [10KB] | |
| AHCCCS Categories of Service Codes | [23KB] | |
| Definition of Form Types | [15KB] | |
| AHCCCS Provider Types | [30KB] | |
| Section F: | Bid Submission Information Note: See RFP Section H, Instructions to Offerors, Paragraph 16.C. Capitation |
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| Bid Template Overview | [Posted 11/19/12, 345KB] | |
| Capitation Bid Templates | [EFT posted 11/19/12] | |
| Acute Care Medical Component Ranges and CRS Rates |
[Posted 12/14/12, 192KB] | |
| Section G: | Crosswalk from Service Matrix to Financial Statements | |
| Introduction | [14KB] | |
| Crosswalk Acute Care/CRS-Service Matrix to Financial Statements |
[27KB] | |
| Crosswalk BHS Service Matrix to Financial Statements |
[25KB] | |
| Section H: | Enrollment Information | |
| Introduction | [24KB] | |
| H-1 Enrollment by County by Contractor | [EFT] | |
| H-2 Report Acute Care Enrollment Activity | [EFT] | |
| H-3 Enrollment by Month (Historical and Projected) |
[EFT] | |
| H-4 AHCCCS Members Count By Zip Code | [EFT] | |
| Section I: | Risk Adjustment Information | |
| Introduction | [Posted 11/13/12, 77KB] | |
| CYE 09 Risk Adjustment Whitepaper | [Posted 11/13/12, 1MB] | |
| CYE 10 through CYE13 Risk Adjustment Methodologies |
[Posted 11/13/12, 102KB] | |
| Proposed CYE 14 and CYE 15 Risk Adjustment Methodologies |
[Posted 11/13/12, 77KB] | |
| Risk Factors | [Posted 11/13/12, 13KB] | |
| Diagnosis Percentages by Form Type | [Posted 11/13/12, 25KB] | |
| Section J: | Financial Information for Prospective Members | |
| Introduction | [19KB] | |
| Acute Care Financial Information | [EFT] | |
| CRS Financial Information | [EFT] | |
| Section K: | Capitation Rates | |
| Capitation Rates | ||
| Section L: | Birth to Member Month Analysis | |
| Introduction | [17KB] | |
| Birth to Member Month Analysis | [EFT] | |
| Section M: | Reinsurance Information | |
| Introduction | [21KB] | |
| Reinsurance Payments | [40KB] | |
| Reinsurance Offsets | [23KB] | |
| Section N: | Hospital Rate Overview | |
| Introduction | [9KB] (contains link) | |
| Outlier Cost Thresholds | [Posted 12/18/12, 179KB] | |
| Section O: | Contractor Audited Financial Statements | |
| Introduction | [13KB] (contains link) | |
| Section C: | Data Book Files | [Acute Care Bid Files updated via EFT 12/20/12, CRS Bid Files updated via EFT 12/20/12, 12/21/12] |
| Section F: | Capitation Bid Templates | [Posted 11/19/12 via EFT.] |
| Section H: | H-1 Enrollment by County by Contractor | |
| H-2 Report Acute Care Enrollment Activity | [EFT] | |
| H-3 Enrollment by Month (Historical and Projected) | [EFT] | |
| H-4 AHCCCS Members Count By Zip Code | [EFT] | |
| Section J: | Acute Care Financial Information | [EFT] |
| CRS Financial Information | [EFT] | |
| Section L: | Birth to Member Month Analysis | [EFT] |
| Draft AHCCCS Financial Reporting Guides and Templates for CYE 14 | |
| Acute Care Contractors | |
| Draft Reporting Guide | [Posted 12/14/12, 1.6MB] |
| Draft Reporting Template | [Posted 12/14/12, 237KB] |
| CRS Contractor | |
| Reporting Guide | [12/20/12, 2MB] |
| Reporting Template | [Posted 12/20/12, 204KB] |
| Revenue and Expense Statement Mapping Guidelines |
[Posted 12/20/12, 43KB] |
| Draft Claims Dashboard Reporting Guide/Template-CYE 14 | [To be revised after 10/01/13. See existing Claims Dashboard Reporting Guide/Template 11/29/12.] |
| Draft Reinsurance Reporting Guide (Effective 10/01/13) |
[Posted 12/20/12, 2MB] |
| Acute Health Care Contractors Financial Reporting Guidelines | [WEB PAGE link posted 12/12/12] |
| Claims Dashboard Reporting Guide | [47KB] |
| Claims Dashboard Reporting Template | [243KB] |
| Encounter Data Validation Technical Document | [78KB] |
| Encounter Reporting User Manual | |
| Fee-for-Service Provider Manual | |
The Fee-For-Service Provider Manual is a publication of the Arizona Health
Care Cost Containment System (AHCCCS), Claims Department, Division of Fee-for-Service
Management. The Claims Department also publishes Claims Clues as a supplement to the manual. |
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| Grievance System Reporting Guide | |
| Program Integrity Reporting Guide | [27KB] |
| Provider Affiliation Transmission (PAT) Manual | [121KB] |
| Technical Interface Guidelines (TIG) |
Contact
Questions about Solicitations, Contracts & Purchasing should be directed to Meggan LaPorte, Chief Procurement Officer:
- Email: procurement@azahcccs.gov
