AHCCCS Health Care Updates for Provider Inquiries and Pharmacy Services
AHCCCS is updating provider inquiries, creating matrices for licensure requirements, and discussing supplemental rebate classes in Arizona. The organization is also focusing on prior authorizations for HCV treatments and medication utilization feedback policies to enhance healthcare quality across the state.
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Presentation Transcript
AHCCCS CMO Update Provider Type Inquiries Pharmacy ASD Advisory Committee BH Service Needs for Children in Foster Care Reaching across Arizona to provide comprehensive quality health care for those in need 1
AHCCCS Provider Types Provider inquiries to AHCCCS have increased re: which AHCCCS Provider Type to obtain Variables contributing to inquiries: licensure rule change, integration efforts underway Recent example: Provider Type 77 vs. IC Reaching across Arizona to provide comprehensive quality health care for those in need 2
AHCCCS Provider Types AHCCCS creating matrix which cross-walks ADHS licensure requirements, AHCCCS PTs, and COS linked to PT Please direct any inquiries to your OCO Reaching across Arizona to provide comprehensive quality health care for those in need 3
Pharmacy Reaching across Arizona to provide comprehensive quality health care for those in need 4
Current AZ Supplemental Rebate Classes 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. COPD (May 2016) HCV (Jan 2015, May 2016) Epinephrine, Inj. (Nov 2015) Cytokine and CAM Antagonists (Nov 2015) Growth hormone (Nov 2015) Inhaled Antibiotics (Nov 2015) Inhaled Glucocorticoids (Feb 2016) Substance Use Disorder (May 2016) Hypoglycemic Agents: Insulin and Related Agents (May 2016) Hypoglycemic Agents: Incretin Mimetics/Enhancers (May 2016) Reaching across Arizona to provide comprehensive quality health care for those in need 5
Policy 310-N Prior Authorization for HCV criteria being updated On the horizon: pan-genotypic product late June Workgroup formed which included health plan participation Next steps: AHCCCS Policy Committee and Public Comment Reaching across Arizona to provide comprehensive quality health care for those in need 6
Policy 310-FF Monitoring Controlled and Non-Controlled Medication Utilization Feedback o Notice requirements o Minimum length of exclusive pharmacy and/or provider assignment Reaching across Arizona to provide comprehensive quality health care for those in need 7
ASD Advisory Committee Reaching across Arizona to provide comprehensive quality health care for those in need 8
Updates BCBA code set finalized Streamlined PCP referral to Specialized ASD Diagnosing Provider to be operationalized by 7/1/16 o Developmental Behavioral Pediatrics o Neurodevelopmental Pediatrics o Adult or Child Psychiatry o Licensed Clinical Psychology, doctoral level Quarterly meeting with committee being scheduled for July Reaching across Arizona to provide comprehensive quality health care for those in need 9
BH Service Needs for Children in Foster Care Reaching across Arizona to provide comprehensive quality health care for those in need 10
Updates HB2442 implementation Psychotropic Report AHCCCS Standing forums o Monthly RBHA/CRS Meetings with stakeholders o Monthly CMDP/DCS Meetings o Monthly Operational Meetings Reaching across Arizona to provide comprehensive quality health care for those in need 11
