Proposition 206 - rate and capitation adjustment effective 1/1/2018

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December 15, 2017

Proposition 206 - rate and capitation adjustment effective 1/1/2018

Effective with dates of service on or after January 1, 2018, AHCCCS has made changes to the Fee-For-Service (FFS) rates and capitation adjustments for the Home and Community Based Services Fee Schedule and the Nursing Facility per diem rates. These adjustments are to address the increased labor costs resulting from the Arizona minimum wage increase and employee benefit provisions mandated by Proposition 206. Mercy Care Plan and Mercy Maricopa will pass through these rates to our contracted providers in order to comply with AHCCCS requirements. The following important rate changes will be passed through to providers:

Select Home and Community Based Fee Schedule rates will be increased by 1.4% to the HCBS fee schedule expenditures.*

HCPCS codes affected are as follows:

S5100 - Day Care Services, Adult; per 15 minutes
S5101 - Day Care Services, Adult; per half day
S5102 - Day Care Services, Adult; per diem
S5125 - Attendant Care Services; per 15 minutes
S5130 - Homemaker Services, NOS; per 15 minutes
S5135 - Companion Care, Adult; per 15 minutes
S5136 - Companion Care, Adult; per diem
S5140 - Foster Care, Adult; per diem
S5150 - Unskilled Respite Care, Not Hospice; per 15 minutes
S5151 - Unskilled Respite Care, Not Hospice; per diem
S5170 - Home Delivered Meals
T1019 - Personal Care Services; per 15 minutes (not inpatient or residential; not home health aide or CNA)
T1021 - Home Health Aide or Certified Nurse Assistant; per visit
T2016 - Habilitation, Residential, Waiver; per diem
T2017 - Habilitation, Residential, Waiver; per 15 minutes
T2018 - Habilitation, Supported Employment, Waiver; per diem
T2019 - Habilitation, Supported Employment, Waiver; per 15 minutes
T2021 - Day Habilitation, Waiver; per 15 minutes
T2031 - Assisted Living, Waiver; per diem
T2033 - Residential Care, NOS, Waiver; per diem

*The requirement to pass through the HCBS increase of 1.4% does apply to Assisted Living Facility codes, thus include those codes for which AHCCCS does not establish a FFS rate. The cap rates will including funding for these expenses.

Keep in mind that this pass through of rates is based on your individual contract with Mercy Care Plan or Mercy Maricopa Integrated Plan. Please refer to your individual contract for additional detail.

Nursing Facility Per Diem rates will be increased by 0.7% across the board.**

Revenue Codes affected are as follows:

0183 - LOA/Therapeutic
0185 - LOA/Nursing Home
0191 - Subacute Care Level I
0192 - Subacute Care Level II
0193 - Subacute Care Level III

** The requirement to pass through the Nursing Facility increase of 0.7% does apply to all codes, including those for which AHCCCS does not establish a FFS rate - e.g. specialty rates. The increase is being applied to 100% of the capitation Nursing Facility spend, thus specialty rates and add-ons are included.

The Nursing Facility pass through requirement is not limited to ALTCS MCOs - this applies to all lines of business when a Nursing Facility stay is covered. Cap rates will be amended accordingly.

Keep in mind that this pass through of rates is based on your individual contract with Mercy Care Plan. Please refer to your contract for additional detail.

Language regarding the mandated pass through will be included in a contract amendment. The contract amendment and cap rate adjustment will occur sometime in early calendar year 2018, retroactive to January 1, 2018.

The changes proposed for the rates in this notification are proposed to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available at least to the extent that such care and services are available to the general population in the geographic area.

As always, don't hesitate to contact your Mercy Care or your Mercy Maricopa Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care Plan or Mercy Maricopa website.

Thanks for all you do!

QB 3165