Best Practices in Medicaid - Arkansas

The Center for Health Transformation is inviting leaders from all 50 states to share their transforming solutions for the Medicaid program. In order that key decision-makers and industry leaders from around the country may learn from others’ successes, it is our intention to provide this interactive resource for showcasing the most innovative practices in the country. Please note that the following contributions have not been edited by CHT staff and will remain open indefinitely to future updates.

View Arkansas Medicaid website >>

Consumer-directed care demonstrations (include number of beneficiaries served now and in any expansion plans)

In 1998, Arkansas was one of three states to pilot a “Cash and Counseling” program sponsored by the Robert Wood Johnson Foundation and the U.S Department of Health and Human Services. The project, known as IndependentChoices in Arkansas, was approved as a Medicaid 1115 demonstration. The program concept allows Medicaid eligible individuals who receive personal care services from an agency to instead choose to receive a monthly allowance to purchase their personal care service from an individual of their choosing. A State Medicaid agency-contracted financial intermediary handles the Medicaid billing and payment transactions, so the IndependentChoices participant does not actually receive cash, but they do make decisions about who provides their personal care, how much to pay the care giver (within program parameters), and other decisions about how and when they receive personal care. The IndependentChoices program has been independently evaluated and the findings show that participants are more satisfied with their services and more likely to receive the amount of personal care services allowed in their care plan than those who do not self-direct their own care (see this and other reports at www.cashandcounseling.org/library ). In 2003, IndependentChoices won the Council of State Governments innovations Award. IndependentChoices is currently limited to 3500 participants. The operating agency, the Division of Aging and Adult Services (DAAS), and the Medicaid agency, the Division of Medical Services (DMS), may request to increase the number of participants with the renewal application later this year depending on the availability of State match for Medicaid funding.

Arkansas is now developing a second consumer-directed program that would apply the “Cash and Counseling” principles to Medicaid eligible individuals residing in nursing homes who want to return to live in their homes and communities. Arkansas plans to propose this program to the Centers for Medicare and Medicaid Services (CMS) in 2006 as a 1915(c) Medicaid waiver piloted in Southwest Arkansas with a few hundred potential participants.

Arkansas also operates the Alternatives for Adults with Physical Disabilities (AAPD) 1915(c) waiver, which provides for consumer-direction of attendant care and home modifications. This waiver was first approved by CMS in 1997 and was recently renewed for five more years. During the next five years, AAPD will serve from 1600 to 2200 individuals per year. As with IndependentChoices, a financial intermediary contracted with DMS handles billing and payment transactions while the waiver participant hires and supervises their care giver and chooses and supervises the home modification provider.

Delivering high quality, coordinated, long term care for the disabled and/or the infirm

Arkansas was one of ten recipients of the CMS Systems Transformation Grant in 2005. The goals of Arkansas grant include the following outcomes or products: 1) individuals receiving the right care at the right time through a streamlined application process for home and community-based waiver services that shortens the time from eligibility determination to access from 45+ days to less than five; 2) individuals receiving home and community-based services rather than institutional care through a triage process; 3) measurable quality improvements through management reports that accurately document progress and enable key entities to make continuous system improvements; 4) easier participant access through an integrated information technology; and 5) improved health, better outcomes, and reduced use of institutional care through a primary care case management program for dually eligible individuals with chronic illnesses. Arkansas is now in the strategic planning phase for the grant. The strategic plan must be submitted to CMS by May 1, 2006. The grant period is five years.

Use of health information technology (electronic health records, e-prescribing, electronic billing, etc) The Arkansas Medicaid Management Information System (MMIS) supports electronic billing by Medicaid providers. The MMIS processes the billing and pays claims, including electronic financial transfers. Claim information is stored in a data warehouse, the Decision Support System, from which scheduled and ad hoc reporting is created.

Doctors' Office Quality Information Technology (DOQ-IT) was a 1.5-year Special Study that was designed to improve quality of care, patient safety, and efficiency for services provided to consumers by promoting the adoption of Electronic Health Records (EHR) and Information Technology (IT) in primary care physician offices. Arkansas was one of 4 states (including California, Massachusetts and Utah) that piloted the DOQIT project through CMS OCSQ beginning in May 2004. In addition to this Medicare-directed pilot project, the Arkansas Department of Health & Human Services Division of Medical Services (DHHS DMS) asked Arkansas Foundation for Medical Care (AFMC) to expand this work to include interested Arkansas pediatric and specialty offices. AFMC leads this physician office HIT work in Arkansas and has over 150 physician practices actively engaged. AFMC and ADHHS are also embarking on a new partnership to conduct work toward development of core plans for a health information network in coordination with pertinent stakeholders throughout the state.

Expanding coverage through private sector initiatives

Arkansas recently received CMS approval for a new Health Insurance Flexibility and Accountability (HIFA) 1115 demonstration called the Arkansas Safety Net Benefit Program, This Medicaid demonstration program will increase health insurance coverage through a public/private partnership that will provide a “safety net” benefit package to approximately 50,000 uninsured individuals over 5 years. This demonstration is unique because it is designed to allow employers who have not previously provided health care coverage to their employers with this opportunity through a public/private partnership. The Arkansas Safety Net Benefit Program will provide coverage to adults who are employed by employers participating in the demonstration. The State will require enrollee cost sharing as follows: $100 deductible; 15 percent coinsurance for all services except pharmacy; and a $1,000 out of pocket maximum per year for the deductible and coinsurance. Premiums for individuals will not exceed $15 per month. The planned implementation date is October 1, 2006.

Transparent and publicly-accessible measurements of patient outcomes and/or quality improvements

CMS awarded Arkansas a Systems Transformation (New Freedom Initiatives) grant in 2005. Beginning in 2006, Arkansas will begin development of an automated Medicaid Home and Community-based Services (HCBS) waiver quality management system, which will track key quality management and improvement activities for each HCBS wavier. The Quality Assurance reports generated by the system will be available to the public in a web-based format. Implementation is planned for 2008.

AR DHHS subcontracts with the state Quality Improvement Organization, Arkansas Foundation for Medical Care, to provide quality improvement evaluation, education and outreach to primary care providers throughout the state. AFMC provides tools and support needed to provide the best care for consumers, by applying proven national standards of care, streamlining processes and improving cost efficiency in physician practices. AFMC offers quality improvement opportunities backed by national research, tools to help communicate with patients and staff, easy-to-use information and statistical data, and support navigating the Medicare and Medicaid systems. Quality improvement projects for the physician office setting include:

• Adult Immunization
• Antibiotic Resistance
• Asthma
• Benzodiazepine Use
• Breast Cancer Prevention
• Cervical Cancer
• Chlamydia
• Diabetes
• Pediatric Overweight
• Prenatal Sickle Cell
• Well Child Screening

Specific focus information and resources for each of these topics can be found on our website. Learn More >>

Efforts to combat fraud and abuse

Arkansas is currently using the following procedures to combat fraud. We identify high risk Medicaid programs and providers. An analysis of those providers whose billing practices fall outside of the norm are scheduled for an on site review. In addition to this practice we track complaints from the recipient, providers and concerned citizens alerting the department of fraud and abuse. We investigate all complaints and approximately 80% of these complaints are scheduled for on site review/investigation. We also use the time line approach to identify duplicate times and overlapping times of service to combat fraud. Our success rate in using this approach has been very good. Arkansas’ success rate in combating fraud and abuse has been improving progressively, with limited technology. We have also asked CMS to join the Medi-Medi program. We were assured that we will be included during the federal fiscal year 2007-2008. We are also independently exploring the possibility of purchasing or contracting with an outside contactor to perform data mining tasks to improve our ability to combat fraud and abuse.

What are your future plans?

We plan to analyze the Deficit Reduction Act provisions regarding Medicaid for flexibility and new ways to plan and administer our Medicaid program.