Arizona Health Care Cost Containment System Amendment - Medical Home Program for American Indians

Program Location: 
Phoenix, AZ
Payer Type: 

The Arizona Health Care Cost Containment System (AHCCCS) administers Medicaid to approximately 1.35 million members largely through a managed care delivery system. This system operates managed care insurance programs that establish each member with a primary care physician (PCP) upon enrollment. Through a Medicaid Section 1115 Waiver Ammendment, in August 2011, Arizona proposed the creation of a Medical Home Program to adddress disparities and support the ability of the Indian Health Services facilities to better manage care  (by enhanced case management and care coordination) for American Indians enrolled in the traditional AHCCCS fee-for-service (FFS) program. Patients will be assigned to a primary care team lead by either a primary care physician, nurse practitioner or physician's assistant.

AHCCCS will incorporate the effectiveness of utilizing medical homes as part of the program evaluation and evaluate the success of improving health disparities between American Indians and other populations in Arizona. AHCCCS will also identify best practices and report on opportunities for improvement.  The state expects to see trends indicating cost savings through prevention of hospital readmissions and improved control of non-emergent use of the emergency department.


Payment Model: 

Reimbursement would be provided for primary care case management services, a 24-hour call line and care coordination services.  A flat monthly rate of $4.39 PMPM  would be used to pay providers for participating in the medical home program.

Last updated April 2019
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