State of Arizona Project S.L.I.M. report on the Arizona Health Care Cost Containment System

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STATE OF ARIZONA
PROJECT S. LI. M. REPORT ON THE
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
J~ 2, 1992
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AHCCCS
PROJECT SUM
TABLE OF CONTENTS
EXEa1TIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1
RECOMMENDATIONS
Consolidation of AHCCCS E1lglbUIty Determination 58
Long Term Care eligibility 68
DES - AHCCCS eligibility Determination Budget n
IRMD Consultant Usage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 79
Establish Training Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 97
Third Party liability ( TPL) Outsourcing 101
Warehouse Operations Outsourcing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 107
Overall Agency Realignment 112
Director's OffIce Reorganization 122
OffIce of the Director - General Counsel . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. 125
OffIce of the Medical Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 130
Proposed Division of Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 136
Realignment of Bureau of Member Services 141
Proposed Bureau of Health Care Contracts Management ( HCCM) . . . . . . . . . . . . . . . . . . .. 146
Proposed DMsIon of Management Review 149
Realignment of Division of Business, Finance & Research . . . . . . . . . . . . • •. 155
Establish Teiecommunlcatlons Position 163
ClaIms Processing '.' .......................•....................•..... 165
Personnel Functions 171
CAP for HCBS E1dertyand PhyslcaJly Disabled : .•......................... 174
ALTCS - eligibility Quality Assurance ..........•.............................. 181
Lump Sum ApproprIatIon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . .. 192
AHCCCS
PROJECT SUM
TABLE OF CONTENTS
EXHBITS
1. SUM IntervieIN Ust 14
2. Summary of Recommendation TItles & Savings .............•..•...............•. 21
3. AHCCCS Implementation Schedule ........•.................................. 24
4. AHCCCS, Proposed Organizational Structure ......•...........•..........••..... 25
5. Office of the Director, Proposed Functional Organizational Structure 26
6. Deputy Director, Proposed Functional Organizational Structure . . . . . . . . . . . . . . . . . . . . . .. 27
7. OffIce of the Director, Proposed Organizational Structure 28
8. Medical Director, Proposed Organizational Structure 29
9. OffIce of Policy and Intergovernmental Relations, Proposed Organizational Structure 30
10. General Counci, Proposed Organizational Structure 31
11. Tucson Office, Proposed Organizational Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 32
12. Public Information OffIce, Proposed Organizational Structure 33
13. Indian Health Services Coordinator, Proposed Organizational Structure . . . . . . . . .. 34
14. Affirmative AetionjEEO OffIcer, Proposed Organizational Structure 35
15. legislative uaisonjOIent Advocacy, Proposed Organizational Structure 36
16. Division of Management Review, Proposed Functional Structure 37
17. DMslon of Management Review, Proposed Organizational Structure 38
18. Bureau of Grievance and Appeals, Proposed Organizational Structure , 39
19. Bureau of Fraud and Abuse, Proposed Organizational Structure 40
20. Bureau of Quality Control, Proposed Organizational Structure . . . . . . . . . . . . . . . . . . . . . . .. 41
21. Information and Resources Management Division, Organizational Strueture 42
22. Division of Health Care, Proposed Functional Organizational Structure . . . . . . . . . . . . . . . . .. 43
23. Division of Health Care, Proposed Organization Structure . . . . . . . . . . . . . . . . .. 44
24. Division of Health Care, Proposed Central OffIce Organizational Structure ....•.......... 45
25. Bureau of Health Care Contracts Management, Proposed Organizational Structure 46
26. Bureau of Member Services, Proposed Organizational Structure 47
27. Bureau of Long Term Care Eligibility, Proposed Organizational Structure ~ ......•....... , 48
28. Bureau of LTC Eligibility, Proposed FIeld Organizational Structure ...•.........•••..... 49
29. Division of Business, Finance & Research, Proposed FunetionaJ Organizational Structure . . .. 50
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AHCCCS
PROJECT SUM
TABLE OF CONTENTS
EXHBITS
30. DMsion of Business, Finance and Research, Proposed Organizational Structure .......•.. 51
31. Bureau of Claims & Encounters, Proposed Organizational Structure ...............•... 52
32. Bureau of Contracts & FacHItIes, Proposed Organizational Structure 53
33. Bureau of Finance & Accounting, Proposed Organizational Structure . . . . . . . . . . . . . . . . . .. 54
34. Bureau of the Budget, Proposed Organizational Structure . . . . . . . . . . . . . . . . . . . . . . . . . .. 55
35. Bureau of Personnel & Training, Proposed Organizational Structure . . . . . . . . . . . . . . . . . . .. 56
36. Bureau of Research, Proposed Organizational Structure 57
37. Program Comparison ( ALTCS LTC) 64
38. MN/ MI Error Savings Calculations 65
39. Federal Categorical Programs - Savings Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 66
40. Staff Reductions Savings Calculations 67
41. Intake Financial EJlgibDity Process - ALTCS, OMB and ODWI 73
42. Medical EllglbMlty Determination 74
43. Breakout of Bureau of Medical Eligibility from DMslon of Member Services 75
44. Breakout of Bureau of Financial EJiglbDIty from the DMsion of Member Services . . . . . . . . . .. 76
45. IRMD Employee Position Titles, No. of FTEs and Salaries 84
46. AHCCCS Consldtants 85
47. AHCCCS DOA Costs 87
48. IRMD Administration, Present Organizational Structure 88
49. IRMD HCFA CertIfication/ Documentation, Present Organizational Structure 89
50. IRMD IM/ UR/ OA/ CM FlnanclaJ, Present Organizational Structure 90
51. IRMD Claims/ Encounters, Present Organizational Structure ....................•..... 91
52. IRMD Recipient/ Health Plan, Present Organizational Structure . . . . . . . . . . . . . . . . . . . . . . .. 92
53. IRMD Operations and Telecommunications, Present Organizational Structure ..........•.. 93
54. IRMD Planning/ Budget/ Control, Present Organizational Structure . . . • .. 94
55. IRMD OffIce Automation Services Center, Present Organizational . . . . . . . • . . . . . . . . . . . . .. 95
56. IRMD DataBase Admlnlstration/ Technlcal Support, Present Organizational Structure 96
51. FlOW etlart at lPL Process ." ••. "....... • . , .•.•••.•. , ,. 104
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AHCCCS
PROJECT SUM
TABlE OF CONTENTS
EXHIBITS
58. AHCCCS, Present Organizational Structure .
59. Office of Grievance and Appeals, Present Organizational Structure .
60. Health Plan Contract Bidding Process .
61. Oalms Process, AHCCCS - Fee for Service .
62. ALrcs, Forecast of Enrollment, ArIzona FY 1992- 93 .
63. ALrcs, Rates Used In Forecasting Expenditures, ArIzona FY 1992- 93 .
64. Bureau of Financial EliglbHity, ALrcs Quality Assurance Process .
65. Bureau of Financial Eligibility, ALrcs Quality Assurance Process
Corrective ActIon Plan - Follow- up .
66. Bureau of Medical EllgibHIty - Central Office, Present Organizational Structure .
67. Bureau of Financial EllglbDIty - Central Office, Present Organizational Structure .
68. Bureau of Financial EllglbHIty, Proposed ALrcs Quality Assurance Process .
69. Bureau of Financial EligibHlty, Proposed ALTCS Quality Assurance Process
Corrective Action Plan - FollOW- Up .
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July 2, 1992
Dr. leonard J. Kirschner, M. D., M. P. H.
Director
ArIzona Health care Cost Containment System
801 E. Jefferson Street
Phoenix, AZ 85034
Dear Dr. Kirschner:
We have completed the Governor's Statewide Long- Term Improved Management ( SUM) review of
the Arizona Health care Cost Containment System ( AHCCCS), and are pleased to present to you our report
of findings and recommendations. Our analysis was conducted from November 1991 through March 1992.
This summary describes the objectives of the review, the approach used throughout the analysis, and
the major changes recommended as a resutt of the study. We have quantified the potential benefits and
summarized the key Implementation tasks, Including legislative support needed to Implement proposed
recommendations Into actual benefits. Our detaUed findings and recommendations follow this summary.
Total benefits of $ 36.1 mUlion were identified through this review, Including $ 28.1 mUllan In benefits
for the Agency, $ 7.3 mUlion In direct benefits for the citizens of ArIzona, and $. 7 mUlion In benefits to the
Federal Government.
OBJECTNES AN) GOALS
The overall objective of this study was to find ways to Improve the delivery of services In AHCCCS,
using various business analysis and Total Quality Management ( TQM) techniques. Our goal was to
streamline processes, eliminate rework and unnecessarywork, Improve systems and procedures, and realign
groups with s1mlar functions to deliver services at a lower cost. In addition, our goal was to establish
organizati0nai structures that will support the long term goal of continuous Improvement.
Dr. Leonard J. Kirschner
AHCCCS
Page 2
APPROACH
We approached this study by taking an Integrated view of the organization. For each area we
reviewed. we studied the mission and strategic focus. the product/ process delivery methodology, the
service Issues and measurements. organizational structures, and the logistics and physical assets used by
the organization to deliver products and services.
We began by using the · shelf data · provided to us by AHCCCS to become famUlar with the mission,
size. structure. and responsibilities of the major areas of the Agency. We then concIucted Interviews with
aJlleveis of supervision, selecting technical and line personnel to enable us to focus on areas which could
be Improved. Where appropriate, we used Interviews to develop detaUed process flows which enabled us
to identify non- value added elements that could be eliminated. During the course of our review, we
conducted over 200 Interviews of Agency and external personnel ( see Exhibit 1, SUM Interview Ust).
In addition to developing process flows, we employed the following analytical techniques:
• Quantification of cost to provide a quality service or product and opportunities to reduce related
cost elements
• Identification of prevention activities ( upstream) to reduce more costly faHures further In the
process
• Identification of areas where root cause analysis can be used to assess the Incipient causes of
faHure
• Assessment of the organizational structures Including consideration of the following Issues:
- Span of control
- Managerlallayertng
- Alignment of departmental missions
- Distribution of responsibilities
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Dr. Leonard J. Kirschner
AHCCCS
Page 3
- Fragmentation of duties
- Overlapping or redundant functions
- Centralization versus decentralization.
Ourfirst step In analyzing the organization Invotved identifying opportunitiesfor streamlining processes
and modifying practices to Improve performance. In addition, we assessed the 1) alignment of units,
sections, bureaus and divisions; 2) appropriate spans of supervisor control based on work requirements to
reduce the cost to manage, Improve organizational ftexibUIty and empower lower levels of the organization;
and 3) elimination of redundant functions and consolidation of fragmented responsibBItIes.
In order to quantify the effects of making changes, we obtained time estimates for work requirements.
In some Instances, we observed and measured the work volume and actlvttles. In addition, we used Agency
avaUable statistics to assess the variety and volume of transactions processed.
As we developed our recommendations, we reviewed the proposed changes wtth appropriate
supervisors and managers to determine completeness of the analysis. In addition, we met with senior
Agency management to review our findings on a regular basis.
suMMARY RNDINGS & RECOMMENDAl1QNS
Overall Agency Realignment
Major efficiencies and substantJal savings can be realized through a realignment of the Agency and
Its business functions.
The present- day organization of AHCCCS reflects an environment of rapid program growth In the
number of State and Federal programs and dollars spent, wtth administrative functions developed and based
on short- term needs. One resuft of organization evolutJon Is that c1ose1y- related functions are sometimes
found In different divisions, or different bureaus, IncreasJng the dlfflclity In coordinating activities. As a
Dr. Leonard J. Kirschner
AHCCCS
Page 4
We recommend restructuring the Agency's present five operating dMslons Into four. The proposed
realignment Is consistent with the mission of AHCCCS, which Is to malntaln and enhance abUIty to provide
indigent health care services, and to obtain full economic value for monetary resources expended. We also
recommend broadening the spans of supervisory and management control within c1earty distinct functions.
We recommend the realignment bll( e the following form ( see exhibits 4- 36, AHCCCS, Proposed
Organizational Structure):
• A core " DMsion of Health care" establishing and maintaining a comprehensive acute and long
term care system, ensuring access to and delivery of the full range of quality health care services
required for Arizona's Indigent cItIzens. The Division would have three bureaus supporting Its
mission:
- A Bureau of Health care Contract Management
- A Bureau of Eligibility
- A Bureau of Member Services
• A " Division of Management Review" providing all AHCCCS administrative and program contractor
decision revl9\ NS, as well as official quality control and Investigative actions. The Division Is
comprised of three bureaus:
- A Bureau of Grievance and Appeals
- A Bureau of Ellglbllty Quality Control
- A Bureau c: A Fraud and Abuse Control
• A " Division of Business, Finance and Research" handling the accounting, budget, personnel,
training research, and claims processing functions; services, with some exceptions, currently
provided In the present Division of Business, Finance and Research
• A " DMslon of Information Resource Management" providing Information management and user
support for data services and communication.
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Dr. Leonard J. Kirschner
AHCCCS
PageS
These four dMslons represent the focus of service delivery and service delivery support for AHCCCS.
In the proposed organizational structure the AHCCCS Deputy Director Is the manager of the service delivery
system. Add/ tlonal operational advisory functions are placed as staff functions to the Deputy Director.
These include:
• Client NJvocacy
• AffIrmative Actlon/ EEO
• Indian Health Services Coordination
• Public Information.
The role of Director of AHCCCS Is placed as oversight to the Deputy Director; besides operational
oversight, Its primary focus Is concerned with the poI/ tlcal, regulatory, policy setting and legal guidance for
the Agency.
The two components of the AHCCCS reorganization - ( 1) business unit consolidation, and ( 2) intemal
unit restructuring - wli serve to provide a number of benefits to the agency, in addltlon to substantial cost
savings, as follows:
• Improved program communication will occur among managers and program line employees
because current organizational barriers will be eliminated. The need for artificial or ad hoc
communication devices, such as coordinating committees or units Is diminished
• Improved accountability will occur because management and/ or supervisory roles are c1eariy
distinct from line functions. Under the proposed realignment of functions, appropriate
responsIbllties wli be distributed among managers and supervisors to support appropriate spans
of control and reporting relationships
• Improved ability to plan for program changes and successftjly Implement either planned or abrupt
changes to AHCCCS wli be faclltated
1. Consolidation Savings
Dr. Leonard J. Kirschner
AHCCCS
Page 6
• Substantial cost savings wUl accrue by virtue of the restructuring and realignment. These savings
are reflected In the following nine allied recommendations and amount to $ 673,895 for your
Agency and the State and $ 411,645 In Federal Government savings. as follows:
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State
Dollars Saved
$ 140.030
.()..
31,008
38.500
66,240
129,137
42,240
63,500
163,240
Area of Restructyrlng
Overall Agency Realignment
Director's OffIce Reorganization
OffIce of the Director - General Counsel
OffIce of the Medical Director
DMsJon of Health Care
Bureau of Member Services
Bureau of Health Care Contracts Management
Organization of DMsion of Management Review
Business, Finance and Research Realignment
Total
AHCCCS E1lglbUIty Determination
There are two significant areas of savings to the State In connection with our recommendation that
all AHCCCS- reJated e1lglbUIty determination functions be consolidated under the Department of Economic
Security's ( DES) control. The first reiates to those benefits and savings which wUl be realized by the State
and Its citizenry through a streamlined and simplified consolidation process; the second relates to the
introduction of Federal Medicaid funding screening into the eJigibHIty determination process.
The AHCCCS e1lglbKIty determination is both fragmented and overly complex. Four separate entities
are presently responsible for determining eligibility for AHCCCS Acute and Long Term Care services: the
Department of Economic Security, ArIzona Counties, the Social Security Administration and AHCCCS.
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Dr. Leonard J. Kirschner
AHCCCS
Page 7
We recommend consolidating the e1lglbllty process for the MN/ MI's ( currentty being done by the
counties) and the eventual transfer of the financial eligibility process for Long Term care ( currently being
done by AHCCCS) Into the e1lglbUIty processes at DES. DES should be the focal point for all e1lgibUIty
determinations Involving AHCCCS services. Applications for SSI would remaJn with federal SSA offices.
The major benefits associated with implementing this recommendation are as follows:
• 81mlnatlon of Ineligible Individuals being served In the MN/ MI State funded program. savings to
the State are estimated at $ 8 millen annually
• Creation of one uniform and common system for financial e1lglbUIty determination. SSA will
continue to do SSI e1lglbUIty, while existing agencies will continue determinations where medical
e1lglbHIty Is a component.
2. Federal Medicaid Funding Screening savings
Additional savings, estimated at approximately $ 16 mU110n annually will accrue to the State as a by­product
of the DES consolidated e1lglbUIty determination process. At the present time, counties are not
adequately screening Individuals to determine eligibility for Federal Medicaid funding. It has been estimated
that 15% eX this population are qualified to receive federal assistance under the AId to FamUles with
Dependent Chldren ( AFDC) program. The Federal Government will pay 63% of the health care costs under
this program. The State Is currently paying 100% of these costs.
Information Resoyrces Management DMslon ORMD)
1. ConsUtant Usage
IRMD places a heavy reliance upon the use outside consultants In the day to day operation of Its
division. ApproxImately 60% of Its 1992 budget Is allocated to conslitlng assistance. Although this Is a
Dr. Leonard J. Kirschner
AHCCCS
Page 8
We recommend IRMD become more self- sufficient and eliminate Its dependence upon outside
assistance for running Its day to day operations. ( Consultants are currently being utUlzed as Project
Managers, Analysts. Programmers. Data Base Specialists, Documentation Clerks. Computer Operations
AssIstants and clerical support - among others.) It Is recognized that consultants may be reqUired. on an
occasional basis, for special projects. However, these should be of limited duration.
To successfully phase out the 48 consultants currently on contract to IRMD, the following actions will
first be required:
• Initiate an Intensive training program designed to bring current IRMD employees up to IndUstry
standard
• Increase the number of budgeted positions from 106 to 118 to provide for 12 additional
programmer/ analysts In the Systems and Programming area
• ! dentlfy, through a careful process of employee evaluation, non- productive personnel at all
professional and managerial levels and develop a corrective action plan with specific timetable
targets for implementation, not to exceed one year
• I"'- onduct a compensation study to determine whether IRMD employees' pay scales are competitive
with the private sector. If the study confirms that wide disparities In compensation exist, adjust
the pay scales accordingly. This wli help qualified and experienced employee retention
• Establish the professional and managerial positions as exempt. This wli attract and retain
qualified staff, Including presumably some who are currently consultants, and mcDltate the removal
of non- productlve employees.
The phasing- out of conslitants accompanied by the above recommendations wli result In a net
savings of 4.5 mUllan; $ 2.65 mUllan wli accrue to the State and $ 1.85 mUlion to the Federal Government.
This amount takes into account the estimated costs associated with upgrading the personnel compensation
package and the addition of 12 programmer/ analyst III positions.
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Dr. Leonard J. Kirschner
AHCCCS
Page 9
Outsourcing
We recommend outsourcing the following two current In- house AHCCCS functions to third party
contractors:
1. Third Party L1abUlty
The Recovery and uen Unit of the DMslon of Business, Finance and Research, also known as the
Third Party UsbUity ( TPL) Recovery Unit, has as Its mission the recovery of funds from Insurance companies
and other parties who are liable for the payment of covered services rendered to AHCCCS members and
eligible persons. It Is currently composed of 17 FTEs.
We concur with the current thinking of AHCCCS management that the TPL Recovery and Uen Unit
be privatized. The principal benefit to AHCCCS lies in the potential for recouping much larger amounts of
the recoverable dollars. Over the past five years, an average of 20% of the 2,000 cases referred annually
from the PMMIS Case Management Sub- System were successfully completed and money recovered. If the
TPLfunctions were to be privatized and the recovery function were to match that of current private collection
agencies' performance, we believe a much larger percent of the 2,000 annual cases could have been
SUccessfully completed.
The net reduction of 15 FTEs would represent an estimated annual savings of $ 499,685, 58.4% of
which would be In the form of salaries, and 42.6% In ernployee- related expenses and other operating
expenses. The actual savings to the state Is estimated at $ 286.819 since the Federal share of TPL positions
Is 43%.
2. Warehouse Operations
The ftxed costs associated with renting and operating a warehouse by AHCCCS are not efficiently
operating an AHCCCS warehouse can be reduced by outsourcing.
Dr. Leonard J. Kirschner
AHCCCS
Page 10
We recommend that the mal handling and copying services functions be placed with an outside
contractor. Additionally, we recommend that the supplies function be relocated to the AHCCCS main
building and that all claims records and other AHCCCS- related historical records now stored In the
warehouse be relocated to the DOA Records Retention Center. These operational changes will eliminate
the need for the warehouse space now leased by AHCCCS.
First year savings of $ 94,640 are projected In connection with this recommendation. This would be
followed by annual recurring savings In the amount of $ 54,640.
HCBS elderly/ PhYSically Disabled Program
The current average cost of serving e1derty and physically disabled Individuals In the regUlar long term
care program Is $ 2,000 per month; the cost to serve this same group In the Home and Community Based
Services program Is approximately $ 800 per person. At the current 25% cap, only 2,400 of the
approximately 9,600 elderly and physically disabled Individuals can be served through the lower cost
program; the balance must be served In more expensive nursing care programs.
Although this Is a controversial Issue, significant savings will be realized by the counties through
authorization of an Increase In the current cap ( 25%) on HCBS services by the Health Care Finance
Administration ( HFCA).
Savings of up to $ 7.4 mUlion per year for the counties are possible; the Federal Government also
benefits by an amount of $ 13.7 milion. We believe that concerns about the " woodwork" Increase effect are
sufficiently mitigated by the stringent eligibility formula currently In effect governing HCBS ellglbHity.
QT't£ R RECOMMENDATIONS
Miscellaneous other recommendations Include:
• UtHIzIng automated claims processing ( estimated total $ 246,000 savings/ year of which the State
portion would be $ 123,000 savings/ year)
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SUMMARY OF SAVINGS
• Establishing a Personnel DMsion outstation within AHCCCS ( no estimated savings)
• Establishing an Internal training unit within AHCCCS ( estimated annual cost - $ 152,000 of which
the State's cost share would be $ 76,000)
• Providing the Director of AHCCCS with full lump sum budget authority, both above and below the
line. In the administration of the AHCCCS program ( no estimated savings)
$ 28,054,598
7,381,756
682.416
S3 § . 118. no
State Savings
County SaVIngs
Federal Savings
Total
• Establishing an IntemaJ telecommunications position and discontinuing the use of third party
services for this function ( estimated $ 108,000 total savings/ year of which the State portion would
be $ 50,760)
• Strengthening the field level ALTCS Eligibility quality assurance function and eventually dismantling
the Headquarters Quality Review Unit once the field quality review process has been made
accountable ( estimated total savings of $ 276, ooo/ year of which the State's portion would be
$ 110,500)
Dr. Leonard J. Kirschner
AHCCCS
Page 11
exhibit 2. Summary d Recommendation TItles and Savings. outlines the Impact of each of the
recommendations, and reflects savings to the State. the Counties and the Federal Government. The
magnitude d each Is as follows:
The Improved services and benefits outlined above are achieved through the 22 recommendations
discussed In this report. The recommendations apply to several areas such as organizational restructuring,
process changes. Income enhancement, management controls, functional realignment, public benefits and
staffing requirements.
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Dr. Leonard J. Kirschner
AHCCCS
Page 12
exhibit 4, AHCCCS, Proposed Organizational Structure, outlines the proposed structure of AHCCCS
following the Implementation eX these recommendations. These structures are consistent with the
recommendations and mission of the Agency. Anallzlng the specific detaBs of the proposed organlzatlona1
structures wli be completed during Implementation In conjunction with the management team.
IMPLEMENTATION
Implementation Is the critical step In the process of achieving savings. Potential savings are often
identified but not achieved when the Implementation process Is distracted by day- to- day aetMtles, and
managers shy away from the necessary reduction In staff. Successful Implementations are marked by two
realities:
• Strong commitment from senior management to achieve as much of the savings as proves
possible
• Designation of implementation team leaders with the mental toughness to see the task through
to completion.
The Implementation process Is best carried out soon after the review process. This maintains
momentum whBe the topics are fresh In people's minds. We estimate that most of the recommendations
contained In the report can be Implemented within a period of twelve months. Some recommendations,
however, may require additional time as they are dependent upon legislative approval.
Our recommend8d Implementation Plan ( see exhibit 3, AHCCCS Implementation Schedule) outlines
an Implementation sequence and approximate duration for each recommendation. A detaled plan will be
established at the outset eX the Implementation. Individual recommendation and Implementation
requirements are Included with the recommendations In the detaBed section of this report
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Dr. Leonard J. Kirschner
AHCCCS
Page 13
AGENCY RESPONSE
AHCCCS has submitted a written response to our recommendations which Is generally supportive
of 12 of the 22 recommendations. These constitute 97% of the estimated savings.
The Agency has expressed concerns about the remaining 10 recommendations, however. These
recommendations, for the most part, deal with organizational realignment and restructuring Issues.
We have reviewed their concerns with them on a polnt- by- polnt basis and have jointly " agreed to
disagree" untJllmplementation time. At that point, we will review the organization structure again as part of
the implementation phase tasks. Their written response will become part of the Implementation phase plan
and is avaHabie for review upon request.
* * * * *
We appreciate the opportunity to be of service to the Governor and the SUM Steering Committee In
this endeavor. Should you have any questions regarding this report, please feel free to contact the Project
executive or any member of your Project SUM Team:
• James Griffith, Department of Economic Security
• Carl Jager. Department of Transportation
• MUa HUI, Department of Land
• Thomas Donahue. Coopers & Lybrand
The Agency Director's comments foIlO'N this signature page.
AHCCCS - 13A
801 East Jefferson · Phoenix, Arizona 85034 · ( 602) 234- 3655
P. O. Box 25520 . Phoenix, ArIZona 85002
While the SLIM report on AHCCCS makes several excellent
recommendations to improve the program's efficiency, it also
proposes several organizational changes that require further study.
Overall, we support 12 of the 22 recommendations and are in
agreement with 97 percent of the dollar savings identified in the
report.
The AHCCCS staff agrees with and fully supports Project SLIM's
goal to make state government more efficient for Arizona's
taxpayers. Because AHCCCS itself is run this way, the program has
become a national model of cost- effective quality health care.
President Bush's FY 93 budget document states, " Arizona was the
last state to join the Medicaid program -- and as a result may be
the most progressive. Rather than running a Medicaid program
similar to other states, Arizona has run the program since its
inception as a coordinated care operation." This letter is an
abridged version of the de~..: ailed comments already submitted in
response to the SLIM report and is written in the context of our
intention and desire to remain a state- of- the- art Medicaid program.
Director
LEONARD J. KIRSCHNER, M. D., M. P. H.
June 8, 1992
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
The key area of agreement is a streamlined eligibility system.
We enthusiastically support SLIM's recommendation that acute care
eligibility be consolidated under the Department of Economic
Security. The Medically Needy/ Medically Indigent ( MN/ MI) program
is 100 percent state funded with an annual budget of approximately
$ 200 million. Because of the large amount of state dollars in the
program and the inability to leverage federal dollars for these
clients, it has the largest single savings potential. Presently,
15 counties do eligibility for the MN/ MI program and their
incentive is clearly to make people eligible, not to protect the
General f'und. Consolidation of eligibility under DES would insure
that individuals are placed in appropriate categories and available
federal dollars are brought into the state for their health care
Dear David:
Mr. David st. John
Project Executive
Project SLIM
1700 West Washington
Phoenix, Arizona 85007
Governor
- -::::::-.=:::::'
, -:=:: I
FIFE SYMINGTON
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Letter to David st. John
June 8, 1992
Page 2
needs. In addition, the present error rate would certainly be
decreased. An administrative system that has 15 separate
eligibility systems in our 15 counties can no longer be sustained.
Financial eligibility for the Long Term Care Program uses an
SSI methodology. Since DES uses an AFDC methodology for its
eligibility determination a long learning curve will be required.
Transfer of long term care eligibility to DES should be done with
extreme caution since eligibility errors inevitably lead to federal
sanctions with the potential for losses in the millions of dollars.
AHCCCS agrees with the recommendation to reduce dependence on
MIS consultants and has, in fact, been phasing them out for many
months. It is not possible, however, to complete a phase- out
within the recommended 12 to 18 months because of projects such as
a new hospital reimbursement system, eligibility consolidation,
implementation of mental health services and special projects from
the Governor's Office to develop cost control initiatives.
We strongly support a more liberal limit on Home and Community
Based Services ( HCBS). At present, the HCBS program is limited by
the Federal Government to 25 percent of the elderly and physically
disabled population in the state's Long Term Care Program. SLIM
recommends negotiating a 50 percent cap with the Health Care
Financing Administration. Our past experience has demonstrated
that this will be a difficult negotiation. We will again propose
an open ended HCBS program in our annual waiver renewal, but the
reality of the population we serve indicates that placing
50 percent of our clients in a home and community based setting may
not be ~ chievable. Many of these people have no homes in which to
receive services or would require so many services that costs would
exceed those in nursing facilities.
We disagree with several recommendations for agency
realignment. Principle among those disagreements is the suggestion
to develop a new Division of Health Care. The proposed
organization would be too massive and cumbersome to manage and
would have too many disparate components. It is counterproductive
to dismantle the present Office of Managed Care ( OMC) and combine
various components with other divisions. OMC is a distinctive
organization based on private- sector design, and its evolution over
the last several years has been extremely effective for AHCCCS. It
provides the critical regulatory control and oversight of our
health plans, program contractors and nursing homes. Without this
organization we run the risk of losing regulatory control and in
the long run of increasing total expenditures.
AHCCCS - 138
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Letter to David st. John
June 8, 1992
Page 3
The Office of Grievance and Appeals should remain as a
separate unit and should not be joined with other areas of the
agency as recommended in the report. AHCCCS has already
implemented the SLIM recommendation to remove the General Council
from Grievance and Appeals because of concerns that an
organizational separation be maintained between the fair- hearing
process and other agency functions. It would clearly be a step in
the wrong direction to place the quality control function and Fraud
and Abuse under the current Office of Grievance and Appeals.
The proposed reorganization in the Division of Business,
Finance and Research requires further evaluation. We clearly agree
with the recommendations to out- source the Third Party Liability
function and warehouse operations. Details of this reorganization
need to be developed over the next several months during the
implementation phase.
AHCCCS is in agreement with Project SLIM that efficiency and
savings is the objective. Our overriding concern, however, is
that change enhances our present situation as a cost- effective
health care delivery system and is not in fact counterproductive.
The AHCCCS Administration supports the Governor's attempts to
improve the efficiency of Arizona state government, and we look
forvtard to working with Project SLIM during the implementation
phase.
Sincerely,
p ./' ~( fG~'~
Leonard J. Kirschner, M. D. , M. P . H.
Director
LJK: ejt: SLIM
AHCCcs - 13C
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SLIM INTERVIEW LIST EXHtBIT 1
1 OF 7 PAGES
AHCCCS
Date: May 15, 1992
Name Title Date Time Interviewer
Kickoff Meeting NA Nov. 13,91 11: 15am Team
D. Lowenberg Deputy Director Nov. 14,91 8: 00am "
D. Van Dyk AD, Managed Care Nov. 14,91 1: 00pm "
R. Austin AD, Bus. Fin. & Research Nov. 15,91 9: 00am "
L. Redman AD, Policy & Intergov. ReI. Nov. 18,91 1: 00pm "
D. Ahuja AD, Info. Res. Mgmt. Nov. 19,91 8: 30am "
M. Chen, M. D. AD, Member Services Nov. 19, 91 1: 00pm "
G. Relkin AD, Grievance & Appeals Nov. 20,91 9: 00am "
M. Veit Mgr., BFR, Contracts & Purch Nov. 20, 91 1: 00pm TBA
R. Cox Mgr., BFR, PersonnellTPL Nov. 20, 91 1: 00pm TBA
G. Schneider Mgr., BFR, Budget Nov. 21, 91 9: 00am TBA
P. Nolan, M. D. AD, Medical Director Nov. 21, 91 1: 00pm TBA
L. Kirschner, M. D. Director Nov. 22,91 1: OOpm Team
S. Morley BFR, TPL Nov. 22, 91 9: 00am M. Hill
L. Allen BFR, Personnel Nov. 22, 91 10: 30am M. Hill
L. Young BFR, Purchasing Nov. 22, 91 9: 00am C. Jager
' D. Yearyean BFR, Copying Nov. 22. 91 10: 00am C. Jager
M. Carter BFR, Mail/ Courier Nov. 22.91 11 : OOam C. Jager
F. Teitelbaum BFR, Research Nov. 22, 91 9: 00am BandinilGrif
L. Linker BFR, Warehouse Nov. 26. 91 10: 00am J. Griffith
D. Nance BFR, Contracts Nov. 26.91 1: OOpm J. Griffith
K. Woods BFR, Contracts Nov. 26, 91 3: 00pm J. Griffith
P. Ruiz BFR, Personnel, TPL Nov. 26, 91 10: 00am B. Bandini
M. Prudence Mgr., BFR, Finance & Acctg. Nov. 26. 91 10: 00am Hill/ Jager
P. Akers BFR, Admin. Budget Nov. 21, 91 11 : OOam M. Hill
C. Schultz BFR, Payroll Nov. 27, 91 1: 00pm C. Jager
P. Perry BFR, Appropriations Nov. 26, 91 2: 00pm M. HiII
H. Couvert BFR, TPL Nov. 26, 91 3: 00pm M. HiII
S. Gallagher BFR, Payroll Nov. 27, 91 9: 00am C. Jager
J. Lopez BFR, Appropriations Nov. 27,91 9: 00am M. HiII
B. Osborne BFR, Payroll Nov. 27, 91 10: 30am C. Jager
K. Fairman BFR, Research Nov. 27, 91 10: 30am J. Griffith
C. Steele BFR, Research Nov. 27, 91 9: 00am J. Griffith
R. Bichanich BFR, Program Nov. 27, 91 10: 30am M. HilI
F. Ontiveros BFR, Recovery/ Lien Nov. 29, 91 10: 00am M. Hill
page 1
AHCCCS - 14
SLIM INTERVIEW LIST EXHIBIT 1
AHCCCS
2 OF7 PAGES
Date: May 15, 1992
Name Title Date Time Interviewer
B. Page Fin. Collect. Agencies, Inc. Nov. 29,91 AM M. Hill
S. Sandler Fin. Mgt. Services, Inc. Nov. 29,91 PM M. HiII
D. Ross DMS, Fin. Elig. Dec. 02, 91 9: 00am Hill/ Jager
P. Fethiere DMS, Med. Elig. Dec. 03,91 11: 00am 8andini/ Grif
M. Veit 8FR, Contract & Facilities Dec. 04,91 2: 30pm Jager/ Griffit
P. Vancil DMS, Fin. Elig. Dec. 04, 91 9: 00am C. Jager
B. Sassman DMS, Med. Elig. Dec. 04,91 1: 30pm 8. Bandini
A. Schafer DMS, Med. Elig. Dec. 04, 91 10: 00am B. Bandini
J. Salm DMS, Med. Elig., QC Dec. 04, 91 10: 30am J. Griffith
M. Norton DMS, Med. Elig. Dec. 04, 91 9: 00am J. Griffith
B. Pearson DMS, Fin. Elig. Dec. 04, 91 11: 00am C. Jager
L. Montgomery DMS, Fin. Elig., Pol. Dev. Dec. 05, 91 3: 00pm C. Jager
B. Noonan DMS, Fin. Elig., Training Dec. OS, 91 11: 00am C. Jager
. E. Nesmith DMS, Fin. Elig., QC Dec. 05,91 10: 00am C. Jager
R. Skinner DMS, Fin. Elig., Pol. Dev. Dec. OS, 91 3: 30pm C. Jager
K. Sullivan DMS, Fin. Elig. Dec. 05, 91 9: 00am M. Hill
K. Kuhfuss DMS, Med. Elig. Dec. OS, 91 11: 15am B. Bandini
S. Wolak DMS, Fin. Elig., Pol. Dev. Dec. 05,91 2: 00pm C. Jager
C. Trujillo DMS, Fin. Elig. Dec. 05,91 10: 00am M. Hill
J. Sterrett DMS, Med. Elig. Dec. 05, 91 10: 30am B. Bandini
M. Purvis DMS, Fin. Elig. Dec. 05, 91 1: 00pm M. Hill
G. Collins DMS, Systems Coord. Dec. 06, 91 1: 30pm Hill/ Bandini
L. Peters DMS, Fin. Elig. . Dec. 06,91 9: 00am M. HiII
E. Fraijo DMS, Fin. Elig., Training Dec. 06, 91 2: 00pm C. Jager
M. Himes DMS, Encounter Claims Dec. 06, 91 10: 00am Jager/ Griffit
L. Kirschner Director, CANCELLED Dec. 06, 91 12: 30pm Team
M. Himes DMS, Encounter Claims Dec. 09, 91 9: 00am C. Jager
V. Noor DMS, Fin. Elig. Dec. 09, 91 10: 00am M. Hill
. S. Coddington DMS, Policy Dec. 09,91 3: 30pm C. Jager Is, Clark DMS, SCU Systems Res. Mgr. Dec. 09,91 10: 00am B. Bandini
D. Wimmer DMS, Med. Elig., Field Svs. Dec. 09, 91 2: 00pm J. Griffith
J. Lurie DMS, Policy Dec. 09, 91 2: 30pm C. Jager
R. Haugen DMS, SCU, HP Interface Dec. 10,91 2: 30pm 8. Bandini
K. Beiard DMS, SCU Dec. 10,91 11: 00am M. HiII
IR. Austin 8FR, AD CANCELLED Dec. 10,91 9: 00am Team
L. Bloom DMS, SCU, HP Maintenance Dec. 10,91 10: 1Sam 8. Bandini
page 2
AHCCCS - 15
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•
SLIM INTERVIEW LIST EXHIBIT 1
AHCCCS 3 OF 7 PAGES
Date: May 15, 1992
Name Title Date Time Interviewer
W. Miller OMS, SCU Dec. 10,91 10: 00am M. Hill
L. Madrid OMS, Mesa, BFE Dec. 11,91 1: 00pm M. Hill
M. Turley DMS, Mesa Field Office Dec. 11,91 2: 00pm B. Bandini
T. Wood OMS, Mesa, BFE Dec. 11,91 2: 00pm C. Jager
B. Walker DMS, Mesa Field Office Dec. 11,91 3: 00pm B. Bandini
C. Snyder OMS, Mesa, BFE Dec. 11,91 1: 00pm C. Jager
B. Brant DMS, Casa Grande, BFE Dec. 11,91 9: 00am M. HiII
L. Ellis DMS, Casa Grande Field Office Dec. 11,91 10; OOam J. Griffith
P. Scriminger DMS, Casa Grande, BFE Dec. 11,91 10: 00am C. Jager
F. McHenry DMS, Mesa Field Office Dec. 11. 91 2: 00pm J. Griffith
M. Garcia DMS, Casa Grande, BFE Dec. 11,91 9: 00am C. Jager
C. Aragon DMS, Mesa, BFE Dec. 11,91 2: 00pm M. Hill
B. Whitfield DMS, Casa Grande, Ast. Reg. Mgr. Dec. 11,91 9: 00am BandinilGrif
K. Brennan DMS, Casa Grande Field Office Dec. 11,91 10: 00am B. Bandini
J. Sherwood DMS, Casa Grande. BFE Dec. 11.91 10: 00am M. Hill
B. Walker DMS, Mesa Field Office Dec. 11,91 3: 00pm J. Griffith
C. Hanley DMS, Mesa, Ast. Reg. Mgr. Dec. 11,91 1: OOpm Griffith/ Ban
T. Zynda DMS, Phoenix Field Office Dec. 12, 91 1: OOpm Griffith/ Ban
P. Boozer DMS, Phoenix Field Office Dec. 12, 91 1: OOpm J. Griffith
C. Ford DMS, Glendale, BFE Dec. 12,91 8: 30am C. Jager
J. MacKenzie OMS, Phoenix Field Office Dec. 12,91 12: 00pm B. Bandini
P. Ellis DMS, Glendale. BFE Dec. 12,91 9: 30am C. Jager
R. Callahan DMS, Glendale Field Office Dec. 12,91 10: 00am B. Bandini
V. Worthington OMS, Glendale, BFE Dec. 12,91 8: 30am M. Hill
O. Runnels DMS, Glendale Field Office Dec. 12, 91 10: 00am J. Griffith
L. Webster DMS, Glendale, BFE Dec. 12,91 10: 30am M. Hill
B. Meredith DMS, Glendale Field Office Dec. 12,91 9: 00am J. Griffith
L. Hall DMS, Phoenix, BFE Dec. 12,91 12: 00pm M. Hill
R. Franco DMS, Phoenix Field Office Dec. 12,91 12: 00pm J. Griffith
J. Clark DMS, Phoenix, BFE Dec. 12, 91 1: 00pm M. Hill
W. Phillips DMS, Glendale Field Office Dec. 12,91 9: 00am B. Bandini
T. Miller DMS, Glendale Field Office Dec. 12,91 8: 30am BandinilGrif
S. Miller DMS, Phoenix, BFE Dec. 12,91 12: 00pm C. Jager
C. Blanco DMS. Phoenix, BFE Dec. 12,91 1: 00pm C. Jager
S. Clark DMS, SCU, DES Processing Dec. 13, 91 2: 15pm B. Bandini
I. Sandoval DMS. SCU, Training Dec. 13,91 1: 00pm B. Bandini
page 3
AHCCCs - 16
SLIM INTERVIEW LIST
EXHIBIT 1
AHCCCS 4OF7PAGES
Date: May 15, 1992
Name Title Date Time Interviewer
R. Potter OMC. Program Rev. & Audits Dec. 16,91 9: 00am Bandini/ Jag
T. Sherman OMC, Central Reg. & Prog. Mgmt. Dec. 16.91 1: 00pm Bandini? Hili
G. Grimm OMC, Fraud & Abuse Dec. 16,91 1: 00pm Griffith/ Jage
N. Noto OMC. QA/ UR Dec. 16,91 9: 00am Griffith/ Hill
C. Washington OMS, Member Services/ File Dec. 17,91 10: 00am J. Griffith
K. Gerard OMS. SCU. DES Interface Dec. 17,91 10: 30am B. Bandini
M. Hazelton OMS, Memberfile Dec. 17,91 . 3: 00pm J. Griffith
S. Clark OMS, SCU Dec. 17,91 2: 15pm B. Bandini
D. Nickolis OMS, Member Services Dec. 17,91 3: 00pm C. Jager
S. Henson OMS, Member Services Dec. 17,91 1: 30pm C. Jager
D. Winter OMS, Memberfile Dec. 17,91 2: 00pm J. Griffith
I. Sandoval OMS, SCU Dec. 17,91 1: 00pm B. Bandini
N. Garcia OMS, Members Services Dec. 17,91 3: 30pm C. Jager
R. Austin BFR, Asst. Director Dec. 18,91 3: 00pm Team
L. Kirschner Director Dec. 18,91 2: 00pm Team
T. Adebule OMS, Member Services Dec. 19,91 9: 00am C. Jager
K. Horphill DMS, Member Services Dec. 19,91 10: 00am C. Jager
B. Schmudde DMS, Member Services Dec. 19, 91 1: 30pm C. Jager
N. Morales DMS, Memberfile Dec. 19. 91 8: 30am J. Griffith
P. J. Sun OMS, BEC Dec. 19. 91 3: 00pm C. Jager
N. Settler DMS, Memberfile Dec. 19,91 9: 30am J. Griffith
L. Michalakes DMS. Claims Adjudication Dec. 19.91 1: OOpm M. Hill
M. Humphrey DMS, BMS, SCU Dec. 19,91 9: 00am M. Hill
M. Barnes DMS, Memberfile Dec. 19.91 2: 00pm J. Griffith
C. Scholz DMS, Claims/ Encounters Dec. 19. 91 10: 15am B. Bandini
D. Hays OMS, Memberfile Dec. 19,91 1: 00pm J. Griffith
C. Chavez OMS, Encounters Dec. 19,91 12: 00pm C. Jager
T. Lucas DMS, Claims/ Encounters Dec. 19,91 11: 00am M. HilI
G. Fisher OMC, HP Management Dec. 19,91 9: 00am B. Bandini
R. Bitar OMS, Encounters Dec. 19,91 11: 30am C. Jager
L. Peters DMS, Claims/ Encounters Dec. 19,91 1: 00pm B. Bandini
S. Abeyta OMS, BEC, SCU Dec. 19,91 10: 00am M. Hill
M. Beverly DMS, Claims/ Encounters Dec. 20, 91 10: 30am J. Griffith
M. Sheridan DMS, Memberfile Dec. 20, 91 9: 00am J. Griffith
L. Otlowski OMC. QE, MEQC Dec. 30, 91 10: 00am M. HiII
D. Downey OMC, QC Dec. 30,91 9: 00am Hill/ Jager
page 4
AHCCCS · 17
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SLIM INTERVIEW LIST
EXHIBIT 1
AHCCCS 5 OF 7 PAGES
Date: May 15, 1992
Name Title Date Time Interviewer
R. Love OMC, QC Dec. 30, 91 10: 00am J. Griffith
G. Randall OMC, EDP Audits Jan. 02,92 9: 30am C. Jager
J. Johnson OMC, EDP Audits Jan. 02,92 1: 30pm C. Jager
R. Robles OMS, Admin. Jan. 06,92 3: 00pm J. Griffith
C. Goldberg OMD, QAJUR Catastrophic Jan. 06,92 2: 00pm B. Bandini
S. Chockney OMC, Auditor Jan. 06,92 1: 30pm J. Griffith
B. Ward OMC, EDP Audits Jan. 06,92 10: 00am C. Jager
L. Skinner OMS, Admin. Jan. 06,92 1: 30pm C. Jager
G. Carlson OMD, QAJUR, Med. Policy Jan. 06,92 3: 30pm B. Bandini
L. Shuler OMD, Admin. Jan. 07,92 9: 00am B. Bandini
B. Givens OMD, FFS Jan. 07,92 9: 00am J. Griffith
K. Green OMD, Mental Health Jan. 07,92 1: 30pm C. Jager
J. Schoonover OMD, QAJUR Jan. 07,92 10: 00am M. HilI
L. Krater OMD, FFS UR Jan. 07,92 1: 30pm J. Griffith
D. Abdouch OMD, QAJUR Jan. 07,92 11: 00am M. Hill
J. Abujbara OMD, Maternal Jan. 07,92 9: 00am C. Jager
P. Hellyer OMD, QAJUR Jan. 07, 92 9: 00am M. Hill
C. Gilman OMD, FFS PA Jan. 07,92 3: 00pm J. Griffith
L. Powers OPIR, Mental Health Jan. 08,92 3: 00pm M. Hill
C. McFarlane OMD, Admin. Jan. 08,92 1: 00pm B. Bandini
L. Shuler OMD, Admin. Jan. 08,92 2: 00pm 8.8andini
J. Davich OGA, Hearings/ Grievance Jan. 08,92 1: 00pm J. Griffith
D. Wells OPIR, Admin. Support Jan. 08,92 2: 00pm M. Hill
D. Shapiro OPIR, Mental Health Jan. 08,92 1: 00pm M. Hill
H. Walthall OGA, General Counsel Jan. 08,92 2: 30pm J. Griffith
L. Kirschner Director Jan. 09,92 2: 30pm Team
J. Kelly OGA, Hearings Jan. 09,92 8: 30am C. Jager
R. Austin DBFR, AD Jan. 10,92 10: 00am Team
D. Angulo OGA, Hearings/ Grievance Jan. 10,92 11 : OOam C. Jager
M. Quinn OGA, Hearings Jan. 10,92 8: 30am C. Jager
T8A DES, APIS/ AZTEC Systems Jan. 10,92 8: 00am M. Hill
L. Dunton OPIR, Policy Dev. Jan. 10,92 9: 00am 8.8andini
Austin/ Bridgewater IRMD Jan. 10,92 10: 00am C. Jager
M. Franklin IRMD, App. Development Jan. 13,92 1: 00pm M. Hill
J. Obenaur IRMD Jan. 13,92 3: 30pm C. Jager
L. Legutko IRMD, Off. Auto. Support Ctr. Jan. 13,92 3: 30pm M. HilI
page 5
Nieces - 18
SLIM INTERVIEW LIST
EXHIBIT 1
AHCCCS 6 OF 7 PAGES
Date: May 15,1992
Name Title Date Time Interviewer
D. VanDyk OMC, AD Jan. 13,92 2: 00pm Team
M. Cben OMS, AD Jan. 14,92 1: 00pm Team
K. 8omaritto IRMD, Off. Auto. Support Ctr. Jan. 14,92 2: 00pm M. Hill
P. Nolan OMD, AD Jan. 14,92 9: 00am Team
A. Harding IRMD, Off. Auto. Support Ctr. Jan. 14,92 1: 00pm M. HilI
J. Obenaur IRMD Jan. 14,92 2: 00pm C. Jager
R. Dart DHS, Elig. Maricopa County Jan. 15, 92 1: 00pm Team
M. Hyland IRMD, Ops. ITele. Jan. 15,92 3: 30pm C. Jager
M. McWherter OGA, Hearings/ Grievance Jan. 15,92 9: 00am C. Jager
K. White Director's Office Jan. 15,92 3: 00pm J. Griffith
J. Wilbirt OMS, 8MElSierra Vista Jan. 16,92 1: OOpm J. Griffith
K. 8arnes IRMD, Systems & Programming Jan. 16,92 2: 00pm 8.8andini
N. Mukerji IRMD. Systems & Programming Jan. 16.92 1O: OOam 8.8andini
J. Joe IRMD. DatabaseITech. Support Jan. 16,92 3: 00pm 8.8andini
D. Mansker DMS, Sierra Vista Field Office Jan. 16.92 11: 30am J. Griffith
P. Allegrio OMS, 8FElSierra Vista Jan. 16,92 10: 30am J. Griffith
T. McClung IRMD. Systems & Programming Jan. 16,92 11 : OOam 8.8andini
J. Walker IRMD, Systems & Programming Jan. 17,92 11 : OOam M. Hill
J. Walker IRMD, Systems & Programming Jan. 17,92 11 : OOam M. Hill
R. Dunn Director's Office, Client Adv. Jan. 17, 92 1: 30pm J. Griffith
F. Lopez Director's Office. PIO Jan. 17, 92 9: 00am J. Griffith
A. Alonzo Director's Office, AAlEEO Jan. 17,92 10: 15am J. Griffith
A. Caldwell Director, DHS Jan. 20,92 2: 30pm Team
D. Rushton IRMD, Computer Operations Jan. 20,92 9: 00am C. Jager
8. LaSota IRMD, Help Desk Jan. 20,92 1: OOpm C. Jager
L. Stubblefield IRMD, Operations Jan. 20,92 10: 30am C. Jager
M. Decker IRMD, Operations Jan. 21,92 10: 30am C. Jager
J. Guest IRMD. Operations Support Jan. 21, 92 9: 00am C. Jager
G. Martinez IRMD, Release Management Jan. 21,92 9: 00am 8.8andini
M. Smith IRMD, Systems & Programming Jan. 22,92 11 : OOam 8.8andini
D. Kalasky IRMD, Systems & Programming Jan. 22,92 1: OOpm 8.8andini
M. Furze IRMD, Systems & Programming Jan. 22,92 9: 00am 8.8andini
G. Nicholson IRMD, Systems & Programming Jan. 22,92 10: 00am 8.8andini
J. Lundberg IRMD. Systems & Programming Jan. 22.92 2: 00pm 8.8andini
D. Wilson OGA. Administrative Jan. 24,92 9: 00am C. Jager
L. Shuler OMD, Administrative Jan. 24,92 10: 30am C. Jager
page 6
AHCCCs - 19
I
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SLIM INTERVIEW LIST
EXHIBIT 1 .
AHCCCS 7 OF7 PAGES
Date: May 15, 1992
Name Title Date Time Interviewer
D. Lowenberg Deputy Director Jan. 29,92 9: 00am Team
D. Ahuja IRMD, Asst. Director Jan. 29,92 10: 30am Team
G. Relkin OGA, Asst. Director Jan. 29, 92 3: 00pm Jager/ Griffit
L. Kirschner Director Feb. 04,92 3: 00pm Team
K. Dusenberry Steering Committee Feb. 24,92 4: 00pm Team
M. Hodge Maricopa County Mar. 02, 92 1: 30pm J. Griffith
M. Lopez Maricopa County Mar. 02, 92 1: 00pm J. Griffith
M. Temm OMS, Mesa Field Office Mar. 05, 92 2: 00pm
K. Bryn Mercy Care Mar. 04, 92 1: OOpm J. Griffith
M. Kelly Mercy Care Mar. 06, 92 1: 30pm Jager/ Griffit
M. Chen Assistant Director Mar. 10,92 10: 00am Jager/ Griffit
page 7
AHcces - 20
SUMMARY OF RECOMMENDATION TITLES & SAVINGS
AHCCCS
EXHIBIT 2
1 OF 3 PAGES
~ g
& J
N
-"
State Savings Other Savings Reductions
May 21,1992
Title Income Avoidance Reduction County Federal State FTE's Fed'i FTE's
Filled Vacant Filled Vacant
1. Consolidation of AHCCCS Eligibility Determlnallon $ 16,000,000 $ 0 $ 8,000,000 ($ 16,000,000) - 3 0 0 0
2. Long Term Care Eligibility $ 0 SO $ 205,029 $ 205,030 - 5 0 - 5 0
3. DES - AHCCCS Eligibility Determination Budget $ 0 SO SO $ 0 0 0 0 0
4. IRMD Consultant Usage $ 0 SO S2,655,000 $ 1,845,000 0 7 0 5
5. Establish Training Unit $ 0 SO ($ 76,000) ($ 76,000) 0 2 0 2
6. Third Party Liability ( TPL) Outsourcing $ 0 $ 0 S286,819 S212,866 - 9 0 - 6 0
7. Warehouse Operations Outsourcing $ 0 SO $ 25,680 $ 28,960 - 3 0 - 4 0
8. Overall Agency Realignment SO $ 0 $ 140,030 $ 57,196 - 3.5 0 - 1.5 0
9. Director's Office Reorganization $ 0 $ 0 SO $ 0 0 0 0 0
10. Ollice of the Director - General Counsel $ 0 SO $ 31,008 $ 26,778 0 - 0.5 0 - 0.5
11. Office of the Medical Director $ 0 $ 0 $ 38,500 $ 38,500 - 1.5 0 - 1.5 0
12. Proposed Division of Health Care $ 0 $ 0 $ 66,240 $ 71,760 - 2 0 - 2 0
13. Realignment of Bureau of Member Services $ 0 $ 78,400 $ 50,737 $ 89,739 - 4 - 2 - 2 - 2
14. Proposed Bur. of Health Care Contracts Mgl.( HCCM) $ 0 $ 42,240 $ 0 $ 5,760 0 - 1 0 0
15. Proposed Organization of Dlv. of Mgt. Review $ 0 $ 0 $ 63,500 $ 0 - 2 0 0 0
16. Realignment of Dlv. of Bus., Fin. & Research $ 0 $ 41,328 $ 121,912 $ 121,912 - 5 0 - 5 0
17. Establish Telecommunications Position $ 0 $ 0 $ 50,760 $ 57,240 0 0.5 0 0.5
18. Claims Processing $ 0 $ 122,841 $ 0 $ 122,840 - 6 0 - 6 0
19. Personnel Functions $ 0 SO $ 0 $ 0 0 0 0 0
20. Cap for HCBS Elderly/ Physically Disabled $ 0 SO SO $ 7,381,756 $ 13,708,974 0 0 0 0
21. ALTCS - Eligibility Quality Assurance $ 0 $ 0 $ 110,574 $ 165,861 - 3.5 0 - 5.5 0
22. Lump Sum Appropriation $ 0 $ 0 SO $ 0 0 0 0 0
Totals $ 16,000,000 S284,809 Sll, 769,789 $ 7,381,756 $ 682,416 - 47.5 6 - 38.5 5
Total State Savings .. $ 28,054,598
Total County Savings .. $ 7,381,756
Total Federal Savings .. $ 682,416
Grand Total .. $ 36,118,770
- - - - -- ---- .. -- ------
- - - - - - - - - - .. - - - - - - - -
SUMMARY OF RECOMMENDATION TITLES & SAVINGS
AHi::: CCS
EXHIBIT 2
2 OF 3 PAGES
~ g
fA
~
-- Systems Statute Law Rule Vacant Monlhs
Ma) 15,1992 Changes Changes Changes Changes FTE To
Title Required Required Required Required Positions Complete --
1. Consolidation of AHCCCS Eligibility Determination See Nole 1 Yes Yes Yes 12
2. long Term Care Eligibility Yes Yes 6
- s. lIES - AHCCCS Eligibility Determination Budget Yes 1
_ 4.. F= tMD Consultant Usage Yes 18
5. Establish Training Unit 6 -- 6. Third Party Liability Outsourcing See Note 2 Yes 6
7. Warehouse Operations Outsourcing 6
8. Overall Agency Realignment 18
f---..
- 9. Director's Ollice Reorganization 3 10. Office of the Director - General Counsel 1 1
11. Office of the Medical Director 6
_ 12. P.. roposed Division of Health Care 12
13. Realignment of Bureau of Member Services See Note 3 4 12
14. Proposed Bureau of Health Care Contracts Mgt. 1 12
15. Proposed Division of Management Review 12
16. Business, Finance & Research Realignment 12
17. Telecommunications Position 6
- 18-. Claims Processing by OCR Yes 6
- 19-. Personnel Functions 3
20. Increase Cap for HCBS Elderly/ Physically Disabled 3
21. " LTCS - Quality Assurance of Financial Eligibility 6
_ 22.. Lump Sum Appropriation Yes 1
-- Vacant FTE -- -- Positions c 6
SUMMARY OF RECOMMENDATION TITLES &. SAVINGS
EXHIBIT 2
3 OF 3 PAGES
Notes:
1. Full implementation of this recommendation
will also require computer system changes.
2. Additional savings are possible if the
present law mandating compromise is changed
or waived for the contrador.
3. A portion of the savings associated with this
recommendat ion require minor computer system
cNinges.
a I
t1
-------------------
- - - - - - - - - - - - - - - - - - -
AHCCCS IMPLEMENTATION SCHEDULE EXHIBIT 3
( PRELIMINARY)
I MONTHS
POI~ T DESCftl~ TION I I I 2 I 3 4 I 5 I 6 I 7 I a I 9 I" I" / 12 113 I 14 I 15 I 16 I 17 I la I 19 I 2. I I
I I I I I I I I I I 1. CONSOLo OF AHCCCS ELIGIGIBILITY DETEftNINATION I
I I I I I 2. LONG TEftN CAllE EUIIBILITY I
3. DES - AHCCCS ELIGIIILITY DETERMINATION IUOGET .... 1 I 1 I 4. IftMD CONSULTANT US~
I I
II I I I
I I
5. ESTABLISH TftAININe UNIT -
I I
I I
6. THlftD ~ AIITY LIABILUY - OUTSOUftClNe I
I I I I I
7. WAIlEHOUSE OUTSOUftCr: I
I I I I I •• O¥ IIIALL AGENCY ftEA~ ICltIlENT I
6
I I
t. DIRlCTOft'S OFFICE. EOftGANIZATION I
1.. C1PPICE OF TIlE DIftEI: TOft - GENEftAL COUNSEL .... 1 I 11. C1PPICE OF THE NEDIir. AL DIIlECTOft I
I I I I
I 11. DIVISION OF HEALTH CAllE I
I I I I I I I I I I
~ 11. MlMlEft SEftVICES ftE'LICltIlENT I
I I I I I I I I I I
14. IUIlEAU OF IlEALTH CI'ftE CONTftACTS IlGT. I
I I I I I I I I I I
15. OftGANIZATION OF DI~ ISION OF IlGNT. IlEVIEW I
I I I I I I I I I I
16. BUSINESS, FINANCE ~ ftESEAIlCH ftEALIGNNENT I
I I I
17. TELECOMMUNICATIONS POSITION I
I I I I I
la. CLAIIIS ~ ftOCESSIIIG lilY OCft I
19. ~ EftSONNEL FUNCTION~ I I I I I I I I
21. INCftEASE C~ FOft IIt: BS ELDEftLYI~ HYS. DISABLED
I I
I
I I I
21. ALTCS - QfA OF FINANCIAL ELIGIBILITY I
22. LUII~ SUII A~~ lIOl'ftIA'" ION ....
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ( AHCCCS)
PROPOSED ORGANIZATIONAL STRUCTURE
EXHIBIT 4
~
~
OFFICE OF
THE
DIRECTOR
DEPUTY DIRECTOR
I I I I I I I I
CLIENT PUBLIC AFFIRMATIVE INDIAN TUCSON MEDICAL OENERAL INTERGOVERNMENTAL
ACTION HEALTH SERVICES
ADVOCACY INFORMATION EEO COORDINATOR OFFICE DIRECTOR COUNSEL RELATIONS
I I I I
DIVISION OF INFORMATION DIVISION DIVISION OF
MANAOEMENT RESOURCE OF BUSINESS, FINANCE
REVIEW MANAGEMENT HEALTH CARE & RESEARCH
DIVISION
- - - - - - - - - - .. - - - - - - - W4J01- 6 -
- - _ r - - - - - - - - - - - - - - - - AHCCCS
OFFICE OF THE DIRECTOR
PROPOSED FUNCTIONAL ORGANIZATIONAL STRUCTURE
DIRECTOR
I I I I
INTER-MEDICAL
GOVERNMENTAL DEPUTY GENERAL TUCSON
RELATIONS &
DIRECTOR POLICY DIRECTOR COUNSEL OFFICE
DEVELOPMENT
EXHIBIT 5
- ADMINISTRATIVE RULES
- DEVELOPS !" OLICIES AND - LEGISLATIVE LIAISON
PROCEDURES RELATED TO
MEDICAL SERVICES AND - IGA'S
FEE- FOR- SERVICE
- RESOURCE TO ACUTE AND LTC
NEGOTIATIONS PERSONNEL - PLANNING AND POLICY
IMPLEMENTATION
- ADVISES DIRECTOR ON
MEDICAL ISSUES -!" OLICY DEVELOPMENT
~
~
- INTERFACE WITH MEDICAL
CCMalNITY
- QUALITY REVIEW OF
HEALTH CARE
- FEDERAL LIAISON
- PROVIDES DAY- To- DAY
OPERATIONAL DIRECTION
TO ( 4) AHCCCS DIVISIONS
- SUPERVISES PUBLIC
INFORMATION OFFICER
- SUPERVISES CLIENT
ADVOCACY/ LEGISLATIVE
LIAISON
- ADVISES AGENCY DIRECTOR
- SUPERVISES EEO/
AFFIRMATIVE ACTION
- SUPERVISES INDIAN HEALTH
SERVICES COORDINATOR
- PARTICIPATES IN ALL MEETINGS
RELATING TO POLICY/ RULES/
LEGAL OPINIONS FORMULATION.
PROVIDE INDEPENDENT COUNSEL
TO THE DIRECTOR ON THESE
MATTERS.
- REPRESENTS AHCCCS
AT HEARINGS
- LEGAL COUNSEL TO
DIRECTOR
- PREPARES LEGAL
OPINIONS
- REPRESENTS AHCCCS IN
LEGAL PROCEEDINGS
- SOUTHERN ARIZONA
REPRESENTATIVE
TO DIRECTOR'S
OFFICE
- CCMalNITY LIAISON
- CCMalNITY EDUCATION
- HANDLES CONSTITUENT
PROBLEMS
V4121
AHCCCS
OFFICE OF THE DIRECTOR
DEPUTY DIRECTOR
PROPOSED FUNCTIONAL ORGANIZATIONAL STRUCTURE
EXHJBIT 6
OFFICE OF
THE DEPUTY
DIRECTOR
DIRECTOR
DEPUTY
DIRECTOR
u
I
PUBLIC
INFORMATION
I
INDIAN
HEALTH
SERVICES
COORDINATOR
I
EEO/ M
I
CLIENT
ADVOCACY
CONST ITUENT
SERVICES
PRESSIMEDIA CONTACTS
ARRANGE FOR PRESS CONFERENCES
PREPARE MEDIA COVERAGE
NEWSLETTERS
SPECIAL PUBLICATIONS
~
BROCHURES I
- LIAISON TO 21 ARIZONA TRIBES
- OVERSEES AHCCCS IGA'S WITH
TRIBES
- PROVIDES AHCCCS LINKAGE TO
TRIBAL GOVERNMENT
I
- EEO INVESTIGATIONS
- AFFIRMATIVE ACTION PLANNING
- TRAINING EEO/ M
I
- ADDRESSES CLIENT, PROVIDER
AND LEGISLATIVE
COIPLAINTS
- PROVIDE FOLLOW- UP TO
CONSTITUENT CONCERNS
1
DIVISION
OF
MANAGEMENT
REVIEW
DIVISION
OF
BUSINESS,
FINANCE &
RESEARCH
DIVISION
OF
HEALTH CARE
DIVISION
OF
INFORMATION
RESOURCE
MANAGEMENT
- GRIEVANCES & APPEALS
- QUALITY CONTROL
- FRAUD & ABUSE
- CONTRACTS
- ACCOUNTING & FINANCE
- BUDGETING
- FACILITIES MGMT.
- RESEARCH
- CLAIMS & ENCOUNTERS
PROCESSING
- PERSONNEL
- HEALTH CARE CONTRACTS
- CASE MANAGEMENT ( LTC)
- MEMBER SERVICES
- HEALTH CARE GROUP
- LTC ELIGIBILITY
- QA/ UR ACTIVITIES
- PROVIDER REGISTRATION
PROVIDER ASSISTANCE
- DATA PROCESSING
- PIilMIS
- MGMT. INFORMATION
- SOFTWARE ACQUISITION
- P C DISTRIBUTION & USE
- - - - - - - - - - - - - - - - - - v.. e22 -
- - - - - - ------ ­AHCCCS
OFFICE OF THE DIRECTOR
PROPOSED ORGANIZATIONAL STRUCTURE
- - - - -- EXHIBIT 7
DIIIECTOII
AHCCCS
1 ' OSITION
GRADE ' 6
EXECUTIVE
SECIIETARY
1 ' OSITION
GRADE 16
NEDICAL DIIIECTOII AONINISTIlATOIl ADNINISTIlATOII GENEIlAL
OFFICE OF THE OFFICE OF ' OLICY & TUCSON OFFICE COUNSEL
MEDICAL DIIIECTOII INTElIlJOVEIINMENTAL
1 ' OSITION IIELATIONS 1 ' OSITION 1 ~ SITION
eIIADE "
1 ' OSITION GIIADE 22 ClIIADE ZZ
lJIIADE Z4
~
~
DE'UTY DIIIECTOIl
AHCCCS
1 POSITION
GIIADE za
CLEIIK TY'IST
III
1 ' OSITION
GIIADE 11
DIIIECTOIl DIIIECTOIl AFFIIIMATIVE I I INDIAN HEALTH
' UIILIC CLIENT ADVOCACY & ACTION OFFICEII SEIIVICES
INFOIIMATION OFFICE LEGISLATIVE LIAISON COOIIDINATOIl
1 POSITION 1 POSITION 1 POSITION 1 POSITION
GI! ADE Z3 GIIADE ze GIIADE 19 lJIIADE ZZ
OJOEIlATIONS
DIVISIONS
V4047- 2
a
t8
AHCCCS
OFFICE OF THE
MEDICAL DIRECTOR
PROPOSED ORGANIZATIONAL STRUCTURE
DI" ECTOIt
AHCCCS
1 !' OSITION
GIIADE !' 6
AllIlINISTMTIVE NEDICAL AllIlINISTMTIVE
SERV OFFICE" DI" ECTO" SEC" ETQY
IV
1 !' OSITION 1 !' OSITION 1 !' OSITION
GIIADE 19 ClIW> E ItS lJIlAOE 14
I
I I I
MEDICAL !' OUCY HEALTH !' LAN MATE!' NAL & CHILO
UNIT U"' QA AND FFS QA HEALTH UAISON
r- AllIlINISTMTOIt - DI" ECTOIt - & TMININe
1 !' OSITION 1 !' OSITIOIl 1 !' OSITIOIl
lJIlAOE ZZ SUGMSTED lJIlAOE 21 8lWlE 21
MENTAL Ilf: ALTH MEDICAL SE" VICES MEDICAL SE" VICES
!' OLICY !''' OOIWI " EVIEW !' 1IOelIAN IlEVIEW
I- CDOItDIMATOIt I- S!' ECIALIST - S!' ECIALIST
1 !' OSITION 1 !' OSITIOIl 1 !' OSITIOIl
lIMOE 21 8lWlE 19 lJIlAOE 19
CATAST" OI'HIC MEDICAL SE" VICES MEDICAL SE" VICES
CASE !''' 0lJIlAN UVIEW !' 1IOelIAN " EVIEW
I- CDOItDI NATOIt I- S!' ECIALIST - S!' ECIALIST
1 !' OSITIOIl 1 !' OSITIOIl 1 !' OSITIOIl
GIIADE 21 8lWlE 19 8lWlE 19
USEAlICH MEDICAL U" VICES HEALTH EDUCATIOIl
ANALYST II !''' OOIWI " EVIEW !''' OOIWI &!''' OJECTS
I- - S!' ECIALIST - S!' ECIAUST II
1 !' OSITION 1 !' OSIT lOll 1 !' OSITIOIl
lIllAOE 17 lJIlAOE 19 lJIlAOE 19
CLERK "!' IST INFOItNATIOIl CLE" K "!' IST
III !' IIOCESSING III - - S!' ECIAUST III - 1 !' OS I TIOIl 1 " OSITIOIl 1 !' OSITIOIl
lIllAOE 11 lJIlAOE 13 lJIlAOE 11
EXHIBIT 8
- MEDICAL !' OLICY
DEVELOI'NENT AND I'EVIEW
- LIAISON TO DIVISIOIl
01' HEALTH CA" E
- !' ROVIOE" 1' E8ISTMTIOIl
- QUALITY AND COST
EFFECTIVENESS OF
HEALTH !' LAMS
- QUALITY AND COST
EFFECTIVENESS OF
FFS "" OVlDE" S
- E!' SDT !''' OOIWI
- !' I'E- MATAL !''' OOIWI
- HEALTH EDUCATION
V41J40- 2 - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - -
~ a
~
AHCCCS
OFFICE OF THE DIRECTOR
OFFICE OF POLICY AND
INTERGOVERNMENTAL RELATIONS
PROPOSED ORGANIZATIONAL STRUCTURE
DIRECTOR
AHCCCS
1 POSH ION
GRADE P6
ADMINISTRATOR
OFFICE OF
POLICY AND
INTERGOVERNMENTAL
RELATIONS
1 POSITION
GRADE 24
ADMINISTRATIVE
,.- SECRETARY II I
1 POSITION
GRADE 14
CLERK TYPIST
~ IV
1 POSITION
GRADE 11
I I I I
EXECUTIVE ADMINISTRATIVE EXECUTIVE ADMINISTRATIVE
CONSULTANT SERVICES OFFICER CONSULTANT SERVICES - II ,.- II r-- II OFFICER IV
1 POSITION 1 POSITION 1 POSITION 1 POSITION
GRADE 22 GRADE 21 GRADE 22 GRADE 23
PROGRAM & EXECUTIVE PROGRAM &
PROJECT SPEC. STAFF PROJECTS
I-- II - ASSISTANT ~ SPEC. I
1 POSITION 1 POSITION 1 POSITION
GRADE 19 GRADE 20 GRADE 18
PROGRAM & ADMINISTRATIVE
PROJECT SPEC. ASSISTANT - II - III
1 POSITION 1 POSITION
GRADE 19 GRADE 17
PROGRAM &
PROJECT SPEC. - II
1 POSITION
GRADE 19
- POLICY DEVELOPMENT
- GOVERNMENT RELATIONS
ATION
EXHIBIT 9
§
-( 0)
EXHIBIT 10
AHCCCS ORGANIZATION CHART
OFFICE OF THE DIRECTOR
GENERAL COUNSEL
PROPOSED ORGANIZATIONAL STRUCTURE
DIRECTOR
AHCCCS
1 POSITION
GRADE P6
AHCCCS
GENERAL
COUNSEL
1 POSITION
GRADE 22 *
I I I I
INFORMATION LEGAL LEGAL AHCCCS
PROCESSING SECRETARY I ASSISTANT II GENERAL
SPEC IALIST II COUNSEL
1 POSITION 1 POSITION 1 POSITION 1 POSITION
GRADE 11 GRADE 15 GRADE 17 GRADE 22
- PROVIDES LEGAL COUNSEL
TO AHCCCS
- REPRESENTS AHCCCS AT HEARINGS
- PROVIDES LEGAL OPINIONS
- REPRESENTS AHCCCS AT LEGAL
PROCEEDINGS
- REVIEWS LAWS, REGULATIONS,
AND RULES * LEAD GENERAL COUNSEL - DIRECTS ACTIVITIES OF UNIT.
- - - - - - - - - - - - - - - - - - -
-.... - - - - - - - - - - - - - - - - - -
~
B
~
AHCCCS
OFFICE OF THE DIRECTOR
TUCSON OFFICE
PROPOSED ORGANIZATIONAL STRUCTURE
DIRECTOR'S OFFICE
DIRECTOR AHCCCS
GRADE P6
I POSITION
DIRECTOR
TUCSON OFFICE
ADMIN. SERVICES
OFFICER III
GRADE U
I POSITION
I I
ADMINISTRATIVE CLAIM SPECIALIST CLERK TYPIST
ASSISTANT III II III
GRADE 17 GRADE IS GRADE II
1 POSITION I POSITION 1 POSITION
- REPRESENTS DIRECTOR'S OFFICE
IN SOUTHEASTERN ARIZONA
- ADDRESSES CONSTITUENT PROBLEMS
( RECIPIENTS & PROVIDERS)
- PROVIDES COMMUNITY EDUCATIDN
AND TRAINING
EXHIBIT 11
V~ 0~ 8- 2
~
fj
AHCCCS
OFFICE OF THE DIRECTOR
PUBLIC INFORMATION OFFICE
PROPOSED ORGANIZATIONAL STRUCTURE
DIRECTOR
AHCCCS
1 I'OSITION
GRADE 1' 6
DEI'UTY DIRECTOR
AHCCCS
1 I'OSITION
GRADE za
DIRECTOR ADIlINISTRATIVE
I'UBLIC SECRETARY III
INFORMATION
OFFICE 1 I'OSITION
1 I'OSITION lJlIADE 13 • GRADE Z3
I I
I'UBLIC I'UBLIC I'UBLIC
INFORMATION INFORMATION INFORMATION
OFFICER II OFFICER II OFFICER III
1 I'OSITION 1 I'OSITION 1 I'OSITION
GRADE 17 GRADE 17 GRADE 19
- MEDIA COVERAGE
- COMMUNITY OUTREACH TO
TARGETED GROUI'S
- I'UBLICATIONS
- BROCHURES
- COMMUNITY EDUCATION
- I'UBLIC I'RESENTATIONS
• 1' 10 DIRECTOR DOES
I'ERFOIlMANCE EVALUATIONS
BUT I'OSITION I'ROVIDES
SECRETARIAL SUI'I'ORT TO
VARIOUS STAFF IN THE
OFFICE OF THE DIRECTOR.
E. G. INDIAN HEALTH SERVICES
COORDINATOR AND
EEO/ M OFFICER
EXHIBIT 12
V4e4S- 2 - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - -
~
~
AHCCCS
OFFICE OF THE DIRECTOR
INDIAN HEALTH SERVICES COORDINATOR
PROPOSED ORGANIZATIONAL STRUCTURE
DIRECTOR
AHCCCS
1 POSITION
GIIADE P6
DEPUTY DIRECTOR
AHCCCS
1 POSITION
GRADE 211
INDIAN HEALTH
SERVICES
COORDINATOR
1 POSITION
GRADE 22 •
- AHCCCS LIAISON TO THE STATE'S
21 TRIBES ( TRIBAL GOVERNMENTS)
- AHCCCS LIAISON TO TRIBES WITH
IGA'S FOR LTC ELIGIBILITY AND
ACUTE CARE MANAGEMENT
- PREPARES FEDERAL REPORTS AND
OTHER REQUIRED REPORTS
- DISSEMINATES INFORMATION REGARDING
AHCCCS SERVICES
- ADVISES THE DIRECTOR
• CLERICAL SUPPORT PROVIDED BY
ADMINISTRATIVE SECRETARY 11
POSITION ASSIGNED TO PIO
EXHIBIT 13
V~ 0~ 2- 2
~
~
AHCCCS
OFFICE OF THE DIRECTOR
AFFIRMATIVE ACTION/ EEO OFFICER
PROPOSED ORGANIZATIONAL STRUCTURE
DIRECTOR
AHCCCS
1 POSITION
ClIIADE P6
DEPUTY DIRECTOR
AHCCCS
1 POSITION
GIIADE 211
AFFIRMATIVE
ACTION
OFFICER
1 POSITION
ClIIADE 19 •
- DEVELOPS AGENCY AFFIRMATIVE
ACTION PLAN
- MONITORS EEO/ AA COMPLIANCE
- RESOLVES EEO ISSUES
- RECRUITMENT
• CLERICAL SUPPORT PROVIDED
IY ADMINISTRATIVE SECRETARY
III POSITION ASSIGNED TO
PIO
EXHIBIT 14
V~ 0~ 3- 2 - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - -
~
~
AHCCCS
OFF ICE OF THE DIRECTOR
LEGISLATIVE LIAISON/ CLIENT ADVOCACY
PROPOSED ORGANIZATIONAL STRUCTURE
DIRECTOR
AHCCCS
1 I'OSITION
GRADE 1' 6
DEI'UTY DIRECTOR
AHCCCS
1 I'OSITION
GRADE 28
LEGISLATIVE
LIAISON & SUI'V. OF
CLIENT ADVOCACY
I I'OSITIN
GRADE 2.
I I
CLERK TYI'IST III ES CLIENT ES CLIENT
REI'RESENTATIVE 1 REI'RESENTATIVE 1
1 I'OSITION
1 I'OSITION 1 POSITION
GIlADE 11 GRADE 17 GRADE 17
- LEGISLATIVE LIAISON
- ADVOCACY FOR RECII'IENTS
AND I'ROVIDERS
- RESPOND TO LEGISLATIVE AND
EXECUTIVE BRANCH INQUIRIES
- NEDICAL DISI'UTE ISSUES
EXHIBIT 15
V~ 0~~- 2
AHCCCS
DIVISION OF MANAGEMENT REVIEW
PROPOSED FUNCTIONAL STRUCTURE
EXHIBIT 16
DIVISION
OF
IIANAGEMUT
REVIEW
I I
HEARINGS, FRAUD QUALITY
GRIEVANCES & AND CONTROL
APPEALS ABUSE REVIEW
~
~
- ADMINISTRATIVE HEARINGS
- GRIEVANCE HEARINGS
- EDP AUDITS
- FRAUD AND ABUSE
INVESTIGATIONS
- ELIGIBILITY CONTROL AUDITS
- OTHER QUALITY CONTROL
FUNCTIONS
V4020 -------------------
- - - - - - - - - - - - - - - - - - - AHCCCS
DIVISION OF MANAGEMENT REVIEW
PROPOSED ORGANIZATIONAL STRUCTURE
EXHIBIT 17
~,
~
ASSIST. DIRECTOR ADMINISTRATIVE
ADMINISTRATIVE DIV. OF MANAGEMENT SERVICES OFFICER
SECRETMY II REVIEW I
1 !' OSITION 1 !' OSITION 1 !' OSITION
GRADE 14 GltADE. TO 1£ GltADE 19
DETEIUIINED
I I
BUIWW CHIE' BUREAU CHIEF BUREAU CHIEF
HEMINGS, GlIIEVAllCE LEGAL SECRETARY I BUREAU OF FRAUD BUREAU OF CLERK TY!' IST III
r- AND A!'!' EALS BUIWW - 1 !' OSITION - AND ABUSE r- QUALI n CONTROL l- I !' OSITION
1 !' OSITION GRADE 15 1 !' OSITION 1 !' OSITION GltADE 11
GRADE. TO 1£ GltADE al GRADE aa
DETEIUIINED
HEMING AND EDI' !' ROGItAIl !' UBLIC ASSISTANCE
A!'!' EALS OFFICER AUDITOR II QUALITY EVAL.
I-- IV - - SU!' ERVISOR II
1 !' OSITION 1 !' OSITION 1 !' OSITION
GRADE a4 GRADE al GRADE 19
GlIIEVANCE AND EDI' !' ROGIWl !' UBLIC ASSISTANCE
A!'!' EALS HEMING ANALYST III QUALITY EYAL.
I-- OFFICER III - I-- SU!' ERYISOR II
1 !' OSITION 1 !' OSITION 1 !' OSITION
GRADE aa GRADE al GltADE 19
HEMING OFFICER ED!' !' ROGIWl !' UBLIC ASSISTANCE
III ANALYST II QUALITY EYAL.
I-- .- I-- SU!' ERYISOR II
S !' OSITIONS 1 !' OSITION 1 !' OSITION
GltADE U GRADE III GltADE 19
HEMING OFFICER INYESTIGATIYE !' UBLIC ASSISTANCE
II SU!' ERYISOR II I QUALITY EYAL.
i-- i-- I-- S!' ECIALIST II
, !' OSITIONS 1 !' OSITION IS !' OSITIONS
GRADE al GRADE al GRADE III
ADMINISTRATIYE MEDICAL SERVICES CLERK
ASSISTANT I !' ROGIWl REYIEW n!' IST III
I-- I-- S!' ECIALlST I--
1 !' OSITIOlI 1 POSITION 3 !' OSITIONS
GRADE 13 GRADE 19 GRADE 11
CLERK n!' IST MEDICAL SERVICES INFOIUIATION
III !' ROGIWl REYIEW !' ROCESSING
'-- "- S!' ECIALlST ..... SPECIALIST III
7 !' OSITIOlIS 1 !' OSITION 1 !' OSITION
GRADE 11 GRADE al GRADE 11
V~ 1il53- 2
~
~
AHCCCS
DIVISION OF MANAGEMENT REVIEW
BUREAU OF GRIEVANCE AND APPEALS
PROPOSED ORGANIZATIONAL STRUCTURE
BUIlEAU CHIEF
GIlIEVANCE & LEGAL SECIlETAIlY I
A.... EALS 1 " OSITION
1 .. OSITION GlW> E 15
GIlADE. TO IE
DETEIUlINED
I
r I
HEAIlINGS & GIl IEVANCE
AI'.. EAL5 & A.... EALS
...- HEAIlING r- HEAIlING
OFFICEIl IV OFFICEIl III
GIlADE Z4 GIlADE ZZ
HEAIlING HEAIlING
OFF ICEII OFF ICEIl - III'S f0- Il'S
S .. OSITIONS 6 .. OSITIONS
GIlADE ZZ GIlADE ze
HEAIIIING AONINISTIlATIVE
OFF ICEIl ASSISTANT
~ II'S fo- I
3 .. OSITIONS 1 .. OSITION
GIlADE ze GIlADE 13
CLEIlK CLEIlK
..... n" IIISIT "- n" IIISIT
4 .. OSITION 3 .. OSITIONS
GIlADE 11 GIlADE 11
EXHIBIT 18
- OFFICIAL HEAIlINGS
AND A.... EALS
- GIlIEVANCES
( INFOIlNAL IlEVIEWS)
V4036- 2 - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - AHCCCS EXHIBIT 18 i
DIVISION OF MANAGEMENT REVIEW
BUREAU OF FRAUD AND ABUSE
PROPOSED ORGANIZATIONAL STRUCTURE
BUREAU CHIEf
BUREAU OF CLERK TVI'IST nl
FRAUD AND 1 I'OSITION
ABUSE GRADE 11
I I'OSnlON
GRADE II
I
I I I I I I
EOI' I'ItOOIU< Il EOI' I'IlOGIWl EOI' I'ROGlWiI UlVESTlGATlON NEDICAL MEDICAL
AUDITOR ANALYST ANALYST SUI'ERVISOR SERVICES I'ROe SERVICES I'ROO
n nl n ,..- UI REVIEW REVIEW
SI'ECIALlST SI'ECIALlST
ItltADE Ie 8lWlE Ie GRADE 111 GRADE Ie GRADE 19 GRADE 19
\ I \ I
INVESTIGATOR
nl
I-GRADE
17
INVESTIGATOR
In
I-GRADE
17
I INVESTIGATOR
In -
GRADE 17
\ / I \ /
~
~
- FRAUD AND ABUSE
INVESTIGATIONS
V4037- 2
~
......
AHCCCS
DIVISION OF MANAGEMENT REVIEW
BUREAU OF QUALITY . CONTROL
PROPOSED ORGANIZATIONAL STRUCTURE
BUREAU CHIEF
BUREAU OF CLERK TYI'IST III
QUALITY GIlADE 11
CONTROL 1 I'OSITION
GRADE U
1 I'OSITION
f
I I I
I'UBLIC ASST. I'UBLIC ASST. I'UBLIC ASST.
QUALITY EYAL. QUALITY EYAL. QUALITY EYAL. - SUI'ERYISOIl ,-- SUI'ERYISOIl - SUI'ERYISOIl
II II II
0IlADE 19 GRADE 19 0IlADE 19
I'UBLIC ASST. I'UBLIC ASST. I'UBLIC ASST.
QUAL ITY EYAL. QUALITY EYAL • QUALITY EYAL. - SI'EC. II - SI'EC. II f- SI'EC. II
0IlADE 18 GRADE 18 GRADE 18
6 I'OSITIONS 7 I'OSITIONS Z I'OSITIONS
CLERK INFOIlNATION CLERK
TY" IST I'ROCESSING TYI'IST - III - S" ECIALIST II - III
GRADE 11 GRADE I I GRADE 11
1 " OSITION I " OSITION 1 " OSITION
EXHBIT 20
\ /
- QUALITY CONTROL EYALUATIONS ON COUNTY
ELIGIBILITY DIYISIONS
- NEOC REVIEWS
( FEDERAL REYIEWS)
- OYERSEES DES QUALITY
CONTROL REYIEWS AND
ACTS AS LIAISON
,_~~- 2 - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - -
AHCCCS
INFORMATION AND RESOURCES MANAGEMENT DIVISION
PRESENT ORGANIZATIONAL STRUCTURE
INFORMATION
AIID
RESOURCES
MAIIAGEMEIIT
DIVISIOII
EXHIBIT 21
- INSTALL AND MAINTAIN - EVALUATE IIEW
MICRO- COMPUTERS TECHNOLOGY
~
t
APPLICATION
DEVELOPMEIIT
&
SUPPORT
- , SYSTEMS DESIGII
- I'" ROG~ 11lG
-, ':: OORDINATE TESTIIIG
- I.' SER ACCESS TRAIIIIIIG
- ' rRAINIIIG MATERIALS
- i,. IBRARY COIITROL
COMPUTER
OPERATIONS
&
TELE­Ca..
INICATIOIIS
- MANAGE OPERATIONS
CEIITER
- COORDIIIATE SCHEDULIIIG
- DESIGN & MAINTAIN
TELECa.. INICATIONS
IIETWORK
INFORMATION
TECHNOLOGY
CEIITER
- MANAGE EIID USER AND
AUTOMATION
CEIITER
- PROVIDE TRAINIIIG ON
WORK PROCESSIIIG
AND EIID USER
APPLICATION
SPECIAL
PRo. JECTS
&
DOA
COORDINATOR
- STUDY AIID DEVELOP
PROJECT
I"' LEMENTATION
BY OPERATIONAL
AREAS
- LIAISOII TO DOA DATA
CEIITER
ADMIIIISTRATI 011
&
CONTROL
- PLANIIIIIG ( 3 YEAR
AUTOMATION PLAN)
- COORDIIIATE PROJECT
MANAGEMEIIT
- OVERSEE DIVISION
PERSONNEL
ACTIVITIES
- BUDGET AND BUDGET
TRACKIIIG
* NO DeTAXL PROVXDED SXNCE NO CHANGE TO EXXSTXNG
ORGANXZATXONAL STRUCTURE.
* * RECOMMENDATXON XS TO ADD
EXXSTXNG XRMD STAFFXNG
USAGE.
12 ADDXTXONAL POSXTXONS TO
LEVEL TO REDUCE CONSULTANT
118 TOTAL POSXTXONS
V4.23
AHCCCS
DIVISION OF HEALTH CARE
PROPOSED FUNCTIONAL ORGANIZATIONAL STRUCTURE
EXHIBIT 22
DIVISION
OF
HEALTH CARE
I I
BUREAU OF
HEALTH CARE MEIIBER ELIGIBILITY
CONTRACTS
MANAGEMENT SERVICES LTC
~
~
t;
- NEGOTIATE ACUTE AND
LTC CONTRACTS
- PROVIDE TA TO PROGRAM
CONTRACTORS - MANAGED
CARE PROVIDERS
- LIAISON WITH PROGRAM
CONTRACTORS AND MANAGED
CARE PROVIDERS
- MONITOR PROGRAM CONTRACTORS
AND MANAGED CARE PROVIDERS
- PROGRAM REVIEWS
- HEALTH CARE GROUP
- ENROLLMENT
- COMMUNICATIONS
- MEIIBER FILE INTEGRITY
- INFORMATION AND ASSISTANCE
- HMO ASSIGNMENTS
- FEE FOR SERVICE AND
PROVIDER INFORMATION
- PRIOR AUTHORIZATION
- UTILIZATION REVIEW
- FEE FOR SERVICE PROVIDER
SYSTEM
- FINANCIAL ELIGIBILITY
FOR LTC
- MEDICAL ELIGIBILITY
FOR LTC
- INFORMATION AND
REFERRAL
- CASE MANAGEMENT
- NURSING HOME REVIEWS
- 0118 & ODWI ELIGIBILITY
- MEDICAL CONSULTATION
, .. V4019 - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - -
~
t
AHCCCS
DIVISION OF HEALTH CARE
PROPOSED ORGANIZATIONAL STRUCTURE
DIVISION
OF
HEALTH CAllE
I I
BUREAU OF BUREAU OF BUREAU OF
HEALTH CAllE NENBER ELIGIBILITY
r- CONTIlACTS r- SERVICES .- FOIl LTC
NANAGEIlENT
CONTIlACTOIlS COMlIUNICATIONS INTERNAL
I'ROVIDER AND I'ROVIDER OI'EIlATIONS
I- REVIEW I- ASSISTANCE I-FISCAL
REVIEWS
LIAISON WITH MEMBEIl FILE FIELD
CONTIlACT INTEGRITY OI'EIlATIONS
I- I'ROVIDERS I- L-TECHNICAL
ASSISTANCE
OIlGANIZAT IONAL
ANALYSTS
I'RIOR
AUTHORIZAT ION
HEALTH l- AND
UTILIZATION
l- CAllE REVIEW
GROOI'
EXHIBIT 23
v~ e~ 1- 2
AHCCCS
DIVISION OF HEALTH CARE
PROPOSED CENTRAL OFFICE ORGANIZATIONAL STRUCTURE
EXHIBIT 24
§ ,
~
AI* IIIISTIIATIVE ASSIST. DIRECTOR
ASSISTAIIT II DIVIS1011 OF AI* IIIISTIIATIVE
HEALTH CARE SECRETARY II I
GIIADE 15 GIIADE TO BE GIIADE 14
I ~ OSITIOIl DETERIIIIIED I ~ OSITIOII
I ~ OSIT 1011
I
I I I
BUREAU · CHIEF BUREAU CHIEF BUREAU CHIEF Al* IIIISTIlATIVE
BUREAU OF HEALTH BUREAU OF IIE11RR BUREAU OF LTC SERVICES Al* IIII5TIlATIVE
CARE COIlTIlACTS SERVICES EUGIBILITY OFFICER II SECRETARY I
OIIADE 25 OIIADE 23 GIIADE 24 GIIADE 21 OIIADE 12
I ~ OSITIOIl I P'OSITIOII 1 P'OSITIOII I ~ OSITIOIl I ~ OSITIOIl
I I I I
P'ROOIIAIl & AI* IIIISTIIATIVE ~ ROOIlAll & IIiFORIIATIOII CLERK TY~ IST
P'ROJECT ASSISTAIIT III ~ ROJECT P'ROCESSIIIO III
SP'Et IALIST II S~ ECIALIST II SP'ECIALIST II
GRADE 19 GIIADE 17 GIIADE 19 OIIADE II GIIADE 11
1 POSITIOII I ~ OSITIOII 1 POSIT 1011 I ~ OSITIOII 1 ~ OSITIOII
V4051- 2 - - - - - - - - - - - - - - - - - - -
-.... - - - - - - - - - - - - - - - - - - AHCCCS
DIVISION OF HEALTH CARE
BUREAU OF HEALTH CARE CONTRACTS MANAGEMENT
PROPOSED ORGANIZATIONAL STRUCTURE
EXHIBIT 25'
~
&
BUIIEAU CHIEF
PIlOOIlAM & PIIOJECT BUIIEAU OF HEALTH ADMINISTRATIVE
SPECIALIST II CAllE CONTRACTS SECIIETAIIY II
OIlADE 19 OIlADE 25 OIlADE 12
1 POSITION 1 POSITION 1 POSITION
I I I I I I
ADMINISTRATIVE IlAIlA8EII FINANCIAL FINANCIAL FINANCIAL FINANCIAL J ASO II HEALTH
SEIIVICES OFF. IlAIlA8ED CAllE CONSULTANT III CONSULTANT III CONSULTANT III CONSULTANT III CAllE GIIOUP
r-- II ~ PLAN IIOT. PDO SUBMISSION F~ r--
1 POSITION 1 POSITION 1 POSITION 1 POSITION 1 POSITION CIIEATION 218". 1 POSITION
lRADE 21 GIlADE 24 OIlADE Z3 GRADE Z3 OIlADE Z3 1 POSITION OIlADE 21
GIlADE Z3 I I I
PIlOOIlAN & PIlO. 1EC1' EXECUTIVE 1' 1100 COlII' 1' 1100 COlII' 1' 1100 COlII' PIlOOIlAII & PIIOJECT
SPECIALIST CONSULTANT AUDIl III AUDII III AUDIl II SPEC IALIST I - I l- II - 1 POSITION 1 POSITION 1 POSITION 1 POSITION 1 POSITION 1 POSITION
OIlADE 18 GIlADE U OIlADE 19 GRADE 19 OIlADE 18 OIlADE 18
INFOIUlATION EXECUTIVE INFOIlMATION
PIIOCESSING CONSULTANT I PIIOCESSING - SPECIALIST III l- II - SPECIALIST III
1 POSITION 1 POSITION 1 POSITION
OIlADE 13 GIlADE U PDO IIEQUEST TO CIIEATE, PDO IIEQUEST TO CIIEATE. OIlADE 13
EXECUTIVE STAFF EXECUTIVE STAFF
ASSISTANT ASSISTANT
1 POSITION 1 POSITION
GRADE 2. OIlADE 2.
INFOIlIIATION PIlOOIlAN AND INFOIlNATION
PIIOCESSING PIIOJECT PIIOCESSING
I-- SPECIALIST II I- SPECIALIST II - SPEC IALI ST II
1 POSITION 1 POSITION 1 POSITION
GRADE 11 GIlADE 19 GRADE 11
CLEIIK ADMINISTRATIVE SECIIETAIIY
TYPIST II SECIIETAIIY
I-- - I - 1 POSITION 1 POSITION 1 POSITION
GRADE 11 GRADE 12 OIlADE 11
] SECIIETAIIY
- 1 POSITION
OIlADE 11
V4038- 2
~
~
AHCCCS
DIVISION OF HEALTH CARE EXHIBIT 26
BUREAU OF MEMBER SERVICES
PROPOSED ORGANIZATIONAL STRUCTURE
ASSIST. DIIlECTOll
DIVISION OF
HEALTH CAllE
1 ' OSITION
GIlADEITO BE
ESTAlILISHED
BUIlEAU CHIEF
ADMINISTRATIVE IlUIlEAU OF ADMINISTRATIVE
ASSISTANT III MDlIlEIl SEIlVICES SECIlETARY I
1 ' OSITION 1 ' OSITION 1 ' OSITION
GRADE 17 GIlADE 23 GIlADE 13
I
I I
ADMINISTRATIVE SECT ION NAMA8EIl SECTION ADMINISTRATIVE SECTION IlAllAGEIl CLEIlK TY'IST III
ASSISTANT III MEIlaEII fILE MANAGEIl ASSISTANT II Ca. lUNICATIONS
INTElJIIITY UII/' A CENTEll 1 !' OSITION
1 !' OSITION 1 ' OSITION 1 ' OSITION 1 !' OSITION 1 ' OSITIOll GRADE 11
GRADE 17 GIlADE 21 GIlAIlE 21 GRADE 15 GIlADE 19
CLEIlK TnIST II MEDICAL IlEVIEW
1 !' OSITIOll ' IIOC IlEVIEW S'EC
lJIIADE 9 II ' OSITIONS
GRADE 19
CLEIlK TV'IST II
1 ' OSITIOll INFOIUlATIOll
lJIIADE 9 , IlOC S'EC II
1 ' OSITION
GRADE 11
COMMUNICATIONS
INfOllllATIOll
' IlOCESSING S'EC. I I I I I I I
1 ' OSITIOll
lJIIADE 9 ADMIN. SU" OIlT ADMIN. SU'~ T ADMIN. SU" OIlT ADMIN. 5U" OIlT ADMIN. SU'~ T ADMIN. SU" OIlT ADMIN. SU" OIlT
S'ECIALIST S'ECIALIST S'ECIALIST S'ECIALIST S'ECIALI5T S'ECIALIST S'ECIALIST
I I I I I I I
I I 1 ' OSITION 1 ' OSITIOll 1 !' OSITIOll 1 ' OSITIOll 1 ~ ITION 1 ' OSITIOll 1 ' OSITIOll
GRADE 14 GRADE 14 GIlADE 14 GRADE 14 GRADE 14 GIlADE 14 lJIIADE 14
ADMINISTRATIVE ADMINISTRATIVE
5U" OllT S~' OIlT
SU'EIlVISOIl II SU'EIIVISOll II CLEIlK CLEIlK CLEIlK CLEIlK CLEIlK CLEIlK CLEIlK
1 !' OSIlION 1 ' OSITION n'IST III TV'IST III TV'IST III TnIST III TV'IST III TV'IST III TV'IST III
8IlADE 16 GIlADE 16
7 ' OSITIONS 7 !' OSIT 10115 1 ' 05ITIONS 7 !' OSITIOllS II !' OSIT lOllS 7 ' OSITIOllS II ' OSITIOllS
INTEGRITyl
GRADE 11 GIlADE 11 GIlADE 11 lJIIADE 11 GRADE 11 GRADE 11 GRADE 11
MEMBER FILE
I I I
ADMIN. SU" OIlT ADMIN. SU'~ T ADMIN. SU'~ T ADMIN. SU" OIlT ADMIN. SU'~ T ADMIN. SU" OIlT
S'ECIALIST S'ECIALIST S'ECIALIST S'ECIALIST S'ECIALIST S'ECIALIST
I I I I I I
1 ' OSITION 1 !' OSITIOll 1 !' 05ITIOll 1 ' OSITION 1 ' OSITION 1 ' OSlTION
GIlADE 14 lJIIADE 14 GIlADE 14 GRADE 14 GIlADE 14 GIlADE 14
I I I I
CLAIMS CLAIMS CLAIMS CLAIMS CLAIMS CLAIMS
S'ECIALI5T I S'ECIALIST I S'ECIALIST I S'ECIALIST I S'ECIALIST I S'ECIALIST I
6 ' OSITIOllS 5 !' OSITIONS 5 ~ ITIOllS 5 ' OSITION5 6 !' OSITIOllS 6 ' OSITIOllS
lJIIADE 13 GRADE 13 GRADE 13 GIlADE 13 GRADE 13 GIlADE 13
V4MZ- Z - - - - - - - - - - - - - - - - - - -
-.... - - - - -------~ AHCCCS
DIVISION OF HEALTH CARE
BUREAU OF LONG TERM CARE ELIGIBILITY
PROPOSED ORGANIZATIONAL STRUCTURE
- - - - -- EXHIBIT 27
~
&
ASST DIRECTOR
DIVISION
OF HEALTH CAllE
1 I'OSITION
GIIAD£
TO IE ESTABLISHED
ADMINISTIIATIVE BUREAU CHIEF ADMINISTIIATIVE
ASST III LONG TEIIM CAllE SECRETAAY
ELIGIBILITY II
1 I'OSITION 1 I'OSITION 1 I'OSITION
GIIAD£ 17 GllADE 24 GIIAD£ 13
I
HEALTH I'II08IWl HEALTH I'IIOGIIAIl
lWlAlJl! RIII MANAGER II I
1 I'OSITION 1 !' OSITION
GIIADE 21 GIIADE 21
I'II08IWl & I'ItOJ! CT I'II08IWl & I'IlO. 1ECT
SI'ECIALIST II SI'ECIALIST II
2 I'OSITIONS 2 I'OSITIONS
GIIADE 19 GIIADE 19
NED SEIlVICES Ilt: LFAM: STAFF
I'IIOCIIIWl REV DEY SI'EC
SI'ECIALIST I
1 I'OSITION 1 I'OSITION
GIIADE 19 GIIAOE 18
HSS III CLERK
TYI'IST III
1 I'OSITION FIELD 1 !' OSITION
GIIADE 18 OI'EIlATIONS GllADE 11
NANAGER
1 I'OSITION
GIlADE 22
CLERK
TVI'IST III
1 I'OSITION
CIIIADE II
I I I I
REGIONAL REGIONAL REGIONAL REGIONAL REGIONAL
MANAGER NANAGER NANAGER NANAGER NANAGER
REGION I REGION II REGION III REGION IV REGION V
1 !' OSITION 1 I'OSITION 1 I'OSITION 1 I'OSITION 1 I'OSITION
GllADE 21 GllADE 21 GIIADE 21 GIIADE 21 GllADE 21
, V41S4- 2
AHCCCS
DIVISION OF HEALTH CARE
BUREAU OF LTC ELIGIBILITY
PROPOSED FIELD ORGANIZATIONAL STRUCTURE
ADIUNISTAATION
BUREAU OF LTC
ELIGIBILITY
1 POSITION
GAADE 24
EXHIBIT 28
n I
~
REeION I
PROeIWl llAIlACIt: R
1 POSITION
GRADE 21
llEDICAL
ELIGIBILITY
TOTAL STAFF
3.
31 TOTAL STAFF
REGION II
PROOIIAN llAIlACIt: R
1 POSITION
GRADE 21
MEDICAL
ELIGIBILITY
STAFF
U
Z4 TOTAL STAFF
F! ELD SERVICES
MANAGER
1 POSITION
GfltADE U
REGION III
PROGRAM llANAGER
1 POSITION
GfltADE 21
MEDICAL
ELIGIBILITY
STAFF
16
17 TOTAL STAFF
REeION IV
PROGlWl llAlIAGER
1 POSITION
GRADE 21
MEDICAL
ELIGIBILITY
STAFF
1.
11 TOTAL STAFF
REGION V
PROGRAIl IlANAGER
1 POSITION
GRADE 21
MEDICAL
ELIGIBILITY
STAFF
12
13 TOTAL STAFF
• TOTAL FIELD STAFFING, INCLUDING RE' 3I0llA1. p'DOrAN 1i~: lAGER BUT NUT HiE FIELD SERVICES llAIlACIt: lI, IS 96. - - - - - - - - - - - - - - - - - - -
- - - - - -- - -- - -- - AHCCCS
DIVISION OF BUSINESS, FINANCE & RESEARCH
PROPOSED FUNCTIONAL ORGANIZATIONAL STRUCTURE
EXHIBIT 29
DIVISION
OF
BUSINESS.
FINANCE &
RESEARCH
I I I I I
CLAIMS CONTRACT & FIIIANCE
AND FACILITIES AND BUDGET PERSONNEL RESEARCH
ENCOUNTER'S MANAGEMENT ACCOUNTING
- CONTRACT ADMINISTRATION - PROGRAM & HEALTH CARE
GROUP ACTIVITIES
~. g
- PROCESS FEE F~
SERVICE CLAIMS
- PROCESS ENCOUNTER
DATA
- ASSISTANCE WITH
CHARGING PAYMENT
ISSUES
- SYSTEMS COORDINATION
- MATERIAL MANAGEMENT
- FORMS MANAGEMENT &
FIXED ASSETS
- TELECOMMUNICATIONS
- SWITCHBOARD
- ACCOUNTS RECEIVABLE AND
ACCOUNTS PAYABLE
- ADMINISTRATIVE ACCOUNTING
- ADMINISTRATIVE ACCOUNTS
PAYABLE
- PAYROLL
- COST AVOIDANCE
- ACUTE CARE BUDGET
- ADMINISTRATIVE- SUPPORT
AND MIS BUDGET
- AGENCY PROJECTS
- LONG TERM CARE BUDGET
- PERSONNEL
- TRAINING
- ANALYSIS & PROJECTION
OF PROJECT COST
- DEVELOP HEALTH CARE
REIMBURSEMENT
METHODOLOGY
- PREPARE MEMBER PROFILE
STUDIES
V4e18
AHCCCS
DIVISION OF BUSINESS, FINANCE AND RESEARCH
PROPOSED ORGANIZATIONAL STRUCTURE
EXHIBIT 30
ADMINISTRATIVE ASSISTANT ADMINISTRATIVE
ASSISTANT SECRETARY
III DIRECTOR III
DBFR
I
I I I I I
BUREAU OF BUREAU OF BUREAU BUREAU BUREAU BUREAU
CONTRACT OF
,....- CLAIMS & ..- AND r-- FINANCE ..- OF THE r-- OF r-- OF
FACILITIES &
ENCOUNTERS IilANAGEMENT ACCOUNTING BUDGET PERSONNEL RESEARCH
PROVIDER
CLAIMS PAYROLL ACUTE RATE
>-- SERVICES CONTRACTS PERSONNEL NEGOTIATION
AND ~ - & - AND LTC - - DATA AND
RESEARCH IilANAGEMENT ACCOUNTS ACTIVITIES ANALYSIS
PAYABLE BUDGETS
ENCOUNTER - TELE- PAYROLL BUDGET DATA
DATA COIMJNICATIONS ADMINISTRATION TRAINING DEVELOPMENT
~ AND - & - - - &
ADMINISTRATIVE ACCOUNTS BUDGET ACTIVITIES ANALYSIS
SUPPORT PAYBLE
CLAIMS
- CONTROL
SU,. PLY APPROPRIATIONJ
( IiIAI L ROOIIl) HOSPITAL - & - ACCOUNTING -
& REI IllBURSEMENT
INVENTORY FINANCE
CLAIMS
~
ADJUDICATIOIl
RESEARCH
- COST - &
CLAIMS AVOIDANCE
~ EVALUATION
ADJUDICATION
SYSTEMS
COORDI NAT 1011
>-- UNIT
~
(.. I. I
- - - - - -- - - - - - -- - - - V4e24
~ -
- - - - - .. _------- - .- - - - AHCCCS
DIVISION OF BUSINESS, FINANCE & RESEARCH
BUREAU OF CLAIMS & ENCOUNTERS
PROPOSED ORGANIZATIONAL STRUCTURE
EXHIBIT 31
~
I
~
ASSISTANT
DIRECTOR
DBF& R
GRADE 27
1 POSITION
I
BUREAU CHIEF
CLAIMS &
ENCOUNTERS
GRADE 23 ADMINISTRATIVE
CLERK TYPIST U 1 POSITION SECRETARY U
GRADE 9 GRADE 13
1 POSITION I 1 POSITION
I
I I I I I I
SUPV. PROVIDER SUPERVISOR SUPERVISOR SUPERVISOR SUPERVISOR ADMIN SERV
SEFlVICES & ENCOUNTER CLAIMS CONTROL CLAIMS CLAIMS OFFICER II
r-- RE!; EARCH r-- DATA r-- ( MAIL ROOM) r-- ADJUDICATION - ADJUDICATION r-
GRI, DE 19 GRADE 2. GRADE 17 GRADE 17 GRADE 17 GRADE 21
1 pel, SITION 1 POSITION 1 POSITION 1 POSITION 1 POSITION 1 POSITION
CIAIIIlS RESEARCH & CLERK CLAIIIlS CLAIIIlS MANAGEIIlENT
SPECIALIST U STATISTICAL TYPIST SPECIALIST SPECIALIST ANALYST
f- GIU< DE 15 f- ANALYST I f- U'S I-- U'S ...- U'S I--
5 pel'SITIONS GRADE 17 GRADE 11 GRADE 15 GRADE 15 --
I POSITION 5 POSITIONS 2 POSITIONS a POSITIONS 9 POSITIONS
CIAIIIlS
SPEClALIST I CLAIMS CLAIIIlS CLAIIIlS CLAIIIlS ADMIN - GRADE 13 SPECIALIST SPECIALIST SPECIALIST SPECIALIST ASSISTANT
1 POSITION f- II ~ TRAINEE I-- I'S - TRAINEE f-
GRADE 15 GRADE 11 GRADE 13 GRADE 11 --
I POSITION 3 POSITIONS 7 POSITIONS 1 POSITION 7 POSITIONS
CI. AIIIlS
SPECIALIST - TRAINEE CLAIIIlS CLAIIIlS CLAIIIlS ADIIlIN
GRADE 11 SPECIALIST SPECIALIST PRESCREEIIER SECRETARY I
2 P() SITIONS - TRAINEE I-- TRAINEE - f-
GRADE 11 GRADE 11 GRADE 9 GRADE 11
1 POSITION 1 POSITION 1 POSITION 1 POSITION
I,: LERK
TYPr, ST UI
f- OUDE 11 INFORMATION CLERK
1 Pi) SJTION PROCESS TYPIST U
~ SPECIALIST U ""-
GRADE II GRADE 9
1 POSITION 1 POSITION
': LERK
TY~ IST U
""- GItADE 9 \ I 3 P,) SJTIONS
- ASSIST PROVIDER ON CLAIIIlS
RELATED ISSOJES
- RESEARCH CL~ IIIlS ISSUES
IIlENTAL HEALTH, DEFERRED
LIABILITY, REINSURANCE
AND ALL OTHER CLAIIIlS
V4e25
AHCCCS
DIVISION OF BUSINESS. FINANCE & RESEARCH
BUREAU OF CONTRACTS & FACILITIES
PROPOSED ORGANIZATIONAL STRUCTURE
EXHIBIT 32
~
~
ADMINISTRATIVE
ASSISTANT
III
GRADE 17
1 POSITIOIl
r
COHTRACTS
MANAGEMENT
r- f SUPERVISOR
GRADE 2.
1 POSITIOH
COHTRACTS
MANAGEMENT
H SPECIALIST II
GRADE 19
1 POSITIOH
COHTRACTS
NANACl£ MENT
H SPECIALIST II
GRADE 18
1 POSITIOH
COIlTRACTS
MANAGENENT
'-- i SPECIALIST II
GRADE 18
1 POSITIOH
- CONTRACT SPECIALISTS
FOIl AllCCCS
- PIIOVIDE TA
- EXPEDITE CONTRACTS
- DEVELOP LEGAL REQUIRENENTS
( PROVISIONS)
- SPECIALI2ED CONTRACTING
- IGAS WITH GOVERNMENT
AGENCIES
BUREAU
CHIEF
CONTRACTS &
FACILITIES
MANAGEMENT
GRADE 23
1 POSITIOH
CLERK TYPIST
I I III
GRADE 11
1 POSITIOH
TELE- 1 COMMUNICATIOHS
~ & AOIlIN. SUPPORT
SUPERVISOR I GRADE 21
TO BE ESTABLISED
I I
TELE­COMMUNICATIOHS
SPECIALIST
f- I GRADE 19
1 POSITIOH
CLERK
TYPIST
f- I
IU
GRADE 11
1 POSITIOH
CLERK
TYPIST
II
~ GRADE 9
1 POSITION
SWITCHBOARD
OPERATOR
II
f- I GRADE 9
1 POSITION
SWITCHBOARD
OPERATOR
II
l..... I GRADE 9
1 POSITION
- 1
STOREKEEPER
GRADE 13
1 POSITION
- SUPPLIES
- FORMS
- INVENTORY CONTROL
- EOUIPMENT DELIVERIES
- MOTOR POOL
- TELECOMMUNICATION SERVICES
FOR CENTRAL AHCCCS OFFICE
- SWITCHBOARD
- SWITCHBOARD BACK- UP AND
CLERICAL SUPPORT
I _, ,__~",,_~~. P' ---------- - - - - - - -- - - -
- - - - - - - ~ - - - - - - - -- .. - - AHCCCS
DIVISION OF BUSINESS. FINANCE & RESEARCH
BUREAU OF FINANCE & ACCOUNTING
PROPOSED ORGANIZATIONAL STRUCTURE
BUREAU CHIEF
FINANCE &
ACCOUNTING
1 POSITION
GRADE 22
CLERK
TYPIST III
1 POSITION
GRADE 11
EXHIBIT 33
- ACCOUNTS I'AYABLE
FOR ALL EXCEI'T
I'AYROLL
~
I
~
- FIS!'.: AL FISCAL
SERVi( CES SERVICES
SI'ECIA ,. IST V SI'ECIAUST II
1 I'OSnION 1 I'OSITION
GIIAI)" 19 0IWlE 16
ACCOUNTIIlO
lION ITOlI " S IlATCH TECH
RAni:)' S III
1 I'OSITION
I'REI'ARE; AND SU. ITS OlIADE 13
CHA'lOES
r
ACCOUNTIIlO
TECH
1- 1 III
I !' OSITION
0IWlE 13
ACCOUNTIIlO
TECH
1- 1 II
1 !' OSITION
GRADE 11 --
CLERK
TYI'IST
L.... f II
1 !' OSITION
GRADE 9
1
FISCAL
SERVICES
.- f SI'EC IALIST I
I I'OSITION
GRADE 15
ACCOUNTING
TECH
1- 1 II
1 POSITION
GRADE 11
ACCOUNTING
TECH
1- 1 II
1 I'OSITION
ORAD£ 11
- I'AYROLL
I
FISCAL 1 SERVICES
r- I SI'ECIALIST III
1 POSITION I GRADE 17
ACCOUNTING
TECH
1- 1 III
I I'OSITION
GRADE 13
ACCOUNTING
TECH
1- 1 II
1 I'OSITION
GRADE 11
CLERK
TYPIST
l- I II
1 I'OSITION
GRADE 9
- CAI'ITATED I'AYNENTS
- FEE- FOR- SERVICE
I'AYNENTS
FISCAL COST
SERVICES AVOIDANCE
SI'EC IALIST IV UNIT SUPV.
1 I'OSITION I POSITION
GRADE 18 GRADE 2.
NAHAGENENT
- FEDERAL REI'OlITS ANALYST II
1 I'OSITION
OlIADE 18
NANAGENENT
ANALYST II
1- 1 ( I'ROPDSED)
I POSITION
GRADE 18
I'ROORAN "
I'ROJECTS
I- ISI'ECIALIST II
I I'OSITION
GRADE 18
I
i
ADMINISTRATIVE
ASSISTANT II
1- 1
1 1' 05 IT ION
GRADE 15 --
CLERK
1- 1
TYI'IST
II
I !' OSITION
GRADE 9
CLERK TYPIST
III
l- I
1 I'OSITION
GRADE 11
I
- THIRD I'ARTY LIABILITY
\/, 1"''' 7
- ADMINISTRATIYE BUDGET __ liiif--_---------
H I
8:
- -- -
AHCCCS
DIVISION OF BUSINESS, FINANCE & RESEARCH
BUREAU OF THE BUDGET
PROPOSED ORGANIZATIONAL STRUCTURE
ASST. DIRECTOR
DIVISION OF
BUSINESS, FINANCE
AND RESEARCH
GRADE 27
I POSITION
I
BUREAU
CHIEF
BUDGET
GRADE 23
I POSITION
I
T
I
BUDGET
CONTROL
BUDGET
r-- DEVELOPMENT
CONTROL DEV.
OFFICER
r-- SPECIALIST II
GRADE 21
GRADE 19
I POSITION
I POSITION
BUDGET
BUDGET
CONTROL DEY.
CONTROL DEY.
~ SPECIALIST II
- SPECIALIST I
GRADE 19
GRADE 17
I POSITION
I POSITION
BUDGET
INFORMATION
CONTROL DEY.
PROCESSING
~ SPECIALIST II
I-- SPEC. III
GRADE 19
GRADE 13
I POSITION
I POSITION
FISCAL SENIOR
INFORMATION
COST ALLOC.
PROCESSING
~ SPECIALIST
- SPEC. II
GRADE 19
GRADE 11
1 POSITION
I POSITION
ADMIN.
ASSISTANT I - GRADE 13
I POSITION
-
EXHIBIT 34
V40? Q- 2
- - - - .. - - I!! II, .. - - - - - - - - .. -
~
~
AHCCCS
DIVISION OF BUSINESS. FINANCE & RESEARCH
BUREAU OF PERSONNEL & TRAINING
PROPOSED ORGANIZATIONAL STRUCTURE
ASST. DIRECTOII
DIVISION OF
BUSINESS. FINANCE
AND RESEARCH
1 POSITION
GRADE 27
I
BUREAU
CHIEF
PERSONllEL
&
TRAININO
I
r 1
PERSONNEL TRAINING
ANALYST SUPERVISOII
r- III ~ ( TO BE EST)
1 POSITION 1 POSITION
GRADE 2. GRADE 2.
PERSONNEL
ANALYST TMINER .... 11 .... ( TO BE EST)
1 POSITION 1 POSITION
GRADE 19 GRADE 18
ADMIN.
ASSISTANT TRAINER
l- II I- ( TO BE EST)
1 POSUION 1 POSITION
GRADE IS GRADE 18
PERSONNEL CLERK TYPIST
TECH. 111
I- "- ( TO BE EST)
1 POSITION 1 POSITION
GRADE 13 GRADE 11
PERSONNEL
TECH.
I--
1 POSITION
GRADE 13
SECRETARY
l.-
I POSITION
GRADE 11
- PROVIDES PRIMARY PERSONNEL
FUNCTIONS FOR AHCCCS - IS
DEPUTIZED BY DOA TO HAVE
FULL AUTHORITY
INO ( KNOWLEDGE AND
NINO SKILL ACQUISITION
T/ CAREER DEVELOPMENT
OPMENT
MINING
EXHIBIT 35
AHCCCS
DIVISION OF BUSINESS, FINANCE & RESEARCH
BUREAU OF RESEARCH
PROPOSED ORGANIZATIONAL STRUCTURE
EXHIBIT 36
- BUDGET DEVELOPMENT
AND ANALYSIS
HEALTH
PLANNING
~ CONSULTANT
GRADE ze
I POSITION
~
Ul .....
I
ECONOMIST
III
CJRAOE ZI
I I'OSITION
RATE NEGOTIATION
AND ANALYSIS
OATA
I
HEALTH
PLANNING
CONSULTANT
GRADE Z.
I /' OSITION
ASST. DIRECTOR
DIVISION Of
BUSINESS,
FINANCE AND
RESEARCH
GRADE Z7
I POSITION
I
BUREAU ADMINISTRATIVE
CHIEF SECRETARY I
RESEARCH
GRADE Z4 GRADE 13
I POSITION I POSITION
ECONOMIST ECONOMIST
IV IV
r-- I
GRADE 2Z ORAOE 2Z
I POSITION I POSITION
MANAGEMENT
ANALYST
1- 1 II
GRADE II
I POSITION
PROGRAM &
PROJECT
L- f SPECIALIST II
GRADE 19
I POSITION
- HOSI'ITAL REIMBURSEMENT
- PROORAIl BUDGET DEVELOPNENT
ANALYSIS
RESEARCH &
STATISTICAL
1- 1 ANALYST II
GRADE 17
1 POSITION
NANAGEMENT
ANALYST
1- 1 I
GRADE 16
1 I'OSITION
MANAGEMENT
ANALYST
L- f I
GRADE 16
I POSITION
- RESEARCH AND
EVALUATION - - .. - - - - ... ~. - - - - - - .. ... H. A() I"} r'II "') .. -
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CONSOUDATIQN OF AHCCCS BJGIBlUIY DETERMINATIQN
No single focal point for AHCCCS eIlglbHIty determination within the State of ArIzona currently exists.
There are four entities responsible for determining eIlgibUIty for AHCCCS Acute and Long Term Care ( LTC)
services: the Department of Economic Security, ArIzona Counties, the Social Security Administration and
AHCCCS. The distribution of responsibilities Is as follows:
• DePartment of Economic Secyrity - Responsible for determining eligibility for Individuals who
receive Aid to FamUles with Dependent Children ( AFDC), chUdren under 14 years of age of Food
Stamp recipients ( EAC), Ribicott children under 18 years of age, S. O. B. R. A. women ( pregnant
women) and certain aged chUdren of S. O. B. RA women
- Applications are taken in DES Family Assistance Administration ( FAA) Offices statewide
- Determinations are transmitted via magnetic tape to AHCCCSjDepartment of Administration
( DOA) at the end of each day
- The individuals determined eligible by DES are categorically eligible - meaning they
automatically quality for AHCCCS Acute Health Care services
- These individuals are also eligible tor Federal Financial Participation ( FFP) to cover partial
payment for health care services
• ArIzona Coynties - Responsible for determining acute care eligibility for the medically needy
medically Indigent ( MNjMI), food stamp children under 14 years of age and S. O. R. BA eligibility
- Applications are taken In ottIces within each county statewide
- 81glbllity Information Is called into AHCCCS and keyed Into the data system by AHCCCS
employees
• Services to these Individuals are paid for with State dollars only
AHCCCS - 58
- Counties contribute dollars to the State at the beginning of each State Fiscal year ( SFY), which
are used for federal match for Acute Care Services
• Social Security Administration ( SSA) - Responsible for determining e1lglbUIty for Supplemental
Securtty Income ( SSI) for individuals who are disabled
- Applications are taken at local Social Securtty OffIces throughout the State
- If the Individual Is approved for SSI this decision Is transmitted by the Social Securtty
Administration via electronic mail to AHCCCS
- SSI recipients are categorically eligible for AHCCCS Acute Care Services and can be partially
funded using federal dollars
• AHCCCS - Responsible for determining e1lglbUIty for Long Term Care ( LTC)
- Applications for eligibility for LTC are processed at 14 offices statewide
- Eligibility is determined based on both financial and medical eligibility
Medical eligibility is based on the individual's risk of institutionalization due to the severity of
disabUIty
- AHCCCS maintains two bureaus within Its DMsion of Member Services ( OMS) and 14 field
offices statewide to meet this responslbUity.
Each of the aforementioned governmental entities maintains Its own administrative staff and line
operations to carry out their part of the e1iglbUIty determination process ( see Exhibit 37, ALTCS LTC ­Program
Comparison). However, two of the four, DES and SSA, are responsible for determining e1iglbHIty
for cash and other services and benefits which are provided by them. AHCCCS e1lglbHIty Is a by- product
of this process where clients are automatically determined eligible for Medicaid funded health care services
as a result of the DES and SSA e1lglbUIty determinations.
AHCCCS - 59
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As previously stated, AHCCCS does LTC e1lglbUIty and carries out their responsibility through the
Division of Member Services. It has two bureaus and 14 field offices to do this activity. The two bureaus
have a combined total of 370 staff.
The counties also employ ellgibUIty staff to do both eliglbUIty for MN/ MI's and to certify If an Individual
is eligible for straight county services based on Income need. The counties, by law, have residual financial
responsibility for health care If the Individual does not meet the AHCCCS eligibility requirements.
AHCCCS conducts quality control ( OC) reviews of the eligibility determinations made by the counties
for the MN/ MI and other State only funded groups. This process Is defined In AR. S. 36- 2905.02. Table A
summarizes the OC reviews for the past three State fiscal years:
TABLE A.
AHCCCS QUALITY CONTROL REVIEW
SFY'a 1989, 1990, 1991
NUMBER OF NUMBER PERBIT EfR) R EfR) R
COUNTY FEVE'NED ~ RATE DOU. AR
a: RIFCATJONS AIIOlJ\ IT
SFY' 89 89.978 1,425 1.6 7.0 $ 532,497.18
SFY' 90 89,950 1,561 1.7 9.8 $ 479.839.10
SFY ' 91 95,797 1,509 1.6 6.7 $ 332.451.94
The Ouallty Control Unit's review In Table Aabove reflect an annual average of $ 448,263 In erroneous
payments on 1.6% of the e1lglbUIty determinations reviewed. The results of this review point to substantial
State dollars being expended on Ineligible Individuals In the MN/ MI ( State funded) AHCCCS System. It
should be noted however, that these error percentages are not statistically valid as these cases were not
selected using a generally accepted sampling methodology.
There appears to be a strong Incentive for the counties to determine Individuals - AHCCCS eligible­since
this places the responslbllty for heatth care costs on the State funded MN/ MI program. The potential
AHCCCS - 60
for ineligible Individuals being enrolled In the MN/ MI program is based on the effect of ( 1) a high error rate,
and ( 2) performance standards ( a set quota) of two referrals per day to be determined MN/ MI eligible by
county eligibility workers in some Maricopa County OffIces.
As Klustrated in Exhibit 37, ALTes LTC - Program Comparison, the e1lgibUlty determination process
is both fragmented and complex. There are a multitude of e1igibUlty groups each with their own financial
and age requirements. Additionally, the disbursement of the e1lgibUlty determination process throughout the
state makes It difficult to effectively and efficiently administer.
We recommend consolidating the e1lglbDity process for the MN/ MI's ( currently being done by the
counties) and the financial eligibility process for LTC ( currently being done by AHCCCS) with the eligibility
processes at DES. All e1lglbUity determinations Involving AHCCCS services can be performed through DES,
except the SSI determinations, which would remain with Federal SSA offices.
• Elimination of MN/ Ml's served by AHCces who are not eligible for State funded health car€>
services. Savings = $ 7,9n, 384 ( see exhibit 38, MN/ MI Error Savings Calculations)
• Increased placement of eligibles in Federal categorical programs. AHcces studies estimate
general fund savings of $ 11,424,000 for State Fiscal Year ( SFY) 1993 and $ 20,439,000 for SFY
1994 by conversion of MN/ Ml's to Federal programs for which the counties are not presently
screening ( see exhibit 39, General Fund Savings Calculations Groups)
• Elimination of AHCCCS staff ( three Oerk Typist III positions) to key in the MN/ MI eligibility
determinations made by county workers - Savings = $ 59,027 ( see exhibit 40, Staff Reduction
Savings Calculation)
• Reduction, State and county- wide, in the overall number of FTEs engaged In the eligibility
determination process Onsufficlent data avaUable at this time to estimate savings)
• Implementation of a streamlined and more efficient process In DES
AHcces - 61
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• Reduction in applicant confusion
• Creation of one uniform and common system for eligibility determination through consolidation
of the present disparate processes within one State agency - DES.
- Estimated start- up costs for DES are $ 4.5 mUlion which Include FTE positions, automation,
space, telephone, and equipment.
The total Savings for the State which are associated with this recommendation amount to $ 24 million
per year ( SFY 1994). Federal costs wUllncrease by $ 16 million, however, as the transfer of eligibles to
Federal categorical programs gradually takes place.
These savings are derived using the projected savings shown In exhibits 38 through 40.
The following implementation activities are needed to attain the projected savings:
• Change the statute which gives the counties the authority to administer the MNjMI program and
requires their financial contributions to AHCCCS
• Establish DES as the State agency responsible for eligibility determination
• Establish a means whereby county employees can be picked- Up as State employees or contracted
to do service
• Implement the recommendations for transferring the LTC financial e1iglbHIty process In AHCCCS
to DES
• Change the statute to address county residual responsibility Issues
AHCCCS - 62
• Perform a thorough analysis of systems appiication requirements including the abUIty to establish
a network system, to be used from any location, for consistent and reliable e1igibUIty determination
• AHCCCS, DES and the counties should Jointly develop a comprehensive implementation plan.
The pian should take Into account the following key issues:
- Staffing levels
- Salary levels
- Locations/ Outreach
- Costs/ Budget
- Automated Systems Components
- Common data base
- Contract requirements.
AHCCCS- 63
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Reoulred
Required
11/ 25/ 91
Reaulred
Reaulred
Required
Not
Required
Not
Required
Required
Required
Required
Reaulred
Required
Required
Required
Required
Required
Required
Reaulred
Reoulred
Required
Also County
residency
Required
Also County
resldencil
Reaulred
Criteria
Not
Reoulred
Not
Reouired
U. S. Cltlzen
or
LeQal Allen
U. S. CItizen
or
LeQal Alien
U. S. Citizen
or
Leoal Alien
U. S. CItizen
or
LeQal Alien
U. S. Citizen
or
Leoal Alien
U. S. Cltlzan
or
Leoal Allen
U. S. Citizen
or
Leoal Allen
U. S. Clllzen
or
Legal Allen
N/ A
N/ A
N/ A
N/ A
S1.000
$ 1.000
S2.000
S5 .000 lIould
SSI
$ 2,000 Individual U. S. Cilizen
$ 3,000 Couple or
$ 1.000 AFDC Legal Allen
Eligibility
S929
$ 740
$ 407
$ 610
$ 198
$ 1,117
S1486
$ 1.235
3
4
2
2 $ 1.036
3 $ 1.300
4 51.564
3 $ 1.300
4 51.564
1 773
2 S103fl
4 S401
Nieces · 64
I 5198
,
3 $ 334
1 S734
4 $ 1,117
2 S2fl6
2 $ 740
4 $ 1.117
3 5929
1 ' S552
Houunold
Siz.
Individual .;; 1 ?? 1
300% FBR
individual
Coupl.
1 552 S50.000
1_..;. 2 -= S-= 7"" 4"" 0~ liquid/ Non- liquid
3 S929
I £ 266
1-":" 2----= S-:: 3-= S-= S'- i Liquid / Non- LIquid
" I $ 400 S50, OOO
4 $ 446 S5.000 liquid
45 days
45 days
45 days
45 days
45 days
30 days
30 days
4S days
30 days
45 days
SSI Cash/ Aged
AFDC Cash
90 days- disabled
45 days
AQed/ Blind
90 davs- Dlsabled
County
Eligibility
oHices
County
Eligibility
offices
DES/ FAA
or County
Eligibility
offices
DES/ FAA
offices
DSSfFAA
offices
SS. A.
DSS/ FAA
offices
EXHIBIT 37 .
DES/ FAA
otfices
DES/ FAA
offices
DES/ FAA
oHlces
AHCCCS/
ALTCS
Offices
PROGRAM COMPARISON
Application .
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Long Term
Care I 551
CASH
I
AFDC
I EAC
Children < 14
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EUC
I Children < 14
RIBICOFF
I Children < 1 B
5.0. B. R. A.
Pregnant
I -- W-- om- 14- e0n -% FPL
Children
I < 1 year old
----- 14- 0-% FPL
Children
< 6 years old I ----- 13- 3-% FPl
Children
I < 9 years old
100% FPl
NA = Not Applicable
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EXHIBIT 38
1. Elimination of MN/ Ml's served by AHCCCS who are not eligible for State Funded Health Care Services:
MNIMI ERROR SAVINGS CAlCULATIONS
a. Assumption: Using error rate of 5% ( three year average for
non- statistically valid sample was 7.8% of 95,797 SFY ' 91
County certifications
b. MN/ MI annual ( 347.83 per month times 12) capitation rate per member
the cases reviewed
c. Estimated County error rate percentage
d. Projected dollar error on 100% of cases
( using estimated 5% error rate)
e. Average DES error rate
( AFDC eligibility error rate currently at 2.83)
f. Projected number of error cases at 3%
g. Difference In number of cases at 5% versus 3% error rate ( 4,790 • 2,784)
h. Estimated Savings per Year ( 1.916 cases times $ 4,174 per member
per year cost)
AHCCCS - 65
$ 4,790
$ 4,174
5.0%
$ 19,993,460
3.0%
2,874
1,916
$ 7.997.384
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* Pregnant women only. SFY94 figures increased by 5% over SFY93
Estimated General Fund Savings and Members Affected by Converting
Non-" Categorical Population to Categorical Status
and EAC/ ELlC Phase- Out
AHCCCS Division of Business, Finance and Research
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Dollars ( 000s)
MN/ MI Emergency Svcs *
MN/ MI/ ELlC to Categorical
EAC to Categorical
EAC/ EUC Phase- Out
Total
Members
MN/ Ml Emergency Svcs *
MN/ Ml/ EUC to Categorical
EAC to Categorical
EAC/ ELlC Phase- Out
Total
SFY93 SFY94
$ 5,360 $ 5,628
$ 2,206 $ 5,597
$ 1,427 $ 3,052
$ 2,432 $ 6,163
$ 11,424 $ 20,439
SFY93 SFY94
1,944 2,041
4,921 7,443
4,301 4,008
3,406 4,206
14,572 17,698
AHCCCS- 66
04/ 08/ 92
EXHIBIT 39
EXHIBIT 40
b. Assumption: One- half of the 10% of total calls are new members
STAFF REDUCTIONS SAVINGS CALCULATIONS
3. Elimination of AHCCCS Staff to key In the MN/ MI EllgibUIty Determinations made by county workers:
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$ 59,027
AHCCCS - 67
• Approximately 10% of total calls are MN/ MI related calls ( adding to the member rolls,
updating/ changing member data. redeterminations)
c. Equates to three Clerk Typists III
a 50 line staff handling all communications
d. Savings
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LONG TERM CARE 8JGIBIUTY
AHCCCS' Long Term Care ( LTC) program is responsible for serving the long term health care needs
of persons who are elderly, physically disabled or developmentally disabled. LTC Is provided to this
population through a combination of Program Contractors ( HMO's for LTC), fee- for- servlce providers In
counties where HMO's do not exist, and through the Department of Economic Security's Division for the
Developmentally Disabled. EligibUIty for LTC Is determined through a dual process administered by two
separate bureaus In AHCCCS' Division of Member Services ( OMS):
• The Initial phase of eligibility addresses the applicant's financial needs. It Is performed by the
Bureau of Financial eligibility ( BFE)
• The second phase of eligibility addresses the applicant's medical needs. This Is performed by the
Bureau of Medical E1igibUity ( BME)
These two bureaus share field offices yet maintain their own separate management and line personnel.
The Bureau of Financial Eligibility is responsible for determining financial need ( see Exhibit 41, Intake
Financial Eligibility Process, ALTCS, OMS and ODWI). The process entaUs securing and documenting
Information regarding the applicant's income, assets and resources. The following are outcomes of the
process:
• If found !! Q! to be financially eligible, client is notified in writing and advised of appeal rights
• If client is found 12 . b § financially eligible or If it appears, based on preliminary review, that the
applicant Is ~ 12 121 financially eligible, client information is routed to staff In the Bureau of
Medical E1igibUIty to begin their phase of the eligibility process.
The Bureau of Medical E1lgibHIty Is responsible for determining medical eligibility for LTC ( see
exhibit 42, Medical EllgibUIty Determination, flow chart for process). This e1lglbUIty Is determined through the
use of 8 Pre- Admlc;.~ lo" S~ r~"'!"! g ( PAS) tool ( document) which ! s admln! stered by BME stollff Its purpoSt: l
AHCCCS - 68
is to ascertain, through a comprehensive series of functional assessment and accompanying scores, if the
individual's physical or developmental condltlon( s) place them at risk of Institutionalization.
The following activities occur upon completion of the medical assessment:
• If the score In the PAS ( or subsequent medical review) ~ n2! document the applicant's
Imminent risk of Institutionalization, this decision is routed back to BFE staff and BFE notifies the
applicant, In writing, of the ineliglbDIty decision and their appeal rights
• If the score on the PAS ( or sUbsequent medical review) ~ document Imminent risk of
Institutionalization, this decision is routed to BFE and If client has met financial eligibility
requirements BFE notifies the applicant they are eligible for AHCCCS funded LTC services.
In addition to eligibility determination, some staff In BME also do on- site review of nursing homes and
of facilities serving the developmentally and mentally disabled to determine quality of care. They also case
manage LTC cases for the elderly and physically disabled In areas where there are no Program Contractors.
Both BFE and BME are required to perform i!:!! lYI! redeterminations of eligibility for the elderly, physically
disabled and developmentally disabled. As of 11/ 1/ 91 there were 14,718 Individuals receMng LTC services.
The two bureaus ( BFE and BME) responsible for determining LTC eligibility are two separate
organizational entities. Each maintains Its own administrative, management, line and support functions.
The two bureaus share field offices which are geographically dispersed throughout the state. There
are 14 of these field offices with BFE staff housed In all 14 and BME staff located In all but the Lake Havasu
area. The Lake Havasu office is served on an itinerant basis by BME staff.
The total number of staff, statewide, In both BFE and BME is 370. The salaries for these 370 staff
members is $ 7,849,615 per year with employee related expenses ( ERE) calculated as .225 being $ 1,766,163
per year. The total annual personnel costs ( salaries and ERE) are $ 9,615,778.
In addition to personnel costs. the other budget line Items; professional and outside services ( P. O),
In- state travel, out- of- state travel, space, equipment supplies, and other expenses bring the total budget for
AHCCCS - 69
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the two bureaus to $ 12,434,300 per annum ( see Exhibits 43 and 44, Breakout of Medical and Financial
Eligibility Costs). This budget figure is the cost associated with providing for Initial eligibility assessments,
eligibility, redeterminations, on- site review of nursing homes and facUlties for the developmentally and
mentally disabled, and for the case management of clients in the fee- for- servlce areas.
We recommend transferring the functions of the Bureau of Financial Eligibility to the Department of
Economic Security and renaming the Bureau of Medical Eligibility the Bureau of Long Term Care Eligibility.
The transfer of the functions of the Bureau of Financial EllglbUity will have significant benefits,
including:
• Estimated savings of $ 410,059 In Administrative staff costs
• Providing for a single focal point for financial e1lglbUity determination for all AHCCCS programs,
consistent with the recommendation to consolidate eligibility determination processes.
The administrative positions to be eliminated are detailed in Table A, Proposed Positions Reductions,
on the following page.
AHCCCS · 70
•
Proposed Position Reduction
TABL£ A
POSITION TITLE GRADE NUMBER OF x ESTIMATED • ESTIMATED
POSITIONS POSITIONS SALARY REG.
SALARY
BUREAU CHIEF 23 1 $ 46.471 $ 46,471
HUMAN SERVICES 21 1 $ 38.804 $ 38.804
PROGRAM MANAGER
REGIONAL MGR 19 2 $ 31,647 $ 63.294
REGIONAL MGR 20 2 $ 35,309 $ 70,618
REGIONAL MGR 21 1 $ 38.804 $ 38,804
ADMIN SERVICES OFFICER 21 1 $ 38.804 $ 38,304
ADMINISTRATIVE ASSISTANT 13 1 $ 20.278 $ 20.278
SECRETARY 11 1 $ 17,669 $ 17,669
SUB TOTAL SALARY $ 334,742
.225 ERE $ 75.317
TOTAL PERSONNEL COSTS $ 410.059
There could be additional savings In the areas of supplies. travel. equipment to be allocated to other
AHCCCS offices In lieu of new purchases. space and miscellaneous expenses. These savings will need to
be developed In the implementation and continuous Improvement phases.
• Total savings = $ 410,059 ( State = $ 205,030. Federal = $ 205.030)
The following actions wUl need to occur to facilitate implementation of this recommendation:
• Identify one- time start- up costs for DES
AHCCCS - 71
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• Identify and analyze Impact on the CATS and LEOS sub- systems of PMMIS for needed
modifications to the systems to accommodate the transfer of BFE to DES
• Identify and address space and facility change requirements and effect a plan, when possible,
for DES to utUize existing space
• Develop a 1 to 2- year plan for transitioning the financial e1igibUIty functions and essential staffing
for Long- Term Care to the Department of Economic Security ( DES). This Is consistent with
long- range plans for consolidating all AHCCCS financial e1lglbUltyfor Acute and Long- Term Care
with a single Agency, I. e., Department of Economic Security.
These are key areas of Implementation which will be expanded and added to as the actual
Implementation plan gets developed within AHCCCS.
AHCCCS - 72
INTAKE FINANCIAL ELIGIBILITY PROCESS EXHIBIT 41
ALTCS, QUB AND QDWI .
APPLICANT OR I FRONT ELIGIBI LITY I RESOURCE I LOC I BUREAU OF
APPLICANT I DESK INTAKE UNIT UNIT I VERIFICATION I AND I MEDICAL
REPRESENTATIVE I CLERK WORKER CLERK SUPERVISOR I ENTITIES I RM I ELIGIBILITY
I I I I
I I I I
I I I I
I I I I
WALK- IN OR
+
I I I
REFERRAL I LEDS • LONG TERM ELIGIBILITY DETERMINATION SYSTEM
" ART I I - I
LEDS INPUf\ II
APPAPLRITCANIT ): I
CONTROL I
NUMBER) :
~ IIII
QUALITY I
CONTROL I
REVIEW II
+ I ,
I II
SEND OUT I
APPOINTMENT ,
NOTICE I
PART II ,
DOCUMENTS
I
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FILL IN AND/ 1f
I I
I ELIGIBILITY
SIGN .... LTIPLE I I INTERVIEW
PART II ( ael
DOCUME!!! l.. I I CONDUCTED IN
~..--.~: I OFFICE)
I
'--'..--. I + I
'--' I I
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I LEDS l' I
I PART II I I
I APPLICATION I , J: , I , , I
~~ m IIII ,
I I MEDICAL
COMPUTER l DAILY ACTION , PRE-GENERATED
~ r " j LOG- POTENTIAL ADMISSION
NOTICE OF ELIGIBLE PREADMISSION I SCREENING
ELIGIBILITY I I I SCREENING ,
DECISI. 2!!-.. I I I RELEASE I
" r ..... I I I I
- YES I I I I I I
I , I
UPDATE , , I
I I I
LEDS I I I
I I I
+ I I I
I PEIIDING NOTICES
PRE.. ARE AND J I,
FINANCIAL I SEND I NSURANCi' ,
ELIGIBILITY AND FINANCIAL , I
VERIFICATION I DOCUMENTATION I I
I I I ....
~ , I I I I QUALITY , I
I I ASSURANCE , I
CASE I I DOCUMENTATION , , , DISPOSITION ELIGIBILITY I REVIE.!--. I I
ELIGIBILITY
:~ I I
, I DECISION DOCUMENTATI ON I I I I \/' I I
I I I I I
I I I I I ,
I I I I I ,
I I I I , I V4e14
AHCCCS · 73
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MEDICAL ELIGIBILITY DETERMINATION EXHIBIT 42
, ASST REG IIIGR I PHYSICIANS I PHYSICIAJlS
BFE I CLERK REG IIIGR PAS I MEDICAL I
,, I SUPERVISOR WORKERS CLIENT II RECORDS ' CONSIDERATION I
I I
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REFERRAL
+
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I LOGGED AND
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II
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I I SCHEDULES I
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I I APPOINTMENT I
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I I I REQUEST CONDUCTS ,
, I I I MEDICAL PAS I , I I RECORDS +- INTSR I I
I I I I I , I MEDICAL
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I I I RECORDS
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+ I I I
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I I , SCORE ,
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ENTERS \ 1 I I
PAS II I I I
DATA I I
CATS I I I
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I I I I
~ • I I
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QUALITY
CONTROL CLERK
INPUT
LETTER YES'
NOTIFICATION ~ APPROVAL?
OF I
ELIGIBIJ.!!!.. IIIII
PHYSICIANS
II
REVIEW
I REQUEST
I PHYSICIAN'S i~ I REVIEW
II
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REVIEWS I LETTER ~ ~ ~ i~ DECISION I I I
~
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I I I
I I 1 I
I I I I EITHER WAY
I I I V4i15 I DISPOSITION
AHCCCS - 74
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ARIZONA fiEALTH CARE COST CONTAINMENT SYSTEM ( AlleeeS)
Breakout 01 Bureau 01 Medical Eligibility Irom Ihe Division 01 Memoor Services
Project SUM
Program 09: Bureau of Medical Eligibility
Fiscal Year 1992
( 000) State Federal Tolal
FTE Positions 5\. 90 54.10 106
========= c ====-==.=== =========
Personal Services $ 1,305.6 $ 1,358.8 $ 2,664.4
----_.~---- --------
Employee Relaled E_ p 3520 366.3 718.3
--------- --------- -------
Prof & OutsIda & p 216.7 2256 442.3
Travel · Stale 30.2 31.4 61.6
Travel · Oul of Slate 0.3 0.4 0.7
Other Operetlng & p 294.6 306.6 601.2
Equipment 0.0 0.0 0.0 -------_..- ..-----_.-.._- ------_._-
All Other Operating & p f. 41.8 564.0 1,105.8
-"--------- _..._..._--_...._-
Tolal Admlnlslrative Req 2,199.4 2.289.1 4,488.5
========= ==-======= === 1:====:'
Tolal Program Roq 0.0 0.0 0.0
======:::: c= ========= ===== lIIa=_
AHCCCS Orand Total 2,199.4 2.289.1 4,488.5
========= ========= ========-
Other Tolal 0.0 0.0 0.0
===:::=:==== ========= =====-::_ aa
Total Implementatlc n Aeq $ 2,199.4 $ 2.289.1 $ 4,488.5
=======:::::: ========= ========: c
1. Personal Services was Iaken Irom Ihe FY 1992 Budge1Aequos~ Schedule 50, Cosl Cenlors 0903 and 0932 through
0945.
2. ERE Is 26.96% 01 ! he Personal Services amoun\.
3. P& O was Iaken Irom tha FY 1992 Budgol Aequesl, Schedule 7 ' lhislncludos $ 20,000 lor logal e_ ponses,
$ 119,700 lor PAS Tool Revision, $ 102,600 lor CMSA, $ 155,000 lor Physician lIevlow, $ 45,000 lor PASARR.
4. Travelln · Stale was anelyzed by Bureau from 7/ 1/ 91 through 12/ 15/ 91. The percontage 01 tolal dollars spont
In Non · Public Transportation, lodging and Por Diem by BME ' or lhls period Was muhlpliod by Ihe FY 1992
OMS lIavelallocatlon ( SchedUle 8, In the FY 1992 Budgot AC9ueslj.
Dale prepared:
EXHIBIT 43
27 · Jan92
01: 47 PM
5. ODE e_ pendilures were analyzed by Bureelllrom 7/ 1191 through 1/ 10192. BME ." ont23% 01 lolal
e_ pendilures for lhe division for Ihls period. BME's poltlon 01 Flold Ollice Rontl. Includod In the ODE
Iigure above. However, rent cen not be soparolod because OFE ' unctlons must continue. The total cosI 01
aillioid ofllce rent Is $ 1,116.5.
- - - - - - - - - - - - .. - - - - - -
- - - - - - - - - - - - - - ~ JIP - - -
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Of
ARIZONA llEALTH CARE COST CONTAINMENT SYSTEM (/ lIICeeS)
Breakout 01 Burealll 01 Financial Eligibility Irom Ihe Division 01 Member Services
Projecl SLIM
Program 09: Durnu 01 Financial Eligibility
Fiscal Vear 1992
( 000) Stela Federal Tolnl
HE Positions 128.90 132.10 259
=:======== :=:======== :::. 0======= 1::
Parsonal Sarvlcas $ 2,533.1 $ 2,638.5 $ 5,169.6 -------.-- ----------- ------------
Employee Ralaled Exp 682.9 710.8 1,393.7
..._-_...-_.--- ------_....------- ----------
Prol & Oulslda Exp 9.8 10.2 20.0
Traval - Siale 21.9 22.7 44.6
Travel- Oulol Stala 0.0 0.0 0.0
Other Operating Exp 610.4 666.5 1,300.9
Equlpmenl 0.0 0.0 0.0
-----._-.----.---_.-.-. _..._---.-..._-----_...- -----.----------
All Other Operallng Exp 672.1 699.4 1,371.5
---------------- --------._-- ----_._-----
Tolal Admlnlslratlve Req 3,866.1 4,046.7 7,934.8
========= ========= =========
Tolal Program Req 0.0 0.0 0.0
========= ========= ========~
AHcCCS Grand Tolal 3,808.1 4,046.7 7,934.8
========= ========= =========
Other Total 0.0 0.0 0.0
=======-=== ====== e== =========
Tolallmplemanlatlon Aeq $ 3,800.1 $ 4,046.7 $ 7,934.8
========= ========= =========
NOTES:
1. Personal Services was taken Irom Iha FY 1992 Budgel Requesl, Schedula 50, Cosl Cenlers 0902 and 0912 through
0925,
2. ERE I. 26.96% ollha Personal Services amount.
3. P& O was laken from Ihe FY 1992 Budgel Request, Schedule 1 - Ihls Includes $ 20,000 lor legal expenses.
4. Travelln- Slala was analyzed by Bureau from 7( 1/ 91Ihroull" 12( 15( 91. The percenlage ollolal dollars ~ penl
' n Non · Publlc Transportation. Lodglnll and Per Diem by BFE lor tills period WRS mulliplled by lhe FV 1992
OMS Iravelaflocatlon ( Schedule 8, In I" e FY 1992 Budgel Request).
5. OOE expenditures were analyzed by Bureau Irom 7( 1( 91Ihrough 1( 10( 92. AFE spenl 50% ollolal
expendllures lor Ihe division lor this period. BFE's portion 01 Field Olliee Re,, 1 Is Included In the OOE
figure ebove. However. renl can nol be separated because BME lURelions mllst continue. The lolal cosl 01
alllleld ollice renlls $ 1,116.5.
Dale prepared: 27- JRn · 92
03: 08 PM
DES- AHCCCS B. JGIBIUTY DETERMINATION BUDGET
The percentage of time that Department of Economic Security ellglbUIty workers Spend on AHCCCS
cases is funded by an AHCCCS budget line Itern. Although the funds are provided to AHCCCS, they are
transferred directly to DES through an intergovernmental agreement ( IGA).
As a practical matter, AHCCCS has no control over the management of the DES- placed resources.
AHCCCS does, however, remain accountable for the budget dollars covering these positions. In effect,
AHCCCS is responsible and accountable for resources not under Its control and management.
We recommend appropriating funds to the DES budget Instead of the AHCCCS budget for eligibility
work performed at DES.
Since both management of resources and accountability for resource cost will be under one agency,
there will exist a single control and reporting point for the administrative eligibility appropriation.
Although not quantified here, time savings will also accrue In the area of IGA preparation, modification,
revieW. monitoring, and approval. An IGA will no longer be