JUSTICE GROUPS


Dashboards

The dashboard is now available to authorized users. To access, go to data.tipqic.org and sign in.

Tutorials to help make the most of the dashboards:




Measures

In TI Program Years Four and Five, milestone incentive payments will be based on performance measures in contrast to the Core Components used in Years Two and Three. Year Four and Five metrics align with various other applications and uses, including the CMS Core Set and Statewide TI measures. For the Year Four and Five Milestones specific to each Area of Concentration, please refer to the AHCCCS website.




Measure Evaluation & Attribution

Read below or watch the Justice Measure Evaluation & Attribution video (Slides)

  • Attribution is done using member referral lists. Members will be included in a TI participant’s denominator if they meet all measure denominator criteria and were referred to the TI-participating organization within the two years prior to the end of the measurement year.
  • Member enrollment and numerator compliance requirements for each measure align with HEDIS standards with some modifications for the Justice population. Details are indicated below:
  • Alcohol and Other Drug Abuse or Dependence Treatment (AOD): 1+ Visits in 34 Days

    • The standard HEDIS measures for initiation and engagement of treatment have been replaced with a custom AOD-34 measure.
    • To qualify for the denominator, members must be enrolled on the episode end date through 34 days after the episode end date with no breaks in enrollment.
      • This differs from HEDIS standards, which require enrollment from 60 days prior to the episode end date through 48 days after the episode end date with no breaks in enrollment.
      • The episode is defined as either an inpatient or outpatient visit with an AOD diagnosis and qualifying service (e.g., IET stand-alone visit or detoxification). If a member has multiple denominator-qualifying episodes in the measurement year, only the first episode is considered for the measure.
    • To qualify for the numerator, members must have at least one qualifying follow-up visit within 34 days of the episode end date.
      • This differs from HEDIS standards, which require at least one follow-up visit within 14 days (initiation of treatment) and at least two follow-up visits within 34 days of treatment initiation (engagement of treatment).

    Follow-Up After Hospitalization for Mental Illness (FUH), 7/30 Days

    • No changes from HEDIS standards.
      • See HEDIS Resources for HEDIS measure definitions and qualifying billing codes.
    • Attribution is done at the level of hospitalization episodes.
    • Day Zero is the day of discharge and is not eligible to be included in the 7/30 days follow up after hospitalization. This is a CMS and NCQA policy. AHCCCS seeks to align with the national standards to the greatest extent possible.

    Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)

    • To qualify for the denominator, members must be enrolled for at least 180 days during the measurement year. There are no restrictions on the number or length of enrollment breaks.
      • This differs from HEDIS standards, which require enrollment for the full measurement year with no more than 1 break of no longer than 45 days.
    • No other changes to HEDIS denominator- or numerator-qualifying criteria.
      • See HEDIS Resources for HEDIS measure definitions and qualifying billing codes.



Telehealth

Several TI performance measures allow qualifying visits to be conducted via telehealth. AHCCCS adopted telehealth coverage changes pre- and intra-pandemic that require specific procedure code modifiers, rather than place of service “02” (telehealth). Therefore, the TI team has taken steps to ensure that all telehealth visits are counted accurately for measure evaluation.

Encounters that fit any one of the three criteria below will be counted as telehealth:

  • Place of service = “02” (telehealth)
  • The encounter has a procedure code listed on the AHCCCS telehealth code set with the “GT” or “GQ” procedure code modifier, a qualifying place of service, and service date on or after 1 Oct 2019.
  • The encounter has a procedure code listed on the AHCCCS temporary telephonic code set with the “UD” procedure code modifier and service date on or after 17 Mar 2020.

Additional information can be found on the Medical Coding Resources page on the AHCCCS website and in the TIP April 2021 QICs.




Performance Measurement Targets

An AHCCCS Committee in consultation with CHiR established the targets. The committee considered National Medicaid Performance, AHCCCS Historical Performance, TIP Historical Performance, AHCCCS Minimum Performance Standards (MPS), and TI Fiscal Year 2019 and 2020 performance to determine TI Year 5 targets. The identity of the TI participants was blinded.

  • A single target was established for each measure. To qualify for the performance incentive, Organizations must improve from their performance level in the baseline year to meet or exceed one of the two options below, whichever is lowest:
    • The target established for the measure, OR
    • 10%-points above the Organization’s performance in the baseline year.
  • If an Organization’s baseline performance is above the target, they must maintain performance above the target in the measurement year in order to qualify for the performance incentive.
  • Examples of this logic:
    • The AOD measure has a target of 78%.
    • Provider A has a performance of 65% in the baseline year. To qualify for the performance incentive, the Organization must improve to equal to or greater than 78% in the measurement year.
    • Provider B has a performance of 60% in the baseline year. To qualify for the performance incentive, the Organization must improve to equal to or greater than 70% in the measurement year.
    • Provider C has a performance of 85% in the baseline year. To qualify for the performance incentive, the Organization must maintain performance equal to or greater than 78% in the measurement year.
  • Tiers and targets may differ across AOCs for the same measure. These differences accommodate variation in attribution methodologies.

  • Justice Targets

    AOC Measure Description Y5 Target
    Justice Alcohol and Other Drug Abuse or Dependence Treatment (AOD): 1+ Visits in 34 Days 78%
    Follow-Up After Hospitalization for Mental Illness: 18 and older (30-day) 85%
    Follow-Up After Hospitalization for Mental Illness: 18 and older (7-day) 68%
    Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) 68%


    Justice Year 4 Incentive Payments

    • AHCCCS will de-weight the performance measures for determining the incentive payments for the providers. The basis for the incentive payment will be limited to the 1 QIC and submission of IPAT scores.




Referral Lists

Read below or watch the Justice Referral Lists: How to Prepare video (Slides)

    Monthly Referral Lists Due to CHiR on the 15th of Each Month (Starting 11/15/2020)

    • Include members released from incarceration and referred to a TI-Justice Clinic, as well as members referred to a TI-Justice Clinic via Diversion Programs (e.g. drug court)
    • Include all TIP-Justice referrals made during the previous month (first day of previous month through last day of previous month)
      • For example, file due 12/15/2020 to include TI-Justice referrals 11/1/2020 – 11/30/2020
    • Each referral in the Referral List should include:
      • File Source: Organization sending the referral list
      • AHCCCS ID: A# for individual referred to a TI-Justice Clinic
      • Referral Date: Date member was referred to the TIP Justice Clinic (For the ReferralDate column, use the "3/14/2012" date format in Excel)
      • Referral Source: Organization/ Entity that referred the member, and
      • Referral To: TI-Justice Organization that the member was referred to
    • Use this template file with columns for each of the data elements required


    File Naming Conventions

    • Use the following conventions for the file name: ReferralList_[OrgName]_[YYYYMM].xlsx
      • [OrgName]: Name of your organization - Use the values allowable in the "FileSource" field (e.g. AzCH, BUFC, Care1st, CHA, etc.)
      • [YYYYMM]: Month and year of the most recent referrals in the file - If the file includes referrals made through September 30th 2020, then this value would be 202009
      • Example: ReferralList_AzCH_202009.xlsx


    Additional Preparation Notes

    • Title the sheet containing the referrals as "ReferralList"
    • Use the column names as they are shown in the template file - do not reorder or rename the columns
    • Do not include extra notes or data outside of the columns in the template file
    • Please submit via SFTP by the 15th of the month