Pima Health Loses AHCCCS Appeal Bid
By Dale Quinn, The Arizona Daily Star, Tucson
Jun. 12–Pima Health System will lose 90 percent of its acute-care patients after the state’s Medicaid program denied its request to keep most of those members.
About 27,000 patients in Pima and Santa Cruz counties will have a new health-care provider Oct. 1 because the health system, which is a non-profit arm of Pima County, lost its contract, said Jo Ann Siemsen, a Pima Health System spokeswoman.
Arizona’s Medicaid program, called the Arizona Health Care Cost Containment System, awarded the latest round of five-year acute-care-service contracts in mid-May. Acute-care services are used by low-income families with children, pregnant women, children and disabled people.
Officials at Pima Health System are still working to figure how the lost patients will affect the health-care provider, Siemsen said.
"We don’t know what the impact is yet," Siemsen said.
Those who will no longer get health care from Pima Health System will receive a notification in July, Siemsen said. Pima County patients can select from providers that were awarded contracts — Health Choice, Arizona Physicians IPA, University Family Care or Phoenix Health Plan — or they will be assigned to one of those providers, she said. Santa Cruz patients can choose from University Family Care or Health Choice.
Even those who don’t make a decision by Oct. 1 and are assigned a provider will have the option of changing it after that date, said AHCCCS spokeswoman Rainey Holloway.
Also affected by the AHCCCS decision are the more than 170 Pima Health System employees and about $100 million in County expenditures and revenues, according to a memo sent Wednesday by County Administrator Chuck Huckelberry to the Board of Supervisors.
Pima Health System could be downsized by 120 employees because of the reduced number of patients, Huckelberry said.
About 4,000 patients in Pima Health System’s Arizona long-term-care system will not be affected, Siemsen said. The system would continue to operate to accommodate those patients and would likely re-enter the bid process for acute care for the next five-year contract, she said.
The Arizona long-term-care system program is for blind patients, disabled individuals or those older than 65 who need ongoing services at a nursing-facility level of care, according to the AHCCCS Web site.
After Pima Health System was notified it had lost the state contract, it appealed and requested an enrollment cap to keep its existing patients.
AHCCCS notified Pima Health System late Tuesday that it couldn’t find a compelling reason for it to keep all its existing acute-care patients and the enrollment was capped at the 3,000 members eligible for both Medicaid and Medicare — the federal program that provides health-care assistance to those over 65.
Pima Health System had also challenged the bid process, but that appeal was denied as well, Siemsen said.
As of June 1, AHCCCS had 155,816 members with health-care plans in Pima County, Holloway said.
Although Pima Health System has 25 percent of the market share for those clients, it didn’t make the cut in the highly competitive process because its monthly rate per member was higher than the chosen bidders’ rates, system director Virginia Rountree told the Star shortly after the bid was lost.
Follow the latest local health-care news at www.AzStarBiz.com.
–Contact reporter Dale Quinn at 573-4197 or dquinn@azstarnet.com.
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