Arizona Health Care Cost Containment System—Review of Selected Behavioral Health Services
Learn how the AI-generated research projects were createdOverall Conclusion
AHCCCS did not ensure all peer specialists met qualification and supervision requirements; some peer specialists were not supervised, potentially jeopardizing the quality of peer support services. The agency should enhance oversight and monitoring of contracted health plans to ensure compliance.
Source Document
Audit Scope
Scope: AHCCCS administration of behavioral health services, including peer and recovery support specialists’ qualification and supervision requirements, the AHCCCS Housing Program (including Scattered Site and Community Living Program), and related reporting and governance; time frame largely FY2021 with specific datapoints through March 2022 (peer specialist sample from Oct-Dec 2021; housing waitlist data through Mar 2022).
Key Findings Summary
AHCCCS provided behavioral health services to more than 583,000 members in fiscal year 2021 and spent over $2.7 billion, but did not ensure all peer specialists met qualification and supervision requirements, potentially jeopardizing the quality of services.
AHCCCS has established behavioral health performance measures and contracts for independent assessments, including services provided to members with a serious mental illness (SMI).
Did not ensure that 21 of 23 peer specialists reviewed met both State and federal qualification requirements and/or were supervised according to requirements, potentially jeopardizing the quality of peer support services.
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AI-Assisted
AI Scope Summary
Build on this report by applying a similar scrutiny to other Medicaid programs to ensure peer specialist qualifications and supervision are consistently enforced, and expand oversight of housing-related programs to improve access and outcomes for members with serious mental illness.
AI-Generated Insight
The report identifies critical oversight gaps in AHCCCS's behavioral health services, particularly around peer specialist qualifications and supervision, and highlights housing program management issues. Implementing monitoring processes and standardizing oversight across contracted plans could improve service quality and accountability.
Audit Objectives
To determine whether AHCCCS ensured peer specialists who provide services to AHCCCS members met qualification and supervision requirements and to provide information about the AHCCCS Housing Program, housing-related committees and work groups, and behavioral health-related reporting requirements.
Audit Findings (8)
AHCCCS provided behavioral health services to more than 583,000 members in fiscal year 2021 and spent over $2.7 billion, but did not ensure all peer specialists met qualification and supervision requirements, potentially jeopardizing the quality of services.
AHCCCS has established behavioral health performance measures and contracts for independent assessments, including services provided to members with a serious mental illness (SMI).
Did not ensure that 21 of 23 peer specialists reviewed met both State and federal qualification requirements and/or were supervised according to requirements, potentially jeopardizing the quality of peer support services.
Directed contracted health plans to oversee the provision of peer support services but did not have a process to ensure this oversight occurs.
Provides housing rental subsidies to eligible AHCCCS members with an SMI and some with general mental health/substance use disorders; as of March 2022, about 2,300 enrolled with 4,134 on waitlist.
Contracts with a Housing Administrator to manage the Housing Program and has established performance measures for assessing Housing Administrator performance.
Administers various committees, councils, task forces, and workgroups related to behavioral healthcare services.
Provides reports to the Legislature, Joint Legislative Budget Committee, and Governor on behavioral healthcare expenditures and programs in response to legal and statutory requirements.
Recommendations (1)
AHCCCS should develop and implement processes for monitoring its contracted health plans’ oversight of peer specialists to ensure they meet qualifications and receive supervision as required.