Differential Adjusted Payment Program CYE 2025

Differential Adjusted Payment Program CYE 2025

DAP Program & Health Information Exchange

The Arizona Health Care Cost Containment (AHCCCS) Differential Adjusted Payment aims to distinguish providers that have committed to supporting designated actions to improve patients’ care experience, improve members’ health and reduce cost of care growth. An integral part of the DAP program includes participation in and meeting milestones related to a qualifying health information exchange organization, such as Contexture, Arizona’s HIE.

The program has proven to be a success and continues to expand to include new provider groups across the state for related DAP requirements within:

  • Health Information Exchange (HIE)
  • HIE Data Quality Indicators
  • Social Determinants of Health (SDOH) – CommunityCares
  • Arizona Healthcare Directives Registry (AzHDR)
  • Crisis Providers

AHCCCS Public Notice

Preliminary Public Notice Posted January 31, 2024

Final Public Notice to be Posted March 16, 2024

Scope of Work (SOW)
Due: April 1, 2024

Scope of Work (SOW)
Eligible providers must submit a Scope of Work (SOW) for each DAP Program provider type they wish to participate in. A SOW is required in order to participate in the program. If you intend to participate, Contact Contexture or your Quality Improvement (QI) Advisor to complete and return your SOW and provider forms. If you do not know your QI Advisor, email DAP@contexture.org.

If you have questions about the DAP Program for CYE 2025 as it relates to HIE milestones, Data Quality Indicators, AzHDR, Crisis Provider or SDOH milestones, or if your organization has not yet signed an Arizona HIE Participation Agreement, please contact DAP@contexture.org.

AHCCCS Eligible Provider Types HIE Increase HIE Data Quality Indicators Increase SDOH Increase AzHDR Increase Crisis Providers Increase
Hospitals Subject to APR-DRG Reimbursement (Type 02) excluding Critical Access Hospitals

0.75%

0.75%

0.5%
Critical Access Hospitals (CAH) 8.0% 1.0% 1.0%
Other Hospitals and Inpatient Facilities (Types 71, B1, B3, B5, B6, C4) 0.75% 0.75% 0.5%
IHS and 638 Tribally Owned and/or Operated Facilities (Type IHS/638) 1.5% 0.5% 0.5%
Nursing Facilities (Type 22) 0.5% 0.5%
Behavioral Health Outpatient Clinics and Integrated Clinics (Types 77, IC) 1.0% 1.0%
Physicians, Physician Assistants and Registered Nurse Practitioners, (Types 08, 18, 19, 31) 1.0%  —
Provider Specialty (Obstetrics and Gynecology, Pediatrics, Cardiology and Nephrology) (Types 08, 18, 19, 31) 1.0% 1.0%
Behavioral Health Providers (Types A3, A4, A5, A6) 1.0%
Home and Community Based Services Providers (Type 23) 1.0%  2.0%
Home and Community Based Services Providers (Type 49) 1.0%
Home and Community Based Services Providers (Types 39, 40, 46, 95, F1) 2.0%
Crisis Bed Registry Providers (Only existing Participants with a Crisis Bed Registry SOW signed by 12/31/22)

(Types B5, B6, B7, 71, 77, IC)

3.0%

Note: Providers may earn any increase up to the maximum indicated in this chart.

Webinar Recording & Presentation

To learn more about the DAP Program, HIE, AzHDR, SDOH and Crisis Provider Milestones or Data Quality Metrics, check out the links below.

DAP CYE 2025 Webinar Recording: Click Here

DAP CYE 2025 Presentation Slides: Click Here

Questions?

  • Existing HIE Participants should contact their Contexture quality improvement advisor with questions.
  • If you’re new to the DAP Program or need more information about DAP, please contact our QI team at DAP@contexture.org.

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