Will I lose my Care Coordinator?

A big question that many people with developmental disabilities have is:

WILL I LOSE MY CARE COORDINATOR?

The not-so-simple answer is that no one can answer that right now. It depends on who your PASSE is, and how they decide to handle this.

DHS has released a presentation that explains what a Person Centered Service Plan is and what a care coordinator is, but here’s an explanation of what’s going on.

In 2008, a federal regulation went into effect requiring care coordination and case management to be done by different people, but Arkansas has continued in most cases allowing the same person to combine both jobs into one job. The rule is supposed to serve as a check & balance to protect people getting services. DHS says we won’t get anymore leniance, and we have to follow the “conflict-free case management” rule starting in 2019.

According to DHS, it has the financial records of all care coordination and case management hours spent, and it included that in the data used to determine what the big global payment will be. In order to be in compliance with federal regulation, DHS will require the PASSE to do 3 big duties to cover “care coordination” and make it become “conflict free.”

How will the rest work? DHS says that the money to pay for the big 3 “conflict free” duties AND the rest of the duties now called “case management” will be given to each PASSE in the global payment. So in other words, the global payment will not just cover services like therapies and supported living; the global payment will include administrative needs like case management that your provider has been doing for you. DHS will give the PASSEs that money in 2019 and allow them to choose how to spend it.

What does all of this mean?! Well, this basically means that your PASSE would choose whether or not to pay your current care coordinator, and the PASSE gets to choose whether or not you keep your same care coordinator (who would in 2019 be called your case manager).

Clear as mud? Thought so. Find out more below about what a care coordinator will do and what a Person Centered Service Plan is!

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Compare Medicaid in each State

Each and every state may have Medicaid, but it is not all run the same. According to ASHA, “State regulations and standards differ greatly in other areas of Medicaid, including:

  • provider requirements for Medicaid participation, credentialing, and supervision;
  • documentation requirements for plan of care approval, criteria for services, authorization, and reimbursement justification;
  • Medicaid audit process and penalties for errors;
  • use of the Children’s Health Insurance Program (CHIP).”

Make sure you’re aware of these differences. For example, TEFRA is an optional waiver that not all states carry, and if they do, they don’t utilize it the same. For example in Arkansas, if a child meets the health requirements, it is accessible for families, no matter their income, on a sliding pay scale. However, the way we understand its application may be specific to Arkansas. If you move, you may not have TEFRA at all.

So how can you know what’s available to you? Use the resources below to find out more about Medicaid and how it’s different across the US!

What if your state has limited resources? There may be more out there than you know. Look around at state and local resources. There are national programs, state benefits, foundations, organizations, and grants that may help you in a bind. For example, check out this list of foundations that assist for children’s special needs.

If Medicaid matters to you, please constantly tell your elected officials. The trend is to cut Medicaid and provide those funds elsewhere. Get the facts to boost your confidence, but don’t stop communicating! Tell your legislators why Medicaid saves you! Here are some ways we could see Medicaid change in coming years.

Each link leads to a different resource we’ve found to try to help you with info or tangible resources. MSL will add to this list as we find more!

Allen’s Story

Author: Julie Shimkus

This is Allen Shimkus, age 5. His diagnosis: Agenesis of the corpus callosum, seizures, legally blind.

ACC is a rare birth defect (congenital disorder) in which there is a complete or partial absence of the corpus callosum. It occurs when the corpus callosum, the band of white matter connecting the two hemispheres in the brain, fails to develop normally.

Allen NEEDS PT, OT, AND SPEECH THERAPY to teach his brain to do everything from chewing food to walking. Medicaid helps pay for all of his therapies, specialist appointments in Little Rock, the many PCP appointments, emergency helicopter and Ambulence rides, MRI’s, CT scans, his dentist, diapers, and all of his much needed medications.

My 5 year old son Allen (pictured here) can not dress himself, feed himself, walk or even speak, but he has the potential to do all!!!! Thanks to Medicaid, a huge part of my son’s health, therapy, and way of living. Thank you to everyone that has helped Allen on his long journey.

 

Take Action: June Legislative Committee Meetings

Update (6/5/18): The rules were approved in the Public Health joint committee and will be next voted upon by the ALC Rules & Regulations Joint Committee on Tuesday, June 12 at 1pm in Little Rock. Contact the committee members. Read below to catch up if you wonder which issues are being voted upon.


Original post: MSL has announced on Facebook that this committee meeting would be occurring on June 4th and that it was moved to Jonesboro. Here is some information to help you to understand what’s happening when, and what you need to do.

If you’re lost and need to catch up, you can watch a video we previously released on the subject.

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Several important issues are being discussed that affect children as well as adults:

Here is how you can contact the people of the Public Health Committee:

PASSE – Phase II Updates

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DHS recently released a new presentation with updates to their work on the PASSEs Phase II. This includes milestones and network adequacy standards, and where they are with Independent Assessments.

They did listen to our concern that people have been enrolled before the networks were adequately formed, and they will hold open enrollment in October of 2018.

Catch up on all previous PASSE posts!

Your Rights When You Appeal

We appeared live on Facebook with Managing Attorney Thomas Nichols from Disability Rights Arkansas to answer your questions and discuss your rights when appealing a Medicaid decision. Watch because this video is full of helpful information from beginning to end!

Thomas refers to a presentation with more information on appeals that you might want to view.

When filing an appeal, you have resources in the state to help you. Even if you can’t afford it, you can find quality lawyers or law advice. Make sure to contact:

Also, we reference Rights that we listed in a previous post. Make sure to read it.

2018 Election Info

It’s election season! In fact, early voting for primaries has begun. That means it’s time for you to do some homework and make decisions about which issues are most important to you. Sometimes your values on different issues may clash, which is why it’s important to rank one of them as most important to you.

Medicaid is a hot topic. We’ve seen a lot of change, and depending on the officials we elect, we may see even more. That’s why it’s important to be informed about election deadlines, requirements, and the candidates.


Your first question might be:

Who’s running?

Click here to find out.


Next you’re probably asking:

What are the deadlines?

Elections for the office of Arkansas House of Representatives will take place soon!

  • candidate filing deadline – March 1, 2018.
  • primary election – May 22, 2018.
  • primary runoff election – June 19, 2018.
  • general election – November 6, 2018.

All 100 House seats are up for election in 2018. Arkansas state representatives serve two-year terms, with all seats up for election every two years.

Elections for the office of Arkansas State Senate are also happening soon.

  • candidate filing deadline – March 1, 2018,
  • primary election – May 22, 2018.
  • primary runoff election – June 19, 2018.
  • general election – November 6, 2018.

A total of 18 seats out of the chamber’s 35 seats are up for election in 2018.Arkansas state senators serve one two-year term and two four-year terms each decade.

Arkansas will also hold elections for Governor, Lieutenant Governor, Attorney General, Secretary of State, Auditor, and Treasurer on November 6, 2018. The candidate filing deadline was March 1, 2018.

The 2018 U.S. House of Representatives will hold elections

  • candidate filing deadline – March 1, 2018,
  • primary election – May 22, 2018.
  • general election – November 6, 2018.

Arkansans elect representatives to the U.S. House, one from each of the state’s four congressional districts.


How can I be informed about the candidates?

As candidates are campaigning, make sure you take every opportunity to inform yourself. Know what questions to ask!


Have I met the requirements to vote?

Voter Registration

To register to vote in Arkansas you should provide one of the following:

  • The Last Four Digits of your Social Security Number
  • Your Arkansas Driver’s License Number

If you do not have any of these IDs, you can provide a copy of one of the following with your registration application:

  • Current and Valid Photo ID
  • Government Issued Document that shows your current name and address
  • Utility Bill
  • Government Check
  • Bank Statement
  • Paycheck that Shows your current name and address

You can alternatively provide one of these documents when you vote to complete your registration.

Voting In-Person

In Arkansas, you need to show a valid ID to vote. You can use any ID from this list:

  • Paycheck that shows your Current Name and Address
  • Current and Valid Photo ID
  • Utility Bill
  • Bank Statement
  • Government Check
  • Government Issued Document that shows your Current Name and Address
  • Veteran Health ID Issued by US Department of Veterans Affairs

Where should I vote?

Find out.


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Source 2

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What if you don’t agree with your Assessment results?

Even though many people may not need to appeal, several of you have asked before about how to appeal your Independent Assessment if you aren’t satisfied with your tier placement. We asked DHS for the appeal policy.

Watch for more resources on how to appeal, tips, and what your rights are!

DHS says that below is the information that you will receive with your Independent Assessment results packet.  Each person will receive this notice after his/her IA has been scored.  These results packets began going out Friday.  Some individuals began receiving PASSE services prior to the receipt of their results packets. 

 If you do not agree with your assessment results:

You, your representative, and your provider have the right to request a hearing.

Requirements for the request:
  1. the request must be received at the DHS Office of Appeals and Hearings’ address below no later than (date calculated from notice mailing date [35 days + mailing date])
  2. Please put your request for a hearing and for any services in writing. With your request, please include a

copy of this letter and mail it to:
Arkansas Department of Human Services
Office of Appeals & Hearings
P.O. Box 1437, Slot N401
Little Rock, AR 72203
Division of Medical Services

If you ask for a hearing, these are your rights, per DHS:

  • You may go to the hearing
  • You may be represented by a lawyer or any other person you choose
  • Before the hearing, you have the right to see your record and any other evidence to be used at the hearing
  • You have the right to present your own evidence
  • You have the right to bring your own witnesses
  • You have the right to question any witness against you
  • You have the right to request, if applicable, certain current services continue “as is” pending an appeal decision if your request is received at the Office of Appeals and Hearings’ address listed above by (date calculated from notice mailing date [15 days + mailing date])

You may be able to get free legal aid.

If you need legal help, DHS sends these recommendations:

 DHS also recommended the following link might be helpful to review:  http://humanservices.arkansas.gov/images/uploads/occ/DHSPolicy1098.pdf to understand the process.

Watch for more resources on how to appeal, tips, and what your rights are!

MSL has attended presentations by other community resources such as Disabily Rights Arkansas who have explained in more detail what to put in your letter and tips you might need. One very important thing to do is MAKE SURE TO KEEP EVERYTHING MAILED TO YOU AS WELL AS ALL ASSESSMENTS OR THINGS THAT COULD BE USED AT THE HEARING. We will be collaborating with these other organizations to release more resources as soon as we can!

 

What to Ask Candidates About Medicaid

Updated: 6/22/18

This year as political candidates are running for election or re-election, they will be asking for your vote. Since our elected officials determine the fate of Medicaid funds, it’s important that we all place informed votes when the time comes. If/when these people ask for your vote, be prepared to ask them some questions in return!


Cuts to Medicaid:

Currently, it seems that Medicaid is taking big hits to funding in all areas.

  • Are you familiar with the many changes that Medicaid recipients are experiencing?
  • Do you believe that Medicaid needs further cuts?
  • How would you improve Medicaid spending without cutting it?
  • What is your position on adding more restrictions — such as work requirements or enrollment freezes — to programs like Medicaid?
  • How will you ensure that physicians and providers are receiving adequate training about the many Medicaid changes?

Access to Health Care:

In addition to coverage, it is important that families can get the high-quality health care treatment they need. Currently, people struggle to find a doctor who will accept Medicaid to treat them, or they don’t have transportation to the next available provider. By putting the right policies in place, we can improve access to care for all Arkansans.

  • How will you ensure that all children and families in Arkansas have access to high-quality health care?
  • At times, people who work full time can’t access quality healthcare, and they are forced to depend on Medicaid. How will you ensure that more jobs provide quality healthcare coverage, so that people may not need Medicaid?
  • How can you get more providers all over the state to accept Medicaid patients?

 

Coverage for All Children:

Today, 96 percent of children in Arkansas have health coverage because of ARKids, funded by Medicaid, and the Children’s Health Insurance Program (CHIP). It ensures over half of children in the state have a reliable source of coverage that their families can afford.

  • How will you protect health coverage for children?

Special Needs & Disability:

Arkansas has a good reputation for providing for special needs populations. However, recent actions seem to move toward what surrounding states are doing, which is not acceptable.

  • How would you protect the funding for special needs and disabled people?
  • Currently thousands of people are waiting for needed services. What ways do you see to move people off of the DDS Waiver Waiting List faster to get the services they need?
  • Would you move this population to managed care if the current PASSE system doesn’t work?

Behavioral Health Needs:

The Behavioral Health options in this state are lacking, especially when it comes to timely treatment state-wide for someone with those needs.

  • How would you improve Behavioral Health treatment options for those on Medicaid across the state?
  • Would you move this population to managed care if the current PASSE system doesn’t work?

Arkansas Works:

Up to 300,000 adults have access to affordable health coverage because of the state’s Medicaid expansion program, Arkansas Works. This program uses Medicaid funds to enroll eligible adults in a private insurance plan at little or no cost to them.  It has also helped hospitals and doctors who were treating patients that were unable to pay for care.

  • What is your position on providing affordable coverage to adults who are low-income earners?
  • Now that a work requirement is being enforced, what job-training and educational resources do you think the state should provide?

Please press these issues and make sure that the people you vote for will work for you!  Submit more questions!