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.

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!

 

PASSE Q&A Follow-up

DHS recently hosted a FB live about the PASSE to answer our questions, but some of your questions were not answered at that time. The images below show DHS’s follow-up answers to some of the questions.

For those of you who would like to go back and watch the Facebook live video from January 19, click here.





Live Q&A with DHS about PASSEs

MSL took your questions to DHS, and they answered live on Facebook. This video has several good demonstrations and answers that you might need to see. The PASSEs will start taking clients in February 2018.

Watch the video:

New Medicaid Dental Plan

Updated 1/3/18 09:30

 You may have received a letter telling you that your Dental plan has changed. That’s because Arkansas Medicaid has moved their dental coverage to managed care. There are 2 companies: Delta Dental and MCNA. You will be assigned to one, and you have 90 days to switch.

We requested information on the change,  and this was DHS’ response:

The Arkansas Department of Human Services is changing its dental program. Beginning January 1, 2018, two companies will provide dental coverage for families enrolled in Medicaid. Those companies are:

  1. Delta Dental of Arkansas
  2. Managed Care of North America (MCNA)

There will be no changes to the dental services that are covered. Families will be assigned to one of the two companies in December 2017 and will get new dental cards and a welcome packet in the mail for each enrolled family member.
 
If members want to switch to the other company, they will have 90 days to do so. 
Families can begin scheduling appointments for covered dental services after January 1, 2018. Information about what is covered will be in the welcome packet.
 
Clients living in Human Development Centers, individuals enrolled in the Program for All Inclusive Care for the Elderly (PACE), and individuals who are eligible for Medicaid only after incurring medical expenses that cause them to “spend down” to Medicaid eligibility levels will not be enrolled in a dental plan.

It is important to note that as new beneficiaries apply for Arkansas Medicaid benefits, if they qualify for dental benefits, it will take between 15 and 45 days for them to be assigned to a plan and for the plan to complete the enrollment process.  

Then we requested information on the difference between the companies, and this is what DHS said about the new dental plans:

The benefits are identical and the number of dentists in each network is very close to the same (within 1%). The only real difference I can recommend is for the client to check to see if their preferred dentist is in the network to which they were assigned. If confirmed, I suggest they stay with that plan. If not, they should check with the other option to see if their preferred dentist is in that network and they will have until the end of March to change plans if they want to.

Both companies are very good at what they do and have been excellent partners for us to work with.

We also asked DHS to address the rumor that ACH Dentists won’t be covered:

Delta Dental AR has 12 of 17 dental providers at ACH credentialed and in the network. The other five have submitted their applications and are undergoing the credentialing process with the expectation that they will also be admitted to the Delta network. They added that MCNA has also had a meeting with ACH, so we can hopefully expect them to cover ACH dentists as well.

After the new year, DHS sent us more clarifying information on the providers who are included:


[We want to] share the details below to demonstrate how very close the dental provider counts are between the two managed dental care organizations now serving Medicaid clients. MCNA received slightly fewer enrollees due to assignments happening by family (keeping family members in the same plan) but the total number of providers in each network varied by 1 last month. Both companies are continuing to enroll providers including ACH.

On 12/15/17 (the last phase of the auto assignment period) a total of 610,945 beneficiaries were assigned to our two dental managed care companies as follows:

  • MCNA – 304,789
  • Delta Dental of Arkansas – 306,156

As you know, there will be some movement as beneficiaries work through their 90 day choice period.

As of 12/20/17 the two MCO’s have contracted with, or have contracts pending for the following number of dental providers:

  • MCNA
  • Contracts complete – 646
  • Contracts pending – 60
  • 706 Dental Providers


  • Delta Dental of Arkansas
  • Contracts complete – 673
  • Contracts pending – 34
  • 707 Dental Providers




Independent Assessment: How to Be Prepared

Every single person who is a Tier 2 or Tier 3 and receives Medicaid services for a Developmental disability or a Behavioral health issue will undergo an Independent Assessment. This means you need to understand what it is and what will happen. MSL has gathered some resources to help you be prepared:


IMPORTANT INFORMATION

First of all, you’re probably asking, which Tier am I in? Click the link to find out!

If you are Tier 2 or 3, you will receive a notification letter about your assessment. It may come from a company you don’t recognize, but make sure to look for a letter and read carefully for the words Independent Assessment. Once you receive a letter, you will soon receive a phone call to schedule a meeting.

You are allowed to take people with you in these assessments, such as a parent or provider. The assessment itself can take from one hour to three hours. It is critical carefully consider and answer the questions because they determine your Tier placement.

Once your assessment is finished, you will have to wait to receive results. Once they are compiled, both you and your primary provider will receive a copy.


THINGS THAT CAN HELP

DHS has released the following resources to assist you or a loved one in preparation for these Independent Assessments. MSL has gathered it all in one place for you:

  • Read the full assessment itself in PDF form
  • View a presentation to explain the DDS changes
  • View a presentation on IAs for providers
  • Read the training that has been sent to PCPs

The two power point presentations may be of help what is taking place within the DD service system.  Additional information may also be found at the following website https://www.medicaid.state.ar.us/general/programs/passe.aspx.

Click on each image to access the resource.

The Full Independent Assessment people will get:Screen Shot 2017-11-14 at 11.34.00 AM


Presentation for Individuals, Families, and Staff:

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Presentation for Providers:

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Training that was sent to all PCPs:

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Previous related MSL posts:

Independent Assessment Manuals

 

 

What Tier Would I Be Placed In?

Certain people who receive Medicaid through Developmental Disability Services and/or Behavioral Health Services will be contacted about an Independent Assessment – only Tiers 2 and 3. Read the following situations to decide where you might fit:

Developmental Disability Service Tiers

Tier 1:
Individual receives DD services under the Medicaid State Plan (DDTCS, CHMS, therapy, etc.), but does not meet ICF/IID level of care eligibility

Tier 2:
Individual meets ICF/IID level of care eligibility, but does not currently require 24 hours/day of paid support and services to maintain his or her current placement

Tier 3:
Individual meets ICF/IID level of care eligibility and does require 24 hours/day of paid support and services to maintain his or her current placement


Behavioral Health Services Tiers

Tier 1: Counseling
Time-limited services provided by a qualified licensed practitioner in an outpatient setting to assess and treat mental health and/or substance abuse conditions

Tier 2: Rehabilitative
Home and community-based services with care coordination including a full array of professional and para- professional services for individuals with higher needs. Services provided by certified behavioral health agency staff members.

Tier 3: Residential
Services provided in residential setting for individuals with the highest need

Updated PASSE Information

Click the image below to receive comprehensive, updated information on the PASSE systems (as of October 2017). The deadlines have been updated, and if you were wondering what the purpose of the model is, here’s your chance to find out!

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Three PASSEs were officially certified on October 18: Arkansas Advanced Care, ARkansas Total Care and Empower Healthcare Solutions. Read more about them in the image below:

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