PASSEs: Learn More

Everyone is wondering about the PASSEs. How can we find more information? Will I be affected? Well, the bad news is that there’s so much to know it’s overwhelming. But the good news is that MSL is here to help.

Let’s break it up into pieces. First let’s start with the info they’ve already given us and the resources available to us – gathered all in one place!


Resources

1. If you’re thinking, “I don’t even know what a PASSE is,” then you need to begin at the beginning with this post. It will help you understand what all of this means.

If you’re familiar with the PASSEs, but you have questions, proceed to resources 2 & 3.


2. DHS has a PASSE Choice Counseling line you can call. If you want to switch PASSEs, you can call this line. You can also call to report if you feel anyone with a PASSE is doing anything incorrectly or wrong, such as sharing information that you know to be incorrect or if one of them has tried to force you or persuade you to join their PASSE.

3. Last, every PASSE has a 24/7 help line for you to call as needed:

  • AR Total Care // 866-282-6280
  • Empower // 866-261-1286
  • ForevercARe // 855-544-8744
  • Summit Community Care // 844-405-4295

Info On Each PASSE

Each PASSE has a handbook where most of their information is held, and each one is different. The handbooks explain who the PASSEs are, important resources available to you, what your rights and responsibilities are with each PASSE, how you can appeal or file a grievance, and how to change to another PASSE. Some of them also list their networks, although none of them are complete at this time.

In addition to the handbooks, representatives from the PASSEs shared information about their groups at the AWA Conference a couple of weeks ago. Each of them had a presentation, and they are all available for you to see!

How can you contact them? Who are their partners? Who are they? Keep reading to find out!

Arkansas Total Care
  • John Ryan
    jryan@centene.com
    P.O. Box 25010 | Little Rock, AR 72221
    1-866-282-6280
  • This graphic shows their partners:

Empower Healthcare Solutions
  • Nicole May Nicole.May@beaconhealthoptions.com
    1401 West Capitol Avenue, Suite 330 | Little Rock, AR 72201
    1-866-261-1286
  • This graphic shows their partners:

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ForevercARe
  • Michael McCabe
    mmccabe@forevercarehealthplan.com
    400 West Capitol Avenue, Suite 1700 | Little Rock, AR 72201
    1-855-544-8744
  • This graphic shows their partners:

Summit Community Care
  • Jason Miller
    Jason.miller@summitcommunitycare.com
    425 W. Capitol Ave. Suite 233 | Little Rock, AR 72203
    1-844-405-4295
  • This graphic shows their partners:


Chew on this info, and we’ll have some more in depth information as soon as we can.

Upholding the ADA: Living in the Community

Everyone on the CES Waiver, all of you who enjoy having your loved one living near to you instead of in an institution, & providers who support waiver services:

The ability to live freely in the community has been questioned, according to this article, by a top official with the US Department of Health and Human Services, enough to alarm a group of Congressmen. They formed a bipartisan group and took action.


“The lawmakers said they were told that Lazare said she believed the Supreme Court came to the wrong conclusion in the landmark Olmstead v. L.C. case, which affirmed the right of people with disabilities to access community-based living, and that she prefers segregated and institutional settings. In addition, Lazare reportedly said she believed that a federal Medicaid rule outlining what types of settings qualify as community-based should be revisited, according to a letter from Reps. Jan Schakowsky, D-Ill., Gregg Harper, R-Miss., and Jim Langevin, D-R.I.”

Even when things are quiet in the news, someone in power is thinking these things. Maybe they want to save money, or possibly they think less of people with disabilities. Some in power think they have the means to change these protections. We need to always be communicating to our legislators why we want to live in the community or why we want our loved ones out in the community instead of institutions. We need to know our rights and assert them!

Laws that protect people with disabilities

The ADA National Network

Take a moment to make our Congressmen understand how much living in the community means to us. They are the ones who would have to fight a battle that threatens the ADA.

Contact our Arkansas Congressmen!!

Contact any US elected official!

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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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:

Screen Shot 2017-11-14 at 11.45.56 AM


Presentation for Providers:

Screen Shot 2017-11-14 at 11.56.46 AM


Training that was sent to all PCPs:

Screen Shot 2017-11-14 at 12.00.05 PM


Previous related MSL posts:

Independent Assessment Manuals