The PASSE system was voted in by our legislature last year. Right now, we’re in what they call “Phase I,” and during that time, the PASSEs will manage care for their clients, but Medicaid will keep paying the bills. Then in January 2019, we move into “Phase II,” and the PASSEs’ decisions about our care will matter. In January, DHS/Medicaid will give the PASSEs the money and allow them to decide how to use it.
If you need a reminder, the PASSE stands for Provider-led Arkansas Shared Savings Entity, and like insurance companies, they will be covering the care for tiers 2 & 3, what DHS considers to be higher level need, of behavioral health and developmental disability services.
DHS has assigned thousands of people to the 4 licensed PASSEs after each person’s Independent Assessment completion. If you are affected, you will likely first receive a letter or some sort of notification to schedule an Independent Assessment.
If you have questions, DHS has a PASSE counseling line: 1-833-402-0672. They also have regional people you can talk to.
MSL is actively working to get you more information on the PASSEs themselves. Now that details are coming together, we should be able to get more. The information we have so far is listed below in steps that should help you.
These changes may be happening to you or a loved one, but you can do these 8 things to help yourself in this new process:
1. Make sure your provider knows about the PASSE and everything it involves.
It’s important that you ask your provider to join every PASSE. What if next year, you need to switch PASSEs because of a bad experience, but your provider isn’t in any other PASSE? If they choose to join only one PASSE, you could be forced to make a decision between 2 (or more) providers you really like. What if your trusted Cardiologist who did your surgery is in only one PASSE and your Therapist who you’ve been with for years is only in another? You might have to choose. However, even after you ask your provider to join all PASSEs, they may still choose to join only one because they have invested in that PASSE or simply because it’s a business decision. They have that right, but you still have to look out for what’s best for you; for the people whose care and services will be managed by the PASSEs, it’s best for us to have as much choice and freedom as possible. The only way you can have that is when providers give you choices by joining all PASSEs. Some PASSEs have said they will pay for out-of-network costs or make special agreements, but that’s probably only for providers you don’t see often.
DHS said that they are in the process of setting reimbursement rates for providers – the actuary process. Because of that, some providers will not know what you mean when you mention the PASSE to them. Their business office may know and may be waiting on these rates before making any decisions. However, you can still take this information to your provider and/or to the business office.
The following packets are ones that DHS has distributed to providers. Don’t assume yours has received it. Every provider you use needs to be sure they understand this info about the PASSEs. The last is a collection of contact information of all PASSEs specifically for providers to help them join. Take care of yourself, and take these to every provider you see.
- A Family letter to take to your providers that explains this for you
- Resource that was sent to PCPs
- Resource that explains PASSEs Phase I
- Resource that explains PASSE Phase II and updates
- Resource for providers that explains why and how to join
- Give them the contact information below
Some have been concerned whether ACH is covered. This is the response:
“State supported hospitals UAMS and ACH will be enrolled with every PASSE. Many doctors are enrolled through their networks but may not know that yet. You can call every PASSE and interview them so you are making an informed choice.”
2. Get to know the PASSEs.
*MSL has requested websites for all – check back for updates.
Arkansas Total Care
Empower
Summit (Arkansas Provider Coalition)
- Amerigroup Partnership Plan LLC
- http://www.summitcommunitycare.com
- Their HANDBOOK (rules, your rights, and information)
- Network Provider Directory
- Jason Miller
Jason.miller@summitcommunitycare.com
- 425 W. Capitol Ave. Suite 233 | Little Rock, AR 72203
- 1-844-405-4295
ForevercARe
3. Join a PASSE Advisory Committee.
Each PASSE is required by Act 775 (pg 9, line 21) to have a Consumer Advisory Council to give them feedback. They know how things are supposed to happen, but it’s up to you to keep them informed of what’s really happening.
Call your care coordinator to join your PASSE’s council.
4. Remember, you have choices.
Once you have been assigned a PASSE, you have 90 days to change to another. Call your PASSE, and make sure they include your providers. If they don’t, use the info above to find a PASSE that better suits you. DHS is also going to offer open enrollment in October 2018. We will continue to provide more info as we can!
Also, DHS will have open enrollment in March 2019 for all current members. During that time, you will be allowed to switch to another PASSE, and by then, we should know more.
5. If you don’t agree with your assessment results, which you should receive in the mail, know you can appeal.
You have rights, and you can appeal DHS decisions. This is a very new process, and assessors can make mistakes. Check this post to see what your rights are and how to file an appeal. Watch our Q & A with Disability Rights where we answered common questions.
6. If you feel lost, take some time to catch up.
What is a PASSE? Will you be affected? MSL has been following the PASSE from the very beginning. Take some time to catch up and read all about them.
7. Keep MSL informed.
If you learn anything, especially from a specific PASSE, share it with us! If you have any problems, MSL works to solve those for you. Please let us know by:
8. Think about how you’re feeling now, remember that at the next vote.
Our legislature voted this into effect. We called, we emailed, and we visited – all to let them know what we need. If you feel that this good for you, remember that, and perhaps send a note to let them know. You might want to vote for your representatives again. If you feel they didn’t listen to you or didn’t represent you well by voting for this, you should send them a letter to let them know. However, you also have the power to change who is in office. Make sure you place an informed vote. See how your local Representatives or Senators voted on Act 775.
Medicaid Saves Lives 