PUBLIC COMMENT OPPORTUNITY FOR PASSE and DENTAL

HERE’S YOUR CHANCE to speak up!!

DHS is improving the quality of care for its managed care programs including PASSE & Dental.

The full document includes DHS’s goals and improvement strategies, DHS’s role, standard definitions, and what will happen to PASSEs if they do not follow standards (I.e. not answering phone calls).

Read the full document!

Does the document listing improvements address what you care about? Do you have comments about PASSE or DENTAL managed care performance? This is your chance to review this document and submit your public comments.

Public comments must be submitted in writing at the above address or at the following email address: ORP@dhs.arkansas.gov

Please note that public comments submitted in response to this notice are considered public documents.

A public comment, including the commenter’s name and any personal information contained within the public comment, will be made publicly available and may be seen by various people.

If you have any comments, please submit those comments in writing, no later than June 12, 2021.

Tuesday Tips about ARHIPP

1. If you have primary health insurance that covers at least one person on Medicaid, you could qualify to get your monthly insurance premium reimbursed through ARHIPP.

ARHIPP is run by the Arkansas Department of Human Services Division of Medical Services.

Visit http://www.myarhipp.com to learn more.

2. When you want to check on the status of your application or send important documents, you can email ARHIPP: CustomerService@MyArHIPP.com

3. When you apply, they will ask you to send documents that prove you have primary insurance coverage or a copy of your Medicaid card.

Cases are processed faster when emailing documents.

4. After you are approved, you need to email a copy of your paycheck at least once per month that shows your insurance premium has been withdrawn from your paycheck or whatever monthly proof shows that you have paid your monthly premium.

We know ARHIPP confusion is an issue for many of you. Let us know if you’re having problems, and we’ll try to help.

Keep your questions coming, and we’ll keep the Tuesday tips rolling.

UPDATED: Your rights in the PASSE

We have been asked to update this post for clarity. These are your rights, but we don’t want anyone to lose services. So please see the updates below.

The PASSE system has been going for almost 45 days now. We don’t have many more days of the “transition plan” where our plans are supposedly covered as they were before the PASSE took over. Doctors are saying they won’t join, and some providers are saying they haven’t gotten paid. Some people were put into the PASSE system, and they want out. They’re being told that they can’t get out, but there are things people can do.

You have rights!

(1) There is a lawsuit you can join.

If you feel you’ve been wronged by the PASSE system, contact Thomas Nichols at Disability Rights (tnichols@disabilityrightsar.org). He will want to know specifically how you’ve been wronged:

  • have you ever had to pay out of pocket for a service?
  • have you lost providers and have no other choices in your area?
  • has the PASSE denied to pay for a medicine or forced a new co-pay?
  • has the PASSE denied a service you were getting?
  • have you tried and tried to contact your care coordinator with no response?
  • is your PASSE unreachable? have they returned your calls?

(2) You can opt out of the PASSE. (BUT)

If you call to opt out of the PASSE, you will lose access to the services that only the PASSE program provides.
– You will lose your Waiver slot if you are a person with the DDS Waiver or Wait list. This should be a careful decision because a lot of people have waited a long time for these services.
– If you get BH services, you will not be able to get those higher level services you might need.

Yes, there are ways you can opt out of the PASSE. BUT you need to be careful and protect yourself. Dropping out may solve a problem for you now, but it may cause you a problem later. Make sure you ask all of the right questions (see below). You might still be able to get what they call “State Plan Services,” but you won’t be able to get the “Community & Employment Supports Waiver” or the “Arkansas Community Independence Waiver.” Depending on how you qualify for Medicaid, you might not get any services at all.

DD

If you’re with the Developmental Disability side, that means you are giving up your waiver slot. You might be giving up some services you might need. Also, the way you qualify for the DD Waiver is different than other Medicaid, so you may not qualify for any services. Some people have waited a super long time for services, and we just don’t want you to do anything that hurts more in the long run.

Programs like ARKids and TEFRA are only for “kids.” For example, if you are on TEFRA right now, you could choose to drop your waiver waiting list slot and go back to TEFRA. Please remember that TEFRA only lasts until you’re 19. The service options are limited for adults, so make sure you will have coverage if you drop your waiver slot.

If your plan is to drop out and come back to the Waiver, just know that you do have to start all over again.

BH

If you’re with the Behavioral Health (mental health) side, you can go back to Tier 1 services, but there may be some services you can’t get now. So if you are a child who was with ARKids, but then because of a BH assessment were put into a PASSE, you could go back to ARKids. The way you do this is by not getting your next reassessment. You have to be assessed to be in a PASSE, so if you turn down your next Independent Assessment when Optum calls, they won’t put you in a PASSE.

Questions to ask:

  1. What services will I lose if I opt out of the PASSE?
  2. Which Medicaid program will I qualify for if I opt out of the PASSE?
  3. Can I still go to {name the provider} if I drop out of the PASSE?

If you want to drop out of the PASSE, you need to call the PASSE Ombudsman. They can send you the right direction. 1-844-843-7351

*Remember, if you are on the BH side, you might have to wait until you can refuse your next Independent Assessment.

(3) You can turn down an Independent Assessment.

Everyone in the PASSE is supposed to have gotten an Independent Assessment. If you refuse a re-assessment, you will be dropped from the PASSE program. If you are on the DD Waiver, that means you will lose your spot.

Before you get put into a PASSE, you have to get an Independent Assessment. This company named Optum calls and sets up an appointment. You can turn this down. They may tell you that you have to do it, or you could lose services. You do not have to do it. This is your choice.

Not getting an Independent Assessment for DD or BH does mean that you can’t be in the PASSE system. So look at #2, and make sure you are making the best choice for you.

(4) You can call your legislators.

Call your legislators. They voted this in, and they need to hear if something is affecting you negatively. They represent us, and we need to let them know what’s going on.

Here’s how! Visit:http://www.arkleg.state.ar.us/assembly/2019/2019R/Pages/LegislatorSearchResults.aspx?member=&committee=All&chamber=

Click their name, and it will take you to their contact info.

(5) Switch your PASSE during Open Enrollment in May.

May 1-31 is Open Enrollment time for the PASSE, and that means you can switch to a different PASSE if you want to. If you like your PASSE, you can keep your PASSE. If you want to switch, call 1-833-402-0672. Watch the PASSE networks closely for changes before you switch.

UPDATED: Here are your rights with the PASSE system.

We have been asked to update this post for clarity. These are your rights, but we don’t want anyone to lose services. So please see the updates below.

The PASSE system has been going for 31 days now. We have 29 more days of the “transition plan” where our plans are supposedly covered as they were before the PASSE took over. Some people were put into the PASSE system, and they want out. They’re being told that they can’t get out, but there are things people can do.

You have rights!

(1) There is a lawsuit you can join.

If you feel you’ve been wronged by the PASSE system, contact Thomas Nichols at Disability Rights (tnichols@disabilityrightsar.org). He will want to know specifically how you’ve been wronged:

  • have you ever had to pay out of pocket for a service?
  • have you lost providers and have no other choices in your area?
  • has the PASSE denied to pay for a medicine or forced a new co-pay?
  • has the PASSE denied a service you were getting?
  • have you tried and tried to contact your care coordinator with no response?
  • is your PASSE unreachable? have they returned your calls?

(2) You can opt out of the PASSE. (BUT)

If you call to opt out of the PASSE, you will lose access to the services that only the PASSE program provides.
– You will lose your Waiver slot if you are a person with the DDS Waiver or Wait list. This should be a careful decision because a lot of people have waited a long time for these services.
– If you get BH services, you will not be able to get those higher level services you might need.

Yes, there are ways you can opt out of the PASSE. BUT you need to be careful and protect yourself. Dropping out may solve a problem for you now, but it may cause you a problem later. Make sure you ask all of the right questions (see below). You might still be able to get what they call “State Plan Services,” but you won’t be able to get the “Community & Employment Supports Waiver” or the “Arkansas Community Independence Waiver.” Depending on how you qualify for Medicaid, you might not get any services at all.

DD

If you’re with the Developmental Disability side, that means you are giving up your waiver slot. You might be giving up some services you might need. Also, the way you qualify for the DD Waiver is different than other Medicaid, so you may not qualify for any services. Some people have waited a super long time for services, and we just don’t want you to do anything that hurts more in the long run.

Programs like ARKids and TEFRA are only for “kids.” For example, if you are on TEFRA right now, you could choose to drop your waiver waiting list slot and go back to TEFRA. Please remember that TEFRA only lasts until you’re 19. The service options are limited for adults, so make sure you will have coverage if you drop your waiver slot.

If your plan is to drop out and come back to the Waiver, just know that you do have to start all over again.

BH

If you’re with the Behavioral Health (mental health) side, you can go back to Tier 1 services, but there may be some services you can’t get now. So if you are a child who was with ARKids, but then because of a BH assessment were put into a PASSE, you could go back to ARKids. The way you do this is by not getting your next reassessment. You have to be assessed to be in a PASSE, so if you turn down your next Independent Assessment when Optum calls, they won’t put you in a PASSE.

Questions to ask:

  1. What services will I lose if I opt out of the PASSE?
  2. Which Medicaid program will I qualify for if I opt out of the PASSE?
  3. Can I still go to {name the provider} if I drop out of the PASSE?

If you want to drop out of the PASSE, you need to call the PASSE Ombudsman. They can send you the right direction. 1-844-843-7351

*Remember, if you are on the BH side, you might have to wait until you can refuse your next Independent Assessment.

(3) You can turn down an Independent Assessment.

Everyone in the PASSE is supposed to have gotten an Independent Assessment. If you refuse a re-assessment, you will be dropped from the PASSE program. If you are on the DD Waiver, that means you will lose your spot.

Before you get put into a PASSE, you have to get an Independent Assessment. This company named Optum calls and sets up an appointment. You can turn this down. They may tell you that you have to do it, or you could lose services. You do not have to do it. This is your choice.

Not getting an Independent Assessment for DD or BH does mean that you can’t be in the PASSE system. So look at #2, and make sure you are making the best choice for you.

(4) You can call your legislators.

Call your legislators. They voted this in, and they need to hear if something is affecting you negatively. They represent us, and we need to let them know what’s going on.

Here’s how! Visit:http://www.arkleg.state.ar.us/assembly/2019/2019R/Pages/LegislatorSearchResults.aspx?member=&committee=All&chamber=

Click their name, and it will take you to their contact info.

PASSE: 4 Things You Can Do

On Feb 27, a judge denied a restraining order and request to intervene, which would have stopped the PASSE program from starting on March 1.

Some people did not understand the decision or how the judge could process the information and testimony so quickly.

He apparently made the decision based on pure law, saying that the plaintiffs hadn’t shown proof that the start of the program on March 1 would cause them the “irreparable harm” needed to justify such a restraining order.

Since the case will remain open, they may still get the chance to prove that harm later on (although for the sake of the 40,000 people affected, we all hope they don’t see irreparable harm.)

The judge ruled (for now), but you still have things you can do.

What can you do now?

1. Make sure you join the group to let others know what’s going on in your life.

2. If you’re affected by the PASSE, make sure you email Disability Rights Arkansas if you’re seeing problems with the PASSE. If they want to revisit this complaint, they will need a lot of proof to stop the PASSE program. If you’re denied a service, let them know. If your Care Coordinator does a bad job, let DRA know. Email TNichols@disabilityrightsar.org.

3. Also, keep these numbers handy. Make your complaints to the Ombudsman 1-844-843-7351, and send an email with your issues to PASSEOmbudsmanOffice@dhs.arkansas.gov. They have to log them. Every time a provider isn’t in network, or a provider doesn’t know about the PASSE, let your PASSE and the Ombudsman know. If a service is denied, let the Ombudsman know how this will impact you. Most emails and records like this can be subject to requests and investigation, so get them on the record.

4. If you are denied a service you need, make sure you file an appeal immediately. Every PASSE has a different process and rules on their website. If the PASSE denies your appeal, you can then appeal to DHS.

Arkansas Total Care – How to Appeal

Empower – How to Appeal

Summit (APC) – How to Appeal (pg 5)


If the PASSE program does end up doing harm to the people, we will all have to work together to stand up. Don’t wait until that happens. Make sure you’re communicating all along.

Judge rules on PASSE lawsuit (Updated)

Medicaid recipients, parents, advocates, and providers made their best effort on Wednesday, Feb 27 to stop or delay the PASSE program from starting.

What happened?

In addition to the residential association’s complaint that drove the hearing, some plaintiffs, including a parent of a child on DD waiver along with a person who receives behavioral health services, assisted by Disability Rights Arkansas, also requested a motion to intervene. They issued a brief in support of their argument and exhibits.

For the restraining order, the original complaint was filed. Then DHS responded by filing their argument, and the plaintiffs filed an amended complaint.

After hours of testimony for and against the PASSE at the hearing Wednesday, Judge Piazza of the Pulaski County Circuit Court ruled that the PASSE program can move forward on Friday.

The judge ordered the case to remain open for 6 months to allow plaintiffs to renew their request. The plaintiffs could choose to appeal the decision.

Some people did not understand the decision or how the judge could process the information and testimony so quickly. However, he apparently made the decision based on pure law, saying that the plaintiffs hadn’t shown proof that the start of the program on March 1 would cause them the “irreparable harm” needed to justify such a restraining order. Since the case will remain open, they may still get the chance to prove that harm later on (although for the sake of the 40,000 people affected, we all hope they don’t see irreparable harm.)

What did the lawsuit say?

The lawsuit was filed on Feb 21 to stop the transition to managed care, set to start this coming Friday, March 1 that will change the way services are covered for over 40,000 Arkansans who have significant mental illness or developmental disabilities.  

The lawsuit says DHS has refused to do anything about the warnings that the 3 managed care companies planning to participate in the program won’t be ready to take over responsibility for the recipients care March 1.  

Read here DHS full response to the lawsuit, but one of the many reasons it lists why the PASSE program should not be delayed:

“DHS will demonstrate that approximately $1 billion will go to the PASSEs annually in global payments. The proceeds from the premium tax, 2.5%, are expected to generate approximately $25 million dollars each year, which may then be used to pull down federal matching funds. Arkansas’s current federal match rate is 70.51%, which means for every thirty cents the state puts into the program, the federal government puts in seventy cents. The simple math demonstrates that the $25 million in premium taxes will generate approximately $85 million in available spending annually. To break it down further, every day of additional delay will result in approximately $232,000 lost, or $1.63 million per week, or $7.08 million per month.”

Plaintiffs argued that the PASSEs are not ready, that clients had not even received their PASSE insurance cards, that billing plans were insufficient, while the state argued that evidence shows it is ready to move forward.

What do you think?

Reaction by affected families and providers to the lawsuit was mixed in MSL’s social media group. Many families wished to see the program stopped, but a few said they were ready to see it move forward.

“I have heard about the lawsuit about PASSE. They may not be starting on March 1st. The date seems to be getting moved further and further away. Every time we get used to the idea the date changes. If we have to make the change, let’s do it sooner than later.”

“If they are not prepared. I say move the date. Any large change in a program takes time to implement safely. Change should be slow… to insure quality.”

Make sure you join the group to let us know what you think!

What can you do now?

If you are affected by the PASSE, make sure you email Disability Rights Arkansas if you’re seeing problems with the PASSE. If they want to revisit this complaint, they will need a lot of proof to stop the PASSE program. Email TNichols@disabilityrightsar.org.

Also, keep these numbers handy. Make your complaints to the Ombudsman 1-844-843-7351, and send an email with your issues to PASSEOmbudsmanOffice@dhs.arkansas.gov. They have to log them. Most emails and records like this can be subject to requests and investigation, so get them on the record.

Lawsuit filed to stop the PASSEs from taking over on March 1

Update – as of 7:15pm, we still don’t have a ruling. They have been in the hearing since 1pm.

Some of you have been raising concerns for the past year about the PASSE model, and just days before it is set to begin, a lawsuit has been filed with a ruling that should happen on Wednesday.

The lawsuit has been filed to stop the transition to managed care, set to start this coming Friday, that will change the way services are covered for over 40,000 Arkansans who have significant mental illness or developmental disabilities.  

The lawsuit says DHS has refused to do anything about the warnings that the 3 managed care companies planning to participate in the program won’t be ready to take over responsibility for the recipients care March 1.  

Many of those affected have said that care coordinators aren’t trained well among many other worries. Providers say they won’t be able to bill starting March 1.

Click below to read the actual lawsuit.

Arkansas Session 2019

The AR Legislative session has been going on a few weeks. They will be making important decisions that affect us. Here are some resources to help you stay up-to-date no matter where you live.

See the bills that have been filed:

The boxes are check for 2019. Just click Submit to see the latest list.

http://www.arkleg.state.ar.us/SearchCenter/Pages/historicalbil.aspx

See today’s calendar to decide which committees you want to watch.

Public Health, Welfare, & Labor are committees for both Senate and House that discuss bills that affect Medicaid. Each meeting has an agenda, so you can see if the bill you care about is on the list for today.

http://www.arkleg.state.ar.us/assembly/2019/2019R/Pages/Home.aspx

Watch what’s going on right now:

(Business hours)

http://sg001-harmony.sliq.net/00316/Harmony/en/View/UpcomingEvents/20190208/-1

Watch previous sessions and committees:

Bills travel to different committees, to the House, and Senate before they hit the Governor’s desk. You might want to go back to see how your legislators voted or if they discussed your concerns in the meetings.

http://sg001-harmony.sliq.net/00316/Harmony/en/View/RecentEnded/20190208/-1

AR Works – 18K Lose Coverage

The news isn’t good for Arkansas Works. Reports are showing that over 18,000 people have lost coverage so far.

Check out the whole story.

People have to work or report some exemption as a reason that they can’t work, like if they have a disability or a kid at home. If they don’t report 80 hours of work a month, for 3 months in a year, they get kicked off.

What do you think about this? Let us know!

If you have lost coverage, you can contact Legal Aid of Arkansas for help! Call 870-732-6370 ext 2206.