Category: passe

PUBLIC COMMENT OPPORTUNITY FOR PASSE and DENTAL

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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.

UPDATED: Your rights in the PASSE

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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.

Published on by medicaidsaveslivesLeave a comment

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

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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)

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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

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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.

1 PASSE Quits: 5 Things You Need to Do

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Big news this week in case you missed it. There were 4 PASSEs, and now there are 3. ForeverCare says they can’t move forward, right before the PASSEs would all receive the payment to manage everyone’s care on March 1. What does this all mean? Now what?

The news has covered this some in the past few days. Forevercare says the program isn’t ready, but DHS says they are. Watch this video or read this news story to see what ForeverCare had to say:

screen shot 2019-01-19 at 9.33.55 am

If you don’t know what the PASSE is, check this out (MSL Resource).

Or watch this previous town hall recording from DHS.

In light of ForeverCare’s announcement, this is what you can do:

(1) If you are concerned about this whole thing, you need to contact DHS through the PASSE Ombudsman.

They’re supposed to take our complaints, concerns, and help us solve problems:

Call –  1-844-843-7351 (during business hours)

Email – PASSEOmbudsmanOffice@dhs.arkansas.gov

More info – https://humanservices.arkansas.gov/about-dhs/dms/passe-ombudsman If you’re a provider, and you’re confused or concerned about all of this and how it will work before March 1, you need to contact DHS through

Tanya Giles | tanya.giles@dhs.arkansas.gov | 501-320-6189

(2) A lot of people want to contact their legislators and let them know what’s going on. After all, the state legislators voted this through when they voted for Act 775.

Keep them up to date on how this system is affecting you.

Contact our state legislators.

Contact any elected legislator in the US.

See how your local Representatives or Senators voted on Act 775.

(3) If you thought this was confusing, get ready for more. Keep a note pad by the phone. Keep everything that is mailed to you, and keep a phone log.

If you are a ForeverCare family, they are going to be your PASSE until March. Even after you’re reassigned, your new PASSE isn’t supposed to officially take over until March 1. But your new PASSE will be contacting you to give you more information, find out more about you and everything you need. So make sure you don’t forget ForeverCare’s contacts.

FOREVERCARE
  • Gateway Healthplan
  • Their HANDBOOK (rules, your rights, and information)
  • 1-855-544-8744
(4) You’re going to get reassigned in early February, and you’re going to get 90 days to switch PASSEs if you want.

That means you’ll have until May to decide if you like your PASSE, and if you don’t, you’ll have to research which one you want to go to.

Here is the other PASSE information. You need to check out their handbooks and networks. Ask other families what they like and don’t like about their PASSEs.

Some of them are having family and provider meeting this month. Call them to find out when theirs is!

  • Arkansas Total Carehttp://www.arkansastotalcare.com | 1-866-282-6280

    CEO, John Ryan – jryan@centene.com

    Care Coordination Contact: Amber Baker | (501) 478-2597

    Amber.Baker@ArkansasTotalCare.com

    HANDBOOK

    NETWORK LIST – none shown on website

  • Empower Healthcare Solutionshttp://www.getempowerhealth.com | 1-866-261-1286

    CEO, Nicole May – nicole.may@beaconhealthoptions.com

    Care Coordination Contact: Jamie Ables | Office (501) 707-0961

    Jamie.Ables@beaconhealthoptions.com

    HANDBOOK

    NETWORK LIST

  • Summit Community Carehttp://www.summitcommunitycare.com | 1-844-405-4295

    CEO, Jason Miller – jason.miller@summitcommunitycare.com

    Care Coordination Contact: Tiffany Parkhurst | (501) 773-6273

    Tiffany.parkhurst@summitcommunitycare.com

    HANDBOOK

    NETWORK LIST

(5) After ForeverCare’s announcement, everyone became more concerned and had serious questions. Make sure you ask your questions! Ask DHS, ask your legislators, and ask in our group.

This is what DHS had to say to our questions as of Jan 18:

page 1page2page3

What’s the PASSE Ombudsman?

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The PASSE Ombudsman is supposed to be there to help us when our PASSE isn’t.

These are people employed by DHS, not by the PASSEs.

If you have a complaint against your PASSE, your care coordinator, your Independent Assessment Tier, or if something just isn’t getting solved, you might want to try calling the Ombudsman. Call 1-844-843-7351 if you need help.

Preferred Family Health Closure Update

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This is a letter that went out to beneficiaries who received services at PFH to notify them of PFH’s closure. Some of you may be interested in this information as well as this link which lists the available providers. Please note the PDF is searchable!

PFH_LETTER