Tag: arkansas

AR Choices Update

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It’s been over a month since Legal Aid’s last update. After a period of relative quiet, here’s the latest from Kevin De Liban on the ARChoices program. Please note the upcoming legislative committee hearings listed below on 9/13 and 9/18.

(1) Public comments. In July, many people showed up to the public hearings or wrote DHS with comments. Those comments are attached to this email. Though the comments were overwhelmingly against the algorithm, DHS plans to go ahead and start using the RUGs algorithm again in the exact same way as they did before starting on 10/1/18.

RUGs changed the effective limit of attendant care from 8 hours per day to 5.5 or 6. This has not been enough for Legal Aid’s clients. On top of that, the algorithm is nearly impossible to understand, has had multiple software errors, and doesn’t take into account a doctor’s opinion or consider the actual amount of time it takes to provide care to someone on the program.

(2) The legislature is considering the RUGs algorithm this Thursday, 9/13, and next Tuesday, 9/18.  DHS is presenting the algorithm to two separate legislative committees in the next week. Apparently, if the Public Health Committee does not approve it, the algorithm may be delayed or stopped.

Thursday, 9/13, 10 a.m., Public Health Committee, Room A of the MAC Building. I have been told that public comment will be accepted. People who attend must sign in on a sheet to request to speak.

Tuesday, 9/18, 1 p.m., Rules and Regulations Subcommittee, Room A of the MAC Building. I have been told that public comment will be accepted. People who attend must sign in on a sheet to request to speak.

It is not clear that the legislators on these committees will have seen the comments that were submitted to DHS. So, they may not know that most people are against the algorithm. The legislators may not have any source of information other than what DHS tells them. The meetings are open to the public, and I have been told that public comment will be accepted. 

(3) DHS resumed assessments, but only for personal care (not attendant care). People already on the program still cannot get adjustments to their attendant care hours. People who’ve applied for the program are unable to get any attendant care at all. But, after we filed our ongoing lawsuit on behalf of an ARChoices applicant who was denied all services, DHS started determining applicants’ program eligibility and giving them up to 14.5 hours per week of personal care (NOT attendant care, which is slightly different). This isn’t anywhere near enough for many applicants. The lawsuit is continuing and seeks to force DHS to use the prior system of nurse discretion to allocate attendant care until a new valid method is in place.

(4) New Algorithm. As far as we know, DHS is still planning to switch to a new algorithm and new assessment system for ARChoices. This will be based on the same assessment system that is currently in use for personal care, behavioral health, and the development delay waiver. DHS has not provided a timeline for the new algorithm, but, based on the legal timelines required, the new algorithm is not likely to be put into place before 2019.

As always, if you have any questions, please feel free to write me here or call me at my office (800-967-9224 x 2206).

Contact:

Kevin De Liban, Attorney

Economic Justice Practice Group Leader

Legal Aid of Arkansas–West Memphis

310 Mid-Continent Plaza, Suite 420

West Memphis, AR 72301

Phone: (870) 732-6370 x. 2206

AR Works: Urgent News

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Today (September 5) is the day!

If you’re on ARWorks and have not reported your work, school, or some exemptions for the past 3 months, you will lose your coverage after today.

DHS says they have sent multiple notices, yet still we’re hearing news reports that thousands will lose their coverage because they haven’t responded. Unfortunately, these people will not be allowed to reapply until January 2019.

If you are one of these people, you need to report TODAY. If you know someone who is affected, you need to share this with them!

Find out a great update and tips from Legal Aid!

Here are some resources from DHS all in one place to help you know what to do:

Call your insurance provider if you don’t have internet regularly enough to report!

Plus here are some videos to help you know how to get an account and report your activities.

Watch DHS’ Facebook Live where they answered questions we sent in.

Call for help at 1-855-372-1084!

Make sure to pass this info on to anyone who might not realize they are going to lose their coverage after September 5, 2018. This only applies to certain people on ARWorks, so log in and make sure you’re safe.

How to Make a Public Comment Before Sept. 12, 2018

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DHS notified the public of some proposed rule changes on several issues. You have the opportunity to take action and make a public comment until September 12, 2018 on those documents. How would one choose to make a public comment about the many issues that are changing? Watch the video for more details!

This is how you can place your own public comment for the record:

1. First, follow this link (copy and paste it into your internet address window): https://medicaid.mmis.arkansas.gov/General/Comment/Comment.aspx

2. You will see some documents on a long page that are available for public comment by September 12, 2018. The documents you want look just like the ones in the graphic below. The ones in the long section on bottom are old, and the date has passed.

3. You will want to view the documents. Click on the blue link with that name (on the Medicaid website), and it will download the file for you.

4. Open the file from your document downloads, if it doesn’t open automatically for you.

5. At first glance, it may be difficult to understand, but try to read through it as best as you can. You might understand more than you think.

6. After you read through it, you might want to send in some comments about how this will affect you. For example in the PASSE manual, you might want to comment on what the PASSE is required to cover.

7. You can choose to mail your comments, but the faster way is by email. You can send your comments in an email to becky.murphy@dhs.arkansas.gov, but be sure to reference which manual you’re commenting on in the subject line.

8. Make sure to do this before September 12, 2018!

9. You can also choose to go to a public comment and say your comments there:

AR Works: Update from Legal Aid

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Legal Aid of Arkansas sent the following update and wants everyone to know this important information.

We’re writing to let you know the latest information on the work requirements in the Arkansas Works program. With the work requirements now in effect, Legal Aid is available to help beneficiaries understand how to comply and how to assert their legal rights. Anyone affected is welcome to call our special Medicaid line–(800) 967-9224 and press 4. 

Lawsuit: Because of the widespread loss of coverage these work requirements are likely to cause for our clients, Legal Aid of Arkansas has filed a federal lawsuit in Washington DC. While that lawsuit is moving along, we want to make sure people have all the information they need to give them the best chance of keeping their coverage.

Letters of Non-Compliance: Many beneficiaries will have already received notices for non-compliance for the month of July. The notices will have a date of August 6 on them. For some people, this is their second month of non-compliance, and they will be terminated as of September 1 if they do not report compliance in August. For others, this is just the first month of non-compliance, but that means their care is threatened for future months. DHS reported that 72% of people who had to go online in June did not do so. That’s about 7,400 people, and we expect similar numbers for July, which are set to come out later this week.

Resources for People Affected: Anyone who receives notices of non-compliance is welcome to call Legal Aid for information about the program and their legal rights. We have a special Medicaid line–just call (800) 967-9224 and press 4. If someone doesn’t answer right away, we’ll get back with them within a few business hours. You (or they) are also welcome to call me at x. 2206 or Trevor Hawkins at x. 6313.

Here are other ways you can spread the word about the changes: 

(1) Share the Facebook video. This explains the latest on the lawsuit and how to comply with the work requirements:  https://www.facebook.com/arlegalaid/videos/2110260212381560/

(2) Share the flyer

and this (Front/back) handout. 

(3)  Invite us to talk to  your group, community, staff, or clients. We can accommodate any form of participation (in-person, video, phone), various languages, and any time limitations.

Contact:

Kevin De Liban, Attorney

Economic Justice Practice Group Leader

Legal Aid of Arkansas–West Memphis

310 Mid-Continent Plaza, Suite 420

West Memphis, AR 72301

Phone: (870) 732-6370 x. 2206

Fax: (870) 732-6373

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ARWorks: How to Take Action

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The deadline to comply with work requirements for June was July 5. DHS sent out notices of non-compliance to thousands of people that should have already reached clients. If you have not reported your hours, you need to do so as soon as possible because you can only miss a couple more months before you lose coverage. Even if you don’t utilize AR Works, please SHARE this information!

Some people don’t even realize that they are affected. They don’t recognize the name AR Works, or their address has changed preventing these letters from DHS from giving this much-needed information. If you need more information about AR Works (what it is, its history, how to apply), read this article.

If you are unsure if you are affected or how to proceed if you are, keep reading. We have information below that will help!

Anyone who receives those notices or just wants information is welcome to call Legal Aid of Arkansas at (800) 967-9224. They have special Arkansas Works lines–callers can just press 4 at the initial message, dial extension 6313 for Trevor, or extension 2206 for Kevin.

Check this letter to find out if you’re affected or what to do:

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Here are ways you can spread the word about the changes: 

(1) Check out DHS’ website about how to report your work hours, school attendance, volunteer hours, or your exemption.

(1) Share Legal Aid’s Facebook video. This explains the latest and has a link to earlier videos: https://www.facebook.com/arlegalaid/videos/1755020114575199/

(2) Share the attached flyer (ar-works-flyer-latest.pdf) and handout (arkansas-works-information-for-consumers-latest-05-10-18.pdf).

(3)  Invite Legal Aid to talk to your group, community, staff, or clients. They can accommodate any form of participation (in-person, video, phone), various languages, and any time limitations.

If you want assistance from Legal Aid, here is contact info:

Kevin De Liban, Attorney

Economic Justice Practice Group Leader

Legal Aid of Arkansas–West Memphis

310 Mid-Continent Plaza, Suite 420

West Memphis, AR 72301

Phone: (870) 732-6370 x. 2206

Fax: (870) 732-6373

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AR Choices: Update & Public Comment

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Here is a detailed update from Kevin de Liban from Legal Aid about AR Choices.

Also, please note that Public Comment ends on this issue on July 31, 2018. There is one more public hearing on July 26th in Little Rock. Kevin’s update can help you with ideas of what to say as you examine the manuals available for public comment. Don’t miss this chance to speak up for what you need!

As you know, a court invalidated the RUGs algorithm a little over two months ago. DHS is now trying to re-implement the RUGs algorithm to take effect on October 1. Rule-making is the name for the process by which DHS is trying to make this change. DHS has proposed that the algorithm work the same way it did before being invalidated.

Until October 1, it appears that DHS intends to keep everyone on the program at the same level of attendant care they have now and that DHS will not allow any new applicant to the program to receive attendant care services. Legal Aid of Arkansas is actively working to change this through a new lawsuit filed on June 29.

Here is some other relevant information:

(A) The public comment period for rule-making on the algorithm runs until 7/31.  Here are the manuals available for public comment. The public has a right to participate in the rule-making process. If they choose to do so, people may offer comments by email to becky.murphy@dhs.arkansas.gov or by mail to the DHS Division of Medical Services, Office of Policy Coordination and Promulgation, P.O. Box 1437, Slot S295, Little Rock, Arkansas 72203-1437. Please include the title of the document you are commenting on when you email. Here is the notice of rule-making that DHS has published for more information.

(B) DHS is hosting public meetings about the rule-making. The remaining meetings is on 7/26 in Little Rock (Ark. Enterprises for the Developmentally Disabled ;105 East Roosevelt Rd.). People can offer verbal comments at the meeting. The meetings start at 5 p.m.

(C) Legal Aid has had nearly 200 cases relating to the RUGs algorithm in the last two and a half years. Here is some of what we’ve learned about how the algorithm works.

(1) The algorithm doesn’t provide enough care to meet the needs of people on ARChoices.

The most care someone can get under RUGs is 5.5 hours per day unless they need IV medication, suctioning, tracheostomy care, a ventilator, or a feeding tube (then, they can get 6.5 hours per day). This is not nearly enough to meet the care needs of many people on the program. Because of the cuts to care, many people ended up lying in their own waste, skipping meals, getting bed sores, and staying shut in. Even when people have family members make up for the cuts, they have had to go through more anxiety, have family work outside the home in ways that threaten their care, or consider moving to a nursing home.

(2) The RUGs algorithm cuts the hours of people who have not gotten any better.

People who used 8 hours per day (the max for people under 65) or 7 hours per day (the max for people 65 or over) before the algorithm were cut even though their medical conditions and abilities did not improve.

(3) The RUGs algorithm has not been validated or verified in Arkansas.

The only testing that has occurred on RUGs took place in Ontario, Canada and Michigan, which have different situations than Arkansas. Also, though DHS says that it used statistics to come up with the hours that different people get, DHS admits they lost the data.  This means that there is no way of knowing how or why DHS figured that 5.5 hours per day was enough for someone with quadriplegia or cerebral palsy (or any of the other amounts DHS gives for people with different conditions and abilities).

(4) There is no documented evidence of problems with the system of nurse discretion that DHS used for 17 years before the algorithm.

Before 2016, DHS used nurses to decide the number of attendant care hours. Legal Aid never received a single complaint from clients about the nurses’ decisions. Since DHS started using the algorithm in 2016, we have worked on nearly 200 cases. Now, DHS says that nurses were biased and that the algorithm is more objective or fair. But, before 2016, DHS did not tell a single nurse that they were giving out too many or too few hours, did not do any kind of study to show whether nurses were giving out too many or too few hours, and did not tell nurses to change the way they were giving out hours.

(5) Our clients generally do not think the complicated RUGs algorithm is fair.

The algorithm is 21 pages of computer code. Most average people can’t understand it. Also, the way the algorithm works totally excludes a doctor’s opinion about the amount of care someone needs. People on the program cannot understand the criteria by which their hours are set, cannot fight reductions, and cannot plan for the future.

If you need help or more information, here is Kevin’s information:

Kevin De Liban, Attorney

Economic Justice Practice Group Leader

Legal Aid of Arkansas–West Memphis

310 Mid-Continent Plaza, Suite 420

West Memphis, AR 72301

Phone: (870) 732-6370 x. 2206

Fax: (870) 732-6373

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PASSEs: Learn More

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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

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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?

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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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