Tag: CES

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.