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.

ARChoices: Take Action

This is a long but important update from Kevin deLiban of Legal Aid of Arkansas on information about the NEW SYSTEM to determine hours for ARChoices that DHS will start using on January 1, 2019.

The public comment period is open until 11/7/18, and public meetings will be held from now until then.


(1) RUGs Update. Late Monday, the judge dissolved the injunction against RUGs, meaning that DHS will start allocating attendant care to new applicants for the program and will also re-assess people whose plans of care have expired. RUGs will only go back into effect for the next two-and-a-half months and then will be replaced by the new system described below. If anyone faces reductions because of RUGs during that time, they can call Legal Aid of Arkansas at 800-967-9224. We don’t anticipate more court challenges against RUGs (though that can always change), but we may be able to help with administrative appeal hearings.

Due to the hard work of people on the program, caregivers, attorneys (at Legal Aid of Arkansas, the Center for Arkansas Legal Services, and Disability Rights Arkansas), case managers, care agencies, journalists, and others, RUGs is definitely going away (DHS had no plans to switch to a new system before the litigation and public attention), about a thousand people avoided devastating RUGs-based cuts for several months (and at least couple dozen people kept their pre-RUGs hours for a year or longer), 150+ people with cerebral palsy are getting more hours than they otherwise would have due to discovery of a DHS software error, hundreds of people (including legislators and the wider public) have learned more about Medicaid home-care services and the importance of a fair system to determine hours, and a community of people are now activated around these issues. Justice only exists because people work to create it. Grateful for all of you who did so here. We lost along the way, too, and I think about the clients who passed away fearing or fighting cuts, clients who’ve been living with the cuts, and all the suffering we couldn’t stop. They keep me motivated.

(2) The New System. DHS finally released details of the new system it plans to use starting January 1, 2019. DHS’s own summary of the changes are attached. There is A LOT of information in here, so I’ll go through the major items.

New Assessment. Up to now, DHS was using the assessment tool known as ArPath, which had 286 questions. ArPath will be going away. The new assessment will be called ARIA and could have as many as 400 questions. It will be performed by a Registered Nurse who works for a private company named Optum. After the Optum RN comes out to do the assessment, the results will be sent to DHS for a determination about eligibility, the amount of hours someone gets, and what budget category someone fits in. This involves a separate visit by a DHS RN to do the care plan.

Questions/Unknowns:

~ Will people be given enough advance warning in order to get medical records or arrange for caregivers to be present so that the information in the assessment is accurate?

~ Will the new assessment take longer than the old assessment, which already took 60 to 120 minutes? Will the questions be understandable, relevant, and fair?

New Hour Determination System. RUGs used an algorithm that mixed a lot of different factors that didn’t seem to make obvious sense in order to place someone in a group with a fixed number of hours. The new system will be very different. It is called the “Task and Hour Standards.” Based on the ARIA assessment, an algorithm will rank each person from 0 to 3 in each key Activity of Daily Living (bathing, dressing, feeding, grooming, toileting, transferring, walking, cleaning, laundry, meal preparations, and shopping). Then, based on whether you get a 0, 1, 2, or 3, the DHS nurse (who comes in a separate visit from the Optum nurse) will determine how many minutes you get for that particular activity. For example, if you score a 3 on bathing, the DHS nurse can give you between 35 and 45 minutes. If you score a 2, the DHS nurse can give you between 15 and 30 minutes. If you score a 1, the DHS nurse can give you between 5 and 10 minutes. The DHS nurse will then figure out how many times per week you need to do a particular task. The DHS nurse will then add up all the minutes you get for each ADL and give you a monthly number of hours.

Questions/Unknowns:

~ DHS hasn’t said how the algorithm will figure out if you are a 1 or 2 or 3 for any particular ADL.

~ DHS hasn’t stated the frequency that certain tasks will be allowed. Is bathing a daily task? Do people get to be dressed twice per day (once into the day’s clothes; once into bedtime clothes)? Will the frequencies allowed match actual care needs?

~ DHS has said that the time given will be reduced by the amount of time that family, friends, or others do that same task voluntarily. It is not known how this will affect people with family caregivers.

~ DHS has said that no time will be given for the cleaning of shared spaces when the caregiver lives with the beneficiary. There could be other reductions for people who live with their caregiver.

~ DHS has said that nurses can request to go outside the amount of time allowed if there are “extenuating circumstances” and the nurse receives supervisor approval. For example, this means someone may be able to get 55 minutes for bathing even though the highest amount officially available is 45 minutes. BUT, these adjustments might not mean much because of the budget limits described below.

~ Even if you are allowed a particular amount of hours under the Task and Hour Standards, you might not actually get that number of hours because of the new overall budget limits described below.

• New Overall Budget Limits. DHS is doing something it has not done before in ARChoices, AAPD, or Elder Choices. It is setting a hard budget cap for services an individual on the program can receive, regardless of the amount of care DHS’s own Task and Hours Standards says someone needs. There are three budget categories–Intensive, Intermediate, and Preventative. An algorithm will use the answers to the assessment to put you into one these three groups. People in the Intensive group can get no more than $30,000 worth of services in a year ($2,500 in a month). People in the Intermediate group can get no more than $20,000 worth of services in a year ($1,667 per month). People in the Preventive group get $5,000 in a year ($417 per month).

So, even if the Task and Hours Standards states that you need 200 hours in a month, you cannot get those 200 hours if they cost more than is allowed by your budget limit. For example, your budget limit might only allow you to “buy” 150 hours per month (or some other number less than 200).

Questions/Unknowns:

~ DHS has not stated the actual price of the services so that you can predict the number of hours actually possible under the budget limits. However, if you take the standard attendant care rate of $18 per hour, the highest budget level (Intensive, which allows $2,500 per month), would only allow 139 hours per month. This would not be enough for many people. The next highest budget limit (Intermediate, $1,667 per month) would only allow 93 hours per month (at the rate of $18 per hour for attendant care).

~ DHS has stated to media that the cost of attendant care would be less for people who hire their own caregivers instead of using an agency (meaning they could possibly get more hours under the budget limit), but that would seem to give far fewer hours to people who use agencies than people who hire their own caregivers.

~ DHS has stated to media that up to 64 hours of personal care hours may be available apart from this, but that is not confirmed in policy and may still not be enough care for many people who have higher needs.

~ DHS’s process to arrive at these $30,000/$20,000/$5,000 categories has not been independently verified to be reliable. These amounts could be arbitrary. DHS says they are based on the cost of nursing home care, but DHS has given other figures that state nursing home care costs much more than $30,000 per year (these other DHS estimates have put the cost of nursing homes at more like $60,000 per year).

~ DHS did not include in the public documents anything about how the budget limits will actually affect people. How many people will be put into each category? How many people will face cuts because of placement in a particular category?

~ DHS has stated that ARChoices beneficiaries who were on the program in 2018 and who received more than $30,000 in services will not face a cut due to the budget limits the first year. Instead, their budget limit will be the cost of the services they received in 2018. This is known as “grandfathering” people into the program. So, people with higher needs may be able to keep what they got in 2018 if the Task and Hour Standards determination shows they need that many hours.

~ Apart from the “grandfathering,” DHS has stated that the budget limit can be temporarily adjusted upward for one year through an “exceptions process” for “exceptional, unexpected circumstances.” DHS stated that these “exceptional, unexpected circumstances” might include the death of a caregiver or recent release from a facility.

• Will the new system provide enough care? Compared to the system of nurse discretion, RUGs was harmful to our clients because it meant huge cuts in hours for so many people, especially people with the most severe needs. It is not clear if the new system will give people any more hours than RUGs did. It is not clear if the new system will give people enough hours to meet their actual care needs and keep individuals out of nursing homes. DHS has stated that the changes will cut Medicaid spending by about $10 million the first year and about $14 million the second year. If spending cuts are the goal, increased care may not be part of the plan.

• Is it understandable? RUGs involved 20 pages of computer code that didn’t make sense to our clients. The new system seems to be complicated in a different way. First, people will have to figure out how the 400-question assessment turns into a score for each ADL on the Task and Hour Standard (how many minutes you get for each ADL). And, we don’t know if that will make sense. Second, people will have to figure out how the assessment turns into a Budget Limit category. Some people may be qualified for hours under the Task and Hour Standard that they can’t actually get because of the Budget Limit category. These complications may mean that people on the program may not be able to fairly contest decisions about the care they are allotted.

(3) Public Comment. Anyone can participate in the public comment process. Comments can be sent by email to becky.murphy@dhs.arkansas.gov or by mail to Office of Policy Coordination and Promulgation, P.O. Box 1437, Slot S295, Little Rock, Arkansas 72203-1437. Comments must be submitted by 4:30 p.m. on November 7.

(4) Public Meetings. Public comment will also be accepted at public meetings. The meetings are at the following times and places. Some of these meeting places are different from the meetings about ARChoices that were held in summer.

Fort Smith, 10/15, 5 p.m., Arkansas College of Osteopathic Medicine, 7000 Chad Colley Blvd
Monticello, 10/18, 5 p.m., Drew Memorial Hospital Conf. A., 778 Scoggin Dr.
Hope, 10/22, 5 p.m., UA Hope Hempstead Hall, 2500 South Main St.
Little Rock, 10/29, 5 p.m., Arkansas Enterprises for the Developmentally Disabled, 105 E Roosevelt Rd
Jonesboro, 11/7, 5 p.m., St. Bernard’s Medical Center Auditorium, 225 E. Jackson Ave.

(5) Copy of the Full Materials. I could not cover all the changes being made. The full materials can be downloaded here. The full materials have information on other important changes being made to this program, Independent Choices, and the Assisted Living waiver program. For example, the rates of Assisted Living providers are facing significant cuts, which may mean that fewer people can get into an assisted living facility and more people may have to choose a nursing home instead.


This update was provided by Kevin De Liban of Legal Aid. If you have questions, please feel free to reach out to him:

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

PASSE: Take Action!


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.

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

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:

PASSE – Phase II Updates

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DHS recently released a new presentation with updates to their work on the PASSEs Phase II. This includes milestones and network adequacy standards, and where they are with Independent Assessments.

They did listen to our concern that people have been enrolled before the networks were adequately formed, and they will hold open enrollment in October of 2018.

Catch up on all previous PASSE posts!

Your Rights When You Appeal

We appeared live on Facebook with Managing Attorney Thomas Nichols from Disability Rights Arkansas to answer your questions and discuss your rights when appealing a Medicaid decision. Watch because this video is full of helpful information from beginning to end!

Thomas refers to a presentation with more information on appeals that you might want to view.

When filing an appeal, you have resources in the state to help you. Even if you can’t afford it, you can find quality lawyers or law advice. Make sure to contact:

Also, we reference Rights that we listed in a previous post. Make sure to read it.

What if you don’t agree with your Assessment results?

Even though many people may not need to appeal, several of you have asked before about how to appeal your Independent Assessment if you aren’t satisfied with your tier placement. We asked DHS for the appeal policy.

Watch for more resources on how to appeal, tips, and what your rights are!

DHS says that below is the information that you will receive with your Independent Assessment results packet.  Each person will receive this notice after his/her IA has been scored.  These results packets began going out Friday.  Some individuals began receiving PASSE services prior to the receipt of their results packets. 

 If you do not agree with your assessment results:

You, your representative, and your provider have the right to request a hearing.

Requirements for the request:
  1. the request must be received at the DHS Office of Appeals and Hearings’ address below no later than (date calculated from notice mailing date [35 days + mailing date])
  2. Please put your request for a hearing and for any services in writing. With your request, please include a

copy of this letter and mail it to:
Arkansas Department of Human Services
Office of Appeals & Hearings
P.O. Box 1437, Slot N401
Little Rock, AR 72203
Division of Medical Services

If you ask for a hearing, these are your rights, per DHS:

  • You may go to the hearing
  • You may be represented by a lawyer or any other person you choose
  • Before the hearing, you have the right to see your record and any other evidence to be used at the hearing
  • You have the right to present your own evidence
  • You have the right to bring your own witnesses
  • You have the right to question any witness against you
  • You have the right to request, if applicable, certain current services continue “as is” pending an appeal decision if your request is received at the Office of Appeals and Hearings’ address listed above by (date calculated from notice mailing date [15 days + mailing date])

You may be able to get free legal aid.

If you need legal help, DHS sends these recommendations:

 DHS also recommended the following link might be helpful to review:  http://humanservices.arkansas.gov/images/uploads/occ/DHSPolicy1098.pdf to understand the process.

Watch for more resources on how to appeal, tips, and what your rights are!

MSL has attended presentations by other community resources such as Disabily Rights Arkansas who have explained in more detail what to put in your letter and tips you might need. One very important thing to do is MAKE SURE TO KEEP EVERYTHING MAILED TO YOU AS WELL AS ALL ASSESSMENTS OR THINGS THAT COULD BE USED AT THE HEARING. We will be collaborating with these other organizations to release more resources as soon as we can!

 

PASSE Q&A Follow-up

DHS recently hosted a FB live about the PASSE to answer our questions, but some of your questions were not answered at that time. The images below show DHS’s follow-up answers to some of the questions.

For those of you who would like to go back and watch the Facebook live video from January 19, click here.





Live Q&A with DHS about PASSEs

MSL took your questions to DHS, and they answered live on Facebook. This video has several good demonstrations and answers that you might need to see. The PASSEs will start taking clients in February 2018.

Watch the video:

Independent Assessment: How to Be Prepared

Every single person who is a Tier 2 or Tier 3 and receives Medicaid services for a Developmental disability or a Behavioral health issue will undergo an Independent Assessment. This means you need to understand what it is and what will happen. MSL has gathered some resources to help you be prepared:


IMPORTANT INFORMATION

First of all, you’re probably asking, which Tier am I in? Click the link to find out!

If you are Tier 2 or 3, you will receive a notification letter about your assessment. It may come from a company you don’t recognize, but make sure to look for a letter and read carefully for the words Independent Assessment. Once you receive a letter, you will soon receive a phone call to schedule a meeting.

You are allowed to take people with you in these assessments, such as a parent or provider. The assessment itself can take from one hour to three hours. It is critical carefully consider and answer the questions because they determine your Tier placement.

Once your assessment is finished, you will have to wait to receive results. Once they are compiled, both you and your primary provider will receive a copy.


THINGS THAT CAN HELP

DHS has released the following resources to assist you or a loved one in preparation for these Independent Assessments. MSL has gathered it all in one place for you:

  • Read the full assessment itself in PDF form
  • View a presentation to explain the DDS changes
  • View a presentation on IAs for providers
  • Read the training that has been sent to PCPs

The two power point presentations may be of help what is taking place within the DD service system.  Additional information may also be found at the following website https://www.medicaid.state.ar.us/general/programs/passe.aspx.

Click on each image to access the resource.

The Full Independent Assessment people will get:Screen Shot 2017-11-14 at 11.34.00 AM


Presentation for Individuals, Families, and Staff:

Screen Shot 2017-11-14 at 11.45.56 AM


Presentation for Providers:

Screen Shot 2017-11-14 at 11.56.46 AM


Training that was sent to all PCPs:

Screen Shot 2017-11-14 at 12.00.05 PM


Previous related MSL posts:

Independent Assessment Manuals