Tag: kids

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.

Take Action: June Legislative Committee Meetings

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Update (6/5/18): The rules were approved in the Public Health joint committee and will be next voted upon by the ALC Rules & Regulations Joint Committee on Tuesday, June 12 at 1pm in Little Rock. Contact the committee members. Read below to catch up if you wonder which issues are being voted upon.

Original post: MSL has announced on Facebook that this committee meeting would be occurring on June 4th and that it was moved to Jonesboro. Here is some information to help you to understand what’s happening when, and what you need to do.

If you’re lost and need to catch up, you can watch a video we previously released on the subject.

Screen Shot 2018-06-03 at 10.01.07 PM

Several important issues are being discussed that affect children as well as adults:

Here is how you can contact the people of the Public Health Committee:

One Therapy Rule – Part 1

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MSL has done some research on a change coming our way. You may have heard of it – the “One Therapy Rule,” formally known as the EIDT Program. Watch this video and stay tuned for your opportunity to take action.

New Medicaid Dental Plan

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Updated 1/3/18 09:30

 You may have received a letter telling you that your Dental plan has changed. That’s because Arkansas Medicaid has moved their dental coverage to managed care. There are 2 companies: Delta Dental and MCNA. You will be assigned to one, and you have 90 days to switch.

We requested information on the change,  and this was DHS’ response:

The Arkansas Department of Human Services is changing its dental program. Beginning January 1, 2018, two companies will provide dental coverage for families enrolled in Medicaid. Those companies are:

  1. Delta Dental of Arkansas
  2. Managed Care of North America (MCNA)

There will be no changes to the dental services that are covered. Families will be assigned to one of the two companies in December 2017 and will get new dental cards and a welcome packet in the mail for each enrolled family member.
 
If members want to switch to the other company, they will have 90 days to do so. 
Families can begin scheduling appointments for covered dental services after January 1, 2018. Information about what is covered will be in the welcome packet.
 
Clients living in Human Development Centers, individuals enrolled in the Program for All Inclusive Care for the Elderly (PACE), and individuals who are eligible for Medicaid only after incurring medical expenses that cause them to “spend down” to Medicaid eligibility levels will not be enrolled in a dental plan.

It is important to note that as new beneficiaries apply for Arkansas Medicaid benefits, if they qualify for dental benefits, it will take between 15 and 45 days for them to be assigned to a plan and for the plan to complete the enrollment process.  

Then we requested information on the difference between the companies, and this is what DHS said about the new dental plans:

The benefits are identical and the number of dentists in each network is very close to the same (within 1%). The only real difference I can recommend is for the client to check to see if their preferred dentist is in the network to which they were assigned. If confirmed, I suggest they stay with that plan. If not, they should check with the other option to see if their preferred dentist is in that network and they will have until the end of March to change plans if they want to.

Both companies are very good at what they do and have been excellent partners for us to work with.

We also asked DHS to address the rumor that ACH Dentists won’t be covered:

Delta Dental AR has 12 of 17 dental providers at ACH credentialed and in the network. The other five have submitted their applications and are undergoing the credentialing process with the expectation that they will also be admitted to the Delta network. They added that MCNA has also had a meeting with ACH, so we can hopefully expect them to cover ACH dentists as well.

After the new year, DHS sent us more clarifying information on the providers who are included:


[We want to] share the details below to demonstrate how very close the dental provider counts are between the two managed dental care organizations now serving Medicaid clients. MCNA received slightly fewer enrollees due to assignments happening by family (keeping family members in the same plan) but the total number of providers in each network varied by 1 last month. Both companies are continuing to enroll providers including ACH.

On 12/15/17 (the last phase of the auto assignment period) a total of 610,945 beneficiaries were assigned to our two dental managed care companies as follows:

  • MCNA – 304,789
  • Delta Dental of Arkansas – 306,156

As you know, there will be some movement as beneficiaries work through their 90 day choice period.

As of 12/20/17 the two MCO’s have contracted with, or have contracts pending for the following number of dental providers:

  • MCNA
  • Contracts complete – 646
  • Contracts pending – 60
  • 706 Dental Providers


  • Delta Dental of Arkansas
  • Contracts complete – 673
  • Contracts pending – 34
  • 707 Dental Providers




Independent Assessment: How to Be Prepared

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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

 

 

Therapy Cap PA Requests: Q & A 

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The PT, OT, and SH Association Presidents regularly meet with DHS and AFMC to discuss issues that providers have when requesting Prior Authorizations (PAs) for children who need therapy over the 90-minute cap. These are the results of their latest meeting.

Keep track of your questions and email them to be discussed at the next meeting.

The Recap of ArkSHA, ArPTA, and AROTA meeting with AFMC and DDS on 08-25-17:

The following are issues raised by members of ArkSHA, ArPTA and AROTA, and responses from AFMC and DDS.

Issue: Shifting of Units Between Therapist and Assistant

There are still questions regarding the length of time it is taking to shift units from PT/OT/ST to PTA/COTA/SLPA and vice versa. AFMC reports that following completion of the large number of DMS-640 form validations AFMC received many change requests to prior authorizations. AFMC encouraged their staff to continue to process initial DMS-640 validations and that all changes would need to be checked before processing. Currently, AFMC states that they are about 10 days out on corrections and Jarrod McClain, AFMC Director for Clinical Review, indicated that their staff are working diligently to get the updates made as quickly as possible. The updates to the PA’s flow to DXC each night and providers can start billing immediately upon receipt of the changes.

In addition, Jarrod stated that AFMC is working to decrease the timeframe for corrections but they have to ensure that they are getting the correct request ID modified. According to Jarrod, it takes a few days to check and update the claims data extract file. If providers continue to see a delay, please contact Jarrod McClain at AFMC. He will personally see that his staff checks on the status of their request and get it processed.

Issue: Use of evaluations from preschool programs to kindergarten

There was concern from many members as to how long their evaluations will be valid in a schools setting. The consensus is that if the evaluation utilized is an evaluation conducted by a non-educational agency, or by a provider who is not contracted by an educational agency, then the evaluation is good for one year. If an educational agency or a contractor of the educational agency conducted the evaluation, then the evaluation falls under the school-based evaluation criteria of every 3 years.

Issue: Some prior authorizations were only approved after sending in a cover sheet restating information included in the evaluation.

AFMC was aware of this issue and is working to improve their processes for approval. In the meantime, providers are encouraged to highlight justification for medical necessity in the evaluative reports, including statements about how the services recommended are under accepted standards of practice to treat the patient’s condition, how services are complex and will require the skilled services of a qualified therapist, and a statement about therapy prognosis (See Medicaid Manual Section II). Though a cover letter outlining these justifications is not required, providers are encouraged to consider using a cover letter attached to the evaluation to make these medical necessity statements more salient for reviewers.

Issue: Are reviewers actually reading the evaluations or just looking for technical language?

AFMC assured us that they are reading all evaluations. They perform both technical and administrative reviews in order to ensure that all requirements of the evaluative reports are included, as well as a medical necessity review to ensure that justification for medically based services is included.

Issue: I heard that AFMC was using nurse reviewers and not experienced pediatric therapists in each discipline. Is this true?

AFMC utilizes registered nurses to perform the initial reviews of all PA requests. If a request is denied than the request is assessed by an experienced licensed therapists specific to the discipline. If the therapist agrees with the denial it is then sent to a board certified pediatric physician for final review. If a provider does not agree with the denial or would like to request reconsideration they may do so by resubmitting the request.

Issue: What about beneficiaries who receive services from multiple providers for the same service?

AFMC and DDS continue to emphasize the need for care coordination for beneficiaries with multiple providers of the same modality (physical, occupational or speech therapy). Dr. Chad Rodgers, AFMC Medical Director, attended our meeting and reported that the pediatricians and PCPs he has been in contact with are interested in understanding what situations justify the appropriate signing off on multiple prescriptions. He asserts that although he can’t speak for all physicians he personally looks at every request for therapy services before signing them. He recognized that it is difficult to for most physicians to understand why a child needs multiple services. He and assistant director of DDS Elizabeth Pittman stated that it would be beneficial to state on the DMS-640 the specific need for a particular service and that the beneficiary will need the services of multiple therapists. AFMC and DDS are considering a change to the DMS-640 forms in the future to accommodate the different services provided within one discipline. Elizabeth Pittman reported that the new MMIS system (which has an anticipated implementation of summer of 2018) will be less burdensome on providers and will have the ability to disclose is the beneficiary is receiving services from other providers. Until then, providers need to ask during the intake process if the recipient is receiving therapy services from any other provider, and then coordinate as needed. According to Jarrod McClain, only 10 providers have bumped into challenges with the multiple provider issues thus far.

Issue: For short term scripts (i.e. ortho docs who write for 2-6 weeks) that then need an extension once the patient has had a follow-up recheck. What is the most efficient way to keep PA’s from having to be unnecessarily done?

Providers can simply go into Review Point, and click the extend button. The codes will be transferred over and the new prescription can be uploaded. Information about the progress of the patient and continued medical necessity should be included with the extension.

Issue: It has come to the attention of AFMC and DDS that some facilities are sending notices to parents that they should not allow services for their child in the school due to the need for a PA if the school and independent facility are both treating the beneficiary.

Although Medicaid is a “medical” assistance program, it recognizes the importance of school-based services. The federal Medicaid program actually encourages states to use funds from their Medicaid program to help pay for certain healthcare services that are delivered in the schools, providing that federal regulations are followed. The associations stand with AFMC and DDS that sending notices to parents regarding billing for services between schools and independent clinics is not recommended. IDEA laws require schools to provide services to beneficiaries if needed for educational purposes. Schools also must provide therapy that is medically necessary. Therapy services outside of the school setting should not replicate services provided by therapists contracted or working with the school.

Issue: A representative at DHS has stated that physical therapy re-eval codes are no longer a valid code as of July 1st. Has anything changed in the recent rule change?

Reevaluation codes are not currently and haven’t been a reimbursable code. The two billable codes for physical therapy services are 97001 and 97110.

Solution to Denied PAs for Therapy Providers

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MSL has been made aware that there’s a lot of confusion on submitting PAs to request more than 90 minutes of therapy for children since the therapy cap was implemented on July 1, 2017. Lainey has talked with AFMC and DHS as well as the OT Association President who has been successful in submissions.


You need a separate statement letter that answers the following questions individual to the child’s case:

1. How does the therapy administered effectively treat the beneficiary’s condition?

2. What gives you a reasonable expectation that the beneficiary is experiencing meaningful improvement or that the therapy is preventing worsening of the beneficiary’s current condition?

3. How are the frequency, intensity, and duration of the requested therapy services realistic for the age of the child?

List the question and provide the answer. Make sure you provide the other information listed there as well. AFMC told Lainey today that they will deny any submission that does not have this requirement. If you have received denial with 3 statements that say you didn’t meet the requirement, try resubmitting with this.






Friends Don’t Let Friends Go Without Health Care

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Author: Lainey Morrow, MSL Founder & parent

IMG_0382

We’re all struggling, aren’t we? We can’t very well handle someone else’s bills probably, but there are fairly easy things we can do. One very sad thing I frequently encounter is the suffering of individuals when great resources exist to prevent such a thing. Sometimes it might be a person whose health is suffering, while for others it may be a suffering future due to delays in development.

As a matter of fact, I have experienced this myself. For 2 years, my husband and I struggled to provide for my daughter. We went into debt, staying awake many nights with worry, and she went without necessary services. We thought we were on our own. We thought we’d been denied for the only things that were out there. We worked as hard as we could, and still it wasn’t enough.

By the time she was 2, my daughter was very developmentally delayed. We didn’t find out about resources we could have accessed until we moved to another state. My friend told me about TEFRA, and my daughter was easily accepted. It makes me sick to think of all she went without simply because we didn’t know this immense resource was available to us. All I needed was someone to tell me about it, which is why that’s a huge mission of MSL – to pass along important information and to connect people with great resources that exist out there.

Someone from another state recently asked me what resources exist for them, so I started to look into it. What if you don’t qualify for Medicaid? TEFRA is an option that only certain states provide, but how do you know if it’s available in your state? If TEFRA isn’t available or you don’t qualify, then what?

Let no one go without, so here’s all my research for you to share.

Do you qualify for Medicaid?

Ways to qualify for Medicaid.

Where to start if denied.

Which states have TEFRA? (This is a specific type of Medicaid usually for kids with disabilities under 19, usually requiring families who make too much to pay a premium.)

If your state doesn’t have TEFRA or you don’t qualify, what are the other options:

 

Like I said, I didn’t find out about something my daughter desperately needed until another parent told me about it. Two long years, and we could have gone more.

We can’t help everyone, but we can help someone. Someone helped me. Keep your eyes open. You may not need a resource, but someone in your friends list might. If you see a good resource, share it! It just takes a few clicks. Charities are out there to be used. They want to help people who truly need help. Sometimes they just need a little free publicity to connect with the people who need them.

This is just a start. If you know of any great resources, especially ones that apply to all states, please send them to me to share!

 

Making Sense of the Manuals for Public Comment

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Screen Shot 2017-07-17 at 10.36.45 AMDHS released several manuals to the Medicaid website on July 13, 2017 that are available for public comment until August 11. Once public comment ends, these rules will be sent through the legislative committees and passed as law.

“In accordance with federal and state law, the Division of Medical Services of the Arkansas Department of Human Services must advertise and make available for public comment proposed new and amended rules and other documents, such as certain initial waiver requests and waiver renewals.”

However, they released over 60 documents actually, which may have left you feeling confused about which one needs your comment or what’s in them all. Here’s your guide to wading through the state terminology and legalese.

RULE #1: When you send in your comments, make sure to list the document that you wish to comment on!

RULE #2: Make sure you send your comments to the appropriate person.

Send your comments to Shelby.Maldonado@dhs.arkansas.gov, and as long as you’ve included the right document title, she will be able to direct it to the correct person.

  • If you’re viewing this on a phone or tablet, you might want to turn it to the side (landscape) to view the width of the table well. The right 2 columns are what MSL has added to help with the list that DHS provided.

img_0478-1

Instead of scrolling through the long table, which can be confusing, this list of topics can get you straight to what you want to see. Click the link to go directly to the corresponding manual in the table.

 

The following table will attempt to explain what each document is (memo, explanation letter, mark up with changes, or new manual), what it contains, and possibly some documents to assist you. Remember, the list of topics above can assist you in finding what you need much faster.

Document Title Document Description Assisting docs/info
Interested Persons and Providers Letter for DDS Standards for Certification, Investigation and Monitoring; State Plan Amendment 2017-011; Child Health Management Services provider manual update; and Developmental Day Treatment Clinic Services provider manual update IPLtrSPA17-011.doc memo
(SPA011 – 1 of 15)
State Plan Amendment 2017-011 Attachment 3.1A 1i SPA17-011-31A1i.doc STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT: AMOUNT, DURATION AND SCOPE OF
SERVICES PROVIDED, CATEGORICALLY NEEDY (page as it will appear in new manual)
(SPA011 – 2 of 15) Page 1i
State Plan Amendment 2017-011 Attachment 3.1A 1i with tracked changes SPA17-011-31A1i-markup.doc SAME MANUAL PAGE: mark up that shows changes
(SPA011 – 3 of 15) Page 1i
State Plan Amendment 2017-011 Attachment 3.1A 4A SPA17-011-31A4A.doc STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT: AMOUNT, DURATION AND SCOPE OF
SERVICES PROVIDED, CATEGORICALLY NEEDY (page as it wil appear in new manual)
(SPA011 – 4 of 15) Page 4a
State Plan Amendment 2017-011 Attachment 3.1A 4A with tracked changes SPA17-011-31A4A-markup.doc SAME MANUAL PAGE: mark up that shows changes
(SPA011 – 5 of 15) Page 4a
State Plan Amendment 2017-011 Attachment 3-1B 2h SPA17-011-31B2h.doc STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT: AMOUNT, DURATION AND SCOPE OF
SERVICES PROVIDED, MEDICALLY NEEDY (page as it wil appear in new manual)
(SPA011 – 6 of 15) Page 2h
State Plan Amendment 2017-011 Attachment 3-1B 2h SPA17-011-31B2h-markup.doc SAME MANUAL PAGE: mark up that shows changes
(SPA011 – 7 of 15) Page 2h
State Plan Amendment 2017-011 SPA17-011-31B4b.doc STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT: AMOUNT, DURATION AND SCOPE OF
SERVICES PROVIDED, MEDICALLY NEEDY (page as it wil appear in new manual)
(SPA011 – 8 of 15) Page 4b
State Plan Amendment 2017-011 SPA17-011-31B4b-markup.doc SAME MANUAL PAGE: mark up that shows changes 1. IA Public Notice
2. IA Manual Summary
3. IA fiscal Impact
(SPA011 – 9 of 15) Page 4b
DDS Standards for Certification, Investigation and Monitoring – Redline DDS-Stnds-Redline.doc DDS STANDARDS for Certification, Investigation, an Monitoring for Center-Based Community Services  1. Summary DDTCS-CHMS 2. Info
(SPA011 – 10 of 15) entire manual, mark up that shows changes
DDS Standards for Certification, Investigation and Monitoring DDS-Stnds-Clean.doc DDS STANDARDS for Certification, Investigation, an Monitoring for Center-Based Community Services
(SPA011 – 11 of 15) entire manual, as it will appear
CHMS-2-17 Provider Manual Update Transmittal Letter CHMS-2-17.doc letter that explains which parts of the CHMS manual have been changed
(SPA011 – 12 of 15)
CHMS-2-17 Provider Manual Update CHMS-2-17up.doc CHMS Manual mark up with changes. 1. Summary DDTCS-CHMS 2. Info
(SPA011 – 13 of 15)
DDTCS-2-17 Provider Manual Update Transmittal Letter DDTCS-2-17.doc letter that explains which parts of the DDTCS manual have been changed
(SPA011 – 14 of 15)
DDTCS-2-17 Provider Manual Update DDTCS-2-17up.doc DDTCS Manual mark up with changes. 1. Summary DDTCS-CHMS 2. Info
(SPA011 – 15 of 15)
Interested Persons and Providers Letter for State Plan Amendment 2017-010, Outpatient Behavioral Health Services and Inpatient Psychiatric Provider Manual Updates and Residential Community Reintegration Program Certification IPLtrSPA17-010.doc memo
(SPA010 – 1 of 8)
State Plan Amendment 2017-010 Attachment 3.1 A SPA010-Attach3-1A.doc STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT: AMOUNT, DURATION AND SCOPE OF
SERVICES PROVIDED, CATEGORICALLY NEEDY (page as it will appear in new manual – NO MARK UP AVAILABLE)
(SPA010 – 2 of 8) Page 6c17a
State Plan Amendment 2017-010 Attachment 3.1 B SPA010-Attach3-1B.doc STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT: AMOUNT, DURATION AND SCOPE OF
SERVICES PROVIDED, MEDICALLY NEEDY (page as it will appear in new manual – NO MARK UP AVAILABLE)
(SPA010 – 3 of 8) Page 5f17a
Residential Community Integration Program Certification ResCommReintCert.doc Residential Community Integration Program Certification
(SPA010 – 4 of 8) entire manual as it will appear NO MARK UP AVAILABLE
Inpatient Psychiatric (INPPSYCH-1-17) Provider Manual Update Transmittal Letter INPPSYCH-1-17.doc Letter that shows the changes to Manual Update for Inpatient Psychiatric Services for Under Age 21
(SPA010 – 5 of 8)
INPPSYCH-1-17 Provider Manual Update INPPSYCH-1-17up.doc Manual Update for Inpatient Psychiatric Services for Under Age 21
(SPA010 – 6 of 8) entire manual as it will appear NO MARK UP AVAILABLE
Outpatient Behavioral Health Services (OBHS-1-17) Provider Manual Update Transmittal Letter OBHS-1-17.doc Letter that shows the changes to Manual Update for Outpatient Behavioral Health Services
(SPA010 – 7 of 8)
OBHS-1-17 Provider Manual Update OBHS-1-17up.doc Manual Update for Outpatient Behavioral Health Services
(SPA010 – 8 of 8) entire manual, mark up that shows changes
Interested Persons and Providers Letter for Independent Assessment Manual IPLtrAR_IA.doc memo
(AR_IA – 1 of 2)
AR Independent Assessment Manual AR_IA_July_17.doc New manual for Independent Assessment 1. IA Public Notice
2. IA Manual Summary
3. IA fiscal Impact
(AR_IA – 2 of 2)
Interested Persons and Providers Letter for DDS Policy 1076 -Appeals IPLtrDDS1076.doc memo
(1076 – 1 of 3)
DDS Policy 1076 with Tracked Changes DDS1076-Appeals-markup.doc DDS Policy APPEALS Manual
(1076 – 2 of 3) entire manual, mark up that shows changes 1. Summary Appeals
2. Info Policy 1076 Appeals
DDS Policy 1076 -Clean DDS1076-Appeals-clean.doc DDS Policy APPEALS Manual
(1076 – 3 of 3) entire manual, as it will appear
Interested Persons and Providers Letter for DDS Policy 1086 IPLtrDDS1086.doc memo
(DDS1086 – 1 of 3)
DDS Policy 1086 with tracked changes DDS1086-HDC-markup.doc DDS Human Development Center Admission and Discharge Rules Policy Manual
(DDS1086 – 2 of 3) entire manual, mark up that shows changes 1. 1086 HDC Rules Summary

2. 1086 Info

DDS Policy 1086 DDS1086-HDC.doc DDS Human Development Center Admission and Discharge Rules Policy Manual
(DDS1086 – 3 of 3) entire manual, as it will appear
Interested Persons and Providers Letter for Medical Services Policy Manual Sections E-600 through E-670 and Appendix R IPLtrABLE.doc memo
(ABLE – 1 of 2)
Medical Services Policy Manual Sections E-600 through E-670 and Appendix R ABLE.pdf Able Act Policy Manual: Eligibility Factors, Contributions, Withdrawals, Expenses, Exclusions,
(ABLE – 2 of 2) entire manual, as it will appear – NO MARK UP AVAILABLE
Interested Persons and Providers Letter for Community and Employment (CES) 1915 (c) Waiver, DDSCES-1-17 Provider Manual Update and Certification Standards for CES Providers IPLtrDDSCES.doc memo C Waiver
(CES – 1 of 5)
DDS Community and Employment Supports (CES) Waiver Minimum Certification Standards DDSCESCertStand-markup.doc DDS Community and Employment Supports (CES) Waiver Minimum Certification Standards
(CES – 2 of 5) entire manual, mark up that shows changes 1. Summary of Changes

2. Info – CES Waiver
DDS Community and Employment Supports (CES) Waiver Minimum Certification Standards DDSCESCertStand.doc DDS Community and Employment Supports (CES) Waiver Minimum Certification Standards
(CES – 3 of 5) entire manual, as it will appear
Developmental Disabilities Services Community and Employment Supports (DDSCES1-17) Provider Manual Update Transmittal Letter DDSCES-1-17.doc Letter that shows the changes to Manual Update for Arkansas Medicaid Health Care Providers – DDS Community and Employment Supports (CES)
(CES – 4 of 5)
DDSCES-1-17 Provider Manual DDSCES-1-17up.doc Manual Update for Arkansas Medicaid Health Care Providers – DDS Community and Employment Supports (CES)
(CES – 5 of 5) entire manual, mark up that shows changes 1. Summary of Changes
2. Info – CES Waiver
Interested Persons and Providers Letter for Provider-Led Arkansas Shared Savings Entity (PASSE) Waiver and New Provider Manual IPLtrPASSE.doc memo
(PASSE 1 of 5)
Provider-led Arkansas Shared Savings Entity Program – Phase I PASSEWvr.pdf PASSE Program Information B Waiver
1. Summary of PASSE
2. Info & Financial Impact
(PASSE 2 of 5)
Provider-led Arkansas Shared Savings Entity Spreadsheet SpreadsheetPASSEWvr.pdf PASSE Information – Enrollment Projections, Costs
(PASSE 3 of 5)
PASSE-New-17 Provider Manual Update Transmittal Letter PASSE-New-17.doc letter that explains Provider-Led Arkansas Shared Savings Entity (PASSE) Program manual
(PASSE 4 of 5)
PASSE-New-17 Provider Manual Update PASSE-New-17up.doc New PASSE Manual
(PASSE 5 of 5) entire manual, mark up 1. Summary of PASSE
2. Info & Financial Impact
Interested Persons and Providers Letter for Independent Assessment for Personal Care and Criminal Background Check Requirements for Providers IPLtrIA.doc memo
(IA – 1 of 22)
State Plan Amendment 2017-009 with Tracked Changes SPA17-009-markup.doc STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT: AMOUNT, DURATION AND SCOPE OF
SERVICES PROVIDED, CATEGORICALLY NEEDY (mark up that shows changes
(IA – 2 of 22) Page 10aa
State Plan Amendment 2017-009 SPA17-009.doc SAME MANUAL PAGE: as it will appear
(IA – 2 of 22) Page 10aa
ARChoices in Home Care Home and Community-Based 2176 Waiver (ARCHOICES-1-17) Provider Manual Update Transmittal Letter ARCHOICES-1-17.doc letter that explains changes to ARChoices In Homecare Home and Community-Based 2176 Waiver Manual
(IA – 3 of 22)
ARCHOICES-1-17 Provider Manual Update ARCHOICES-1-17up.doc ARChoices In Homecare Home and Community-Based 2176 Waiver Manual
(IA – 4 of 22) entire manual, mark up that shows changes
Child Health Services/Early and Periodic Screening, Diagnosis, and Treatment (EPSDT-1-17) Provider Manual Update Transmittal Letter EPSDT-1-17.doc letter that explains changes to Arkansas Medicaid Health Care Providers – EPSDT Manual
(IA – 5 of 22)
EPSDT-1-17 Provider Manual Update EPSDT-1-17up.doc Arkansas Medicaid Health Care Providers – EPSDT Manual change
(IA – 6 of 22) Section II, mark up that shows changes IA required for certain home health clients
1. IA Public Notice
2. IA Manual Summary
3. IA fiscal Impact
Home Health (HOMEHLTH-1-17) Provider Manual Update Transmittal Letter HOMEHLTH-1-17.doc letter that explains changes to Arkansas Medicaid Health Care Providers – Home Health Manual
(IA – 7 of 22)
HOMEHLTH-1-17 Provider Manual Update HOMEHLTH-1-17up.doc Arkansas Medicaid Health Care Providers – Home Health Manual change
(IA – 8 of 22) Section II, mark up that shows changes background check changes
Hospice (HOSPICE-1-17) Provider Manual Update Transmittal Letter HOSPICE-1-17.doc letter that explains changes to Arkansas Medicaid Health Care Providers – Hospice Service manual
(IA – 9 of 22)
HOSPICE-1-17 Provider Manual Update HOSPICE-1-17up.doc Arkansas Medicaid Health Care Providers – Hospice Service manual changes
(IA – 10 of 22) Section II, mark up that shows changes background check, IAs for personal care
1. IA Public Notice
2. IA Manual Summary
3. IA fiscal Impact
IndependentChoices (INCHOICE-1-17) Provider Manual Update Transmittal Letter INCHOICE-1-17.doc letter that expains changes to Arkansas Medicaid Health Care Providers – IndependentChoices Manual
(IA – 11 of 22)
INCHOICE-1-17 Provider Manual Update INCHOICE-1-17up.doc Arkansas Medicaid Health Care Providers – IndependentChoices Manual changes
(IA – 12 of 22) Section II, mark up that shows changes various changes included background checks
Personal Care (PERSCARE-1-17) Provider Manual Update Transmittal Letter PERSCARE-1-17.doc letter that explains changes to Arkansas Medicaid Health Care Providers – Personal Care manual
(IA – 13 of 22)
PERSCARE-1-17 Provider Manual Update PERSCARE-1-17up.doc Arkansas Medicaid Health Care Providers – Personal Care Manual changes
(IA – 14 of 22) Section II, mark up that shows changes
Private Duty Nursing Services (PDN-1-17) Provider Manual Update Transmittal Letter PDN-1-17.doc letter that explains changes to the Arkansas Medicaid Health Care Providers – Private Duty Nursing Services manual
(IA – 15 of 22)
PDN-1-17 Provider Manual Update PDN-1-17up.doc Arkansas Medicaid Health Care Providers – Private Duty Nursing Services Manual changes
(IA – 15 of 22) Section II, mark up that shows changes background checks
Physician (PHYSICN-3-17) Provider Manual Update Transmittal Letter PHYSICN-3-17.doc letter that explains changes to the Physician/ Independent Lab/CRNA/Radiation Therapy Center manual
(IA – 17 of 22)
PHYSICN-3-17 Provider Manual Update PHYSICN-3-17up.doc Physician/ Independent Lab/CRNA/Radiation Therapy Center manual changes
(IA – 18 of 22) Section II, mark up that shows changes IA requirement
1. IA Public Notice
2. IA Manual Summary
3. IA fiscal Impact
Rural Health Clinic (RURLHLTH-1-17) Provider Manual Update Transmittal Letter RURLHLTH-1-17.doc letter that explains changes to the Rural Health Clinic Services manual
(IA – 19 of 22)
RURLHLTH-1-17 Provider Manual Update RURLHLTH-1-17up.doc Rural Health Clinic Services manual changes
(IA – 20 of 22) Section II, mark up that shows changes IA requirement
1. IA Public Notice
2. IA Manual Summary
3. IA fiscal Impact
Section I (SecI-3-17) All Provider Manuals Update Transmittal Letter SecI-3-17.doc letter that explains the changes to the Arkansas Medicaid Health Care Providers – All Providers manual
(IA – 21 of 22)
SecI-3-17 All Provider Manuals Update SecI-3-17up.doc Arkansas Medicaid Health Care Providers – All Providers manual
(IA – 22 of 22) Section II, mark up that shows changes IA requirement
1. IA Public Notice
2. IA Manual Summary
3. IA fiscal Impact

Medicaid Saves Lila

Published on by medicaidsaveslivesLeave a comment

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This is my sweet girl, Lila. She’s active and intelligent. She loves to swing, eat blackberries, and paint. Don’t you dare turn your back on her because she’s mischievous too! She loves her friends, family, and kitty-cats. She is absolutely the most wonderful thing I’ve ever done with my life, and she just so happens to have Down Syndrome.

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She might smile a lot, but her life hasn’t been easy. Born almost a month early due to multiple complications, Lila spent some time in the NICU. She’s overcome multiple illnesses and surgeries, including open heart surgery soon after her first birthday and many others since. In fact, we have received 2 new diagnoses this year alone, and she’ll have at least one surgery.

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My husband and I are proud Arkansans. We’re educated, hard-working, tax-paying citizens. At the time of Lila’s birth, we lived in another state. Despite the fact that we both had good jobs and primary insurance coverage, we struggled to provide for her needs. When we moved back to Arkansas, Lila was significantly delayed in many areas.

IMG_6519 Our friends told us about TEFRA, a type of Medicaid funding that provides for disabled children and that requires the family to pay a premium. Our primary insurance pays first for all that it will cover, and Medicaid makes sure that Lila doesn’t go without the rest. We gladly pay a monthly fee for this essential assistance!

Lila now receives medical treatments that she needs from specialists and Occupational, Physical, and Speech therapy. She attends a school where she is loved and accepted, and they practice important skills in the classroom to prepare her for mainstream Kindergarten. Lila is constantly learning the necessary skills to be independent: speaking new words, learning to feed herself, to dress herself, and to climb stairs. One of my favorite moments was the first time I ever heard her say, “Ma Ma.” Can you imagine waiting 4 years to hear that?

IMG_2776We never expected to need Medicaid. Even though we’d paid taxes for years for Medicaid, we didn’t know that a person’s life can change drastically in a moment – a car accident, a stroke, a job loss, a cancer diagnosis, a chromosomal difference – to cause them to need Medicaid. We thought that if we worked hard enough, we could take care of ourselves and Lila. But no matter how hard we work or what we give up, we just can’t afford to provide for all of Lila’s needs. Now, because of Medicaid, Lila is thriving, and we’re not being crushed under the weight of Lila’s ever-growing medical debt. We have hope that she will continue to develop and someday be a valued, contributing member of society. We are incredibly thankful for Medicaid.

We tell everyone we can how essential Medicaid is! Lila has visited the Capitol and state lawmakers multiple times to represent herself and friends like her. Since she can’t speak much yet, my husband and I tell them how much Medicaid is literally saving lives. I can’t wait for the day that Lila will tell them herself. She brings a beauty and light to this dark world, and we will never stop fighting for her!

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