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.

PASSEs: Learn More

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.

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!

New Medicaid Dental Plan

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