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!

 

The PASSE System – How to Take Action

Updated: 4/10/18 12:10pm

The PASSE system was voted in by our legislature last year, and now the time has come for us to see the changes.

If you need a reminder, the PASSE stands for Provider-led Shared Savings Entity, and they will be managing the care for tiers 2 & 3 of behavioral health and developmental disability services.

DHS has begun to assign people to the 4 licensed PASSEs after each person’s Independent Assessment is complete.

MSL is actively working to get you more information on the PASSEs themselves. The information we have so far is listed below. If you have a question, you can call the DHS PASSE expert in your area. See the list.

These changes may be happening to you or a loved one, but you can do these 7 things to help yourself in this new process:

1. Make sure your provider knows about the PASSE and everything it involves.

Update: DHS said this week 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 top 2 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. The 3rd 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 in depth
  • Resource that explains 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)
ForevercARe

3. Join a PASSE Advisory Committee.

Every PASSE must have a committee of individuals and caregivers affected by the PASSE to give them feedback on what’s truly happening, especially if that doesn’t match what’s supposed to be happening. Use the contact info above to send your request to join a 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. We will continue to provide more info as we can!

5. 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.

6. 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:

7. 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.

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

 

 

What Tier Would I Be Placed In?

Certain people who receive Medicaid through Developmental Disability Services and/or Behavioral Health Services will be contacted about an Independent Assessment – only Tiers 2 and 3. Read the following situations to decide where you might fit:

Developmental Disability Service Tiers

Tier 1:
Individual receives DD services under the Medicaid State Plan (DDTCS, CHMS, therapy, etc.), but does not meet ICF/IID level of care eligibility

Tier 2:
Individual meets ICF/IID level of care eligibility, but does not currently require 24 hours/day of paid support and services to maintain his or her current placement

Tier 3:
Individual meets ICF/IID level of care eligibility and does require 24 hours/day of paid support and services to maintain his or her current placement


Behavioral Health Services Tiers

Tier 1: Counseling
Time-limited services provided by a qualified licensed practitioner in an outpatient setting to assess and treat mental health and/or substance abuse conditions

Tier 2: Rehabilitative
Home and community-based services with care coordination including a full array of professional and para- professional services for individuals with higher needs. Services provided by certified behavioral health agency staff members.

Tier 3: Residential
Services provided in residential setting for individuals with the highest need

Updated PASSE Information

Click the image below to receive comprehensive, updated information on the PASSE systems (as of October 2017). The deadlines have been updated, and if you were wondering what the purpose of the model is, here’s your chance to find out!

Screen Shot 2017-10-31 at 9.36.43 AM

Three PASSEs were officially certified on October 18: Arkansas Advanced Care, ARkansas Total Care and Empower Healthcare Solutions. Read more about them in the image below:

Screen Shot 2017-10-31 at 10.20.51 AM

Input Needed: INDEPENDENT ASSESSMENTS

Next week, our Founder Lainey Morrow will be meeting with DDS Director Melissa Stone, BHS Director Paula Stone, and Optum (the company doing the Independent Assessments).

They are going to answer our questions about Independent Assessments and explain the whole process. What questions would you like for Lainey to ask them?

Also, they plan to provide training on the IA process, so you can know what to expect. They’ve asked for feedback on which method each one of you would prefer. This doesn’t mean they promise to provide it in that way, but they want your input.

Use the form below to send your questions and input. If you don’t see an option that fits you, add your own.

 

Independent Assessment Resource

As you may know, Independent Assessments will be required for any Medicaid recipient in Tier 2 or 3 for Behavioral Health or Developmental Disability Services of DHS, as well as other Medicaid populations in Arkansas.

Public comment for these rules ends tonight, August 12, 2017! Read the manuals for things that might affect you, and then send your comments and questions to Shelby.Maldonado@dhs.arkansas.gov. Make sure to tell her which documents below you’re commenting on. If you need any help, just watch a video tutorial by clicking the red button below.

img_0478-1

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

See all of the manuals for Independent Assessments.


 Optum (the company that DHS has contracted to do these assessments) has released the following resource to help you understand the Independent Assessment process.

Click on the image below to learn more:

Screen Shot 2017-08-11 at 10.34.16 AM

 

Public Comment Help – PASSE Model Phase I

DHS has released a manual/rule change for public comment until August 11, 2017. After that, you will not be able to get your comments on the record. In addition, they are hosting a public hearing on August 8.


You should read the manual for yourself to make sure you cover everything that concerns you. However, even if you read it, you might still wonder what to say. The comments below are an example of what one person plans to send in.

Use the form below. By choosing “Submit,” you will send an email directly to the appropriate DHS representative. Enter your information, and type your comments into the text box. You may copy/paste the comments listed at bottom into the comment section of the form, but don’t do so unless you have read it first and agree with it all. The following comments are just examples of one person’s opinions. Public comments are most effective when you make them more personal to you!


EXAMPLE | EXAMPLE | EXAMPLE | EXAMPLE | EXAMPLE | EXAMPLE | EXAMPLE

This is my public comment regarding PASSE-New-17up.doc:

Section 211.000 – It says that the PASSEs should begin October 1, 2017. I believe that this model is not ready to begin taking on clients for several reasons. Rules like this one still have to be sent through the legislature for their approval. The Insurance Department isn’t supposed to approve the PASSEs until mid-September, which will only leave them a couple of weeks before they start managing people’s care. We don’t know what the rules will be, and we don’t know who the PASSEs will be. If the PASSEs aren’t ready and don’t do a good job, they could make mistakes. This will hurt people. I want DHS to push the date back and allow us to keep things the way they are until the PASSEs have had adequate time to review all of the finalized rules and to hire and train people who understand the rules.

Section 214.000 – It says that people can choose another PASSE during the first 90 days and once every year. How will we know what the differences between each PASSE is? I want to pick the best PASSE, but I don’t understand all of the rules or what they all offer. (At this point, I have reason to wonder if the PASSEs themselves understand the rules, as they have not been finalized.) It also says “on the beneficiary’s annual anniversary of attribution to a PASSE.” Is this a single day to respond, or is it a week? You need to define how long that amount of time would be.

Section 214.000 D – It says a client can move because of “poor quality of care,” but how do we prove that? That is a relative term. Who determines what kind of care is poor? I believe that the patient should determine whether care is poor and what that means in their situation.

Section 215.000 – What if the abeyance is due to DHS/Medicaid’s fault in paperwork (and the client can prove that)? Will the coordinator help the recipient to know that their Medicaid eligibility is in dispute and help them to figure that out?

Section 222.000 G – “The right to be provided written notice of a change in the beneficiaries care coordination” should be at least 14 days, not 7 days. If you are relying on snail mail, half of the time can be used simply in sending the notification, leaving the receiver very little time to respond or make other arrangements. Why isn’t this policy the same as 223.000 B, allowing 30 days from the time it goes into effect?

Section 231.000 – The travel times and distances listed need to be cut in half, especially for DD and BH providers who are seen on a more frequent basis. For example, it is not in the best interest of a child or adult to have to travel an hour to and then an hour to return from a location to see a therapist multiple times per week.

Section 241 G, 242 A, & 243.000 – DHS needs to give the PASSEs enough money to have a qualified individual available to help me whenever I need them, as many times as I may need them. Many providers seem to be concerned that the amount announced at the AR Waiver Conference (in July 2017) of $177 is not enough. I want them to get what they need so they can give me what I need. After December 31, 2018, they should have a different funding source and should not use any money from recipients’ care for administrative funding needs.

Section 242.000 – It says in the document that care coordinators will be employees of the PASSE (241 B). However, it does not say where the care coordinators should be located. Because Arkansas is so rural, care coordinators located in the communities they serve would be most knowledgeable for their clients.

Section 254.000 – Will DHS be required to submit the data received from PASSEs, such as data that shows savings or lack thereof, for public viewing? We want to see that data as well.

Section 261.000 – This says that grievances must be resolved within 30 days of the filing date. What will happen in the meantime? If a person needs treatment, do they have to wait all that time to receive it?

Section 264.000 – This description needs more definition. Who may serve on a Consumer Advisory Council? I believe that beneficiaries or direct consumers should serve, but caregivers who speak in place of beneficiaries who can’t speak for themselves should also be able to serve.