Tag: provider

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.

UPDATED: Here are your rights with the PASSE system.

Published on by medicaidsaveslivesLeave a comment

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 31 days now. We have 29 more days of the “transition plan” where our plans are supposedly covered as they were before the PASSE took over. 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.

PASSE: 4 Things You Can Do

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On Feb 27, a judge denied a restraining order and request to intervene, which would have stopped the PASSE program from starting on March 1.

Some people did not understand the decision or how the judge could process the information and testimony so quickly.

He apparently made the decision based on pure law, saying that the plaintiffs hadn’t shown proof that the start of the program on March 1 would cause them the “irreparable harm” needed to justify such a restraining order.

Since the case will remain open, they may still get the chance to prove that harm later on (although for the sake of the 40,000 people affected, we all hope they don’t see irreparable harm.)

The judge ruled (for now), but you still have things you can do.

What can you do now?

1. Make sure you join the group to let others know what’s going on in your life.

2. If you’re affected by the PASSE, make sure you email Disability Rights Arkansas if you’re seeing problems with the PASSE. If they want to revisit this complaint, they will need a lot of proof to stop the PASSE program. If you’re denied a service, let them know. If your Care Coordinator does a bad job, let DRA know. Email TNichols@disabilityrightsar.org.

3. Also, keep these numbers handy. Make your complaints to the Ombudsman 1-844-843-7351, and send an email with your issues to PASSEOmbudsmanOffice@dhs.arkansas.gov. They have to log them. Every time a provider isn’t in network, or a provider doesn’t know about the PASSE, let your PASSE and the Ombudsman know. If a service is denied, let the Ombudsman know how this will impact you. Most emails and records like this can be subject to requests and investigation, so get them on the record.

4. If you are denied a service you need, make sure you file an appeal immediately. Every PASSE has a different process and rules on their website. If the PASSE denies your appeal, you can then appeal to DHS.

Arkansas Total Care – How to Appeal

Empower – How to Appeal

Summit (APC) – How to Appeal (pg 5)

If the PASSE program does end up doing harm to the people, we will all have to work together to stand up. Don’t wait until that happens. Make sure you’re communicating all along.

Lawsuit filed to stop the PASSEs from taking over on March 1

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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.

1 PASSE Quits: 5 Things You Need to Do

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Big news this week in case you missed it. There were 4 PASSEs, and now there are 3. ForeverCare says they can’t move forward, right before the PASSEs would all receive the payment to manage everyone’s care on March 1. What does this all mean? Now what?

The news has covered this some in the past few days. Forevercare says the program isn’t ready, but DHS says they are. Watch this video or read this news story to see what ForeverCare had to say:

screen shot 2019-01-19 at 9.33.55 am

If you don’t know what the PASSE is, check this out (MSL Resource).

Or watch this previous town hall recording from DHS.

In light of ForeverCare’s announcement, this is what you can do:

(1) If you are concerned about this whole thing, you need to contact DHS through the PASSE Ombudsman.

They’re supposed to take our complaints, concerns, and help us solve problems:

Call –  1-844-843-7351 (during business hours)

Email – PASSEOmbudsmanOffice@dhs.arkansas.gov

More info – https://humanservices.arkansas.gov/about-dhs/dms/passe-ombudsman If you’re a provider, and you’re confused or concerned about all of this and how it will work before March 1, you need to contact DHS through

Tanya Giles | tanya.giles@dhs.arkansas.gov | 501-320-6189

(2) A lot of people want to contact their legislators and let them know what’s going on. After all, the state legislators voted this through when they voted for Act 775.

Keep them up to date on how this system is affecting you.

Contact our state legislators.

Contact any elected legislator in the US.

See how your local Representatives or Senators voted on Act 775.

(3) If you thought this was confusing, get ready for more. Keep a note pad by the phone. Keep everything that is mailed to you, and keep a phone log.

If you are a ForeverCare family, they are going to be your PASSE until March. Even after you’re reassigned, your new PASSE isn’t supposed to officially take over until March 1. But your new PASSE will be contacting you to give you more information, find out more about you and everything you need. So make sure you don’t forget ForeverCare’s contacts.

FOREVERCARE
  • Gateway Healthplan
  • Their HANDBOOK (rules, your rights, and information)
  • 1-855-544-8744
(4) You’re going to get reassigned in early February, and you’re going to get 90 days to switch PASSEs if you want.

That means you’ll have until May to decide if you like your PASSE, and if you don’t, you’ll have to research which one you want to go to.

Here is the other PASSE information. You need to check out their handbooks and networks. Ask other families what they like and don’t like about their PASSEs.

Some of them are having family and provider meeting this month. Call them to find out when theirs is!

  • Arkansas Total Carehttp://www.arkansastotalcare.com | 1-866-282-6280

    CEO, John Ryan – jryan@centene.com

    Care Coordination Contact: Amber Baker | (501) 478-2597

    Amber.Baker@ArkansasTotalCare.com

    HANDBOOK

    NETWORK LIST – none shown on website

  • Empower Healthcare Solutionshttp://www.getempowerhealth.com | 1-866-261-1286

    CEO, Nicole May – nicole.may@beaconhealthoptions.com

    Care Coordination Contact: Jamie Ables | Office (501) 707-0961

    Jamie.Ables@beaconhealthoptions.com

    HANDBOOK

    NETWORK LIST

  • Summit Community Carehttp://www.summitcommunitycare.com | 1-844-405-4295

    CEO, Jason Miller – jason.miller@summitcommunitycare.com

    Care Coordination Contact: Tiffany Parkhurst | (501) 773-6273

    Tiffany.parkhurst@summitcommunitycare.com

    HANDBOOK

    NETWORK LIST

(5) After ForeverCare’s announcement, everyone became more concerned and had serious questions. Make sure you ask your questions! Ask DHS, ask your legislators, and ask in our group.

This is what DHS had to say to our questions as of Jan 18:

page 1page2page3

Preferred Family Health Closure Update

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This is a letter that went out to beneficiaries who received services at PFH to notify them of PFH’s closure. Some of you may be interested in this information as well as this link which lists the available providers. Please note the PDF is searchable!

PFH_LETTER

PASSE: Take Action!

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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

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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:

Upholding the ADA: Living in the Community

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Everyone on the CES Waiver, all of you who enjoy having your loved one living near to you instead of in an institution, & providers who support waiver services:

The ability to live freely in the community has been questioned, according to this article, by a top official with the US Department of Health and Human Services, enough to alarm a group of Congressmen. They formed a bipartisan group and took action.


“The lawmakers said they were told that Lazare said she believed the Supreme Court came to the wrong conclusion in the landmark Olmstead v. L.C. case, which affirmed the right of people with disabilities to access community-based living, and that she prefers segregated and institutional settings. In addition, Lazare reportedly said she believed that a federal Medicaid rule outlining what types of settings qualify as community-based should be revisited, according to a letter from Reps. Jan Schakowsky, D-Ill., Gregg Harper, R-Miss., and Jim Langevin, D-R.I.”

Even when things are quiet in the news, someone in power is thinking these things. Maybe they want to save money, or possibly they think less of people with disabilities. Some in power think they have the means to change these protections. We need to always be communicating to our legislators why we want to live in the community or why we want our loved ones out in the community instead of institutions. We need to know our rights and assert them!

Laws that protect people with disabilities

The ADA National Network

Take a moment to make our Congressmen understand how much living in the community means to us. They are the ones who would have to fight a battle that threatens the ADA.

Contact our Arkansas Congressmen!!

Contact any US elected official!

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: