On July 30, 1965, President Lyndon Johnson signed Medicare and Medicaid into law. For 53 years, it has served as a safety net for millions of people in times of health and financial hardship.
Let’s celebrate Medicaid by sharing why you’re thankful for it! What has Medicaid done for you, a friend, or a loved one?
Note: Many of these may be shared, so you don’t have to put your whole name. You can include a link to your photo, such as one you’ve shared publicly on your social media profile.
The deadline to comply with work requirements for June was July 5. DHS sent out notices of non-compliance to thousands of people that should have already reached clients. If you have not reported your hours, you need to do so as soon as possible because you can only miss a couple more months before you lose coverage. Even if you don’t utilize AR Works, please SHARE this information!
Some people don’t even realize that they are affected. They don’t recognize the name AR Works, or their address has changed preventing these letters from DHS from giving this much-needed information. If you need more information about AR Works (what it is, its history, how to apply), read this article.
If you are unsure if you are affected or how to proceed if you are, keep reading. We have information below that will help!
Anyone who receives those notices or just wants information is welcome to call Legal Aid of Arkansas at (800) 967-9224. They have special Arkansas Works lines–callers can just press 4 at the initial message, dial extension 6313 for Trevor, or extension 2206 for Kevin.
(1) Check out DHS’ website about how to report your work hours, school attendance, volunteer hours, or your exemption.
(1) Share Legal Aid’s Facebook video. This explains the latest and has a link to earlier videos: https://www.facebook.com/arlegalaid/videos/1755020114575199/
(2) Share the attached flyer (ar-works-flyer-latest.pdf) and handout (arkansas-works-information-for-consumers-latest-05-10-18.pdf).
(3) Invite Legal Aid to talk to your group, community, staff, or clients. They can accommodate any form of participation (in-person, video, phone), various languages, and any time limitations.
If you want assistance from Legal Aid, here is contact info:
Kevin De Liban, Attorney
Economic Justice Practice Group Leader
Legal Aid of Arkansas–West Memphis
310 Mid-Continent Plaza, Suite 420
West Memphis, AR 72301
Phone: (870) 732-6370 x. 2206
Fax: (870) 732-6373
Here is a detailed update from Kevin de Liban from Legal Aid about AR Choices.
Also, please note that Public Comment ends on this issue on July 31, 2018. There is one more public hearing on July 26th in Little Rock. Kevin’s update can help you with ideas of what to say as you examine the manuals available for public comment. Don’t miss this chance to speak up for what you need!
As you know, a court invalidated the RUGs algorithm a little over two months ago. DHS is now trying to re-implement the RUGs algorithm to take effect on October 1. Rule-making is the name for the process by which DHS is trying to make this change. DHS has proposed that the algorithm work the same way it did before being invalidated.
Until October 1, it appears that DHS intends to keep everyone on the program at the same level of attendant care they have now and that DHS will not allow any new applicant to the program to receive attendant care services. Legal Aid of Arkansas is actively working to change this through a new lawsuit filed on June 29.
Here is some other relevant information:
(A) The public comment period for rule-making on the algorithm runs until 7/31. Here are the manuals available for public comment. The public has a right to participate in the rule-making process. If they choose to do so, people may offer comments by email to becky.murphy@dhs.arkansas.gov or by mail to the DHS Division of Medical Services, Office of Policy Coordination and Promulgation, P.O. Box 1437, Slot S295, Little Rock, Arkansas 72203-1437. Please include the title of the document you are commenting on when you email. Here is the notice of rule-making that DHS has published for more information.
(B) DHS is hosting public meetings about the rule-making. The remaining meetings is on 7/26 in Little Rock (Ark. Enterprises for the Developmentally Disabled ;105 East Roosevelt Rd.). People can offer verbal comments at the meeting. The meetings start at 5 p.m.
(C) Legal Aid has had nearly 200 cases relating to the RUGs algorithm in the last two and a half years. Here is some of what we’ve learned about how the algorithm works.
(1) The algorithm doesn’t provide enough care to meet the needs of people on ARChoices.
The most care someone can get under RUGs is 5.5 hours per day unless they need IV medication, suctioning, tracheostomy care, a ventilator, or a feeding tube (then, they can get 6.5 hours per day). This is not nearly enough to meet the care needs of many people on the program. Because of the cuts to care, many people ended up lying in their own waste, skipping meals, getting bed sores, and staying shut in. Even when people have family members make up for the cuts, they have had to go through more anxiety, have family work outside the home in ways that threaten their care, or consider moving to a nursing home.
(2) The RUGs algorithm cuts the hours of people who have not gotten any better.
People who used 8 hours per day (the max for people under 65) or 7 hours per day (the max for people 65 or over) before the algorithm were cut even though their medical conditions and abilities did not improve.
(3) The RUGs algorithm has not been validated or verified in Arkansas.
The only testing that has occurred on RUGs took place in Ontario, Canada and Michigan, which have different situations than Arkansas. Also, though DHS says that it used statistics to come up with the hours that different people get, DHS admits they lost the data. This means that there is no way of knowing how or why DHS figured that 5.5 hours per day was enough for someone with quadriplegia or cerebral palsy (or any of the other amounts DHS gives for people with different conditions and abilities).
(4) There is no documented evidence of problems with the system of nurse discretion that DHS used for 17 years before the algorithm.
Before 2016, DHS used nurses to decide the number of attendant care hours. Legal Aid never received a single complaint from clients about the nurses’ decisions. Since DHS started using the algorithm in 2016, we have worked on nearly 200 cases. Now, DHS says that nurses were biased and that the algorithm is more objective or fair. But, before 2016, DHS did not tell a single nurse that they were giving out too many or too few hours, did not do any kind of study to show whether nurses were giving out too many or too few hours, and did not tell nurses to change the way they were giving out hours.
(5) Our clients generally do not think the complicated RUGs algorithm is fair.
The algorithm is 21 pages of computer code. Most average people can’t understand it. Also, the way the algorithm works totally excludes a doctor’s opinion about the amount of care someone needs. People on the program cannot understand the criteria by which their hours are set, cannot fight reductions, and cannot plan for the future.
If you need help or more information, here is Kevin’s information:
Kevin De Liban, Attorney
Economic Justice Practice Group Leader
Legal Aid of Arkansas–West Memphis
310 Mid-Continent Plaza, Suite 420
West Memphis, AR 72301
Phone: (870) 732-6370 x. 2206
Fax: (870) 732-6373
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
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.
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.
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:
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!
We appeared live on Facebook with Managing Attorney Thomas Nichols from Disability Rights Arkansas to answer your questions and discuss your rights when appealing a Medicaid decision. Watch because this video is full of helpful information from beginning to end!
Thomas refers to a presentation with more information on appeals that you might want to view.
When filing an appeal, you have resources in the state to help you. Even if you can’t afford it, you can find quality lawyers or law advice. Make sure to contact:
Also, we reference Rights that we listed in a previous post. Make sure to read it.
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.
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.
You, your representative, and your provider have the right to request a hearing.
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 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.
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!
Updated: 7/20/18 2:00pm
The PASSE system was voted in by our legislature last year. This year, they are taking on managing clients’ care, and in January 2019, their decisions about our care will matter. DHS/Medicaid will give them 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:
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.
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.”
*MSL has requested websites for all – check back for updates.
Each PASSE is required by Act 775 (pg 9, line 21) to have an 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.
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!
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.
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.
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:
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.
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.
Medicaid Saves Lives 