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!

Your Rights When You Appeal

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.

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!

 

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:

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

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.

 

Waiver Waiting List – Important News for “the 500”


In February 2017, DHS notified 500 people that they would be receiving the funding to come off of the waiver waiting list this year. They sent paperwork for each recipient to fill out. In July, they sent another letter.

As of today, barely 250 people have responded, and the rest are in danger of losing their chance to come off the waiting list.

Our state DHS had to request the additional 500 slots from a federal agency, and that agency, Centers for Medicare and Medicaid, finally granted it on August 22, 2017. In the meantime, DHS sent another letter this summer in order to reach the rest of the people who have not yet responded. They also began working on plans of care for those who have responded. Once a person responds, it will take 60-90 days to set up the Independent Assessment, the staff required for the plan of care, supplies, and possible residencies. 

If you have already been communicating about your plan of care, you will most likely see some progress in September to October. It is important to note that the federal approval was holding up progress. If you had chosen the company who you’d like to work with, please know that they were only notified as soon as the federal approval came through. You should be hearing from them soon.

 Those of you in the 500 who were notified in February should receive DHS’ final letter in the coming days. If you have not yet responded to DHS about your spot in the top 500, they will also attempt to reach you by phone. If they can’t reach you by phone, they will remove you from the list of 500 and move on to the next people waiting. 

If you have questions about this, you can’t simply call any office. You must call these specific people:

– For the status of applications:
Merinesa Morris
(501) 683-0571

– For all other questions:
Regina Davenport
(501) 683-0575

If you are a person on the waiting list, a caregiver, or a provider of someone on the list, please share this to ensure that this information gets to the correct people.

Here is a copy of the letter that will be going out: