behavioral health transition update...• please notify patricia gann [email protected]...
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BEHAVIORALHEALTHTRANSITIONUPDATE
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911ASSESSMENTS
GOAL: ENSURE THAT ALL BENEFICIARIES UNDER THE 911 PROGRAM
WHO QUALIFY FOR AN INDEPENDENT ASSESSMENT ARE ASSESSED
PRIOR TO JANUARY 1, 2019.
• We are working with the Arkansas State Hospital and the 911
monitors to cross reference reports to ensure that all persons under
the 911 program are assessed.
• We are asking providers to review any 911 who is currently receiving
treatment at their facilities to ensure as assessment has been
completed. Presumptive eligibility for 911 beneficiaries who have not
received an Independent assessment ends on December 31, 2018.
• Please notify Patricia Gann [email protected] of any
911 beneficiaries who have not received an Independent Assessment
so that we can review and if appropriate refer for an immediate
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ResidentialAssessments
GOAL: ENSURE ALL BENEFICIARIES CURRENTLY ADMITTED TO RESIDENTIAL SERVICES ARE INDEPENDENTLY ASSESSED PRIOR TO JANUARY 1, 2019. • Optum is currently working with Residential providers to schedule and
complete independent assessments on all beneficiaries who are currently admitted to residential programs who have not received an independent assessment and to schedule and completed a reassessment for those beneficiaries who have been assessed at Tier 1. • We are asking providers to review any beneficiary who is currently
receiving treatment at their facilities to ensure as assessment has been completed. • When the PASSEs assume full risk, there is no payment option under
Medicaid Fee For Service. • Please notify Patricia Gann [email protected] of any
beneficiaries who have not received an Independent Assessment so that we can review and if appropriate refer for an immediate assessment.
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PreparingforTransitionofContract
GOAL: TO ALLOW PROVIDERS TO SUBMIT EXTENSION OF BENEFITS FOR SERVICES ESTIMATED TO BE MEDICALLY NECESSARY DURING A TRANSITION PERIOD FROM JANUARY 1, 2019 THROUGH MARCH 31, 2019.
• Providers may begin to immediately submit requests to Beacon for EOB for medically necessary services for the above outlined period.
• This includes Extension of Benefits for those beneficiaries who will receive Tier 2 and Tier 3 services outside of the PASSE and have active Medicaid coverage.
• This does not apply to those covered by Spenddowns. Spenddowns will continue to be retroactively reviewed.
• Please remember that Extension of Benefits may be requested up to 365 days after the service has been delivered.
• All services provided must be medically necessary 4
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PreparingforTransitionofContract
• Beginning on December 17th and extending through December 31, 2018 the end of the contract, Beacon will only accept and process requests through the ProviderConnect System for the following: ‒ Acute Inpatient Hospital ‒ Residential Admissions ‒ Prior Authorization for Infant Mental Health
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AnnualReassessments(PASSEIneligible)
• Each client must receive a reassessment annually.• All clients whose most recent assessment occurred in 2017 have had
their assessment end date extended to 12/31/2018.‒ DHS will work with providers and with Optum to schedule reassessments
prior to the expiration dates. • For those clients whose assessment occurred after 1/01/2018, DHS
will provide Optum with a reassessment referral roster at a minimum of 30 days prior to the expiration date so as to allow sufficient time to complete reassessments prior to the expiration date.
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PreparingforTransitionofContract
Pending Legislative Approval our new vendor will begin training in December. Please be on the lookout for announcements and training opportunities.
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InformationforBHProviders
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• The Provider-led Arkansas Shared Savings Entity (PASSE) is a model of organized care created by Act 775 of 2017.
• Providers have entered into partnerships with each other along with an experienced organization that performs administrative functions similar to insurance companies
• Under Act 775, the governing body of each PASSE must include several types of providers licensed or certified to deliver services in Arkansas:
• a Developmental Disabilities Services specialty provider
• a Behavioral Health Services Specialty provider
• a Hospital
• a Physician
• a Pharmacist
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WhatisaPASSE?
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PASSE Enrollment Population includes only:‒ Individuals receiving services through DD Waiver‒ Individuals who are on the DD Waiver Waitlist‒ Individuals who are in private DD Intermediate Care Facilities‒ Individuals that have a Behavioral Health Diagnosis and have received an
Independent Assessment that determines they need services in Tiers 2 or 3
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WhoisservedbythePASSEs?
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Whatservicesarecovered?
Community & Employment Supports Respite Supplemental Support Consultation Supported Employment Adaptive Equipment Crisis Intervention Supported Living Specialized Medical Supplies
Community Transition Services Environmental Modifications
Arkansas Community Independence Services Supportive Employment Planned Respite Behavior Assistance
Peer Support Emergency Respite Crisis Intervention
Family Support Partners Therapeutic Host Home Mobile Crisis Intervention
Child & Youth Support Services
Community Reintegration Program
Individual Life Skills Development
Therapeutic Communities Supportive Housing Partial Hospitalization
Adult Rehabilitation Day Treatment
Supportive Life Skills Group Life Skills Development
State Plan Services Personal Care Physician Specialists Family Planning Primary Care Physician Pharmacy Inpatient Psychiatric Durable Medical Equipment Hospital Services Outpatient Behavioral
Health Counseling Occupational Therapy Physical Therapy Speech Therapy Nursing Services
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The following services will be available to PASSE members, but the service provider will continue to bill Medicaid directly for these services.
• Nonemergency medical transportation• Dental benefits• School-based services provided by school employees
If a client has any problems accessing the services above through another Medicaid program, they can contact their care coordinator.
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Whatservicesarecovered?
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Whatshouldprovidersexpect?The PASSE system is a shift in the ways that clients’ care is managed, and how providers bill for services if they serve PASSE clients.
In the coming weeks, providers will need to contact each PASSE to find out how to join each PASSE’s network and how providers will bill the PASSEs for services starting on January 1, 2019.
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WhyshouldprovidersjoinaPASSE?Providers should join the PASSEs to be in-network providers for their current clients whose care will be managed by the PASSEs.
If a provider joins a PASSE, they will be assured of the rate that they will be paid by that PASSE.
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WhatchangeswillprovidersseeinthePASSEsystem?
Phase I Phase II
Clients have been assessed and assigned to a PASSE.
The PASSEs will be responsible for maintaining statewide network of providers.
Care Coordinators have contacted clients and have started plans of care.
PASSEs will receive a global payment to ensure services for all clients.
Providers will sign contracts with the PASSEs to join the networks to continue providing services to clients in 2019.
Providers of clients whose care is managed by the PASSEs will bill the PASSEs instead of Medicaid.
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HowdoesCareCoordinationaffectproviders?
After a client is assigned to a PASSE, each client is given a Care Coordinator who helps him or her develop a Person Centered Service Plan (PCSP). PASSE Care Coordinators help clients to get and coordinate needed services across many systems.
Care Coordinators may contact you to ask for your clients’ plans of care and to assist clients in continuing services, identifying needs for supports, and coordinating multiple plans.
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HowwilltheformationofPersonCenteredServicePlansaffectproviders?
A PCSP helps individuals who receive developmental disabilities (DD) and behavioral health (BH) services to plan for their futures. The care plans you develop for your clients will be a part of the PCSPs.
You will serve as part of a team who implements the PCSPs for your clients.
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HowcanaproviderjoinaPASSE?Each PASSE should be able to provide you more information about how to join their networks. Once a provider receives information from the PASSEs, the provider can choose to join any and all PASSEs. How a provider chooses to participate is a business decision.
Arkansas Total Care [email protected] 1-844-631-6830 | www.arkansastotalcare.com
Forevercare [email protected] 1-855-544-8744 | www.forevercare.com
Empower Healthcare Solutions [email protected] 1-866-261-1286 | www.getempowerhealth.com
Summit Community Care [email protected] 1-844-405-4295 | www.summitcommunitycare.com
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HowwillbillingbedifferentstartingonJanuary1,2019?
Beginning on January 1, 2019, the Arkansas Department of Human Services (DHS) will give each PASSE a global payment, and the PASSEs will be responsible for using that global payment to reimburse providers for the services of their clients’ PCSPs. You will then bill the PASSEs, not Medicaid, for those clients.
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HowwillprovidersbereimbursedbythePASSEs?
Starting January 1, 2019, providers will begin billing the PASSEs for their clients in a PASSE. The PASSEs will accept claims in multiple ways including paper and electronic, but you will need to discuss the reimbursement rates and their specific billing systems when you contact the PASSEs.
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Whatarethereimbursementrates?
The Arkansas Department of Human Services (DHS) hired an actuary to calculate and certify the global payment amount to be paid to the PASSEs. Using the rates recommended by the actuary, DHS and the PASSEs have come to a global payment agreement.
DHS will provide the global payment to the PASSE for each client, but the PASSEs will negotiate reimbursement rates with each provider. The PASSE must comply with any applicable consent decrees impacting Arkansas Medicaid providers.
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Howandwhenwillprovidersbeabletocheckeligibility?
Each client will receive a new ID card with the PASSE logo prior to January 1, 2019 that identifies which PASSE they are in. Providers will want to get a copy of their clients’ cards.
Providers will be able to check the Arkansas Medicaid Eligibility system after December 15, 2018 for PASSE assignment and assessment tier information.
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Whatistheplantotransitionfromfee-for-servicetothePASSEsystem?• PASSEs have a plan to shift from the current fee-for-service
system to the new PASSE system. • PASSEs are required to ensure that all of their network
providers are in good standing and actively enrolled in Arkansas Medicaid.• The PASSE must honor current PCSPs for clients, which include
any current Prior Authorizations (PA) and current rates, for a minimum of sixty days and up to six months. • PASSEs must meet full network standards for all provider types
by November 1, 2019.
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Arkansas Foundation for Medical CarePASSE Choice Counseling
PASSE Ombudsman
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ResourcesforyourClients
1-833-402-0672
501-320-6006
1. If a member has a question or issue, that member should contact the PASSE first.
2. If the member has a concern about their PASSE, that member can call the PASSE Ombudsman office.
3. AFMC is also available for Choice Counseling until we get the Beneficiary Support line set up.
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Resources:PASSEProviderContacts
If a provider has a question or concern to share with DHS, the provider can contact:
Tanya Giles | [email protected] | 501-320-6189
Arkansas Total Care [email protected] 1-844-631-6830 | www.arkansastotalcare.com
Forevercare [email protected] 1-855-544-8744 | www.forevercare.com
Empower Healthcare Solutions [email protected] 1-866-261-1286 | www.getempowerhealth.com
Summit Community Care [email protected] 1-844-405-4295 | www.summitcommunitycare.com
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www.passe.arkansas.gov
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Resources:PASSEProviderwebsite
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InitialReassessments(PASSE)
• Each client must receive a reassessment annually.• All clients whose most recent assessment occurred in 2017 have had their
assessment end date extended to 12/31/2018.‒ Each PASSE was provided with a list of these clients and only 528 have not
received a reassessment at this time. ‒ PASSEs continue to work with Optum and providers to schedule reassessments.• 22,000 clients most recent assessment occurred between 1/1/2018 and
6/30/2018. All end dates for these clients will be extended to 7/31/2019.‒ Each PASSE will be provided with a list of these clients.‒ Optum will attempt to contact all 22,000 clients beginning 12/2018 and will
begin scheduling 3,500 appointments per month to ensure all clients receive reassessment prior to expiration date.
• The remainder of clients whose most recent assessment occurred between 7/1/2018 and 12/31/2018 will have end dates extended to 12/31/2019.
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Abeyance
• The last date for a PASSE to add a client to the abeyance list was 11/5/2018. • PASSEs continue to work with DHS to reconcile abeyance lists and
reconciliation after the final attribution occurring 11/15/2018.• After final reconciliation, DHS will evaluate data to identify clients
who could potentially lose BH Tier 2 or Tier 3 services on 1/1/2019.
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Questions