The Arkansas Medicaid program, a vital healthcare safety net, is jointly administered by the Department of Human Services (DHS) and the Centers for Medicare and Medicaid Services (CMS). It ensures access to medically necessary healthcare services for eligible Arkansas residents, from birth to end-of-life care. Within this framework, the Division of Medical Services (DMS) plays a crucial administrative role, overseeing various aspects of the program, including the Arkansas Medicaid Managed Care Program.
The DMS is structured into four key units, each contributing to the effective operation of Arkansas Medicaid. Among these, Plan Partnerships is central to the oversight of managed care programs. This unit is responsible for the contracts and administration of these programs, designed to provide comprehensive and coordinated care to specific populations within Medicaid.
One significant component managed by Plan Partnerships is the Provider-Led Arkansas Shared Savings Entity (PASSE). PASSE is specifically tailored for Medicaid beneficiaries with complex behavioral health needs, developmental disabilities, or intellectual disabilities. This program emphasizes a coordinated, person-centered approach to care, ensuring that individuals with these specialized needs receive the appropriate services and support.
Beyond PASSE, Plan Partnerships also manages other crucial managed care initiatives. Health Smiles, the dental managed care program, focuses on ensuring access to essential dental services for Medicaid beneficiaries. Furthermore, Non-Emergency Transportation services, also under the purview of Plan Partnerships, guarantee that beneficiaries can reach their healthcare appointments, removing a significant barrier to access. The Arkansas Independent Assessment system, another responsibility of this unit, plays a critical role in evaluating functional needs. This assessment is fundamental in developing an individual’s Person-Centered Service Plan (PCSP), which guides the delivery of personal care services.
While Plan Partnerships directly manages managed care programs, the other DMS units are equally important to the overall functioning of Arkansas Medicaid. The Fee for Service unit handles provider enrollment, prior authorizations, utilization review, and the Electronic Visit Verification system. This unit also oversees rate reviews and the Patient-Centered Medical Home (PCMH) incentive program, which encourages quality and patient-focused care. Additionally, the Primary Care Case Management (PCCM) program, where physicians actively manage the care of their Medicaid patients, falls under this unit, along with policy analysis and development.
Administration & Operations ensures the smooth internal functioning of DMS by managing contracts, reporting, technology systems, and collaborating with DHS shared services such as Human Resources and Finance. Finally, the Pharmacy unit focuses on prescription services for Arkansas Medicaid clients. This includes developing clinical drug criteria and managing prior authorizations, supported by clinical pharmacists and a pharmacy vendor.
In summary, the Arkansas Medicaid managed care program, primarily overseen by the Plan Partnerships unit within the Division of Medical Services, is a cornerstone of Arkansas Medicaid. Through initiatives like PASSE and Health Smiles, these programs aim to deliver coordinated, efficient, and high-quality healthcare services to specific populations, ensuring that Arkansas Medicaid beneficiaries receive the care they need.
