PASSE Program Overview Graphic
PASSE Program Overview Graphic
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Understanding the Arkansas Medicaid Primary Care Physician Managed Care Program and PASSE

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Navigating healthcare systems can be complex, especially when it involves understanding state-specific Medicaid programs. In Arkansas, the Arkansas Medicaid Primary Care Physician Managed Care Program is a crucial aspect of how healthcare services are delivered, particularly for individuals with specific needs. This program aims to improve healthcare quality and efficiency through managed care organizations. A key component of this system is the Provider-led Arkansas Shared Savings Entity (PASSE), designed to integrate care for Arkansans with behavioral health needs and developmental disabilities. This article will delve into the PASSE program, explaining its role within the broader Arkansas Medicaid managed care framework.

What is Managed Care in Healthcare?

Before diving into PASSE, it’s important to understand managed care. In healthcare, managed care refers to systems or settings where individuals receive health services from a network of providers. This integrated approach combines healthcare delivery and payment structures to ensure coordinated and cost-effective care. Managed care organizations (MCOs) work to improve the quality and accessibility of care while managing costs.

PASSE: An Integral Part of Arkansas Medicaid Managed Care

The Provider-led Arkansas Shared Savings Entity (PASSE) is Arkansas’ unique approach to managed care within its Medicaid program. Specifically, PASSE is designed to connect Arkansans with behavioral health needs and developmental disabilities to comprehensive services. These services range from those provided by their primary care physicians to specialized community-based support.

Under this model, organizations led and owned by healthcare providers take on the responsibility of integrating three critical areas of care:

  • Physical Health Care Services: This includes general medical care, which could involve primary care physicians, specialists, and hospital services.
  • Behavioral Health Services: Addressing mental health and substance use disorders.
  • Specialized Home and Community Based Services (HCBS): Providing support services within an individual’s home and community to promote independence and well-being.

Responsibilities of a PASSE in Arkansas Medicaid

PASSEs are not just coordinating bodies; they are risk-bearing entities. This means they are financially responsible for managing the healthcare of their members. Key responsibilities of a PASSE include:

  • Financial Administration: PASSEs manage the payment to healthcare providers within their network, ensuring efficient and accountable use of Medicaid funds.
  • Provider Network Development: A PASSE must build and maintain a robust network of diverse providers. This network needs to be comprehensive enough to ensure that members have access to all necessary care services, from primary care to specialized treatments.
  • Regulatory Compliance: PASSEs are obligated to adhere to all state and federal laws and regulations that govern risk-based organizations and Medicaid managed care programs. This ensures accountability and quality in service delivery.

Becoming a Member of a PASSE: A Step-by-Step Guide

For individuals who are eligible for Arkansas Medicaid and have behavioral health needs or developmental disabilities, becoming a PASSE member involves a structured process:

  1. Independent Assessment: An initial assessment is conducted to determine eligibility and specific needs of the individual.
  2. Assignment to a PASSE: The Arkansas Department of Human Services (DHS) assigns eligible individuals to a PASSE. This assignment is typically done through an auto-assignment process, proportionally distributing members among active PASSEs.
  3. Welcome Packet and PASSE ID Card: New members receive a welcome packet containing information about the PASSE program and a PASSE ID card for accessing services.
  4. Care Coordination: Upon enrollment, members are connected with care coordinators who help them navigate the system and access appropriate services.

PASSE Program Overview GraphicPASSE Program Overview Graphic

Choosing or Changing Your PASSE

After being assigned to a PASSE, individuals have a 90-day period from their coverage start date to switch to a different PASSE if they prefer. If no change is made within this period, the individual remains with their initially assigned PASSE for the remainder of the coverage year. Changes outside of this 90-day window can be requested from DHS only under specific circumstances, known as a “for cause” transition.

Open enrollment for PASSE occurs every year from October 1st to 31st, providing another opportunity for members to change their PASSE.

Arkansas Department of Human Services – DDS & PASSE Services: A Closer Look

The Arkansas Department of Human Services (DHS), through its Division of Developmental Disabilities Services (DDS), plays a vital role in supporting individuals with developmental disabilities. DDS offers a range of services, including:

  • Developmental screenings, therapy, and care plans for infants and toddlers.
  • Day treatment programs for both children and adults.
  • Community-based services and supportive life skills training.
  • Applied Behavior Analysis (ABA) and specialized autism services.
  • 24-hour care facilities in Human Development Centers and private Intermediate Care Facilities.
  • Therapy services: occupational, speech, and physical therapy.
  • Care coordination and case management.

For those seeking services, the DDS Intake and Referral unit is the starting point. They can be contacted at 501-683-5687.

PASSE Services, further information can be obtained by calling 1-833-402-0672 or visiting ar.gov/passe. Common services provided by PASSEs include:

  • Care Coordination: Helping individuals navigate the healthcare system and access necessary services.
  • Person-Centered Service Planning (PCSP): Developing individualized plans that focus on the person’s needs and goals.

Person-Centered Service Plan (PCSP) Explained

A Person-Centered Service Plan (PCSP) is a critical component of PASSE. It is an ongoing, person-directed process that assists individuals receiving developmental disabilities (DD) and behavioral health (BH) services in planning for their future. PCSP meetings bring together a group of people who focus on the individual’s needs and their vision for health improvement and overall well-being over the plan year.

Care Coordination: Connecting You to the Right Services

Care coordination is the process that helps individuals develop their PCSP and connects them to the necessary services. PASSEs are responsible for ensuring that care is coordinated effectively, so members receive the services they need from the appropriate providers. This coordination is crucial for integrated and holistic healthcare.

PASSE Contacts: Connecting with Your PASSE Organization

Here are the contact details for the PASSE organizations currently serving Arkansas Medicaid members:

For PASSE assignment changes or inquiries about your assigned PASSE, contact 1-833-402-0672. For queries regarding Independent Assessments from Optum, call 1-844-809-9538.

The PASSE Ombudsman Office: Your Advocate

If you encounter issues or concerns with the services you are receiving from your PASSE, the PASSE Ombudsman Office is available to assist. An Ombudsman acts as a public advocate, investigating and addressing complaints to ensure fair administration and protect rights.

When to Contact the Ombudsman

Reach out to the Ombudsman Office if you are experiencing:

  • Issues with PASSE Care Coordination Services.
  • Difficulty contacting your PASSE.
  • Questions about Independent Assessment results.
  • Questions about appeals processes.
  • Dissatisfaction with PASSE services.
  • Provider enrollment questions.
  • General concerns where you are unsure who to contact.

Role of the Ombudsman

The PASSE Ombudsman Office is committed to resolving issues with compassion, respect, trust, and integrity. Their primary role is to address complaints from PASSE members who are not satisfied with the resolution provided by their PASSE organization.

Contacting the Ombudsman

  • Phone: 1-844-843-7351 (For hearing/speech impairment: 1-888-987-1200, Option 2)
  • Fax: 501-404-4625
  • Email: [email protected]
  • Mail: Division of Medical Services, Office of Ombudsman, P.O. Box 1437 Slot S-418, Little Rock, AR 72203-1437

Further Assistance and Advocacy

If issues remain unresolved after contacting the Ombudsman, further options are available. Each PASSE has its own grievance and appeals process. Contact your PASSE organization for details. Additionally, advocacy organizations can provide support:

Engaging with your state representative or senator can also be beneficial in addressing concerns about the PASSE program and Arkansas’ managed care system.

Conclusion: Navigating Arkansas Medicaid Managed Care with PASSE

The Arkansas Medicaid Primary Care Physician Managed Care Program, through initiatives like PASSE, strives to deliver integrated and coordinated healthcare, especially for vulnerable populations. PASSE is a crucial part of this system, focusing on individuals with behavioral health needs and developmental disabilities. By understanding the structure, services, and support systems like the Ombudsman Office, individuals and their families can more effectively navigate this program to access the care they need. This system, while complex, is designed to ensure that Arkansans receive comprehensive and person-centered care within the framework of Arkansas Medicaid.

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