A Provider-Led Arkansas Shared Service Entity (PASSE) is a care program that lets a private agency manage the services of Medicaid patients with behavioral health needs or developmental disabilities. If you, your child, or your loved one could benefit from an all-in-one healthcare plan to get the right treatment and support, PASSE could be right for you.
Here’s how PASSE works, what it covers, how you qualify, and how you get assigned to one.
How PASSE Works
PASSEs aim to improve health services for individuals who need specialized care. To do this, PASSEs manage and coordinate everything you need to get the right help. This includes linking providers to a network of specialists who want the best for you and your treatment.
The network is always growing. For example, although it includes primary care physicians and behavioral health providers, it also includes patient-centered medical homes, federally qualified health centers, rural health centers, and pharmacists.
Even better, your care is personalized. Your PASSE will hire a care coordinator to contact you once a month and visit you in person every three months to help with all your healthcare needs. Whether you need to see a doctor, get access to healthy foods, or file an appeal, PASSE helps provide peace of mind because you know you have reliable, quality support every step of the way.
Your healthcare is not only personalized at the care coordinator level but also among your providers. Each of their treatment plans for you come together in one total plan called a Person-Centered Service Plan (PCSP). Your care coordinator’s main job is to carry out this plan and ensure everything works to your benefit.
What PASSE covers
With a PASSE, you get coverage for Medicaid state plan services, Community Independence Waiver services, and Community and Employment Support Waiver services. Here’s a closer look at what these include.
State Plan Services
These include (but are not limited to):
- Primary care physician,
- Specialist physician,
- Occupational therapy,
- Speech therapy, and
- Pharmacy.
Community Independence Waiver Services
These include (but are not limited to):
- Supportive employment,
- Behavior assistance,
- Adult rehabilitation day treatment,
- Child and youth support services, and
- Supportive housing.
Community and Employment Support Waiver Services
These include (but are not limited to):
- Supported employment,
- Supported living,
- Specialized medical supplies,
- Crisis intervention, and
- Environmental modifications.
How to Become Eligible
The State of Arkansas requires anyone who wishes to become eligible for PASSE undergo an independent assessment. A company called Optum will contact you, and a qualified employee will ask hundreds of assessment questions. Someone can be with you during the assessment if you need them. This can be a parent, doctor, or someone from your care staff.
Along with questions about depression, suicide, substance abuse, and gambling, the employee will ask you about your:
- Meal preparation,
- Personal hygiene,
- Eating and bathing,
- Medication and finance management,
- Memory and cognition,
- Ability to communicate, and
- Safety and well-being.
Your responses will place you in one of three levels of need: tier 1, tier 2, or tier 3. The higher the tier number, the more care you need. If your assessment places you in tier 2 or tier 3, you will be assigned a PASSE. Those placed in tier 1 can join PASSE on their own, but they will not be automatically assigned to one.
Optum will mail you the results of your assessment. If you disagree with the results, you can request a hearing to explain in person what you disagree with and why.
To request a hearing, mail a written letter to the Department of Human Services (DHS) Appeals and Hearings Section. State your request, explain why you disagree with your assessment results, and describe the services you need. Remember to do this within 35 days of getting your results and send a copy of your results with the letter.
Services for Each Tier
You will qualify for different services depending on which tier you are assigned to. Each tier differs in the type of services provided, particularly in regard to behavioral health and developmental disability needs.
Behavioral Health
- Tier 1: Outpatient counseling and medication management
- Tier 2: Outpatient counseling, rehabilitative in-home services, and rehabilitative community services
- Tier 3: All services in tier 1 and tier 2 plus potential inpatient admission or residential placement
Development Disability
- Tier 1: Services in a center-based clinic, such as Child Health Management Services (CHMS).
- Tier 2: Paid institutional services and support (potentially constant)
- Tier 3: Constant, paid institutional services and support.
How You Are Assigned
If your assessment places you in tier 2 or tier 3, you will be automatically assigned to a PASSE. Your PASSE will mail you a welcome packet with your member identification (ID) card. After this, your care coordinator must contact you within 15 days of your effective enrollment date.
If you want to change your PASSE, you can do so within the first 90 days of being assigned. After 90 days, you can only change once a year during open enrollment. To change within the first 90 days, contact your PASSE to make the request. They will help you with the transition process.
You can also be removed from your PASSE if you are no longer eligible for Medicaid. However, once you become eligible again for Medicaid, you can re-enroll for a PASSE. If you re-enroll within 180 days, you can return to your original PASSE.
Remember, leaving your PASSE does not mean you are leaving Medicaid. Since PASSE only involves behavioral health and developmental disability programs, leaving it means you no longer have access to those programs.
If you feel like your PASSE could improve in any area, you can attend your PASSE’s Consumer Advisory Council. Every PASSE has a council that meets many times a year. It is a great place to share your opinion about how your PASSE could improve its care or services.
For More Information
Integrity, Inc. provides community-based services for adults and children with disabilities, foster parents of differently-abled children, and older adults. Don’t wait to receive treatment and support that could improve your quality of life and increase your independence. Contact Integrity, Inc. today at (501) 406-0442, or fill out this form to learn more about PASSEs and what they offer!
