Arkansas PASSE Program Readies for Full Risk Capitation

This week, our In Focus section reviews Arkansas’ Provider-led Arkansas Shared Savings Entity (PASSE) model, scheduled to transition to full risk capitation in March 2019. The PASSE program provides care coordination to improve the health of Medicaid members with behavioral health needs or developmental/intellectual disabilities.

Background

The Arkansas Department of Human Services sought to implement an innovative care model to meet the needs of individuals with behavioral health needs or developmental/intellectual disabilities. A 2015 state analysis found that 74 percent of Medicaid claims were for the aged, blind, and disabled population. Of the approximately 2,900 individuals on the Intellectual and/or Developmental Disabilities (I/DD) waiver waitlist, 2,640 individuals accounted for $32 million in Medicaid costs. Supportive living accounted for 96 percent of spending for individuals receiving I/DD services. The cost of care was rising without improved services outcomes, there was a lack of access to quality services, and a lack of care coordination for populations with high needs.

The Arkansas Legislative Health Care Task Force reviewed multiple proposals and selected the PASSE model. The enabling legislation, Act 775, passed in March 2017.

PASSE Model

Each PASSE functions similarly to an insurance company. Under the model, local providers enter into partnerships with an administrative organization to manage the services of beneficiaries. Each PASSE must include several types of providers:

• Developmental Disabilities Services specialty provider
• Behavioral Health Services Specialty provider
• Hospital
• Physician
• Pharmacist

There is not a limit on the number of PASSEs a provider can enter.

The beneficiary is assigned a Care Coordinator, who develops a Person Centered Service Plan (PCSP) and meets members monthly face-to-face.

Phase I

In Phase I approximately 46,000 members were assessed and assigned to a PASSE. Optum conducted the independent assessments to determine eligibility. From February 1, 2018 through February 28, 2019, PASSEs are providing care coordination to members. This includes medical health services, specialty services, prevention services, health education, and medication management. Services are provided on a fee-for-service basis.

Phase II

Phase II was delayed from January 1, 2019, to March 1, 2019. Arkansas Total Care (Centene), Empower Healthcare Solutions (Beacon Health Options), and Summit Community Care (Anthem) chose to move forward with the program, while ForeverCare Health Plan (Gateway Health Plan) has pulled out. ForeverCare will transition its 7,600 members to a different PASSE.

Beginning March 1, PASSEs will accept full risk for covered Medicaid services for their members. Providers will bill the PASSEs, rather than Medicaid, for services provided. Providers will negotiate rates directly.  In exchange, PASSEs will receive a global payment, an actuarially sound payment to cover the entire cost of care, for services. Beneficiary cost sharing will not be permitted.

Eligible Population

The following individuals are covered by PASSEs:

• Individuals receiving services through the DD Waiver (approximately 4,600 individuals)
• Individuals who are on the DD Waiver Waitlist (2,400 individuals)
• Individuals who are in private DD Intermediate Care Facilities (750 individuals)
• Individuals that have a Behavioral Health Diagnosis and have received an Independent Assessment that determines they need services in Tiers 2 or 3 (38,000 individuals)
  • Individuals in these tiers are eligible for targeted services provided in home/community settings or residential settings in addition to receiving counseling and medication management

Covered Services

PASSEs will cover State Plan Services, Community & Employment Supports, and Arkansas Community Independence Services. See table below for examples of included services. Please note, this is not an all-inclusive list.

Source: Arkansas Department of Human Services

The following services are available to PASSE members but will remain as Medicaid fee-for-service:

• Nonemergency medical transportation
• Dental benefits
• School-based services provided by school employees

For more information, please click here.