State officials have authorized a fourth company to provide medical care and other services to nearly 50,000 Medicaid recipients with significant behavioral health or developmental disability needs, according to an announcement Tuesday.
CareSource PASSE has been approved for license by the State Department of Insurance to participate in the provider-led Arkansas Shared Savings Entity Program, or PASSE program, and will become a new option for Arkansians with complex behavioral health issues and people with intellectual and developmental disabilities, the company announced Tuesday.
The company will have an office in Little Rock and will employ local and community care coordinators statewide, according to CareSource.
CareSource PASS will have to go through a review, “this is where we come in and verify that they have all the systems and protections in place to serve the beneficiaries and to ensure that the health and safety of the beneficiaries are protected”, said Mark White. , Chief of Legislative and Intergovernmental Affairs of the Arkansas Department of Social Services.
The three groups currently operating under the state program are Arkansas Total Care, Employer Healthcare Solutions and Summit Community Care, White told the House and Senate public health, welfare and labor committees during of a meeting on Tuesday.
The provider-led Arkansas Shared Savings Entity is the organized care model created by Law 775 of 2017, White said.
Each PAS organization is a partnership of Medicaid providers in Arkansas, and the providers must own at least 51% of each group, he said. Each PASS can also include partnerships with organizations that perform administrative care management functions, such as complaints handling and member registration, he said.
The CareSource PASS includes James A. Zini DO, PA and Zini Medical Clinic; Chenal PL family therapy; Ashley County Medical Center; Outpatient services of the rehabilitation network; Acadia Health Care Company Inc .; and CareSource, a multi-state health plan, the company said in its press release.
The state’s social services department pays a monthly fee for each beneficiary assigned to each PASS to provide care coordination and various services to the beneficiary, White said.
But Senator Kim Hammer, R-Benton, said that “we were led down this path thinking it was going to be a cost saving.”
“But… it seems like the cost keeps going up every year, and when you compare the quarters, there seems to be a bit of fluctuation,” he said. “I don’t see the downward trend. I see the upward trend.”
Hammer demanded an explanation from the state social services department and program participants regarding the costs.
White said PASSE is a new concept that started in 2019, “so it’s been a learning process.”
“As we move towards setting up these services for these beneficiaries, I think we have made savings,” he said.
PASSE’s total savings totaled $ 81 million from March 2019 to the second quarter of fiscal 2021 based on Medicaid’s Transformative Savings Dashboard, the Department of Human Services said in a written response to a question. legislative committees.
White said the state’s Department of Human Services generates the scorecard and the savings are measured against the baseline established by the Arkansas Health Care Reform Task Force of 5. % per annum based on health care inflation.
PASSE has a higher population than initially expected, and that could be reflected in the costs, he said.
Hammer said he had voters working for PASSE and one of them sent an email saying, “You all need to find a job by the end of the year,” then this “message appeared to be withdrawn”.
He asked if the employees of this PASSE would lose their jobs by the end of the year or if this problem had been solved.
Mitch Morris, CEO of Empower Healthcare Solutions, said the company was going through “a small change” in its ownership and organizational structure, “so one of our major service contractors sent this communication to a number of employees “.
“[But] I can tell you that is not the case, “he said.” All of the employees who have received this … have received confirmation … that their employment will continue, and so this should not be a question for the moment.”
With a fourth PASS planning to operate in Arkansas, Hammer wondered what would happen if one of the other groups went bankrupt and the population had to be taken over by the remaining organizations.
Elizabeth Pittman, director of the medical services division of the Department of Social Services, said any PASS must provide 120 days notice to terminate its contract with the state, and that there would be a transition for beneficiaries the past.
Rep. Josh Miller, R-Heber Springs, asked about an email from one of the PASSE regarding his plans to nearly halve the reimbursement rates to vendors that the PASSE purchases from. He said the email prompted vendors to tell their customers that they weren’t sure they could sell them parts for equipment like wheelchairs because they weren’t sure if they would be. able to sell them at the rates at which they would be reimbursed.
John Ryan, President and CEO of Arkansas Total Care, said, “I will take responsibility for our organization after I say this in an email you refer to.”
“We retracted that very quickly and didn’t move forward with it,” he said.
Miller asked Ryan why PASSE was planning to reduce their reimbursement rates so much.
“I think in this specific case we had suppliers that we reimbursed at the lower level and trying to maintain consistency in the market for that reimbursement level was the answer to your question,” Ryan said.
Miller said he wanted it to be “crystal clear” that if something like this happened again, legislation would be introduced to eliminate the PASS program.
“There are some of us who are in touch with the vendors and in touch with the people you all serve and who know and hear about some of the bullshit that is going on,” he said.