PASSE - Information for Providers
What is a PASSE, and how will it affect providers?
The Provider-led Arkansas Shared Savings Entity (PASSE) system is a model of organized care created by Act 775 of 2017. Each PASSE is made up of governing providers who have entered into partnership with an experienced organization that performs administrative functions.
The PASSE system is a Medicaid-funded program. It does not change a person's eligibility for Medicaid, but it will change the way services are paid for by Medicaid for a specific group of beneficiaries. Each PASSE acts a lot like an insurance group that providers join to be in network, and the PASSE pays for the healthcare services for its members.
Providers and their clients will be affected by the PASSE model beginning March 1, 2019. Providers should learn about the PASSEs, negotiate contracts, and join networks as soon as possible.
Which clients will be affected by the PASSE model?
The following Developmental Disabilities Services (DDS) and Behavioral Health (BH) clients will receive services through a PASSE:
- Approximately 4,600 individuals on the DDS Waiver and about 2,400 on the DDS Waiver Wait List
- Approximately 38,000 individuals with a behavioral health diagnosis whose independent assessment determined they have significant needs
- Approximately 750 people in private Intermediate Care Facilities
What are the goals of the PASSE model?
- To improve the health of Arkansans who need specialized care for behavioral health issues or developmental/intellectual disabilities
- To link providers of physical health care with specialty providers of behavioral health and developmental/intellectual disabilities services
- To coordinate care for all community-based services for these individuals
- To allow flexibility in the types of services offered
- To increase the number of service providers available in the community to serve these members
- To reduce cost of care by coordinating and providing appropriate and preventative care
What should providers expect?
The PASSE system is a shift in the ways that a clients care is managed, and how providers bill for services if they serve PASSE clients. In the coming weeks, you as a provider will need to contact each PASSE to find out how to join each PASSE’s network and how you will bill them for services starting on March 1, 2019.
Why should a provider join a PASSE?
Providers should join the PASSEs to be in-network providers for their current clients whose care will be managed by the PASSEs. A provider could potentially lose clients if that provider does not join all networks. PASSEs will be required to reimburse providers out of network, but joining all networks helps to ensure that the provider will get to continue to serve all of their clients managed by the PASSEs.
What changes will providers see in the PASSE system?
|✔ Members have been assessed and assigned to a PASSE.||+ The PASSEs will be responsible for maintaining statewide network of providers.|
|✔Care Coordinators have contacted members and have started plans of care.||+ PASSEs will receive a global payment to ensure services for all members.|
|+ Providers will sign contracts with the PASSEs to join the networks to continue providing services to clients in March 2019.||+ Providers of clients whose care is managed by the PASSEs will bill the PASSEs instead of Medicaid.|
How does Care Coordination affect providers?
After a client is assigned to a PASSE, each client is given a Care Coordinator who helps him or her develop a Person Centered Service Plan (PCSP). PASSE Care Coordinators help clients to get and coordinate needed services across many systems. Care Coordinators may contact you to ask for your clients’ plans of care and to assist clients in continuing services, identifying needs for supports, and coordinating multiple plans.
How will the formation of Person Centered Service Plans affect providers?
A PCSP helps individuals who receive developmental disabilities (DD) and behavioral health (BH) services to plan for their futures. The care plans you develop for your clients will be a part of the PCSPs. You will serve as part of a team who implements the PCSPs for your clients.