What to expect in the PASSE process…
Here at DHS, we want beneficiaries and families to know what to expect during the process of becoming a member of a PASSE. Below are the steps in the process that you would take to be assigned to a PASSE.
- If you or your family member receive Medicaid and have been identified as needing a full array of behavioral health services, receiving developmental disability services through the waiver, or you are on the waiver waitlist then Optum will receive a referral for an independent assessment to determine your service needs. Optum is the company that Medicaid is paying to conduct independent assessments for members.
- If Optum has received your name as a referral for independent assessment, Optum may send a letter or try and call you to help set up a time for the assessment.
- The assessment may be done at the facility where you receive services, a school, or your home. Optum will work with you and your family to try and find the best place that works for everyone. You can have family, and guardians at the assessment to help answer questions.
- The assessment will look at your needs. Different levels of service needs are broken down into tiers. At the end of the assessments, your needs will result in a tier level, and that tier level lets your PASSE and service providers know what level of service you need and can receive.
- The behavioral health (BH) tier levels are:
- Tier 1 – means that you can receive counseling services and medication management (Does not get assignment to a PASSE).
- Tier 2 – means that you are eligible for targeted services provided in home and community settings in addition to counseling.
- Tier 3 – means that you are eligible for all of Tier 2 services and may need services provided in residential settings.
- If your assessment results in a BH Tier 1 level, then you will not be assigned to a PASSE your needs will continue to be met through the Outpatient Behavioral Health system.
- If your assessment results in a BH Tier 2 or Tier 3 level, then you will continue through the PASSE assignment process.
- The developmental disabilities (DD) tier levels are:
- Tier 2 – means that the you scored high enough in certain areas to be eligible for paid services and supports.
- Tier 3 – means that the you scored high enough in certain areas to be eligible for the most intensive level of services, including 24 hours a day/7 days a week paid supports and services.
- Once the assessment has been completed, Optum will send you, your family, or guardian the results in a packet for review. If you, your family, or your provider, do not agree with the results of the assessment, there will be information in the packet on how to appeal that decision.
Assignment to a PASSE
- After an independent assessment, with tier designation of tier 2 or tier 3 service need. You or your family member will receive a letter in the mail that tells you which PASSE you have been assigned to. It will also have instructions on how to change to a different PASSE, if you want. You may change to a different PASSE for any reason for 90 days after joining a PASSE. There will also be an open enrollment period every year for members who want to change their PASSE for any reason.
- After you have joined a PASSE, a care coordinator will contact you or your guardian to start the care coordination process. The care coordinator will want to meet face-to-face on the first visit and will meet with you at least once a month after that.
- The care coordinator will connect you, your family, community support, and doctors or coordinate the services you are already receiving. They will do this by creating a person centered service plan that will help you achieve your goals and connect your medical health and specialty health services.
Services in 2019
- On March 1, 2019, the PASSE that you are assigned to will begin to pay for all the services that you or your family member receive.
- This includes medicine, doctor visits, emergency room visits, and specialty services for behavioral health and developmental disabilities.
- You will receive a welcome packet in the mail with a new card to give to your doctors and pharmacist. It is important for you to have that information and give it to them when you are getting services.