We are sharing this item from last Friday’s Weekly Update as a courtesy to our members.
Written by Donna Martin, Director of State Partnerships and Special Projects:
As we consider the tenants of integrated care, we should take a look at the array of states and programs currently operating a Managed Long-Term Services and Supports (MLTSS) program that specifically includes individuals with I/DD. Presently there are thirteen states or entities with such MLTSS initiatives — some have been longstanding and others are fairly new, but there is a lot to learn from their different structures and processes and we will try to cover them here in a condensed overview.
For the first review we look to Arkansas. They are one of the most recent states to initiate a MLTSS program having begun in 2017 at the behest of the state legislature. At the time, Arkansas Medicaid was spending $1 billion on care and services for 30,000 individuals with high levels of need of behavioral health, substance use disorder, or developmental disability. Then Governor Hutchinson, DHS and a Legislative Health Reform Task Force joined efforts to examine potential reforms to ensure the Medicaid program would be sustainable.
Working with a consultant, two primary options emerged: one was a more traditional, full-risk MCO contract(s) and the second was a 'managed fee-for-service' model to be administered by an ASO. In the latter part of 2016, DHS decided to create a hybrid model and merge its history of strong provider leadership with the resources and risk-bearing expertise of an MCO. In 2017, HB 1706 'To Create the Medicaid Provider-Led Organized Care Act' passed both chambers and was signed into law on March 31, 2017.
As the program began to take shape, providers of specialty and medical services entered into partnerships with MCOs and created a new business model called a Provider-Led Arkansas Shared Savings Entity (PASSE) with service providers maintaining 51% ownership of the PASSE. Each PASSE was licensed and regulated as a 'risk-based provider organization' under the Department of Insurance and as a Medicaid provider under the Department of Human Services thereby being accountable to both.
Individuals needing services then underwent an Independent Assessment and were stratified into three tiers, with the two higher need levels being required to enroll in a PASSE under the Medicaid 1915(b) authority.
Beginning in October 2017, the PASSEs assumed the care coordination responsibility for each of its members and received a per member per month (PMPM) payment for the care coordination. During this first phase, DHS continued to pay on a fee-for-service basis for all other services. And then beginning in January 2019, DHS began providing a 'Global Payment' to cover the cost of benefits (services), administration, care coordination and case management for all enrollees on a PMPM basis.
The goals of service to individuals under the PASSE include:
- Coordinating providers and total care individuals with I/DD and BH needs
- Linking and organizing acute care with behavioral health, long-term services, and community-based social and developmental support
- Preventing under- and over-utilization of services
- Using expensive acute services such as inpatient psychiatric placement only when necessary
- Enhancing the array of services available to beneficiaries
- Increasing the number of community service providers
We will continue to monitor progress in Arkansas and gather information on consumer satisfaction and program effectiveness of the PASSE.