HJAR Mar/Apr 2021

38 MAR / APR 2021 I  HEALTHCARE JOURNAL OF ARKANSAS MEDICAID COLUMN MEDICAID MEDICAID PROGRAMS across the nation have watched spending rise over the last de- cade. In Arkansas, Medicaid clients’ care in specialty populations, specifically those with behavioral health (BH) and developmental disabilities (DD) needs, cost the programover a billion dollars a year. For reference, those clients make up approximately 20% of Ar- kansas’s Medicaid population. In 2018, the Arkansas Department of Hu- man Services (DHS) launched phase one of a unique managed care-like model called the Provider-ledArkansas Shared Savings Entity (PASSE). The program is designed to improve and better connect clients with complex BH and DD needs to tailored home- and com- munity-based services (HCBS) along with providing more intensive services for those who need them. The PASSE organizations that manage clients’ care took on full risk in March 2019. With approximately 45,000 members, each PASSE is responsible for co- ordinating the care of their assigned DD and BH clients through a wide range of available HCBS services in addition toArkansas’s Med- icaid state plan services. deliver Supplemental Supports. Even though HCBS services for DD and BH clients are similar, provider feedback indicat- ed providers were not serving clients in both populations, because the providers felt they needed additional training and better crisis continuum support. Furthermore, providers relayed that they did not have the time and resources to get both certifications required to serve the two populations. The two existing certifications were sepa- rate, and the certifications limited how pro- viders under each could serve dually-diag- nosed clients: • Community Employment Support Waiver, which allows certified providers to serve clients with an intellectual or DD diagnosis, largely focused on home- and community-based supports rather than clinical services. • Outpatient Behavioral Health Agency, which allows certified providers to serve clients with a BH diagnosis, largely built on a clinical framework with home- and community-based support services available. New Provider Type Empowers Providers and Improves Continuum of Care for DHS Clients with Complex Needs Breaking Down Silos Through a New, Integrated Provider Type By the program’s one-year anniversary, the State of Arkansas felt the effects of the COVID-19 pandemic, andArkansas Medicaid had to adapt its methods of service delivery. One such adaptation was identified when some members with BH needs could no lon- ger attend appointments or day programs in person. Historically, a service housed un- der the PASSE program called Supplemental Supports had been available for DD clients. Supplemental Supports help a client con- tinue living in the community by address- ing needs when unforeseen problems arise. These needs, unless addressed by Supple- mental Supports, could cause a disruption in the client’s services or place the client at risk of institutionalization. Although PASSE clients with BH needs could use Supplemental Supports, if appro- priate, the issue was that only a DD-certified provider could perform and bill for the ser- vice. These BH clients did not have or need a DD-certified provider. What they needed was for their primary BH provider to be able to