Provider-Led Arkansas Shared Savings Entity (PASSE) Model of Care
The Provider-led Arkansas Shared Savings Entity (PASSE) is a new model of organized care that will address the needs of certain Medicaid beneficiaries who have complex behavioral health and intellectual and developmental disabilities service needs. Under this unique organized care model, providers of specialty and medical services will enter into new partnerships with experienced organizations that perform the administrative functions of managed care. Together, these groups of providers and their managed care partners will form a new business organization called a PASSE.
This organized care model is designed to achieve savings over a five-year period in the overall effort to “bend the cost curve” of Medicaid and help the program become sustainable. DHS will construct a financial baseline to reflect the five-year cost of covering the targeted population. Individuals served by this new coordinated care service delivery system must meet the Medicaid income, resources, and functional needs assessment qualifications. In addition, they must meet the Tier II or Tier III level of care defined by DBHS and DDS. Individuals will be required to have an Independent Assessment (IA) for a Tier II or Tier III determination, while individuals who need Tier I or crisis services will be able to access them directly from certified providers.
The PASSE model is built around the premise that better case management and care coordination will minimize more costly acute services, such as emergency department visits, inpatient psychiatric stays, and hospitalizations. The PASSE will proactively manage beneficiaries’ health by coordinating the efforts of all providers used by the beneficiary.
Act 775 of 2017, sponsored by Rep. Aaron Pilkington and signed by Governor Asa Hutchinson in March, created the structure of provider-led partnerships to coordinate care for Medicaid beneficiaries who typically require more expensive and specialized treatment.
Researchers have concluded that as health care advances and the understanding of the health needs and experiences of people with intellectual and/or developmental disabilities (IDD) improves, there is value in integrating the many potential elements of acute healthcare and linking acute with behavioral health, long-term services and support systems, and the community-based social and developmental support structures of the person with IDD.
The purpose of the PASSE is:
- To improve the health of Arkansans who have need of intensive levels of specialized care due to mental health, intellectual or developmental disabilities.
- To link providers of physical health care with providers of behavioral health care and services for individuals with developmental disabilities.
- To coordinate care for all community-based services for individuals with intensive levels of specialized care needs.
- To reduce excess cost of care due to under-utilization and over-utilization of services.
- To allow flexibility in the array of services offered to the population served.
- Will reduce costs by organizing care, not just by managing finances.
- To increase the number of service providers available in the community to the population covered.
The PASSE model will include two phases. The first phase will begin October 1, 2017, with conditional PASSE licensure awarded by the Arkansas Insurance Department and independent assessments being completed for the those clients identified by the Department of Human Services. Client assessments will continue and those determined to need services in Tier II and III will be attributed to a PASSE in January of 2018 and each PASSE will begin providing care coordination for their attributed members
February 1, 2018. Each PASSE will receive payment for case management and care coordination for each enrolled member. DHS will continue to pay for services on a fee-for-service basis.
Phase 2 will begin January 1, 2019, at which time DHS will begin making an actuarially sound “global payment” to the PASSE for each enrollee to cover the administration costs and benefits for each patient, while ensuring a level of savings for the state. The global payment will include a percentage reduction to be determined off the projected baseline trend to achieve a guaranteed level of savings for the state and the federal government. The global payment will be made to each PASSE on a per-member per-month (PMPM) basis.
As an insurance product, the PASSE will be certified and regulated by the Arkansas Insurance Department (AID) as a risk-based provider organization and subject to the existing 2.5 percent premium tax.
Frequently Asked Questions (PDF, new window)
Independent Assessment Guide (Word, new window)
Arkansas PASSE Care Coordination Agreement (Word, new window)
The Department of Human Services will hold informational meetings specifically for hospital executives, physicians, and pharmacists detailing planning, network participation and operations of the Provider-Led Arkansas Shared Savings Entity (PASSE) program.
Provider-Led Arkansas Shared Savings Entities were created pursuant to Act 775 of 2017, which establishes a system for providing medical care to certain Medicaid beneficiaries with behavioral health needs or those with intellectual or developmental disabilities through risk-based provider organizations.
Although the first few meeting dates have passed, additional informational sessions will be planned throughout the state. All interested physicians, pharmacists, and hospital representatives are invited and encouraged to attend either onsite or virtually.
On-site seating will be limited, so advance registration is required.
It is best to register early for virtual sessions; however, you can register the day of the training.
Virtual session attendees will use the call-in number to join via computer. Your confirmation email will have a link to access the virtual session, as well as the date and time that you selected.
The links below provide access to promulgation documentation for the PASSE Model of Care Program.
Presentations from Public Meetings
The links below provide access to previously recorded presentations and PowerPoint files from public meetings related to the PASSE Model of Care.