The transition to managed care planned for March 1 will jeopardize services for about 40,000 Arkansans with significant mental illness or developmental disabilities, a lawsuit by 15 residential care facilities contends.
The suit, filed Thursday in Pulaski County Circuit Court, says Department of Human Services officials "have refused to heed the warnings of various stakeholders" that the three managed-care companies planning to participate in the program won't be ready to take over responsibility for recipients' care next month.
As an example, the suit notes that the companies haven't told providers how much they will pay for services and are "wholly unprepared with regards to billing." Internet portals for providers weren't working as of Tuesday, the lawsuit says.
The suit seeks an order from Judge Chris Piazza postponing the start of the program "until further order of the court finding that the system is fully prepared to function for its intended purpose."
A hearing on the request is set for Wednesday.
Amy Webb, a spokesman for the state Department of Human Services, said the managed-care firms, known as Provider-led Arkansas Shared Savings Entities, or PASSEs, are "absolutely ready to move forward toward full implementation."
"All have passed an independent readiness review, and both the PASSEs and the State have been working together very closely to ensure we are ready to quickly handle any issues that may arise," she said.
She said department officials are reviewing the lawsuit.
The shift to managed care is the second phase of an initiative, approved by the Legislature in 2017, aimed at reducing the cost of caring for about 40,000 Medicaid recipients who have significant mental illness or developmental disabilities.
Under the first phase, which started last year, the companies began coordinating patients' care in exchange for monthly payments of $173.33 per recipient.
Next month, the companies are scheduled to take responsibility for all the recipients' care in exchange for monthly payments ranging from $998.86 to $12,671.62. Care includes medical expenses, counseling and help with needs such as finding housing and performing daily living tasks
The payments vary according to whether a recipient is a child or adult, the severity of a person's disability and the region of the state where the recipient lives.
The shift to the second phase was originally scheduled to start Jan. 1, but was delayed to next month to allow more time for the companies to prepare and for the department to provide information to recipients and their families.
The lawsuit notes that one company, Forevercare, dropped out last month after the Human Services Department rejected the provider's request to delay the start of the second phase to July 1.
The company is continuing to provide care coordination to 7,600 Medicaid recipients. The cases were evenly assigned earlier this month to the three remaining companies, which will take over their care next month, according to information on the Human Services Department website.
The recipients were given 90 days in which they can switch to another company.
According to the lawsuit, recipients hadn't received membership cards from any of the companies as of Tuesday.
The lawsuit also complains about the assessments that determine eligibility for some Medicaid benefits based on their needs.
Some Medicaid recipients who previously qualified for some types of services are being notified that they are no longer eligible based on the assessments, the suit says.
In addition to the residential care facilities, the plaintiffs in the suit are the Arkansas Residential Assisted Living Association and 10 unnamed Medicaid recipients.
Ed Holman, chairman of the association, said the facilities receive up to $37.87 per day from the Medicaid program to help residents with daily living tasks, such as dressing and bathing.
The residents also pay $750 a month for room and board.
The facilities, concerned that their reimbursement for services will be cut, want to continue to be paid by Medicaid rather than the managed-care companies, he said.
"There's just too much uncertainty right now," he said.
A Section on 02/23/2019