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Providers unsure of care for disabled

State: Problem is being addressed by Andy Davis | May 17, 2019 at 2:35 a.m. | Updated May 17, 2019 at 2:35 a.m.

More than a year after managed-care companies began coordinating the care of certain Medicaid recipients with expensive health needs, some of their employees are still learning about the services that are available for the developmentally disabled, a state official told a legislative task force on Thursday.

Melissa Stone, director of the state Department of Human Services' Developmental Disabilities Services Division, told the Arkansas Legislative Task Force on Autism that she realized the companies' care coordinators needed more training after seeing posts on social media from the parents of developmentally disabled children about their meetings with the coordinators.

"They weren't going well," Stone said. "Moms, in particular, were put out with a lot of us."

In response, she said, she asked the companies to each assign at least two of their employees to receiving training from the department on the services that are available.

Since April 12, she said the coordinators have been meeting in her office every Friday for weekly training sessions.

She noted that people with developmental disabilities make up only about 7,000 of the 43,000 Medicaid recipients whose care is being provided under the managed-care initiative.

"We've had a couple of really trying cases that would have been trying for our own staff that have happened in the last 75 days, that I would not have known what I would have done with these particular clients," Stone said. "You put that on top of a new process -- for the DD arena I think it's been a harder transition."

The managed-care initiative is designed to reduce the cost of caring for Medicaid recipients with significant developmental disabilities or mental illness while generating premium tax revenue that can be used to reduce the number of people who are on a waiting list for services for the developmentally disabled.

As of February, about 4,600 Arkansans were receiving the services and more than 3,100 others were on the waiting list.

The three managed-care companies, known as Provider-led Arkansas Shared Savings Entities, or PASSEs, started providing care coordination for the 43,000 recipients in February 2018 in exchange for monthly payments of $173.33 per recipient.

The role of the care coordinators gained new significance in March, when the companies became responsible for paying for all of the recipients' care in exchange for larger monthly payments, ranging from $998.86 to $12,671.62 per recipient.

The coordinators also had to take on new clients after a fourth company, Forevercare, dropped out of the program. The 7,600 Medicaid recipients who had received care coordination from Forevercare were assigned to one of the other three companies in February.

The coordinators are responsible for helping the recipients and their families craft a "person-centered service plan" that lists the services the recipient needs and names the provider of each one.

The care coordinator also serves as the recipients' point of contact with the program, Stone said.

The legislative task force was created in 2007 to make recommendations on treating autism and educating autistic students.

Dianna Varady, director of the University of Arkansas' Arkansas Autism Resource and Outreach Center, said she's heard from families who say they have had difficulty reaching their care coordinator and that the coordinator "may not be aware of the types of treatments or services their child is receiving."

She said she's also spoken with care coordinators at the three companies and has had "some pretty frank discussions with them about the challenges they're facing."

"They feel they have not received adequate training -- that they're woefully unprepared to provide information to families and help coordinate care for children with autism and more broadly for people with developmental disabilities," she said.

For instance, she said, care coordinators don't know how recipients with autism can qualify for a type of therapy known as Applied Behavior Analysis.

Because of a directive from the federal Centers for Medicare and Medicaid Services, Arkansas has covered the therapy for children even though it was not listed in the state Medicaid plan as a covered benefit.

One coordinator said she had 68 clients on her caseload, which was "really far too great to provide adequate care coordination," Varady said.

The companies' contract with the Department of Human Services requires at least 90% of the company's care coordinators to have a caseload of no more than 50 clients.

Stone said the department recently added Applied Behavior Analysis to the Medicaid state plan and created a "desk guide" for providers on how to access it.

This month, the department made changes to its billing system that allows providers to bill for it electronically instead of submitting paper claims, as they have in the past.

In addition to holding the weekly sessions with care coordinators, Stone said she plans to have her staff sit in on more meetings with families to offer feedback to the coordinators.

She has also asked each company to post detailed written procedures on their websites on how they develop the care plans and amend them to add new services when needed.

The department will also hold training sessions via video conference for all the coordinators, she said.

"We're trying to be a lot more open in saying, 'Why don't you let us help you,'" she said.

Metro on 05/17/2019

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