Arkansas

Current Updates (as of 4/30/2021)

Managed Long-Term Services and Supports

On April 7, 2021, CareSource PASSE announced that the health plan filed for the license to participate in Arkansas’ PASSE program. CareSoure will join the three health plans currently participating in the PASSE program -Anthem, Centene, and Empower Health– in coordinating LTSS for individuals with I/DD. CareSource PASSE will comprise of five health care organizations in Arkansas. These organizations include: Zini Medical Clinic, Ashley County Medical Center, Acadia Healthcare Company, Chenal Family Therapy, Rehabilitation Network Outpatient Services, and CareSource.

(Source: CareSource Press Release; 4-7-2021)

Past Updates

Managed Long-Term Services and Supports

The Arkansas Department of Human Services (DHS) announced on January 16, 2019 that Arkansas Total Care (Centene), Empower Healthcare Solutions, and Summit Community Care (Anthem) have chosen to move on to Phase II of the Provider-led Arkansas Share Savings Entity (PASSE) program. ForeverCare Health Plan is no longer participating in Phase II and those clients will be reassigned among the remaining managed care organizations (MCOs). On February 12, 2019 Arkansas DHS announced they have signed agreements with the three MCOs after they successfully passed readiness reviews. Each MCO will now be responsible for managing both acute and LTSS for individuals with intellectual/developmental disabilities and intensive behavioral health needs. Phase II of the program began on March 1, 2019 and the three managed care organizations are estimated to cover nearly 45,000 Medicaid-eligible individuals.

On April 30th, Arkansas DHS announced that they would be modifying some of the roll-out timelines in response to public feedback. Some of the changes include:

• Delaying open enrollment from the previously-scheduled May 2019 period until October 2019;
• Extending the client transition period where PASSE plans pay for the previously existing plans of care and service authorizations until September 1, 2019; and
• Extending the period where PASSE plans must pay all providers the in-network rate, regardless of whether they are enrolled in the plan network, until September 1, 2019.

(Sources: Three PASSEs Sign, Move Forward in DHS PASSE Model, 1-16-2019; DHS Conducts Review, Signs Agreements with Three PASSEs, 2-12-2019; Arkansas Department of Human Services and PASSEs Respond to Feedback, Adjust Open Enrollment and Transition Period, 4-30-19)

Balancing Incentive Program

In March 2013, CMS awarded Arkansas an estimated $ 61.2 million in enhanced Medicaid funds (2% en

hanced FMAP rate). (Source: Balancing Incentive Program Award Letter)

Section 1915(i) HCBS State Plan Option

As of October 2017, CMS has not approved a §1915(i) HCBS State Plan Amendment for Arkansas. (Source: Kaiser HCBS State Plan Option website, 10/2017; Summary)

Section 1915(k) Community First Choice Option

The state plans to submit a §1915(k) State Plan Amendment to CMS and implement a CFCO program in 2014. The program will address the state’s waiting list of people with DD seeking services under the existing Alternative Community Services Waiver.

The state has officially submitted a Section 1915(k) Community First Choice Option SPA to CMS for approval. As pf October 6, 2017, the state has not received approval for the SPA.  (Source:  Kaiser Community First Choice website, 10/2017)

Health Homes

In February 2011, CMS approved the state’s Health Home Planning Request for funding to create health homes for people with chronic conditions. (Source: CMS Approval Letter, 02/04/2011) As of June 2014, the state has not officially submitted a Proposed Health Home State Plan Amendment to CMS, but the state plans to participate in the Health Home State Plan Option in FY 2014. (Source: Kaiser Health Homes website, 6/2014)

Managed LTSS Program 

The Arkansas Health Reform Legislative Task Force received a report from The Stephen Group on October 7^th, outlining recommendations for changes in Arkansas’ Medicaid program.  While focused on Arkansas’ Private Option Medicaid expansion program, the report did recommend a move towards managed care for at least some beneficiaries. (Source: Arkansas News 10/7/2015)

The director of the Arkansas Department of Human Services recently testified to state legislators over the potential cost savings of contracting with managed care organizations (MCOs) to manage care for Medicaid beneficiaries with complex conditions and needs. Relevant populations would include dual eligible individuals, the ABD population, and individuals needing long-term services and supports (LTSS). (Source: ArkansasOnline 10/21/2015)

Questions are being raised regarding Arkansas’ proposed shift to managed care for certain segments of its Medicaid population, as recommended in a report from the Stephen Group, a consultant hired by the state, and the Health Reform Legislative Task Force. The report estimated that Arkansas could realize savings as significant as $2 billion over five years by switching to managed care. What’s at issue is a potential carve-out for long-term care providers, more specifically nursing homes. Other high-cost populations such as behavioral health, and developmental disabilities, would be enrolled into managed care under the program being discussed, while some are claiming that long-term care providers have arranged a special deal with the governor and are promising, essentially, to reform themselves. On December 29, 2015, Arkansas expressed intent to continue the “private option” (Arkansas’ Medicaid expansion program), albeit with alterations, and plans on submitting a formal request in the spring of 2016.  (Source: Arkansas Times 12/16/2015; Arkansas Online 1/5/2016)

The Arkansas Health Reform Legislative Task Force directed the Stephen Group, a consusltant for the state, to look for $835 million in savings to the Medicaid program over the next five years, albeit without considering a capitated managed care option. Previously, Arkansas had released a request for informaiton (RFI) on a full-risk managed care program for the ABD, and LTSS populations. (Source: HMA Roundup 1/6/2016

On March 30, 2016 the SWTimes reported that the Arkansas legislature was called to special session on April 6, 2016, to consider two gubernatorial proposals: the first of which would transfer management of parts of the Medicaid to managed care organizations (MCOs), and the other to extend the state’s Medicaid expansion through what is referred to as the “private option.” The Medicaid managed care proposal would include all behavioral health, services for individuals with developmental disabilities, and dental care. The second proposal would rename the private option to Arkansas Works, and would include work provisions, among other proposed changes. According to ArkansasOnline on Tuesday, April 5, the governor of Arkansas formally withdrew his proposal for the legislature to consider managed care in the special session beginning on April 6, after opposition from senior leadership in the legislature. (Source: SWTimes 3/30/2016; Arkansas Online 4/5/2016)

On May 21, 2016, the Northwest Arkansas Democrat Gazette reported that Arkansas and the Arkansas Health Care Association (AHCA)—an organization representing nursing homes in the state—signed a memorandum of understanding (MOU) that aims to save the state Medicaid program $250 million over five years. The MOU requires the AHCA to hire consultants to create these savings while also improving facility and home-based care. The state will focus its managed care efforts on the ID/DD populations, while continuing to pay for nursing home benefits through fee-for-service (FFS). Also of note, the agreement will limit the number of nursing home beds in the state to their current level for a period of ten years. (Source: NWAonline 5/21/2016)

On October 25, 2016, Arkansas Online reported Arkansas is again considering transitioning its Medicaid program to managed care, this time however looking to utilize a provider-led system as opposed to managed care organizations (MCOs). The new plan was discussed at a recent meeting of the Arkansas Health Reform Legislative Task Force. If implemented, Arkansas expects that the new program would save money by decreasing emergency department (ED) use and unnecessary hospitalizations, as well as generate additional revenue through a tax on the new managed care plans. A tentative plan, including recommendations for proceeding, is due to the governor by November 30, 2016. (Source: ArkansasOnline 10/25/2016)