PASSE Care Coordination Paula Stone and Melissa Stone July 24, 2019

Who is in the PASSE PASSE Enrollment Population includes only: Individuals receiving services through DD Waiver Individuals who are on the DD Waiver Waitlist and on Medicaid Individuals who are in private DD Intermediate Care Facilities Individuals that have a Behavioral Health Diagnosis and have received an Independent Assessment that determines they need services in Tiers 2 or 3 Who is in the PASSE

What does the Tier mean for BH and DD The Optum Assessment is a functional assessment that analyzes how the member can function day to day. The Tier is what establishes the global payment amount that is given to the PASSE. The Tier itself does not dictate the services available to the member. A member’s PCSP should look at the IA, any health information, and all other available records. What does the Tier mean for BH and DD

For DD clients, an IA is required every 3 years; a DD member can be reassessed ONLY if the member’s needs have changed. For BH clients, an IA is required every year; a BH member can be reassessed ONLY if the member’s needs have changed. Any request for reassessment due to change in member need requires documentation that is reviewed and approved/disapproved by DHS. IA Reassessment

What is a global payment The Global Payment is an actuarially sound payment to cover the entire cost of care of all non-excluded services provided to all of the members of a PASSE. The calculation includes the cost of providing all services, including but not limited to: DD/IDD and BH specialty services, primary care office visits, hospitalizations, personal care services, and pharmaceutical services. It includes any services a PASSE offers in addition to the services covered by the Medicaid state plan and applicable waiver services It includes payment for care management and care coordination. It includes a reasonable cost to cover administrative expenses. What is a global payment

What is the federal model behind the PASSE 1915(b)—PASSE Managed Care Waiver This Waiver authorizes the PASSE program for five years. Defines the Care Coordination Service to be provided by each PASSE to its members. Requires the PASSE to cover CES Waiver, 1915(i) State Plan Amendment, and regular State Plan services for its enrolled members. 1915(c)—Community and Employment Supports (CES) Waiver This is a home and community based services waiver that offers an alternative to institutional placement for DD clients with high levels of need. Requires the creation of Person-Centered Service Plan for all CES Waiver clients. 1915(i)—Alternative Community Services (ACS)State Plan Amendment This providers home and community based services for individuals with high levels of needs due to a behavioral health diagnosis. Requires the creation of Person-Centered Service Plans for all clients receiving services. What is the federal model behind the PASSE

Services under the PASSE model (cont) Respite Supplemental Support Consultation Supported Employment Adaptive Equipment Crisis Intervention Supported Living Specialized Medical Supplies Community Transition Services Environmental Modifications Services under the PASSE model (cont)

Services under the PASSE model (cont) Behavior Assistance Peer Support Family Support Partners Therapeutic Host Home Mobile Crisis Intervention Child & Youth Support Services Community Reintegration Program Individual Life Skills Development Therapeutic Communities Supportive Housing Services under the PASSE model (cont)

Services under the PASSE model Partial Hospitalization Adult Rehabilitation Day Treatment Supportive Life Skills Group Life Skills Development Personal Care Physician Specialists Family Planning Primary Care Physician Pharmacy Inpatient Psychiatric Durable Medical Equipment Hospital Services Outpatient Behavioral Health Counseling OT, PT, Speech, ABA therapy Services under the PASSE model

Discussion and Questions