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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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)

9. 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

10. Discussion and Questions