CurrentCareSourcePolicy N/A

Community and Employment Support Waiver Services: Provider inability to provide member's identified needs - AR PASSE

Governs procedures when a CES waiver provider in the Arkansas PASSE network cannot provide services to a member, including notification, documentation, transition, and appeal rights; applies to CareSource PASSE, contracted CES providers, members, and care coordinators in Arkansas.

Policy Summary

PayerCareSource

PolicyProvider inability to provide member's identified needs (CES waiver) - AR PASSE

Policy CodePolicy N/A

Change TypeAdministrative — no material coverage changes

Effective DateMay 1, 2024

Next Review DateN/A

Key ActionNotify CareSource within 2 business days if you cannot assure a member's health or safety and submit required notices and documentation.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2 business daysprovider must notify CareSource if unable to assure member health/safety

30 daysminimum notice if unable to meet member needs

60 daysresidential supports notice required

05/01/2024 - 01/31/2026policy effective range

Provider inability to provide services — criteria and procedures

Provider inability to provide services - criteria and procedures

Conditions and procedures when a CES waiver provider is unable to provide services:

All services delivered under the CES waiver must be documented in the member's Person Centered Service Plan (PCSP).

If a member selects an approved CES provider in their geographic location, the CES provider is required to provide the identified services unless they cannot assure the member's health, safety, or welfare.

If a CES provider becomes unable to assure the health, safety, or welfare of a member, the provider must notify CareSource within 2 business days and submit a formal letter to DHS.

If the inability to provide services is due to staffing, the provider's notification must include efforts to employ and retain qualified personnel and the outcomes of those efforts.

Policy Summary

PayerCareSource

PolicyProvider inability to provide member's identified needs (CES waiver) - AR PASSE

Policy CodePolicy N/A

Change TypeAdministrative — no material coverage changes

Effective DateMay 1, 2024

Next Review DateN/A

Key ActionNotify CareSource within 2 business days if you cannot assure a member's health or safety and submit required notices and documentation.

SourceLink

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If the inability to provide services is due to inadequate housing, the provider should develop and propose alternative housing arrangements within the member's resources; if the member is unable or unwilling to accept a proposed alternative, the provider must document refusal of available resources and immediately notify CareSource.

For situations not related to immediate health or safety, the provider must give at least 30 days notice to CareSource; 60 days notice is required when providing residential supports to maintain living.

When a provider is unable to continue services for any reason, the provider must ensure a smooth transition and continuous delivery of care until transition to a new provider is complete.

ALL of the following

After contacting CareSource PASSE, the provider will send a written notice to the member, family member, or authorized representative.
The written notice must include the reason for transitioning care, the effective date, and a statement regarding the member's appeal rights with a copy of DDS Policy #1076 regarding appeal procedures.
The provider must CC the written notice to carecoordination@caresourcepasse.com and place a copy of the written notice in the member's service record.

ALL of the following

The provider is responsible for conducting a transfer or discharge planning conference with the member, family, care coordinator, legal representative, and advocate, as applicable, to support a smooth transition.
The provider must complete a written discharge summary to include at minimum the health, developmental, behavioral, and social issues, and the member's nutritional status for the newly selected provider.

If the member files a timely appeal, the member may remain with the provider and not be transferred until a decision is rendered on the appeal.

CareSource PASSE prohibits providers or partners from refusing to treat, serve, or otherwise discriminate against an individual on the basis of race, color, religion, national origin, sex, age, gender orientation, or disability; CareSource PASSE will not discriminate against providers acting within the permissions of provider conscience laws as outlined by HHS.

Notification, documentation, and notice requirements

Documentation Required

Provider must notify CareSource and DHS promptly when unable to assure member safety

Notify CareSource within 2 business days and submit a formal letter to DHS if the provider becomes unable to assure the health, safety, or welfare of a member; submit incident reports to CareSource and DHS for any reportable event. If inability is due to staffing, include efforts to employ/retain qualified personnel and outcomes. If due to inadequate housing, propose alternative housing within the member's resources and document any member refusal, then immediately notify CareSource.

Notify CareSource within 2 business days and submit a formal letter to DHS when unable to assure member health, safety, or welfare.
Submit Incident Reports to CareSource and DHS for events that meet reportable event criteria.
If staffing-related, include efforts to employ and retain qualified personnel and the outcomes in the notification.
If housing-related, propose alternative housing within member resources and document refusal if the member declines; immediately notify CareSource.

Key definitions

Person Centered Service Plan (PCSP)

DefinitionPerson Centered Service Plan (PCSP): a member's total plan of care made in accordance with 42 C.F.R. § 441.301(c)(1) and § 441.725 that indicates services necessary for the member, specific member needs, member strengths, and a crisis plan.

ScopeAll services delivered under the CES waiver must be documented in the member's PCSP.

PurposeSupports shared decision-making by engaging members and caregivers or family/representatives in planning and specifying needed services.

Provider obligationA selected CES provider is required to provide the services identified in the PCSP unless the provider cannot assure the member's health, safety, or welfare.