CurrentCareSourcePolicy N/A

Arkansas PASSE Administrative Policy Statement

Defines administrative requirements for CareSource PASSE operations in Arkansas, including person-centered service planning (PCSP), care coordination, provider responsibilities, utilization management, and member transitions. Applies to CareSource PASSE members, CareSource PASSE staff, and contracted providers in Arkansas.

Policy Summary

PayerCareSource

PolicyArkansas PASSE Administrative Policy Statement

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateSep 1, 2023

Next Review DateN/A

Key ActionSubmit authorization requests with the member's PCSP and supporting documentation for UM/SD medical necessity review; verify member eligibility on date of service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

15 business daysinitial contact by care coordinator after PASSE enrollment

30 daysinitial services assessment timeframe after enrollment

60 daystime to develop a PCSP for members without an existing plan

365 daysPCSP review frequency

20 business daysrecords transfer on PASSE transition

60 dayscontinuity of care during PASSE transitions

Coverage and Authorization Criteria

Services must be documented in the PCSP and are reviewed for medical necessity; inclusion on the PCSP does not guarantee authorization or payment.

Services must be documented in the PCSP; emergent services are an exception to this requirement.

All services are reviewed for medical necessity and/or nonmedical community supports and services.

Utilization Management (UM) will determine medical necessity for all physical health services; Service Determination (SD) will review behavioral health inpatient and outpatient requests, including HCBS services.

Authorization submissions require review of the PCSP and all supporting documentation; when PCSP and supporting documentation are insufficient, UM/SD will collaborate with care coordination and the provider to obtain additional information.

Policy Summary

PayerCareSource

PolicyArkansas PASSE Administrative Policy Statement

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateSep 1, 2023

Next Review DateN/A

Key ActionSubmit authorization requests with the member's PCSP and supporting documentation for UM/SD medical necessity review; verify member eligibility on date of service.

SourceLink

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Authorization and Medical Necessity Process — Provider Responsibilities

Prior Authorization

Authorization and Medical Necessity Submission Requirements

Submit authorization requests with the PCSP and all supporting documentation so UM/SD can determine medical necessity; providers will be notified of approval or denial within required turn-around times. Authorization is not a guarantee of payment, and providers must verify member eligibility on the date of service.

Authorization submissions require review of the PCSP plus plan of care and additional supporting documentation to determine medical necessity.
UM reviews physical health services; SD reviews behavioral health and HCBS requests; UM/SD will collaborate with care coordination and providers if information is insufficient.
Providers will be notified of approval or denial within required turn-around times.
Authorization does not guarantee payment; verify member eligibility on the date of service.

Key Definitions

inv-03: PCSP (Person-Centered Service Plan)

DefinitionPerson-Centered Service Plan (PCSP): a member-specific plan developed through a person-centered planning process per waiver and state requirements that documents goals, services, supports, risks, and participant preferences.

PurposeDocuments goals, services, supports, risks, and participant preferences to guide service delivery and authorization.

PortabilityAll members with an existing and current PCSP will retain and carry that plan into any newly enrolled PASSE; the existing PCSP will be honored until a new PCSP is completed.

Relation to AuthorizationServices must be documented in the PCSP; inclusion on the PCSP does not guarantee authorization or payment.

Timing RequirementsFor members without an existing PCSP, PASSE has timeframes to assess and develop the PCSP per policy timelines (see coverage criteria for specific days).

inv-04: HCBS — Home and Community Based Services

DefinitionHome and Community Based Services (HCBS): an array of services and supports that, although largely non-medical in nature and based on goals in the PCSP, are necessary to protect the health and safety of an individual and enable the individual to live safely in a home or community-based setting.

Nature of ServicesLargely non-medical supports tied to PCSP goals, intended to maintain health and safety and support community living.

AuthorityAvailable under federal authorities (e.g., 1915(c)) or state authority (Act 775) and provided by AR Medicaid–enrolled providers as approved by a PASSE.

Examples/RoleSupports may include social and community integration activities and services designed to prevent or delay institutionalization when need is identified on the IA and described in the PCSP.

inv-05: Independent Assessment (IA)

DefinitionIndependent Assessment (IA): an assessment conducted prior to PASSE enrollment by a qualified individual using an assessment instrument approved by DHS to identify members as in need of behavioral health or developmental disabilities services.

PurposeIdentifies needs for behavioral health or developmental disability services and supports and establishes functional deficits used in service planning and tiering.

Use in TieringIA results inform tier assignment (e.g., Tier IV Complex Care for high supervision needs) and eligibility for nonmedical community supports described in the PCSP.

Requirement TimingIA is required prior to PASSE enrollment and its findings must be reflected in the PCSP and service planning.

inv-06: Flexible Supports

DefinitionFlexible Supports: alternative services defined in Act 775 that are not included in the state plan or waiver and are delivered at the PASSE's discretion to improve health or social determinants for a member.

IntentProvided to improve health or address social determinants of health (e.g., social activities to counter isolation, temporary supports to avoid out-of-home placement).

Authority and DeliveryNot part of the state plan or waiver; provided under Act 775 and delivered by the PASSE as appropriate and cost‑effective.

ScopeMay include services outside the benefit package when deemed appropriate to prevent or delay institutionalization or support community tenure.