CurrentCareSourcePolicy N/A

Person-Centered Service Plans (PCSP) for Arkansas PASSE

Defines requirements, timelines, roles, and minimum content for development, review, and transition of Person-Centered Service Plans for members enrolled in CareSource PASSE in Arkansas.

Policy Summary

PayerCareSource

PolicyPerson-Centered Service Plans (PCSP) for Arkansas PASSE

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2024

Next Review DateN/A

Key ActionCare coordinator must make initial contact within 15 business days of enrollment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

15 business daysinitial contact from care coordinator after enrollment

30 daysinitial services assessment timeline

60 daystime to develop PCSP for members without existing plan

365 daysPCSP review frequency

20 business daystransfer of records/PCSP during transition

PCSP Criteria and Requirements

Policy Summary

PayerCareSource

PolicyPerson-Centered Service Plans (PCSP) for Arkansas PASSE

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2024

Next Review DateN/A

Key ActionCare coordinator must make initial contact within 15 business days of enrollment.

SourceLink

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PCSP Criteria and Requirements

Minimum standards, timelines, responsibilities, and review triggers for PCSP development and management.

PCSP existence: Each member receiving services must have a Person-Centered Service Plan (PCSP) that complies with applicable federal and state regulations and is accessible/understandable to the member and individuals important in supporting the member (e.g., plain language, accessible to persons with disabilities and limited English proficiency).

ALL of the following

Care coordinator (CC) assignment: Members will be assigned a care coordinator.
Initial contact: The assigned CC or appropriate CareSource team member will make initial contact with the member within 15 business days of enrollment (including any contact between assignment and enrollment).15 business days
Initial services assessment: The CC or appropriate team member will conduct an initial services assessment of each member within 30 days of enrollment; the assessment will be used to develop the PCSP and component parts may be shared with DHS personnel, other providers, or prior PASSE team members to avoid duplication.30 days
PCSP development timeline: For any member without an existing PCSP, CareSource will develop the PCSP, including the initial services assessment, within 60 calendar days from the date of enrollment.60 calendar days

ALL of the following

Periodic review
- Review within 365 days of the initial PCSP date or at least every 12 months.365 days / every 12 months
- Review at the request of the member.
Review upon change
- Review upon reassessment of functional need.
- Review upon significant changes in member circumstances or needs, including changes in functioning or circumstances impacting service needs (increases/decreases in level of care, new diagnoses, sentinel events).

ALL of the following

Minimum content: The PCSP must include, commensurate with level of need and scope of services, relevant medical and behavioral health diagnoses; relevant medical and social history; Primary Care Physician and BH/DD providers; individual with legal authority to make decisions and any advance directives; confirmation that the member chose their residential setting; the member's strengths and preferences; clinical and support needs identified via assessment of functional need; individually identified goals and desired outcomes; services and supports (paid and unpaid) including natural supports; risk mitigation and individualized backup plans; identification of the individual or entity responsible for monitoring the plan; documentation to prevent unnecessary or inappropriate care; and a finalized, approved written plan.
Assessment sources: The PCSP must address needs identified from the Independent Assessment (IA), ARIA, Initial Services Assessment, and, when applicable, adaptive behavior assessments, psychological testing, social/medical/physical/mental health histories, individualized education plans (IEPs), and case plans for court-involved members.

ALL of the following

PCSP development meeting: The CC is responsible for coordinating and scheduling an in-person PCSP development meeting to be attended by the member, legal guardian/parent, primary caregivers, and CC. The meeting should also include others the member desires (in person, by phone, or video), such as HCBS providers, evaluators, or family/friends. The CC must consider the member's preferences when developing goals, objectives, and services and must document member engagement or efforts to engage.

ALL of the following

Provider responsibilities: HCBS service providers must work with the CC to identify specific services needed to execute the PCSP; implement treatment in accordance with the PCSP; communicate with CCs; notify CCs of significant changes or incidents; maintain a copy of the PCSP; and submit timely service requests to Utilization Management/Service Determination (UM/SD). Unneeded services will not be provided.

ALL of the following

Member transitions: Upon transition from CareSource to another PASSE, the care coordination team will provide receipt of medical records, PCSP, treatment plans, and care coordination files to the receiving PASSE within 20 business days and timely notify the receiving PASSE and the member's service providers. Upon transition into CareSource, the care coordination team will engage prior providers to develop the CareSource PCSP, ensure continuity of current services and reimbursement, and coordinate services to ensure continuity of care for 60 days or until the transition is completed, whichever is longer.20 business days / 60 days

ALL of the following

Authorization and UM/SD: Services documented in the PCSP do not guarantee authorization or payment; development of the PCSP and UM/Service Determination are separate processes. The UM team determines medical necessity for physical health services and the SD team reviews BH and IDD requests; all services are reviewed for medical necessity and/or nonmedical community supports and services. Providers must verify member eligibility on the date of service; authorization requires review of the PCSP and supporting documentation and providers will be notified of approval or denial within required turnaround times.

ALL of the following

Independent Assessment (IA) role: The IA identifies areas in which the member needs services or supports and may assign tiers, but it is not the final determinant and a tier assignment does not guarantee a specific type or level of service.

Authorization and Utilization Management

Prior Authorization

Authorization and UM/Service Determination

Services included on the PCSP (Person-Centered Support Plan) do not by themselves guarantee authorization or payment. Authorization for services requires a utilization management/service determination (UM/SD) review to establish medical necessity and to verify eligibility on the date of service. Providers should not treat the PCSP as a prescription or as the sole documentation for approval.

Authorization requires a UM/SD review for medical necessity and supporting documentation.
A tier assignment or findings from an independent assessment (IA) or the PCSP is informative but not determinative — it does not guarantee a specific type or level of service.
A provider’s plan of care and any additional supporting documentation are generally necessary to determine medical necessity.
Authorization submissions are a collaborative effort between the provider and care coordination/UM to ensure a complete, timely request reflective of PCSP goals.
When information in the PCSP or supporting documentation is insufficient, UM/SD staff will collaborate with care coordination and the provider to obtain additional information to support the request.
Providers will be notified of approval or denial within required turnaround times.
Authorization is not a guarantee of payment; claims for services provided to ineligible members will not be paid.

Key Definitions

inv-03: Care Coordination — definition and statutory references

DefinitionCare Coordination: Services that meet requirements of 42 C.F.R. § 438.208 and ARK. CODE ANN. § 20-77-2701, including health education and coaching, coordination with healthcare providers for diagnostics, ambulatory care and hospital services, and assistance with social determinants of health (e.g., access to healthy food, exercise, and activities focused on member health)

ScopeIncludes coordination for diagnostics, ambulatory care, hospital services, and support for social determinants of health

Regulatory basisCited federal regulation 42 C.F.R. § 438.208 and Arkansas statute ARK. CODE ANN. § 20-77-2701

inv-04: HCBS — Home and Community Based Services definition and scope

DefinitionHome and Community Based Services (HCBS): An array of services and supports, largely non-medical in nature and based on goals in the PCSP, delivered in community-based settings

PurposeSupport member goals identified in the PCSP to enable community living and participation

SettingProvided in community-based settings rather than institutional settings

inv-05: Flexible Supports — definition and purpose

DefinitionFlexible Supports: Alternative services outside the benefit package (as defined in Act 775) that are not included in the state plan or a waiver, delivered at the PASSE's discretion

PurposeAppropriate and cost-effective interventions to improve member health or social determinants of health (examples: social activities, temporary supports to avoid out-of-home placement)

AuthorizationProvided at PASSE discretion and are not part of the state plan or waiver benefits

inv-06: Independent Assessment (IA) — required assessment prior to PASSE enrollment

DefinitionIndependent Assessment (IA): An assessment required prior to PASSE enrollment conducted by a qualified individual using an assessment instrument approved by the Arkansas Department of Human Services (DHS)

PurposeIdentifies members as in need of behavioral health (BH) or developmental disabilities services and informs care planning

LimitationsThe IA identifies needs and tiers but does not alone determine specific services or service levels (see related criteria)

inv-07: Natural Supports — unpaid supports definition

DefinitionNatural Supports: Unpaid supports provided voluntarily in lieu of Home and Community Based Services (HCBS)

ExamplesSupports provided by family, friends, neighbors, or community members that reduce the need for paid services

Role in PCSPDocumented in the PCSP as unpaid supports that contribute to meeting member needs

inv-08: Person-Centered Service Plan (PCSP) — definition of the PCSP and governing planning process

DefinitionPerson-Centered Service Plan (PCSP): The total plan of care developed in accordance with the planning process described in the 1915(c) waiver and 1915(i) State Plan Services (42 C.F.R. § 441.725)

PurposeDocuments member goals, needs, supports (paid and unpaid), and the services intended to meet those goals

Governing authoritiesDeveloped per the 1915(c) waiver and 1915(i) State Plan Services requirements (42 C.F.R. § 441.725)

FormatTotal plan of care as required by federal waiver/state plan planning process