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Provider-led PASS organizations defend model; lawmakers press on reimbursements and oversight
Summary
DHS and CEOs of provider-led PASS organizations briefed the committee on PASS operations, enrollment and community investments, reported $81 million in savings since March 2019 through mid-2021, and answered questions about low member vaccination rates, prior proposed reimbursement changes and oversight mechanisms including PBM monitoring and contract transition clauses.
The committee heard a multi-part briefing on the Provider-led Arkansas Shared Savings Entity (PASS) model and its role in serving Medicaid beneficiaries with behavioral health and intellectual/developmental disabilities. Mark White of the Arkansas Department of Human Services described PASS as a model created by the legislature in 2017 that pays a capitated, monthly fee to provider-led entities that coordinate care for assigned beneficiaries. "Each pass organization is a partnership between Arkansas Medicaid providers...Providers have to own at least 51% of each pass," White said.
Scale and reported savings: DHS told the committee there are just under 50,000 Medicaid beneficiaries assigned to PASS organizations. White said DHS has reported $81,000,000 in savings from the PASS model between March 2019 and the second quarter of 2021 and committed to provide a Medicaid transformation scorecard to the committee for more detail.
Messages from PASS leaders: CEOs from Empower Healthcare Solutions, Summit Community Care and Arkansas Total Care described services, membership composition and community investments. Jason Miller of Summit Community Care said PASS organizations have funded community initiatives, citing "we've allocated $7,000,000 to a community investment project" and listed crisis transition, employment supports and provider training as activities enabled by PASS funds. Mitch Morris (Empower) and John Ryan (Arkansas Total Care) provided enrollment breakdowns and said PASS organizations continue to develop care coordination and outreach.
Lawmakers' concerns and oversight answers: Committee members asked about low vaccination coverage among PASS members; Summit reported roughly 22% of members had received a first vaccine dose and 6% a second dose, and CEOs cited a younger age distribution and hesitancy as factors. Representatives raised alarms about a past instance when a PASS proposed fee-schedule cuts to some providers and then retracted the change. John Ryan acknowledged Arkansas Total Care had proposed a fee schedule change and quickly retracted it; Representative Miller said that similar actions could prompt legislative remedies and warned he would file legislation to end PASS if problems recurred. DHS said contract and monitoring tools are in place: PASS organizations are regulated by the State Insurance Department as risk-based provider organizations, are subject to managed-care rules, must pass readiness reviews, and DHS stated contracts include transition provisions to reassign beneficiaries if a PASS fails (DHS later noted contract language requires about 120 days' notice for contract termination).
PBM oversight and other controls: DHS said the state monitors PBM activity, has incorporated 2019 law addressing PBM practices into PASS contracts, and Legislative Audit has reviewed PBM use and spread pricing; DHS reported no suspicious PBM activity so far but monitors quarterly. CareSource reported it received regulatory approval from the Arkansas Insurance Department on July 1 and is proceeding with readiness assessments.
Next steps: DHS and PASS leaders said they will distribute further materials, including the scorecard and community investment summaries; the committee filed the PASS report.
