SPRINGDALE, Ark. (KFTA) — Certain Arkansas medicaid patients could be at risk of losing their doctors.
Provider-led Arkansas Shared Savings Entity, or PASSE, is a medicaid-funded program that provides services for people with developmental disabilities or behavioral health issues.
Starting in May, some patients could lose their primary care physicians or pediatricians if a contract between PASSE and their healthcare provider is not negotiated.
For several years, Dayton Presley, 8, has been going to the same doctor for therapy at Northwest Arkansas Pediatrics.
“It’s hard enough to have a special needs child and having to care for his needs, and it’s not easy. They sit there and say they’re trying to help us but they’re not,” says Kaitlyn Presley, his mother. “It took him almost seven years to get him to get where we are now, to get him to talk to people, to get him comfortable to talk to the doctor. Now they want us to start all over again.”
Presley received a letter from the Mana Clinc in late March, informing her that they would no longer be able to serve as her son’s doctor as of May 1. It’s a change that’s left the family and Northwest Arkansas Pediatrics heartbroken.
On Tuesday, Northwest Arkansas Pediatrics held a private town hall to discuss frustrations and where they go from here.
“We’re not even sure we’ll be able to see his psychiatrist unless we pay out of pocket and that would also involve his medications. If he’s off him medications, there’s a chance he’ll end up having to go to residential treatment,” Presley said.
The Department of Human Services says they’re aware of the concerns regarding continued contract negotiations and released this statement:
The Provider-led Arkansas Shared Savings Entity (PASSE) is a program for a specific Medicaid population that includes individuals with complex behavioral health and developmental disability needs. Each PASSE must meet state and federal requirements to participate in the program, including adequately and timely covering all needed services for each enrolled member. This includes services provided by primary care physicians and pediatricians. If a PASSE cannot meet this requirement with their network providers, then that must use out of network doctors for as long as necessary to ensure each member gets the services they need without traveling too far or waiting too long.
DHS is aware of the concerns regarding continued contract negotiations with pediatricians in Northwest Arkansas. If a PASSE does not meet the above requirements within the next few days, DHS will take immediate action by allowing members of that PASSE to choose a new PASSE who has signed contracts with local pediatricians or has set up out of network agreements.
Any PASSE member who is not satisfied with the service or provider options of their PASSE may change during open enrollment, which begins on May 1, 2019.
But Presley and her husband, Jess, are still left with many questions.
“We have no answers. We are left in the dark. We get told one thing by his insurance company and something else is going on,” Presley said.
After reaching out to lawmakers to no response, she says she just wants what’s best for her kid and that means staying with his current doctor.
“We were told it was supposed to help our family, but it is not helped out family at all,” Presley said.
Northwest Arkansas Pedatrics Statement on PASSE:
March 4, 2019, the State of Arkansas chose the patients for the Provider-Led Arkansas Shared Savings Entity (PASSE), and these patients are no longer covered by Medicaid. Despite Northwest Arkansas Pediatrics’ extensive efforts to negotiate a contract to allow our pediatricians to be providers in the PASSE, we do not have a contract.
We share your concerns and are working to resolve this situation so that we can continue to provide excellent care for your child.
Click HERE for more information on PASSE.