The Provider-led Arkansas Shared Savings Entity (PASSE) system was introduced with noble intentions: to improve healthcare coordination and outcomes for individuals with disabilities in Arkansas. However, over time, it has become evident that the PASSE system has fallen short of its promises, resulting in increased financial burdens for individuals and service providers alike, while sacrificing transparency and accountability in healthcare decision-making.

History of PASSE Legislation:

The PASSE system was enacted by the Arkansas Legislature with the goal of streamlining healthcare delivery and cost savings for the state’s Medicaid program. However, despite its initial promise, the implementation of PASSE has been marred by challenges and shortcomings. Reimbursement rates for service providers have stagnated, placing financial strain on these essential caregivers. Meanwhile, individuals with disabilities have faced barriers to accessing the services and supports they need to live independently and thrive.

Critique of PASSE Implementation:

The lack of transparency and community engagement in the PASSE legislative process is deeply concerning. Despite the noble intentions behind its enactment, the Arkansas Legislature failed to adequately consult with the communities most affected by the PASSE system, including individuals with disabilities and their families. This lack of stakeholder engagement has resulted in policies that prioritize cost-saving measures over the well-being and autonomy of individuals with disabilities.

Policy Proposal:

As Governor, I am committed to dismantling the PASSE system and restoring accountability in healthcare decision-making. This will involve several key steps:

1. Transfer of Funding Sources: I will freeze all funds directed to PASSE organizations and redirect them directly to waiver providers, ensuring that individuals with disabilities have access to the services and supports they need without bureaucratic barriers or cost-saving measures. By eliminating the intermediary role of PASSE organizations, we can streamline funding and prioritize the needs of individuals.
2. End Cost-Saving Measures: I will dismantle the culture of prioritizing cost-saving measures over quality of care in Arkansas’s healthcare system. This includes ending policies that restrict access to necessary services and supports for individuals with disabilities, and instead, focusing on providing comprehensive and person-centered care.
3. Community Engagement and Transparency: I will urge the state legislature to hold town hall meetings with affected individuals and their families to gather input on healthcare policies and priorities. By actively engaging with stakeholders, we can ensure that the voices of those most impacted by healthcare decisions are heard and considered in the legislative process.

Policy Report: Reforming Reimbursement Rates for Medicaid HCBS Waiver Services

Arkansas’s Medicaid Home and Community-Based Services (HCBS) waiver program plays a critical role in supporting individuals with disabilities to live independently and participate fully in their communities. However, the current reimbursement rates for HCBS waiver services have stagnated, placing financial strain on waiver providers and jeopardizing the quality and availability of essential care. Moreover, the lack of inclusion of waiver providers in reimbursement conversations exacerbates these challenges, hindering effective collaboration and decision-making. As Governor, I am committed to addressing these issues and ensuring that individuals with disabilities receive the quality care they deserve.

1. Reimbursement Rate Reform:

The reimbursement rates for Medicaid HCBS waiver services in Arkansas have remained stagnant for far too long, failing to keep pace with the rising costs of providing care. This has created financial instability for waiver providers, limiting their ability to attract and retain qualified staff, invest in training and infrastructure, and deliver high-quality care to individuals with disabilities. To address this issue, I will:

• Conduct a comprehensive review of current reimbursement rates for HCBS waiver services to assess adequacy and alignment with the true cost of care delivery.
• Work with state agencies, Medicaid officials, and stakeholders to develop a plan for increasing reimbursement rates to reflect the true value of services provided.
• Advocate for legislative action to enact reforms that prioritize fair and equitable reimbursement rates for waiver providers, ensuring that they can continue to deliver quality care to individuals with disabilities.

2. Inclusion of Waiver Providers in Reimbursement Conversations:

Despite their close partnerships with waiver providers, PASSE organizations have not adequately included them in conversations regarding reimbursement rates and funding allocations. This lack of inclusion undermines effective collaboration and decision-making, leading to policies that do not reflect the realities and needs of waiver providers and the individuals they serve. To address this issue, I will:

• Establish a commission comprised of representatives from waiver providers and the individuals they serve to serve as a forum for dialogue and collaboration on reimbursement issues.
• Chair this commission with an individual with a disability to ensure that the perspectives and priorities of individuals with disabilities are central to all discussions and decisions.
• Appoint an expert in disability policy-related healthcare issues as the vice-chair of the commission to provide technical expertise and guidance.

3. Executive Order for Reform:

In recognition of the urgency of addressing reimbursement rate reform and the lack of inclusion of waiver providers in reimbursement conversations, I will issue an executive order to implement the following steps:

• Direct state agencies and Medicaid officials to prioritize the review and revision of reimbursement rates for HCBS waiver services.
• Mandate the inclusion of waiver providers in all discussions and decision-making processes related to reimbursement rates and funding allocations.
• Establish the commission described above to serve as a formal mechanism for ongoing dialogue and collaboration on reimbursement issues.

4. Legislative Support:

While executive action is necessary to initiate immediate reforms, comprehensive and lasting change will require legislative support. I will work closely with the Arkansas General Assembly to introduce and advocate for legislation that codifies and expands upon the reforms outlined in this report. By enacting legislative measures, we can institutionalize accountability, transparency, and equity in reimbursement policies for HCBS waiver services.

5. Accountability and Monitoring:

To ensure the effective implementation of these reforms and the ongoing monitoring of reimbursement policies, I will establish mechanisms for accountability and oversight. This will include regular reporting and evaluation of reimbursement rates, stakeholder engagement, and feedback mechanisms to assess the impact of reforms on waiver providers and individuals with disabilities.

Reforming reimbursement rates for Medicaid HCBS waiver services and ensuring the inclusion of waiver providers in reimbursement conversations are critical steps towards building a more equitable and sustainable healthcare system in Arkansas. By prioritizing the needs and perspectives of individuals with disabilities and their caregivers, we can ensure that all Arkansans have access to the quality care and support they need to live full and independent lives. As Governor, I am committed to leading these efforts and working collaboratively with stakeholders to enact meaningful and lasting reforms.