State Capitol Week in Review From Senator Terry Rice

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The
state Human Services Department is reviewing every case this year in which
people have been denied assisted living or home care services in the Living
Choices and ARChoices programs.

Until
January of this year, DHS staff used to determine whether people were eligible.
The criteria include their medical condition, for example, whether or not they
have a disability or dementia. Also, their financial income is a factor.

One
of the most important criteria is their “functionality,” which means how well
they can get around, clean themselves, prepare meals and go to the bathroom by
themselves.

People
who are elderly and frail qualify, as do people 21 and over who have a physical
disability.

In
January, DHS began using a new assessment tool to determine eligibility. The
assessments are also used to set levels of care. Under federal regulations,
eligibility for home care and assisted living is determined by an independent
agency, not by the beneficiary’s physician or health care provider.

DHS
has a contract with a private company called Optum Healthcare Solutions, Inc.
to conduct the assessments.

Since
January, DHS officials and legislators have been receiving complaints from
people who have been denied services from Living Choices and ARChoices. Of the
people who have been assessed this year, 44 percent of those in assisted living
were denied and 31 percent who received some type of help from ARChoices have
been denied.

DHS
is working with Optum, and is reviewing 551 denials in the ARChoices program
and 225 denials in the Living Choices program. A deputy director from DHS told
lawmakers that the reviews should be complete by the end of July.

People
who have been denied already and have filed an appeal have the option of
continuing with their appeal or choosing a new assessment.

According
to testimony at the legislative committee, people who have been in assisted
living facilities for several years have been denied renewal. That is
frightening to the ones who no longer have a home or resources to find a place
to live. That’s why DHS is making it a priority to review their cases.

At
a joint meeting of Senate and House Committees, several legislators expressed their
frustration with the denials and with Optum, in strong terms. One frustration
is that it takes too long to get an assessment, because of a lack of personnel.
According to the DHS official, Optum has replaced some of its staff since the
complaints have become more numerous.

Other
lawmakers reminded their colleagues on the committee that it was the
legislature that directed DHS to find cost savings in Medicaid and health
programs.

One
legislator said that it would be good if the state “grandfathered in” everyone
who already is in assisted living, but a DHS official said that federal law
requires regular reassessments to determine eligibility.

When
the state’s contract with Optum is due to be renewed, it’s expected that the
controversy over assessments will come up again.

Living
Choices serves about 1,000 people in 59 assisted living facilities across
Arkansas, and ARChoices about 8,800 people.

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Tammy Moore Teague

Tammy Moore Teague

Mansfield native, with roots in Scott County. Daughter, sister, wife and Christian. Education: 1995 MHS graduate; 1999 Arkansas Tech University Graduate - BA in Journalism. Career: Managing Editor - The Citizen; Copy Writer - Southwest Times Record; 20+ years experience in the news.

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