Waiver Appeals Under the PASSEs
The changes to Arkansas Medicaid have been many, varied, and confusing. There are more options for coverage, but there are also more reasons for denials. And what do you do if your PASSE waiver claim has been denied? Finnegan Health Services is here to help clarify some of the processes if your PASSE has denied your PASSE waiver claim.
All three PASSEs have a three-step process for appealing a denied waiver claim. But just because all three have the same steps for appeals, does not mean all three steps are equal across the three PASSEs.
Your steps for a PASSE waiver appeal are:
*Complaints
*Grievances
*Appeals
Since there are three PASSEs, I will go through each step per PASSE.*
Empower Complaint
A complaint means you are not satisfied with your care since your waiver claim was denied. You are able to call Empower directly or go see them in person to file your complaint. You may also skip engaging with Empower completely, and take your complaint directly to DHS. Empower gives no timeline for answering or resolving a complaint.
Empower Grievance
This is not specifically defined. See Empower’s definition of complaint.
Summit Complaint
A complaint means you have a concern of care since your waiver claim was denied. You are able to call Summit and they will follow-up on your complaint within the next business day. If your complaint is not resolved in three business days, you may file a grievance.
Summit Grievance
If a complaint is not resolved, you can file a grievance with Summit. It can take up to thirty days to resolve. If your grievance is not resolved by Summit, then you may contact DHS.
Arkansas Total Care Complaint
ATC gives no definition for a complaint. You are able to call ATC and they will resolve your complaint by the closing of business that day.
Arkansas Total Care Grievance
If you are not satisfied with your complaint, you can file a grievance with ATC. You may file a grievance if you are concerned with your quality of care. ATC has thirty to forty-five business days to resolve your grievance. Any complaint and grievance are attended to by the organization and the organization determines the result of both the complaints and grievances.
Appeal Process for All Three PASSEs
If you have filed both complaints and grievances against your PASSE, your last step is an appeal. You can appeal any adverse determination that could seriously harm your safety or your life. If you are the beneficiary or the guardian, you can call your PASSE to file an appeal.
Appeals should be resolved in 72 hours although there is no stated length of time for resolution. You must have exhausted all administrative remedies to resolving your issue. This means you must have made a good-faith effort in working with the PASSE.
Since the appeal system is long, keep written communication for all things concerning your appeal. Write down who said what and when. The appeal system can be tricky and only Summit offers an expedited appeal system.
Finnegan Health Services is the only DME in Arkansas approved for medical supplies through the PASSE waiver program (we do not offer home conversion services, etc). We are here to help you get your supplies when you need them.
If you have questions about PASSE waiver, email us at waiver@finneganhealth.com. We will answer your questions, take bids, and discuss product availability.
*Please note while our sources for the information are accurate, Finnegan Health Services does not make any legal claim to being the source of this information or to it’s accuracy as information is changing frequently.
