Public Health Welfare and Labor Committee - Senate and House
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- October 1, 2026
Representative Jeff Wardlaw
Unverified
0:00
Motion on the minutes. Got a motion. Need a second. All those in favor, say aye. Aye. All opposed. Ayes have it. With that, we'll start moving on through this agenda. We have Ms. Tanya Phillips from Arkansas Wellness Network.
So, if you guys would, turn your mics on and introduce yourselves, and then I'll recognize you to open your presentation.
Tanya Phillips
Unverified
0:41
Good morning. My name is Tanya Phillips with the Arkansas Wellness Network, founder and
Tyler Phillips
Unverified
0:46
president. My name is Tyler Phillips, and I'm the vice president of
Speaker 9
0:50
the Arkansas Wellness Network. Hi, my name is Kenesha Sanders. I'm a registered nurse and a verified wellness provider with the Arkansas
Kathy Lenahan
Unverified
0:57
Wellness Network. Hi, my name is Dr. Kathy Lenehan. I'm an occupational therapist, founder of Alta Integrated Wellness with the Arkansas Wellness Network.
Representative Jeff Wardlaw
Unverified
1:05
So committee, a couple of weeks ago, these guys had a convention across town over in
North Little Rock with our mayors and county judges. And Ms. Tanya, you can fill in where I lead the gaps. And I ran over and ran into these guys and sat down and talked to them and thought it was important that you guys hear what they were telling the judges and the mayors. You won't get to hear the whole thing because this will be a small presentation, but you'll get an idea of what these guys are doing around the state in your communities. And with that, I'll turn it over to Ms. Tanya.
Speaker 13
1:36
Thank you. Thank you so much. It was great to meet you the other day, and
Tanya Phillips
Unverified
1:42
I believe Representative Pilkington is here. Thank you so much for coming. Several others came as well, and we appreciate that. So Senators, Representatives of the House and Senate, Public Health and Wellness, Welfare and Labor Committee, thank you
Speaker 17
1:55
for having us. We appreciate the invitation and the opportunity to tell you about what we are doing
Tanya Phillips
Unverified
2:02
to try and help with health and wellness in the state of Arkansas. My name is Tanya Phillips, and I'm the founder of the Arkansas Wellness Network, an initiative of our 501c3 nonprofit, Reinventing Ourselves.
Before we begin talking about the actual Arkansas Wellness Network, what it is and what it does, I do want to take a moment to explain why creating it was so important to me. December of 2008, five days before Christmas, I returned home from Iraq. I was a National Guard member with the 39th Infantry Brigade.
Speaker 17
2:36
I came home. I was physically broken, and I was on every kind of pain medicine that you could imagine.
Tanya Phillips
Unverified
2:44
my husband had wiped out the bank account and asked for a divorce a month before I returned my twins were a year and a half old and when I left and they were three when I was returning home they didn't really know who I was the day I got home again five days before Christmas I learned that my teaching job had been cut while I was deployed I was National Guard so that was my full-time job my life as I knew it was completely destroyed I was broken mentally physically and financially. I didn't know how to put one foot in front of the other and I
definitely didn't know where the resources were to help me. Within the next few months we lost 15 veterans to suicide here in Arkansas and I completely understood their pain and honestly had contemplated that myself. Ironically I was offered a job as the state's first suicide Prevention Program Manager. That job saved my life, and it forced me to figure out how to heal myself so that I could help others. I quickly encountered the same exact problem, even though
I was working with the statewide agencies and entities in a professional role. It was extraordinarily difficult to determine what resources existed and where people could turn for help, and the help was often very fragmented. If I didn't know that something existed, I didn't know where to find the information about it, and I was unable to refer people that were in crisis or professionals to the right resources. Too often, people in crisis receive a medication or a short-term hospital stay, and then they're sent back to the very
same factors that contributed to that crisis with no other support. I've learned that Arkansas has a lot of caring people, organizations, and programs, but if people don't know where those resources are and that they exist, they don't know to ask for them. And if we do not know what exists, we cannot accurately identify where the gaps are in our state either. Because of that, I returned to school, got two more degrees, and created the Arkansas Wellness Network to help connect
people, creating the policy, the organizations delivering the care, the providers supporting wellness, and the Arkansans needing those resources or experiencing those barriers firsthand. Our long-term vision is to help move Arkansas from 49th towards first. Our immediate vision and mission is to make it easier for every Arkansan to find credible resources, participate in preventative whole health and wellness opportunities,
and have their community's needs heard by the people in a position to help. I'd like
Representative Jeff Wardlaw
Unverified
5:43
to introduce you to Kathy, one of our members.
Kathy Linehan
Unverified
5:47
Hi, thank you for having us all here today. My name is Dr. Kathy. You hit
Kathy Lenahan
Unverified
5:52
that mic for us one more time, please. Oh, thank you. Thank you very much. So hi, thank you for having us. My name is Dr. Kathy Linehan. I'm an occupational therapist. I'm the founder of Alta Integrated Wellness, and I have connected with Arkansas Wellness Network. And what I do is I own a private practice which offers community-based services. So we go directly into the environments, the homes, the grocery stores, the workplaces, and we ensure that people are able to utilize tools that they have in order to be successful in those environments.
and we do that through offering occupational therapy services. This is done under the Whole Health Model of Care, and I'm also a certified veteran-owned, service-disabled veteran-owned, and woman-owned small business. And I'm going to speak today about how Arkansas Wellness Network is breaking down silos and creating connections in a fragmented system. So I have personally experienced this through the Arkansas Wellness Network. I was providing services to an adolescent who needed resources for an injury, and through the Arkansas Wellness Network, I got connected immediately with an expert in our community who not only provided me with resources in hand that I personally delivered to that family, but they provided us with future resources they could use as that adolescent transitioned into adulthood.
So they are helping me set this adolescent up for future success. I've also previously worked in a hospital system, and I helped a patient who suffered a stroke. It affected their left side of their body. The function of their left side of their body was significantly impaired, and they were receiving rehabilitation services. This person wanted to work very much, was very motivated to go back to work, and nobody in that system knew what resources were available in our communities to help support them in the workplace as they would need modifications and adaptations to be
successful at work, and that was within a big hospital system. I've been practicing as an occupational therapist for almost 15 years in Arkansas, and this year I learned about resources that were available that could have helped that patient. And as a practitioner, that hits you pretty hard, that something has been available that you didn't know about that could have impacted the life and well-being of one of your patients. So I am so thrilled to be part of Arkansas Wellness Network where I can get directly connected with other providers and other experts and other
resources. So Arkansas Wellness Network is changing the fragmentation and silo experience we're having in Arkansas by creating a searchable database. That database has certified and vetted healthcare and wellness providers. Also small businesses, local experts, community resources, government services, hotlines, websites, and other services. You can search by using a map, a category, a name.
A name could be a discipline. So you could look for an individual practitioner's name, but you could also look for occupational therapy, nursing, chiropractor. You can look by category or discipline. You can also research by agency name. You can search by keywords such as TBI, maternal health, domestic violence. This makes statewide resources easy to find and searches efficient. This is a very powerful tool because it serves not only the community, but also the patients, the providers, experts,
agencies and systems. Anyone can access and use the Arkansas Wellness Network searchable database. Good afternoon and thank you
Speaker 9
9:30
for the opportunity to be here. My name is Kenesha Sanders. I am a registered nurse with a background in critical care and currently serve as a neonatal intensive care unit nurse. I'm I'm also a National Board Certified Nurse Coach and the founder of The Re-Rise, a nurse-led health and wellness business here in Arkansas.
Through The Re-Rise, I help individuals, workplaces, and communities approach well-being from a whole-person perspective, not simply responding when someone becomes sick, but helping people better support their health and well-being before they reach that point. I want to speak specifically about why the Arkansas Wellness Network matters from the perspective of a small wellness business owner. One of the greatest challenges of starting a small business is not necessarily having something valuable to offer.
Sometimes the challenge is access. How do you get connected to the right people? How do you build credibility? How do you find opportunities to serve? and how do the people who could benefit from what you offer even know that you exist? For an independent wellness professional or small business, building that network alone can take years. That is where the Arkansas Wellness Network has been incredibly valuable to me. Through the Arkansas Wellness Network, I have connected with professionals across health and wellness disciplines,
learned about resources outside of my own expertise, collaborated with others, and become part of a much larger wellness ecosystem across our state. But it has gone beyond networking. Arkansas Wellness Network has created opportunities for me to actually use my expertise to serve others. Through Arkansas Wellness Network involvement in the Healthy Moms, Healthy Babies initiative, I was selected as a subject matter expert and given the opportunity to speak and educate from my perspective
as both a registered nurse and a national board certified nurse coach. I served on a panel alongside several physicians, including Arkansas Surgeon General Dr. Kay Chandler, creating connections and professional relationships that as a new small business owner I may not have otherwise had access to. Arkansas Wellness Network has also connected me with opportunities such as the Central Arkansas Women's Expo and the Arkansas Wellness Summit, along with educational initiatives, retreats, book clubs, podcast opportunities,
and opportunities to contribute professional knowledge through peer-reviewed articles in the free digital Arkansas Wellness magazine. For a larger organization, those opportunities may simply be another avenue for visibility. For a small business, they can be transformational. They allow us to establish credibility, build relationships, collaborate instead of operating in isolation, and connect our expertise with Arkansans who may actually need it.
When you support the Arkansas Wellness Network, you are not simply supporting an organization. You are helping build infrastructure that allows Arkansas wellness professionals, small businesses, health care providers, community organizations, and resources to find one another and work together. As a critical care nurse, I have spent years caring for people during some of the most difficult and vulnerable moments of their lives. As a nurse coach and business owner, I now also have the opportunity to work further upstream to help people develop the knowledge, the resources, the behaviors, and support that contribute to better health and well-being in everyday life.
But professionals like me cannot create statewide impact working independently in our own corners of Arkansas. We need connection. We need collaboration. We need opportunities to share credible information. And we need a way for Arkansans to find the right people and resources that are already here. That is what the Arkansas Wellness Network is building. I have personally experienced what can happen when a small wellness business is given access to that kind of network.
And the re-rise is still a young business. So when I think about the potential impact of Arkansas Wellness Network with additional resources and support, I think about the other small wellness businesses and professionals across Arkansas that could gain those same connections and opportunities, and ultimately, how many more Arkansans we could collectively reach and serve.
Tanya Phillips
Unverified
14:24
both for joining us. As I learned, and as I'm sure you guys know much better than I do, Arkansas has significant room for improvement in the health and wellness of our citizens.
According to the 2025 America's Health Ranking Annual Report, that's referenced in Exhibit C that we provided today, Arkansas ranks 49th in overall health. I will not take your time by reading every statistic and metric, but we have provided some of that information from that report and other recent sources to help illustrate the challenges facing our state. As you heard from our two members, the Arkansas Wellness Network was created to connect every part of our health and wellness ecosystem.
We want to help the individuals, the families, the communities, the businesses, the providers, the nonprofit organizations, the state agencies, and the policymakers, bringing us all together, letting us all know where each other is and what we need. We are not trying to duplicate anyone's good work that's already being done. We want to help find it, connect the dots, and strengthen it. Our podcast that we have recently created gives health and wellness providers an opportunity to explain who they are, what they specialize in, why they chose this work, and how they can help.
It allows the public to see them not simply as providers, but as people who care deeply about the communities that they serve. Our Arkansas Wellness Magazine we brought with us. Our Arkansas Wellness Magazine features educational articles written by our own providers and peer-reviewed by other providers here in the state of Arkansas. Across all eight dimensions are where the articles come from.
So we have articles on physical wellness, nutritional wellness, emotional, relational, spiritual, environmental, financial, and contributional. We want Arkansans to understand that wellness is not limited to exercise and nutrition and a doctor's visit. It includes the relationships, your finances, mental health, your environment, your sense of purpose, and connection to others. All of these areas influence our health and overall well-being.
One of our most meaningful programs is our virtual e-book club for survivors of traumatic brain injury. With our nonprofit, we have provided that in collaboration with UAMS Brain Injury Program for the last two years. This month, Suicide Prevention Month, we are also launching an e-book club for veterans and first responders in collaboration with MEMS, We Are the 22, Tactical Wellness, and the Kitchen Table Foundation. These organizations are all led by veterans and first responders,
And so participants will be among people who understand their lived experiences and the situations that they are dealing with. We're also seeking to collaborate with partners to develop an e-book club for expectant and new moms. This program will complement Arkansas's Healthy Moms Healthy Baby efforts by offering education, connection, and trusted resources to families as we work collectively to improve maternal and infant health. So a book club might not seem like a big deal to you and might seem pretty petty or just like a small program.
But to someone living in a very rural community without the specialized resources or a strong support system, it can be both an educational resource but also a lifeline. One of our members, Kim, gave us permission to share a bit about her story today. Kim was a very successful businesswoman whose car exploded after being struck by an 18-wheeler. She sustained a very severe brain injury that was not diagnosed correctly for over a year and a half.
Because of that injury and not being diagnosed properly, Kim lost her career, her home, the support of her entire family, and most painfully, she lost all hope. She lived in a rural area where neither her or her treatment team fully understood traumatic brain injury. She had to learn to walk, to talk, to do everything all over from scratch. One day, her speech therapist began searching for additional resources and found out about our book club.
Through that one simple connection, Kim gained access to brain injury specialists with UAMS. She gained information about resources that were specific to her injury, and more importantly, she gained a community of people who understood what she was experiencing. Kim was inspired by the books that we were reading, and she went on to write her own book, her own memoir, her experience of what happened.
She dedicated that book to our book club, and her book has since been accepted by a major publisher, and she is now preparing for a national book tour and a TED Talk in New York. The most powerful part about her story is what happened next. When the book publisher told Kim that she had to have professional photographs, she insisted that she would not work with any of their photographers because they wouldn't understand her. She insisted that one of the photographers that was part of the book club
be her photographer because he understood her and her disability and what her limitations were. Then the executives of the TED Talk gave her music options to introduce her on stage. She tried to explain to them that that music would trigger her brain injury symptoms and that she could not work with that. But she told them that she would go out to a song created by one of the people in the book club, a musician, a former musician, that she has gained trust in,
and they worked together to create a song that she could go out to that would work for her the people in that book club did more than read together they became a community kim found hope meaningful work and a renewed sense of purpose and she began creating opportunities for other brain injury survivors as well that is what connection can accomplish in addition to
Tyler Phillips
Unverified
21:10
those programs that you just heard about we are also planning to launch
two statewide initiatives beginning in january of 2027 the first one is a student focused challenge that is called the arkansas healthy future challenge this student-centered initiative will introduce student middle school and high school students to the resources that are available in communities, and also the careers. So we're wanting to help educate these students on principles like, what is your health savings account? What resources are available in your
community? Because that is how we create a healthier future, is helping them understand how they can best utilize what resources do exist in this state and the providers that are out there. The other part of it is to help expose them to potential careers in health and wellness because that is another way that we help create a healthier future Arkansas is by helping expand the variety of services that are available and making sure that we have passionate and qualified people to provide those services.
The other challenge is a city versus city challenge, And it's almost like a scavenger hunt, and we are trying to get people in our community to go out and find those resources and service providers that exist in their community so that they can begin to take advantage of them and become healthier Arkansans. And also to help spur economic development so that the resources that these people have in their, you know, through their various types of insurance aren't just sitting in those accounts, and it's actually being deployed in the community to make people healthier.
So those are two of the programs, and while they are different, they share one purpose, which is creating connection and improving wellness in our state and a healthier future. We also will be looking to connect survivors with peers who understand them. We connect families with trusted resources. We connect providers with the public, and we connect students with future careers.
We recognize that no single organization, agency, provider, community, or piece of legislation can move Arkansas from the 49th healthiest state to the healthiest state on its own. It will take all of us working within our respective roles and finding thoughtful ways to connect our efforts. We are grateful for the opportunity to introduce the Arkansas Wellness Network, share the work that is already underway, and make you more aware of the programs that we are developing for our communities in this great state.
Thank you for your service to Arkansas, for the work that you do to improve public health, and for allowing us to be part of the conversation. We would be happy to answer any questions
Speaker 24
24:16
you all have. Thank you. Thank you. I do
want to point out also the City vs. City Challenge. We will have an app that...
Tanya Phillips
Unverified
24:29
Sorry. I do also want to point out that our City vs. City Challenge will have an app
where the participants will be able to track steps. They'll be able to track meals. They'll have access to on-demand fitness classes and programming. They'll have access to meal plans, shopping lists, all the things that they need to be successful, and they'll also be able to log habits that they're doing, which will give us great metrics around the state to help develop programs as well and as well as learn about
Speaker 17
25:07
where they're going to participate in the different activities
that they're going to be doing in
their cities. thank you thank you appreciate y'all coming in your presentation quick question couple of them one is how
do you vet people as far as providers what does that process look like thank you
Speaker 13
25:33
we have a third-party company that we are working with and that is the only fee to join
Speaker 17
25:38
the network is they do pay for their own background check and there is a third-party company that does a
background check and verifies their license and certification. And we have a list of certification that we believe is appropriate. We have a committee that checks out different certifications. The wellness industry is not as regulated. So we have a committee that looks, and it's full of professionals, doctors, nurses, providers. They look at the different professions. They look at
Tanya Phillips
Unverified
26:13
the certifications, they check the education, that kind of thing, and decide what certifications are appropriate and which ones are not.
Okay, okay, so like how would a, you're looking for licensing, correct, information to make
sure that they're a licensed occupational therapist, for example. Yes. Is there something else beyond that licensing that you're looking for or beyond like an MD or an occupational therapist or physical therapist or nurse? Is there anything above and beyond, like a different level of certification? Yes,
Speaker 13
26:49
ma'am. So we have your traditional health care providers that are
Tanya Phillips
Unverified
26:53
licensed, but a lot of the wellness industry is not.
For example, your naturopaths, your health and wellness coaches, they
Speaker 17
27:01
are licensed in other states, but they are not yet licensed in Arkansas, but they are practicing. You also have personal trainers, nutritionists. There are a lot of different professions that are out there existing and working. Not all of them are trained. not
Tanya Phillips
Unverified
27:19
all of them are certified and they are out there giving advice and training people in areas that they don't have the proper credentialing and so what I'll
Speaker 17
27:29
give a perfect example or I'll give
two examples I know of a naturopath who has no training no experience calls herself a naturopath and is providing services to individual people I knew of a personal trainer who was doing one-on-one services in people's homes. And he was a registered sex offender in another state. I also have seen a lot of people who are, and no offense to anyone who may drink it or purchase it or sell it, but there are a lot of supplement products that are being sold in little drinks.
Tanya Phillips
Unverified
28:07
And those people are calling themselves certified health and wellness coaches. They are not, they do not have
Speaker 17
28:13
the proper training. They don't have the proper certification. So we have taken that step to create a committee that has determined in our professional opinion what is a credible health and wellness coach. There is an actual national board certification for that, and it is recognized in other states and licensed in other states, but it's not yet being done in Arkansas. So this was our way of trying to have a safeguard, and if you are part of that network,
it gives you a little bit more credibility because you have
been checked out and verified. Okay, I got you. Okay, thank you. Yes, ma'am. I appreciate that explanation. And then I'm interested more also in the kids, connecting
kids to activities that you discussed. Could you give me a little bit more about that? I'm hoping, you know, I just feel like kids are way too much on screen time and not getting out and playing Little League football and soccer and baseball
and all those, you know, things. And I see from your background, thank you for playing for the Razorbacks. My brother was also a former Razorback player. And so I just kind of wanted to hear a little bit more about that because so many oftentimes, you know, my brother has participated. He lives in North Little Rock. But you have a lot of single moms, you know, that don't have dads in the family. And so, you know, they struggle with making sure that their kids are getting connected with those Little League football programs and things like that.
So I just want to hear a little bit more, if you don't mind, about that kind of outreach,
Tyler Phillips
Unverified
29:58
particularly for our younger kids. Yes, ma'am. And you're you're you're striking a chord that I vibe with because I just started volunteer coaching for North Iraq football. And so, yes, I'm all about getting these kids involved in our our sports. I stat that's not in our packet. Arkansas is also near the bottom in student sport participation nationwide.
And, you know, what you're talking about and what we're doing in this challenge. One of the things is we're sending people around to providers or people who are doing things in the community and educating families about what is there. You talked about North Little Rock. I grew up playing Lakewood Property Owners Association, you know, baseball. And so many of my friends for life, I developed in that, and we would go on to play high school sports together. So it does, you know, it starts on that level. And part of the challenge will be trying to expose them to the people who are providing
those opportunities for kids to get involved. But also, my mom was a teacher, and she loves to teach, teach, teach, and teach them all about what's healthy about going outside and what is healthy about being part of a team and getting that community of participating on your high school team or in the band, right? It doesn't necessarily have to be purely physical, but there is that community wellness, that contributional wellness of volunteering, and how that can not only help you,
but help us create healthier communities. So it will be educating them on holistic wellness in ways that they can tap into the things that are going on in
our communities. So I think that partners very well through our LEARNS legislation where we require some volunteerism now for graduation. I graduated from Mount St. Mary Academy, and we had to have 100 hours, I think, of volunteer time before you graduated. So I'm a big believer in that.
And then the second thing I would just encourage you to do is also work with our county extension offices. They have a lot of programming already available through the Department of Agriculture. University of Arkansas Cooperative Extension Services and there's a cooperative extension office in every single county and my husband is a family practice physician often connects his patients with that county extension office to take those nutrition classes or to sign up for those exercise classes or what have you but what I'm hearing is you're kind of a connector of existing
resources and that's definitely one of the existing resources we have that's located in every county so i would just encourage you to really look at that and try to incorporate that also into what you're doing thank you
for being here representative bentley you're recognized thank you chairman thank you all for
Representative Mary Bentley
Unverified
32:56
being here today and i hate to miss your event unfortunately some physical therapy and any surgery didn't allow me to be there but thank you for being here today to hear what the great things you're doing and thank you as well for what you're doing to help our constituents to understand who is actually certified as a naturopath and those
that are willing, because to me it's very concerning that folks can do an online course or a six-week thing, call themselves a physician when they're not. It's very, very concerning to me. So thank you for that, to help them to
understand who really is certified and who is not. I think that's great, great customer service.
Speaker 13
33:30
My one question was, how are you guys funded? How are you doing this financially? Well, at this time,
Speaker 17
33:35
it all comes out of my pocket. We are looking to work with others to sponsor some of our activities. We are also looking at future grants to help us with what we're doing.
But right now this has been my passion project for the last 18 years. Oh, UAMS. We do have a small grant through UAMS to help with the book club. We are working with the VA hospital on looking at partnering with some opportunities there as well. So we're slowly developing those resources, but right now we're self-funded. And everything is volunteer. Every single person, every bit of what we do from the magazine to the podcast to everything,
the network providers pay for their background check. And so right now we are just self-funded. Thank you. Thank you for what
Representative Mary Bentley
Unverified
34:30
you're doing. One more quick thing. You might want to check on a group called Every Child a Swimmer. I was a mom from Florida whose young child died at 18 months old, was drowned. And she's very passionate about helping to do sponsorships of swimming lessons. Arkansas does kids that are 1 to 4. This is the number one reason for dying is drowning. Excuse me, 1 to 8. So every child is a swimmer. I will connect you guys with her. I think she would love to help you guys get some swimming lessons
and those things added to your wellness. So thank you
Speaker 13
34:58
for being here today. Thank you. And ironically, I met with them at the Arkansas Women's Expo. They were there, and they asked
Speaker 17
35:04
about joining the network. And I said, 100%, that is a part of wellness. It's a huge part of wellness. Not only is it an activity, a physical activity they could be doing, but it could save their life. So, yeah, 100%, we would love to work with them and promote what they're doing. And that's the biggest part of what we're doing is promoting the people that are doing the work that are out there.
There are lots of great programs in Arkansas. People just don't know where to find them. Thank you so much. With
Representative Jeff Wardlaw
Unverified
35:35
that, we have no further questions. We thank you guys for your presentation. So with that, committee, we'll move on to item D, Ms. Mary Franklin.
if you would I think you know the protocol but tell us your name and
Representative Aaron Pilkington
Unverified
36:12
you're recognized to present good afternoon I'm Mary Franklin director of the division of county operations for
DHS today I have a presentation for you about the snap quality control process and payment error rate improvement strategies all right what is snap quality control this is an audit process that follows the food and
nutrition administration's handbook 310 it's a process where
Representative Aaron Pilkington
Unverified
36:56
that involves sampling of and reviewing two types of cases active snap cases
and inactive snap denials and closures the snap payment error rate is based on the outcome of the reviews of the active cases that are sampled and reviewed during the federal fiscal year October 1. Sure I'm sorry
is that better? Okay so the SNAP payment error rate is based on the outcome of the reviews of the active cases during the federal fiscal year which is October 1 through September 30th. The inactive case reviews are they're reviewed to determine if the adverse action that resulted in denial or closure or termination of the case was correct as of the
Representative Aaron Pilkington
Unverified
37:48
review date the payment error rate cow is calculated by comparing the total benefits issued in that sample universe to the
dollar amount that was determined to be issued incorrectly both under payments and over payments count in toward the payment error rate and both agency caused and client caused errors count toward the payment error rate and for federal fiscal year 2026 errors that are under 58 dollars errors that are 58 dollars or more count in the state's payment error rate but errors that are under that amount do not count in the state's payment error rate unless that case was totally
ineligible in which case it doesn't matter the dollar amount it still counts toward the payment error rate. So here's an example just to help make it more clear about the payment error rate calculation. So assume that a case issued benefits in October is selected for review. The total benefits issued in that case were $900. The QC review determined that income the household received was undercounted and that the benefits that were issued were $75 too much. The correct
amount of benefits should have been 825 instead of 900, which resulted for that case in a payment error rate of 8.34%. So again, $75 incorrect benefits issued out of a total $900 in benefits for that case resulted in that payment error rate. Another example would look at a whole month. Assume 95 cases were selected for review for the month of October. The total benefits issued in those 95 cases was $34,485. Assume that $2,070 of those dollars were determined to be issued in
error. That resulted in a payment error rate for that month of 6.01%. So $2,070 out of $34,485 dollars resulted in a 6.01 payment error rate. How do we select cases for QC review? The Food and Nutrition Administration requires us to sample 1,020 active cases per federal fiscal year. We opt to oversample a little bit to make sure that we review the minimum number of cases.
Cases are selected for review after the end of each month of the federal year and it's based on a sampling plan that we submit and that food and nutrition administration approves states have 115 days for to complete a review once a case is selected in that sample to be reviewed so this also means there's a lag time between the time the case has worked the time the case is selected for review and when the outcome of that review is known so for example after october ends a sample
of active snap cases is randomly identified in november the qc staff have 115 days to complete those reviews of those sampled cases so the reviews for october are due in february depending on the day the case was assigned to the qc staff consequences of the snap payment error rate there is a new benefit cost share that was implemented with the hr1 beginning federal
fiscal year 2028 which starts october 1st of 27 states are required to share in the cost of snap benefits based on the state's payment error rate. Right now, the benefits themselves are 100% federally funded. For federal fiscal year 28, the cost share will be based on either the federal year 25 or the federal year 26 payment error rate. The state can select the year based on which year is most
advantageous based on the error rate for those years. After federal fiscal year 28 that cost share will be determined based on the payment error rate three years prior and will continue on the chart there shows you just the breakout of the error rate in the different percentage of cost share so if the payment error rate is under six there is no cost share if the payment error rate is between six and seven point nine nine percent
there's a five percent cost share and just based on our benefits issued over the last 12 months that cost share for five percent would be 24 about 24 million dollars if the payment error rate is between eight and 9.99 that cost share increases to 10 percent which would be an estimated amount of 48 million and if that error rate is 10 percent up to 14.99 that error rate is 15 percent or could be around $72 million based on our history of benefits issued. There is another consequence
to the SNAP payment error rate that is not new, that has been part of federal law as long as I've known about SNAP. But just to help inform about that, there is a penalty process in addition to cost share, and the H.R. 1 law did not change this penalty process. it is still in effect and what the penalty process is is that in addition to the cost share that begins in 28 states are also subject to penalties based on the payment error rate if a state exceeds
105 percent of the national performance measure for two years in a row two or more years in a row consecutive the liability amount is based on a calculation and it is it's based it is based on benefits issued by the agency during the year multiplied by the difference between the state's payment error rate and the 6% threshold and then that's multiplied by 10%. So I did an example of that. If you assume the national performance rate is 10.62%, that was the national error rate
average. For the second year in a row, the state exceeds 105% of that at say an error rate of 12% uh and that state issued 472 million in benefits for the year so that calculation would result in about a 651 000 penalty if a state is assessed a penalty up to 50 of that in discussion and negotiation with food and nutrition administration can be deferred or 50 of that instead of being
paid to F food and nutrition administration can be reinvested by the state into activities that would specifically help improve payment accuracy and the remaining at-risk amount would become payable as a penalty if the state did not meet the error rate or was again at that penalty threshold the next fiscal year. So this walks through when the QC results are available. So we're about five
months into the federal review year before we start to see the outcome of the reviews from the first month. The lag time does make it difficult to make adjustments to impact that federal fiscal year because we're five months in at that point the results of the state qc reviews are reported to the food and nutrition administration and they in turn review a subsample of these cases to the review behind us to determine the results if there's any differences between the results we
reported and what fna determines those are arbitrated on a case-by-case basis and then fna determines the final miss franklin may interrupt you for a second my co-chair has a question
Representative Jeff Wardlaw
Unverified
46:08
sorry no i know i appreciate this and this
is what i wanted and this is what i requested um but what i what i want to do instead of reading the slides to us which i appreciate this is exactly what i need i need to know specifically because the reason why i asked
for this to be on the agenda is we have to get our error rate down below six percent because of our budget okay we are a balanced budget state we cannot be hit arbitrarily with a 58 million or 48 million dollar you know penalty out of the
blue what i need to know is specifically what is it
that we need to request from the federal government to provide to us or to provide for all states so that we can become more compliant the lag time is what I'm hearing is to be incredibly
problematic and so I need specifically what do we because I want to take legislative action on this issue and I want them to hear from us as a legislature I get what they're trying to do I'm for what they're trying to do but what I'm not for is us is playing gotcha with the state of arkansas and what what what do they need to give to us so that we can become compliant and know what how we're doing and what is happening because to me the way that this is
being implemented or whatever is not well thought out so that states don't have the opportunity to really meet what they need to meet um below to get below that that six percent so so because we are in charge of the state budget that's the legislative our responsibility and so this is a big deal in my opinion and i feel like we as the public health committee in the house and the senate along with our legislature we need to say to the federal government hey we want to work with you
But we've got to have you working with us as well in collaboration. So can you boil this down to what it is exactly that we need from them in order to ensure compliance as quickly as possible so we're not just blindsided with a $50 million hit to the state budget? So I
have some ideas. I can give you some thoughts on what it would be helpful if the federal government would do, And I can also tell you the things that we are working on, you know, ourselves to help improve that rate.
And just, you know, to have it on the record to let you know, this is very important to us, too. It's important to DHS. It's important to county operations. And every person on my team wants to get that error rate below 6% and are working to get there as best we can. but there are some things more time would be helpful before this cost share goes into effect if we could have a little bit more time to adjust our processes to adjust our training
Representative Aaron Pilkington
Unverified
49:21
just to make progress it would be helpful um more
Speaker 87
49:29
time mean meaning delay it don't make it of don't put it into effect in 28 okay give us
more time wait until you know a later federal fiscal year you know even one more year would be helpful for
us um what about real-time data from from them are we being compared to other states that have a different threshold
of benefit amount so every state
has you either review 1020 or like 2500 cases so we're the same in that respect that every state has and i think maybe all but one state reviews the minimum there's not much advantage to reviewing more um because the outcome is the
Speaker 87
50:16
outcome based on that sample um so but arkansas
we have about 116 117 000 snap households that are active right now
texas probably has 1.5 million a lot bigger but they can review the same number of cases either 1020 or 2500 so it's not proportional it's not proportional um
sample size is not proportional to recipients.
Speaker 87
50:46
Right. I mean, it's statistically, I guess, I think statistically valid
because the same criteria applies to all the states, whether you select 1,020 or 2,500, but you're not reviewing
the same percentage of every caseload across the states. Right. There is no way at this point to get real-time data because the work has to be done, the universe has to be established before those cases are sampled they're sampled randomly to you know and the process needs to have integrity in it definitely we don't interfere with it the cases are the cases and we review them and report the outcomes both agency and client caused errors count both so we it counts just as much against
us if we incorrectly count the income and issue incorrect benefits because we didn't put the right income in the case as if someone fails to tell us about a source of income and we don't have a data source that could tell us that even if they you know to find it out to verify it right underpayments and overpayments count in the error rate and if we've underpaid a family that's bad we we want to pay the right amounts to what everyone is entitled to but we've underpaid the federal benefit in that
case not overpaid it but they both count so there are different things that could help from the federal level uh with this whole qc process i mean the the process itself has been in federal regs for many many years and the cost share was added but there was no really other overhaul or just look at the entire process when that new cost share was put into effect okay and then last question and there
may be some others just because i i think this is good information for us to really
have and i appreciate all the effort you did it to the slide and i want you to continue with your slides but i just we what is our asset limitation just remind me
Speaker 68
52:54
one more time in order to qualify the asset limit for snap we
well we use the the federally established asset rates which is different for regular households and aged and disabled households but the state did pass legislation in the last session to implement broad-based categorical eligibility which
essentially raises the asset limit up to five thousand and then we incrementally change it as the federal rate you know increases just to keep it to keep it you know to where there is room But individuals can go over the asset limit up to $5,000 for 12 months. That's what we have in place
now. Okay. And other states that have nothing in place, are we counted against
them? Or how do they, if they have no asset limitation, how are they determining their error rate?
Is it just based on federal then? When you implement broad-based categorical eligibility, you have the option to define how you do that. And broad-based categorical eligibility means that we are using a non-cash TANF service, not a cash benefit, but a non-cat eligibility for that non-cash TANF service to confer that eligibility onto the SNAP recipient. And some states that do broad-based categorical eligibility use it to remove the asset limit, which means the staff are not spending time verifying assets.
And that also means, though, in the QC process, if a case is sampled, you're not going to get an asset error because if the case was eligible for broad-based categorical eligibility, there won't be an asset error. And I can tell you that if there is an asset error, there is no a little bit over or it's just a totally ineligible case. If a case is over the asset threshold, it's a totally ineligible case, unlike, say, a household composition error or an income error, which maybe the entire case didn't close, just the benefit amounts were wrong.
So because of the way that we have it structured, it's harder on, I mean, we are kind of subjecting ourselves to more error rates. Is that a fair statement to say? I mean, just because I feel like it's not a one-size-fits-all across the country, and I need to be able to articulate that to the federal government because I feel like we've tried to be specific about this benefit so that it's not taken advantage of, so that it can be there for the people that need it the most,
but other states are not. And so I want to make sure I can articulate to the federal government, hey and maybe this this legislature doesn't want to do that i do just because it's on us i mean you know it's going to cause an issue with the budget that we're supposed to be in charge of here so i guess my as other people are asking questions i want you to think about how we can articulate that to where they can make sure that we are being held to the same standard as california
Texas Vermont Maine whatever because I feel like right now with the way this is structured we're not being held to the same standard of policy so because of the way that we've implemented our benefit versus the way other states have so as you're you don't have to give me an answer right now but that for me is why I wanted this on the agenda so that we could fully understand this and also push back if we needed to at the federal level to say hey you need to consider this we
we are with you we want to work with you we want to collaborate with you but we can't you
know i'm kind of tired of arkansas always you know we have the lowest medicare reimbursement in the entire country i'm really kind of tired of that i'm ready you know i'm here to represent arkansas so um if you can i'll i'll go to other questions or if you want to but that's why i really wanted to kind of drill down on this thank you yes ma'am how many more slides do you have miss
do have a good stopping point in just a minute where and the rest of it is just really
more information that you all can
Representative Jeff Wardlaw
Unverified
57:10
look at the queue is pretty full i'm gonna let you get to
your stopping point and then i'm gonna come back to questions um oh going the wrong way this line just gives you acclimates you to where we've been our federal fiscal year 24 final payment error rate was 9.56 that was made up of 19,546 dollars of agency
caused errors and $9,653 of client caused errors. In, um, 25, our final error rate was 8.81%, which was made of $10,714 in agency caused errors and 13,107 in client caused errors. Um, and the last bullet there is for this federal fiscal year that we are in as of August 21st, The rate we are reporting to Food and Nutrition Administration as of that date was 7.27.
With October through January reviews 100% complete, the February and March reviews were 90% complete, and April was about 75% complete as of that date. And the current results that we have reported, $6,010 in agency caused errors and $4,284 client dollars in error. And so about 55 or so percent of the way through the review year. These are
Representative Aaron Pilkington
Unverified
58:45
things that we are doing to improve.
We monitor these QC results. Even though they lag, they're still important. We monitor them. we look at root causes of those we look to see are there system changes we can make are there policy considerations we need to look at are there different reviews we need to do we are looking at that we do second party reviews on cases these are reviews that we do that are outside of that qc sampling process we do case investigations we have a special investigations
team that takes referrals from our caseworkers, from the public. They review from transactional information. They review from reports that we create. They investigate case, which is beyond a case review. You know, in an investigation, they are going to try and talk to the client, possibly even visit the client in an investigation. We do refresher training regularly. Some topic that's related to the qc and payment error rate we do something called prevention in a snap which
basically gives caseworkers pointers on hey we had some errors that were caused by this it's plain language it's drilled down to hey if we just did this this could help prevent errors of that type and then we also have done some technology enhancements to help us with that and we do have a monthly team meeting where we look at and review all of this data and talk about ways we can collaborate together as a team or ways we can support each other or any new strategies that we can implement and that is a good stopping point the rest
Speaker 76
1:00:24
of these slides just go into more detail about these things we're
Representative Jeff Wardlaw
Unverified
1:00:30
doing to make improvements representative Pilkerton your answer
Representative Aaron Pilkington
Unverified
1:00:36
you're recognized for a question thank you mr. chairman thank you director Franklin for being here I've got more of a budget question you know as you know uh october 1st the administrative funding is dropping from 50 to 25 percent which shifts our portion from 50 to 75 percent we're going to have to pay for it do we have a funding pool or pot of
money to to be allocated for this and if not i mean how is that how are we going to make
up that difference that's coming down the line so we um that factored into the budget
that we submitted for this federal I mean for this state fiscal year we knew that this was coming and I can tell you we have balanced our budget it's tight we are also looking at efficiency some of the technology enhancements that we've implemented will help with accuracy but part of that help is helping
with efficiency like we we have invested in AI to some bots to help us automate some things so that our caseworkers can spend time on other things just to help reduce the workload and we can spend time on other things so we are going to continue to monitor our budget very closely we're going to be frugal and we're going to look at ways we can invest in things that will help us be more efficient and help us
Representative Aaron Pilkington
Unverified
1:01:56
be more accurate okay that i'm glad to hear that um i guess but that money
that increase that we are using to fill the gap where did that come from just is that you're over general you know general fund that you guys had or was there something we cut somewhere else down the line where where did that 25 that we're going to make up for
Speaker 71
1:02:17
where did that come from um well you know some of that
is has been in not filling as many positions as we had in the past some of it was made up by cutting back some of our expenses uh and some of it is is as you mentioned funds that
dhs was able to make available to us okay great
Representative Aaron Pilkington
Unverified
1:02:36
thank you appreciate the thoroughness representative bentley thank you chairman thank you
Representative Mary Bentley
Unverified
1:02:45
mary for being here today i just want to quickly i know some other states have done like we've talked about landlord uh certification to make sure that when you guys are doing the household composition we're getting it accurate is it something we have looked at possibly doing or not so we typically we
Speaker 111
1:03:00
typically verify everything we we ask for verification yeah i understand that but are you getting the verification back
Representative Mary Bentley
Unverified
1:03:07
from the landlord so they're saying yes what they're saying is correct what you are seeing is correct just i'm just trying to help you guys out when you're doing your report and all the states have found that
very helpful to cut down on their error rate so sometimes that verification is a rent receipt sometimes it might be a lease there are different things that we can take for verification to verify household expenses like rent and utilities we look for mail coming to the person in their name uh check stubs you know i get all that but i'm just saying other states are
Representative Mary Bentley
Unverified
1:03:40
using that that the landlord has to get back with you information to verify yes this people live at this address and this is the number of people that are living there just to help you decrease your error rate and that's what they're using so anyway again i would suggest that another thing is how long ago we um had a marriage penalty in arkansas where folks that are living together their income does not combine with people that are married their income is combined do you know that or can you get back with me on that because i think we should look at when it comes to benefit cliffs that's very hard for folks i think we should look at not having a marriage penalty in our state
so so in snap if you're not married and you do not purchase and prepare your meals together you You can live under the same roof and not be in the same snap case. But if they're married, then that is combined? If you're married, then you have to be in the same snap case, and both of your income will count. So
Representative Mary Bentley
Unverified
1:04:33
other states don't allow that. So I think that's something we need to consider. Other states do not have a marriage penalty. If they're in the same household, then they're considered joint income. So I think we should look, when we're looking at benefit cliffs
and the massive amount of benefit cliffs we have, I think we should consider what other
Representative Jack Ladyman
Unverified
1:04:57
states are doing. So thank you, Chairman. representative ladyman you recognize thank you mr chairman uh well representative bentley asked one of my questions about verification i'm over here uh and i think that's been that horse has been beat enough um but you know um we talked about what can we
what can we get the federal government to do for us and it's been my experience we can't get them do too much uh but we ought to be looking at that like the vice chair said but um what can we do ourselves to to help improve that number to get from 48 million to 24 million to zero get our numbers down to below five or six percent um what can you
identify how many offices do we have around the state we got 75 some counties are shared
right we have at least one office in all
75 counties here in Pulaski we have three local county offices in Saline County we have a main office in Benton in an annex in Bryant which just overflow staff mostly children and family services staff in that bryant annex and we in washington county have a small annex uh in
Speaker 87
1:06:12
addition to the main office but so if
Representative Jack Ladyman
Unverified
1:06:17
we have a problem county or a problem office can you zero in
on you know 90 of your problems may be coming from three counties i mean can you tell where your problem offices are do you have that
ability so we do track the outcome of these results based on um county where they where the staff works not necessarily where the client lives but where the staff works we do we do track results to the county to the area
Speaker 90
1:06:51
we also look at agency versus client yes we look at all of that
Representative Jack Ladyman
Unverified
1:06:57
so in these county these offices it's not county these
agency offices is that office responsible for everything that that they're graded on or do they share customers from other counties i mean you've got a zero you got to identify the problems and zero in on the problem can you do that
Representative Aaron Pilkington
Unverified
1:07:20
so yeah we are trying to do that yes um we have we also trying to
Representative Jack Ladyman
Unverified
1:07:25
do it i mean can you change your policy to
improve that that's what i'm asking we so we do have performance measures in place for our individual staff and and for managers and so
part of that performance is accuracy is accuracy for things they control you know client caused errors we would not necessarily hold an individual staff person accountable for that or a county but yes we do look at errors what are causing them we have performance measures in place we do performance improvement plans when they're needed we do training we do coaching oh i understand you're doing a
Representative Jack Ladyman
Unverified
1:08:02
lot but tell me what your what are your uh three offices that have the highest
Speaker 124
1:08:13
that today but i can get you that do
you look at that on a regular basis we look at the causes more than like i can tell you some of these slides are At the point in time we were at in the QC reviews, what are the top three causes of errors, which number one is wages and salary errors. And at the time that this was pulled, there were more client errors
Speaker 68
1:08:34
than agency errors. And we're looking at what can we do to prevent those errors?
What can we do to make that
Representative Jack Ladyman
Unverified
1:08:41
better? What I'm asking is accountability at the office level. So I would like to know what are the three highest. And then, I don't know if you understood my question, but so one office, say the office in my county, so are they just responsible for the cases that they work, or are the calls transferred to other cases, work by other people outside of that office that is in their numbers?
They're responsible for the cases they work, not necessarily responsible for the outcome of all the reviews for clients who live in their county. So if you identify
Representative Jack Ladyman
Unverified
1:09:18
your three worst counties, it would be the people in that office that are working all those cases. That's how we track
and attribute the errors, yes, based on where the case was worked, not where the client lives. Well, I know y'all are doing a
Representative Jack Ladyman
Unverified
1:09:31
lot, but I hope you understand what I'm asking. I do. Your worst case is where you ought to be putting your resources to try to fix that. Yeah, I'd like to know what the top three are.
Representative Jeff Wardlaw
Unverified
1:09:44
Thank you. But, Ms. Franklin, if I remember correctly, we've had this discussion before. If I call Bradley County right now, I may end up getting a different county on the phone, correct? That's correct. So what he's asking you, you're contributing that error rate to those counties, but it may be somebody else in another county that made the error, correct? Right. Because if I talk to them in Drew County and I called Bradley County, Drew County does my case,
Bradley County got attributed my error when Drew County caused the error, if it was
Representative Aaron Pilkington
Unverified
1:10:21
an agency-caused error. So when a case is selected for review, wherever that worker reports to, that's where we attribute the error to. So
if it's a client who lives in Bradley County, but a worker in Drew County is the one who worked the case, then that error goes to Drew County, even though the client lives in Bradley County. Perfect. Yeah.
Speaker 129
1:10:45
Senator Senator Irvin you recognize and
is there any penalty for somebody who for an individual that incorrectly reports information? So
there are penalties some, you know, if it rises to the level of fraud like intentional withholding and not reporting Then we do refer those to our fraud team for further workup prosecution. They also can have Intentional program violations where they are ineligible for SNAP for a period of time because of that violation.
And they can have an overpayment. Even if it was an unintentional, you know, mistake, it can result in an overpayment. So there are incentives for clients to not, you know, repeatedly make
mistakes in reporting and providing information. So how many of those cases have been reported for fraud of the client-based, not the agency-based ones, but the client-based ones?
How many of those client-based cases where it was their fault for not reporting the correct information to us? I'll get you that. Yeah, I'd like to know that because, and is there any federal rules that prohibit us from increasing those penalties?
The intentional program violation is progressive, like first offense is. Is that state or federal law? The intentional program violation is allowed in the federal law.
I need to take that back and find out how much
room we have as a state to establish this time period. I'd like to see how, I mean, if we're trying to pull as many levers as possible to get our error rate down, we've got to look at this from every angle, agency, rate of incorrection,
Representative Jack Ladyman
Unverified
1:12:45
and client-based. Thank you. Representative Ladyman. Thank you, Mr. Chairman. I had another question after that discussion. I ask you for the three offices. what are the three uh most often mistakes made do you know what that is i mean is it income is it
family members is it debt is it assets i mean can you zero in on one thing and then try to
figure out how to fix that question so on the client side it's usually unreported information uh on the on the agency side it can be um several different things in income calculated incorrectly information that we knew that we had that we didn't apply to the case so careless error but
Representative Jack Ladyman
Unverified
1:13:33
you have the ability to to find which question is most often answered incorrectly you have that through data so for each
Representative Aaron Pilkington
Unverified
1:13:42
error type i can tell you the not
today but in the data i can tell you the most common cause like for example if it's client reported client cause income error i know so we still have a lot of rules on the agenda
Representative Jeff Wardlaw
Unverified
1:13:57
so i'm gonna i'm gonna halt this for a second can you put together a report that would answer most of the questions we're getting from the
members today and send that to staff and i think that would help and then we can have a follow-up meeting to go over that report if need be sure i
can put some of this together and send it
Senator Bryan King
Unverified
1:14:24
to you you're welcome senator king you're recognized for a question just one quick question what's deloitte's role
in all this with this uh snap program deloitte is our system integrator that helped us build the eligibility system, the Arkansas Integrated Eligibility System. Okay.
Representative Jeff Wardlaw
Unverified
1:14:41
So with that, thank you for your presentation. We look forward to seeing your report. We'll
move on to item E. Ms. Elizabeth Putnam-Pittman. if you would introduce yourself for the record and you're
Speaker 148
1:15:12
recognized to present good afternoon Elizabeth Pittman division for director for the division of medical services
I have a simple rule today I hope and it is a rule that we passed pursuant act 431 of 2025 it was a law that required that Medicaid pay for diabetic shoes and inserts and also that anyone who could prescribe within their scope of practice be able to prescribe them. We already covered the shoes and inserts themselves, so we just expanded the language of the rule to make it clear that anyone who has prescribing authority within their scope of practice can prescribe those diabetic shoes and inserts.
Representative Jeff Wardlaw
Unverified
1:15:46
I'm happy to take any questions. So, I used to be in the DME business,
full disclosure, not anymore. But I got quite a few calls this week from audits from Medicare where they're disallowing a nurse
practitioner signature so if we pass this is that putting us in direct violation
Speaker 149
1:16:07
with medicare so we can have different rules than medicare um what we
Representative Jeff Wardlaw
Unverified
1:16:11
i'm again very familiar with the process we can have different rules but our rules can't be
less than their rules we can always be more but we can't be less and by allowing a nurse practitioner or a physician's assistant that would be less so have we got approval
for medicare to do this so we
Speaker 148
1:16:31
didn't have to submit a state plan we have approval from medicare cms the medicaid federal partner to allow for
Speaker 149
1:16:37
nurse practitioners and physicians well we're going through the process of allowing for physician's assistance to be we're going through the process or we have the approval we have approval for aprns and cns's and the physician's assistance is pending with
them right now. Okay. Any other questions from committee? Go ahead. So if the DME providers that have contacted you are being audited under Medicare, are they, I mean, I guess does the DME people that that for me it would cause a lot of confusion I wouldn't want to subject myself to
audits I mean I know we passed the law and I know you're doing your job as like is trying to implement the rule I'm just saying I I think DME providers need to figure out if this is something they want to do or not because if you're subjecting yourself to you know accidentally not following the medicare rule but following this rule for medicaid and get confused then you're potentially recreating a an audit for yourself that's not really for you to answer but you're just doing
your job and implementing the rule based on the legislation that was passed but i was just i
Representative Jeff Wardlaw
Unverified
1:18:03
read a report yesterday and cms does not allow a aprn or a pa to sign for diabetic shoes they can do the initial face-to-face and send the order in but a physician has to co-sign on the rules RDO for it to be valid payable claim that's what the audit said I read one yesterday well as they saw this on the agenda and they said this is
they said exactly what you just said this will be very confusing for them because they'll be doing it one way for Medicaid and a second way for Medicare and that's the reason I asked Ms. Pittman did she have that approval because why would
they approve for one hand to do it and they're not letting themselves do it it's kind of my point I ask that
Speaker 148
1:18:48
often um so it will it will mean they have to bill Medicare according to the Medicare rules so they would
Speaker 149
1:18:53
not be able to use a nurse practitioner a physician's assistant if it's not allowed and then that would limit who they could if they want to cross over to us that would limit who they
could use for us if it's a sole medicaid patient they could then use a pa or or a nurse practitioner that's how that would work for them and so yes i agree it's something they'll have to look at happy to take a look at those audits and see but commonly cms has applied different rules to medicare and medicaid um for whatever reason yeah and
i understand that it's really not for you i mean i don't have any issue with the the rule as it's written because it does follow the legislation i would just encourage the dme folks to get these audits and get with you guys and decide if this is
something that they really want or not
Speaker 35
1:19:37
because yeah they may want to repeal this law okay thank you any other questions seeing no other questions thank you
Representative Jeff Wardlaw
Unverified
1:19:44
for the rule uh it stands reviewed without objection thank
you y'all have a great day we'll move on to number to item f uh department of Health Christy Kreese. If you guys would introduce yourselves for the record
Speaker 161
1:20:09
and you're recognized to proceed. Good afternoon my name is Christy Kreese and I'm the EMS Section Chief
Speaker 163
1:20:24
for ADH. Good afternoon Chuck Thompson attorney
Speaker 164
1:20:29
Arkansas Department of Health. Good afternoon Craig Smith attorney for the Arkansas Department of Health and committee members we thank you for your time this afternoon. Our first rule is the rules for emergency medical services. This includes changes to both the rules and the appendices. The proposed amendments are to comply with Act 384
regarding the interstate compact as well as 863 regarding the removing the advisory council and establishing the emergency medical services advisory committee as well as changes recommended by blr and incorporation of the accreditation manual for training facilities into the rules the department opened for public comment we had two periods one for the rules one for the the appendices last days were march 31st as well as june 16th for each only one comment was received
Speaker 165
1:21:21
on the rules and it's just a cleric error and with that open
to any questions senator so the committee is uh we're establishing just per the law
if you'll just remind me real quick we are we abolish the emergency medical services advisory council and then established the emergency medical services advisory committee which is under what yes ma'am that
Speaker 164
1:21:47
is under the board of health as was the advisory council this was an act that was sponsored by representative
johnson and it adjusted how how involved the advisory council was before the advisory council was very limited it advised on certain standards this advisory committee is more involved with rules and more involved with disciplinary actions for licensees and other areas and they've been doing some wonderful work over the past year once they were established okay no i thank you i just wanted
to make sure we were they were still under the board of health yes ma'am standalone okay thank
Representative Jeff Wardlaw
Unverified
1:22:25
you seeing no further questions the rule stands reviewed without objection with that we'll move on to item G I think the only change is Miss Paula Day thank you if you guys want to take up G and we'll just move all the way down to K I think y'all are the same presenters all the way through yes
Speaker 169
1:22:50
sir thank you thank you Paula Day section chief health facility services with Arkansas Department of Health you're recognized
Speaker 164
1:22:57
the next rules are the rules for critical access
hospitals in Arkansas these proposed amendments are pursuant to act 52 acts 52 138 141 772 819 861 and 862 of 2025 include changes that allow admitting privileges for certified midwives permitting certain hospitals to operate retail pharmacies adding provisions for emergent blood transfusion process allowing APRNs to pronounce and document patient death and adding requirements regarding the In-Oregon and Genomic Harvesting Act for this rule,
as well as the last day for comments was August 4th. No comments were received.
Representative Jeff Wardlaw
Unverified
1:23:44
Seeing no questions, we'll move on to item H. Without objection,
Speaker 164
1:23:51
it stands reviewed. Thanks, sir. These rules are for home health agencies in Arkansas. The proposed amendments are to add a provider exemption for PACE providers, add entities that solely provide therapy services not reimbursed under Medicare Part A as an exemption, and
allow home caregivers that have previously received the required training to not have to repeat that training. As stated earlier, the department opened for public comment. Last day was August 4th, and no comments were received. See no questions
Representative Jeff Wardlaw
Unverified
1:24:23
item stands reviewed without objections move on to item I The next
Speaker 164
1:24:30
rules are the rules for hospice agencies in Arkansas the proposed amendments are to allow Add allowances for electronic medical records allow private professional providers to complete building project review and approval as well as change
Name for additional hospice locations for a primary location from satellite office to alternate delivery site multiple location Utilizing the same terminology as CMS again department open for public comment ended on August 4th and no comments were received See
Representative Jeff Wardlaw
Unverified
1:25:03
no questions without objection the item stands reviewed without objection move on to item J These
Speaker 164
1:25:12
rules are for hospital and related institutions in Arkansas
the proposed amendments are pursuant to acts 52 138 141 772 819 861 and 862 of 2025 include allowing admitting privileges for certified nurse midwives preventing hospital certain hospitals to operate retail pharmacies adding provisions for emergent blood transfusion process allowing aprns to pronounce and document patient death and adding requirements regarding the in-organ and genomic harvesting act the department opened for public comment and the last day was august 4th and no
Representative Jeff Wardlaw
Unverified
1:25:49
comments were received seeing no questions or objection this item stands reviewed
Speaker 164
1:25:59
we'll move on to item k our last rule is the rules for private care agencies in arkansas the proposed amendments are to allow home caregivers that have previously received the required training to not have to repeat that the revised definitions for contractor to state does not receive a form w-2 remove independent from the scripture for contractor and add contracted individuals
to have the same requirements as employees as well as remove certification by dhs's dpsqa as well as adding additional requirements for reimbursement through the medicaid program The department opened for public comment, and last day was August 4th, and no comments were received. Seeing no questions, without objection, the stand is
Representative Jeff Wardlaw
Unverified
1:26:44
reviewed as well. Thank you, committee members. Thank you. You guys did that like champions.
With that committee, Senator Irvin has some remarks on
the health rule transformation grants that were given out this week, so I'm going
to recognize her for those. Thank you, Mr. Chair. members as you know the rural health transformation program last thursday the first uh grants were awarded that was nearly 150 million dollars for thrive impact all 75 counties will receive benefits from the selected projects another 55 million approximately in grants will be announced later this month for the rise and the heart um buckets we there was nearly 700
applications uh with almost 1.5 billion in requests year one budget is 209 million year two funding opportunities will be available this fall so if projects were not funded they are encouraged to reapply emphasizing multi-year projects collaboration and partnerships across healthcare systems and providers um year this is a year one out of your five-year plan with cms under the one big beautiful bill um for rural health transformation program and we are also
competing with other states so cms is rewarding states who are meeting um federal metrics with potentially more money so i just i just wanted to give us a report um so that you should be looking for the rest of those grants at the end of this month for RISE and for HART. And we will have the link sent out to all the members of public health from the governor's press release last Thursday. But tremendous amount of support for rural Arkansas and rural health care.
And the projects were really great. And we will send the link out that provides the list of all of those. Once all of the grants have been given out for all of the buckets of money, then we will invite them to come and have a complete report to the committees at that time. Yes. We are
Representative Jack Ladyman
Unverified
1:29:05
recognized. Is there any, will this report have the pending requests
that have come in that have not been approved? Can you see that somewhere?
No, I don't have access to all of the projects that were submitted. I don't have that. And I think at the end, the report, because I think what they're doing is they're working with a lot of folks to try to tweak those or collaborate with them to make those stronger applications for year 25. So right now all we can see is the approved
Representative Jack Ladyman
Unverified
1:29:37
ones that come out? Correct. Yes. Thank you. And so
be on the lookout for the end of the month for those other projects that will hopefully get funded.
So any other questions from members of the committee? I really want to thank Jim Hudson, Secretary Hudson, and Brad Nye, and Representative, I mean, Secretary Mowry, and Janet Mann, and the doctor with the crime lab, and our Surgeon General. Those were kind of the team that reviewed all these projects. So anyway, if you have any questions, but we'll send that link out to everybody. All right. And if there's no other business to come before the committee, we are adjourned. Thank you, members, for being here.
Agenda
A. Call to Order
B. Consideration to Approve the August 5, 2026, Meeting Minutes [Exhibit B]
C. Presentation on Arkansas Wellness Network [Exhibit C]
D. Discussion of SNAP Error Rates [Exhibit D]
E. DHS, Review of Rule, Signature Authority for Diabetic Shoes and Shoe Inserts [Exhibit E]
F. Arkansas Department of Health (ADH), Office of Preparedness and Emergency Response Systems, Review of Rule, Rules for Emergency Medical Services [Exhibits F1-F2]
G. ADH, Division for Health Protection, Health Facility Services Section, Review of Rule, Rules for Critical Access Hospitals in Arkansas [Exhibit G]
H. ADH, Division for Health Protection, Health Facility Services Section, Review of Rule, Rules for Home Health Agencies in Arkansas [Exhibit H]
I. ADH, Division for Health Protection, Health Facility Services Section, Review of Rule, Rules for Hospice Agencies in Arkansas [Exhibit I]
J. ADH, Division for Health Protection, Health Facility Services Section, Review of Rule, Rules for Hospitals and Related Institutions in Arkansas [Exhibit J]
K. ADH, Division for Health Protection, Health Facility Services Branch, Review of Rule, Rules for Private Care Agencies in Arkansas [Exhibit K]
L. Other Business
M. Adjournment
Documents
Speakers
Representative Jeff Wardlaw
Unverified
Tanya Phillips
Unverified
Tyler Phillips
Unverified
Speaker 9
Kathy Lenahan
Unverified
Speaker 13
Speaker 17
Kathy Linehan
Unverified
Speaker 8
Speaker 24
Senator Missy Irvin Chair
Unverified
Representative Mary Bentley
Unverified
Representative Aaron Pilkington
Unverified
Speaker 87
Speaker 68
Speaker 102
Speaker 76
Speaker 71
Speaker 111
Representative Jack Ladyman
Unverified
Speaker 90
Speaker 124
Speaker 129
Senator Bryan King
Unverified
Speaker 148
Speaker 149
Speaker 35
Speaker 161
Speaker 163
Speaker 164
Speaker 165
Speaker 169