Public Health, Welfare and Labor Committee- Senate and House

OK, members, sorry, we're a little delayed. Uh, we'll call this meeting to order. Uh, thank you everybody for being here. Good morning. Um, first, the only thing that I would just like to say is thank you to all the people, especially the legislators that traveled to our meetings that we held in West Memphis area in Memphis. They were fabulous meetings and our staff, kudos, they did an amazing job. Thank you, staff, of setting up all those meetings and, um, and then all the different people that we, uh, that participated in those. Meetings, they were really, really incredible, so, um, if you didn't get to make it, you missed out. I will just tell you, but it was phenomenal and it was just great to see what was happening in, uh, the eastern part of Arkansas with Memphis being a partnership with us in, uh, the trauma system and, uh, also with Lebonar Children's Hospital. So that. Um, and so we've got a long agenda ahead of us, so we are going to go ahead and get started, um, to have a motion for the minutes. And second, All those in favor say aye. And oppose the, the minutes, uh, are approved. Um, OK, we'll move to item C. We have a lot of um ISPs, um, listed, um, I think we are going to hear one of them and, uh, Represented Pilkington, you want to go ahead and sit down at the table. We're gonna actually go to number 4 1st because he has asked for, um, someone to come up and speak on this ISP and so if, um, Mr. Kozlowski could come forward, we will have You at the table with Representative Pilkington, the two of you can introduce yourself for the record, and then you can begin speaking about, um, Number 4. There's 2 other guests that I'd like Oh, OK. John uh you do your mic, sorry. Oh, there we go. Yeah, Jonathan Taylor and Logan Collins. OK. They can just, everybody just introduce yourselves for the record and uh then you may proceed. Push your mic when it shows green, it'll be ready to go. My name, can you hear me? OK, great. Well, she's getting the rest of the mic's work. I'll just give the 30,000 view of what this ISP does, and then I, we can hear the testimony from our witnesses. Uh, chairs, thank you for letting me be here today and present this ISP, um, like a lot of good pieces of legislation, uh, sometimes it comes from, um, places we're not expecting and, and one of mine was, um, a mother in Arkansas who had an autistic child who reached out to me, um, about the Blue Envelope program, which was something she saw that was going on in other states and wanted to adopt something similar to Arkansas. So, We started doing research on it and found that it was a it was a great way in which that those, um, with autism or other disabilities who are able to drive in the state, um, have their materials put into a blue envelope that, uh, is a way for police officers when they engage in traffic stops to understand that the, the driver has a special need and adequate ways to handle that encounter so that there's a better situation and a better outcome. I think this is not only good for the law enforcement officers, but good as the drivers as well, and I think it's a Good, uh, healthy step, uh. Uh, to make Arkansas a safer and better place. So with that, I would just be happy to turn it over to, uh, my guests up here to give their testimony about some of the issues they've had when dealing with traffic stops and how they think this could, could help them in their lives. Uh, good morning. Thanks for having us. I'm Jonathan Taylor. I'm executive director of the Governor's Council on Developmental Disabilities. And when the council saw that representative Pilkington was pulling this up, I immediately called him and said, I know normally ISPs don't require testimony, but there's a few stories I'd love to tell because this is a fantastic program. Um, a few states have already rolled this out. Some statewide, some county by county. Arizona is the most recent one to roll this out. Uh, so I just started looking at it and he was kind enough to let me bring two people. Who I'm going to pass it over to, but, uh, my co-chair, who I work for, Lud Kozowski, and then Logan is also going to take a moment and tell their story. Thanks for having us. Thank you. Uh, I am Budd Kawski. I am the vice chair of the Governor's Council on Developmental Disabilities. I'm also on the autism spectrum. Uh, I want to thank you, Senator, Senator Irvin, uh, Representative Johnson, Representative Pilkerton for allowing me to uh give my testimony here. I live in Northwood Rock, Arkansas, and I'll be happy to share my story momentarily. Good morning. My name is Logan Collins. I serve on the Arkansas Autism Foundation as well, and I want to extend a big thank you for having me here and I also want to thank Representative Pilkington as well. I live in Jacksonville, Arkansas, and I am a truck driver by occupation, and I'm also on the autism spectrum and so I'm very excited to have an opportunity here today to be able to help. help others with autism. All right. Thank you so much for being here and if you would like to, Mr. Kozlowski, we'll just go ahead and hear your story as well. Yes, so back in 2004, I was a domestic preparedness programs instructor at the Pine Bluff Arsenal. Uh, I was working on a project, um, wait at night till late at night, um, it was in the middle of summer. Um, and I was just 11 of the things about people on the spectrum, they get very intensely focused. Um, so I worked like a 12 hour day and before I knew it was 9 o'clock at night. Uh, and I was just ready to go home, had an hour commute, um, got in my car, um, and had to drive 1 mile, mile and a half to get off post and, uh, as I was driving, uh, there were deer crossing the road. Uh, there were two baby deer, um, that crossed ran right in front of my car, made it right across the street in front of the woods, and then there was a big uh parent deer that. ran right into my driver's side door, did not make it across its face smashed right into the window like made a face like this, and it. Just slapped right indented my door, fell back onto the road and collapsed on the side of the road. Um, I went to Drive on, um. Uh, I looked back, there was collapsed. I went to the military post exit. The security guy looked at my car and he goes, you cannot leave. We need to get a security guy to go with you to do a report. Now, when you're on the autism spectrum, you can get overwhelmed, sensory overwhelmed. I just wanted to go home. Um, at this time, I did not realize I was on the autism spectrum, so there's a lot racing in my mind. Um, I had to wait for security. Uh, we went back to the post, uh, we went to the spot where the deer was. Mind was racing, um, get out and, um, he takes out his pad and he starts asking me questions. She goes, what time did this happen? I'm answering him. I'm interpreting everything literally. That's one thing we take these concretely. And I gave him the time and then he asks me the following question. Were there any other witnesses? And I answered him and I said, Sir, there were 2 other deer, and they ran into the woods. And she just looked at me. And I forgot to mention when we came back the deer was already gone if I didn't say that. And he goes, Excuse me? And I, and I looked at him and I got really a little bit irritated. I go, Looking at him again. There were 2 other deer, and they ran into the woods. And he just looked at me and he just Just shook his head. Looked down at the pad, paused a moment, and just kept going. And he let it go. It could have, could have escalated where possibly would have had a meltdown and it could have gotten worse because I, I cannot tell you the number of times, not necessarily with security, but other things where things get misunderstood, you're reading things, interpreting things, and it could lead to bad, bad circumstances. Luckily this didn't, it bothered me though, um, we got through. Luckily, it didn't end up with anything, but all night I was just upset. testing over it and then the next day when my mind cleared, I was like, oh my God, did I actually say that? And so while, luckily everything went OK in my situation. There are other situations where this doesn't end up OK. And something like this would be very helpful to have a bill such as this to uh help gear the conversation so that, you know, things are, um, go smoothly and are, um, Positively and, uh, it'd be a great thing to have. So that's, that's what I just want to share. Um, so thank you, thank you for that. Thank you so much. I can imagine the, uh, you know, I mean, you're shaking up any, I've, I've hit, I, I can't tell you how many deer I've hit. It's sad. They need to put deers with strike marks through them. Oh my cars because of where I live, but you're shook, you know, I understand. And, and so I think important, um. For people to have a heads up and an understanding of the situation that they're encountering that would be helpful for anybody in law enforcement to say, OK, let's have a different conversation and let's understand, you know, who, who these folks are that, that we're engaging in this conversation with that's great. Do you want to share your story as well, sir? Yes, I would like to share my story so my story happened this year on July 19th in the evening time. At this time I worked for a company called Texas Trans Eastern, and I was hauling fuel and I had actually had diesel headed towards cotton plant of Brinkley, Arkansas on exit 216, and it was pretty heavy traffic that evening on I-40, which it usually is, and. As I was headed eastbound, there was a this was near Hayn in Grand Prairie County, there was a wreck on the side of the interstate and so. I tried to get over, but there was already a long line of traffic to my left and you know, I can't move over, you know, I can't force the car off the road, so uh the only other thing I could do was slow down and so I slowed down and put my flashes on. To about 20 miles an hour and the officer that was working at the scene of the wreck at that time. He As he motioned to came behind the truck and motion for me to pull over and so I pulled over to the shoulder of the, uh, interstate. And he came up to the side of the passenger side of the truck and he began to he, he immediately came up and began to escalate, I would say, and so, and I think on my end, I also uh regrettably escalated and so I think it ended up being a regrettable situation where there was a lot of misunderstanding and miscommunication. that I really hope that something like this could help and it ended up being with me getting out of the truck, which I shouldn't have done, but I didn't necessarily mean to do anything, but I ended up getting tased twice and, uh, And so I really hope that not so much for me, but I really hope that a bill like this, something that a driver could hand to an officer could help them understand that, you know, make their job easier, make them understand. That this is just somebody that has a disability, has a communication barrier. And so I would hope that it can make it better for everyone. And and so that that's my story and I'm, I'm hopeful that this kind of bill can help somebody in the future. Thank you, appreciate that very much. Representative Pilkington. Thank you, Senator. Uh, our chair, um, I, I think you can see from these testimonies that this is an issue that's happening in our community and, and I think you can see a lot of times it just comes down to broken communication and, and like I said before, I think this not only is a benefit to those disability, but it's also benefit to the officers as well when they approach these scenes to make sure that they're doing things. Uh, the way they would want to be handled if it was one of their loved ones who had a disability. So, uh, with that, I just asked that we adopt this ISP and, and I am hopeful that in the next couple of months we can work on it with DNA and, and law enforcement training and then have a a a solid bill come January. OK OK, thank you. Um, and I would imagine that, would there be something inside the envelope that would be a standardized card with a statement on it that talks about, um, the just, you know, I have that this individual has this disability which presents these certain issues in regards to communications like, would that be something that would be developed so that that can be developed in the card. They've also seen it in some areas where they've actually printed that on the outside of the. envelope and with a little box too where you could print out like a label to say, you know, the specific ways of communicating are are beneficial or these are, you know, this is the severity of the issue. And part of the envelope too is you're keep putting your driver's license and your insurance is there as well, so kind of like during a normal routine traffic stop when they say license to registration, they know that's where their license registration is, so they're gonna hand it to them. And so it's not, oh, I gotta get my, you know, my stuff out of here and then I also remember to hand in the blue envelope. It's one fell motion of handing them. But yeah, you can either do a In it or we can print it on the outside of the envelope so that when the officer's looking it over, they can say, OK. This is here. This is the steps how to do it. And then there is, I think, um, another car too for those with a disability, so they can have to remind them this is how a traffic stop goes when the officer goes back to their car to check, don't drive away, that's happened in some, some circumstances because they didn't, you know, they didn't fully understand. So by them having that, uh, car, it kind of helps to guide them and have something they can hold on to during, uh, that situation because it is a stressful situation. I think we've all been pulled over and, you know, that's, it's stressful, so. OK, Representative Johnson. Yeah, just a thought, you know, um, certainly it's a great idea and I love this idea. Uh, but for parents of children with autism. Um, sometimes, you know, I, I have a child who's has developmental disorder and, and I have an occasion been pulled over for going a little too fast, uh, and that's also a very, um, touchy situation, right, because my child, uh, very upset, scared, nervous, didn't know what was going on. I'm trying to deal with the child in the car and at the same time trying to interact with the officer. Uh, just a thought to think about, is there a way to maybe extend this to parents of children with autism, so that if they have a child in the car when they get pulled over, at least alerts the officer that, hey, this is a, you know, I'm not saying I wouldn't speed, not saying I don't need a ticket, but just understand like this is gonna be a hard situation on the side of the road here for me and for my family. Yeah, no, that's, I had not considered that point, but that's a wonderful thing and that's kind of the beauty about doing these ISPs is it gives us time to bring a lot of people to the table and have ideas like that. So I'd love to discuss with you all Ofline may be a way to have something for those parents because you're right. That's great, thank you. Thank you. I'll share a story, my own story, I was 9 months pregnant with a child in the back seat in a car seat and got pulled over and panicked because my husband had cleaned the car and I had no idea where he had put the proof of insurance. And so I couldn't find it and I was probably about 1 mile from where I lived at the house and, um, they impounded my car. And I was so angry and, um, this was Camac Village, if you ever know Little Rock and Cammack Village, but they impounded my car and I was like, this is, this is the car I have to have in case I go into labor and, um, I couldn't believe it. And then my husband, I call, you know, didn't have a cell phone at that time, but I called somehow got a hold of him, and, um, I was not going to put my baby in the backseat of a police officer's car in a, in a car seat. Oh, I'm gonna do that. And so I refused to get in the car and I decided to walk home because I was so angry, um, and then my husband came and, uh, we show and he pulled out the proof of insurance and handed it to them and they. still, they refused to accept it. And um. And they continue to impound my car, even though I had proof of insurance, license, and everything. And so, um, you know, I, I, it led me to make sure that we had legislation to where, uh, they can check for your proof of insurance online and that you can have it on your phone, um, so that, you know, somebody is fumbling through and can't find the piece of paper, you can pull it up on your phone and have it, so, um, it led me to create legislation because of what I went through, um, as, as a young mom, you know, panicked because I just lost my car. Um, and I was 9 months pregnant with a baby in the backseat too. So I, I think there's a lot to what you said of, you know, even if you don't have a, a, a child that's disabled, sometimes those kinds of things happen and it's really unfortunate, um, that those things occur. Senator Love had a question. I digress. Thank you, Madam Chair, and Representative Pilkington, this is a great idea. Um, I've read up on this, um. But I, I am just curious in regards to the, you know, um. Standardization of kind of what goes in the envelopes, um, in, in the couple of states that you've mentioned, what, what has actually gone into those envelopes? Is it, is it something that, that, uh. The person themselves, I guess the, the family members are putting in the envelope or, or are we gonna have standard forms? What have they done, uh, in other states that have passed this law to make sure that it's standardized. Yeah, so, um, as I mentioned, insurance and driver's license, you know, those are standardized to the standard documents. And then my understanding too is like the card that explains the how the traffic stop works, that's a standardized document as well. Um, but I do believe the, um, you know, from what I've seen in some it's like the car, like I said, there's like a box where they're able to fill out, you know, or put a sticker where they, you know, printed something out like a label to talk about their exact issues and and how to deal with them. So that wouldn't be standardized, but it It is like a standardized form, you know, like you would say, like, you know, do you have X, do you have Y, you know, check the boxes that apply to you. So it could be something like that, and I, I wanna say I think it's Riverside is, is the one that I'm thinking of that did something like that, so that, you know, when a police officer looks at it, they can see this is a form, OK, they checked this box and this box, uh, and it's not just, you know, whatever someone wanted to come out, you know, and say, make up their own diagnosis. There's, there's a form in which they're going to check what is theirs. So it's, it's not. Super standardized, but it's formatic if that makes. I don't even think that's a word, but you know what I mean. Yeah, well, I mean, that's, and that's what I would be more concerned with, uh, in regards to this legislation. It's not that I, you know, I, I would be against it, but, uh, because there's varying degrees of, of people on the spectrum, so I would, we should, we should actually have some sort of form that kind of can speak to. So they can speak to that. I mean, you get what I'm saying, because some people, some people are higher functioning than others. And so therefore, but you know, they can, you know, all persons can drive or or persons can drive. I just, I was just kind of curious about that and see if we can come up with a more standardized way of, of actually, uh, making certain that officers when they are stopped, you know, if they pull the envelope, then it kind of covers the Gambit. So, yeah, and I think when we, when we actually proposed the legislation, you know, that's on the ISP. It's a pretty short ISP, uh, because obviously I want to give the departments the flexibility to do that, but we could maybe add some language in there to kind of make sure that there's a standardized way and those things are, are in there because I do think, uh, I, I understand the point you're making and I, I, I get that, so yeah, happy to. Look at that and then make sure there's something in there so that the departments are using some sort of standardization and that we're having a better way to understand where on the spectrum this driver in that particular case is falling. OK. All right. Thank you. Thank you, Madam Chair. Are there any other questions? Uh, Representative Wooldridge. Thank you, Madam Chair, and thank you, Representative Pilkey and I think this is a great idea also, uh, I guess my question, and I'm really wanting you to educate me on this kind of to the process. Why is this something that requires legislation? Again, I think it's a great idea, but why could the council not create this envelope process that then they distribute to people around the state that have autism, what is the need for the legislative process, I guess would be my question. I think it's to encourage statewide adoption. And so obviously, you know, some, like I said, some places that underwood County County, but, you know, just take it in my area, you know, if you live in Knoxville, you're going in between Pope County and Johnson and Logan and Yale and Franklin. And if only half of those counties have it, you're getting pulled over and you're handed a blue envelope and you some officer going, what, what is this, you know, and so I think, you know, creating a standard, letting everyone know that way whether you get stopped and Desark or Marmaduke or or uh came back Village or uh Mount Home, you know. There's um They're gonna know what to do when they have that. So that's, that's why I, I think so so. OK, well I appreciate the clarification. Thank you. Any other questions? All right, seeing none without objection, this ISP is adopted. Thank you. Thank you, um, on your, uh, thank you so much, all of you for being here. Thank you for sharing your story and we appreciate you being with us today. Thank you very much. You're so welcome and we'll look forward to seeing you next session. All right, thank y'all. Appreciate it. Have a great day. OK, and then, um, Representative Pilkington, do you just want to briefly talk about the others and then like speed round them. OK, go ahead. We'll start with C1. OK, um, Yeah, so this is a bill to require remote ultrasounds, reimburse for remote ultrasounds. I've been working with uh Representative Hudson, uh, on this, uh, basically, we can already do it. It's just creating clarification. We, when we talked to a lot of OBGYNs, they've said they would like to do it, but they just don't feel like there's clarity in the law whether or not they get reimbursed. We believe there it is because of the telehealth laws we passed in the past. So this is just a clarification, uh, once again, it's an ISP. It comes from, uh, a working group that me and Representative Hudson are on on ma health, uh, through the future caucus, so that's what that one is, um, Next one is the Medicaid coverage for postpartum, uh, For one year, that was the same bill from last year, I think we've heard enough about that. We can just. Talk about that more, uh, later on. And then, uh, the third one is presumptive eligibility that came from the governor's task force on maternal health that we all work so hard on, um, you know, obviously it's important to make sure we're wanting to get women in before they're delivering as opposed to after, and so that's just a helpful, uh, trying to turn that into law. That's a suggestion from that, uh, program. And then the last one is, uh, processed food safety, which I don't know if y'all call the congressional hearings a couple weeks ago, but obviously this is an issue that's coming on where people are wanting to know more about what is in their food, uh, of especially processed food and some of the uh hazardous things that go along with it. Uh, this kind of mimics some of the things that the European Union has put on and trying to let people know more about, uh, what is in their food and so I always like to give a good example, red dye number 5 is banned from being a cosmetic products, but yeah, you can put it in your food, so you can't put it on your lips, but you can digest it for some reason. So, uh, I think it's just a good conversation starter about the healthiness of our food. We have an obesity. epidemic in this country and, uh, I think it's good to start kind of asking the questions, what is going into our food and that's. Fire round ISPs. Any questions? All right. Without objection, these are adopted. Thank you. OK, moving on to item D. Thank you. If you can introduce yourselves for the record. You may proceed. Good morning, Janet Mann, um, DHS. And Elizabeth Pittman division of Medical Services. All right. The, the first rule before you today is on the hospital cost settlement process, and it's the reopening. It was, um, it did go out for public comment and we did not have any public comments received and, um, we do not anticipate a financial impact. This, um, Ms. Pitman can explain the detail. Yes, good morning. Um, it's a pretty simple rule. It basically just clarifies that we align our our reopening process with Medicare. Um, we needed this clarification in our state plan to be able to ensure that we could claim federal match on things open beyond the eight quarters. The reason we do this is an emergency rule and is this a permanent role? we tried to do it earlier to align with a quarter rule and the hospitals had some concerns because it did not align with Medicare, so we took it back, researched it and figured out that if we clarified that we were aligning with Medicare, we would still be able to file Time perfect. Any questions? All right, without objection, this rule is reviewed. With approval. Thank you. Our next rule is uh Life360 State plan amendment for targeted case management for pregnant women that are not in our home, this will, um, allow us to, um, offer some additional services which does align with our maternal health program. Ms. Pittman has further details. That pretty well covers it. And for the non our home population, it does only allow for a year's worth of services, and it does establish a, a rate for the services and we are, um, the Saint Bernard's in northwest Arkansas is an anxiously or northeast Arkansas, anxiously awaiting the approval of this rule so they can get started seeing clients. So very excited about this. Any questions? I just, I just, as if anybody is out there listening, I hope we have more like Saint Bernard's that are gonna Step up and fill that space. It's a, it's a being at Saint Bernard's, we spent a year there, um, they're just an incredible institution and they really see this as a need in the community and they're stepping up as part of their ministry and service and I just want to shout out to them, uh, to Saint Bernard's for, for doing what they're doing in this space. Thank you without objection, this rule is reviewed. Next. F The this rule is for the access payments, which is also commonly called the upper payment limit, um, payments for the for the hospitals. This is done annually. We submitted a state plan amendment to, um, adjust the rule a little bit to give us some flexibility to be able to increase some of those payments. We didn't, I don't believe we received any public comments on this rule, and there is no financial impact that hospitals put up the state's share to pull down this federal share of money. So, um, I'll answer any questions. OK, any questions? All right, CNN this rules reviewed. Next, Adam G. Thank you. Um, can you do that one because I don't. Sure. Item G is, uh, we're calling it our dental transition rule. Um, it is the only piece that we had to, to change in our. Roll packet, um, and it's the Chip spa for children in our, um, children's health insurance plan, uh, just changes the language in that spa to take out the reference to dental managed care. happy to answer any questions. OK? Any questions? Uh, yes, Representative Gonzalez, you have a question? Yeah, thank you, Madam Chair. Yes, sir. So do we have approval from the federal government to, to change this? Um, we have, so we have two sides we're dealing with the Medicaid side and the CHI side. The Medicaid side said they don't need to approve. We just need to submit a formal notice that we're withdrawing our waiver. We have done that. The chip side is, um, in the process of approving, they did have some questions about the benefit package in the state plan service that we're clarifying with them to get that approval. OK, so when do you plan on, on implementing this if it's we're still planning on November 1st, simply because the carriers really needed 90 days or 60 days' notice and so they really are beyond the timeframe that they can go backwards get approval, then what happens? Um, as long as we get approval, I believe within the quarter that we filed, it'll retro back, so we should be good and there's no indication from CMS that that won't happen. But if we don't, what happens? I guess we'll have to figure out how to cover 30,000 people. Um, I really don't anticipate that happening because it really is only for those chip kids. OK, can you tell me why we're going back to feed for service? I mean, didn't we, we go from FIFA service to this managed care, um, And what metrics are you using to track the results of it and. So this is in response to, um, a procurement that had a lot of questions and had a lot of influence. So we did not, um, award. We, we tried to award and then we withdrew it. We then did a separate study on whether or not to reprocure or to go back to fee for service and given some of the results that we had seen in from the EQRO which is our external quality review organization, we decided as, um, The group to go back to fee for service for a time period to then reevaluate because a procurement can take up to 2 years, so. Reading through the comments, Delta Dental, uh, thought that there were better results, more people getting sane, more people getting treated. Y'all seem to argue that fact in the response. Can, can you tell me more about that? Sure, um, I will attempt to and we can get you any information you would like after that. So, uh, my understanding from, from looking at all of the data is that we don't disagree with what they're saying as far as the numbers, but we believe there was a data anomaly in the year that they saw it go up simply because it doesn't line up with all the other numbers and we've got some charts for you there. It's not that they did worse than fee for service. It's that we didn't see any appreciable improvements within dental managed care. So it's, it's not that they were bad actors or Doing bad performance wise, we just didn't see enough, um, appreciable gain or any real difference in that to, to not pull it back and try to look at it more holistically. So I had Dennis in in my district that, um. You know, wanted the fee for certain or wanted, wanted the managed care part of it because they weren't making any money in fee for service and said that they couldn't, they could no longer participate under the. under what was being paid for that. So can you address that or are we gonna lose providers in the system when we go back to a fee for service. We're monitoring the provider uh enrollment numbers continually to try to make sure that doesn't happen. Did we have more enrollment when we changed? Um, so when the, when the carriers brought their networks to Arkansas Medicaid, they had to enroll with Arkansas Medicaid to be able to continue to be providers in that network and see if Medicaid clients, so our numbers did go up from that. Um, we met with the dental association last Friday to discuss some of the concerns that have been raised and we're beginning ongoing meetings with them starting October 11th to try to make sure we can address those concerns. OK, thank you. Thank you. Are there any other questions? Senator Boyd, you recognized? Thank you, Madam Chair. Just so going back to the health reform task force that we had in 2015. What I remember is we went to, and you can correct me if I'm wrong, but my recollection is we went with managed care and dentistry, one because the dentist asked for it, and 2, because payment was better, which should have helped with the network. Um, so do we have any data on. You know, if, if payment were Paired, there was parity between. What the managed care dentist or, or managed care providers are paying the, the dentist versus what Medicaid is paying? Do we have any idea what that would cost the state to just use regular fee for service Medicaid and just up the rate. So we would have to look at exactly what that would cost, and the consent decree that we're currently under actually sets the rate for us at a fairly high percentage of a commercial plan back in 2008. So we have been comparable up until at least last year and we're redoing that study, um, with all surrounding Medicaid states as far as dental rate goes, just because that was such a favorable rate at the time. Now, I know that that has been 16 years ago, so I don't know what that looks like today and we would have to run those numbers. OK, so we're, we're operating under a consent degree. Does that make. Someone sued the state and the state had to raise its pay to get up to covering the costs, and that was back in 2008. And so we have ongoing meetings with the dental association in addition, I would add that there have been two great reviews done on dental, the, uh, one, the latest or the most recent was done in 2020 that, um, did not recommend a rate increase because the rates were comparable with other states internally in our internal rates and our external comparison to the. Other states was comparable. OK. Thank you. I appreciate the information. Thank you, Representative Pilkington. Thank you and, uh, first, I just want to say I love that blaze it represented Wardlaw, that is. That is awesome. Um, real quick, uh, on page 176 on the administrative costs, it's, it's 0 for everything. If there are costs, well y'all have to come back and get that reapproved or is there, cause I mean, to do this. With zero cost is pretty bold, um, I think you can probably do it, but if there is a case like that where that does pop up or you're going to have to come back to us to get approval for that spending or you have a cushion built in, so. So we have already, um, brought forward to you a contract for some administrative services for dental, it would be on the Medicaid side, which is why it's listed as 0 on the chip, um, on the chip side. In addition, we are absorbing it with current staffs. You, um, Representative Wooldridge. Thank you, Madam Chair. Um, my question was, when you're doing the managed care now, you're going back to fee for service. What is the fee or when was that fee said? Is it something you've set now because you're going back to fee for service or are we just reverting back to an old right? Uh, we are reverting back right now, um, simply because we needed to be able to make the transition into our system. We had it an already existing fee for service. Population, it was only about 5000 people. So you didn't hear a lot about it. So we're moving everyone into that existing system, um, just for stability's sake, and then we're immediately starting this comprehensive review to look at rates, but we're paying the, the rates that we had paid. And I believe, like I said, those were established in 2008 and the study in 2020 showed, like I said, we were so, um, favorable in 2008. We were still fairly favorable in 2020 and there was no need for a rate increase at that time. We're looking at that again. OK, how long will that rate increase steady? Take We are starting it, um, next week, I think in my first meeting with him is October 11th, um, and part of what we will be working on is timelining that out, and I mean I can't guarantee it will be a short process. It takes a while to get CMS approval and you guys have to approve anything we, we do, so. But we were, we are hoping to get that done as quickly as possible. OK, um, I guess this is just for my, I'm trying to learn because I'm new to the process. Are we talking about 6 months, 4 years, not 4 years. OK, but not 6 months to 12 months for the complete process. Thank you, ma'am. You're welcome. Thank you. Representative Wardlaw. Thank you, Madam Chair. One of the things that came to my attention lately, my dentists are absolutely happy with the direction you've taken, by the way. But one of the things that they're concerned about right now is a type of filling material that they're using today was covered under the managed care plan and now not covered on the antiquated Medicaid plan. And that's a huge problem because this material is actually very beneficial, mainly to kids and very durable, and they're concerned that if they placed that material and bill for the antiquated filling material, then that's fraud. And that's kind of the direction they were given from the department when they called in and they're very, very, very, very liriious of doing that, and I don't blame them. So how, what's the answer to that? How soon can we have that and where are we at in that process. Happy to answer that. Yes, I've received those emails as well. I've learned more about fillings than I ever thought I would in this process. Um, but we are meeting with OMIG this week, the Office of Medicaid Inspector General to try to make sure that our plan to bridge that until we can get our codes updated. Um, it does work under the integrity rules and if it does, we're going to put out, um, clear guidance on that, but we believe if we add some states specific modifiers and put that guidance out and work with OIG. We can at least bridge the time till we can get the correct. in place. Well, thank you, but you guys need to put some sort of memo out Dennis because they, they, that is the one thing they are freaking out about at the moment. So thank you for your attention to the issue. Yeah, that it's amalgam was the old and then composite is the new and so yeah, that's generally they're going to be using composite for fillings instead of the amalgam because that's old and even though it's a little more reliable, it's not as aesthetically pretty as composite, but it also composite, yeah. Um, is very beneficial and hearty and just new, new technology. So that, that is a good point. Appreciate that you brought that up as soon as we can get a memo out, I think that would probably be beneficial. It would help prevent more calls and more emails. Any other questions? So there's a lot of discussion around data, um, are we able to track within DHS utilization and enrollment and those kind of data points with with this change providers or both, yes so it feels like a big change, right? It feels like we're shifting from fee for service which we made a conscientious choice to switch to managed care and now back to fee for service. I think it would be helpful to be able to bring some data back to the committee, um, uh, uh, you know, Because in fact November, I'm not sure the timing, uh, we want to give you time to collect a reasonable amount of data, but just, you know, to give us an idea of, of, you know, effectually how's this uh change impacting, uh, in a positive or negative way, right? We don't know how it's gonna be. It could be that this turns out to provide better utilization. Um, and I think it'd be important to have that data come back to us so we kind of have a feel of, of how it's going if that's a reasonable request. Yes, we're happy to do that, I believe, um, Ms Mann is telling me we have already said we would do that, so we would be happy to do so. The other thing I would say after, you know, being, um, Actually wasn't on the health task force, but I, I, I was. Um, there were some circumstances around why that decision was made, and I think majority was a systems issue and we've updated those systems. And so at the time, and I think members that weren't here during that time need to understand the dynamics around all the different decision points there and why that decision was made. It was, it was. It was a, it was more I think about a systems issue with billing and and and and reimbursement and those kinds of things. Um, but we have updated that system dramatically and so I think a little bit of background would also be helpful, um, you know. As well. Sure. So, um, when we went live with you, you can just put it on the, the report but you you can go ahead today too, but I think, OK, you know, having a paragraph, but you, I mean, you can say it today or, OK, we, uh, we updated our system back in 2017, about, I think, right before we went live with this program, but after about 2 years after the decision had been made. And that, that new system is much more streamlined. Um, additionally, we, uh, have added two new PAUR. Fenders and a new PAUR system which is prior authorization request. Um, and it's a much more streamlined system. In fact, the system that we have put the dentist on, we get the most favorable comments on how easy it is to use. And so we have set up, um, that vendor system for them as well as the new streamlined billing system. We have billing education out there, um, through a vendor that is going into dental offices similar to how they do for PCPs to provide that billing assistance, and then we've set up a call center with the PAUR vendor and webinars to make. make sure that they understand all of that. So we are really utilizing some of the systems and technology and the support that we've put in place since 2017 to try to help our providers understand. And also, isn't it, wasn't it a data upload issue too because you because you take so many different X-rays, which has to be part of the PA process and that's heavy, heavy data usage and they rely a lot more on um on X-ray and, and those images. uh, a lot more sometimes than it was a very manual process for them before we miss what I understood the dentists have brought that at the Dental Association and providers have brought that up as a concern of transitioning to fee for service from managed care, and we've tried to address that with the system upgrades that we had already made. Yeah, yeah, because I mean, because those kinds of things cost you time and money if you can't get an answer. and get paid, um, because you can't upload your images and the system can't handle it. That's a huge problem. But, um, and so being able to just address that is, that's time and money for them as well. It's it's more than just a right issue. It's really about user friendliness and being able to really be, you know, um, avail available to, to, to make that seamless and not have to have somebody, you know, Spend. I mean, back in the old days of, of billing where it would take unbelievable amounts of time. To to submit to Medicaid. It's, it's day and night difference between what it used to be for billing and what it is today. Any other questions? All right, Good morning. Um, Mary Franklin, director of the division of County operations with Department of Human Services. Thank you for being here. Go ahead. This role, what we are doing is clarifying our workers with disabilities policy to make it clear that individuals who qualify in this category can receive community employment supports waiver services if they meet the financial and medical requirements of that waiver while they're in the workers with disabilities category, um, The waivers indicate that they're eligible. We are serving them, but our Eligibility policy only mentioned the AR Choices waiver. And so we're just correcting that to make it clear that you could receive either waiver if you need it and qualify for it while you're in workers with disabilities. OK. Are there any questions regarding this rule? See none without objection, this rule is reviewed. Ms. Franklin, again, thank you for all your work that you do. I know that Senator Chesterfield, um, gave you glowing, um, compliments at our meetings in West Memphis, Marion area, and so again, I just want to reemphasize, we really do appreciate all the work that you do in our counties, in our county offices and you've done a fabulous job. Well, thank you for those kind words and I'll, I'll accept the thanks on behalf of our whole team. We have a wonderful, wonderful. Thank you. Pass it along. Thanks. OK, next we have Miss Smith. Ms. Smith is out ill, so Sarah Schmidt is going to be stepping in for her. OK. Welcome. Good morning, Sarah Schmidt, deputy director for the division of provider services and quality assurance. The rule before y'all this morning is, um, streamlining our nursing home rules, and we've worked with the association. It's um it's, it was a pretty lengthy rule, lots of pages, but we were clarifying and updating to the federal guidelines and, um, I think we can answer any questions, any questions from members of the committee. All right, CNN, this rule is reviewed. Next. Thank you, ladies, for being here. Good morning. I'm Laura Shu. I'm general counsel for the Department of Health. Good morning. My name is Christy Cressy, and I'm the section chief for EMS for the Department of Health. Craig Smith, attorney for Arkansas Department of Health. Thank y'all all for being here. Please proceed. The proposed role you have before you is the rules for emergency medical services. The proposed amendments are to comply with Act 54 of 2023 regarding the required hours for community paramedic license and Act 258 of 2023, creating the licener for emergency medical responders, the public notice was published on June 28th, a hearing was held on July 30th, um, and a couple of comments were received and reviewed and will be taken into consideration and work with the industry in the uh, promulgations and, um, with that, uh, open to any questions? OK, are there any questions from members of the committee? All right, see you then. Thank you so much. This rule is reviewed. Hi, my name is Ashley Mason, and I'm an epidemiologist with the lead-based paint program. Thank you for being here. Please proceed. OK, great. Uh, the rules in front of you are the rules pertaining to lead-based paint activities. Um, these changes are to comply with Act 137 of 2023 regarding automatic military licenser. A notice of public comment period was published on June 30th, uh, the period ended on July 30th and no comments were received and that open to any questions. Are there any questions from the members of the committee, seeing none, this rule is reviewed. Thank you. Item L, thank y'all so much. Matt Gilmore, Department of Health. Thank you. Sue Tedford, director of the Board of Nursing. Thank you. Please proceed. Um, we're here today looking at exhibit L, um, changes to Chapter 4 Advanced practice registered nurse? We had public comment period and we had the public hearing on July 12th. There was no opposition to any of the proposed rules and no financial impact on, um, the agency. Would you like me to go through the rules or? Um, I'll just ask if anybody has any questions. Um, I Representative Gonzalez, do you have a question? Yes, thank you, Madam Chair. Um, my question will be on exhibit M. Um, the delegation. It, it seems like we're on, I think. I thought, OK, I'm sorry. Let's, let's do L and I'll come back to to present them all at the same time, we're on L. Do you just want to go through L for us real quick. OK, um, on page um. Let's see, of the proposed rules, page 4-3. We added clinical nurse specialists because of change in, um, statute. And we made an editorial change on a date, 49, we took out, um, number 7 because it was repetitive language. 410. We added, um, the aurian canned, um, prescribe opioid antagonists due to statutory changes. When you say opioid antagonist, that's like Narcan, correct? OK, just want to make sure everybody know. OK, go ahead. OK. 4-12. Um, we did some clean up on, um, prescription drug monitoring program when the program originally went into place, um, the APRNs felt like they needed some type of more stricter control of delegation, and as they got into practice, they decided they did not need that, that they could delegate to anybody and it'd still be a safe process. So they wanted that taken out. And that's consistent with physicians now it's consistent with statute. OK, because we were, uh, had a little bit extra. And then, um, they added in here, this, this next edition was from the APRNs wanting this added for tighter control of prescribing stimulants and so they added to, uh, they have to check the PDMP every time they do a stimulant from Schedule 2 for the first time in every 6 months they're after prescribing for a patient, which is more restrictive than statute, but they feel like it's necessary for safe practice. And on the bottom of that page we added clinical nurse specialists to full practice authority due to statutory changes. Let me ask you a question back on the what was added there. That's more strenuous than statute. Do you have the ability through rule to do that without the legislative language. OK, thank you. Keep going. 4-13, um, we made some changes to the full practice authority to allow it to be easier for an IPRN and that is independently practiced in another state to be able to practice independently in Arkansas because the way it was first written, um, it didn't allow, um, Those that didn't have any type of agreement in those full practice states to come into Arkansas, so they could have been practicing independently 20 years in another state and we say no. Crime, so this allows them to be reviewed and, and have the possibility if the committee decides they. Um, meet the qualifications. And that was all the changes in that. OK, any questions on exhibit L? On this rule. All right, see, none, this rule is reviewed. OK, now let's go to M. And Representative Gonzalez, yeah. OK. Go ahead and present. OK. Again, we had the same, uh, the public comment period was the same as the previous chapter with the public hearing on July 12th. Again, we had no opposition to any of the proposed changes, and there is no uh, financial impact on the agency. OK. Representative Gonzalez, you. Thank you. Thank you, Madam Chair. So it seems like some of the responses you got, there was confusion on what you're actually doing with the rule because they wanted, they wanted to talk about delegation to MA's, um, and your response was y'all would continue to look into that. Uh, is that, would you consider that a scope of practice change that needs to be handled by the legislature or is that something that y'all can do with the nursing board. APRN scope of practice at all. Uh, currently. Physicians are able to delegate to MA's, um, which are unlicensed individuals. So it really doesn't change their scope of practice either. It just allows, let me step back in in clinics, what you're finding now is there are more, uh, MA's and other unlicensed individuals working in fewer licensed individuals like LPNs and RNs. So the APRN has to do all of the work herself and cannot delegate to the MA that does it every day for the physician. They do it for themselves, so it's It's holding back their practice to some degree, but it does not change their scope at all. OK, so it is something that you can do through the nursing board and would not require legislation. Correct. OK. Thank you. Are there any other questions? But I, I, I would say MAs don't have a scope of practice, correct? If they're unlicensed individuals. They are unlicensed and they're not really regulated by any group in the state, any agency, however they are certified, they have a standard education and a standard certification. If they're a certified MA. Right, but they can't be delegated to, to give shots, for example. They are every day. They're, they, yes, they do give injections. OK, well. That's interesting because we have a situation where someone is. Not considered an MA, but is a X-ray and phlebotomists, they can draw blood, but they can't give shots. So has that been changed? In other words, is this, is this consistent with other Licensed individuals that are working in clinics like a phlebotomist, kind of phlebotomist give a shot? Well, phlebotomist is regulated, so they do have a defined scope of practice. That's what I'm saying though is that They can draw blood, but they can't give a shot because of their, that, that doesn't make any sense to me. Somebody who can stick a needle in somebody and draw blood, but can't be authorized to give a shot, but yet, somebody who's completely unlicensed can give a shot. Mm-hmm. So, Mr. Gilmore, could you, I don't want to add confusion, but I think some of the, the physicians have some delegation authority that APRNs don't have in statute. I think that may be. Some of the discussion here, so. OK. All right. Any other questions? All right. Without objection, this rule is reviewed. Thank you. Thank you committee. OK. Is there anything else? Come before the committee? All right. See then, um, members, we will be working on a couple of different things. I will say, um, The Department of Ag, I mean, the committee of the committee on ag and economic development is having a meeting in October at NCorp, um, I had wanted us to schedule a meeting at New Corp, um, but, uh, since they're going to have a meeting there, I would just encourage you if you wanted to go and attend that meeting to do so. Um, I will be doing that, um, and primarily because of the used tire issue. As you recall, that is an issue that comes through this committee, um, and we most likely will be dealing with that next session as well. So, um, it would be a good opportunity for members of this committee to attend that committee and go to New Corp and see what they are able to do, um, and, uh, I'm, I'm anxious and and excited to work with them, hopefully on some great solutions for our used tire problem that we have. Um, and I appreciate. Corps really stepping into that space and, and working with the state on a couple of things. And the last thing I would say UAMS, uh, texted me, they submitted their maternal life 360 application today. So, um, that was great. Any other things to come before the committee? Seeing none, we are adjourned. Thank you. Oh, I'm sorry. Was there somebody else? Representative Pilkington, sorry. No, no, no problem. I Did it kind of last second. Um, I just want to say we during the special session or the fiscal session passed a piece of legislation in special language to get a report on the transferring of women after postpartum 6 weeks and that first report should be due next week or next month at our next committee. So, I, I just want to stay excited for that and everyone keep your eyes peeled for that report as well. I'm, I'm excited to get it because I think it'll help. The work we've been doing to kind of continue that and get a real worldview of where we're at on that, so. All right, thank you. If that's it, then we're adjourned. OK.