Task Force on Autism
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6 documents
Bills discussed (3)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
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HB1150
· 1 mention in transcript
Matched: “…t it passed, but I'll go over these really quickly. We have HB 1150. This was to”
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TO AMEND ARKANSAS CONSTITUTION, AMENDMENT 98, TO MODIFY THE DEFINITION OF "QUALIFYING MEDICAL CONDITION". | House | WITHDRAWN BY AUTHOR |
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HB1935
· 1 mention in transcript
Matched: “…d then the last failed legislation that I've put on here is HB 1935. This would have required DHS to cover non-emergency transp…”
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TO REQUIRE THE DEPARTMENT OF HUMAN SERVICES TO COVER NONEMERGENCY TRANSPORTATION SERVICES FOR INDIVIDUALS RECEIVING … | M. Gray | Sine Die adjournment |
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SB317
· 1 mention in transcript
Matched: “…rew this in February, and it did not pass. And then we have SB 317. This was Senator Davis's bill. This died on sine die adjou…”
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TO PROHIBIT DISCRIMINATION AGAINST INDIVIDUALS WITH DISABILITIES REGARDING ACCESS TO ORGAN TRANSPLANTATION; TO REQUIRE COVERED … | B. Davis | Sine Die adjournment |
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to be taken care of. Representative Boyd is going to be maybe in and out. I had talked to him earlier. He's juggling a couple of things. The first item of business to be brought before the body is the adoption of the minutes from November 8, 2018. Has everybody had a chance to review those? If they have, then the chair would entertain a motion that we suspend the reading of the rules and approve them as submitted.
We see a motion? We have a motion. We have a second. All in favor, please signify by saying aye. Aye. All opposed? The next item is to adopt the task force rules and procedures. I think these are the rules and procedures that have governed us in the past. They are exhibit D. if you want a second to look at them.
Are there any questions? If there are no questions, then the chair would recognize a motion to adopt the Task Force on Autism Rules of Procedure for 2019. Do I have a motion? Yes, I have a motion. I have a second. All in favor, signify by saying aye. All opposed. All right. The next item is the motion to authorize the chairs to approve the specialist expenses incurred by the task force. That's Exhibit E. Any discussions regarding this?
If not, the chair would entertain a motion that we adopt the expenditure of legislative council funds. There's a motion by Diana. Is there a second? There's a second. Dr. Scott. All in favor, please signify by saying aye. All opposed? Y'all don't be too loud out there. I know it's still early for some. Apparently, in talking with Melissa Stone, they're going to try to be here.
They're in another meeting this morning. They're going to try to be here around 11. They were going to try to get out, if they could get out
of a meeting they were in. Apparently, we only have, out of 10,000
employees at DHS, we only have two that have the ability to talk about autism and passes. So they will be here, hopefully, a little earlier than 11. I guess that would take us to any changes by DHS and DDS on our specific autism program.
We have attached, that's Exhibit 1. Well, let's just jump down to I, discussion of legislation from the 92nd General Assembly. Jessica Beal is here with us. Jessica, you have a handout that's Exhibit 1 that walks us through the acts that affect the Autism Task Force.
Jessica, if you'd give your name and position, you're recognized to present. Good morning, everyone. Let me
Speaker 5
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get this closer. I'm Jessica Bill with the Bureau
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of Legislative Research, and the chairs have asked me to put together a little legislative summary of what we've done dealing with autism, affecting it, relating to it in the 2019 General Assembly.
So that's what this is. Now it may not cover everything because autism could be included in developmental disabilities, it could be included in intellectual disabilities, or in some legislation it could be included in just regular disabilities. So if a particular legislation that you're looking for is not in this, excuse me, a lot of coffee this morning. Let me know and I will get you the information on that. This is the substantive legislation. So first we've
got it the definitions of healthcare provider were amended in insurance law dealing with the Patient Protection Act of 1995 and any willing provider at any any willing provider laws. It adds certified behavioral health providers and licensed intellectual and developmental disabilities service providers to those lists. Then we have Act 557 concerning corporal punishment in public schools.
It prohibited the use of corporal punishment on a child who is intellectually disabled, non-ambulatory, non-verbal, or autistic. Anyone who does this, does administer corporal punishment, is not subject to the protection of
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civil liability, of attorney's fees, and costs of defense.
And if anybody has any questions, stop Jessica as she goes through the particular legislation.
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Yes. Then we have Act 548. This was to deem a student with an individualized service plan eligible for participation in the Succeed Scholarship Program. Then we have Act 660. This was the Public Safety Act. This amended all of the emergency communications. And this one is a very long act. It's about 40, 50 pages, but the part that pertains to autism, it's about on page 37.
It amends the law to require training for telecommunicators, dispatchers, and supervisors for an answering point, a public safety agency, a dispatch center, or a 911 public safety communication center. Then there's Act 1004. Or this one added a facility for individuals with developmental disabilities to the distance requirements for a dispensary of medical marijuana.
This one had an emergency clause, so it became effective on April 15, 2019. Then there's Act 1033. It was to eliminate the waiting list for the developmental disabilities waiver. It's also known as the Alternative Community Services Waiver Program, but there is some confusion as to whether that's the real name. This was Representative Miller's bill, and it requires DHS to eliminate the waiver as
it existed on March 1, 2019, for this program, as soon as possible, but no later than three years after the effective date of this act. The effective date of this act will be July 24, 2019 because it did not have an emergency clause. There was act 1035. This was to ensure respectful language is used within the Arkansas code regarding individuals with intellectual and developmental disabilities.
This removes the terms mental retardation and disabled person. It does a few other things, amending certain things with developmental disabilities and intellectual disabilities, kind of making the terms clearer. And it's also a very long bill. So if you have any questions about that one, let me know. Then we have Act 1041. This created the task force on transportation of non-emergency behavioral health patients.
Now, while individuals with autism are not necessarily behavioral health patients, I went ahead and included this one just in case. Sometimes behavioral health can be included in autism. Now, this is an executive branch task force. It is not a legislative task force. And they have to review and recommend protocol and procedures to create standardization and consistency when transporting behavioral health patients in a non-emergency setting.
They have to give a report to the public health committees on or before March 1, 2020. On March 1, 2020, this task force will expire. And then we've got Act 1078, this one expanded the eligibility for students participating in the Succeed Scholarship Program to an individual who had been medically diagnosed by a licensed physician as a child with a disability.
So now these students can participate in the Succeed Scholarship Program. And now we're going to go to the appropriation legislation. There was only two appropriation legislations that were really affecting autism. There are several appropriations affecting developmental disabilities, but I've narrowed it down here for this presentation. If there are any that are not included in this, please let me know and I'll get you that information. First is Act 338.
This is the appropriation for the University of Arkansas for Fayetteville. This gives $250,000 to the Partners for Inclusive Communities, and then $250,000 for the University of Arkansas for Fayetteville, Arkansas Centers for Rural Education and Autism and Related Disabilities. This is the same as was given in past years. Yes? Is that $250,000 or $2,500,000? You
Speaker 16
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I want to say, I want to say it's supposed to be $250, but let
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me double check and I'll get back to you and I'll make sure the staff knows. And then the last appropriation act, specifically dealing with autism, is act 874. This is the appropriation for the Division of Developmental Disability Services within DHS. Section 10 gave $273,974 for autism treatment coordination grants and aid, as well as for
the autism waiver services. That's the same amount as it's been given in past years. There was a new section added, section 15. This section requires that the Division of Developmental Disabilities budget, allocate, and expend up to $1 million for the elimination of the Autism Waiver Services Program waiting list. And that is new language. Now I've included some of the failed legislation just in case anyone was following some of it and thought it passed, but I'll go over these really quickly. We have HB 1150. This was to
modify the qualifying medical conditions within the medical marijuana amendment. It would have added attition deficit disorder, attition deficit hyperactivity disorder, and autism, as well as several other conditions. However, Representative House withdrew this in February, and it did not pass. And then we have SB 317. This was Senator Davis's bill. This died on sine die adjournment. And it would have required, yes, this would prohibit discrimination against individuals
with disabilities regarding access to organ transplants. And then the last failed legislation that I've put on here is HB 1935. This would have required DHS to cover non-emergency transportation services for individuals receiving developmental disabilities. This also died on signing day adjournment. Now, that does not mean that this is not happening now, but just this particular bill died.
And does anyone have any questions? Thank you, Jessica. Any questions from the committee? I know that one thing we missed on here I saw was Representative Letting's license plate piece of legislation that passed. It changed the sticker, I mean, that they used, if I remember right. But that was late in the session, as I remember. Any other questions? If not, Jessica, thank you so much.
We appreciate that recap. You're welcome. Uh, I guess with, uh, sort of trying to wait a bit on DHS, uh, do we want to talk a little bit, maybe hear a little bit about, uh, any of the, uh, what's going on with the passes, uh, and, uh, any issues, problems that, that families or any, that any, anybody might be privy to, uh, I would open the floor to that, uh, Diana. Sure.
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Can you hear me? Okay. So since the passes took over back
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in March, we've begun receiving phone calls from families whose children with autism have been attributed to the passes. Some of the issues, and I actually wrote some down, so let me pull up my notes. Some of the issues that families are reporting and something I've not been able to come to the table
and present to the state agency's committee is that they have a difficult time accessing or reaching their care coordinators. Care coordinators may not be aware of the types of treatments or services that their child is receiving. In an attempt to help families, I have been talking to and working with PASS care coordinators
from all three of the PASSes, and I have had some pretty frank discussions with them about some of the challenges that they're facing, and this is not to criticize anyone at the passes, these are just real issues that are going to have to be worked through. One of the biggest is for children who are or would be eligible to receive
applied behavior analysis services, that request for services that used to go through Arkansas Medicaid and DDS now has to go to the pass. and care coordinators have no information on how that process should work. So I'm actually meeting with some folks from one of the passes next week to talk about how they should proceed as far as developing a process
for evaluating those requests for coverage and then issuing prior authorizations and allowing the child to begin receiving treatment. Let's see. What do my notes say? In some other discussions with past care coordinators, what they have confidentially been willing to share with me is that they feel they have not received adequate training,
that they are woefully unprepared to provide information to the families and to help coordinate care for children with autism and more broadly for people with developmental disabilities. There was one instance where a family contacted me because their child, who has autism, was making statements like,
I want to kill you, I'm going to kill myself. He was in the midst of a mental health crisis. And under those circumstances, my understanding was that the PASS would be able to deploy mobile crisis intervention team to assist. When I told the family about that, they called their care coordinator. Their care coordinator called me and asked what is a mobile crisis intervention team and how do we access that? So that was a big
concern because those children and adults with autism who are experiencing those mental health crises are landing
Katie Sursa
Unverified
18:23
in psychiatric hospitals. And by and large, the outcomes for
Speaker 26
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those folks is not good. The other thing that this particular care coordinator said to me was that her caseload was really far too great to provide adequate care coordination.
She confided in me that at that moment she had 68 people on
Katie Sursa
Unverified
19:01
her caseload. So those are the main concerns that I have and issues that I have
when it comes to the pass. Anybody, Representative Murdoch, you're recognized.
Representative Reginald Murdock
Unverified
19:19
Thank you, Chairman, Senator Ingram.
I've had a couple of families contact me, specifically on the assessment side of this as well, with Optum, have you guys got so? If I'm not here, Senator, when DHS does come, please let's discuss that. I know we've talked about that in our larger meetings, Senator Ingram, but it seems to be prevalent across all aspects of this service that often continues to come up in terms of their assessments or lack thereof, and it's causing a quagmire in the process.
Let me use that word. The process, and I think I hear it's affecting this group as well. Thank
you. You know, Representative Murdoch and I have said three state agencies and joint health, and just from the, I guess, the rollout, and I'd like some comments for anybody that has any experience with this, but, you know, there's been such problems with what you refer to as training.
With the rollout, we don't know whether the program itself is flawed or whether the implementation is the problem. I mean, is that what everybody sort of sees at this thing? Karen? I don't
Senator Missy Irvin
Unverified
20:41
want to throw her to the wolves, but I do want to introduce Angeline Franks, who is here
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sitting in Melissa's place. Angeline is one of the new, they hired two speech-language pathologists in DDS to work to help coordinate the autism programs.
She is not responsible for the passes, So don't anybody start throwing fruit at her at this point in time. But they have been working really closely and very fast and furiously on a number of the autism programs and the expansion of the waiver EPSDT. So I think she could probably help speak to that. I think some of what has happened is that there have been so many changes from an autism perspective that, you know, everything was in one place and now we've got it all divided up.
Some people go to the passes, some people go to DDS, some people stay at Partners, and so everybody's confused about what's going on. It might be that what we need, because I think some of these questions with people going to their pass and saying, you know, I want to make a request for ABA therapy or I want you to continue, what we did when people were attributed to the passes was I sent to the various passes the plans of care and the active authorization forms from the children's primary care physicians for each person that that pass had become responsible for.
They got all of that. I don't really know if they knew what they were supposed to do with it at that point in time. I do know that Melissa Stone sent the codes to the passes that they were to use for those services because I was sitting in a meeting with one of the pass executives when that happened, and we had Melissa on the phone. It may be that there's so many emails going and so many things changing that what may need to happen is maybe Melissa or someone from DHS who's been really involved in the pass rollout
needs to meet with the top people in all three passes and say, okay, there's a ball that's gotten dropped somewhere. Here are the codes. This is what you're responsible to do. This is how it needs to work. And then you guys figure out what process you're going to use. Because I don't think they know they're supposed to be providing it. We've heard that over and over from care coordinators. When a parent asks for the service, the care coordinator says, we don't provide that. And sometimes they even go to their supervisor and they still come back and say, I'm sorry, we don't provide that. Well, clearly the word just hadn't filtered down to
the people who need to know it. So it may be that we just should ask DHS to just sit down with all three of the past folks, maybe their care coordinator supervisors or whomever
Senator Missy Irvin
Unverified
23:16
they decide is appropriate and explain, go through this all again, rather than assuming that people
are going read an email that came to them.
Speaker 52
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Matt Sewell, you're recognized. Matt Sewell, Department of Ed. We have received several phone calls, and it's funny, as you introduce her, you say she's not
responsible for the past. When I go into those meetings, I have to remind the public school people that I'm not responsible for it either, because they're very frustrated with the way that they're being reimbursed through Medicaid because some of the students that qualify for Medicaid reimbursement do qualify for the managed care, and a lot of the holdup has been with either the optimum assessments or they've had the assessment, but it's just
there's a real delay in the billing process, and it's hitting them in two ways. One, they rely on these funds to offset their costs, their state and local expenditures. And so when they don't have these funds that they have said, okay, we're going to use this pot of money, it drives their MOE up, their maintenance of effort. And their maintenance of effort for a calendar year cannot go down on how much they spend on special education. And so I had one tell me the other day that their funds had just entered into,
they'd just been reimbursed, and that was on everything they've billed for personal care since September. The other area it's affecting them is this is the time of year when we do catastrophic occurrence. So they can apply for catastrophic funding. But Medicaid billing is one of their offsets. And so they're calling us saying, I have not received a payment yet. And it's with these students who are high cost and part of the managed care.
And they're asking us, what do I put in this spot? because eventually I could be reimbursed some funding, but I'm applying for this funding, and I don't have any offsets to list at this time. So from the MOE piece to the catastrophic registry
Katie Sursa
Unverified
25:34
piece, it's creating some issues there. You're recognized, Diana. So I have a question. What happens to a school that has billed for a service to the pass
or they still have outstanding claims at the end of the school year? What happens? I mean, at some point, what happens to that MOE? When is it? Is there any going back and correcting? Oh, no. So I
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met with Lori Vanderplog, who is the director of the Office of Special Education with the
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Department of Ed in Washington, D.C. I was able to meet with her in Denver a few weeks ago, and I explained to her what has happened in the state of Arkansas
and this issue with driving up MOE because the exceptions that school districts can take, there's only three of them. You're losing students, a teacher retired, and you don't have to refill the position because you have enough staff, and I can't think of the third one right now. So when I went through this with her, and she was sympathetic to the issue, but she said these are federally mandated exceptions, and so there would be no exceptions. So if that money does not come in by June 30th, but prior to June 30th,
they can go back and correct their books. But if it's not in by then, their MOE is set, and then therefore they must reach that maintenance of effort for the following year until they
either lose kids or lose staff. Other questions? Let
me ask you, on catastrophic funding, how
Speaker 52
27:25
is that reimbursed so currently the new rules just passed through the state board of
education and now it will come over to the legislative education committee the way it's set right now is if a student is what you do is you calculate all the expenses um for a particular student throughout the year and that that includes a pro rata share of the teacher a pro rata share of an aid if they have an aid all your pt ot speech you could use transportation costs involved with that um if you have a student that and i'm i'm
taking i'm giving you guys more details than you than you may want but if you have a student who has feeding and swallowing issues and you have to buy thickening uh for them to use throughout throughout the school day that could be something nursing care personal care which you if you have a personal care aide they have to take some professional development in order to perform those duties you can take all those costs and and under the current rules if they exceed fifteen
thousand dollars you're reimbursed up to a hundred percent and then it goes into levels so it's i I think it's from $15,000 to $65,000 and then $65,000 to $100,000. And I'm going to tell you I'm probably wrong about that because the new rules change that up a little bit. But the bottom line is they're reimbursed up to 100%, and then I think it goes to 80% and then maybe to 60%. The reality is that there's so many who apply for it that there hasn't been enough funding to fund them at 100%.
So ultimately, they end up getting an average of about 40% of their estimated cost that they applied for. Under the new rules, we are trying to reset the initial figure on the lower cost students that they're applying for. So that $15,000, they wouldn't be reimbursed until they hit over $15,000, and it would be 100% from $15,000 to $50,000.
and in the district the loss of the district is fifteen thousand the thing to consider with that is their ADM which is 6781 is part of that that's not counted as an offset that is part of the fifteen thousand so the actual loss to the district isn't is somewhere around eight thousand dollars and then from the The 15 to 50,000, it's 100%, and then from 50 to 100, I think it's at 60%.
I wish I had that right in front of me to tell you. So forgive me, because I know I'm giving you a little bit bad
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information on the specific numbers. It's 8,000 times the number of students. Say that
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again. It's 8,000 times the number of students. Times the number of students. That's correct. But the definition of catastrophic are those costs that are incurred that would be considered unduly or extraordinary for the cost to provide FAPE to an individual student. And so when you think about the severity of needs and then you also look at the discrepancies across the state of Arkansas in salaries and benefits,
you would see the need to increase that to over $15,000 to determine what is
truly catastrophic. As I remember, and Representative Murdoch, you might recall as well,
I think it was underfunded by about $10 million, if I remember right. I think it's something like $113 million that we've got, that we're putting toward it, and
I think it's about $123 million. It seems like those numbers, but I know it was underfunded.
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31:22
And if the new rules pass, under the new rules, the preliminary calculations that we've done is the money that is there to cover those costs now would be able to cover the costs by the district. Dr.
Speaker 75
31:43
is more of a comment about the previous conversation we were having about issues with passes, and specifically the Optum assessments. Just to make a comment that, from what I understand, the initial functional interview is how I've
heard it described, to tier an individual in terms of their severity needs, which has is not called a clinical assessment for a reason, and that it's an interview with the parents about what the child actually needs. Just want to mention that we've had a few instances in the DDC where a child comes in for an evaluation. We ask the paper, ask the parents to bring all the paperwork from every evaluation they've ever had. Of course, they come in with a folder, and there's the tiered assessment. And many times, the information collected is wrong in ways that are clinically concerning
to us in terms of how that's going to affect that child's life. If someone sees that on paper later down the road, we've had two instances where it said that the child had autism spectrum disorder, which must have come somehow out of that conversation with the parent, but it was news to the parent, and of course that's what they're there in our center to do that day, and one of them did and one of them didn't, and now how do we get this off this piece of paper? So we've had some issues with the information. It's not clear to me how that matters, but I feel like it probably does matter in some
way. The other is just a conversation that I had had with a member of the board of one of the passes, and I said, oh, that's interesting, you know, I'm a developmental pediatrician, and we're very concerned about ABA and all of that. And after the what's that conversation, and I explained all that, which is fine, I mean, And I got the impression that this person was relatively higher up in this pass, and I don't know the structure, but he said, we have still not figured out what we are choosing to cover and what we are not choosing to cover.
And it's my understanding that there is a certain list of things that the passes will cover, and that seemed to be a discrepancy in his understanding. Now, that's just one individual. I just want to share with this body the details and instances that I've heard, because I feel like for every one thing that we see and lay eyes on, there are
probably several that might not get picked up. So I guess what you were
saying earlier, you're saying that the assessment turned into a diagnosis.
I mean, is that in layman's
Speaker 75
34:15
terms? On the piece of paper that came out of the assessment was written
Speaker 26
34:24
a diagnosis as if it had been rendered. Yeah, okay. I got
Katie Sursa
Unverified
34:32
you. So another thing I'd like to point out is that EPSDT is used for more than requesting coverage
Speaker 26
34:41
for ABA. EPSDT is the mechanism or the particular section of that benefit is the mechanism by which you request coverage
for a treatment or for a diagnostic evaluation that is not otherwise covered under the Medicaid state plan. And so traditionally, it's been used to request coverage for medications that were not part of the Medicaid formulary or for durable medical equipment that was not listed under the under the state plan as covered pieces of durable medical equipment.
And so I think rather, not rather than, but
Katie Sursa
Unverified
35:28
in addition to a conversation with the passes about this particular issue of using that EPSDT request for a non-covered service to access applied behavior analysis services, I think it would be good
Speaker 26
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to know how much the passes understand about EPSDT
and the obligations to provide medically necessary services and treatments to children
Katie Sursa
Unverified
35:58
under the age of, well, up through age 21, and how they're going
Speaker 26
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to follow those rates. it's not something they get to opt out of. It's required. That's all. Any
other comments? Nancy, you're recognized.
Speaker 87
36:28
Hi, I serve as a parent for this group.
Speaker 88
36:32
My daughter is 26 years old with autism and had her annual service plan. I want to add on to what you're talking about. There are a lot of parents talking, but not necessarily calling. I gathered case managers, care coordinators from the agency that we work for, several staff members. And then I came to the meeting and discovered that I had a new, or Molly had a new, care coordinator.
And they told me he wouldn't be coming, but he would call in. And then when it came time for his input, he just sent a message, I guess, through them that he didn't have anything to add to our annual plan. We're good. I have a good team. But I would like to, I think he was supposed to contact me in March. And so it's just some other trouble that is happening. to think that we were going to roll
this out in january is a scary thought wasn't it uh any other
any other questions uh melissa stone has just texted me melissa's on her way uh do we want to move to uh we've talked a little bit about the passes uh do we want to talk uh in depth a little bit more
about the specific Autism programs, the expansion of the Autism Waiver
Senator Missy Irvin
Unverified
38:02
slots. Karen? What I understand from Elizabeth
Speaker 46
38:06
Pittman relative to that is that she has submitted a revision
of the Autism Waiver to CMS that both expanded the number of slots by 30 children, which which would move us from 150 to 180, and that she also then had increased in that waiver application the number of unduplicated children, which would have to happen so we could continue to take those children in. I don't know where we are with that. I assume that where we are is we're waiting for CMS to respond with, you know, with an approval. You happen to know, Angeline?
Yeah. So I think that typically if that's all that's changed in a 1915C waiver application, That's not a hard approval. Usually CMS is happy when states want to serve more children under a waiver, so I don't anticipate that there would be any kind of problem with that, but I don't know how long it will take for them to get that approval. But we're on go ready for
Speaker 101
39:18
Okay. Can you hear me? Yeah. Okay. So as of May 1st, the new codes were available for EPSDT therapy, or sorry, ABA therapy under the EPSDT.
We are working, we worked through a desk guide to outline the program and then we've had a work group last week to work with the providers, the BCBAs and BCBADs throughout the state to have them be a part of the development of the program. And so, I don't know. Let's see. Melissa had me bring a PowerPoint. I don't know if you want to see it.
I don't know how. I'm sorry, I didn't catch that. Sorry, Melissa had me bring some copies of a PowerPoint that explains the process. I don't know if you'd like me to hand that out.
Sure, if you've got copies, please. Sure, yes. We wouldn't want
Speaker 101
40:41
to kill a lot of trees unnecessarily. Thank you. Wait a minute. No, I have one. Thank you. That might be the easiest way.
Yeah, if you have
Speaker 101
41:03
don't. Okay. Sorry. It's all right. Oh, I'm sorry. I can scoot in as well. So under our program, the BCBAs and the BCBADs will be the providers enrolling through provider enrollment. We are working on getting a provider enrollment for those behavior paraprofessionals who provide
a lot of the services under the supervision of the BCBAs, and those are the behavior therapists. And so everything, after a child gets a diagnosis of autism, everything else in our program right now will have a prior authorization. So they will submit their diagnostic information through EQ Health, and they will give a prior authorization for an assessment.
and then the BCBAs will conduct the assessment and develop a treatment plan and then that will need prior authorization as well. And so once they have that, they can go forward and get the treatment. I'm going to skip these facts about ASD in Arkansas. I'm sure you all know them more than anybody else.
But so one of the parts of our program is they must have that official three-prong diagnosis by a physician, a psychologist, and a speech-language pathologist. They must be receiving Medicaid. And at that EPSDT visit, that well-child visit, the doctor will fill out the prescription for that service that isn't part of the state plan like we were talking about before.
and they will recommend ABA. And so this prior authorization process infographic walks you through all the things that I've said, because those are a little bit confusing. And I've provided these infographics to a lot of the providers, because it can be very confusing. and they're in our desk guide as well.
In the program, there will be the ABA evaluation. There's an option for individual treatment as well as group treatment, and then family treatment is another treatment code that we
Speaker 100
43:48
have in there. So those are all ways that the children will be able to receive
those ABA services. And you said these were submitted May 1st, or were they approved May
Speaker 101
44:06
1st? So there are some of the providers under the, they were providing EPSDT, ABA under the EPSDT program with partners.
And so on May 1st, everything came over to our office. Okay. And so there are children receiving these services now under EPSDT. I think what we did was open up the opportunity for more providers to enroll, not just under the waiver. And so as that gets going, I think provider enrollment can take a little bit of time.
And there have been some things that are getting ironed out there. And so as those providers grow, there will be more children
who can receive the services. Thank you. Any questions regarding Angeline's presentation? All right. Thank you. Thank you for putting the acronym dictionary in front of it. You're welcome. We have, I see where Melissa Stone has joined us, and we appreciate her being here.
We had skipped over the past process. Melissa, we sort of talked a little bit in here about some of the problems that are sort of universal that are going on. Why don't you just come to the end of the table and introduce yourself and your position, and we will take some questions. But first, introduce yourself, please.
Representative DeAnn Vaught
Unverified
45:49
Sure. Melissa Stone, Division Director for Developmental Disability Services at the Department of Human Services. And Senator Ingram, I brought with me Janet Mann. I don't know if you've met Ms. Mann. She's the Division Director for Medicaid. Okay. She's not
one of the other two people that intend to have an employee. Well, we actually found three. We found three. We found a third. We've already.
We rounded up a third. 50%. Great. Do you want to make a little opening statement on what you see going on with
the passes, or do you just want to take the gunfire right off the bat?
Representative DeAnn Vaught
Unverified
46:26
I know. I just left one that's gunfire meeting. I'll do a brief overview.
Maybe I'll cut down on some complaints. That'll work. Thanks for having me. Sorry I was late. I just left talking to the Developmental Disabilities Provider Conference. They had all the, you know, they have a three-day conference. That's our largest group of providers that do DD services in terms of those specialized services under the waiver and personal care. And they run our intermediate care facilities, the private ones out in the community.
So they had a three-day conference, and they brought the passes in all day Wednesday to do breakout sessions and ask each pass specific questions on things that they're running into. And then this morning I just gave a brief update on kind of where we are from the DHS standpoint of our relationship between us in the past, which is more of a contractual monitoring type relationship at this point, because we've got now the business of approving plans for clients who are in a pass.
So now we're making sure that they are complying and providing service to past members. So from that standpoint, just to set the tone, from the monitoring standpoint, we, of course, have been actively working these first 75 days. We launched March 1st to make sure that we had the capacity to take and record and follow up on all complaints. So we're running, I'm sure y'all have heard, we're running a command center that's staffed with my staff and Medicaid staff over in our office.
We developed or utilized a ticketing system called JIRA. And every single email, social media post, phone call that comes through the call center, a ticket is opened. A DHS staff member is assigned. It's a sent to the appropriate pass to ensure resolution. And then once we get that, it would go back in and close it out. We, on average, have 150 open tickets any given time.
Of course, much, much higher at the beginning, higher certain days of the week. Therefore, while we were open 24, we were open on weekends. So weekends, of course, you see more complaints about pharmacy because lots of people fill their pharmaceuticals on Saturdays. So, it ebbs and flows, but on average, we have about 150 open complaints that we're actively working. We, I'm sure you've seen, we've been over to state agencies now two times. I felt like the second time went a lot better than the first time.
That's just my personal opinion. So, we spent a lot of effort in between that first meeting and the second meeting that happened on Monday to just try to engage even more. So we set up daily phone calls with our specialty providers. So I've been doing a daily call with the ICF and the waiver providers. Paul and I have been doing daily calls with personal care and residential care facilities. We did weekly calls with our day treatment centers and with the therapist.
I will say right now that therapy is where I'm trying to focus attention because I think we kind of stabilized some of the major problems with waiver billing and with ICF billing. We still have some, but they're able to submit claims and be paid. We're having problems on the therapy side with a particular set of codes and some modifiers, so we're focusing our attention on that right now. We have developed a work plan based on feedback we've received from
the provider community on these calls and just things that they've actually submitted to us in writing and through the ticketing system and through reviewing each passes, um, compliance, right? Because they all have their own system where they take compliance. So we take all of those documents, um, we were doing on a daily basis, um, and compile it into an overall report that we go over every day, and now from that, we've developed an overarching work plan.
One of the suggestions that I just got at that conference, which I thought was a really good suggestion, is part of, I think, the problem is, although we are doing a lot of efforts to assist with these problems that are coming out of the past, it's very hard if you're not on the call to kind of see where we are at DHS on any given moment and what we're working on and kind of what the status is so one of the suggestions that janet and i are going to actually look at this afternoon can we get that working excuse me working document
somewhere online that you can see it on in a real-time basis of see what we're see exactly what we're doing and what the passes are doing because the plan is we have filled in what we can on the work plan and then friday which is tomorrow time flies uh tomorrow we're sending that work plan the very first uh of this draft to get them to fill in exactly what they're doing on each one of those items and i do think it'd be beneficial for our provider network to be able to
see exactly what's going on some of these things that keep coming up are they're broader than one provider type, right? So seeing those trends of like, well, yeah, maybe DD waiver providers having problems with billing third-party liability, which is billing Medicare or private insurance first, but that's happening across the board, right? So being able to say these are bigger problems that are happening, and then these are specialized problems to these codes and
these provider types and that's how the work plan is laid out so like I said hopefully we'll get a solution on that where we can actually make that visible where it's not just whoever's on the call with me gets to go over it because lots of times providers can't be on those
calls and with that I'll stop and I'll
take any nice question that you guys have all right we've
got a few for you One of the things that we keep hearing repeatedly is that the care coordinators, Melissa, are not,
they don't know the breadth of services that can be provided. And it appears that maybe they have not been trained sufficiently or have enough knowledge, specific knowledge, to work with the patients. And has that, I guess, first tell us a little bit about what the PASS, how they train their people, and then is this something that's coming up in other areas as well as just specific to this?
Representative DeAnn Vaught
Unverified
53:37
That's a great question. So let me answer from the position of what DHS is doing on that issue, because I don't want to speak for the PASSes. I can get that information and supply it to you on their specific training. But I know for us, so, of course, I'm focused on the developmental disability side of the house more so than the behavioral health side, right? Although I'm involved in both. But we set up, we asked at the 1st of April, just seeing all the comments on social media about how these meetings were going with families.
And they weren't going well. Moms in particular, very put out with a lot of us. I get it. So we, on the 1st of April, asked each pass, we said, this ain't going to work. We can't, every time we get a complaint that comes in, I can't try to figure out who this person's care coordinator is and then train these people one at a time, right? I mean, because we were trying to do technical assistance to get people up to speed, but we were having more of a widespread issue than that. So we asked each pass to designate, at a minimum, two people that we could specifically train in DED, right?
So we started those strategic trainings on Friday, April the 12th. We have them at my office every Friday. What we have done so far is we've trained them on what are the state plan services? What are people on the wait list getting? What are the people on the waiver getting? What are people that are in an ICF? What are they getting? Um, how you do PCSPs in terms of the federal requirements, and I'll come back to that because
that needs more work, but, um, how you make sure that your clients or your members keep their Medicaid eligibility every year, which is now a responsibility of the care coordinator. We don't want people becoming Medicaid ineligible because these are Medicaid recipients in a program called the pass so how do you keep for our clients that long that institutional level of care eligibility up to date every three or five years depending on your age so we've gone through all
of those items as well as kind of these nuance issues that come up for DD clients that are just very unusual and just the passes are trying to get used to it we've gone over DME equipment we're having an issue with that i talked to everybody about that the hearing on monday trying to get more people signed up to do these very specialized codes that we need um that um in fact at the meeting monday i talked about how we were reaching out to the 500 approximately dme providers right
now and asking them to come apply to be this specialized provider and that is running on their billing systems today. So when you go into MMIS to bill us today and for the next week, it's a banner that runs across the bottom of that screen telling them step-by-step instructions on how to sign up to do that for us because
that is a deficit. But I will tell you, trying to teach someone to
do a person-centered service plan for a DD client is almost unteachable. And we have
struggled to um to have my waiver staff go out and sit in on these meetings and really it i think it gets down to that providers really need step-by-step operational procedures for how each pass is going to handle them and so yesterday we issued our first um technical bulletin from the passes that basically states you are required to do a person-centered service plan for every single
member, and these are the federal requirements that have to be in it, and we need detailed operational instructions from each one of you within the next 30 days submitted to us, put on your website that outline exactly how that takes place with families, how services get approved, how families know they're approved, how providers know they're approved. How does that circle back around? So we're all very aware of what we're trying to do here. And in addition to that, if you have a new member, like a new person that doesn't come in with a plan,
or a new service that that person needs all of a sudden, how does that work? How do you ask for it? What are the steps in that? And I think that is one thing. we talked to the passes yesterday we've been doing this at dd for so long i think people knew exactly who to call and we had a we had a process that we peppered people with forms right which is not where we want to go in this new model i mean people should not have to fill out these hundreds of forms to get something but they also do need some flow and um and some procedures that are
very visible for each pass on how this should work and so i do think that's going to help Once those get released, I think it'll help a lot in these meetings. We're going to ramp up my staff going out and sitting in these person-centered service plan meetings and just gently saying, I wouldn't do it like that
or maybe do it like this. Did we not anticipate or did the passes not anticipate that this was going to be
a problem when their coordinators maybe weren't familiar with?
Yeah, I understand. I can't see the two people right here below me. Was this something that was unanticipated that there would
be such a disconnect? I think,
Representative DeAnn Vaught
Unverified
59:20
this is my personal opinion, the model has 43,000 clients in it and 7,000 are DD clients. So the majority of the members in the past are behavioral health clients who did not historically receive any type of care coordination at all, right?
I think everybody underestimates the level of advocacy from DD parents. Everybody, right? And it's not a bad thing. I mean, all these people here know I have two kids. Like, I'd be doing the same thing. They're not going to let it go. So, and I think that, and the uniqueness where every situation is very different, that we are doing a lot of
Speaker 126
1:00:02
technical assistance on, I never anticipated X, Y, and Z would occur. We've had a
Representative DeAnn Vaught
Unverified
1:00:08
couple of really trying cases that would have been trying for our own staff that have
Speaker 126
1:00:13
happened in the last 75 days that have, I would not know what I would have done with these particular clients.
And so you put that on
Representative DeAnn Vaught
Unverified
1:00:25
top of a new process. And for the DD
arena, I think it's been a harder transition. Two
other things that have come up in discussions were, do we have any optimum number of caseloads that, you
know, say the passes, they've got the care coordinators.
Is there any guidelines about what the optimum number should be and so that they're not overloaded and can't do their job in a timely manner? So all of those
Speaker 121
1:01:05
metrics in terms of what we mandated in numbers are
Representative DeAnn Vaught
Unverified
1:01:09
in the contract between us and the pass. And y'all are free to go read that, too, and I can give you that number today. But if y'all want to go look at the agreement, it is up on the PASS website that's in our office. So www.pass.arkansas.gov.
And the agreement's up there if you want to go look at some of these
things. But I believe that the metric for caseworkers is 1 to 50. They cannot have more than 50.
Of course, they can have less than 50. Well, I don't think that less than is a problem. Um, and, and what about the assessment with Optum? We, we still continue to, uh, as you know, in state agencies and everywhere else, it seems that that, that is not, uh, uh, proceeding in a timely manner.
Representative DeAnn Vaught
Unverified
1:01:58
So that's where Paula is right now, actually. She's got, um, she's meeting with Optum and, um, I think Senator Hammer's there and, um, Our vendor, EQ Health, is there as well, and the behavioral health providers. Knock on wood, it's DD. You know, we do, we've done our huge block of assessments for our clients, and they're not due again for three years. So a lot of this is surrounding behavioral health reassessments
because they're reassessing their clients on an annual basis, and the minute they finish it's like you turn around and have to start over because like I said out of 43,000 people the bulk of that are BH clients and so they're all trying to schedule reassessments when when the past took over in March now we added another leg into that process where before it was DHS working with the BH providers and Optum to schedule these assessments
and they scheduled them in a way where they did them in blocks. So, like, they would say, hey, you, a BH provider, you have this many clients that y'all have said you need an assessment. We're going to send out Optum staff for two weeks and knock this out. It doesn't work that way under the pass because they're all in different passes. Does that make sense? So, and the passes are scheduling the assessments. So I think this morning what
Speaker 121
1:03:30
they were doing was literally looking at that and going,
Representative DeAnn Vaught
Unverified
1:03:34
how do we make this more efficient? Because, you know, when we first started the Optum contract, we had it written in there. We were going to do three calls and assess people at home. And that works for some, but that did not work for the majority of the clients. So we're trying, I think that is actually what Paula is doing
Speaker 126
1:03:52
right now, is figuring out how can we make this more effective and easier for people and get these done timely. questions from the committee diana
Katie Sursa
Unverified
1:04:05
um so i just wanted to pass along to you what what and i've already commented um before you came in here so um we have been our organization has been receiving phone calls from families and even from some care coordinators. And these are things that are not things that you can affect or change.
Speaker 26
1:04:35
These have to do with the passes. But the two that are the top concerns for me, number one,
Katie Sursa
Unverified
1:04:45
the care coordinators didn't have any information about EPSDT or even that that was a covered benefit EPSDT generally, and then more specifically, the request for ABA coverage. But I think that that's going to get nailed down probably in the next week or two.
I actually think they're going to have processes at each one of the passes that hopefully when families call me, I can ask them, which pass are you in, and contact your care coordinator, and here's how it's supposed to
Speaker 26
1:05:26
work so we can make families aware of that process. The one that gives me way more heartburn and I'm really concerned about is the mobile crisis
Katie Sursa
Unverified
1:05:37
intervention. I've had at least one phone call
where a young man with autism was experiencing a mental health crisis, was threatening suicide, was threatening to kill people in his home. he needed immediate attention, I mentioned to the family that they needed to ask their care coordinator about mobile crisis intervention. The care coordinator ended up calling me asking me what is mobile crisis intervention. So my concern
Speaker 26
1:06:09
is that we're going to end up with
a lot of kids with autism and other developmental disabilities, being placed in psychiatric hospitals, and coming out without
Katie Sursa
Unverified
1:06:24
the kind of services and supports they need. And, you know, what the care
Speaker 26
1:06:35
coordinator was struggling with, just to provide everyone with a little bit more detail, was finding just anything for this kid in that moment.
Katie Sursa
Unverified
1:06:48
They were calling every single psychiatric hospital they could find. I mean, they were literally looking in the phone book for some place that could provide him with some assistance. So, and the care coordinator didn't know how else to do it. And those are the issues, like the ABA coverage under EPSDT, that's not a crisis situation. We can work through that as an issue,
Speaker 26
1:07:17
but these crisis situations have me really, really concerned.
I am happy to help however I possibly can to give the care coordinators and the families the information they
Katie Sursa
Unverified
1:07:27
need to get them the help they need in that moment. Okay. If I could respond. Yeah. So I agree
Representative DeAnn Vaught
Unverified
1:07:38
with you on the EPSDT and the ABA coverage. Again, I think a lot of that ties back to, we've asked them as well, in addition to this PCSP flow and new service flow chart,
just a one pager on what services have to be prior authorized, right, between now and September 1st. Because there's just, there is confusion surrounding that. And if they each do it just a tad different, that makes it even worse. So if we could just, that's what we've asked for, is just a one-page document. These services need PAs. These services do not, so that it's very clear and clear-cut for families. And so, and we would be asking for all the services to be kind of laid out,
if not on that document, but a link, because I know two of the three passes, you're able to go on their portal and enter a service, and it'll tell you if you need a PA or not. So I know two of them have that. So one or the other, either a one-pager that gives the link to everybody or a listing of all of them. Mobile crisis intervention. Now, this is a new service. We've never done mobile crisis intervention in this state. We're kind of in the same holding pattern that we've been with developmental
disabled clients for a long time, which is when they go in crisis, what do we do? Again, my staff would call every provider and work with the supported living provider to try to find a placement for people in crisis working with moms, but it's still, we are trying to get them, the care coordinators to that point by offering technical assistance as much as we possibly can to say, this is how we handled it. But yes, the service of crisis intervention, mobile crisis intervention is a brand new service. So, and it's still
Speaker 126
1:09:27
building out. And so it's not surprising to me that the care coordinator would
be confused about that. Other questions? Committee? Melissa, I've just
heard anecdotal stories about the assessment that, I'm trying to put this in the proper scope, that maybe during the process it is more of a
check the box real quick, push through, and some people might not realize they need some services. You know, how just straightforward is that assessment process? I mean, you know, I don't want anybody to miss services that they're eligible for. and that assessment that they go through, how quick is, how quick does that,
Representative DeAnn Vaught
Unverified
1:10:30
walk me through that real quick. So we do, Optimist, four types of assessments for us, for the department. They do an assessment for behavioral health. They do an assessment on DD clients once DDS has deemed them eligible. So the people still go through my psychology unit to meet the medical criteria, and then they go through the full-blown independent assessment. We do for personal care, they just started using it for that AR Choices waiver
for physically disabled and aging adults. And then we do a developmental screen, which is the Battelle, for kids that go to a day treatment clinic. So there's four different, four, five running at all times. For DD, I would say the tool is accessible. Y'all are welcome to look at it. I think it's online as well. Questions are very straightforward. Now, if the assessor does not act appropriate, then y'all need to call me. I'll lodge a complaint. The questions are extremely straightforward.
And I think the key to remember on this for us, for DD clients, the assessment, you've already been deemed institutional level of care, right? You've already met the medical eligibility. We're putting you in a tier two or a tier three. There is nothing else for DD. All right? It's one or the other. That is for purposes of attributing people to a pass, and it's for purposes of the monthly payment we pay the pass for that member. I have said in email over and over to families and to the passes,
the pass is a risk-based model that operates very similar to an insurance company, whereas money is not directly tied to a person. If you come in and somebody needs something and it's in the person-centered service plan, you need to provide it. Somebody else that month might not need as much service. And I think we have just always tied a dollar amount to the head of every single one of our clients all these years in the concept of giving a global lump sum payment to a pass
that you then decide how you spend the money on your members based on what they need, it's just a constant re-talking about it, that that's what risk is. That's why that we set it up this way, because people ebb and flow. So I think it's still the concept of, like, I tiered it a two, and I'm only going to get X. Well, that's not true. And just because you tiered it a three doesn't mean you're getting the gold star package if you don't actually need it.
So it's all tied to that individual's person-centered service plan. And that's why we're putting so much emphasis on that with the passes on how are you going to redo those on an annual basis? Who's going to be at the table? What's that going to look
like? Any other questions? Karen? Alyssa, as your staff are
Senator Missy Irvin
Unverified
1:13:37
doing these trainings on Fridays, you know going through the various things one and you
Speaker 46
1:13:42
may have already done this i hope you have but
one of the things i suggested earlier was that maybe dds could have in some way a connection with all three of the passes to explain to them that you did send them codes for aba therapy and that that is one of the things that they're supposed to know something about because they don't the care coordinators are telling families we don't provide that service they go to their care coordinator supervisor and the supervisor says we don't know what you're talking about so And I know you sent those out because I was sitting in a meeting with Beacon when we talked about them. But I don't think they read their e-mails.
Okay. So at some level, that needs to
Speaker 141
1:14:19
trickle down. I think I'll have you come talk and try. Trickle
Representative DeAnn Vaught
Unverified
1:14:23
down to those care coordinators because I don't think they got the memo. And I don't think it's just ABA therapy. I think it's, again, them understanding the distinction. It's on the wait list clients in particular that we are running into this. what is a state-planned service versus what's a waiver service, and this idea that if you're not in waiver, then you don't get some of these things, and trying to explain to them, no, no, no, no, no.
We put all that money in their global payment. Everything you got under Medicaid is in there. So I think the more we roll out and talk about the new ABA codes and the EPSDT services and that handbook we gave to EQ Health, We just talked about that this morning in the presentation that Angeline did. I think the more we talk about that, that is also going to help. But I'm being serious about you coming on Friday to talk to him. I think it would be great. I'll call you.
Speaker 74
1:15:21
Yes, Dr. Scott. Hi, Melissa. Hey. I had a quick question, and this may be something that if it gets into
Speaker 75
1:15:29
the weeds, we can talk about later. about the content of the report or the documents that come out of the assessments that Optum does. And I'm trying to remember the specific incidents that I am wondering about. I don't know if these children, I don't know which of the assessments, because I don't know if they came in under the behavioral health side because they had had some behavior issues,
or if they came in already having been on the DD waiver. But there have been a couple of children who come into the DDC for evaluations, and they have a copy of their assessment. And my understanding is that this is the functional assessment, which is the interview with mom.
Speaker 121
1:16:09
And I understand... No, no, no, not interview with mom. If the child is very little and unable to communicate, but no, the client is present. Okay, so
Speaker 74
1:16:21
these are like two- and three-year-olds. Yeah, that's mom. So I guess my question is, how can we best help correct
Speaker 84
1:16:27
clinically incorrect information that comes out typed on those reports?
Speaker 121
1:16:31
So there should be no clinical medical diagnosis information on those assessments? That's what I understand. Okay. Just get with me on
Speaker 147
1:16:37
those. Those are behavioral health, I'm assuming. Fair. Thanks. Okay. Other questions?
Yes. Matt, you're recognized. Mine is more of a comment or
Speaker 51
1:16:49
a call for help. I think Jerry Clark's been working with you guys on some of the issues that we're seeing in the schools,
Speaker 52
1:16:55
and I think some of it has to do with I know that schools weren't supposed to be part of the past,
but some of the students they work with are, and I think with some of the optimum assessments, there's just been some delays in billing that is driving up or could potentially drive up their MOE, which would cause them not to be able to reduce that past June 30th. So any help that you guys could provide to speed up those processes would be much appreciated. Absolutely.
Representative DeAnn Vaught
Unverified
1:17:26
We've been communicating with Jerry a lot. Diana.
Katie Sursa
Unverified
1:17:35
Maybe we can end here on a good note. I do want to tell you about a conversation I had with a care coordinator actually yesterday who she had called me looking for, she wanted more information, she was wonderful, more information about services available to children with autism. When I talked to her about requesting applied behavior analysis under the EPSDT benefit, she was thrilled. I mean, we were on the phone for
about an hour and a half. She was taking copious notes. She has been texting me back and forth. So there are success stories. I have no doubt this child is going to access appropriate treatment and intervention services. So I just thought I'd throw that out there after all of this negative stuff. There are some really excellent care coordinators who are working really hard for their families. thank you thank you
any other questions from committee for melissa if not uh melissa thank
you so much thank you sender uh hustling over here i'm sorry i was late oh that's all right i know you had uh you had another engagement equally as important so uh thank y'all and the the next item that we have on the agenda is the early diagnosis of children asd uh specifically the Dentist Developmental Center. Anyone want to comment? Dr. Scott? I
Speaker 75
1:19:13
should have introduced myself earlier. I'm Angie Scott, developmental pediatrician. I work at the
Dentist Developmental Center in the UAMS Department of Pediatrics. I want to introduce Mr. Tim Thomas, who is our clinic administrative director, and he is, along with Maya Lopez, who's the medical director of the clinic, helps us get all of the kids through, which, as you know, historically has been a challenging task that at times I feel like we have really risen to, and at times we have been, frankly, squished by, and we try our best to sort through the children
in a clinically rigorous, appropriate way, but also quickly. So, just a real brief overview, and then if you have questions, Tim can probably give you more details than I can. As you know, the famed wait list at the DDC has been at times quite long and then at other times shorter. The reality is that there is not a construct quite so simple as a wait list. We have a number of children who are waiting to be appointed and sorted out in triage.
Not all of them are there for an autism evaluation. And so the number that we have for a wait list may not actually be what any given person is asking about, and we can talk more about that. There have been times when it has been rumored to be upwards of 18 months or so. I'm not sure that was ever true, but people said it was. I'm not sure how you would know that. At this point, we have around 400 children that are currently on our list to be triaged and appointed but are not yet appointed, which we estimate would take about four to five months
to get through. Not all of those children are there for autism evaluations, and that's part of the process of sorting through the information we have to triage them into the appropriate. Some of them are there for feeding therapy, and some of them are there for neuropsych evaluation, and so trying to get them into the right spot. So that's some time. It's not as bad as it's ever been, so I feel like our excellent administrative team has been working hard, and we're seeing some of that payoff. We're bringing in a new developmental pediatrician to add to our group in August, which should help us get through those kiddos easier. So we'll go up to a group of six rather
than five. One of them is full-time, I mean half-time. We also have outreach clinics. I was counting up, we do about 32 yearly now, and that's an increase from what it used to be, to travel and see kids in other parts of the state, as well as the COBOLT program, which is where we train local teams of PCPs, APRNs. We have some social workers in some of the sites. We have some speech paths in some of the sites. And they do sort of a first-pass triage evaluation and send the ones that need to come on to the DDC
but are able to sort out a lot of the children that would have waited on the list for a long time to be told that, in fact, they do not have autism. So that's been a helpful model. Right now, this afternoon, they're training two more sites at the DDC, which will bring us up, I think, to nine. We have had some difficulty maintaining a full team at each of those sites. They're busy positions, and some of them are able to do more work for us than others are, so some of the sites see relatively more kids than others.
At the end of the day, our work is sometimes lately driven by what we know the children will need administratively to get services. There are some children, a lot of children, that are complicated and need a full diagnostic evaluation, and I absolutely want them to have a psychologist and a speech pathologist, and I want to know what their IQ is, and I want to know what their adaptive score is to be able to understand them well enough to confidently diagnose. That is not true of all children, but we currently go through all of those processes for every single child in order for them
to get ABA, which is what we will recommend based on their diagnosis of autism. So the requirements for service provision do affect our workflow and how efficiently we're able to get them the parts and pieces that they need to go and get the services that we're going to recommend. I know that's a part of an ongoing conversation about what the requirements are to access ABA under the current system and under the system that we're looking into. I'm part of a group nationally that's looking at, because of a conversation that we've had
with my supervisor, Dr. Purcell, has had with folks in this room about the trifecta, as we call it, and whether it's clinically appropriate to require all three disciplines to sign off on each child, that we're actually the only state that does that. And in that conversation with other colleagues at different states, we've actually sort of triggered this large study that our national society is trying to put together a guideline or at least a state of the, not really state of the art, but state of the union, as it
were, about what each state requires and what the evidence behind each system is. So that'll be a couple of years, I'm afraid, in the making. But it's, our conversations in Arkansas have launched some of these national conversations that we're a part of, and we're happy to continue to be a part of it as we're trying to get our kids here in our home state taken care of. So, if anybody, there's my spiel. If anybody has any questions, I'm sure that if I can answer them, I can defer to Tim. You can.
Senator Missy Irvin
Unverified
1:24:47
Karen? Angie, I'm not sure if there's a difference. I know there's a difference in how they operate between the outreach clinics and the cobalts, but in either of those types of sites, are any of those children ever diagnosed or are they just triaged and then if they're suspicious
Speaker 75
1:25:05
for autism they're sent into the dentist center that's a good question by and large both of those programs are triage models but there are some cobalt clinics if the physician is confident
enough to provide the physician agreement and if there is a speech pathologist either in the cobalt site or in the community, and if there is a local psychologist, and that psychology piece has been the hardest for us to find outside of our academic model, there are some children who manage to get all the pieces and parts and have a diagnosis and not have to come back to Little Rock. That happens sometimes in outreach, less often. It's us, the developmental pediatricians, who are going to outreach as opposed to local
PCPs being trained in cobalt, so that's one of the differences. And there are times, depending on where I am or where my colleagues are, where we have those resources available to us. We don't take our entire diagnostic team from the DDC and go to outreach because at a certain point, the rate-limiting step is manpower. So if we're in outreach, it means nobody's at the DDC diagnosing kids. So we have to sort of balance that. Sometimes we can piece it together. They're more than not, more likely than not, that families will come to outreach to be told that you have a provisional diagnosis of autism, and I'm almost sure of it.
Some of them I say, you know, I really can't tell, and I really want an ADOS, but some of them I
Speaker 2
1:26:37
say, I need you to come to Little Rock
to get the trifecta. Any other questions? Okay, thank you for that report. The last piece of that is the capacity for private entities to complete assessments. Do we want to,
Senator Missy Irvin
Unverified
1:26:53
Karen? Yeah, I think this goes back to something that you referenced, which was the difficult piece to get is the psychology piece.
Speaker 46
1:27:00
And, you know, we've been working in some areas even that overlap with where you guys do a cobalt team, Helena in particular, trying to piece together the pieces that you would need for those children to get a diagnosis and be able to come into services because we're pretty certain that those families are not going to make it to Little Rock, even if they're seen in a triage setting. It's just not going to happen. And so I would just as a suggestion, any of those places where any of your developmental peds people go, if you're comfortable as a child with autism,
even if you don't have the other parts of that team, if you could make that call on that one part of the team, there's a likelihood that the other pieces could be picked up. It doesn't have to be a team together doing the assessment. You just have to have those three pieces. And so, you know, I'm just wondering if there's a way that we could address that. The issue with the psych assessment, it has been a coding issue, has been a Medicaid code that would stand alone and allow a private practice psychologist to be able to do an assessment on a child with autism
and be able to be reimbursed by Medicaid for that assessment. That's something that I understand that DDS is working on a code. Most of the people out in the rural areas are practitioners in behavioral health centers. That's been an express prohibition in the BH codes. You cannot test a child with autism and be paid if it's part of the behavioral health system. So DDS was trying to fix that. I know there's a code now that's been included sort of attached to the ABA therapy codes,
but we're looking for something that stands alone. We're wanting a way that could be billed to Medicaid for an assessment by a psychologist of a child when they don't have any idea if that child needs ABA therapy. It has nothing to do with an intervention that's coming forward. It's just a child has red flags for autism, and you need that psych eval to determine if, in fact, it looks like that's what it is. So I think DDS is working on that particular code. And once that happens, then I'm hopeful that we can try to piece together some things
that will work in these rural areas so that a family can come to one appointment and get what they think they're coming there for. Because when they see a COBOL team, they are not happy at the end because they think they're coming to get a diagnosis, and they don't. They get a triage, and then they're told to make a trip to Little Rock. And we've had some calls from some of them that are really not happy about it. And even beyond that, I think it's just highly unlikely in some of those rural areas, people don't have transportation. They can't get to Little Rock to the dentist center.
You know, if you could see them the next day, they're not going to make it there. So we've still got those young children out in those very rural parts of the state that are not able to access the services that are there for them now. and DDS in their new EPSDT ABA codes have opened it up even, I mean, far wider in terms of the locations it can happen. It can happen in a school. It can happen in a, in, you know, some of the developmental preschools. There are places that kids can get service, but they're not going to be able to unless we can figure out how to get that assessment code that can stand alone. And
I think it's in the works, as I understand it, but that's a, that's a huge piece because we've just got to stop expecting families to travel from all of these little towns into Little
Senator Missy Irvin
Unverified
1:30:23
Rock. They're not going to make it. Dr. Scott. Yeah, thank you, Karen.
Speaker 75
1:30:30
I appreciate that. And that's something we've, you know, obviously struggled back and forth about. Is it more important to have it all done on one visit? Is it more important to not travel? Is it more important to have it quicker? We're actually working on a new model at the DDC, and again, this is in Little Rock, but we get feedback from some families that if I could just get in and see somebody, and what if the
child doesn't have autism, then I don't have to spend another nine months on the hook. So one model is to have them come in for a triage visit at the DDC and then decide if they need a team or not. Hopefully they can get in sooner, but it may take more than one trip. Another model is to try to take our full team out into the boonies, as it were. You know, at a certain point at the DDC, see there's five of us, two psychologists, two LPEs who require the psychologist sign off, and three speech paths who are really the autism experts who have gone through the
certification and are active nationally in that field. And I don't mean to say that we're the only ones in this state who have the capacity to diagnose autism, but I also think that we do it the way we do it in part because that's the way the requirements for the services make us do it. There are families who can't get services because they don't have a psych piece. We've done an ADOS. We've diagnosed the child. I'm confident. And all I need is someone with a PhD to sign off behind me because of the service requirement,
not because it makes me more or less confident about the diagnosis. That's not every child. I guess what I'm saying is we're very open, and we're constantly looking for new ways to do this, so if anybody has any ideas and we want to be creative, at a certain point I think we need to think about what do we need, what could we potentially open up and make a little less restrictive about the ways that you can get ABA, the diagnostic requirements
to get autism specific services. And again, I want to be careful because some children do need a full team. And some children, I absolutely want a psychologist to be a part of that. But there are times when I would stand behind that diagnosis 100% and we've got all of the national guidelines met. It's the state guidelines that we're begging and pleading for in terms of going around chasing people to sign off so that
we can check a box. And those state guidelines are developed and approved by DHS?
Speaker 46
1:33:11
And it's not, it's not, as I understand it, it's not a requirement for autism-specific services. The way DDS has it structured for all DD services in order for a child to qualify, and we have categorical eligibility in state statute for DD services, and it lists particular diagnoses that are qualified for DDS services. In order for a child to qualify under an autism diagnosis, the state has always said you
wanted that diagnosis from a psychologist, a speech pathologist, and a physician. And so that it has nothing to do with ABA, it's just about DD qualification and it's it's set up as a protection for the child so that there's a team of people that have to agree not just you know any one practitioner who can just you know rattle them in in a diagnosis mill and so i think it's you know it does create some issues but it was i think it
was started as a way to protect as a
protection for the child well dr scott is uh one who represents a rural district, I think it's important to look at taking the team to the community. I think you have to look no further than when a mobile dental clinic shows up in a community. Now, we've got access to a lot of dentists, but you will have hundreds and thousands of
people that show up for the dental clinic. And I think that is a great example and a good model that you might take a look at, consider. Any other
Senator Missy Irvin
Unverified
1:35:01
discussion? Karen? Yeah, I just, I have one thing that's sort of a request for the Department of Education folks.
Speaker 46
1:35:08
We have recently, I think it's a pretty simple fix, recently crossed paths with like a number of people over the last few weeks who seem to be confused about how the standards you guys have put out for autism work.
And specifically, there are, we've run into LEA supervisors and folks who think that a child cannot be served under the IDEA in schools as a child with autism unless they have a medical diagnosis of autism. So they don't understand about the educational classification. And they're interpreting the part in the program standards that says you need a medical exam, as a medical diagnosis, and then one step further than that, they believe, or what they've expressed is that the services that a child receives are tied directly to the diagnosis.
We've been told if they don't have a medical diagnosis of autism, then all we could provide for them would be maybe a little bit of speech therapy. So they don't, and I know that's not what the department is saying. I actually sent a clarification request to Courtney Salas forward and said, Courtney, I know these things are wrong, but I need you to say they're wrong in writing to me so I can go back and quote you, because these people really believe that they've got it right. So I wondered if you could send out maybe a director's memorandum or some kind of
communication out through the LEA supervisors that says, hey, this is misunderstanding that appears to be out there, and it is misunderstanding. And
Speaker 58
1:36:37
did Courtney respond to you? Absolutely she did. All right. Yeah, absolutely she
Speaker 165
1:36:50
is. I just wanted to make sure. Oh, no, immediately. Dr. Kaler. Yeah, thank you. I was wondering how much of this, if any, might be practical using telemedicine, telecommunications,
not physically being in the remote communities. is what could be done if you didn't have to physically be there? Oh, yeah, Dr. Scott, please. Yeah, thank you for that, Dr.
Speaker 81
1:37:15
Kaler. We've actually thought about that in trying to come
Speaker 75
1:37:18
up with not only our outreach model, but also trying to revamp our model at the DDC. And my understanding, and of course I'm sure there are many people in the room who know more about this than I do, is that there are certain legislative requirements on the use of telemedicine
and that specifically a physician visit over telemedicine should be a follow-up visit rather than an initial visit. It's unclear to us at this time, but maybe somebody can educate me about whether that would apply to some other non-MD member of our team at least having an initial triage, what we would call a diagnostic interview, which is a piece of the puzzle. It's not the only puzzle, and I would never, you can't diagnose a child.
with autism over telemedicine, and I don't think that we would be able to do the entire visit. But I do think that what we're, unfortunately, because we'd like to travel with the whole team, but that means that we have to lock up shop at the DDC when we have this huge wait list, because we only have a couple teams. So if we could have part of the team involved in a triage process where you get the information, at least the historical information, and then maybe be more strategic about how to organize the direct testing and all of that,
that's something that we'd be very
interested in looking at. I know that, you know, we, and
I'm at a loss right now, you know, we modified the telemedicine thing this go-around. And so, Maddie, we're going to look at that and pick that up and just see where it, one phone call to Deborah Ferguson would answer
the question. but we will check into that. Any other, Diana?
Speaker 26
1:39:06
Just one more thing. I'm guessing. Okay, good. One of the topics that we have over and over and over again since the task force was created back in 2007 is the question of the use of restraints in public schools. And over the last couple of years, I have been providing awareness-level training to school resource officers all across the state.
And I provided one just this week to police officers and a few first responders. just awareness level training and despite the fact that the Department of Education has put out really very good guidance on the use of restraints in public schools for students with disabilities the people I'm talking to
aren't aware of it and obviously don't know what it says. And every couple of years we ask the Department of Education can you promulgate regulations to provide some rules around how restraint can and cannot be used for students with disabilities and the answer every every time we ask from Courtney is we don't have the statutory authority to do that. And I think it's time for this task
force to have a conversation and to make a legislative recommendation about
Katie Sursa
Unverified
1:40:50
that. If the position of the Department of Education is that they cannot, their hands are tied, they cannot promulgate regulations on the use of restraints. And And so schools are just going to keep doing whatever they do, and it's very different from school to school, then I think it's time we need to pass a law that
Speaker 26
1:41:14
tells schools, that tells the Department of Education they need to promulgate regs.
And I'm just going to put that out there as something that we might be able to work on before the next regular session to have very specific recommendations for legislation on this particular issue.
That's it. Okay. We will look into it, and we will also visit
with Department of Education and just maybe get a confirmation that that's something that they would need.
All right. Anything else to be brought before the committee today? I thought it was a good meeting, aired out a few
issues. With that, we'll notice you for the next meeting. With that, we stand adjourned. You
Agenda
Call to Order
Opening Comments by Co-Chairs: Senator Keith Ingram and Representative Justin Boyd
Adoption of Minutes from November 8, 2018 [Exhibit C]
Adoption of Task Force Rules and Procedures [Exhibit D]
Consideration of a Motion to Authorize Chairs to Approve Special Expenses Incurred by the Task Force [Exhibit E]
Impact of the Provider-Led Arkansas Shared Saving Entity (PASSE) Process on Individuals with Autism Spectrum Disorder (ASD)
Changes By DHS/DDS on Specific Autism Programs - Expansion of Autism Waiver Slots - New Process for EPSDT - ABA Therapy Provision
Capacity for Early Diagnosis of Children with ASD - Dennis Developmental Center (DDC) Waiting List - COBALT Clinic Outreach - Capacity for Private Entities to Complete Assessments
Discussion of Legislation from 92nd General Assembly Regarding ASD [Exhibit I] -
Other Business
Adjournment
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — TASK FORCE ON AUTISM, May 16, 2019 | Agenda | 1 | Official source ↗ |
| Draft Minutes Autism Task Force 11-8-18 | Exhibit | 1 | Official source ↗ |
| Exhibit D--Autism Rules and Procedures | Exhibit | 2 | Official source ↗ |
| Exhibit E--Approve Special Expenses | Exhibit | 1 | Official source ↗ |
| Exhibit I Autism Related Legislative Overview 2019 | Exhibit | 19 | Official source ↗ |
| Handout-- New Process for EPSDT-- Angelyn Franks | Exhibit | 5 needs OCR | Official source ↗ |
Speakers
Senator Keith Ingram Chair
Unverified
Speaker 5
Speaker 8
Speaker 11
Speaker 19
Speaker 16
Speaker 25
Speaker 26
Katie Sursa
Unverified
Speaker 33
Representative Reginald Murdock
Unverified
Senator Missy Irvin
Unverified
Speaker 46
Speaker 52
Speaker 51
Speaker 67
Speaker 72
Speaker 75
Speaker 87
Speaker 88
Speaker 97
Speaker 101
Speaker 106
Speaker 100
Representative DeAnn Vaught
Unverified
Speaker 126
Speaker 121
Speaker 141
Speaker 74
Speaker 84
Speaker 147
Speaker 2
Speaker 58
Speaker 165
Speaker 81