Public Health, Welfare and Labor Committee- House & Senate
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take their seats we appreciate everybody being here this morning good
morning glad to be here and so we will call the meeting to order and mr. co-chair do you have
any comments thank you madam chair I'm just
Representative Jack Ladyman
Unverified
11:48
glad to be here be a part of the committee looking forward to work in the interim thank you
I will just say folks we you know i really want to dive deep into all the different issues that we are tasked with
being familiar with and educating ourselves so during the interim yeah it's my intention at least from the senate side to really have some meetings in different areas of the state as well and to participate and recognize and engage in our communities because i feel like sometimes we hold our committee meetings here, but we want other people in the other parts of the state to be able to participate in our committee process and hear from them, see what they're doing on the ground. So I would really like to be able to do more of that in this committee. So just be on the lookout
for those meetings, and I'd like to be able to visit and look at the health care that's going on, and not just the health care that's going on in different areas of the state, but also the welfare issues and the labor issues and the environmental issues those all come under our purview and I think it's really important for us to fully exercise our opportunities to educate ourselves about all those issues and how they're impacting the different parts of our state. So you can
look forward to that. At this time we will go to, okay, I'm going to recognize Senator
Chesterfield, you have a personal point of privilege. Yes, Madam Chair, thank
Senator Linda Chesterfield
Unverified
13:22
you so much, and thank you for allowing me to do this. It is imperative as the Committee on Public Health that we are very, very much aware of the health issues that are being so very challenging during this particular period of flooding and disaster.
and I want to thank the Department of Human Services especially because there are people who have hospice care and special needs and they have been very responsive in dealing with that because when you're about to lose your home where all of your services are it is imperative that those services be able to follow you so this committee I think should be very very much involved in the oversight of that as well because it's imminent and we have people whose lives are in imminent danger and their health issues are going to continue to grow
with the mosquitoes and the alligators and all those other things that seem to be challenging us. So I wanted to say thank you for allowing me to say that, but to keep our people
in your prayers as well. Absolutely. I concur with your comments and it's been on my mind
and as it has been all Arkansans, I'm sure. And there's going to be a lot that we're going to have to deal with in the follow-up of this flood and the disaster that's occurred in our state. I'd also ask you to keep Representative Ferguson in your prayers.
She's had an issue with her family, so if you would keep her in your prayers as well, I would appreciate it. All right, moving down our agenda, item C. Item C is expenditure of legislative council funds. This is special expenses, which our committee would have that may incur other than payment of mileage and per diem to members of the General Assembly for attendance at the meetings. This would include, without limitation, witness fees, interpreter fees, court reporter fees, things like that.
So I would like a consideration, a motion to authorize us to approve those special expenses.
So is there a motion? Senator Sample.
makes a motion is there a second second all right those in favor say aye a question Senator Hickey you're recognized yes I'm just going through what what does
Senator Jimmy Hickey, Jr
Unverified
15:42
B means special expenses does not include expenditure of funds in relation to hiring of a consultant why would that not special expense mr.
price you're recognized the issue there is it doesn't concern hiring a consultant if that that has to go before the council that has to go for legislative council to do that okay so so it would have to go before
alc what you're saying is this this committee would not do that But ALC would still have to do it themselves. Yes, sir. That's fine.
Thank you. Any other questions? All right. We have a motion and a second. Those in favor say aye. Aye. And opposed? Ayes have it. Motion is adopted. Thank you. Okay. Moving
down the agenda, item E, Department of Health, if you could come forward, please.
And as far as item D, consideration to adopt, if there's no objection, we will go ahead
and approve the minutes from the previous meeting without objection. all right you're recognized good
Shane David
Unverified
17:22
morning thank you madam chair members of the committee i'm laura shu i'm general counsel for the department of health and i have with me my subject matter experts to help me with our rules today we do have three rules to present to you and i will just go ahead and have mr
Speaker 41
17:39
david introduce himself thank you my name is shane David I'm a pharmacist with the pharmacy services section for the Arkansas
Shane David
Unverified
17:45
Department of Health our first rule before you today is dealing with the list of controlled substances there are several substances that we are adding to our list the first are adding some hallucinogenic substance substances to schedule one there are synthetic cannabinoids to schedule six and also to The Schedule V cannabidiol, which is a prescription also known as Epidiolex, this is part of the permanent promulgation process that we began last fall.
We had a public hearing. There were no public comments received on these additions. In addition to these substances I mentioned earlier, we also have some other synthetic cannabinoids that are being added. We also follow the DEA schedule. Dronabinol is an oral solution, and we're following the DEA scheduling of that, which is Schedule 2, and some of the other hallucinogenic substances that we're adding into Schedule 1. These are substances that were requested by the crime lab as items of concern.
Also, we try to always make sure that we're keeping up to date with the DEA recommendations. And so that's our presentation on the controlled substances list, and Mr. David is here
if you have any specific questions. okay while you're here why don't you since this is our first meeting public health just go through the different schedules and why they
Speaker 41
19:14
are what they are do you mind just for information purposes absolutely um okay so the schedules have been set forth are basically schedules in the state of arkansas are one through six schedule one and uh schedule ones have the highest level of
addiction potential or abuse potential with no medical defined use for those products. Schedules two through five, twos being the addiction potential decreasing with each schedule, excluding schedule six. Schedules two through five do have medical purposes but range based on their level of addiction
Speaker 50
19:52
or treatment. Schedule six is a designated scheduling that was put in place for marijuana and synthetic cannabinoid substances those substances as
defined do not have specific medical uses that are being determined in order to issue prescriptions for them okay
thank you other questions representative gonzalez thank you madam chair
Speaker 54
20:21
Will the Schedule 6s be reportable on the PDMP?
Speaker 41
20:27
From my understanding is that those substances aren't
Speaker 50
20:30
issued by prescription, and so I don't believe that would be accurate,
but I would have to consult with the Prescription Drug Monitoring Program about anything in
the future. I'm not aware of
that. Thank you. Any other questions? All right. Seeing none, without objection. this rule will be reviewed. Item F.
Shane David
Unverified
20:59
Moving on to item F, this is onsite wastewater rules and regulations. This rule's purpose is to establish minimum standards
for the design and construction of onsite wastewater septic systems in suitable soils. The rule details various system designs and soil criteria. We had a public hearing on November 16th. There were some public comments that were received and we did respond to those. Our responses were provided directly to the stakeholders that attended, and we also posted those on our website. This is a result of a collaboration with several different groups, and we have responded to any comments or concerns
and addressed those and made the changes to our rules. I do have Terry Paul here with me if you all have any specific
questions. are there any questions regarding this rule any questions okay thank you seeing none we will without objection that rule will be approved item G moving on
Shane David
Unverified
22:10
to item G this is regarding food service
establishments the purpose of this rule is to safeguard public health and to provide consumers food that is safe and unadulterated and honestly presented the proposed rule requires a certified manager to be employed by the establishment and the food certified manager requirement as a minimal cost and they will have one year to comply with that requirement we had a public hearing on November 16th and no one attended and we received no public comments and Terry Paul is also here
to respond to any questions was this rule
derived from legislation or could you tell me the origin of the rule it's
Shane David
Unverified
22:55
my understanding that this is to follow along with the FDA guidelines they have a four-year cycle and so we're catching up with the four-year
cycle okay any questions from the members of the committee all right seeing none without objection that rule will be approved all right and
I think that's it for y'all
thank you item H Department of Human Services Medical Services Thank you, Madam Chair.
Representative Roger D. Lynch
Unverified
23:59
I'm Isaac Lynham with the Department of Human Services Office of Rules Promulgation. Good morning.
Speaker 69
24:05
Janet Mayen, Director of Division of Medical Services.
Speaker 71
24:10
Good morning. Jim Brader, excuse me, with the Office of Chief Counsel at
Representative Roger D. Lynch
Unverified
24:16
Department of Human Services. Madam Chair, we're bringing this rule today. This is a state plan amendment that raises the reimbursement fee for private duty nursing. There is a consent decree from 1993 that requires us to get together with the stakeholders
and come up with reimbursement increases, and this is a result of that collaboration. Okay. This is one
of the stakeholders that you're... Could you describe this process, and are you doing this with all stakeholders? This rule
Speaker 69
24:52
began before we began our rate review process, so this is coming through prior to what we started on May 1, and this is just for private duty nursing to increase their hourly rates for RNs and LPNs
to help with our recruitment and retention of those private duty nurses. The total impact annually is
Speaker 72
25:12
estimated to be about $430,000, which is a combination of state and federal funds.
So is this through home health, hospice, that type of services? Yes,
Speaker 69
25:23
they can have private duty nursing and they can have separately through a private-duty nursing agency in their
Speaker 72
25:29
home. It's a combination. You can get private-duty nursing several ways.
Okay. And have you given us a timeline on your rate review?
Have you published or given that to any committee
Speaker 69
25:42
yet? I do have a monthly update you had requested. We started in May. We are reviewing the five other categories, and we have begun working on all of that and have reached out to each of the five provider types. I can get into further detail with this or no
we'll do that at a later time okay I mean yeah we will need we I may have you come back at the end of us
reviewing rules to have that certain update okay questions
Representative Jack Ladyman
Unverified
26:18
the hourly rate for these nurses up to be competitive with others in the region we hope so it does raise them to $56
Speaker 69
26:27
an hour and $38 an hour for our ends and LPNs respectively so did you look at in the region when
Representative Jack Ladyman
Unverified
26:36
you did the study was it regionally or was it within the state or how what were the parameters of that yes
Speaker 69
26:43
sir we looked within the state and we
did we did pull some Bureau of Labor Statistics for occupational employment for Arkansas nurses that were both RN and LPNs and then we did look at the fringe benefit calculations from other nursing home cost reports to see what they were averaging and then we did an overhead calculation to be built in and there was an allowance added for travel also all right thank you senator
Chesterfield thank you madam chair may I
Senator Linda Chesterfield
Unverified
27:16
go back to G for one moment
please okay one of the things that is of concern to me is what I perceive to be the growing number of individuals with hepatitis and the handling of food I'm on item G where you're talking about food service establishments okay what up
to get public we'll have to get Department of Health I'm going back to you that's Department of Health that's fine but I'll have them
Senator Linda Chesterfield
Unverified
27:47
come back it's not a problem. Let me go to the advanced practice nurses. I'm seeing that you're talking about the
registered nurses and the RNs. Are we dealing at all with the salaries of advanced practice nurses and where are they coming in with this increase? Yes, ma'am. At
Speaker 69
28:04
this time, this rule and these rates are applicable for registered nurses and LPNs. APNs we will be addressing when we do our rate reviews in the different provider types so today is just our ends and LPNs
Senator Linda Chesterfield
Unverified
28:22
maintaining individuals in the state are they moving
Speaker 69
28:25
to other areas because of salary I don't know that I can answer that
I know we increasing the rates to maintain the staff but I don't I can't tell you why they're leaving today
thank you thank you madam chair thank you and I'll come back
Senator Kim Hammer
Unverified
28:46
to you um senator hammer thank you madam chair would you give me some specific locations where this is going to apply to would this be like
the health service center down in Haskell or give me some specifics where these
occupations are utilized by DHS I will have to get excuse
Speaker 69
29:04
me senator hammer I have to get you specifics but a lot of these private duty nurses are used in homes with children that would like to be at home with their families and
so I will have to get you specifics of the agencies and where they're located in the
Senator Kim Hammer
Unverified
29:19
state okay that that kind of took me
in the right direction and so are there any providers here madam chair signed up to speak for against this rule no okay
Representative Roger D. Lynch
Unverified
29:31
and senator on that note I would note that there
Senator Kim Hammer
Unverified
29:34
were no public comments received whenever we ran this. Okay and these rates are comparable to regional rates?
Yes sir. Okay all right thank you thank you Madam Chair.
Thank you. Okay are there any further questions? All right seeing none without objection we'll review this rule. All right item let's see is that the only one I have from you from DHS? Okay we'll have you come back
and give us an update on the rate review timeline actually if you could just print off a timeline for us and send it to us that would be great and if we have additional questions from the members of the committee we may have you come back at the end of the committee meeting okay all right Ms. Hsu if you don't mind coming up I'll let Senator Chesterfield if you'll push her button I'll recognize you for that question on item G. Senator Chesterfield.
Senator Linda Chesterfield
Unverified
30:39
Senator Chesterfield, you're recognized. Yes, thank you, Madam Chair, and thank you so much for indulging me. One of the concerns that I have is the growing amount of what I perceive to be Hepatitis C, and I'm wondering what we're doing to protect
Shane David
Unverified
30:58
the consumers as these people work in restaurants. Yes. Thank you, Laura Shue, General Counsel for the Department of Health. I appreciate your concerns. We did assist Representative Ladyman with a bill this past session, attempting to address some of those issues that we've had with hepatitis A and the outbreaks in the restaurant industry. Unfortunately, that bill did not pass.
We are continuing our efforts with our local health units. We have 92 health units across the state, and we are able to get folks immunized and vaccinated as well as we can. Anytime there is an outbreak, we do address that on an emergency basis, and we do follow up with folks. If you would like further information, I'm happy to have Dr.
Haslow, the epidemiologist, follow up with you with more specific questions. Well, I become concerned when I see people rolling
Senator Linda Chesterfield
Unverified
31:42
hamburgers around in their hands without the use of gloves, and we don't know whether or not they're ill.
And I'm just wondering, is there an increased number of restaurants that are using gloves as a precaution just in case? And I don't know the answer to
Shane David
Unverified
32:01
that question, but we can certainly follow up with our environmental health folks and our investigators that look into the restaurant practices and get you the specific information that you need. I would appreciate it. Thank you so much,
Senator Linda Chesterfield
Unverified
32:14
Madam Chair. Sure. You're welcome. Representative Leidyman.
Representative Jack Ladyman
Unverified
32:20
Thank you. The bill that you referenced that I ran didn't get out of the House. There was a lot of good information that you all provided, not just within Arkansas but within the nation, and a lot of people didn't get that information. A lot of people in this room don't know that there were 4,000 cases in Kentucky. and it's moving this way my question to you uh would you all be willing to come and present some of that data that you gave to me uh updated at a future meeting happy to do so all right thank
you thank you all right any further questions all right thank you all right moving on item i Arkansas Department of Environmental Quality, if you will come forward.
Speaker 117
33:33
Good morning. Michael Grappay, Arkansas Department of Environmental Quality Chief Program Officer. Good morning, Madam Chair. Stuart
Speaker 122
33:41
Spencer, Associate Director, Office of Air Quality with ADQ. Good morning. William Montgomery, Policy
Speaker 124
33:48
and Planning Branch Manager, ADQ, Office of Air Quality. Thank you. You may
Speaker 122
33:58
proceed. I'll proceed with this item before you this morning. This is a fairly straightforward rule.
essentially the department is undertaking a rulemaking before our Arkansas Pollution Control and Ecology Commission that was initiated in the fall of 2018 to adopt the 2015 ozone standard that was put into place by the United States Environmental Protection Agency in 2015. We initiated that rulemaking, took it out for public comment, had a public hearing in November of 2018 there were no adverse comments essentially what this does we have a state law on the books
that requires that the department adopt the federal standards before they are effective in the state of Arkansas and just by way of background we do have a monitoring network that we employ throughout the state that measures the concentrations of various pollutants one of those is ozone and we are currently in full attainment uh with that standard throughout the state which means that we're meeting that standard or beating that standard um at all our monitored locations throughout arkansas and so i would ask um for a good vote on this um particular
or for for passage of this uh regulation before you this morning and also if you have any questions i'd be happy to entertain those
thank you are there questions okay um representative ladyman thank you um but you say
Representative Jack Ladyman
Unverified
35:26
we are in full attainment in all the large metropolitan areas little rock west memphis and those places that's correct are we close well i mean are we barely entertainment or is this going to could someone go over the line so we are in currently in ozone
Speaker 122
35:45
season ozone season starts may 1st and it runs through the fall and that is when arkansas is prone to have ozone issues because that's when it forms in the atmosphere cooks in the atmosphere per se we have weekly reports that our department puts out and i'm currently evaluating those design values at the monitors we're currently below the standard and at all locations the area where we see the highest value is in crittenden county in that memphis metropolitan statistical
area but we're hovering around 66 parts per billion and the standard right now is 70 so we're not in imminent threat of violating
Representative Jack Ladyman
Unverified
36:27
the standard do you know when the last time was that west memphis was a non-attainment it has been non-attainment
Speaker 122
36:37
correct it has been non-attainment shortly after i took my position i want to say in 2015 we undertook to redesignate from marginal non-attainment to attainment for Crittenden County.
We worked with Mississippi, Tennessee, Shelby County. But that was in 2016, I believe, when EPA made that redesignation. Thank you. Representative Payton. Thank you,
Speaker 133
37:02
Madam Chair. So I've got a few questions. We're adopting
Speaker 134
37:09
something that was drafted in 2015, and if my memory serves me right, there was quite a stir about this new plan and and what all impact it was going to have on
on the state of Arkansas if we tried to submit ourself to the new plan. Has there been revisions to it since 2015? Because this language specifically denotes as it stood on October whatever of 2015. Is it still the same or has the federal USDA changed it since 2015? So
Speaker 122
37:43
your recollection does serve you correctly. When EPA proposed to revise the standard, there was some concern that in several parts of the country we would be getting close to background levels of ozone.
I can say that since the standard was adopted that we have not seen that occur here in Arkansas. I think there were a number of measures that were taken into place. um we've seen facilities um take measures to lower some of the precursor pollutant levels epa also had the opportunity to revisit the standard under the current federal administration and they declined to do so so they have essentially moved forward with implementing the 2015 standard as it stands if i could have a follow-up yes please
Speaker 134
38:30
uh so what happens if we go over if we adopt this then we go
Speaker 122
38:36
over what happens well yeah non-attainment is does create some financial issues for the areas that are found to be in non-attainment it's usually a county level it can be a portion of a county but as we saw in west memphis there are measures that have to be put in place some of those were at the service stations the gas stations where equipment had to be added to the gas nozzles to basically trap some of that vapor that would otherwise have escaped and also you um the permitting process is
more difficult in an unattainment area there's non-attainment uh permitting requirements that are put into place that require more stringent modeling and um analysis before you can get a permit through a state permitting authority i think going back to representative ladyman's question the good news is that all of our data that we're collecting we show no imminent threat of of hitting that point where we would even be close to to non-attainment and i'd like to keep
Speaker 134
39:38
going go ahead so what prevents us from doing taking measures prior to this adoption that you know keep our standards keep us within the standard i mean is there anything preventing us from putting those adapters on the fuel nozzles or whatever as it's you know as it stands now
Speaker 122
40:01
no i mean in fact there's a program that's a federal program called ozone advance where a county can take measures voluntarily to thwart you know that particular area going back into
non-attainment if it was previously non-attainment and we actually advocated for we put out some public notice for participation in that program and i have to say that we didn't really receive that much of a response but there are voluntary measures that can be put in place several of those filling stations in in that area of arkansas continue to use that control technology for lack of a better term to to mitigate those fumes so that those are still in place in a number of
locations they're just not required under our state plan but there is a voluntary program that that is administered through epa and the states can avail themselves of that we just didn't really see that much interest when we put that out there so the
Speaker 134
40:57
only thing you seem to be referring to in ozone prevention is these nozzles at the gas stations what other measures would have to be taken if we were out of
Speaker 146
41:07
attainment well one of the interesting issues with ozone i guess you could
Speaker 122
41:12
say is transport and what what most people fully recognize is that air
has no boundaries like water has boundaries you have air sheds but you those aren't defined the same way that water is so one of the responsibilities of all the states is to implement plans that take into account the good neighbor provisions which says that you're not going to impact the air quality of another state negatively and so we are the recipient of some of that air I I don't want to pick on Texas, but we do get some of those emissions blowing in from that state. So Texas has to put into place a plan that shows that their air emissions are not going to negatively impact us
to put us in a position where we could go into non-attainment. So we work with the other states. We have a planning group that we're a part of that runs from the Mississippi all the way up to the Canadian border, or almost to the Canadian border where we we plan as as groups of states as a collective to to put in place measures where we're not going to trigger each other going into that kind of situation. Representative Payton I'll come
back to you if you have further questions no problem Senator Hickey. Right after I
Senator Jimmy Hickey, Jr
Unverified
42:20
pressed my button you touched on it of course my district I heard
you mentioned West Memphis earlier of course I'm adjacent to Texas Louisiana and Oklahoma what what and I heard what you said about the other states what if those other states do not have those plans in place but we do feel like that that's coming across the border how do we keep that from impacting us you know if this if this goes above the 70 above the 70 or whatever it is what would we do in that case it's a good question I
Speaker 122
42:53
mean I don't want to say that it normally
results in litigation. You see a petition, it's called a 126 petition. That's a section of the Clean Air Act that is invoked if one state sues another to say you're contributing to our air pollution, our air quality. That has happened before. It's happened recently. I can say that we work well with our region six partners, that is Louisiana, Texas, and Oklahoma. So we normally can stave off some of those issues arising. And the issues that we've seen with non-attainment in louisiana are pretty much limited to baton rouge new orleans the the southern parts of the
Senator Jimmy Hickey, Jr
Unverified
43:32
state as opposed to the northern parts of the state one follow-up madam chair what's the danger of not passing this rule it's been out there since 15 we
Speaker 122
43:45
haven't done anything why why now yes sir i can explain that there was some pause we hit the pause button because we did understand that the current federal administration was evaluating the rule evaluating the standard and there was some thinking that it could have been um adjusted that not being the case um we move
forward with adopting it at the state level um it's already in effect for the largest facilities the the biggest facilities when they model they have to model using the new standard and also it's a statutory requirement that we do adopt um the federal standards so they before they become effective in our state thank you sir thank you do you know how
long that's been a legislative standard the i'm sorry how
Speaker 122
44:27
long it's been on the books that we adopt the standard that
we adopt whatever federal rule i think it's
Speaker 122
44:34
2015 i want to say it was a couple of sessions
ago maybe 2015 is that correct 2013 2013 and what's that
Speaker 121
44:46
code reference it's eight four three eighteen b1 okay thank you thank you senator hammer thank
Senator Kim Hammer
Unverified
44:54
you ma'am chair can you tell me in an area where that is identified as being out of compliance how do you go
to the source of who's actually contributing to that area being out of compliance how do you separate it it's a good question a lot
Speaker 122
45:08
of times modeling is done you can use backed trajectories to show the impact from that particular modeling profiles the truth of the matter is in Arkansas you don't see point sources which are the sources that we regulate being primary primary contributors to ozone it's it's largely area sources and also vehicle emissions and which we don't regulate so we are in a in a tough spot where if we did have to implement measures we there's really not that much
more that the regulated facilities can do because they've already implemented a lot of innovative control technology to to ratchet down their emissions so
Senator Kim Hammer
Unverified
45:46
what's the purpose of dating this rule then if you can't get down to the source of the problem well we have to adopt the 2015 ozone standard
Speaker 122
45:54
on the state level to prove to EPA that we have what we need to implement the standard. If we don't do that, and I know you guys have heard the threat of EPA before, and I can say we're enjoying a good relationship
with EPA at this point, but if it's demonstrated we don't have what we need on the state level to implement our measures according to the Clean Air Act, then EPA could come in and threaten to pull our program or to come in and implement it themselves. One more, Madam
Senator Kim Hammer
Unverified
46:30
Chair. What is the financial impact to the smallest person in the chain of events that this rule is going to impact?
Is it going to impact the independent gas station, or what's going to be the financial impact to the providers? There is no
Speaker 139
46:48
impact on this rule in particular. As we mentioned before, if the areas of the state, you know, they're prone
Speaker 122
46:54
to go into non-attainment in Pulaski County, Crittenden County were to go into non-attainment, that would have a financial impact, a negative financial impact. But as it stands with this rule and adopting it, there would be no fiscal impact. To the
Senator Kim Hammer
Unverified
47:07
county or to who specifically are you going to look to as far as holding them
Speaker 122
47:14
accountable? Well, when a facility is built, they don't have to actually model for ozone. Ozone isn't naturally produced from the facility. There are precursors. so I mean that is where we immediately look in our permitting process but as far as attainment non-attainment status you do look to the counties to see who can who can put in place measures to to be in compliance with that standard. Thank you. Thank you. All right any further questions?
Representative Jack Ladyman
Unverified
47:47
Representative Leidyman. You touched on this if and the discussion here seems to be why do we need to do this now and is there is there a real need to do it but the the epa has the authority if they choose well they monitor let me ask the first question they do audit how we implement our in our environmental programs is that correct epa does on a regular basis yes that's correct
is that is that on a five-year basis or is that ongoing what is that monitoring
Speaker 122
48:23
program We receive federal funding from EPA in the form of a grant, the 105 grant, and part of that grant involves a work plan that we submit to EPA that has certain criteria that they check to make sure that we're in compliance with receiving that funding, and one of those is ozone, or our NACs, the National Ambient Air Quality Standards,
Representative Jack Ladyman
Unverified
48:45
implementing those effectively. So the state implementation program that we have EPA monitors that if we do not adopt the national standards and don't have good reason for not adopting those they could come in and it is a possibility that they could withdraw our implementation program and EPA would be basically running the environmental program in the state. Is that correct?
Speaker 122
49:09
They could call our implementation plan in for review, and they would be, I think, very arduous in the way they reviewed that if we weren't complying with a federal requirement. Thank you. Thank you.
Speaker 133
49:27
Representative Payton. Thank you, Madam Chair, and I think you may have just answered a large
Speaker 134
49:34
portion of my question. back to the language here where we're adopting it as it existed on october i don't see the date
right offhand in 2015 i mean october 26 2015 i mean the federal epa i mean they can change that and we would still be locked in to the October 26th of 2015 so have they are you saying that it has not changed since then with a new administration coming in and
Speaker 122
50:10
everything that's correct in fact they've reviewed other pollutants other emission
criteria pollutants and they've kept the levels where they were previously and I
Speaker 134
50:19
think somebody asked you earlier but if you would tell me again what your answer was we have not been out of compliance anywhere in the state since 2015 when this was adopted correct
Speaker 133
50:34
okay thank you thank you madam chair thank you
are there any further questions any questions all right seeing
none is there an objection to review in this rule okay see no objection then the rule the rule stands review thank you for the diligence and for all the questions members of the committee and also agency for giving us all the information we appreciate the work that you do and that's another example of us diving a little bit more deeper into these issues and being able to visit and see actually what you do and how the permits work I really want to make sure that we schedule those so I'll be in contact with you okay thank you madam
Chair. Yep, thank you. Senator Hammer. Yes. Thank you, Madam Chair.
Senator Kim Hammer
Unverified
51:22
Senator Hammer. Can we just ask, is y'all's building in danger of being impacted by the flooding? We know you're sitting down there. Can
Speaker 172
51:31
we get a report on that, Madam Chair? Yes. Yes. Actually, we do not believe that we'll now be impacted by the flooding. We've got a barrier up to prevent that if it happens. Currently, all of our people are at our building today so so no interruption of services no interruption of services today no
sir all right thank you thank you ma'am chair thank you for the
question thank you all right moving next is this the same we
item J you're staying there and we
have mr. gates with us all right if you will state your names for the record and
Speaker 117
52:17
then you're recognized to present item J. Michael Ruppe, chief
program officer for the Arkansas Department of Environmental
Speaker 177
52:24
Quality. Alan Gates, I'm an environmental attorney with Mitchell Williams here today on
Speaker 179
52:31
behalf of Tyson Foods. Jordan Wimpy also with
Speaker 182
52:38
Mitchell Williams on behalf of Tyson Foods. Thank
Speaker 177
52:41
you. May proceed. Thank you Madam Chair. Tyson Foods is asking by this rulemaking to increase the minerals water quality standards, excuse me, in the Poteau River and an unnamed tributary of the Poteau River, all in Scott County. Tyson Foods operates a poultry
processing plant in Waldron. It's been there for 30 years. In 2010, the plant received a new water permit, which imposed limitations on the concentration of minerals, chlorides, sulfates, and total dissolved solids, basically the salts that are in their wastewater discharge. And the understanding at the time was that the standards in the stream
were too low for them to be able to meet. They were given in their 2010 permit a three-year time period to proceed with a rule-making to increase the water quality standards. There's no practical way, economically feasible, to remove these salts from the wastewater discharge. They had been in the stream for 30 years. The question really was that the standard had not reflected what was really going on in the stream.
The study was done. A controversy arose, some of you may recall, in the 2014-15 timeframe about how these studies should be done. And EPA and ADEQ at the time asked Tyson to go back and add additional data, conduct additional field work. That has now been done. Tyson is still under the 2010 permit. It has managed to reduce somewhat the minerals simply by
recapturing some of the marinade and some other things, but there's a the basic amount of minerals in the wastewater Simply can't be removed and it's always been in the stream since that plant's been in operation So this rulemaking would increase the speed limit if you will the water quality standards for minerals to match what the stream's been doing. It will not allow for an increase in the minerals to be discharged. It will simply set the standard at a level where the stream has actually been for decades.
To support this request, Tyson conducted a couple of rounds of field study, going out and collecting biology samples from upstream, downstream, and from reference streams. And all of that sampling showed that the aquatic life use, which is the most sensitive use, the fish and bugs actually live in the stream, they're the most sensitive, that that use is protected. We believe that we have agreement from the biology people at the department that this is an appropriate change to be made now.
and we went out for public comment a second time based on the new data. There were no comments received and no one attended the public hearing other than Tyson's representatives. The matter has now been approved by the governor's office to proceed. We have a letter of no objection from ADEQ and we would like to proceed with finalizing this rulemaking. This will allow us to adjust the permit to match what Tyson's is actually discharging.
Representative Jack Ladyman
Unverified
56:17
thank you madam chair uh just for clarification i think you i think you stated this answer but just for clarification uh so this increase in the uh limit would match the stream standard in other words, it would not deteriorate the quality of the streams. Is that correct? That's correct. The
Speaker 177
56:49
stream, the actual concentration of minerals in the stream will remain the same. There's not going to be room for an increase in discharge in minerals to the stream. Okay.
Representative Jack Ladyman
Unverified
57:06
at the rule here and it talks about the tributary for chloride is 180 milligrams per liter and then for the river it's 185 is that due to other influences in the river
other tributaries is that why those numbers are different yes
Senator Kim Hammer
Unverified
57:35
okay thank you any other questions senator hammer thank you ma'am chair i noticed that this river in question that it flows across the state line so our neighboring states that are going to be impacted by this decision
have they been consulted are they in agreement or any potential litigation as a result of us
Speaker 177
57:50
passing this oklahoma is aware of this change but there will be no change in the water quality standards in the last five miles of the Poteau River so there will be no change in the current standard at the state line so they're good with it all right thank you thank
Representative Mary Bentley
Unverified
58:11
you representative Bentley just a point of personal personal privilege I want to thank Tyson for your great corporation in the city of Dardanelle during this flood Tyson has been outstanding incorporating with our community community community there and helping with sandbag and keeping our
community safe so I just want to take a minute to thank you very much for what
you've done there for the city of Dardanelle thank you very much representative thank you I'm sure you'll pass that on to your clients any other questions and this wouldn't affect drinking water
Speaker 197
58:39
is that correct there's no is there this these the drinking water use has been removed
from the Poto River for some years ago years ago okay thank you any other questions all right seeing none without objection this rule will stand reviewed thank you so much. Thank you very much. All right, moving on to item K. Mr. Gilmore?
We will be passing out the quarterly report from the Arkansas Tobacco Settlement Commission,
and we have you here with us. And Dr. Henderson, thank you for being here. Well, thanks for letting me come
Matt Gilmore
Unverified
59:25
before you. This is Dr. John Henderson, Chairman of the Tobacco Settlement Commission, Matt Gilmore. I'm former Director of the Commission, now with the Department of Health. This is a similar report we submitted you all in the past. Covers the quarter of July through September of 2018.
There's two different things. You should have a colored handout there, about three pages, and you also have the actual report. I encourage you to read both if you have time, but there's lots of information there. I will keep this as brief as possible and just kind of cover a few things here, take any questions you might have. We've broken this down into several different topics that the programs focus on, education's important, service, economic impact, things like that. And I'll keep it as brief as possible. on the front page of that infographic that you have there that he's passing out now.
Programs reached out to about 65,000 individuals across the state, health care members, community members, about 9,000 youth. This is about 20,000 more than this time period last year, so seeing a good increase there. It's important for the programs to get out and have some educational opportunities and educate folks on how to improve their health and keep their health at a good level. I'll keep going here. I'll point out one more thing down on that same page on the bottom on the left.
The number of screenings that were provided by the Minority Health Initiative and also UAMS East over in the Delta, about 85,000 screenings, 8,500, excuse me, screenings across the state there. And this is an increase as well from the same time period last year of about 2,000. So this is a good way for folks to go to one of these events. They don't charge for this, and they can get their numbers checked. then get partnered up with a local health care provider and get some guidance on how to maintain their health at the level they're at or improve it. Moving on, if you'll turn the page on the
research section on the top of that page, I'll point out a couple of things there. The College of Public Health at UAMS here in Little Rock involved in a couple of different research programs there. One with looking at birth defects and how that impacts the state and different things like down syndrome this is one of 10 programs in the nation that they're involved in there just seeing some good impact there and ways to provide some treatment for folks and prevent those in the future and then just below that another program they're involved in with some obesity studies and finding ways to improve weight loss outcomes here in the state
working with health care programs across the state particularly communities of community of faith programs and churches where they have an impact across the state working with folks that are on the ground level the local level and one more thing on that page I'll point out down below on the economic impact you will see there the programs all try to find ways to leverage outside funding in front and provide support for their different activities whether it be research or community education screens things like that they all are focused on that and try to make
the best of that as they can one program there the Arkansas Bioscience Institute on the right side of that section for every dollar they were given in tobacco settlement funds leveraged about four dollars and forty four cents so that's a good return they're seeing there and as I said all the programs try to do this and some are succeeded it very well so on the next page there you have some testimonies I won't read all those but you can feel free to read those if you have time and as I mentioned earlier you have the actual report there in front of you it's about 40 to 50 pages but lots of good information there lots of detail that is specific to each program that you can look and see for more
information there so I'll be happy to take any questions you might have if you have those or Dr. Henderson I don't know if he has any comments to make but be happy
to take the questions you might have. All
Speaker 210
1:03:15
right Dr. Henderson do you have comments? I would add that since this report was published the Minority Health Commission now has a new mobile clinic and I think we're going to see an even greater expansion of the preventive health screenings because of that mobile
clinic that's going out all over the state. The the other thing that I think is very important since the Health Department has taken over the control of the tobacco quit line I think we're going to see great improvements in what's done there to get people to stop smoking. They're training people in each one of the health departments, health nurses in each of the local health departments to instruct people on tobacco
cessation. So I think it's going to be much more effective than it has been in the past. Okay. Thank you.
Are there any questions regarding the report? All right. Seeing none, thank you so much for your testimony and for the report. Thank you. Thank you. Thank you for being here. Item L, update on the Medicaid reimbursement from the Department of Human Services. If you will all come to the table.
Speaker 216
1:04:48
GREG BRUDNICKI- Madam Chair, Kelly Link, Legislative Intergovernmental Affairs, would you like to go over uh, the report you
Speaker 217
1:05:13
asked for earlier on um, on, on rate reviews? while Ms. Mann is up here?
Speaker 69
1:05:18
Okay. Good morning. Janet Mann, Director of Medical Services, Arkansas DHS. I have a report, and I can get you your copy so that it can become monthly. We did announce the rate reviews on May 1st. The first five provider types that were selected were physician with a focus on primary care, ambulance providers, dental providers, personal care services, and day habilitation services in several different programs.
Since we have announced that, we have reached out and tried to speak with different provider organizations associated with those groups and individuals. We've received some very positive feedback. We're working on some surveys to get out this month. The clock is 90 days. I apologize. I should have led with that. So from May 1st, our goal is to issue our first round of rate review reports
Speaker 72
1:06:15
in 90 days. In some of the areas that we're working on is we've developed teams internally to work on this
that are program finance systems and rules and regs,
Speaker 69
1:06:27
subject matter experts. So we're going to look at the history and the utilization of the rates. We're going to look at network adequacy around the state from where beneficiaries are living to where they can reach these providers within a 30 to a 60-mile radius. We are also going to be looking at other states and innovative ideas and interested parties is a big focus for us to be able to reach out and have communication back and forth with the providers, their associations, and any
interested party. As indicated we have attended several meetings, we've reached out to them, that we've received letters, and then the internal operations right now as indicated we're doing the review of the history of the rates we've finalizing the cost surveys
Speaker 72
1:07:14
to send out and we've begun the mapping of the networks so that's a brief overview of the activity for the first month okay
when you say cost surveys are you talking about i mean because
i think a lot of times what we this happens i think everywhere is you have the cost of the cost of business goes up but the reimbursement hasn't really matched that is that what
Speaker 81
1:07:40
you're talking about with cost surveys it is we're
Speaker 69
1:07:43
going to look um the cost survey is the objective of that is to look at the expenses including overhead and expenses that have been dropped over the years for the provider types in addition to their revenue that is associated with those codes and then generic what the providers are comfortable with giving us about their overall revenue
percentages to be able to look at the whole scenario yes right because costs have gone up and reimbursements haven't okay all right and you're looking at all different types of groups you're not just looking at hospital-based or clinic you're looking at no you're looking at all across we're pulling
Speaker 69
1:08:27
we started with these provider types and they are not being but within each provider type you're looking we are not limiting it
okay with specialties or anything within those we're looking at the entire provider type be
it fee-for-service or specialties and okay
all righty other questions senator hammer
Senator Kim Hammer
Unverified
1:08:50
thank you madam chair when you look at provider types and the cost how are
you distinguishing between like a
say up organization that has multiple providers within that versus maybe one that is in a rural setting that has just very few participants within that provider group
and do you have any insight as to how you're going to associate the cost of doing business in one versus the cost of
doing business in another yes senator hammer we are we are
looking at trying to look at codes that are billed a good example would be with the personal
Speaker 69
1:09:31
care we're looking at very specific codes we haven't broken that down by provider type but the next layer after we get the raw data will be to then look at the network map of where they're located and
where the beneficiaries are located and that's the opportunity for us to be able to look at a rural versus an urban setting and additional I have not we have not designed anything for groups versus independent yet I'm not saying it's not on the to-do list but this we're trying to look at everything and specifically the urban versus the rural with with the provider reimbursement but also access and and how
Senator Kim Hammer
Unverified
1:10:14
are you going to when you or do you know at this stage
of the of the process do you know that when you get that back if it would be more cost-efficient to the state to say you need change your business model to become this because we can only afford to pay this are you going to leave it up to the individuals and just to make that choice once you you know come forth with what will be the the the reimbursement proposed reimbursement
Speaker 69
1:10:44
changes more than likely the latter I don't know that we will have the opportunity nor the
expertise to look at a business model for that individual type of provider I'm focused on the Medicaid reimbursement and the Medicaid beneficiary that may be getting a great deal out of my scope okay all right thank you thank you madam chair thank you are
there any challenges I mean that you have faced so far with trying to get the information that you need not so far not quite
so far but can may I get back to you on that in about two weeks after
Speaker 69
1:11:21
surveys have gone and come back and as we continue through the process
sure yeah I think I think that's probably yeah I think that's probably
important but we need to make sure that that's clearly communicated so that we get the proper information so that they can make you can make a good determination and a judgment so just we'll keep in constant contact about that all right thank you that. Are there any other questions? All right. Anything else that you have before
Speaker 225
1:11:54
us? Madam Chair, I think the next would be the kind of the update on where we're at with the Medicaid reimbursement through the PASS model. Okay. And our PASS team is down there with Paula and Melissa Stone. If they can introduce themselves and give you hopefully a brief update on kind of where we're at
Speaker 229
1:12:19
okay good morning my name is Paula Stone I'm the deputy director with the division of medical services and work with the passes and so we are three months in to the passes
taking full risk and beginning to pay make payments to providers so we have gone through many different different things and being able to assist providers in getting their claims paid. So we've done quite a bit of analysis on the types of providers who are struggling with claims payments and how the passes were needed to change things to make sure that claims were getting paid. We have two different kinds of providers in Medicaid. We have typical providers and those providers are professionals
and provide professional medical services through physicians, psychiatrists, mental health clinicians, OTPT, and speech. Those are our typical providers. And then we have a group of providers called atypical providers. And those atypical providers are the ones who typically don't provide services to the broader population of Medicaid. Those services are generally for people with high needs. And so those services are services like personal care, some of the DD waiver services, and services provided by paraprofessionals. So what we found with the
passes as we began this program is that the atypical providers were having a little more difficulty with processing their claims. So we analyzed that across all of the passes to make sure that there were things that we could do to ensure that their claims were being processed. So there is some short-term solutions for that, and there are some longer term solutions that we're all working together with those provider types, with the passes, and with DHS to ensure that those processes, they get in place and that they're maintained.
So with the providers overall, we worked through some atypical and typical provider payment issues with all passes. What we also did was we had, from the very beginning, a provider support line that we had at the PASS office at DMS. and if there were any specific issues with providers because not all of the issues were based on claims payment they were just sometimes where a provider needed additional training or there were some issue that sometimes we identified from that provider support log if there were particular issues that didn't
relate to the overall issues that we had identified then we work with the pass and that provider to make sure that those claims get processed in a timely manner. The passes will come after us and they can talk specifically about the number of claims that they've received and that they've processed. I think the second thing that we've done that happened is the DDPA, which is the Developmental Disabilities Provider Association, submitted to us a plan that they needed assistance with, a work plan. And so
We began daily calls with DD providers, with residential care facilities. We began weekly calls with other types of providers, making sure that we were able to work through. And so those were calls where DHS staff members, the members from those provider organizations, or those provider types, and the passes were on the line. We were able to work through a lot of issues, and then the DDPA also outlined some global issues that they needed. We've also been adding to that work plan, so we added the residential care facility issues
to that work plan, and we're working through that. So in that work plan, we have short-term fixes to issues. We have longer-term issues that we're all gonna work together. And then we have some things that are coming up across all passes. I'll let Melissa talk about the work plan specifically, unless there are any questions about the first part
Speaker 232
1:16:16
of mine. Melissa Stone, Division Director for Developmental Disability Services at the Department of Human
Services. So, as Paula mentioned, we started probably about five, maybe not, five weeks ago, it feels like maybe four, doing a whole bunch of phone calls. So we were doing daily calls with personal care and community and employment support, which is the DD waiver providers, and then providers of day treatment, and then speech therapists, occupational therapists, physical therapists, and behavioral health providers, and we started a call specifically
for durable medical equipment providers. So we've taken all of those suggestions based on those calls and emails and every other line of communication that comes through us, And as Paula said, kind of started morphing a document that the DD providers gave us into a master work plan. So last Friday was the second week that the work plan has been up and available online for anyone to view it. So anyone at any point in time can go to the PASS website, which is www.pass.arkansas.gov, that we operate at DHS, and see right where we are on the work plan.
so the right now the work plan is 10 pages it shows you the overarching issue that's affecting our providers that um that goes across all three passes so we try to make it universal issues not as paula was saying individualized questions coming in that we're working one at a time but if it falls into one of these major category buckets that we think is affecting multiple providers at all the passes it's entered on the work plan it's given a scheduled tentative completion date you'll see who's responsible for it and then each week we go in and we update the
progress that's being made on it if it's being tweaked or added to based on the multiple calls we've had that week um so uh as i said we stated we posted this second version um friday night about 5 30 and our plan is to update that um on a weekly basis and post each friday it is the plan that Paula and I and the PASS team are working off of with the PASSes, so it is the primary focus, except for the urgent calls that are coming in, of course, are also a focus, but
this work plan encompasses a lot of different issues, and we hope it is helpful. So far, I think the providers have found it helpful, and we will continue to add issues to this work
plan. Okay, questions? Senator Hammer? Thank you,
Senator Kim Hammer
Unverified
1:19:01
Madam Chair. Would you talk to us about Optum and the assessments, if this is appropriate time, Madam Chair? Give us
an update on Optum and the assessments and where we are on that,
Speaker 229
1:19:18
please. Senator Hammer, I can update from the
PASS perspective and so the individuals that are going into the PASS are either behavioral health, have a behavioral health, significant behavioral health issue and a functional deficit due to behavioral health disorder or they have a developmental or intellectual disability. So for those individuals that have a developmental or intellectual disability, most of those or all of those independent assessments have already been completed. They only have to be updated every three years and there would only be an independent assessment for those individuals once they went through the eligibility for the C waiver and so that's
another process. On the behavioral health side of things then we do have an annual behavioral health reassessment that's done because we know that those individuals with behavioral health disorders can improve. They can recover and they can get better so they may not need continued services in the past since we only have those with functional deficits. So we had about 23,000 individuals who got an independent assessment for the PASS between January 2018 and May 31, 2018, which meant that they had to get a reassessment in the
midst of having all of this new PASS piece come into place. So we sent over referrals for all of those assessments. So in that process DHS identifies those individuals that need an independent reassessment and then Optum makes those calls. They've begun working with the passes because the passes are providing care coordination to all of those individuals as well. So we were able to get through, Optum was able to get through about half of those independent reassessments. So to ensure that we did not have an individual that did not receive that independent assessment
that needed to continue get services, we move the end dates for those independent assessments to August the 31st. So we have some renewed focus on getting those independent reassessments completed. As well, for the behavioral health individuals, there are individuals who are being newly identified as needing those home and community based services that are only offered through the pass. We are continuing to get referrals for those.
Those referrals come from the behavioral health provider. They go to our prior authorization retrospective review vendor, that is EQ Health, and EQ Health sends those referrals to Optum for that independent assessment. Optum does make phone calls for those independent assessments, and when the beneficiary responds of that phone call, they schedule those and complete those. So we don't have a lot, and I don't have my numbers with me.
I'm sorry I'm not prepared for the number of individuals that are actually responding and scheduling independent assessments based on the number of individuals that are being referred for those independent assessments. I will say, Senator Hammer, that we have a meeting that we're scheduling the week of, I believe June the 17th with the providers with Optum and with EQ Health to review all of those referrals that are coming in. We are going to do some data analysis on the number of beneficiaries
that are being referred for independent assessment. If
Senator Kim Hammer
Unverified
1:22:48
they're tier one, they don't need an independent assessment.
Speaker 229
1:22:51
Is that correct? That is correct. If they only need counseling services, they do not need an independent assessment. They can get those services with those outpatient behavioral health agencies or independently licensed practitioners. And is there any
Senator Kim Hammer
Unverified
1:23:04
effort to move as many people to Tier 1 so we can minimize the number of assessments, or is there any effort to move them to Tier 1?
Speaker 229
1:23:15
So any time you're providing services, then the hope is for the behavioral health population is that people will utilize those services and they will recover, they will get better, and they would not need those home and community-based services. So in that we are creating plans for the providers are creating plans and providing services, I think the effort is always to move individuals to only needing Tier
Senator Kim Hammer
Unverified
1:23:45
of the – I mean, hindsight 2020,
was that not part of the problem? A lot of people were sending for assessments when they didn't need to be because they should have just been Tier 1, and a
Speaker 229
1:24:00
lot of there was an influx of assessments that were going yes we believe that to be the case that that providers and and even beneficiaries may be confused that they have to get an independent assessment to get any service so we are scheduling that meeting to try to work together to to make sure that all the providers understand the array of services that can be provided without
Senator Kim Hammer
Unverified
1:24:18
the independent assessment and that's going to be the
Speaker 229
1:24:23
june 17th meeting y'all are having the week of june 17th
Senator Kim Hammer
Unverified
1:24:26
we haven't set the date but we'll let you madam chair i'd like to ask some questions
about care care coordinators you want me to go to the bottom of the queue
yeah um just to follow up a little bit on that because it seems like do you have a percentage of how many let's say kids that are in medicaid and how many of these kids that are in medicaid are going into the passes because it seems to me not every child that's in medicaid needs occupational therapy physical therapy or speech therapy but it seems like everybody's going into the passes and that's not
what was intended is that correct yeah
Speaker 229
1:24:58
that that was not we only the only individuals who needed to be in the past are those that have met the criteria to be on the dd waiver or those who have a behavioral health condition that causes a functional deficit so they would not be able to stay in home and community-based settings without a lot of support and so just those individuals who just need counseling services OTPT speech therapy or that just need behavioral health counseling should not be going into the
pass okay and do we know that that's the case
Speaker 229
1:25:29
or not so I think we can do the analysis of how many but I think the only way you can get in the front door of the pass again for the DD side with the developmental disability or intellectual disability would be if you went through the DD waiver and that is a and I'll let you talk about the process for that so you you would not be admitted to the past through the independent assessment
Speaker 243
1:25:53
okay so for the for the DD side Paul is exactly correct so we still maintain control of
Speaker 232
1:25:59
establishing that medical eligibility through the front door so when you apply to get services through DDS. You go through the DDS office through our intake. You fill out an application. You have to meet those five categorically qualifying medical diagnoses and have deficits in your daily living skills. And you're either, as Paula said, you're living in an intermediate care facility, the private ones. You're on the waiver itself, which is about 4,600 people right now, or you're on the wait list. And we have about 2,400 people on the wait
lists that are in the past so those and also there is a high use of otpt speech for that population but we we have a pretty finite number of people that are going to be in the past so we're going to always have around seven eight thousand people because there's only so many slots on the waiver and so many people that actually meet that eligibility criteria
for us okay so so what's So how many, what's the percentage of Medicaid recipients that are in the past currently, like today?
Speaker 229
1:27:07
So there's, for the total population, I mean, we can do the calculations, but we have almost, so over 800,000 people who are Medicaid beneficiaries today. Right. And less than 45,000 people are in
the past currently. Okay. But the 8,000 number you're referring to, Melissa, is part of the 45,000.
Speaker 232
1:27:39
Yes, ma'am. It's the clients that meet the eligibility criteria to be intellectually developmentally disabled. Okay. But what
about the rest of the people that are in the 45,000? So that would be behavioral health clients. Right. And that's what I'm talking about, is behavioral health clients that are there. what is the definition of a significant behavioral health issues because I feel like there's
an over-utilization at this point and
and I say what what qualifies somebody as a as a significant is
it because they're taking Ritalin because they have a prescription of Ritalin that's a
Speaker 229
1:28:21
behavioral health issue or no it should not be so the what what we for particularly for children it's the definition, the federal definition of seriously emotionally disturbed, which is a pretty significant designation. And the designation for that is that it's an age range, which is under 21. It's a range of diagnoses that are medically in the diagnostic manual that only a professional can give that
diagnosis. And then the independent assessment does the functional piece of this. And so what we should be seeing is that they meet the criteria for the medical diagnosis and the professional has diagnosed them, but then the independent assessment is reflecting once the parent is interviewed is that that diagnosis is causing a deficit that if they don't get additional services beyond the counseling or the medication management that they would go into institutional levels of care. And so what, again, what Senator Hammer was referring to, and I think it's the same thing
that you're referring to is the concern that instead of just those individuals getting into the pass is that we're seeing every individual who signs up for behavioral health services or has a diagnosis getting referred for an independent assessment and then going into the pass. And so, yes, and so we have some work to do around that. Again, we've gathered all of our data and we're going to be meeting with providers as well as Optum and EQ Health to make sure that we are
looking at and actually independently assessing only the people who truly need that independent assessment. We don't want to have parents. Do they have the opportunity
to say no we do not believe this one meets the criteria for an independent assessment? Do they have the ability to tell you that? So the parent could decline the independent
Speaker 229
1:30:16
assessment. No I'm talking about Optum. This is Optum. So we do not have that set up where Optum could say they do not meet. But what Optum does is once they're referred by that provider, then they go ahead and do the independent assessment.
We do, and so they do the independent assessment. If they tier out one, then that means that they don't need those services. Okay.
And I just would like to get a breakdown of who the 45,000 people are. Like how many of them are children, how many of them are adults, how many are on the waiver. You know, it would be nice to have that information. Okay,
Speaker 250
1:30:52
I'm going to go to Representative Murdoch. Thank you, Madam Chair. On the topic of assessment and reassessments, as
Speaker 251
1:30:58
they have done to the individuals that are currently getting care,
my concern is I continue to get from my constituents, I got a card even this weekend, a note in the mail that their treatment was changed based upon an assessment, and they totally disagreed with what was happening to them. It was affecting their quality of life. And they would continue to try to work and maintain, but in the note that was sent to me, it was just a continual concern of them not being heard in the process.
Senator Irvin just asked a question about who can have input in these final determinations, And certainly the patient should have some, or in my opinion anyway, a lot of input as to their care, meaning we make decisions of diagnoses, and then as we practice medicine, if you will, or you all practice, or the providers practice, excuse me, their expertise, then they sometimes find out later that the decisions they made was not effective. So at the end of the day, if quality care, helping people, getting people better is our goal,
then it certainly is important that we listen to those that are being affected. So I'll be drilling down with you all personally to talk about these cases. But I want to know, when assessments are made, do the patients have an input in the process of the final determinations of what happened to them in their care? So Representative Merck, I'm glad you're going
Speaker 232
1:32:43
to drill down so we can look at the particular cases.
So it's different really for every population, not in terms of client information, but just in terms of kind of what the independent assessment means and what it means in terms of your care. So from the past perspective for the DD and the behavioral health clients, the independent assessment for developmental disabilities kind of...
Speaker 250
1:33:11
So this is behavioral health and this is therapies. Their therapies were reduced. Okay, go ahead.
Speaker 254
1:33:19
So if it's behavioral health, I'm going to
Speaker 229
1:33:24
let Paula talk about that. Thank you. So I want to make sure, and we may want to get together so I can understand what happened. Yes. Yes, absolutely. And so the independent assessment should have, if it tiered them a Tier 2 or Tier 3, then they would either go into the pass or if they had Medicaid eligibility, there are a small group of adults that are Tier 2 and Tier 3 and are not going into the pass due to their Medicaid eligibility.
And so for those individuals that are going into the PASS, if they're in the PASS, then the PASS is the one who makes that medical necessity determination for the services. So the only way someone's services would have been changed on the behavioral health side is if they got a behavioral health reassessment and they tiered a 1 instead and then they were disenrolled from the PASS. And so the only services that they would not have available to them would be those services that are contained in Tier 2 and Tier 3, which are those paraprofessional services.
Speaker 250
1:34:28
Senator Irvin, you guys help me if you can. When we went to this model and we talked about the
Speaker 251
1:34:35
rules and how this would kind of work out, we talked about the patient input and the patient care at the end of the day. Now your answer is that the pass, if you will, have the determination for the final results, if you will. So I want to make sure that we are not, as we go through this process, that we're not forgetting the end user,
the intended one to be helped in this particular case, that their voice is still
Speaker 236
1:35:06
being heard. Yes, absolutely. So I'll go back and talk about the independent assessment itself. So
Speaker 229
1:35:13
the independent assessment is not only, it's independent of any entity that has an interest in what happens to that patient, and we did that purposefully. And the independent assessment is a face-to-face assessment with the beneficiary. And so they have all of the information. So Optum goes out and interviews either the beneficiary themselves, if they're an adult,
or they interview the guardian or family member and may make some sort of observation with the child. But that is 100% done with a self-report from that beneficiary. So whatever they report on that independent assessment is what is documented. If they have some concerns that an independent assessor did not ask them the questions appropriately or did not interpret their answers appropriately, they can either file a complaint or they can appeal that independent assessment.
And so that's something that can happen. And we can also do quality reviews, and we've done a lot of those where if we have a call from a beneficiary that says, I don't believe that the questions were asked in the manner or I don't believe that I was heard or my independent assessment was scored, we go right back to Optum, and they go through those independent assessments and they look at that assessor and look at any sort of pattern that has happened with that assessor. So we can do those on those cases.
But, again, they all have a 90-day window for an appeal, but we can do that quality assurance piece of that before it gets to
Speaker 251
1:36:46
that. Madam Chair, if you will, a lot of times in these meetings, in this meeting and other related meetings to the passes and to help this Medicaid and all of that we're doing, Optum name continues to come up, but they're never at the table. Can I plead to someone to get Optum here so we can ask directly some of these questions?
Because when you have a 90-day window for appeal, a lot of these people have capacity issues. So they don't have the capacity to adhere to a compliance, something in black and white. We need someone to intervene on their behalf prior to that to make sure that it happens. But is that possible that we can get optimum here at some point? Yeah, I'll
visit with you afterwards. I don't have a problem with trying to get information from the people that we have contracted with
to provide these different services for us and to figure out how it's working and what needs to be done to make the relationship better. Because at the end of the day, it's about having a good relationship with DHS and whoever they're contracting with in order to get the end result quickly so that the patient doesn't get an interruption in care. And so I think obviously there's been some major bumps along the road on the implementation of this whole system and a lot of the work that Senator Caldwell has done in state agencies
has helped rectify some of those situations, but I think there's more work to be done, so we can talk afterwards. Thank you. Thank you. Senator Hamer. And if I could quickly correct myself, Melissa
Speaker 229
1:38:22
just reminded me, I think I said 90, she said I said 90 days for the appeal. It's a 30-day window for appeal. And then I also just wanted to add is that's one of the reasons why we set up the past ombudsman office, And so I want to make sure that if anybody has an issue that's in a pass or is trying to get into a pass
is that we can call the ombudsman for that very thing that you're saying is because individuals that are going into the pass may not have a capacity to represent themselves and adhere to those windows. So I want to make sure that they know that that ombudsman is out there
to represent them. Yes. I mean, I think the patients, I think that's important. However, it's also very important as far as who is treating the people. The providers have to have a level of, you know, comfort to say, am I going to get paid if I see this person or not?
So, you know, a lot of the patients are calling the providers saying, you need to sign up for this pass or this pass or this pass. Well, that's a business decision that a lot of providers have to make, and they're going to make a decision on that. So, you know, and I've had some problems and issues with the way that's been handled, And that was unfair to a lot of your different providers and level providers, particularly in rural Arkansas. So, you know, I think that part still needs to be flushed out because it's not accurate to say that they're getting paid 100% of what Medicaid is paying
when there was an additional amount of money that was going to handle those more difficult cases. And that difficulty doesn't change. It doesn't go away. so the money as the incentive to see those more difficult patients has gone away but the difficulties for those people to see those patients haven't gone away and so there's no incentive at this point for them to see those patients so I think there's some major problems still existing and it's and I think we have to work through that and I know that y'all are working towards
that and we'll discuss that I think further and Senator Hammer you're recognized thank you
Senator Kim Hammer
Unverified
1:40:28
madam chair real quick just a couple things the independent assessment tool that Optum uses they
Optum doesn't go out and solicit the people they just get the referrals from the providers or from other sources and then they implement the usage of the tool right that is correct but once they make that assessment does Optum have the ability to say this person was sent to us but based on the results of the assessment they should be a tier
one or tier two tier three and if somebody doesn't like that then they appeal that
Speaker 229
1:41:00
is that correct that is correct they do make that a tier designation and then that's appealable
Senator Kim Hammer
Unverified
1:41:06
right so they do have some input but it's driven strictly by the tool that they've been given to use that is correct and are any of the have any of the beneficiaries um are any of the beneficiaries being reduced to tier one by anyone um if they can't get assessed in other words because they can't get assessed they're automatically being pushed to tier one which really isn't the way
Speaker 229
1:41:29
out of work then that is right that that is what i was speaking about earlier with the end dates for those independent assessments we need to get those independent reassessments done for the behavioral health population so at this point in time no one has had an independent assessment or been disenrolled from the past because they haven't had that independent reassessment you're correct that has not happened but if they had their services dropped
Senator Kim Hammer
Unverified
1:41:53
tier one they have not okay and care coordinators would you give us an update on care coordinators
Speaker 229
1:42:02
yes so each of the passes have a requirement to have a care coordinator for each of the 50 50 clients for each 50 past members so it's a 50 to 1 ratio and they report on this they report on it quarterly but they've started we've asked for a monthly report and so we know that when the passes began in March that they absorbed the fourth passes beneficiaries their members almost 8,000 members came into those three passes in March because forever care determined
that they would not move forward into pass phase two so they've absorbed those and I think the PASSes are now working through making sure that they had to get all of the care coordinators hired and trained to make sure that those members got those. They are currently updating person-centered service plans because that's the main duty of the care coordinator is to have the person-centered service plan. So those are being updated for all PASS members and they are working diligently on
doing that I know that there is some turnover in care coordinators as there is out in the field for for any provider type you see some turnover and each pass is working towards stabilizing that workforce and making sure I can let Melissa speak it specifically to the care coordinators as they're working with the DD clients if you remember that behavioral health clients didn't have a service called care coordination that was not a service that Medicaid paid for
so this is a new service for the behavioral health population but for the DD population the DD waiver providers were providing care coordination so in that sense there was a shift between what the DD waiver providers were doing in that care coordination shifted over to the passes and so there's been some work ongoing that we've been involved in with that so just briefly and stop me if I'm saying too much. Is it
Speaker 243
1:44:02
getting better is what I want to know. It is getting better. Tell me why it's getting better.
Convince me that it's getting better. Let's do that. So
Speaker 232
1:44:20
I think for the DD, for the DD members specifically, it's a very case-by-case unique population that has a lot of family involvement and they're strong advocates, as all moms are, and um and they know what's best for their children and it's been hard for them and aggravating to have someone come in that they didn't feel like was trained enough or knew enough
and um ask them questions and to try to learn about the child but it it definitely came across as they were unprepared and so um we've just been working on what what we we thought would help so we've been bringing in a select group from each pass that are DD supervisors and training them specifically on things that we thought they need to know for this population of members and we hit a wall where I feel like we got to the point where we had trained them on all of these broad topics
and so we regrouped a week ago and said we need to have all of the care coordinators who serve clients with developmental disabilities train so they can ask questions to me and they can ask questions to Paula and to their passes in a group. So June 10th is a DD pass all care coordinator training. It'll be one of many. It'll be webinar so they will be live to answer questions that
they send in. We've engaged the providers to make sure that they understand what we're training on so that we're all singing to the same music sheets and keep getting them involved. But we're starting at ground zero. So we're starting with just keeping clients Medicaid eligibility packets renewed each year and keeping their DD level of care renewed every three or five years. And then what are the services in the past? And what do we need to do on the person-centered service plan?
And so it's going to be in-depth, and like I said, it's going to take time, and we're going to keep doing it and keep training on it until we're all more comfortable. We've been doing these trainings every Friday, but this one will involve a lot more people. So we think it'll be helpful, and we hope that the parents of our clients with disabilities see value in it because I do think that we have to keep training.
Speaker 262
1:46:54
thank you all right thank you representative richie thank you madam chair i'm encouraged to hear that as far as the uh the training and especially you know working with the parents i have a i guess a unique perspective because i do have a child who uh receives behavioral services I've got his Empower Pass card, all that stuff. And so, I mean, I know for me, as a parent, it's been confusing to try and figure out.
I mean, I get a letter that tells me, so we've got to do an evaluation or an assessment with Optum. And then after that, then we've got to go do this and we've got to do that. And so I guess I don't necessarily have a question as much as encourage you to show some grace. to the clients and the parents who are trying to figure all this out because if I didn't know all this stuff was going on I'd be extremely confused and I mean I have a little bit better insight than most of our clients so I just encourage y'all
Speaker 264
1:48:01
to show them some grace some latitude and over
communicate with them what's going on thank you thank
you I mean I've heard from a lot of people as well but you know again
I go back to the relationship a lot of times that they have with their their physicians and their doctors then that got interrupted and that was not supposed to happen you know and I think that's the number one relationship that I mean with that's got to be acknowledged with their parents and then who those parents trust for the care for their children
and all that's got to be part of that discussion and so thank you for that I appreciate your perspective and more work to be done on that and representative Crawford just I feel push your yellow
button and don't touch anything okay there you go thank you
Representative Cindy Crawford
Unverified
1:49:04
madam chair on a provider's point of view we're doing better than we
were the last time we were here. I think we were at 25% of people getting reimbursed. Today in my area with my constituents we're setting it around they still lack 40% and one in particular with arkansas total care outstanding is 29 percent empower is 34 percent and summit is 55 percent
what can i tell these providers because it it is slow is it ever going to speed
back up to where medicaid was so i think
Speaker 229
1:49:57
all of the efforts we've been making with those providers and and my guess is that that you're talking to providers who are atypical providers and i know that there have been a number of things that have been an adjustment for atypical providers as well as the passes
is understanding how to pay them and that claims have denied for a number of different reasons. They've either rejected at the front end or they've denied. And those are the things that I think we're working diligently on and making sure that in our work plan that we're looking at anything that impacted claims being paid across all three passes. And then, as you pointed out, the difference between the passes. And so one of the things that we've done, And we have daily reports that come in, and so daily reports for providers that call us
to say we're having trouble with our claims being processed or paid, so if there are specific issues. And then we've asked the passes to send daily reports to us as well to ensure that those providers, if they call the pass directly, that we're tracking that. So we're not only tracking the calls that are coming in, we're tracking the timeframe for resolution of those and claims to be paid. And then if there are any things that we need to do to intervene or support the passes.
And then the passes are also doing their own work on training providers how to use their portals or making sure that those individuals who are leading or providing or entering those claims have the training that they need to do that correctly. So we have seen, as you said, that there was an improvement, and I think between those individual efforts that we're making for individual providers, and then the overall efforts for different provider types, and I would use the residential care facilities as an example
of that, and so they were having particular problems. We started out with daily calls, phone calls, to make sure that they were getting paid, they ask those to be reduced to every twice a week, so we're down to twice a week calls. And then they've come up with a request that they would have each of the passes come to their next in-person provider meeting and spend a big portion of their time just going over claims, payment, and the provider portals and use of that. So I think we are, we have approached that in a number of ways, trying to make sure if
there are overall issues that we address those, if there are individual issues that we address those and in that if we see individuals across several providers then we know that there may be an individual issue for all passes or for one pass and so we are working specifically with a pass if there is a provider type and claims aren't getting paid or if they're being delayed or they're being rejected so we've taken that approach of working together collaboratively with those providers with all passes and then individually if needed okay and I
Representative Cindy Crawford
Unverified
1:53:04
appreciate that the ones that I'm working with had no mistakes all other NPI numbers mad everything was was perfect in an order but the slowness of the payment was still there so what about those who've made no mistakes who are doing everything they're supposed to be doing but yet they're lagging in the payments do you know what provider type
Speaker 244
1:53:35
that we're still having a problem is it
a specific provider is it a I have two that I'm working with yes
Speaker 232
1:53:47
so do you know if it's a developmental disabilities or it's a behavioral health because there is some differences in what
Representative Cindy Crawford
Unverified
1:53:54
we're dealing with right now yeah one of them is Western Arkansas counseling and guidance in Fort Smith they deal with both and the other is uh
Speaker 232
1:54:04
linda short and her okay facilities a behavioral health provider and then an rcf um so uh like paula said we do have a daily provider log if um if you haven't sent that to us
or they haven't sent to us please do so that we can assist them to see what's going on and why their claims are being so slow um because not only do we have a daily provider resolution log but as I'd like to mention Representative Ritchie we also do that for beneficiaries too so because it's not just all about providers and so we look at both reports every single day in addition to the master work plan okay I'm
Representative Cindy Crawford
Unverified
1:54:41
sure they're doing that they're in contact with you just wondering let me let
Speaker 232
1:54:46
me look I mean we do a date we do a weekly call with them as well
so I'll tell you this and I'll look into their particular case for you but some of what we're seeing is if they're not signed up for electronic fund transfers, it is taking an abnormally long time to get a check in the mail. And so we are looking at that. And it takes getting two paper checks many times to be able to get on the electronic fund transfer in their system. And then some people have had problems getting into that electronic fund transfer. So I'm wondering if that could be it. But I'll definitely look at Western Counseling and Linda's facility because
were very Paula talks to that facility a lot okay thank you thank you
and we have others and I'll make sure that they either come to me and I've got one right here I'll give you here and then I know that there's others that have outstanding billing and invoices and the different ones so I think that continues to be a something it's got to happen they can't see these people for free it's just not they have to pay their bills they have to pay their employees
they have to pay their light bills stay on so we'll continue with that all right seeing no other questions I appreciate that and we will have our next meeting and we'll have another update I'm sure on this the next meeting oh we do have we're going to hear from the passes sorry okay if they'll come up thank you Thank you.
State your name for the record, and then I'm not sure if we have any questions. We'll go to questions, or if you can give
Speaker 274
1:56:58
us an update, that would actually be nice. I'm sure.
Speaker 275
1:57:01
John Ryan, Planned President, Arkansas Total Care. Thank you. Nicole May, Interim Executive Director
Representative Cindy Crawford
Unverified
1:57:09
for Empower Healthcare Solutions. Jason Miller, Planned President for Summit
Community Care. Okay, if you could each give us a brief update as to, you obviously have heard from the previous meetings what's happened and then updates and changes that have been made
Speaker 279
1:57:24
from each of you that'd be great I'll start with you in the middle good afternoon thank you we have started we've had multiple provider calls and have been going on site to meet with providers who are having difficulty in billing or using our portal we started back up provider forums today every Monday starting today from 12 to 1 that will last through August so any providers that are having difficulty with empower can call into those forums
and ask questions as far as claims payment that has speeded up for us we have paid a total of two hundred and fifty eight thousand claims we're denying about 12% of our claims a lot of that is due to duplicate submission of claims and then we have 6.2% of claims pending or 19,697 as of this morning
okay what about your relationship with DHS and how is that working and is that are there some things that we can approve upon anything in
Speaker 279
1:58:42
that regard so So we pretty much have daily contact with DHS. We had a meeting this morning, we have a meeting tomorrow. So we are working with them very closely. We also have these provider calls that the passes participate in with providers and with DHS. So there is frequent contact with DHS on issue resolution.
Like they said, if we have a provider or member complaint, we send them a daily log every day on resolution or if it's still outstanding and the work that we're doing on those resolutions so I mean
thank you mr. Miller sure thank you similar
Speaker 276
1:59:24
to Nicole I think we're again we all are working very
Speaker 282
1:59:27
diligently with DHS we are on those daily calls as well which has been very helpful because we've learned some information so we're continuing to
to pay the claims and finding, continuing to find potential gaps or errors that may be there. They sort of range in different pockets from a variety of different things, but just last week, I guess before last, one of the things that I did was brought 15 technical people to the office, both locally and from our parent company, to delve into claims and kind of all the nuances and differences. then DHS volunteered their staff for about five hours and so collectively used what we had learned
and what we were gathering to what they had known, what they were gathering to make sure we were matching. So there's always those issues of matching and making sure that the MPI, the providers, everything is lined exactly in the system or things obviously can go awry. So what we've learned is really over the last several months and certainly the last few weeks, we've started to narrow the the group of folks that may still be having problems so while they are still there may still be questions or we're still working through those we've learned that our best approach has been to individually have
conversations some of them were conversing with daily sometimes several times a week in addition to those calls with DHS to make sure we're dealing with those issues one thing that got us a little bit as we were working on fixes and changes, some things changed in the middle, provider rosters changed or their profile changed. So we're having to really go back and find out how do you look now versus, okay, we put a fix in to do it, but if something's changed, we need to make sure we've got you back in the right fit so you fit in the kind of pig that's in a pig.
So we've been doing a lot of that individually. From a claim standpoint, we process to pay about $368,000, and we still have about $30,000 are still pending to pay that most of those are from may what's your
average time of receiving a claim and then paying it i mean globally we're still hitting
Speaker 282
2:01:32
uh seven days about 89 of the time but unfortunately for some of these atypicals and a few of the folks that aren't that we're still trying to figure out all the nuances there they may not always be falling in the seven days so
we've continued if that's the case and these have slowed as well mentioned in the other committee you're in that we are issuing uh advanced payments or credits based on claims as we've done we've given about four million dollars out to ensure that folks can have uh payroll and reserves and all that and then we'll balance it with the claims later so we are continuing to do that those that we don't do but a few a week now but but we that option is still there so that while we're working on something that needs to be fixed or we're working with this provider to work through
the details we have we have the option to still issue that credit if we need to
do that. Okay, is that the same with you?
Speaker 274
2:02:29
Okay, Mr. Ryan. Sure Senator, in response to where we see
Speaker 289
2:02:32
things today we're continuing to do outreach to providers as my colleagues have indicated on a daily basis on a weekly basis we're having webinars with providers. We have field reps out with specific providers that might have issues actually traveling to their offices and helping them resolve issues, et cetera, that seems to be improving and that's helping alleviate
some of the claims issues that are uniquely situated with provider types and provider volumes, et cetera. In terms of those volumes, in the month of May, we paid about 73,000 claims, and in total we paid about 164,000 claims. Turnaround time in the month of May was 82 percent within seven days. So in the inventory as it sits today, it's about 12,000 claims, I would note most of which our biggest check run of the week is on a Tuesday. And so since last Thursday, you have built some inventory up
that are a little bit higher
than you might normally see. Okay. Any other further issues or issues that we might need to focus in on? Not
Speaker 289
2:03:33
specifically. From where we sit, there's individual provider issues that we're seeing with billing in terms of what might be required and might not be required, connectivity with clearinghouses connectivity with edi payments etc and then that's where i see the biggest problems sure sure i i would agree with that um and they are getting resolved again
on a specific provider uh provider level i don't know every one of you have an online
portal is that correct that's correct which you're allowed to
Speaker 289
2:04:02
submit claims through that portal okay and in terms of the relationship with dhs i would just echo what both nicole and jason said it's been very collaborative uh been pretty intense as it should have been over the last couple of weeks with uh multiple interactions on a daily basis and i i feel like we've been able to to get things resolved with the agency and as we move forward towards getting in a good steady state okay thank
you representative crawford you have one question i'm sorry senator hammer that was you thank you Madam Chair,
Senator Kim Hammer
Unverified
2:04:35
are each of you still then offering accelerated payments? Yes. Yes. Okay.
And do you know today how many claims you have not paid, let's say, back to March when this all began? I don't have it broken down like that, Senator
Speaker 282
2:04:54
Hammer. One of the issues for us is we're seeing so many still come in for March.
It's hard to exactly look at which ones aren't paid for March and which ones are new for March. um because claims can for example this month we have um 33 000 more claims in from for march just in may so it's continuing to grow every month so it's hard to kind of at least for my standpoint i don't have
Senator Kim Hammer
Unverified
2:05:21
that broken down okay uh well let's let me let me move on and ask you a different question different
area there there are some individuals out there that maybe don't
qualify for TANF let's say because their incomes too high and then they get passed off to a pass or do you guys give individuals in that situation the same accessibility to providers that you do every everyone else or is there any anything that you do to distinguish differently between anyone that's sent you in terms of the provider
network that they might have access to or do you
Speaker 233
2:06:01
dictate which provider they have to go to absolutely
no okay all right thank you madam chair
Representative Cindy Crawford
Unverified
2:06:15
okay thank you last question representative Crawford you're recognized thank you madam chair I heard from one of my constituents that with summit they were wondering when the system would get fixed rather than just paying providers advancing them Monday month excuse me rather than advancing
providers money when will the system be fixed where you'll actually be paying the claims so I
need to get the details specifically but we have put in several fixes and several bypasses to
Speaker 282
2:06:47
overcome some of the connectivity issues with the EDI system or whatever it may be so that that has been done again as I mentioned there are sometimes the as we put in those we then have to make sure with that individual provider that we're able to get over some of those other
bumps and humps so we're trying to figure out with individuals and I know Claude and I and my folks they speak weekly daily usually so we're trying to We need to figure out exactly what the issue is and where the breakdown may be, but the system should be there for them to do it. Again, we're trying to analyze by provider what might have changed, what might have changed in the profile. Someone linked their NPI that didn't normally have it linked, that then changes their profile in the system versus how we changed the system. We need to make sure all that's built together. If we can get individually and have conversations about that, I'd be glad to do it.
It's easier to take the individual issue and address it because most of the global issues of sort of coming down now it's usually individual provider linkages because we have several that will go through and then someone else that doesn't so I want to make sure we get down so I'll be glad
to analyze that yeah and let's follow up on that and thank you for the question representative Crawford but if there's follow-up I know there are people in the audience or specifically that have issues or billing issues they can contact me or a representative but I will then be that person then that can contact DHS and then each of these three individuals as well I'm happy to do
that so um I know I've got a few here but whether it's a claims issue outstanding billing issue or um not being able to get timely phone calls you know to say what's going on with my claim I think you know those things are really important so that people are able to pay their bills out there and and then continue to see the patients and their care is not interrupted. So my number is 870-740-9694.
It's my cell phone for anybody out there. They need to contact me. I'll be happy to work in that manner with these individuals as well as DHS. All right. Senator Hammer, last question. Thank
Senator Kim Hammer
Unverified
2:09:01
you. are you are you tracking the amount of advances that you've given and what's your projected recoupment for getting that money back because one of the things that was brought up in the last meeting was a concern about some of these providers being advanced money and then kind of like payday lending
catching up with them down the road so do you have any providers that are not getting their billing methodologies down and continuing to get advances because I sure would like to know for providers going to go out of business before they do because they've been advanced but for whatever reason y'all aren't reimbursing them or recouping that money
Speaker 289
2:09:41
back so senator speaking for us we've had about 1.2 million dollars in advances or credits I asked this morning and we have not had any requests in the last week to ten days so our process and in
In part of that 1.2 million, we've actually had about a fourth of that actually paid back by providers, but we're not putting any time constraints on that payment recoupment. It's a big reconciliation process that will happen when we can coordinate with the providers and they are at a point where there's a stabilization and they're able to do that. So we're not putting a point in time settlement period in place. We're just working with the individual providers to accommodate them in the way in which they can.
Senator Kim Hammer
Unverified
2:10:25
Madam Chair, if we go down the line, but also are you keeping track of what you anticipate the recoupment amount from all providers is gonna be? Well, that's the 1.2 million that I mentioned. Okay, so that coincides with that number? Yes.
Speaker 275
2:10:42
Okay, Madam Chair, can we just get the other two on record, please? Yes, please. So Empower has advanced around
Speaker 279
2:10:48
$3.8 million. We have already been repaid back 25% of that. we are not I would say we've probably done two accelerated payments in the
last couple of weeks most providers are getting paid and using the system and so we do have in our accelerated payment agreement a 60-day time period in which you know they're supposed to return payment but we're working with providers individually as they're able to pay back those we
Representative Cindy Crawford
Unverified
2:11:21
here at summit we've issued about four million as well we know who those
Speaker 282
2:11:26
providers are but we have issued no mandated communication about when
that payment would come back we have had a few providers who have preferred to send their some of their initial payment back and we they've done that but we have a system in place to allow them to spread that over time so that we're not, we're not, we don't want anybody, the whole point of giving the advance was so they wouldn't have financial problems. We're not going to put them back in those situations. So there is no mandated time because you have up to 365 days to file a claim and we're still processing through claims month to month. We really don't have a mandated period
Senator Kim Hammer
Unverified
2:12:01
of time when those have to be in for us.
But each of you are still offering accelerated payments
if need be. If needed. All right.
Thank you, Madam Chair. Thank you. Thank you for those answers. All right. Seeing any further questions. Appreciate your time. Thank you for being here. Appreciate the work you're doing. Thank you. All right. Seeing no other business to come before the committee, our next meeting will be July the 8th at 1 p.m. in this room. So July 8th, 1 p.m. in this room.
And check your emails in case we have any further meetings or additional meetings beyond that. I will say if you have an interim study proposal Or you know of a member that does have an interim study proposal with this committee We will if they will contact me or representative ladyman We will work to coordinate with them when that interim study proposal will be heard We will schedule it so that we can maximize their time and hours All
right seeing no other business to come up for the committee we are adjourned
Agenda
A. Call to Order
B. Comments by the Chairs
C. Consideration of a Motion to Authorize Chairs to Approve Special Expenses Incurred by the House and Senate Interim Committees on Public Health, Welfare and Labor (EXHIBIT C)
D. Consideration to Adopt the December 10, 2018, Meeting Minutes (EXHIBIT D)
E. Arkansas Department of Health (ADH), Pharmacy Services and Drug Control, Review of Rule Regarding the Scheduling of Controlled Substances (EXHIBIT E)
F. Arkansas Department of Health (ADH), Center for Local Public Health/Environmental Health Protection. This Rule Revision Updates Soil Science Terminology and Removes Outdated Portions of this Rule (EXHIBIT F)
G. Arkansas Department of Health (ADH), Center for Local Public Health/Environmental Health Protection. This Rule Updates the Arkansas Code to the 2013 FDA Food Code Guidance, and Requires a Certified Manager to be Employed by the Establishment (EXHIBIT G)
H. Arkansas State Department of Human Services (DHS), Division of Medical Services, Review of Rule that Establishes the Rate Calculation Method for Private Duty Nurses for Dates of Services on or after January 1, 2019, State Plan Amendment 2018-015 (EXHIBIT H)
I. Arkansas Department of Environmental Quality (ADEQ), Office of Air Quality, Review of Rule Regarding Regulation 19, which Deals with the Arkansas Plan of Implementation for Air Pollution Control which Adopts the 2015 Ozone National Ambient Air Quality Standard, Promulgated by the U.S. Environmental Protection Agency (EPA) on October 26, 2015 (EXHIBIT I)
J. Arkansas Department of Environmental Quality (ADEQ), Office of Water Quality, Third Party Rulemaking Regulation 2, Establishing Water Quality Standards for Surface Waters of the State of Arkansas, Modification of Arkansas Water Quality Standards for a Segment of the Unnamed Tributary from the Tyson-Waldron Facility to the Confluence with the Poteau River, and for the Poteau River from the Confluence with the Unnamed Tributary to Scott County Road 59 (EXHIBIT J)
K. Review of the Arkansas Tobacco Settlement Commission (ATSC) Quarterly Report for July, 2018-September 2018
L. Update on Medicaid Reimbursement from the Department of Human Services (DHS)
M. Update on Medicaid Reimbursement from the 3 PASSEs (Provider-Led Arkansas Shared Savings Entity)
N. Other Business
O. Adjournment
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH WELFARE AND LABOR COMMITTEE - SENATE AND HOUSE, Jun 3, 2019 | Agenda | 2 | Official source ↗ |
| Exh C -Special Expenses | Exhibit | 1 needs OCR | Official source ↗ |
| Exh D -Minutes from December Meeting | Exhibit | 8 needs OCR | Official source ↗ |
| Exh E - Controlled Substances | Exhibit | 10 needs OCR | Official source ↗ |
| Exh F - ADH-Onsite Wastewater | Exhibit | 8 needs OCR | Official source ↗ |
| Exh G - ADH-Food Service | Exhibit | 12 needs OCR | Official source ↗ |
| Exh H - ADH-Private Duty Nursing | Exhibit | 14 needs OCR | Official source ↗ |
| Exh I - ADEQ-Reg 19 | Exhibit | 8 needs OCR | Official source ↗ |
| Exh J - ADEQ-Reg 2 | Exhibit | 12 needs OCR | Official source ↗ |
| Handout-ARK Tobacco Settlement Commission July-Sept 2018 Quarterly Report | Exhibit | 51 | Official source ↗ |
Speakers
Senator Missy Irvin Chair
Unverified
Representative Jack Ladyman
Unverified
Senator Linda Chesterfield
Unverified
Senator Jimmy Hickey, Jr
Unverified
Shane David
Unverified
Speaker 41
Speaker 50
Speaker 54
Representative Roger D. Lynch
Unverified
Speaker 69
Speaker 71
Speaker 72
Speaker 31
Senator Kim Hammer
Unverified
Speaker 117
Speaker 122
Speaker 124
Speaker 133
Speaker 134
Speaker 146
Speaker 121
Speaker 139
Speaker 172
Speaker 177
Speaker 179
Speaker 182
Speaker 186
Representative Mary Bentley
Unverified
Speaker 197
Matt Gilmore
Unverified
Speaker 210
Speaker 216
Speaker 217
Speaker 81
Speaker 225
Speaker 229
Speaker 232
Speaker 237
Speaker 243
Speaker 250
Speaker 251
Speaker 254
Speaker 236
Speaker 262
Speaker 264
Representative Cindy Crawford
Unverified
Speaker 244
Speaker 274
Speaker 275
Speaker 279
Speaker 276
Speaker 282
Speaker 289
Speaker 233