Public Health, Welfare and Labor Committee- House & Senate
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If everybody can get to their seats, we will start, we have a long agenda, so we'll just give a little bit,
everybody a minute to get down into their seat, to get to their seat.
And as everybody's coming to their seats, I'm going to
ask Secretary Gillespie if she can come up real quick, if Secretary Gillespie's here, just quickly have her come up right at the beginning. Okay, everybody in here? All right, I'm going to call this meeting to order. So I wanted
Senator, I mean, Secretary Gillespie to come to the table and talk right outside Outside in the lobby area, everybody out there paying attention, you've got this on your desk.
It's the Blue Umbrella shop. There's a pop-up shop out there. And I'm going to let Secretary Gillespie talk about
Speaker 10
1:46
Blue Umbrella real quick. Thank you. Thank you very much, Madam Chairwoman. And thank you, Mr. Chairman, for letting the Blue Umbrella do a pop-up shop here today. It's incredibly special for us. The Blue Umbrella was opened last February, and it is a shop that sells items that are
made by craftspeople and artists in the state with developmental disabilities. 100% of the proceeds go back to the artist and craftsperson. And this money is incredibly important for them because it gives them, a number of these individuals live in our human development centers around the state. Others are part of our adult day treatment programs, and this gives them some money of their own to be used. But I have to tell
you what it means to them is more than just the money. The fact that people want to purchase the items that they've made, you would not believe what it does. I mean, it just is such, it just really makes them feel like they are part of the Arkansas community which they indeed are and that they're recognized for their talents. So please take a moment if you can to stop by the blue umbrella outside and it's a great place for Christmas gifts. I saw that you had bought one
of the rugs that are made at Boonville and every part of that rug is made from the cotton that comes in and then it's colored and then it's dyed and woven every single piece of the process process is done by residents there and it really it's it's so important for them because they're all part of making something and it is the work they do every day everyone at boonville has a job and they all work and now their work is being sold so thank you for supporting the blue umbrella
here today and if you get a chance we have the store open there in the lobby of DHS come by our offices it's right there on main street we're doing an event with the rep in the spring so I mean it's really really exciting for us to see this shop take off and to see all of our artists and crafts people around the state get the recognition that they deserve thank you for making
Speaker 12
4:11
this happen today oh you're welcome and folks the
lanyard that she is wearing that was
made by one of the residents who can't keep up with the demand apparently um but that cute lanyard she's wearing is one of the products and if you'll look up here here's the rug and some christmas cards christmas ornaments um this cute candles and magnets um anyway they're just really cute stuff so it's a great little gift they have earrings jewelry out there ornaments decorations candles goodies all kinds of stuff so if you get a chance they take cash debit card um
or check or credit card so they've got the little machine to do it and represent ladyman i know that this is very close to your heart so i wanted you to
Representative Jack Ladyman
Unverified
5:03
make comments yeah let me just add one thing um it's really important to these clients that are making these things. It gives them value. If you're around them and see them and see how they work and they know what money is and they look forward to that money, but it gives them worth or value. I was at a meeting yesterday at the Jonesworth Human Development Center,
and they've got a new arts coordinator there, and they're really excited about expanding the paintings that they do and the birdhouses that they make and those other things so it is a really really good program and we appreciate you doing that thank you so much thank you for the support you're
giving them thank you so important so pass that around for folks and do a little christmas shopping thank you thanks thanks um as far as that we have a very busy agenda i'll try to move through this very succinctly as much as possible we are going to skip around a little bit in this agenda because
we are and we've got a lot on on the on this agenda but we're gonna skip around a little bit and with that I really don't have any other comments representative lady men do you have any other comments okay so first we're gonna go to item O that's on your agenda which is dr. Smith a report of Arkansas PANS PANDAS advisory council pediatric acute onset neuro neuropsychiatric syndrome is what PANS is. This was legislative, we had legislation that was passed during this
past session. Senator Hammer and I believe Representative Warren led this effort. So Dr. Smith has patients that he has to get back to, so we wanted to have him go ahead and come up first. So Dr. Smith, we're happy to have
you here. Look forward to your report and you're recognized. Thank you
Speaker 27
6:54
Senator. My name is Rick Smith and I'm a psychiatrist. I'm a professor of psychiatry at UAMS. I'm the acting head of child psychiatry at Arkansas
Children's Hospital and somebody who's old enough at UAMS to get unusual assignments. So I've gotten this assignment. My charge is to create a statewide resource for children with PANS, PANDAS, and what the larger broader term is childhood post-infectious autoimmune encephalopathy. That's a lot of big words. These are complicated illnesses that strike suddenly for
children that may be normal children and they develop very severe obsessive compulsive disorder or they may be children that are already affected by areas conditions and they suddenly get worse. After working with Senators, with Senator Hammer and Representative Warren in the last session, we were fortunate enough to link up with the Pace Foundation and their consortium of clinics. We at ACH and UAMS have become the fifth of eight clinics planned
nationwide to be multidisciplinary clinics to treat these children, to diagnose, treat, and assist with the care of these children. Those clinics are in Tucson at the University of Arizona, UCLA, Stanford, Wisconsin, Arkansas Children's Hospital, UAMS, the others that are likely to be developed at Harvard, Emory and one of the institutions in New York City. So far in terms of a progress
report we have recruited and trained two medical co-medical directors via site visits in Tucson, Drs. Rainey and Dr. Vera Pandian. Dr. Rainey is a child and adolescent psychiatrist. Dr. Vera Pandia is a pediatric neurologist. Subsequently made a site visit to Tucson. The current status is we've had a very soft opening of our clinic at ACH. We have seen one patient who's an 11 year old boy from
Northwest Arkansas who did have the disorder. Fortunately his pediatrician picked it up almost instantly and got him on an appropriate medication which I think has a much better prognosis for his longer-term outcome. For further details in this process and plan, we plan a weekly clinic that will see four to
six kids per week. I'll probably be able to start that in January. This is a nurse intensive model that we are proposing and the Pace Foundation advocates and it requires a full-time nurse. The funding for that full-time nurse has not yet been determined and is the subject of discussion as we go on. Last week we had a semi-surprise site visit to Little Rock by Paul and Patricia Ryan who are the
founders and guiding lights of the Pace Foundation. We had a whirlwind series of meetings through about a 24-hour period. During that time the Ryans met at a reception with advocates and key leaders. They met with the Arkansas Department of Health's communication team. They met with members of the governor's staff. They met with the Arkansas Children's Hospital communications team. There was a luncheon with Senator Hammer and
Representative Warren present. They toured Arkansas Children's Hospital in the clinic and they wanted to see the clinic space. We showed them the clinic space and they met with Ms. Marcy Dorterer, the CEO at Arkansas Children's Hospital. And we think that was a very significant meeting and I think it continues to submit the relationship with the Pace Foundation, which is pretty essential for us to get multi-site clinical trials. There's a big one that's
about to be open in about three months for intravenous immunoglobulin which is both a U.S. and a European study. We are working on a primary care strategy which is very essential for being able to treat these children effectively to educate primary care physicians pediatricians about the signs and symptoms of the disorder and the first steps to do that and then we'll provide
the backup for them at ACH. The future agenda is to secure the last details of the clinic including the full-time nursing to create the programs for primary care and pediatricians and to establish a clinic to see adults who have had these disorders at Children's and who had these disorders after being in childhood so these kids age out once they become 18 they're no longer seen at
Children's Hospital and we'll do that clinic at UAMS and the Psychiatric Research Institute so I'll be happy to pause and take questions or responses whatever thank you for that report are there
any questions and I just want to say so I love the systematic and
process that you're going through and the systematic approach and all that you're doing I mean
you're you're just not gonna I think on all levels and so I'm really excited about the partnership
with the private, the foundation, and what you're doing there and building those relationships and those connections and then learning from our fellow, your colleagues in Arizona and other states. So I couldn't be more pleased. I'm sure Senator Hammer feels the same way. It's a pretty good crowd, the other universities that are listed. It's a pretty good
think it would be a tremendous asset for our state and for our citizens particularly. Great. Thank you. Thank you so much for the report. Thank you.
Thank you. Okay. And then before we move on, I need a consideration to adopt the September meeting minutes. Do I have a motion? Second. Those in favor say aye. Aye. And consideration to adopt the October meeting minutes for Marshall and Jasper. Motion. Second. All those in favor say aye. Aye. Opposed. I have it. Consideration to adopt the November meeting minutes, which is Exhibit C. Motion and a second.
those in favor say aye and opposed eyes have it um and then i also would like to represent or rec i'm sorry recognize our newly elected colleague representative in it hi do
you have some comments welcome to the circus just push your button hold on just a second okay should come on
there you go I'm happy to be here thank you well we're glad to have you and congratulations on your election congratulations applause applause applause applause okay
um the next thing i'm going to do like i said we're going to skip around a little bit on this agenda um and so i want to get to our rules um first um just because that's that's one of the
main things that we need to look at um that need approval so um we're going to move to item j and we're going to do J, K, L, M, and N, which are our rules. So if I can have DHS folks come up. Yes, I'm trying to get you on. Are you 82? I think so. Senator Chesterfield, you're recognized.
Senator Linda Chesterfield
Unverified
15:48
Yes, thank you, Madam Chair, and thank you for recognizing my personal representative, representative in it and we look forward to working with her we ask that you be as helpful to her
far more than you have been to me thank you thank you senator chesterfield all right
item j um mark white and janet mann you're recognized thank you madam chair mark
Speaker 55
16:18
White, Chief of Legislative and Intergovernmental Affairs for
Speaker 55
16:26
DHS. And so members, we have three rules from DHS for you today. Each of these are the results of legislation, so I think these should be relatively straightforward, just implementing acts from the 2019 session. This first one, this implements act number 58 from the session, which adds spinal muscular atrophy to the list of metabolic diseases
for which all newborn infants in the state must be tested. And so this is simply implementing that act in our Medicaid manuals. Are there any questions? Seeing
none, without objection, that rule will be reviewed. Item K. Thank you. And item K, I
Speaker 59
17:09
tell you what, see, I have Trish Gan who's going to join me if there are any questions
Speaker 64
17:21
let's see trisha ghan deputy director division of aging adult and behavioral health services
Speaker 55
17:25
so item k implements act 567 this is a bill related to deaf mental health created some standards and some other provisions related to mental health services for those who are hearing impaired what these rules do specifically is as required by the act they create a certification process for mental health professionals who want to be certified in deaf mental health services and so the rules create that certification process and criteria so we can implement those provisions
of the act are there any questions i appreciate that you attached the legislation to
the rule that's very helpful thank you any questions all right seeing none without objection that that rule will stand reviewed exhibit l and then
Speaker 55
18:18
for exhibit l uh i'll allow jay to introduce himself as well in case there are any questions jay hill director for
Speaker 75
18:27
aging adult behavioral services you're recognized for this
Speaker 55
18:33
rule this implements act 567 this is an act relates to the ability of the Arkansas State Hospital to charge for services there is some language that was in the statutes that got accidentally repealed a couple years ago and so this act reinserted that language and essentially what provides is that the state hospital may charge for services but it does provide for the waving of charges for individuals who are indigent or unable to pay and these rules simply take what's in the statute and add it to the rules does not add to or expand on the statute in any way are
there any questions all right seeing none that
route that rule stands reviewed thank you thank you members okay department of health i mean yes come on up
we have item m which is exhibit m and Exhibit N and and call it members of
the committee Exhibit O is the legislation from Senator Hammer and Representative Warren on the PANS Panda that we've already had the report on
all right if you'll state your name for the record you're
Speaker 79
19:43
recognized good afternoon I'm Laura Hsu I'm
Speaker 80
19:45
general counsel for the Department of Health and if possible if I could present for item N Instead of item M, Dr. Patil is on his way. He also had a client that he was meeting with this afternoon, and so he was trying to get here as quickly as possible. So we're predicting his arrival about 2.15. That's fine. We can come back to it. If we could move to item number N.
This is the Department of Health from the Engineering section. This is the review of the rule which would increase the public water system service fee rate by 10 cents per water meter per month. It also updates references to two disinfection standards published by the American Water Works Association in accordance with Act 788, sponsored by Representative Douglas. This is 788 of 2019. And this rule also removes the word regulation and consistently uses the word rule in accordance with Act 315 of 2019.
And we had the public comment period in September and October. We also had a public hearing, and we received no public comments. Okay,
are there any questions? Seat 82. Senator Chesterfield. Yes,
Senator Linda Chesterfield
Unverified
21:03
Madam Chair, thank you for taking my question. We're having a
fee increase of $0.10 per month per service connection. What would be the average impact of that on a home,
or have you done anything to just look at that? Does
Speaker 89
21:27
10 cents begin to add up? Correct. Senator Chesterfield, I would ask for Jeff Stone. He is the director of our engineering section
Speaker 79
21:33
to come up and assist me in answering that question for you.
Speaker 94
21:44
Thank you. Thank you. I'm Jeff Stone of the Department of Health's drinking water program.
Ten cents per meter per month adds up to $1.20 a month for each individual house. So it's an amount of money that cumulatively through all the homes goes into being able to fund primarily our chemical analysis and drinking water quality assurance program.
Senator Linda Chesterfield
Unverified
22:19
And so we decided that what we had was insufficient, therefore it needed to have an upgrade in fees in order to do what it is you need to do. Yes, ma'am.
Thank you, Madam Chair. Thank you. Are there any
Senator Jimmy Hickey, Jr
Unverified
22:43
other questions? Yes. Senator Hickey? Just one, since you're up there. What analysis did you do to come up with the 10 cents? What did we do to come instead of $0.09 or $0.08 or $0.12, what did you do to arrive at that number?
Speaker 94
22:56
The program had for many years been spending a backlog of federal monies that help our program, although those federal monies are not able to cover the drinking water analysis directly. So different monies were needed for that. It brings us back roughly to the purchasing power of the original fee that had been depleted with inflation since our last increase many years ago.
And looking down the road where it appears that we're basically, due to federal rules, going to have to double our expenditures on lead and copper, sampling for water systems and also for unregulated contaminants it appears to be a balanced amount that would cover those things. Okay just one follow-up so the 10 cents was it equal to
Senator Jimmy Hickey, Jr
Unverified
23:56
the inflationary part was that is that all you covered with 10 cents or was there additional? I think there was
Speaker 94
24:03
a little bit more than just the inflationary part but it should be enough to
cover the added workload for lead and copper and unregulated contaminants. Okay and how much
Senator Jimmy Hickey, Jr
Unverified
24:15
was the inflation part just so we'll know I don't have you don't know that okay
all right thank you sir any other questions okay no questions without objection we'll let this rule stand reviewed and we'll come back to you on item M thank you okay as
they are leaving the table I'd like to We have Secretary Gillespie come up with Paula Stone and Mark White and whoever else you
need to bring to the table. You can just
Speaker 110
24:53
state your name for the record and then
you're recognized. She passed on this route? Yeah, without objection that rule stands reviewed. But we're coming back to M. Okay, just take your name for the record you recognized
Speaker 12
25:11
Cindy Gillespie secretary Department of Human Human Services. This is
Item D Members, we're going back to the top of the agenda item D. Go ahead
Speaker 115
25:32
director division of medical services Dawn Staley,
Speaker 10
25:39
DHS, Deputy Director for Health and Medicaid Director. Thank you. Thank you. We came to our attention recently that there was an issue that regarding ownership of a
provider that was part of one of the PASS ownership groups and we met with a number of you here. Thank you very much for organizing the meeting. You and Chairman Ladyman organized a meeting. We met with several representatives and senators along with those who had been involved in passage of the PASS legislation to discuss our, what we had believed to be the intent of the legislature when yes just one second members we're
on item d there's not an
exhibit for item d this is
just a report from dhs first and then we're going to have the representatives from the three different passes come up um what has participate or precipitated this was an article i believe by andy davis in
the arkansas democrat gazette that highlighted the fact that one of the past entities did not meet the membership threshold as outlined in the law that was passed and so there was some meaning so this is a report from DHS as to the actions
that are being taken I'm sorry go
Speaker 10
27:04
ahead thank you very much so the in that meeting what we discussed was both what we had thought was the intent of the legislature, which, and it was confirmed by the parties there that indeed it was the intent that all of the providers that are owners of the pass should be provider owned. They should not be owned by an insurance company.
Very simple. And that, as the legislation says, 51% of the ownership of a pass should be by those providers. Following that I'm going to turn it over to Deputy Director Stone to talk about the language that we then prepared. We do an annual provider agreement with the passes in which a number of items are set forward, rates, etc. as well as specific terms and we decided to address that
clarification in this agreement so she can update you both on the language as well as the discussions with the passes to date around this thank
Speaker 113
28:20
you go ahead so we added some clarifying language to our agreement with the passes each pass signs the same agreement and this would be for our 2020 agreement and that language adds some that a participating provider shall not be owned in whole or
in part by an entity licensed by Arkansas Insurance Department or by any state's insurance regulatory agency as an insurance carrier or a health maintenance organization participating in the same pass. So we had sent this language out to each of the passes we have written agreement from one of the passes that they agree with this language we have verbal agreement from another pass and then third pass has asked that they take that language back before their board at their next board
meeting we also have some contract language changes that we're working on just as a on other issues that we're working on and we have a meeting with all the passes on Thursday to complete that contract language so they've asked that they take that back before their board but no one has had any major problems with the language at this point and it it it appears that this is going to go forward in our new contract in our new agreement correct okay so um we're going to open it up to
questions and members for dhs the the there are representatives from all of the passes that are here that can answer and they'll come up next to discuss this and so that we can ask them
questions as well about their makeup how they're made up and their boards and how they're act you know all of that so um senator hammer you're recognized thank you madam chair was there any financial
Senator Kim Hammer
Unverified
30:04
gain that the passes who exercised this option on their own realized as a result of it did they
get any more money than they would have if they'd operated the other way or what
was uh from dhs's perspective what was the uh intent for them doing it in the first place so that would have
Speaker 113
30:24
would not have changed the per member per month or the capitated payment that they received from us that's based on their membership follow-up madam chair yes would
Senator Kim Hammer
Unverified
30:37
it have and maybe this will be a question for them so they can get ready when they come up but would it have changed the way they were able to reimburse providers within their individual
structure because of them taking that view of how the language was written. The payment to individual providers also is regulated through
Speaker 113
31:01
a different part of this agreement, so it wouldn't have changed that either. Okay, thank you. Thank you, Madam Chair. Senator Hickey? Yes, ma'am. I
Senator Jimmy Hickey, Jr
Unverified
31:14
would have liked to have had what you read in front of me of course I was trying to listen could you read that last sentence again there
was something you said about participating in the same pass I want to hear
Speaker 113
31:31
that a little closer a participating provider shall not be owned in whole or in part by an entity licensed by the Arkansas Insurance Department or by any state's insurance regulatory agency as an insurance carrier or a health maintenance organization participating in that same pass so could
Senator Jimmy Hickey, Jr
Unverified
31:53
a pass have ownership in another pass would that be allowable the
Speaker 113
32:08
this speaks to the 51% ownership by an Arkansas enrolled Medicaid provider. So if a pass, I think it would depend on if they're a provider of service and if they're counting that in their 51%. okay i personally personally and
Senator Jimmy Hickey, Jr
Unverified
32:28
i want to i'd like to see that i i wouldn't want any pass
to have an ownership in another one either directly or indirectly or whatever and that may be something we need to discuss because i don't want one pass to have an ownership interest through some subsidiary or something like that and another one to have it this way and they're working together to try to control it if you're going to be a member of the past i don't know that you should have any ownership in any of them since we just have three anyway so i would like us to look at that and i would i would like to have
Speaker 143
33:05
a copy of that to look at closer thank you let me
ask you did y'all work with the insurance commissioner and the insurance department on that language yes yes okay did you push your button uh let
me go to representative gray real quick and then senator sample can you press your button thank
Representative Michelle Gray
Unverified
33:29
you madam chair um i think just what to senator hickey was talking about is we also have passes that have ownership in more than one pass and so i think he's wanting that addressed in the future so that you can just have
ownership in one pass um so we kind of have two separate issues here we have the one we're dealing with today and then another one i foresee coming in the near future but my question is how much ownership did this company how much did they have ownership in total with what we're talking about here today was it
Speaker 113
34:04
70 total ownership they had no i don't believe so but that may be a question for that pass specifically but it was um my understanding it was 25 ownership of that 51
25 total ownership of that that specific group so follow up please yes so
the insurance company had the 74 i believe yeah so the
Representative Michelle Gray
Unverified
34:24
insurance company had the 49 plus the 25 for a total of 74 ownership okay thank you but you can ask that
to the when they come up representative gray we'll put you back in the queue for that. Senator Sample,
Senator Bill Sample
Unverified
34:41
you're recognized. Thank you, Mr. Chair. Madam Chairman,
I'm sorry. I also would like a copy of the statement that Ms. Stone just read, please. Madam Chair, if it's all right, we'll provide that
Speaker 55
34:53
to staff and they can distribute it to the committee. Yes, provide
that to Mr. Price and then we'll get it out to the members of the committee.
Speaker 153
35:00
Thank you. We'll get that to you. You're welcome. Senator
Senator Kim Hammer
Unverified
35:07
Hammer. Thank you, Madam Chair. Educate me real quick. If a pass becomes insolvent or they no longer can continue to operate for whatever reason,
what's the process for the patients being cared for that are in that pass, and how are the
Speaker 113
35:26
other ones able to absorb them? So they're required to give us notice of that, and we would then begin immediately, just as we did before the pass went live, with the forever care members, and we would begin distributing those members of the passes leaving between the two remaining passes. We also have all of that data and information that would follow those individuals,
and they would have time to then hire care coordinators and be able
Senator Kim Hammer
Unverified
35:56
to provide those services. Okay, and based on that and
the discussion that preceded my questions, the way that language is written is there a barrier if it
boils down to where there's just two passes left the way that language is written that you have read is there a firewall to where in reality we're just talking about one ownership group represented in two different passes but owned by the same ownership group i i think
Speaker 113
36:26
that would be the language that everybody's just
ask about so i want to make sure that we take that that language and those concerns back as an issue that that is of concern to this group and and come back with that that full language to make sure that we're covered in that way okay and madam
Senator Kim Hammer
Unverified
36:46
chair question of the chair yes we're hearing all this discussion today but when will we be involved in the next discussion based on their review of what they find are you going to are we there will be no action today will be held to the next public health
meeting right yes yes because they're still in negotiations
with the different entities and so language hasn't been finalized yet but it was necessary i believe to have this discussion today as a follow-up to what's been reported so i think you know that's an ongoing negotiations but that should be finalized
i think fairly soon Because the language, I think, when is the deadline for them to achieve this? This is the annual provider agreement. Okay.
So it has to start January 1. Yes, and
Speaker 113
37:37
there has been some requests from the past that was involved to have an effective date of coming to compliance with that added to the agreement. so it has the request has come in that that while we have that agreement going live that they would have a compliance date on that of April 1st or later in April okay did that move we have
Speaker 133
38:03
not agreed to that but that has been the
request that's come back as part of that language
Senator Kim Hammer
Unverified
38:14
oh okay all right Senator hammer now I just want to reassurance that before any final decisions made on this we're gonna have a chance as a committee and legislative branch to review that and just just to address the pointed issue where we got three passes now I
would want to make sure that the language provides that if it came down to two passes that there's a safe firewall so that it's not a gobbling up effect where we end up with just one pass without us having a chance to put a
stop to that and have a discussion about it before and I want to make sure that language is unmistakably clear that that can't happen the I
Speaker 10
38:52
think we'll have I I think we need to see if there's a way to have a discussion with you around some of this because the provider agreement is something we need to get finalized so that we can move on with our January 1 start date the issue we were dealing
with in this language was the issue of a pass in which a provider was partly owned by the same insurance company that owned the 49% and that was never the intent in the language and it was not clearly enough written in our provider agreement from last year so getting that written and having that clear as we
start this next year was our intent and what we were trying to do right now that doesn't mean it has to be put off you know for forever or anything like that but I think we'd all prefer not to have to delay trying to move a provider agreement through till, you know, sometime in January, if that's possible, but that doesn't mean we will not address with you this other issue. I mean, if I need, if we need to call another
public health meeting at the very end of December, you know, for you to report back to us, I'm not opposed to that, you know, after you've gotten things
solidified. I'm done. Thanks, ma'am. sure okay i mean if the members if that's senator hammer that's
what i'm hearing from you and others i think i think that's once we get it finalized we can do that
Senator Jimmy Hickey, Jr
Unverified
40:42
senator hickey i just i want to go one step further what you just said whenever that provider they had an ownership in that
insurance company do we know if those insurance companies they wouldn't have any ownership in the other passes would they is there any way that they could have tied back in through another company are we allowing something like that to happen or are we does our language are we going
Speaker 10
41:08
to try to limit that i'm not a corporate lawyer to use the correct phrasing all right we did not come prepared for that question so i i want all of that caveat out here as we start
this discussion and also I would prefer to have AID part of that kind of discussion a lot of times with as you know in the health world we are getting more and more entities that are coming under large national corporate ownership right or within groups and they put in place firewalls and they put in place all kinds of operating elements in the last year one of the administrative
operation of one of the passes was merged purchased I'm not sure what the correct technical term is you can ask them when they come to the table with the administrative operation national administrative insurance company that operates the other one of the other passes so there is a connection now how that connection works and whether or not that connection has any ability to
influence is part of what they reviewed and discussed as they were going through some of the hearings about that over at AID the legislation when we were working with y'all on the legislation at that time the concern was that for an individual pass the decisions by that pass that pass ownership be weighted so
that the providers in that pass had more weight in the decision-making right with the idea that if the providers had more weight there the providers would be able to ensure that that pass quite bluntly since this is a form of managed care the concern was to make sure that those passes did not try to maximize profit on the backs of the beneficiary right so by giving the providers 51% the providers therefore would make sure that the decision-making that took place
always considered the needs and issues of those who served those beneficiaries and the beneficiaries. So it was a it was really at that time around control within that passes decision-making which is why in our minds there was no question as to the intent on this one because the intent was clearly to make sure that that never happened. Right and you and I are you and I
Senator Jimmy Hickey, Jr
Unverified
44:02
are saying the same thing but what I want to do some way somehow is to extend it so that we
don't get that same insurance company owning it in another pass and then another insurance company own it in that pass and they're working together behind the scenes to control them I think the simple part with the legislation is just as you said it was for those providers to have the 51% the providers that we know our local providers the people that we know the people that we deal with and those are the or those are the particular ones that we're supposed to have the 51 percent so however we need to structure that is what i hope that we strive towards because i think that's what we all understand it was supposed to be and we don't
want any attempt to try to do a around the back side to get
Speaker 12
44:55
comfortable with this sir um you know as uh deputy director stone said
Speaker 10
45:01
if if everybody was comfortable and after you look at this language what we'd like to do is move forward with this agreement and then in a relatively quick period of time work with all of you around that concern and issue because that may involve with the and pull aid in and others because that may involve with the
complexities of the way ownerships work and and controls work with so many you know national entities that come into play secretary i'm going to have booth
rand from the insurance department come up and actually answer this question one one other thing while she's at
Senator Jimmy Hickey, Jr
Unverified
45:35
it which pass was it and which insurance company i want to know the names and just it seems like we've danced around that what who was it that was doing that which pass it'll be
Speaker 10
45:46
arkansas total care it's the total I don't care. Yes. Okay.
Speaker 174
45:52
Thank you. Okay. Thank you. Boothran Insurance Department. I'm trying to help answer some of your questions. I believe when we implemented the original pass program, Anthem insured one of the passes and I can't recall the name of it. Then, as Cindy explained, Anthem merged with Beacon, which was in a different pass. I think has insurance relationships in two different passes. It wasn't premeditated or
intended to be. It's a monopolistic sort of activity. I think the reason why that consequence occurred is recently Anthem purchased Beacon nationally. And so you have Anthem, I think, involved in two of the passes. Now, going back to the language that Cindy cited to try to help reduce or limit some of the concerns that many of you members have about a pass, not only another pass or an insurance company not owning a provider. I've worked with Jim Brader to try to develop some of the language proposed.
Now, it can be quite technical because a lot of our insurance companies are actually owned by holding companies, okay? So you theoretically could even have a scenario where a holding company, you know, would own a provider and it really could directly own a provider network and also own an insurance company. So one thing I would suggest, Jim and I can develop language, visiting with all of y'all to make sure that we have a cumulative language that's going to give you guys what you want in terms of the protections to avoid a monopolistic situation.
So when Jim sent me the language, I was okay with it, but as I started listening to questions, maybe we need to add a prohibition that a pass can own another pass and add language addressing holding companies also not being able to own a provider. So a holding company could own an insurance company and also own a provider. So you want to address that scenario. So as you get into these very sophisticated, complicated layers of health insurance regulation, it's important to have an adequate clause to help get you guys and gals what you want.
And I'm going to work on that with Jim certainly well before y'all get these contracts out within the next
day or so. All right, Mr. Randall. Thank you, sir. Yeah, and I think you've got two issues. I mean, both are concerning, right? But that doesn't diminish the setup of the PASS program because I think the Anthem Beacon portion is like a 16%, I think, in at least one of them. I'm not sure what it is in the others, but the passes can they're here to be able to answer those questions um but that ownership didn't change anthem doesn't own the provider or any one of the provider portions of that
not that i'm aware of not that we're aware of but what we are aware of is in the one that the insurance company owned the provider and that's what created the scenario that occurred which is what we're trying to fix with this language. And I'm just adding the scenario that
Speaker 177
48:56
if you really want to capture all of this, then you need to also prohibit holding companies of insurance companies. Because
Speaker 179
49:02
Blue Cross is actually owned by a holding company. Yeah, I agree with that.
Representative Leidyman. Thank you, Madam Chair. I
Representative Jack Ladyman
Unverified
49:10
think you've answered my question here, but I want to make a comment.
The corporate world changes all the time, and these are private corporations, and they're not just in Arkansas. This one was in 10 states. It involved a number of different states and that's going to continue. I mean, we cannot know how these corporations change and who they buy and who they sell and their interacting activities, but what we need and what I think you're trying to do is develop language. We have one example here of something that happened
that we didn't expect. We need language to fix that one example. If you can add to that and improve that in a few days, I'm okay with that. But I don't think we want to delay this. We need to fix the problem that we know about today and work on these other issues that are brought up and work on those as we go through this. Because I believe this is something we're going to have to tweak a number of times with the number of companies that are going to be involved in this. Is that the way you see
Speaker 186
50:16
it, sir? Yes, sir. And, you know, I'm right now working, after
Speaker 174
50:20
hearing all these issues, as I looked at the language, it looks like it needs to be a little bit, encompass a little bit more issues.
And so something that we can get, I can work with Jim on in the next day or so. We're talking about in a day or so in getting the language that I think will be effective. Not that this language isn't effective, it just doesn't capture all of the niceties of insurance companies, holding
company systems, and those kinds of things. okay thank
you all right um i think this is representative
Senator Linda Chesterfield
Unverified
50:58
murdoch no you're okay senator chesterfield thank you madam chair as we look at this convoluted ownership piece
and it is indeed that one of the things that is concerned to me is how is it working for the people it's intended to work and have we begun to assess how past is a working period we know that that's the new thing today but as we've looked at the ownership and the makeup of the ownership and whether or not it is majority owned by whom and whether or not insurance companies are engaging in a creeping ownership of that over which they have
more control than they should what is happening to the
Speaker 113
51:45
people that it's supposed to serve? So our goals with PASS were to improve the services that people received. And one of our main goals with PASS was to keep people out of institutional settings and emergency rooms and make sure that they got the services that they needed. How are you measuring that? So we have a couple of ways that we measure.
So the PASS's have monthly reports, they have quarterly reports, and then we have to, federal regulations require us to have an external quality review organization that comes in annually. So we would have that review of the overall pass program as well as the individual passes from this external quality review organization. What are we doing to visit with the individuals who are supposed
Senator Linda Chesterfield
Unverified
52:26
to be served? So we have a couple of different
Speaker 113
52:30
ways that we interact with the individuals who are being served. So we have an office of the ombudsman,
and if an individual does have an issue with a pass or the services that they're receiving, they call our ombudsman office and we interact with them and then we also take that information back to the pass to make sure that that person gets what they need and then we do an overall trending and tracking of those calls that come in to us. We're also required to go out as DHS and review person-centered service plans So the PASs have a person-centered service plan for each and every individual that they serve.
So we go out and do that review as well as if there are other issues. So they send us a report, for example, of if the beneficiary, if their PAS member refused care coordination. And that's a way that we also interact directly with the beneficiary. so our ombudsman office calls each and every one of those individuals and asks them why they decided they did not need the services of a care coordinator and address those at that point. Madam Chair, I'm
Senator Linda Chesterfield
Unverified
53:39
not going to beat this to death,
but I'm trying to get to patient-centered care. Yes. And what is of concern to me is if I am relying on the provider to tell me the level of service, that I'm going to get probably a glowing report. So I need to know how many ombudsmen, how many people are the ombudsman serving? Is it more than one ombudsman? Is it ombudsmen or men? And how many individuals are being served?
Because traditionally we've had one person serving as an ombudsman, for instance, in our youth care. How many do we have serving how many
Speaker 113
54:23
people? So we have an enrollment of the past enrollment currently of about 44,000 people. And so we have an office of the ombudsman that is located within our division of medical services. And we have division medical services staff. And then we've also expanded. How many people are in that? So we have at least three people on DMS staff.
But the other thing that we did was that a number of these individuals with high need were served by the Division of Developmental Disabilities. So that's a portion of our population. Each of those members that had the waiver for developmental disabilities had a waiver specialist. So we've also converted waiver staff that work for DDS, and they also do outreach and do ombudsman activities. So there are additional nine of those DHS staff members that can help us with those cases.
All right. Thank you, Madam Chair. Thank you, and I don't disagree with your comments, and I appreciate
them. And I'm going to give them the number for the Office of the Ombudsman because, folks, if you're hearing from patients or if you're hearing from your doctors or providers, then
you need to have them call this number if they're having issues or problems. It's 1-833-402-0672, because I hear all the time from folks,
and so if you need help, make sure they call that number, 1-833-402-0672, because it is about the patients. We want to make sure that the patients
are getting proper care and that they're able to access care. there have been issues with a lot of different things which i've brought up privately many many times but we need to um keep working on that all right are there any other questions for the members of dhs or the insurance department representative gonzalez thank you madam
Speaker 203
56:29
chair so was dhs aware
that that the insurance company owned the provider group going into this we're
Speaker 203
56:41
was on the record. No, we were not. So have there been more issues with the pass, more issues than normal with the pass that was owned by the provider group, or more
Speaker 165
56:54
complaints from patients or not? No. I'm going to
Speaker 10
56:58
look to Deputy Director Stone again since she sees the daily report on issues and follows them.
But each of the passes has had specific issues and problems. You know, I would not say that any one of them has been having so many more issues than any other, right? There have just been different issues that we've all made our way through as we've all gone along through the process. So their clients have had just
Speaker 203
57:25
as good a care as all the rest up until this point? Yes, and
Speaker 113
57:31
looking at their monthly reports and then our trending reports from the
ombudsman, they have not stood out as a pass that's had more problems than any other
pass. Okay, thank you. Thank you. All right. See no other questions. Thank you. We'll bring everybody
else up. Okay, and now we will have the folks from Empower Summit and Arkansas Total Care, if you'll come to the table, please. I think
the issue is about following the law as the law was passed.
If you'll state your name for the record and then you may proceed. I've
spoken with a few of you. I'd like information about your makeup and where we're at. I am Rob Slattery. I am
Speaker 216
58:26
the chief executive officer for Empower Healthcare Solutions. I'm Jason Miller. I'm the plan president
Speaker 218
58:34
for Summit Community Care. I am John Ryan, plan president for Arkansas Total Care.
Speaker 225
58:56
may proceed. I'm on? Yes, you're on. Okay, thank you. So Empower Healthcare Solutions, it has a governance structure that is divided amongst six members. And each of those members have 16.67% equity ownership in the organization. Five of those individual members are provider.
They are provider-sponsored organizations and provider-led organizations. The sixth member is a managed care organization, and we've already heard discussion that entity is Beacon Health Options. Our other members, we have Woodruff, which is primarily a group of FQHCs but also pharmacy. We have Arkansas Health Care Alliance, which is an alliance of hospitals.
We have Arkansas Health Care Alliance, which is also a group of behavioral health and mental health organizations that span the state. And then Statera, which is an organization that is a culmination of different provider organizations, provider groups that serve Arkansans here in the state. Okay. So you're a five to
one ratio. That's correct. Okay. All right.
anything else you want to add before we get to
Speaker 225
1:00:25
the next person I think I will wait for questions and I believe from an ownership structure that addresses what
Speaker 223
1:00:33
we see is kind of the topic today thank
you madam and and you were your yours was beacon is
that correct that is correct and so talk to me about
Speaker 225
1:00:45
the transition between now anthem purchase beacon correct it is actually in the process anthem is in the process of acquiring beacon health options and beacon is an organization
that falls under the structure of the holding company so there is a bvo holdings company so beacon health options is subsidiary to that that parent organization is being acquired by anthem and anthem and beacon have not consummated in completeness that acquisition okay so that is ongoing but that doesn't change your five to one ratio it does not um and it will not much of the
discussion within our organization at a governance level amongst the board members is to ensure that there's proper firewalls in place so as we move forward under the beacon acquisition the anthem acquisition of beacon that we have the appropriate firewalls to ensure that our information stays separate and distinct and that there's there's no co-mingling of that information and or of the staff that support empower versus the anthem business which I'm sure Jason will speak
to okay and then is there is there any good is there going to be
any disruption of services in that transition or payment to providers or anything
Speaker 225
1:02:13
do you anticipate any disruption no we do not we we anticipate businesses as usual okay and that there
Speaker 219
1:02:19
would be no disruption okay thank you
Senator Breanne Davis
Unverified
1:02:24
all right mr miller thank you so summit community care um is formed a
Speaker 233
1:02:29
little differently. The Arkansas Provider Coalition began first. This is a group of 71 providers in
Arkansas. I was initially a member of the Arkansas Provider Coalition when I was a provider two years ago. These 71 providers invested in the coalition and became a coalition and then brought in Anthem, Anthem Partnership Holding Company, to be their partner in the PASS model. The contract between Arkansas Provider Coalition, APC, and the Anthem Group is 51% Arkansas Provider Coalition, 49% Anthem.
So the 71 Arkansas Provider Coalition members have elected a 15-person board, and they serve as as the provider coalition board and then there are three executive members merge with three executive members of anthem as the
Speaker 234
1:03:23
joint operating committee for final decisions if there are decisions about the pass but the provider coalition is is the 51 percent
Speaker 233
1:03:33
owner of summit and the mco anthem owns 49 okay so your 15
person board those are all providers they're elected from
the provider group they're elected from the provider group and then you said three within three of that group goes on
Speaker 233
1:03:51
an executive executive leaders merge with their three anthem side and three arkansas provider side for decisions final
Speaker 234
1:03:57
decisions about direction in the pass okay but the but the provider coalition is the 51 percent owner
of the pass okay so they could if okay so it could come back to the 15 the board of 15 for
final decision making if possible okay
Speaker 239
1:04:16
all right thank you sure let me yeah Senator Hickey but
Senator Jimmy Hickey, Jr
Unverified
1:04:21
the 71 members are the ones
that are the 51% coalition is that public information yes I even have a list I can give you there are
Speaker 233
1:04:29
40 I mean make sure I've got around 41 developmental disability providers 23 behavioral health providers and then the rest of it is hospitals pharmacists physicians and DME providers so they're all part of that coalition i can give you a list
Speaker 244
1:04:40
i would like to have that okay if you'll just send it to mr price we'll give
it out senator hammer do you want to wait till the end for a question okay thank you all right mr
Speaker 247
1:04:54
ryan thank you senator um john ryan arkansas total care
Speaker 248
1:04:57
so when the uh the past program was developed a few years ago our organization took an opportunity to meet with several of the provider investors uh actually and some of our competitors here today as everyone was actually trying to figure out where the best fit was we we took a look at the provider landscape that was emerging in the in the marketplace with regard to some of the issues with behavioral health providers other issues that were going on and made a conscious decision to bring one of our
external provider entities that that Centene who's the parent company ultimately of our share of Arkansas Total Care really to the to the state that was a company called Lifeshare and Lifeshare our ownership structure as it sits today is 49% Arkansas Health and Wellness Health Plan which is a domestic insurance company in Arkansas and then 25% an IDD provider Lifeshare and the last 26% but Mercy Healthcare of Arkansas which is roughly seven
hospitals and three or four hundred physicians in the northwest north central part of the state, really northwest part of the state. So our evaluation was that we had some expertise external to the state in IDD and wanted to get in a clean and efficient way and brought Lifeshare to the table and they became one of our equity owners in the PASS organization. I would say that that has been challenged as of late.
We do feel like that under the current letter of the law that we do actually comply with it but do understand the individual's concerns. It was vetted out through the licensing process by the regulatory agency, the insurance department and it was noted very clearly within several readiness reviews that we did have. So we do understand the difficulty that folks have with that and we have agreed to the language change about
Speaker 250
1:06:56
restructuring that DHS has proposed to us in the last week or so.
Okay. All right. Senator Hammer, you're recognized for questions. Thank you, Madam Chair. And
Senator Kim Hammer
Unverified
1:07:13
I guess I need a little perspective from each of you because only one of the
passes, and don't let me be wrong here, Total Care was the only one
that exercised your interpretation of the way the law was written to do what you did that's under discussion today
Speaker 253
1:07:37
of the three. Is that correct? anybody i i
Speaker 225
1:07:40
will say from an empower perspective the the intent of its founding members was to
really align itself to the intent of the legislation as well as the past contract so in such the the founding members identified the the key providers that would account for the 51 percent of the past ownership recognizing also that they required the capabilities of a managed care organization such as beacon so beacon really filled out that that need as far as its membership the difference I think
that the empower organization took in formulating its fundamental organization is that it had equal equity stake amongst each of the members to include the MCO so when you look at the empower governance structure and its ownership structure it is primarily provider owned okay so let me clean the question up and be
Senator Kim Hammer
Unverified
1:08:45
direct mr. Ryan your group total care is the only one that has taken the approach of the three passes represented
at the table that has created this conversation today. Is that a correct statement? Not knowing the
Speaker 248
1:09:00
intricacies other than what I've heard here, I would think that's correct, Senator Hammer. And I would think I would clarify, too, that the way we view the intent of the law, in addition to what... Can you pull that mic up
Speaker 60
1:09:12
to your... Sorry. Sorry. Yep, right there. Thank you. So I think one thing
Speaker 248
1:09:15
I would add that is very important in the conversation and the intent of the law is that we really, and Senator Chesterfield got to this, was how well are we serving the outcome of the member?
Are we doing a cost-effective manner? Are we doing quality outcomes? Are we serving the client or slash the member to our best ability? So I would just wouldn't want to lose sight of fact of that with regard to
Senator Kim Hammer
Unverified
1:09:36
the intent. Okay. And, you know, the word intent, there's the intent of the perspective of the way in which the legislation was written. Certainly. And, I mean, from a legislator's point of view, I'm looking. I've got two out of
three that didn't do what you did. So what was your intent in doing what you did that you kind of pushed to the edge a little bit?
Speaker 248
1:09:57
Certainly. So I think, as I was saying earlier, really what we looked at was the available partnerships that were there to us and the landscape from a provider perspective of who we could partner with. And it was pretty clouded from our perspective. So we knew we had an IED provider with experience in seven or eight different states. What does IED stand for? I'm sorry, intellectual developmental disabilities. yes IDD yes we we knew we had some of that experience and uh chose to go that
route so but if I don't mind if I can interject but you you purchased life share correct I mean you
several years several years ago several years ago but they weren't operating in the state of Arkansas they were operating in other states not until 2018 that's correct
and then you sold the rest of them but kept the one in arkansas that's correct yes ma'am okay so sorry senator hammer
Senator Kim Hammer
Unverified
1:10:55
i just wanted to go back to what my understanding of the facts were sure and i appreciate that so by dhs proposing at the discussion that is being brought by the legislative branch how is that
going to limit you and will the other two passes um how is that going to limit total care if the proposed change that DHS Insurance Commission is going to bring, how is that going to limit you? And is that going to affect patient care, access to
Speaker 248
1:11:26
care? Senator Hammer, I don't believe it will. Again, recognizing and respecting the intent that we had and the intent of the legislation that's seen by your law or by this body,
I don't see who sits in our
Senator Kim Hammer
Unverified
1:11:39
boardroom as affecting patient care. Okay, my last
one. I'll stop. Thank you, Madam Chair. Of the providers, can each of you say with certainty that of the required 51% that have to be providers, are all of those providers Arkansas-based, or are they owned and influenced by any
out-of-state entities? All of you all have 51%?
Of the providers, of your providers, are they Arkansas-based providers? and what is their influence over your board and
Speaker 225
1:12:18
your decisions thank you madam chair I will go first from an empowered perspective they are Arkansas based providers and they have significant influence as it pertains to not only the governance of our organization but our operations and are heavily involved in the operations we have monthly board meetings from a from a member ownership
perspective but we also have a governance structure that has a committee structure so a finance committee a quality committee an operations committee etc so from that perspective it is in many respects an Arkansas based pass with Arkansas based providers that service the needs of our Kansas thank you okay mr. Miller yes for some of the
Speaker 233
1:13:06
same it's true all of our providers have to be licensed with arkansas medicaid so all of our investors are licensed
with medicaid so right there may be some that cross there's a difference
between being licensed by medicaid and actually operating sure sure well all of
Speaker 233
1:13:22
ours operate here i mean of course there may be some like in texar canada that cross the border and you know border states and
Speaker 234
1:13:28
things like that but now all of our providers are in your communities local mental health centers idd providers uh hospitals that are local so they're all in of the 71 i don't honestly know every every entity on here may be owned by somebody else i don't know all the structure of that um in terms of like for example we have a hospital that may be owned by a corporate
institution or something but they're all arkansas-based facilities providing service to patients in arkansas yes that's right
Speaker 248
1:13:58
so our provider structure um for life share local local offices licensed arkansas medicaid provider just as both have indicated and representation full representation as a provider on our board frequent interaction with them and they're currently have an active patient load of about 30 members that they are seeing
actively today i'm gonna push back just a little bit on that because i mean when they were up
when you when you actually licensed life share they weren't actually seeing patients at that time that's correct okay and then your patient as
Speaker 277
1:14:33
soon as as soon as they were we obviously commenced that yes right so but you yes
so that's the difference between since march of this year
Speaker 278
1:14:40
since march of this year when we went live with the full program yes so we went live this year in march when
did y'all acquire life share i'd have to get back to you senator but it's it was in the
fall no no it's uh no last fall six or seven
Speaker 248
1:14:57
years ago oh okay okay before this was even considered. But you just, you opened up a life share
in Arkansas. That's a fair way to think
about it, yes. Okay, so you opened up a life share in Arkansas in March, but they didn't start really seeing patients until? March. And they started in March? Yes. Okay, and you have currently how many
Speaker 250
1:15:17
patients? About 30, I believe. That was
my last check. Is that primarily in one location in the
Speaker 248
1:15:23
state? No, no, it's, I'd have to get the dispersion of where they are. They're primarily
central arkansas uh but there are uh i know there were individuals seeing life share life share individuals seeing uh seeing clients in northwest arkansas for example on friday i tried to reach somebody and i couldn't so you're based in
that where's their facility uh it's here in uh
Speaker 248
1:15:42
little rocket down riverdale plaza okay and that's where your offices are as well that's where
some of our offices are yes so they you should they y'all share office space um yes okay all right
senator hammer did you have any other questions
thank you senator chesterfield you're recognized or representative murdoch y'all are just playing the musical chairs over there i think thank you uh representative
Senator Linda Chesterfield
Unverified
1:16:16
murdoch yes yes ma'am so why senator hammer and you guys because i think it's still some minutiae with that that's going on with with what you were just discussing I have another question though and this is a pretty simple question that we visited before with all three of you all provider payments I'm
starting to hear again that we have some providers they're not getting their money their montees talk to me a little bit about provider payments where you are individually and
Speaker 225
1:16:50
what we're looking at so I did prepare for that question and thank you for asking from an empower perspective to date we have processed 1 million one hundred and twenty seven six hundred and thirty claims of those
we have paid 977,196, so for a percentage of claims paid, that equates to 86.7%. Of that total, we had a total that were denied, and the primary reason for denial were duplicates, and that typically happens in a startup operation. you'll have duplicate claims as as providers do not have the the timely payment which there were
some bumps in the road as the organization came online we had 132 282 that that were denied so that equates to an 11.7 percentage points the the total claims that we have pended today are just over 11,000 and 11,500, which is a percentage of 1% of those that are in pended status.
We are paying claims rather timely, DHS was here previously. We do have a monthly operations meeting with them and there are specific metrics that we have to adhere to that are contractual metrics, but I would also say they're top decile metrics to ensure that the plan performs accordingly to ensure that providers are being paid timely. That being said, we fall within the contractual arrangements.
If not, we're a little better than those. The total pharmacy claims, I'll just round it off because pharmacy claims are a part of the program as well. We have paid over 326,000 claims on the pharmacy side as well. So it
Speaker 290
1:19:04
sounds like there should be no complaints with
Speaker 225
1:19:07
your providers based on your report. Anecdotally, if there are, while we strive to perfection, I wouldn't say that we're perfect. There are situations that will arise, and we rapidly respond to those.
My staff, as well as my own contact information, is posted on the website, and I'm rather new to Arkansas, so people probably don't know me as readily, but I say that to say this, that they can directly approach me if there are issues. typically it gets resolved at the staff level we do have provider relations staff that stay pretty active across the state so we hear about it pretty quickly and we respond equally as quick
to ensure that we do not have any hiccups and that we maintain a high level of satisfaction within power. Thanks Representative
Speaker 233
1:20:01
Murdoch I can give you the data but I know when it comes down to it data doesn't matter if you're the person not getting paid right so we have it we all have it we share it i'll be glad to tell you we're how we're paying claims and we're getting it done quickly we're entering a stage fortunately where many of the large large issues have subsided and we're dealing with smaller issues with smaller pockets of providers or smaller pockets of people
whether it's a linkage to medicaid something in our systems or something we need to work with providers on one things we did since our since even since our last hearings I've added five members to our provider relations team four of them now live in your communities we have someone living in northwest Arkansas someone living in the west someone living in the east northeast to east and we're going to bring somebody in the southwest and the idea is there is that they don't just answer the phone like we do at our office here but they can literally get in their car travel to your office and work through details so we know there are still some claims issues out
there we know there are occasionally things here but luckily folks are able to as Rob said able to contact me directly we have a an expanded provider relations department we're visiting with them often and again most of those are sort of being checked off a little bit by a little bit and I think for those folks that if there are if there is a claims issue and we don't know about it they certainly need to let us know as quickly as possible and we address it but we we do know of a few we know of a few issues that are still lingering that are catching a few providers here and there, but we're working through them diligently, and we are, I mean, we are paying
98% of our clean claims in 60 days, and we're paying almost 90% of them in seven days, so it's those folks that get caught in the middle of those little bumps that we're working on, so we're glad to give you
Speaker 238
1:21:42
as much detail as you want, but we definitely put
Speaker 248
1:21:47
in some implementation plans to get that fixed. Sure. Representative Murdoch, I can tell you that Arkansas Total Care It's paid about 635,000 claims, 35,000 claims to date. Our turnaround time, about 82% of our claims are paid within seven days, which is the agreement metric that we have agreed with DHS.
And we have about 95% of our claims that are paid within 14 days. We do have a local staff here that are deployed to communities to seek out and respond to provider inquiries and more than willing and ready to come to any part of the state. would meet with any provider about any claims issue at all so that that was going
Senator Linda Chesterfield
Unverified
1:22:23
to be my last question with each one of you would you agree to meet with providers having some acute issues that we need to work through to make sure that they're able to provide the services to the
end users our constituents and the patients so we want a hundred percent if you
Speaker 248
1:22:38
want to we have each other's number if you want to text it to me i'll be happy to look into anything you've got specifically or any other any other member we even want to
Speaker 233
1:22:46
go personally senator davis i I was just in Russellville a few weeks ago. I was there myself at the table with my PR team because we wanted to get to the bottom of the issues. So we're willing to go. I'm willing to go. My team's willing to go. I think all of us have done that. So absolutely. Thank you so much. Thank you. Senator Hickey.
Senator Jimmy Hickey, Jr
Unverified
1:23:05
Thank you, Madam Chair. I just want to touch on this ownership interest a little bit more. And sir, within power, is it Slattery? Yes, sir. Okay. If I understood you correctly, and I want to make sure I did, at the beginning of your conversation you said you all had some firewalls set up so that you didn't have
Speaker 267
1:23:27
any cross ownership with the other passes is that
Speaker 225
1:23:31
correct we what i was referring to senator was actually the firewalls that would that will exist when anthem acquires beacon
to ensure that the empower business being supported by beacon does not co-mingle both in data but also in staff specific to the Empower related business. So you are going to have some
Senator Jimmy Hickey, Jr
Unverified
1:23:53
cross ownership in the other passes is that correct?
Speaker 225
1:23:58
Empower will not. One of its members which is Beacon which has 16.67 percent is being acquired by Anthem which Anthem has equity
ownership through a subsidiary called Amerigroup in the Summit Community Care. Okay and as far as the
Senator Jimmy Hickey, Jr
Unverified
1:24:14
other two passes, Mr. Miller and Mr. Ryan I assume do you know if your members, if they have ownership in the other passes have you
all looked into that? Not to my knowledge, Senator Hickey. You haven't looked into it, it's just not to your knowledge you don't believe any of them do? No, I don't believe any of them do, no. Same here, I don't
Speaker 300
1:24:38
know of any member that owns anything
Speaker 170
1:24:40
in another pass, to my knowledge. Alright,
Representative Lee Johnson
Unverified
1:24:55
thank you sir. Thank you. Representative Johnson. This out.
There we go. So my question is from Mr. Ryan. So if this contract language gets sorted out that would prevent life shares from having part ownership in the past, do you have a plan in place yet as to who would replace life shares in that ownership portion?
would that be extended to mercy first or what's your thoughts on
Speaker 248
1:25:19
that we do and and we've actually met with several providers that you would know names of not only recently but as far back as the fall of 2017 gauging various interest levels unfortunately I've got non-disclosure agreements with with most of them and rather than maybe a bad choice of words negotiate that in public I'd rather
Speaker 258
1:25:42
I'd rather say we're in active conversations with a number of different providers. So I'll
Representative Lee Johnson
Unverified
1:25:47
phrase it differently so if this language goes through how disruptive to services do
you see that being is that something you perceive to be a big issue for the past? I do not. And then for a similar question for Mr. Slattery so if we have concerns in the legislative body about one managed care provider having ownership in two passes and we were to raise issue with that the way we've Raised issue here with life shares having ownership while they also have centene in their group How disruptive would it be to your past if there were language developed in the future that would prevent?
Beacon because it has ownership now in two passes from participating
Speaker 225
1:26:30
in your past Sure, I would say just clarifying it anthem is the acquirer sorry my fault I got it backwards but from that perspective again beacon has a sixteen point six seven percent ownership in empower if right now under the current regulatory environment that is permissible if things were to change
in the future then I would anticipate that my board would take appropriate action to ensure that there's no disruption to service and or supports that are being provided to members that are attributed to Empower.
Representative Lee Johnson
Unverified
1:27:08
So if regulatory changes were to come down the pipeline in the future that would prevent Beacon as it's now owned by Anthem from participating in Empower, your sense is that that would be not a catastrophic event for your past, but the business would carry on. You would just seek out a new 16.67% partner.
Speaker 225
1:27:27
I feel pretty confident that our board of managers would remediate anything that needed to be remedied. Okay, thank
you. Thank you. Just to follow up on that, so Mercy is operated in
Arkansas. They are Arkansas-based providers, but they actually are, their parent company is not in Arkansas. I believe that's correct. I
does Mercy have any ownership in Centene?
No. No, but they're both located in St. Louis. Yes. Because
Speaker 220
1:28:08
of those Catholic nuns. We both have some experience
Senator Bill Sample
Unverified
1:28:14
with that. Yes, we do. Senator Sample. Thank you. And this question is for Mr. Miller. You said that you reimbursed most of your clean claims within seven days. 88%, I think. Okay, 88%.
That's most of them. uh i hear rumblings that you're changing your reimbursement rate of 7 to 14 days out to 30 days extending out 30 days
Speaker 269
1:28:45
i don't reimburse i mean you would know yeah i don't have any knowledge that we're extending our reimbursement
Speaker 294
1:28:53
rate out or time no we're still we haven't changed any rules so you're you're we're still we're still we're
Speaker 233
1:29:01
seven to 14 days well the seven day rule is part of our agreement with dhs so we have to pay 70 percent in seven days so our our effort is still to pay as quickly as we can when we get a clean claim in absolutely we haven't changed
Speaker 320
1:29:13
any of that that's maybe i'm getting some false information
Speaker 233
1:29:15
i'd love to have the detail i'd be glad to explain it to whoever or get some information about where that came from. Okay. Thank you. Thank you, Mr. Chairman. Madam Chair. Yes.
And any information that's requested, if you'll just give it
to Mr. Price, we'll send it out to all the members of the committee. That would be great. Senator Hammer. Thank you, Madam Chair. I may have missed it,
Senator Kim Hammer
Unverified
1:29:35
but I heard you talk about the percentage of clean rates that you
paid. What claims that are not clean are out there you know what you tell us about the clean rates and about the reimbursement of the of the clean claims i'm sorry uh but what about the ones that are being denied what percentage of what you're receiving is does that represent let mr mills start off with you sure i don't have
Speaker 233
1:30:03
an exact number for you senator hammer i can get that for you
about what the denial rate is there's there are some claims that get rejected of course by the way they're entered and there are some claims that may be denied our denial rate is very small but claims are kind of move every day so I can get you a point in time number and give it to you give it to give it
Speaker 234
1:30:21
to you I don't have the exact number today about how many claims collectively are denied but it's a small number compared to here if we just get that and send
Senator Kim Hammer
Unverified
1:30:33
it because I'd be glad to send it to you yes and let's do percentage and dollar amount on that if you don't mind like a comparison
of the two and then um tagging on to a question i think maybe
representative murdoch brought up when it comes to the to the reimbursement used to be if i remember correct me if i'm wrong but under the old system there was a amount that was that was given to the providers but also to the the pcmhs to just kind of manage when when the transition happened and we went under the PASS model, did all of those dollars translate down to those providers, whether they were independent
or maybe they were working with a group, or can you educate us about what you did as
Senator Breanne Davis
Unverified
1:31:23
PASSes with regards to that money? So our knowledge of the way we understand from DHS is when the PASSes,
Speaker 233
1:31:29
and I'd probably have to defer to DHS to confirm, the way I understood it was When the pass model became effective, the PCMH dollars, they did not filter down to the passes to pass on to those PCPs, and therefore they were not carved into those payments.
We have since had discussions with providers, and many of us are doing that now, to work with PCPs about how we can adjust that and address that with them if needed. Every pass may be different, but the PCMH
Senator Kim Hammer
Unverified
1:32:01
to the passes. Here's what I'd be concerned
about and relieve me or confirm my concern. We've only got so many providers in the state that can provide services to the population represented in the passes. If we don't give them an incentive to want to see those individuals, there's no motivation for them to want to see that population
because, you know, I think we used to pay for care management and we used to pay to the patient-centered medical home model. and if that money has not been translated down to the providers and all of a sudden providers don't want to don't want to take patients we've we've got a problem and I need some assurance of what you're doing as passes because I don't want to I used to get a lot of calls from my Medicaid patients saying hey I can't find a doctor and if all we're doing is shuffling the deck and we're going to start getting those calls back because those providers are not being taken whether a
single shop or they're in a group i don't care because the people ought to have the choice where they're going to go see their doctor so
give me give me some relief of that how you're going to fix that if it's a
Speaker 248
1:33:05
problem and so senator i would echo what jason says that that pcmh or pccm payment or both of them was not in the capitated rate as we understand it was provided to us within our contract i would tell you what we're doing to solve for that i agree with you not only does there need to be a good relationship with providers but there are access issues with pcp community etc we have mailed letters to our providers i believe as recently as last week saying we will
Senator Kim Hammer
Unverified
1:33:26
begin those payments in january january the first okay i'd like a head madam chair i'd like a head nod from dhs or an explanation why that wasn't included in the negotiated rate and what was the were we just leaving it totally up to you as the passes to take care of that if you
want to come up to the table okay thank you madam chair my understanding it was
supposed to be negotiated into the rates and is that not i i think each of your organizations you did have different
negotiations with groups is that
Speaker 217
1:34:03
and sometimes it may be factored into the rate
they were paying that particular provider but not all of them
Speaker 133
1:34:15
not necessarily it's all it's not necessarily individual basis.
Speaker 113
1:34:19
Paula Stone, DMS. We did allow the passes to determine their relationship with PCPs and if they were going to do an enhanced rate for those members. We do pay the passes for care coordination and that is
conflict-free care coordination that they're providing and so they would be able to do that be able to determine that relationship that they have with the PCPs and I know each pass has determined a different way of handling that. So may I, Madam Chair? Yes.
Senator Kim Hammer
Unverified
1:34:53
So are you are you telling me
it was never in the contract that that money would be passed on to the providers it was basically just negotiated into the rate paid to the passes and then they would work it
out with their providers i'm going to
Speaker 113
1:35:11
have to go back and double check myself on this but my understanding is at this point is that that money was not part of the rate so that the pcp p the pccm and pcmh payments were not part of the rate that went to the
Senator Kim Hammer
Unverified
1:35:24
passes could you get that and clarify that and madam chair if that could be sent to the chairs now
to us i think that that would be good to know because they're yeah i'm confused but you're giving them money for care coordination which you did give PCMH and primary care doctors money for care coordination
so if you're taking care coordination money away from this group and giving it to this group
how is that how is that not filtered to them through their rates so I believe
Speaker 113
1:36:00
that the way that the rates were set was looking at all of the claims data for that proxy population. And so, and again, I'm going to have to go back and double check on this, but my memory,
if my memory of this serves me correctly, is that that money
Speaker 133
1:36:19
was not calculated into that rate setting. So you just stopped giving it to this group, basically? So
Speaker 113
1:36:28
what we did was that each of those beneficiaries or those members that went to the pass had a capitated rate associated with them based on all of the claims data for that population. And so that was not part of that. And then there's an additional care coordination rate that's given to the passes
Speaker 133
1:36:47
for each of their members to coordinate all of the care.
But that's the same thing, isn't it? if you're giving them so outside of their rate if you're giving this group used to get the care coordination amount of money but you took it from them and you gave it to them and
that I mean that's what you just said I think
Speaker 113
1:37:14
didn't you I I think I think I was trying to determine the difference between the way the rates were calculated for the individuals so it was not
So it's not part of the rate,
Speaker 113
1:37:27
but it's an additional payment that the passes are getting. And so the care coordination that the passes are doing is encompassing a number of things for this special population. So we have a special, we have a list of activities that they must provide as care coordinators, and we also have it as conflict-free case management, which is part of our federal regulations for conflict-free case management for this specific population.
And so conflict-free case management means that the entity that's providing the care coordination for that population cannot be a Medicaid-enrolled provider of service. So they're a separate entity that's providing care coordination.
Okay. I do understand that. But I think to what Senator Hammer's point is, there's an issue there.
Senator Kim Hammer
Unverified
1:38:25
Senator Hammer, did you have anything else? Only that
I would just say that we have delegated through a rate to the passes to take care of the needs of the populations
that they represent. if there was in this case a case management fee or a payment
that was made to what was the patient center medical home model that was no longer there how did the how did the responsibilities
to do that job that was previously stunned by them transferred over to the passes and how are we measuring that that is effectively being done because again to my point what I don't want to see happen is physicians or whoever is the primary care provider that's providing the service not want to see the population because the negotiated rate of reimbursement is too low and what they used to be able to have access to financially they're no longer having and and and I would say this too
throughout rural Arkansas there's a real dependency I think upon independent providers even in my hometown this past week i won't say the name of it but a major pharmacy is shutting down if it wasn't for the independence in the community absorbing those patients that are going to happen you know to lose that and i don't want to see that translated into into the providers not getting enough money to survive on the other side of the coin you got 51 percent of the providers that y'all testified that are owners in the past is are you not hearing from
that 51 percent on this issue or what kind of feedback are you getting from the 51 percent of providers so that we're not having to have these discussions because y'all are having it where it should be and that is among yourselves and I direct that to the passes I guess so
Speaker 248
1:40:23
not not to speak Senator Hammer for my colleagues here but I think that's been something that's been raised for a period of time throughout the course of the first part of this year hence one of our reasons for addressing it by resuming those payments January the first so
Senator Kim Hammer
Unverified
1:40:39
you are going to start we have that money that was not passed on in the contractual rate that's correct you're going to start sending back to the providers we are dollar for dollar or did you negotiate
a lower rate than what they were receiving before yeah we
Speaker 248
1:40:53
took an average of the weighted average of what the payments were and it came arrived at a singular number because It's a scale,
Speaker 239
1:41:00
isn't it, depending on that? Right, it is, based on
Senator Kim Hammer
Unverified
1:41:05
the severity. So that sliding scale, we've got a weighted average of that.
Okay. And I guess that's the same for the
Speaker 233
1:41:12
two without y'all getting into each other's business publicly. Yes, we are looking at doing it. We haven't sent out a letter and said what the rate would be. We have been looking at that, and we have heard from some providers about it. Again, my understanding of the dollars, again, it is upon us if we want to put that in there. The care coordination dollars also came from the IDD providers who used to get a rate. I don't know how the math worked, but we were assured that it was in proportion. When you look at all the money for the physicians and the other providers that were getting care coordination dollars,
the amount we received was not equal to all of that. So the PCMH money, to our knowledge, has never been included in that factor. We are looking at still finding a way to pay that to providers, either through their rates or through some other measure. And we're still working
Speaker 225
1:42:00
through that, Senator Hammer. I have a summit. Senator, we're in the same position in the sense that we are evaluating those types of relationships and really looking to tie that payment to a value-based payment so we have better access to care
but then also being able to tie it to better outcomes, whether that be from a clinical perspective and or a financial perspective so we can ensure that we're being good stewards of those dollars and the dollars are going to where they need to go to ensure that we can provide a high-quality care and we have a good patient experience. Okay, and we're about to come into
Senator Kim Hammer
Unverified
1:42:32
the fiscal session. Are you all going to ask for an increase in your rates, or is there any discussion about that, or DHS, can you all, are we looking at any increase? Because if you're going to start giving money to providers that wasn't previously covered in the cost,
that alone, along with anything else, are we looking at having to reimburse you anymore as passes for that? or are you going to be able to
Speaker 248
1:42:58
hold where you are? Thank you, Madam Chair. Not from our perspective, Senator. I think
Speaker 225
1:43:06
that's good money spent. We are not at this time asking for a rate increase. We're in the same position. And, again, where we're looking at this is that we're in that first mile of a marathon. And from the perspective of being able to be an entity that is leading some transformation
in partnership with the state in partnership with DHS and being able to provide a level of care and an access to care in a very I would say manageable way from the perspective of being good stewards for the dollars that we're collecting through our capitated arrangement we're looking at being able to move forward in such a way that we can take out a lot of the waste the redundancy within the network that's delivering the care so we can ensure that we're reallocating
to those dollars that are given to us to provide supports and or benefits to the beneficiaries that are attributed to us to where we can have something more sustainable and something that we can be proud of not just as a pass but as our Kansans. Thank you. Thank you for the answers. I would i mean
i just thank you for the questions and the answers i would reiterate though that if you will look at a lot of people in rural arkansas who have been out there practicing
medicine and taking care of this population and doing a good job of doing
of of of this it's not hard to figure out and so if you start to cut because when you say providers there's a million
people that fall into that bucket right and so I mean I think the concern is you've got primary care doctors primary care nurses that have taken care of these patients for a very long time
and the disruption because of the past that has occurred is that some doctors and nurses have not but had the ability to continue to care for those patients. And so, you know, you can contract with this organization or contract with this organization, but it comes back down to trusting the citizens of this state to take care of each other. You have to trust Arkansans are going to take care of their neighbors.
Because guess what? When someone in rural Arkansas walks into a Walmart or to a grocery store, it's real hard to say I'm sorry I can't take care of you or your family anymore I've taken care of you for 20 something years but I can't take care of you anymore that's real difficult to do in a small town in rural Arkansas and that's just about in every single look and cranny of our state and those are the people that we represent those are our constituents so these are the phone calls that we get on a daily basis so all the talk and all the little buzzwords of you know quality and
blah blah blah great fine whatever but you need to boil it down
to what works best for Arkansans so I appreciate that Senator Davis you're recognized my
Senator Breanne Davis
Unverified
1:46:19
question was the same as Senator Hammers just wondering about the distinction between clean claims and then claims that are not clean um you know the one of the things we met about just even going back to march and i'm talking about ot and pte evals so i'm curious if those things and the prior authorizations and
stuff like that if those are also included in the non-clean claims um so when we get that information back i'm just kind of curious where those land um because i know you know you guys are trying to figure out maybe coding issues or how to um deal with insurance in the appropriate way so everything goes right and so i don't know if those fall in non-clean claims or they're just out there in their own uh i
guess category yeah now many of them are are outside of that that
that statistic but we know what the
Speaker 233
1:47:11
issues are as we've discussed when we met um to try to figure out exactly what pieces and parts need to be done as far as prior authorizations go um the authorization process is an earlier step usually if there is a pa it's required and then the claim is subsequent to that so connects but not exactly the same it's not in that same number but you you could be denied for medical necessity reasons legitimately but what we're talking about when we're talking about the table were glitches in the system about how it connects to codes and
coding and that and that's not those are going to be paid it's just it was just a matter of reworking it to get the system
Speaker 234
1:47:47
to accept it which is different than denying the service okay it's just not it was
Senator Breanne Davis
Unverified
1:47:52
something no something not happening with the payment so so for all three passes if um can we add to senator hammer's request not just for what's not paid um based on the non-clean claims but if there is a category of claims out there that are just sort of um floating in the middle where you guys are working out maybe technical issues or whatever it might be
so they don't fall in either category can we also get um a number on that on you know what that looks like that has not been paid. Thank
you. Thank you. I appreciate that. Senator Wallace. Thank
Speaker 351
1:48:28
you Madam Chair. This is for all of y'all. You had mentioned earlier the the standards of payment of invoices. I heard a seven day and a 14 day. Would you repeat those to me again just so I have the percentages? So go
Speaker 248
1:48:43
ahead. If I understood that right. So for ours 82% within seven days and 95%
percent within uh 14 days and this will be part of the claim submission report that we'll get to mr price
Speaker 258
1:48:57
is that across the board no that those are our performance measures
Speaker 233
1:49:01
against those time periods specifically all three we are required under the agreement um to pay 70 percent of our claims in seven days 95 of our claims in 30 days and 99 of
Speaker 234
1:49:12
our claims in 60 days so we track those metrics and a follow-up yes
Speaker 359
1:49:17
sir mark are we meeting those standards so we measure
Speaker 113
1:49:31
each pass in in meeting the standards and if my memory serves me correctly I do not have all of the information with me today but I can go back and get that to the committee. I think we have, I don't believe we have all three passes on the 70% in seven days. So I can give that report back to you on which passes are meeting that performance
Speaker 133
1:49:51
measure. I would like to see that, please.
Speaker 359
1:49:54
Thank you, Madam Chair. Yes, yes, sir. Representative
Senator Linda Chesterfield
Unverified
1:50:03
Murdoch. Thank you again, Madam Chair. The intentionality of the, of the, of the legislation was that the providers ultimately would be, as Senator Irvin had been mentioning, they would be taken care of so that they don't have those situations, as she talked about in Walmart. My concern continues to be this, is that happening? So from an oversight standpoint, if we could have AID and DHS,
if Rand is still here, Booth, yes, if he can come. Because my question is this. a lot of times why the money is not getting where it or the services or the coordination is not getting where it's supposed to be you all have an agreement with DHS in DHS I'm assuming we are you are the ones that's overseeing the relationship between the past team the individual passes and our providers so we have to have someone in that
relationship ensuring that those things are done the money is flowing the everything is being done according to the agreement so who on the state side is responsible because I continue to hear that the past is working it out with the providers but then you hear these complaints we have these meetings where all you know people are being not properly kept so from our standpoint how can we be assured that DHS and or AID or the collaboration of the two is taking care
of the people the providers and and the constituents it will be serviced
Speaker 290
1:51:46
meaning there's an agreement between DHS and the providers
Speaker 113
1:51:52
so yes sir so we have an agreement with each of the passes DHS holds that agreement with the passes and within that agreement we have all of the performance indicators for things such as the clean claims which Jason just testified to the claims that have to be
paid if they're submitted in a clean claim we have a monthly report that we look at to make sure that that is happening if there are outside of the performance that is required by them then DHS can act on that contractually We can have a corrective action plan. We can have a sanction of some sort if that doesn't happen. The other thing that we do is investigate or work with the provider if we get a phone call or if we get a report that the pass is not paying a claim or if there's a problem
with a specific type of claim. So just as we do on the beneficiary side, we have a call center at DMS where providers can call. We also have constituent services within DHS where we get those phone calls, and then we track down each and every one of those to ensure that if there's a problem with the pass, with a specific type of claim, with a specific provider, that that pass does do that additional work with them to ensure that they understand how to bill appropriately.
or if there is an issue that we're seeing trending across all three passes with a specific type of claim, maybe a code changed, or there's a provider type that seems to be having some problems, then we work on that with either that provider type or with the passes in our
Speaker 364
1:53:34
own internal group. Do we regulate the agreement so that there won't be
Senator Linda Chesterfield
Unverified
1:53:39
any callbacks or ways that the pass can retrieve money from the providers and the providers say, well, I've got to deal with them. I'm kind of stuck here.
Do we monitor, or AID maybe, do we monitor that relationship to make sure it's not a predatory or a, where they're taking advantage of when that
Speaker 174
1:53:58
properly paid? Representative Murdoch, Boothran, Insurance Department. I believe when this last came up, we tried to explain our legislative role. If you look at the original pass legislation, the role of the Insurance Department is to ensure that the passes are stable financially and can pay claims. and say, and so the issues about slow pay, clean claims, any coding or claiming requirements,
prior authorizations and that, those go under the Medicaid contracting requirements. We do not apply the Arkansas Insurance Department rules and regulations, our clean claim rules on the passes, because our role has been financial solvency. Now, having said that, over the last couple of years, the legislature has carved out some laws that we do apply to the insurance industry on the passes. One of them is the PBM law, okay? And so we have seen over the last several sessions, the other is the prior authorization
law, okay? So when the legislature wants the insurance department to apply its particular statutory and regulatory claims handling requirements or laws, it does so, but the original focus of the legislation was for this to comply with Medicaid provider contracting time periods. Our regulatory time periods are probably a little bit more flexible, in my opinion, than the Medicaid.
I think Medicaid's got a quicker turnaround time period for the most part. But we have deferred to Medicaid. The legislature has really wanted AID's role just to be solvency, with some exceptions for
Speaker 113
1:55:43
PBM and for authorization. DHS. so yes sir so we we do have all of those requirements for payment of claims the authorization of claims the authorization of services for medical necessity all of those
requirements are in our contract and we do monitor all to all of
Speaker 286
1:56:00
those requirements so before a provider calls myself or senator hammer or one of us and and complaining about payments we've been dealing
Senator Linda Chesterfield
Unverified
1:56:06
with this for a minute before they call us they do they
Speaker 113
1:56:11
call you i don't think that they have been calling us directly um at at dhs um and and we we've noted that uh to some degree so um that that they tend to call you first and call us second so whatever we can do to repair that or to
to make a difference in that to say please call us first because it's going to help us do that more quickly if you call our offices first and then we can get with that pass. I know that the passes also have representatives in each of their passes that also address these issues. I know there's been testimony to that, but we would also like to track that and also like to be involved in that because it does speak to their performance on this contract. So we are tracking all of those.
Senator Linda Chesterfield
Unverified
1:56:57
Yeah, my last add, and I'm done. But I think really we should make sure, we meaning DHS, should make sure that we have somebody monitoring or a group or a section monitoring payments and claims specifically, even without complaints, just to make sure that the money is flowing properly, nothing is being improperly handled, just to make sure that our providers are taken care of. Because it's supposed to be a provider-led relationship.
Speaker 113
1:57:28
Yes, sir. And so in addition to the contractual requirements that we're monitoring from that side, also each claim that gets paid comes back to DHS as an encounter. And so those encounters either get accepted or rejected as well. And so we are monitoring all of the encounters so every claim that gets paid comes back to us to make sure that it's paid appropriately. We're not going to have many
Senator Linda Chesterfield
Unverified
1:57:51
problems then with all this coverage I'm hearing about. We won't have any more complaints.
Thank you, Representative Murdoch. Representative Gray. Thank you, Madam Chair. So I've had
Representative Michelle Gray
Unverified
1:58:03
this, I've had my button pushed for like 45 minutes. So you may get a couple of things here, but one I'd like to. Yes. One thing I'd like to say, just kind of listening to Representative Murdoch and Senator Hammer, was that per member per month fee that all the providers got, and I thank you, Mr. Ryan, for going ahead and getting that back out to the providers because not only are the rates that they get reimbursed the lowest rate of any insurance company,
I mean, it's half of Medicare, and Medicare is lower than commercial, but that helped supplement them, and so now they're no longer getting that, so I would really like, and they came in the form of quarterly payments to the providers. I would really recommend that the other two passes look at doing something to that effect because now, you know, Senator Irvin and I and others used to complain about Medicaid rates and how bad they were. Well, now it's even worse, and I know that all of the providers that I talked throughout the state were not given the opportunity to negotiate rates, really, because they were
individual providers, and they didn't have the manpower. The only people that had the power in the state to try and negotiate rates were UAMS and Children's. Everybody else got what contract came to them so just from a provider perspective I'd like to ask you to really look at doing that I've I've received an email or a text a couple people I think in the room have received the same thing we have got one one provider in the state they provide pediatric services I think
it's therapy services and they're having issues especially with summited in power with secondary claims that are crossing over from a primary payer. They're not being submitted directly from the client, but third party. So I would like to get with you after the meeting and show you that and see if we can't get you to work with at least this provider and address their issues, if that would be agreeable to both of you. I've heard of others across the state having issues. Those issues so far have been great to work with individual providers
to get those paid I guess just in summary too so I haven't necessarily had a question yet is I see two separate issues here I see the issue with Arkansas total care and I think that's a more immediate thing because that goes against the intent of what the legislature had and I remember helping I don't want to say write the legislation but I looked at it and asked for changes and was involved, that goes against the intent. The other with Anthem, I think that Anthem does not have a
controlling interest on either of their boards, and I don't know if that's the right term to use or not, but they're well underneath the 51%. I don't see that as an immediate thing that we need to address, so what I would ask is that we let DHS go ahead and get the provider agreements ready for this upcoming year with the address that Mr. Ryan's agreed to with that change, and then we look and we don't do anything rash um and i love you booth ran wherever you're at look at him um i don't want to do anything rash or too too bold because the last thing i want is for all three of
these passes to fail we've worked so hard on this for so many years i'd like to address that issue a little more um with a little more thought and diligence because right now anthem does not have a controlling interest on either of your boards is that correct that's correct all right thank you
With that, I think I'm through. Thank you. Thanks. I mean, I will follow up. I was given repeated assurances that this would not disrupt primary care for these patients, and it has.
I would have never voted for this legislation if I knew the amount of disruption that has occurred with your primary care providers. You may have a lot of IDD providers, behavioral health providers, or whomever, hospitals as providers, in your provider network and your board make up, but when it hurts that immediate connection that these patients had with their doctors, then that's a problem,
and that needs to be addressed immediately, in my opinion, because I was given assurances that this would not hurt that relationship, and it has. So, yes, it is happening in response to Representative Murdoch, Senator Hammer, and Representative Gray. It is happening, and it's a
Speaker 375
2:02:39
problem. Representative Penzo? I've also received emails about delays in payments.
I've got one facility that states that they've been waiting on a site visit since June. How long does it typically take to get a site visit to have a provider evaluated? They're about $19,000 behind in pending claims, and I'm just kind of curious how long it takes to get that taken care of. representative
Speaker 247
2:03:11
bit more about the site visit i'm i wanted to
Speaker 375
2:03:15
understand that context a little better well i think it's probably probably more of a medicaid issue they've been trying to get a hold of um trying to get a site visit to come out to get a provider approved for reimbursements so um just wondering if that's atypical or if y'all are that far behind on getting site visits taken care of?
Speaker 55
2:03:41
Representative, there have been some issues with provider enrollment with that process in general and that has affected the site visits. I know the
last report I had as of end of last week is that we were current on the site visits that have been passed out to the folks that do those. It may be that that case that something else has happened to that particular provider through that provider enrollment process. So if you'll give me the information on that provider and we'll follow up and
Speaker 375
2:04:07
make sure that they get taken care of. I would appreciate that, and I'd also like to catch up with you three after two to
Speaker 376
2:04:14
try to get some of these other issues corrected with a provider.
Thank you. Just to follow up on Representative Penzo on credentialing. So credentialing, is there a separate credentialing, though, between Medicaid and network for the passes? Do you have your own credentialing? Does that make sense? Or is that negotiated contracts credentialing? Is there a process and how long is that process? Senator, we do have a unique
Speaker 248
2:04:43
credentialing process, but it's consistent with what, keeping in mind, we've had a provider network in the state for close to 20 years.
So some of those are direct credentialing relationships with us. Some of them are actually delegated to the providers themselves, so they perform their routine credentialing process, and then we have some level of oversight, but we
accept their credentialing, if you will.
Speaker 248
2:05:08
How long does that take, do you know? It depends on, if everything is submitted to us, about 60 days is typical. It goes to our credentialing committee for review, for peer physician review. But the time varies because of completion of information that we receive
or lack of information or just back and forth in the mail or e-mail, et cetera. So that's a typical average. okay
what about the two do y'all have credentialing senator we do um and we
Senator Breanne Davis
Unverified
2:05:37
would do it through the anthem the anthem side the managed
Speaker 233
2:05:41
care side because all insurance companies the the what we did just so you know and just maybe something down the road to talk about as you hear if folks have concerns we did um except from dhs a deemed status situation so what we did is we
were allowed in this first year and a half to to allow folks to come in so we didn't have to kind of infiltrate people we're You're going to have to do that at some point, and probably most providers will tell you the worst part about credentialing is not the waiting, it's the doing. It's the getting the paperwork. You've done that probably with your husband. You have to go through all the paperwork and send in everything. But if they've been a Medicaid provider for 25 years. Right. So what we're trying to do, even though we have to do it as an individual entity, we're trying to find ways we can bridge the two together. And that's why we did the deemed and trying to see if there's any way we can make those two streamline it, do it simpler.
This particular pass, our pass with Anthem, was newer to the market, whereas John's group has been here, so it was a little easier to piggyback in. We're going to have to do
Speaker 238
2:06:36
it a little more from scratch, but we will be doing that and make it as smooth as we
can. Okay. And that's the same for Empower as well. You just got a member. Okay, that's good. Thank you. But that may be an issue. If it's a new provider, credentialing might be
an issue, whether it's with Medicaid or with network. It just takes time. Two separate processes. Yeah, that's true. Right, okay. All right, thank you. Okay, any other questions?
Representative Johnny Rye
Unverified
2:06:59
Representative Rye. It's not a question, but I wanted to do an appreciation at the end, if
you don't mind. Okay. Yes, ma'am. Is this it? Well, for this discussion, this
Representative Johnny Rye
Unverified
2:07:15
item, yes, we're at the end. I have no other questions. Thank you, Ms. Co-Chair. I just wanted to congratulate a senator here that is a granddaddy for the first time, and I want to say congratulations, Senator Pawpaw Wallace. Yay.
thank you representative rye for reminding us all right thank you all right there's no other questions thank you we look forward to and i think if if
we do have another meet just to try to say this is what occurred because we know that we're still in negotiations with board
members we do appreciate the acceptance of the language and following the intent of that law i think that immediate issue i agree with representative gray but but we can work through that with with um and
then if we need to do something we might try to do a 15 minute meeting at the end of december which i'm fine with all right so be on notice thank you so much for the long
discussion we do have somebody signed up for comment that is here your, if you'll just keep your, Dr. Loretta Cochran, Dr. Loretta Cochran, if you'll just
state your name and then recognized. I'm Loretta Cochran,
Speaker 397
2:08:49
I am a parent and guardian of individuals with disabilities, also a person with a disability, and one of, and the reason I asked to speak today is because, and I realize it's late in the day, and I'll keep my comment short, is that in, I've been dealing with the passes since I began, I was actually a plaintiff in the failed attempt to stop the movement to the pass because we knew the network wasn't secure and we knew that this was going
happen. We've lived through it because we are, even though I know we like to talk about full risk, the only people here at full risk are me and my child. Not the passes, not the insurance companies, not the state, but it's the parents and children. We told you that the network wasn't ready. We told you that we were having problems and we went ahead anyway. Given that, we have all hung in there and we are trying to make things work. The issues right now with billing are still durable medical equipment that seems to be the biggest issue now we have parents
showing up to providers and being told that handed our cards back and say thank you but no thank you they're no longer in the past even though my assurance is from the Allen's Budsman whose office is fabulous by the way that they're supposed to notify us first okay so we do have great we have an excellent Ones Budsman past Ones Budsman's office run by Dena Perry she deserves a raise ways, and so do her staff, because they are fantastic. Well, Senators
have to feel to be happy to hear that.
Speaker 397
2:10:20
But throughout this process, the folks that have the most knowledge about these individuals, the individuals with disabilities have been left out of the discussion. We've not been at the table, not with the passes, even though we were promised we'd be at the table, not with EHS, even though we're supposed to be, but we haven't. We've not been at the table. We could have told you where the issues were. We can actually tell you where the cost savings are, but we're not engaged. We get lip service, but we don't get any real service. Right now, we have problems because pay rates for direct support professionals are so low.
We have zero stability in a workforce that needs greater training, greater credentialing, greater expertise, and better pay to retain them. I can't trust to have my child in the community and live a fully integrated life that he wants if I don't have the appropriate support paid at a competitive rate with the skills that he needs. And that is the problem facing, that's the crisis facing every parent. Do you institutionalize your child at the rate of about $128,000 a year
cost of the state at a human development center which is not acceptable to most of us that are on waiver or do you have this churn of caregivers that are not trained that don't have the right mindset which is just like the mindset of the past CEOs and DHS they haven't lived
this and when you talk about the the the workers are you talking about personal care workers are you talking about direct
Speaker 397
2:11:55
service person direct service persons that are either waiver waiver
assistance which allows my son to go to work part-time and you know do whatever he wants to in the community just like you and I would okay and we have more complex individuals on waiver than we used to they have the right to live outside of an institution and they need care staff that are trained to do that our providers bless their hearts they're great but they still have the mindset of an institutional setting where we provide that care as opposed to being person-driven, person-centered care. They have not been able to break out of that mindset.
I actually have experience with LifeShare being an Arkansas Total Care client. I think that I can see the reasoning why they brought them in because what they're able to, what they do is they provide a skill set training to individuals that's just not really owned by anyone in the state. they're trying actually to provide continuum of care and you know john's on my short list right now because my son's plan's not working so i don't have any there's no incentive for me to say nice things about arkansas total care but the idea behind the company they brought in was actually
a good idea there's a massive skills gap there still is there's a massive service gap and i think they're in their best trying to fill that because it's not we don't do a good job of keeping our individuals in the community. We start segregating them almost at birth when we find out they have a difference. We put them in separate classrooms. You have to fight tooth and nail to get your child to stay in the classroom to get the supports they need, that extra staff, extra training. You have to be the scariest person in the room to get them
what they need, and you cannot back down. Now, it shouldn't be this way. I have parents who did this 40 years ago telling me you're fighting the same fight. We have federal legislation that prevents this, but we're still doing it. The state prefers segregated care. They prefer institutionalization. I understand the concepts of efficiencies. I have a PhD in it, but these are children. These are adults that have lives. They get to live independently. They get to work. They get to be taxpayers should they choose to. We need to elect them.
We need to give them the supports to do that. My son wants to get a college degree, maybe an associate's degree. he wants to work. Will he need supports? Will he need transportation? Yes. It doesn't exist. The supports he needs to be in the community doesn't exist outside the natural supports and I don't care what the providers are aren't getting paid. Parents aren't getting any pay and we are still doing 100% of the care coordination and all the things that we were supposed to be able to have through the passes that have not come through for whatever reason we have for not doing it.
we always get a good excuse but it's still not being done so if we wish to move this forward the system needs to be held not accountable by DHS not the insurance commission but their clients people with disabilities and the families they set the standard not anyone else I wouldn't allow a facility to exist so I wouldn't want my child to live in but they definitely exist in the state and the folks in the state that live there have no one to sit here,
have no one to sit here and fight for them. And mothers of children with disabilities, we don't leave another mother and another child out there. We don't go away. We will see you on Election Day. We will see you in the statehouse. We will be here because our children, young adults, doesn't matter. They matter in this community. They matter in this state. Their lives are just as important as anybody else. They have the right to an independent life just like anybody else. If they need a more structured setting, they have the right to choose that.
If they don't, they have the right to choose that. It's a choice. As long as there's a choice without coercion, it's a choice. Right now, there's not one. It's coercive. If you want your child to be safe and secure, you better look for an institutional setting because of all the turmoil that has been made worse in this past process. but to stop the constant bleed of money you've got to have what the passes offer which is an opportunity to be innovative the people that are already innovative are the parents
and individuals with disabilities they're in the community we've done more with less for decades we wrote the book but no one allows us a voice that is what i wanted to
say well i i appreciate you lending your voice to us today and if you have anything written we would love to have it and then we'll share it to the other members that may have stepped out or were not here today. I will.
Thank you. Okay. Thank you so much Dr. Cochran. Okay.
With that we're going to move on. Exhibit E. I mean I'm sorry. Exhibit E. Item E. Mr. Gilmore. thank you for your time this
Matt Gilmore
Unverified
2:17:19
afternoon I know it's been a long agenda I'll keep
this as brief as possible I'm Matt Gilmore with boards and commissions of Department of Health so what I have for you today is the quarterly
report for through March of 2019 of the Tobacco Settlement Commission programs and this is similar to what you've seen in the past what we've given to you in past meetings it's a just a summary there's a three page colored infographic that you can see here it's a summary of the report itself I encourage you to read the report when you have time but this just kind of hits some of the highlights
and focuses on different areas with the programs engage in and I'll keep it as brief as possible take any questions you might have but if you look at the first page their education that's done through a variety different ways you can see that working with health care professionals courses offered through the College of Public Health at UAMS and then also working with community education across the state working with community leaders caregivers things like that you can see that number there 49,000 that's an increase over the same time period last year but then also the number of youth there's a significant
increase there as well of about 11,000 there so we're trying to reach as many folks as we can. I think the programs are doing a good job of that reaching out across the state. Moving down below that you'll see that service as well and it's done through a variety of different ways as well through exercise encounters, health screenings, health clinics, and also working with DHS through their Medicaid expansion program with tobacco settlement dollars. They fund four populations over there that's pregnant women, seniors, extended hospitals, hospitalization benefits and also the development disabled waiting list
there's a population there they serve as well so there's some increases there as well about 800 of the same time period of the previous year so if you turn the page and if I'm going too fast you can slow me down but research as well there's a couple of programs that engage in that the Arkansas Bioscience Institute and then also the College of Public Health at UAMS we'll start with ABI there in the top left you'll see that they're working with the Arkansas all-payer claim database this is a partnership they've had for a while working with them looking at insurance claims paid here in the state looking at that data
looking at issues that pop up through the insurance system there health issues and able to look at that data and engage in research across the state that can help solve some of those issues over time and then also the College of Public Health if you look towards the left corner excuse me the right corner of that section working with the College of Pharmacy at UAMS has established a Center for Dietary Supplements engaging some research in that field. There's not a lot of research or regulatory controls over that right now so that'll be an
added benefit there here in the state that they're able to engage in and provide some guidance there. And then down below you'll see the economic impact we try to highlight this every time as well but the programs engage in different ways and finding money to bring into their programs and leverage that whether it be through contracts and grants but also through federal dollars and some donations as well private donations so you can see a couple of numbers there the Medicaid expansion match there but also money is given through contracts and grants through private donations and then one more thing I'll point out on
the next page you have some testimonials and we try to highlight this every time as well but this kind of gives a personal glimpse into some of the different programs and ways they are impacting individuals across the state, whether that be through worksite wellness events, but also through screenings and working with programs and individuals on a personal level. So I encourage you to read that when you have time, as well as the entire report. I know it's a little lengthy, but there's lots of good information in there and specifics about each one of the programs. So with that, I'll take any questions you might have. If I can assist or provide further information, I'll be happy to do that.
Mr. Gilmore, I attended an event for Champions for Health Foundation, and they honored Dr. Kenneth Cooper of the Cooper Clinic. And Governor Mike Huckabee was there to give
the keynote address. And I believe I'm repeating one of his remarks was that the tobacco settlement, all the money that we received, we spent 100% of it towards health initiatives and health-related everything.
expenses to help medicaid dhs um whereas other states did not do that other states actually took the money and plugged holes in their budget or filled potholes with it but did you want to comment i thought that was a remarkable thing well i appreciate the state yeah i appreciate the legislature and
Matt Gilmore
Unverified
2:21:57
the governor keeping it that way we are the only state in the country that does that that keeps it all towards health so i appreciate y'all's focus on that and and working with these programs and helping us and the governor as well so thank you yes
and dr cooper said it's real simple we spend trillions of dollars on health care but it's real simple eat right exercise daily don't drink and don't smoke true that's very true i totally agree representative mcgee you recognize her question yes she did
Representative Richard McGrew
Unverified
2:22:33
you push the yellow button and then you don't touch anything
push your green button there you go push the green button
Speaker 412
2:22:44
now i'm here now i'm here i got it johnny yeah i got johnny representative right over here help me out thank you madam
Speaker 413
2:22:55
chair when i read through this i read this independent evaluation and it talked a little bit about electronic vaping devices what could you have any comment about what any efforts are being made that to address that as it's really becoming an epidemic so one
Matt Gilmore
Unverified
2:23:10
of our programs the tobacco prevention cessation program the Department of Health is focused on tobacco use in
general but also vaping they've ramped up some efforts there but mainly focusing on the young people that seems to be where the epidemic is going into schools providing education also to colleges around the state with their athletic teams but also just you know students in general so it is it is an issue I think we're making the appropriate steps in the right direction but it's going to be a while before we see a I think a decrease in that okay thank you madam chair thank you yeah I hope
that you do ramp up and use use your ability and
your reach to really address that because it's becoming an epidemic and it's a huge huge problem we need we will be having another public health meeting on vaping coming up in the near future so we may actually invite you to participate in that as well any other questions by members all right seeing none thank you
thank you i'm going to go back and catch the last rule that we had on our agenda before we lose everybody so arkansas department of health if you will come back up and it's item m exhibit m we're going to go back to item m exhibit m members if you'll
look at this i want to make sure we
Speaker 89
2:24:39
catch this last rule i'm sorry i'm skipping around but thank you madam chair members of the
Speaker 80
2:24:45
committee laura shu general counsel for the department of health and the department is bringing you some more good news this is actually a rule that was brought to us by Dr. Patil who's here with us today it's Dr. Naveen Patil P-A-T-I-L and he is
the medical director for our infectious diseases and he noted that the CDC in May of this year changed its tuberculosis guidelines and he brought this idea to the legal department so we could assist in drafting the rule and bringing this before you today. The basic premise of the rule change is to remove the requirement for yearly TB testing after a baseline has been found and adding language indicating that there's no routine follow-up testing required. This will save
millions of dollars for hospitals and for our jails and for our correctional facilities. So this is a money-saving rule that we're bringing for you today. I have Dr. Patil with me if you have any technical questions about the rule. Are there any
questions from the members about the rule? Representative Brown? Thank you Madam
Speaker 418
2:25:59
Chair. I might have missed something. Why do we don't we
Speaker 420
2:26:04
don't need follow-up testing. Good afternoon chair, ladies and gentlemen. The reason is CDC came up with this rule about six months ago. The incidence of tuberculosis among healthcare workers and low-risk population is so low, so there is no need to test them on an annual basis. It's a huge burden economically, you know, people coming a couple of times in a year to get tested and again low-risk groups when you test them you have a chance of being falsely positive
and the incidence of TB cases in this low-risk population has been negligible so we need to concentrate on you know testing high-risk groups and populations and that's where efforts are going nationwide. Thank
you. Yep. Absolutely. Any other questions? Well we appreciate that you had an eye on this i couldn't agree with you more and um so really appreciate you bringing the rule forward and y'all making it happen thank you without objection that rule will stand reviewed
and we'll see you at rules and regs subcommittee all right item f miss clummer exhibit f members this is the annual status report for the prevention of unplanned Pregnancies on Campus Act 943 of 2015 and Ms. Clemmer's here with Higher Ed. If you'll just
state your name and then you may proceed with your report. And Clemmer Division of Higher
Speaker 426
2:27:37
Education now part of Department of Ed. It'll take us a minute to get used to saying it that way.
Speaker 425
2:27:46
A quick question Madam Chair. Did you also wish to hear on the sexual assault prevention? I believe that was in Mr. Price's request. I
Speaker 426
2:27:57
just wanted to double check. F and G. All right. As you may remember, some of you, in 2015, the General Assembly passed Act 943, directing then the Department of Higher Education, along with the Coordinating Board, to develop an action plan to dealing with unplanned pregnancy.
it was brought to the legislature's attention that a great number a huge percentage of that teen pregnancy rate happens 18 and 19 not necessarily the younger years as you might expect although it is still troublesome at every age of course but it led a number of people to believe that actions needed to be taken by the campuses and this is as a result of the action plan, the legislation also directs us at the department to submit an annual report to you
Speaker 425
2:28:55
and that's what this is. The legislation asks, let me
Speaker 426
2:29:00
just run real quickly, that campuses identify methods of addressing the problem of unplanned pregnancy, to collaborate with health centers, to identify measures of success, and to incorporate into academic coursework as appropriate those are all recommendations the mandate from the legislation is that campuses include in their orientations information on the prevention of unplanned pregnancy
we are happy to report that all schools did submit their annual report this year and I thought madam chair I'll go into I'll try to keep this brief but the report outlines just about five or six highlights from the different schools and if you're ready to leave you can tell me to no stop at arkansas tech student leaders and atu staff all got trained on act
943 this is unplanned pregnancy right so they're teaching the material to in small group sessions And they conducted these sessions during the fall 2018 session to over 1,300 freshmen. Incoming freshmen and transfer students were also presented the curriculum. At the University of Arkansas, UA students provided community outreach to teens in northwest Arkansas through service learning and through the Center of Community Engagement,
as well as their federally funded pre-college programs. The U of A, in dealing with the piece in the legislation to measure effectiveness of prevention activities, the U of A surveyed students in spring 2019 using a national college health assessment survey to collect data, and they're seeing
Speaker 425
2:30:54
some progress among their students as far as who's being reached and the awareness of birth control and safe sex alternatives.
University of Arkansas Little Rock conducted with health services Trojan Wars playing
Speaker 426
2:31:10
on their mascot an event so focused on safe sex and unplanned pregnancy prevention residents resident assistants in the dorms use bulletin boards and they promote the statistics and the data on unplanned pregnancy did I
no I'm not gonna say anything no I'm like no it's
the school also set
Speaker 425
2:31:43
up mentorships with the Pulaski County School District and some of the legislation
Speaker 426
2:31:49
did specifically request not mandate that colleges reach out to teens in the area and University of Arkansas Little Rock did do that University of
Central Arkansas had a host of activities student health clinics were set up where comprehensive overview was provided to students a lot of students at four-year campuses aren't aware of the services they have through this through campus health services and they're going over that more and more with students a number of young women who need birth control may seek those services or they need to get their exams so that they can go to the pharmacy and get their birth control they can do that at college campuses at UCA there was a
get yourself tested campaign a month-long campaign to promote sexual responsibility in February they had a health fair where students are are volunteering to promote well-being, and they're focusing on many of those abstinence and safe sex and smart choices when they're going through these programs and their student volunteer programs. They promoted in March a safe spring break week,
and safety kits were handed out that included protection methods. the UCA wellness fair hosted by student wellness and development included booths covering pregnancy prevention and provided contraceptive over-the-counter contraceptives at the college let me
ask you a quick question is i mean i'm laughing because trojan wars is an appropriate I guess a fitting name for their event I mean I know that's their mascot however there's another
yes okay so but is there is there any focus on abstinence and they're not having sex because there is there's a self-esteem issue there with young women and so I mean I don't want this to turn into this free-for-all where we're just handing out prophylacte you know I mean there I would really like us to be
focusing on abstinence and many of the schools
Speaker 426
2:34:16
did include that as part of their wellness even in in the reports that we got on the next the next item on the sexual
assault prevention a number of them were talking about prevention and making better choices you know not going to parties inebriated not ending up not ending up as a result of assault in as a teen pregnancy statistic if you follow me so a number
of them do um is there any
um leadership through the arkansas department i mean department of education higher ed division um for you know
those type of programs um where abstinence and care for your body and an understanding of that is I guess promoted or we at best provide resources
Speaker 426
2:35:12
uh to campuses it is um as you know this didn't come with any additional funding for any of the campuses many of them are engaging in the partnerships with Department of Health to provide these resources.
They're getting their resources from the Department of Health, not from us, when they're engaging in these activities. We are just the collector of the reports and reminder that the reports are due and that they are
Speaker 425
2:35:46
to have a program for unplanned pregnancy prevention. I'm going to just go ahead and
go to questions we can read the report Representative Flowers Thank you Madam Chair
Representative Vivian Flowers
Unverified
2:36:01
I was just wondering is there any data that's collected or is there any way to collect data so that we even know whether or not there is what the rate
Speaker 435
2:36:14
of pregnancy is of young women in college We have had
Speaker 431
2:36:20
that. That was brought, I think, when the legislation started, and we had
Speaker 426
2:36:25
it, I think, through the first year. I reached out to the Department of Health belatedly, but I haven't gotten anything back from them on that.
We just did see a surprising rate of unplanned pregnancy in the 18-, 19-year-old. age group but i mean so so we are
Representative Vivian Flowers
Unverified
2:36:49
collecting that data we have that information the department
Speaker 426
2:36:57
do not collect uh the teen pregnancy data at the department of higher education um one thing i would say that to the chairman to the chairman's question chairwoman's
question um we had a very interesting launch of this campaign to start off with that we were involved in a lot at our department we produced a film a video and it was really a lot of testimony from college students who
Speaker 425
2:37:26
found themselves parents and you know it was just a real
Speaker 426
2:37:32
a very real video where the kids are saying look I used to go out and hang out and go to parties and now I stay home
with Dora and we watch a lot of Dora now and my life is different and it's wonderful but it could have been it could have happened when we were more ready later and those were really good testimonials and we share that video with all the campuses that want it we got some grant money federal grant money and worked with some volunteer students who were willing to step up and talk about their experiences. And there were males that talked about their experiences
as a new dad trying to finish college. A
Representative Vivian Flowers
Unverified
2:38:17
follow-up, Madam Chair? Thank you. I noticed that there are, well, the colleges
in my area are not on here, so does that mean that they did not submit? No,
Speaker 435
2:38:29
excuse me. I just, what I was going to, should have
Speaker 426
2:38:33
probably said a little clearer. We just picked out a few of the activities that were from colleges that were doing interesting things. They're all doing sort of the basics.
Some are doing more than others. Is there a
Representative Vivian Flowers
Unverified
2:38:49
full report that illuminates what every college is doing? Because I would love to see what's happening in my area.
Speaker 426
2:38:57
I have every report. I started to bring them. It stacks about eight inches high. Why don't I pull it and send you an electronic copy of, if you'll converse with me after, tell me who you'd like to see, and
Representative Vivian Flowers
Unverified
2:39:08
I can just send you an electronic copy of it. I can tell you now, C-ARC and UAPB, those are
Speaker 431
2:39:14
my district, so I'd love to see what they're doing. Okay, and we sometimes have to
Speaker 426
2:39:21
encourage them to not forget about this mandate from the legislature.
you know it's one of those additional items that colleges I wouldn't say were just jumping up and down about so sometimes we remind them that this has been mandated and that they're to do this but they're all doing something and some are doing it a little more wholeheartedly I'm not saying anyone's really reluctant but some are just putting a little more energy into the work and sometimes that's a staffing issue I mean I really had
Representative Vivian Flowers
Unverified
2:39:52
forgotten about this I'm glad to see that
there's activity I'm just wondering what's happening in my area and maybe if you could help well I can maybe help me get a contact with the department of health I'd love to see what the numbers are
Speaker 426
2:40:07
as well okay I would also point out that because representative Ferguson reached out to me over the weekend to ask if we had anything and told me that she wouldn't be able to be here today um we we would like to see the numbers of teen pregnancies drop it should probably be pointed out though that we only have about 50 percent of our high school graduates going to
college so we're only going to be able to help with the section of you know a segment of that population we're not going to have all teenagers obviously we're not even going to have all the 18 and 19 year olds under our purview to be able to influence assuming we
Speaker 432
2:40:51
could how many of our colleges especially of course our four years have clinics or infirmaries where all
Speaker 431
2:40:59
all the four years to have them okay but the two years
Speaker 426
2:41:03
don't okay and so what the the challenge is for the two years is really to connect students with the resources that are they available maybe through the county health department so that's where that's that's what a lot of the activity is at the two
Speaker 425
2:41:21
year level is saying hey let's remember to practice good choices and here's your resources if you need
Representative Vivian Flowers
Unverified
2:41:29
help abstinence or birth control that's it but thank you thank you madam chair
Speaker 426
2:41:36
yep there you go on the other report it's very the report's not similar but the mandate is similar. This was 2017 legislation. It was Act 563 from 2017. And I think the timing of the 2017 General Assembly was fortuitous in some ways because of the issue of sexual assault around the nation. It was the year we were hearing from Harvey Weinstein and
and some of the others that have been widely reported. There are a number of national campaigns that our campuses have gotten involved in, in the prevention of sexual assault. And what we have done on our website is link all the other websites that offer ideas to campuses. There's a red flag campaign, a walk a mile in her shoes campaign. There are a number of different bystander intervention trainings. I was reading a little bit about those and that was spawned from a, I believe the college
was in Sacramento, but it was California, where a woman was watching another woman being raped and there were 10 people standing around cheering and she said, I didn't say anything because I thought it was consent. I didn't realize I was, there was a rape going on in my presence and this bystander training is about training people that witness something to step in and help. And our colleges are doing this kind of training.
One of the campaigns is the What You Were Wearing, because a lot of times women assume it's something they were wearing that caused them to be assaulted or attacked. And that's a very powerful campaign. And I would encourage you, if you're interested, to click on some of those campaigns. We have linked them. If you go to our website, adhe.edu, data and publications, the comprehensive report, the links are all there
in the report on sexual assault prevention. So these are the campuses, Representative Flowers, to your question, that have done a little bit more than the others that we that we're mentioning here they're they're all trying to do something yeah
Senator Kim Hammer
Unverified
2:44:14
you madam chair two questions one on the sexual assault orientation
is there do you distinguish between sexual assault as in student on student versus
Speaker 426
2:44:24
faculty on student there is no differentiation as far as campus is
Senator Kim Hammer
Unverified
2:44:32
concerned okay and then on the on the prevention of pregnancy is there in any
of the material included discussions on adoption versus abortion and if so who's controlling the
message messaging and the content of that material that's being offered to the students should they find their self in that position i didn't see
Speaker 426
2:44:56
any mention of abortion in the reports i really would have to defer to the campuses um and i would what i could do is i would be happy to make a note of that as far as committee feedback when i respond to the campuses to let them know because they know that this is presented to you i'd
Senator Kim Hammer
Unverified
2:45:24
like to know do you ultimately approve the content is it the responsibility of the department of ed
or each individual university to approve the content of the
Speaker 426
2:45:33
material? Each campus is in control of their material. I'd like to
Senator Kim Hammer
Unverified
2:45:37
get a copy of what it is, and you can summarize in a report. Are the campuses advising individuals that if they find themselves pregnant that they have the option for adoption if they want that? But also, more importantly, I want to know what each of them are saying about abortion and is that included in the messaging
that they're giving to the students, please? And that's
Speaker 342
2:46:08
it. Thank you, Madam Chair. Yes. Representative Flowers? Can you share that with the full committee? Because I would like to
know that as well. If you'll just get that information to Mr.
Speaker 447
2:46:20
Price, we can share it to the full committee. Let me just be clear.
Speaker 240
2:46:25
Information about what they're advising. Senator Hammer? pregnant can you repeat the request
Senator Kim Hammer
Unverified
2:46:30
yes ma'am i'd like to know for those well one i want to know
who's not educating who's not being obedient to the law that was passed because i think with budget hearings coming up that'd be good information for us to have number two um of the ones that are doing it what um what what is the content of what they are instructing uh the population about if at all abortion and adoption and and then i'll ask you for specific content once i know that that's included in what they're telling the students so you're asking for
the message that is given the students thank you for cleaning it up that's what i want what message are they putting out about adoption and abortion if
Speaker 426
2:47:19
at all when they talk to i should say when you say who is participating and who isn't as far as the report we're hearing from everyone
Senator Kim Hammer
Unverified
2:47:29
okay so so 100% of the higher ed institutions are
Speaker 431
2:47:32
doing something they are following the mandates okay they're not all going above
Senator Kim Hammer
Unverified
2:47:39
the mandate right each individual school based on their conscientious duty is
responding accordingly I just want to know which ones have abortion and adoption included in the
materials okay thank you for example I mean in Phillips Community College I think when you say including information on family planning and birth control what does information on family planning mean does that mean abortion does it mean adoption does it mean what does
that mean because that that term has been used in various ways.
Okay, Representative Flowers. I just have a
Speaker 455
2:48:24
question. Is there, and I just want to
Representative Vivian Flowers
Unverified
2:48:27
be clear just from the questions in the conversation, is there a prohibition on mentioning abortion or providing resources or information to young young women seeking abortion or in the conversation about this? The conversations when
Speaker 426
2:48:50
the bill was being debated and discussed,
they very much talked about including abstinence.
Speaker 425
2:48:56
I don't recall any prohibitions on, to your question, I don't recall
Speaker 431
2:49:02
any prohibitions on what's told. I mean, there's
Representative Vivian Flowers
Unverified
2:49:06
going to be Dr. And I just wanted to make sure that as we're looking at this information that a university or a college providing, you know, an opportunity for there to be some activity, that if resources and information for that as an option, as it exists legally in the state, that there wouldn't be any perception or any rhetoric indicating that that would be somehow not following the law.
Speaker 431
2:49:39
And if it is, then so be it. But I just want to make sure. I haven't seen anything that promotes abortion.
Speaker 426
2:49:49
I don't know that we would be told what, and I'm not sure what we would find out, because the, unless there's a script, and I doubt there is, but there's going to be confidentiality between whoever's advising, the health professional advising the student, there's going to be confidentiality there. but if there's something
Speaker 447
2:50:05
equivalent to a script but there's brochures right if it's in if there's
so if you're giving brochures were included in each student's orientation packet information on family planning i think
a copy of the brochure is what is requested and what does it say about that if there's materials i think that's what senator hammer's trying to get at is that correct senator hammer i mean the intention of this law was really to prevent unplanned pregnancies right so the intention of the law was not to promote really one thing over the other it's just to try to get to unplanned pregnancies so not to have sex or to if you're going to practice safe
Representative Vivian Flowers
Unverified
2:50:48
sex madam chair that was my understanding it's just when that came up i just right
but i think each university I mean
Representative Vivian Flowers
Unverified
2:50:57
if we're talking about prevention then we were talking about prevention but as adoption and abortion came up in the conversation right and budget hearings I'm just concerned that as we if we go into that conversation that there won't be a perception or a rhetoric that any college that is providing information for someone asking for it or as a part of the
activities, that it won't be perceived that a university is not following the law by providing that as one aspect of the information. No, I understand your question. Okay. Senator Hammer, you
want to clarify? Madam Chair, may I read a
Senator Kim Hammer
Unverified
2:51:32
text message Representative Ferguson sent me? She's watching. Okay. The legislation
doesn't address counseling about abortion. It only addresses abstinence and birth control. If the student finds they are pregnant, they are referred to a provider to have that discussion. also about birth control they are informed of the different types but
referred to a provider to acquire it so based on that it may be that the I still and well I'll do offline because we're taking a lot of time I appreciate it but I just want to make sure the messaging that is be given because Department of Higher Ed is not controlling the messaging you're just enforcing the responsibility and i want to make sure based on some universities tolerance and maybe their different perspective i think it's we need to have a consistent message when it comes to all of this
but we can drill down and look at that offline and
i'll take that up thank you all right thank y'all for the discussion thank you thank you if any of you have questions don't hesitate to let may not. Okay. I appreciate that. Okay, next item is item I. H. H.
Chris Howlett
Unverified
2:52:58
Good afternoon. My name is Chris Howlett. I'm the
director for the Employee Benefits Division. so you have exhibit
Speaker 465
2:53:08
h in your packet members well i believe that content madam chair is actually one of the two were questions okay were asked of me today okay go right ahead whichever one you'd like to yes i guess exhibit h on um in your literature uh would have the brief timeline
of the Emerging Therapies Act of 1089 of 2017. Act 1089 was signed into law April of 2017. The Employee Benefits Board was to explore the options related to the act by the end of the plan year, and that was plan year 2017, so basically the end of December of 2017. The board was not able to make a decision by the end of 2017. and also in lieu of that we did have a new board appointed by our governor due to term limits of
the board so in essence we've had a slight reset and with some of that EBD has provided orientation for the new board and we started the review again of Act 1089. The pilot option was approved in the board or by their board May of 2018 and the EBD leadership part of that task was to basically look at things from the waist and all the way down to the toes and shoulders as one of the some of the criteria for treatment and and looking at that the the
main charge of that act was to look at emerging therapies as a alternative and cost-saving means and mechanisms to traditional surgeries and procedures, and we did so. The third, from the bottom bullet point, basically outlays what we did. EBD worked to operationalize the board decision and to work on creating a network, and that was a network of providers that didn't presently exist as far as regenerative medicine and
stem cells as well as platelet-rich plasma and the like. We worked with the identified providers and helping them credential and that was with our carriers at the time and then create the fee structure. When applicable we based it on the Medicare fee schedule for those applicable ICD-10 codes that were there but when not we had to work on a negotiated attempt to do that and then for the first patients were seen in March of 2019 so I'm very comfortable in saying
that I'm proud of the group and the effort that what we had done inside of 10 months to operationalize the act and really the other charge of the act was to come back and report to the board for cost-saving mechanisms and looking at other I guess you would say care protocols and that right now the image the data is immature okay to be able to provide that
Speaker 418
2:56:16
okay represent Brown thank you mr. Allen I was especially interested in this and was anxious to
see it become operational do you so are we just talking about regenerative medicine are we talking about all emergent the emerging therapies I
Speaker 468
2:56:35
mean where I thought the focus was on the regenerative medicine
Speaker 465
2:56:40
well as you're probably aware representative Brown the the Act 1089 was for the for the board to establish a pilot program that was respective of certain conditions the
board established what areas that we were to focus on and from a plan administration standpoint we took that information and and took that charge and that's what we work to develop that doesn't mean because it is limited in scope at the present moment that doesn't mean that it can't be broadened as the evidence either proves
Speaker 418
2:57:17
one way or the other so follow up yes so so this could be a broader... Certainly so. ...reach out to other... I just
Speaker 468
2:57:28
came back from a conference where
the discussion of emerging therapies is just amazing, and there should be quite a few great opportunities available to us in Arkansas, but I was especially interested in the regenerative medicine and um can you kind of give me an idea of um what the process is in establishing the pilot program and why does it seem to be taking so long i realize you've had these hiccups here with
Speaker 475
2:57:57
the changing of the board and things like that well as you're probably aware
Speaker 465
2:58:05
as far as a true network for stem cells and regenerative medicine essentially that does providers as a base they exist in the state and they're credentialed for traditional modes of care through through most insurance carriers that operate in the state what we see though is not everyone embraces the same that you or ours a few others may embrace as far as or acceptance acceptance of the program or the treatment protocols and so from there
we had to look at those individuals that would be able to fulfill the requirements and then establish those to be credentialed inside the state and credentialing for a provider would be where they meet certain thresholds have them set up where they can build claims and such as far as the the most labor intensive was the fee schedule because you have all the different mechanisms and coding some that exists some that pseudo exists you have to find that that blend and that's what we that was where
we took the biggest amount of time to help develop and we utilize health advantage who is our carrier for the health plan as well as the partners bluetail who was asked to come alongside they did the presentation we had a lot of other individuals there that they actually took on that are in the state to be able to do that and that's the group that we help credential to be able to perform the services so
Speaker 468
2:59:39
it was kind of confusing to me because i'm not a medical
professional but when you say credential and we're talking about insurance companies credentialing medical professionals so we're just talking about their billing ability we're not talking about their skills or their
Speaker 465
2:59:54
services are we no ma'am that that would be the medical association that would be charged with the
Speaker 468
3:00:01
oversight of procedures. So credentialing just deals
Speaker 465
3:00:04
with billing? Not just billing, being set up as an in-network provider to perform
Speaker 475
3:00:09
the services. So although the state of Arkansas is self-insured, you're using a health advantage to process claims,
and so it had to fall within their
Speaker 465
3:00:18
guidelines? Yes, ma'am. The best way to think about the Employee Benefits Division is we're the we're the benefit and plan administrator for the state and public school group we are self-funded we do not adjudicate or which means process our own claims and we do not have a network so in essence we do not have a pharmacy or a medical network so what we do and we just started in january of 19 with a bundled contract we have every a lot of the groups that were
independent groups we've saved about 5.2 million dollars by bundling those groups bringing them together and health advantage administers our claims provides us a network of providers does full service as far as medical management disease management utilization review but the primary function to this question here would be they adjudicate the claims and which is process the claims and we basically have them use their network so
Speaker 465
3:01:17
up and running or are we still working on it yes ma'am as of march of 2019 the
first patients were we're seeing thank you yes ma'am
okay thank you all right um let's go to and i appreciate that um discussion there is one other issue that representative johnson um we wanted while you're here at the table just discuss briefly i know that several of us have had some constituents call us and some issues with um
i'll just let representative johnson and you and
Representative Lee Johnson
Unverified
3:01:59
i've visited now several times and i feel like i have a good understanding of the situation i appreciate your efforts to help me understand it better and we've discussed this um it really my questions have been fully vetted through you at this point i think i understand where we're at how we got to
this point um so from my standpoint i have a good understanding of the process and i
think for the benefit of the members though it's important to know like what exactly is going on so you had individuals who were able to be
covered by state insurance um that were disabled individuals yeah so i can
Representative Lee Johnson
Unverified
3:02:34
express my understanding which is, or I can just let you delve into it, but, you know, what was brought to us was a constituent who had a concern because their adult dependent child got benefits through both waiver as a secondary provider and EBD as a primary, if I have that correct, and there were other people that fell into this category of adult dependents, not all of which
have developmental disabilities. So the decision was made through your department to look at these people who had a secondary provider. Or tertiary. Yeah, or tertiary even, who were on the EBD plan as an adult dependent over the age of 26. Correct. And the decision financially was made, hey, look, these are adults. Most commercial insurance providers cut off adult dependents at this age. So the decision was made through a process that was vetted through the Insurance and Commerce Committee.
to and through your board to take those people off of that program knowing that they had coverage from other places and wouldn't be abandoned to
Speaker 465
3:03:44
no coverage. In just a slight tweak the decision was never done
Representative Lee Johnson
Unverified
3:03:48
in financial. Right okay okay okay and you know my understanding is the people that were
dropped as adult defendants still have coverage they just don't have primary through ebd is that correct that would
Speaker 489
3:04:03
be correct yes sir and um to recap from a from an internal
Speaker 465
3:04:08
audit perspective and the fall of 2018 the employee beneficiary division did an internal audit on its plan membership we have about 157 000 members the spring of 2019 we became aware of that subset of that population of the 157 000 and we averaged in looking around up to 89 um what we where we stand now um is we have um 80 that would fall in some of that um some of that
bucket if i can use that word um with when we identified them out of that six of those individuals should have never um been allowed to continue what we're dealing with is when you take the population at the age of 26 you age off um and that that is a standard uh protocol that's provisions that's still afforded to any health plan or anyone uh under the affordable care act as well as the state law still allows for that um we look to establish legal guidelines and
policies with that we we do not take lightly that it's our membership and we do care about those members in reviewing that subset of that population we applied standard eligibility criteria as well as any ACA provisions guidelines or legal precedent that was set we looked at that in the spring late spring we were also at the same time setting rates and at the same time the board the employee benefits board asked for the health plan to perform an independent audit which I've
been here four and a half almost well five years this coming May and we have never had an independent audit on the health plan so this kind of piggyback in the same sense this same information would be presented in the findings in the spring so we as we started looking at that population we identified those individuals that's when we first became aware of them we looked at what would be I guess the least impactful if you will we had 25 members that have Medicaid in Medicare 23 of them
with Medicaid 26 of them with Medicare and as I mentioned six that were not qualified to be on the plan not all of them are developmentally disabled some are from a standard eligibility requirements we were looking at the the health plan and made the decision based on they they had additional coverage and that the health plan under normal guidelines they would have aged off prior to ACA they would have aged off at 18 as most are probably aware we I say that
as we started developing how to how to communicate and talk with the membership um we we were looking at some lead time so in the end of june we um we formulated our plan and that was to uh letter all the membership we communicated with the members via phone call so they were lettered they were communicated with my request was always try to get them if we have active information and numbers try to communicate with the members and we've heard back from some of those
and then come alongside those during this change for any assistance or anything that they need as much as possible. And then we extended the date out to the end of this calendar year, which was 1231 of 19. For a period of time, we didn't hear much. We have heard equally from probably some of the same individuals that have spoken with you. the plan from that standpoint we've as i mentioned to you representative johnson we're open for some
discussions and considerations but the basic premise just to recap is it was a eligibility issue with a population that had additional coverages and i might add those coverages were generally never used because the plan paid is active and primary so it never
Speaker 491
3:08:15
switched to Medicaid or Medicare, unless the member didn't provide the AR benefits card and used a Medicaid or Medicare card. Representative Blaneyman. Thank you, Madam Chair.
Representative Jack Ladyman
Unverified
3:08:34
I've received a number of comments about this, and I did not know that you were making these changes. um when you have a disabled child and you and they turn 26 you can keep them on your insurance that is allowed you can um in most cases you pay the premium so the parent would pay that premium and the two people that call me that i'm very familiar with that have disabled children
disabled adults now and they paid this premium for 40 years and they want to continue to pay that premium I do that myself and what you said is actually true if you have Medicare and Medicaid and this is a third insurance but these are individuals that are you know may be severe they have high medical bills they may have very very expensive medical bills so if I'm a parent and my child
could stay on that insurance or my adult child and I'm paying the premium why would you say after December 31st of this year I can't do
Speaker 501
3:09:52
that I would say again it was an eligibility decision we're open to some
Speaker 465
3:09:57
discussions but the The eligibility decision was not based on or predicated on the fact of their status. As far as being disabled, it was done anybody else in the same situation without the disability
or a spouse that has qualifying coverage at another plan, at their employer, they have to come off the plan and they've been in the same situation. It wasn't done in such a way, sir, that we had continuity of care. Medicaid and Medicare was afforded these individuals as well, so it wasn't done from the standpoint of they paid their premiums and we can make an exception because they were disabled.
Speaker 501
3:10:47
It was done based on standard legal guidelines afforded
Representative Jack Ladyman
Unverified
3:10:52
to the plan through ACA. Well, it's legal for them to stay on their insurance. That's not a legal question here. It's your policy that you're talking about. And you're talking about a vulnerable population here. Yes, sir. And these parents are paying the premium, and as it was just stated here, they very seldom use that. It's a backup program for these adult children who may have very expensive medical bills.
so it's an insurance policy to cover that person who's very vulnerable who may need thousands and thousands of dollars worth of medical services and I as a parent am willing to pay that extra premium and it's not costing you anything so why are you forcing me to stop paying premiums on my disabled child? I would contend that I'm not
Speaker 465
3:11:43
stopping you from paying the premiums we are applying the eligibility guidelines if we were looking at it from a funding mechanism well you're
Representative Jack Ladyman
Unverified
3:11:52
so the letter said I can't have that insurance after December 31st so
Speaker 465
3:11:57
you're forcing me to stop based on the plan based on the plan administrative decision for eligibility you can't the the provision allows it to be a plan decision sir and so from a from a funding standpoint as a health plan we're on fixed funding based on employer contributions so coming alongside an individual and ensuring that they have continuity of care was important to us but also from a medicare
a medicaid standpoint there if you want to look at it from that perspective there's a match there that's not afforded the same opportunity for our health plan our health plan has x amount of money that we receive every year. And so in essence, if we do not continue to look at inflationary cost changes and things over a period of time, we could see rates going up and we could see rates going up on our whole population to subsidize, I use that word loosely, a population that could
be afforded other care. The goal was not for denial of care. The goal was to look at the overall um population apply those guidelines i see your point and i think they're valid and i'm open to other discussion points with that
Representative Jack Ladyman
Unverified
3:13:16
well i think you're missing something here in your valuation okay because these are individuals that are not using this insurance so they're helping your rate they're not really using it now they may be at risk but as far as the pool goes they're probably not using that insurance as much as active working people on this program so I didn't validate that
well they well what I'm saying is they're paying they're paying the premium for 40 years and never using it because they've got two other insurances are you following what I'm saying there I am so it's not hurting your program it's not increasing your premiums because they're paying in and not using it so that's not a valid reason for for cutting that group out maybe we can do this offline but i think we we really need to look at these individuals that are high risk and they have parents who are willing to pay the premium so give them the option that that's what i think
we need to talk about and maybe that's a small population i don't
Representative Lee Johnson
Unverified
3:14:23
know what that population is I would suspect it's pretty small. If I may say a comment, that's pertinent to our discussions, which you and I haven't had these. You didn't know I was having discussions with him as well, but you have how many members, 150? 157,000. And really, we're talking about about 24 individuals who fall into this category of adult dependents who have lost eligibility, who are also developmentally disabled.
Do I have my numbers about right there? In our conversations, you've been open to the idea to reopen enrollment for that subset of people. So I think there's opportunity to have some discussions where this small subset of people, we could reopen enrollment and kind of back that up and rethink this process. Because I think when the decision was made, it wasn't specifically clear that this small group of individuals are going to be affected this way. And when you look at what that population of people have been through this calendar year,
when you consider that the people that are on waiver have also been through the processes with the passes and the challenges that they've had there, you know, this is sort of an extra kick in the teeth to them as far as what they've been feeling from us as an executive body providing, you know, problems and difficulties for already
difficult families who have issues. So discussions are one thing, but process is another. So, you know, you have a process of how that gets done. So what is your process, and is that a doable thing to change your policy?
I mean, you can't give us an answer
Speaker 501
3:16:01
without going to the board. Well, from an eligibility standpoint, that
Speaker 465
3:16:05
can be operationalized. If it's not necessarily changing benefits or the tenants of the trust funds, that can be done and reviewed. I would like
Chris Howlett
Unverified
3:16:13
to sum it up by saying we're open to discussions, and we'd be glad to have those this
week. Well, I think it's important, Representative Leidyman.
Representative Jack Ladyman
Unverified
3:16:23
Since this is a small population and you know who they
are, can this be communicated to that population that's under evaluation or something?
I mean, because when I get these calls, they're, hey, in two weeks, I'm losing my insurance. Yes, sir. we can we can
Speaker 465
3:16:38
let her do the same communication that we did to alert them to this in the beginning yes okay thank you representative gray thank you madam chair
Representative Michelle Gray
Unverified
3:16:50
I just want to make sure I'm following along and understand that representative Ladyman was saying that there's no cost to the plan is there a cost to the plan I mean these are beneficiaries they are using the plan
Speaker 465
3:17:02
some is primary so to be fair to his statement if they're not utilizing they're active on the plan so the plan would uh most generally pay first what we what you could see is you could see where an individual would excluding what representative johnson was saying as far as waiver um traditional medicaid and medicare it's whatever card is on file and what they're showing um i will tell you we're looking at about a million dollars a year to the plan for these individuals that the plan has paid out on. How many are there? If you look at 80 total
that I have here on the list, six of them don't meet any of the thresholds that we've discussed today. A lot of what was done is they used to call them collateral dependents. I use the term incapacitated because collateral is more into life insurance, but a collateral dependent was those that were basically on a health plan for the entirety of their life those individuals we through identifying this most of those were added by some of the predecessors when we researched
them one was on there specifically for breast cancer diagnosis and had been listed as a collateral dependent never aged off and then when we looked at the subset we found that population And that wouldn't have been a diagnosis to do that. And the young lady, fortunately, is doing well and still she's been, I guess, free for years of that. But by the way, it was coded that we were unaware of when we discovered that she has been on it way past the age of 26.
So, again, it was just identifying that subset.
Speaker 472
3:18:45
But the total dollar amount that we have was around a million a
Representative Michelle Gray
Unverified
3:18:51
year. okay do you know do the so we're talking maybe 74 that 74 do all of those 74 have medicare and medicaid they are they all covered by other
Speaker 465
3:19:03
insurances as well based on this 25 of them had medicaid and medicare 23 have medicaid this is just my rough math 26 have medicare um for like ssi and disability um and then the six that i mentioned um i can work in this
Speaker 472
3:19:20
conversation we can identify those that may be waiver service uh oriented and look at those as well okay
Senator Kim Hammer
Unverified
3:19:32
thank you senator hammer thank you madam chair it used to be if i remember right the policy only required you to cover them
up to age 18 am i right on that back before aca yes sir the affordable care act of 2010.
All right and then ACA came in and that pushed it up to 26 right? They did. Okay so in talking to your board are we looking at just eliminating the age
limitations altogether in case ACA goes away or federal government does some health care change or does that have any relevance?
Speaker 489
3:20:03
You wouldn't be able to do that sir under the current law federally so um and i don't know that you would um look at it that would be the i don't
Speaker 465
3:20:15
believe that would be the best approach notwithstanding what you're if i'm missing your point but um as far as the age limits and the criteria if you start eroding some of those thresholds then basically it's you have uh you can have a cousin on the health
Speaker 472
3:20:28
plan or as long as they show you
You've muddied the waters a little bit
Senator Kim Hammer
Unverified
3:20:33
there. Well, and that's why I was trying to get it because I thought I heard you or
I heard the conversation built around the age of the person. But in reality, it's not so much the age that's going to have any bearing
on whether you can cover this population as it is a different criteria. Am I
Speaker 465
3:20:51
interpreting it right? I would say, as Representative Johnson and Lady Minn have stated, you'd be accurate. This is a unique situation
Chris Howlett
Unverified
3:20:58
and a subset. and we're we're open to other lines of thinking to how to meet the need and at the current cost
Senator Kim Hammer
Unverified
3:21:06
it's a it's estimated to be a million dollars but potentially depending on who would come on the system and who knows that answer to that question it could go up but I'm just thinking from a budgeting purpose or from a membership that's going to have to absorb that million dollar cost you know
Chris Howlett
Unverified
3:21:23
what the unintended consequences would be under standard eligibility requirements yes And I say that
Speaker 465
3:21:28
because tomorrow we could have a member run a million-dollar claim Right, I'm just tomorrow alone and that member could be
Chris Howlett
Unverified
3:21:37
20 and just have a be in a bad situation So it was again, it was never derived in that are you gonna consult with the actuary on this or you guys do it yourself? Or I mean, just give me a quick Are as far as can we do it or not? It'll be a negotiated or discussed decision I'll look and re-verify that the it doesn't have to go through our board but I'll just to cover all the bases and yes my actuary will be made aware of everything that
Speaker 465
3:22:04
we've done because there would be some when you look at OPEB liability and you look at
unfunded liabilities and other things this don't one exception is this is a non-retirement type addition to the plan but when that age when you've added dependence past the time 80 people presently it's not too much but a million dollars is a one percent rate
Chris Howlett
Unverified
3:22:27
increase sure essentially just for those that are watching live stream not trying to be
Senator Kim Hammer
Unverified
3:22:32
insensitive because i appreciate the position they're in but i just want to make sure whatever we start we're able to continue deliverance of services taking in
consideration the cost that's going to go with it so thank
you yes sir so the plan is third payer so you're billing or it's the first payer is the plan is the first payer because medicaid's always
Speaker 491
3:22:54
the last the payment of last right medicare we would be secondary yeah to medicare secondary and medicaid we medicaid in most
Speaker 477
3:23:02
situations are primary yes medicaid is primary
the health plan has the health plan is primary
Speaker 522
3:23:11
right it also depends upon what what is submitted
Representative Jack Ladyman
Unverified
3:23:14
at the rendering provider okay representative ladyman yeah you're right it depends on what card they give them yes sir so you
it could be primary and probably your insurance would be primary if if they get them all three cards but but medicare would be primary if that's the first card if they give them that
first person medicare and medicaid and then well i guess it could vary but it would still depend but it depends on who gives secondary on
Speaker 501
3:23:46
medicare yes sir yeah yes sir okay it would be individually specific
madam chair to each individual person representative
johnson then representative gray and then we've got to go back and
pick up my folks that came here to talk about emergency emerging therapies that was requested by represent brown just a quick
Representative Lee Johnson
Unverified
3:24:01
clarification so the million dollars is really the 80 people is the million dollars that you're speaking of as a cost to the plan is is the 80 people that were taken off it was the claims it was claims cost for those individuals for that for the total 80 not for the subset that we were that we've had a discussion about the subset we've been discussing is a smaller number than 80
i never broke it out right but it's it's going to be a smaller number of people not all 80 of these people have developmental disabilities the subset that we've discussed has primarily been the adult children with developmental disabilities they we don't know what proportion of the million dollars they represent but certainly not all of the million dollars so if we were to put that small more than likely yeah if we were to put that small group back on the plan it wouldn't the cost of the system wouldn't be a total million because it would be the proportion of that million
Speaker 503
3:24:55
that that small group represented I would say that I can agree with your your comments without looking like
Representative Lee Johnson
Unverified
3:25:04
oh you don't know right because who knows for sure but but in theory it's not just so that everyone knows it's not the whole the it's not the whole lot right it's not the whole lot that we've discussed maybe reopening this to but just the specific subset of that 80 that has developmental disabilities so yes right but again it
could be the individual one person that could drop the whole cost up for everybody representative gray thank you and i just
Representative Michelle Gray
Unverified
3:25:31
want to clarify from a claims perspective if you have three cards it doesn't matter which one you give because like if you give a medicaid card and you go look online on mmis it'll show their secondary or tertiary same with medicare so in the end if somebody billed medicaid it would get denied and then they would go online and look and see that this plan was the primary so no matter which card was handed out in the end as long as medicaid and medicare had this plan listed as primary this plan would be billed so i just wanted to clarify how that billing process i'm sorry but
Representative Jack Ladyman
Unverified
3:26:01
that's not right because i i've done that before um
Representative Michelle Gray
Unverified
3:26:06
well medicaid if it's listed if medicaid is listed as secondary or tertiary online they will not pay a primary claim and if medicare is listed as secondary they will not pay a primary claim they'll deny i'm sure there's always a nuance or a something i'll get
Speaker 530
3:26:20
through a system but maybe a nuance from the perspective well one thing's for certain the providers going to render care and receive payment so
Representative Jack Ladyman
Unverified
3:26:28
well I just have to tell you that's not true because I have the three
insurances and I that insurance that third
insurance has not paid anything in 40 years so I
Representative Michelle Gray
Unverified
3:26:41
know that's a fact when that's if if the Medicare or Medicaid does not have the plan listed as primary then they will
Speaker 467
3:26:50
pay that that is correct it could in that scenario but it also still goes back to representative ladyman who where's the assignment and the the payer assignment and um what's
on file all right thank you okay um i'm so sorry we're going to pick up dr david harshfield and rob
tilman if they can come up quickly sorry you've been waiting all this time but i didn't realize you were
part of this first discussion thank you
go right ahead if you'll just push that button thank you
Speaker 534
3:27:40
trying to the University of Arkansas I've got an MD and
I've got three fellowships the last is an orthopedic medicine which is think about a second orthopedic medicine not surgery and so we do biologics and Rob Tillman and I worked for almost 20 years we worked with the legislature to help pass the Emerging Therapies Act about three years ago we've done about 12 patients and no offense to Chris Howley's trying his best to get this implemented this is going all over the United States now it's all over the world we have an Institutional Review Board meeting we look at all the protocols in the world at what they're using and and there's the complication rate is zero and
This stuff cost 20% of what you're spending for opioids narcotics insets and unnecessary surgery This is happening Arkansas passed the first law in the US awesome We didn't do anything about it. It's sitting there taxing around the runway and we awarded the pilot program we have cellular medicine centers all over the country. We work with the Federation of State Medical Boards and the FDA, and what's coming, we think, is a national health insurance,
where you take all the private money and the public money and put it into a health insurance product. If you look at how this is going, we're in private care now. I trained at a university in academics. We're in private practice, and we're working with the federal government through the FDA, and it's just like Wayne Gretzky. How did he know, how was he so good? He didn't skate where the puck was, he skated to where it was gonna be. The FDA tells us where their rules and regulations are gonna be. So there's no, there should be no fear
about doing biologics, although it sounds kind of different if you've never heard of it. It's been going on for decades, since the 1900s actually. The key is we can't get all wrapped up in the injection therapy,
Speaker 535
3:29:33
that's cool, but you have to get the patient ready. That's prehab and rehab, and
Speaker 536
3:29:38
that's what Rob Tillman does. I'm a physical therapist by trade. I'm also on the Arkansas State Board of Physical Therapy, and I'm president of the National Minority Physical Therapy Association. Everything's headed toward outcomes.
I think that word's missing from the conversation right now. What was it again? Outcomes. Oh, okay. Are we getting people better, or are we not? Are we given the appropriate musculoskeletal, how the joints are working, what's pathological diagnosis in the first place and directing them to the appropriate care. So what's happening is we're seeing people that are just taking a little part of the management of the healing tissue matrix, what we're trying to get better, and injecting it and then walking away from it.
And that's not what we intended when we started setting up the algorithms for the address of these problems. And so we're not getting the outcomes that we would hope, and we're certainly not participating and the throughput of Arkansas citizens into what we put together as the legislation to make sure that we were ahead of the curve and that the citizens of the state of Arkansas were getting the best care available in the most cost-efficient and non-invasive fashions. Because no matter what, a cellular medicine injection is nowhere near as invasive as a
And if we do the appropriate care on the front end, then we can decrease people's needs for sustained time on opioids, which is a buzz phrase now. It all comes down to patient management, appropriate diagnoses and patient management. And we're just here again to just bring some things to
Speaker 539
3:31:14
the table as to I haven't seen a patient. Zero. From the legislation that was passed. And I don't do the injections. I do the rehabilitation and management of the healing tissue matrix and
Speaker 536
3:31:29
sometimes on the diagnostic end to say whether or not they need the injections because not everybody needs it.
But if the implementation is, hey, we think you need stem cell injections, okay, well, let's have these people come in and inject you. And there's no follow-up and there's no triaging. That's not going to get us the best outcomes. And what it's going to do is it's going to create a huge amount of indemnity as far as the money that we're spending
Speaker 534
3:31:55
on this. one of the things that we know now is that the international relationship knowing what's going on in the entire world is important and that at a national level arkansas was the first in the u.s to do this but the other 50 states are right behind us and we're working with the national
foundation for state medical boards we talked to the arkansas state medical board because the legislators passed this a lot of those folks are attorneys attorneys decided how health care going to be practiced in Arkansas. The State Medical Board, they're busy doing stuff, so we're kind of like the PCP pipe connecting those two silos. What we do know though is that what's going to fix this is not the international, national, it's state level, state and local. This is going to be, Arkansas is going to do it in a certain way, Texas is going to do it in a certain way, and so forth. And so we
just want everyone to understand that we know what's going on, we know what we're doing we have certified credential arkansans to do it we chose plan a which is a group out of st louis they're great folks but they're not arkansans and these out-of-state groups don't have the same interest they don't they haven't sent a single patient to rob and by the way rob introduced me to the folks from nasa we get to work with those guys how you rehab on the space station is a whole different ball of wax than you do on earth and also how your body heals so we are we have access
to intellect beyond belief we want to bring that home to arkansans and we have seen zero patience so if these folks now from st louis are not able to facilitate that chris is under a lot of pressure in all different ways we've been working together for almost four years now and he has been nothing but helpful but you're going to hit natural barriers natural pushback from folks when we try to tell people quit smoking we had to fight the tobacco industry and tobacco farmers well
so so i'm looking at the legislation and the legislation directed the state
public school health life and health insurance board um to to basically do this so it's in their bailiwick basically right so um but i mean i just had this discussion actually with with dhs and medicaid and And I think 2017, opioids wasn't talked about like they are now. But the discussion I had was we're going to have to look at physical therapy.
We're going to have to look at these
issues because there is no, you have to offer this as an alternative for not prescribing something. But then if it's not going to be addressed and available to them, then it's no good for me offering it right so
i mean i do think i i think it's a new conversation because of the realities of what we're
undergoing not that this crisis is new it's been going on for literally
30 years i mean the opioid epidemic you know that has been going on literally for 20 plus years and so it's like harvey weinstein everybody knew he was doing it well opioids is the same thing you know it just all of a sudden has reached this level of intensity that everybody's talking about but people were were doing this and and and are addicted for
years and years and years and years but it's hard to get them off of it once
they're addicted but it is but if you're going to have to offer something and to get them off but but then if that thing that you offer them is not acceptable
or accessible to them well because
of payment structure because it's not available then it But why are you, you
Speaker 539
3:35:33
know, it's not really an option. We need to be clear about how if we were just
Speaker 536
3:35:40
talking about injection therapy is one thing. But what we work together with, with other aspects of our group, is an algorithm of the appropriate diagnosis on the front end. Communication with the general practice practitioners. Making sure that the appropriate physical therapy or other modalities of modes of care are implemented.
because sometimes, you know, PT is an emerging profession as well. And if you're just going to go to a physical therapist that just prescribes passive modalities, it's not going to work. Hands-on care and exercise is delivered by a trained individual. And so as things become more and more defined, the delineation of competencies is going to be more and more defined. We've written algorithms for several different things that are implemented regionally and nationally. that's how we stay relevant but we also want to make sure that we're at the table when our state
is into discussions as to what's going on with the dealings of musculoskeletal disorders and emerging therapies and things that we travel around lecturing on internationally and I get patients from cellular medicine injections didn't manage their healing tissue matrix I prescribe patients for those injections I make referrals for them we're just not in the loop as of right now and what's happening with the patients that are being seen under the Emerging Therapies Act of Arkansas. And we're here just to talk about and dialogue because I've found that if I'm not at the table, you get what you get.
That's right. And tell me your title because I can't read this. I'm a physical therapist. Oh, okay. Okay. Did
Speaker 536
3:37:15
you write down your organization? I own orthopedic rehab and specialty centers. I'm also president of the American Academy of Physical Therapy. That's the National Honorary PT Association. Oh, okay, okay,
Speaker 534
3:37:25
you did say that, okay, good, okay. If we could, and just, and respect for everyone's time here, we're done, but here's the thing. When I went to medical school, they taught me that human beings were binary, that disease required, you gotta make a diagnosis,
that's key, and once you do it, there's two solutions, what drug and what surgery. It took me a long time to figure that out, but once I knew that, I owned it, and if I kept practicing that way, it's on me. So today, you know this, so you own it. And Arkansas is going to be a leader in this, and this is crazy. We're still getting the first episodes of Andy and Mayberry, and we're leading the country in cellular medicine. This is an awesome opportunity, except we're kind of taxing around the runway, and I'm not, Chris is not here.
He's trying his best to get this done, but we need help. We need people just
to push. Yeah. No, I hear you, and I think we have to have a public policy. health public policy discussion and dialogue about this because I mean you're right but we have to get
beyond that yeah and so I thank you for your testimony thank you for staying so long I appreciate the attitudes you guys have had
Speaker 539
3:38:30
on vendors coming into the state and making sure that they're practicing in the best
Speaker 536
3:38:35
interest of the citizens of the state of Arkansas and I you know we've been
here for four hours but time and time again I've heard this group try to force the conversation on accountability and moving toward what's best for the state so that made me feel better about what's going on here well i've never sat through
it before i appreciate that thank you for that comment we we do our very best thank you very much we appreciate it okay item
exhibit i we have two more things members hang in here with me we have i and p exhibit i and thank y'all so much for
sticking around for all these hours we appreciate your testimony okay
state your name you're recognized mark
Speaker 552
3:39:27
white with dhs mary franklin director of division of county operations for department of human
Speaker 55
3:39:33
services thank you madam chair thank you members uh i know there's been some discussion and questions from members about uh individuals who are receiving
Medicaid benefits, who maybe they've left the state, maybe they've gotten into prison, but otherwise shouldn't ordinarily be eligible for Medicaid. And so what we thought might be helpful is to just give you a very quick walkthrough of the accuracy efforts that we're doing to help make sure that our Medicaid roles remain accurate, and also some numbers about individuals who we've removed for some of these reasons over the last year or so. And so Ms. Franklin's going to present that and after that we'll be happy to answer any questions. One of the accuracy
Speaker 554
3:40:12
initiatives and these things that I'm going to
Speaker 552
3:40:16
talk about are all in addition to our normal requirements that we must meet with CMS to do how we process applications and renewals and changes. We do Paris matching. Paris is an acronym that stands for Public Assistance Reporting Information System. That is a a quarterly match that states can subscribe to with CMS where they all provide information about their beneficiaries for that quarter, and then the information comes back to us
if that beneficiary also receives services in another state during that same quarter. When we get a match back that says someone on our rolls also was reported on some other state's rolls in that quarter, it's not verified upon receipt, and it doesn't just in and of itself mean they were not eligible here in Arkansas because they may have started the quarter in another state and moved here or vice versa they were here and then moved there but we do send notices to those individuals who were not already closed for some other reason or that we
had not already been aware of that address and if those notices are not responded to we do close the And in 2019 to date, I can tell you that we've closed 5,529 MAGI Medicaid cases, MAGI being the categories that follow the Affordable Care Act, modified adjusted gross income rules, which include Arkansas Works, pregnant women, parent, caretaker, relative, our kids A and B, newborns, and our former foster care category.
Speaker 552
3:42:01
we also with our Arkansas Division of Workforce Services we have had a match ongoing with them specific to Arkansas Works where we match our entire Arkansas Works clients each month with Division of Workforce Services new hire information and any of those that were reported back to us by workforce services as having been newly hired somewhere we we have an
automated process now where we check to see if we knew about that income and if not we send a notice and if they don't respond we close the case if they do respond we re-evaluate their eligibility to make sure that they're eligible if they are they continue if they're not their cases are closed and we do that monthly and we have as of the end of october closed 33 607 arkansas works and could be some other categories as well because if there are parents and children in a home and
the parents are covered on arkansas works and they also have our kids that income affects both cases so if they don't respond then it could result in both cases being closed we also do a daily incarceration match with Department of Corrections and as of October we have closed 4,335 cases as a result of that daily match we do death matching and this is monthly that we do death matching and that process has been
enhanced over the last year to include the CMS it's called the TBQ TBQ file territories and states benefit query which is is really the best source of information for deaths and not just deaths within Arkansas but even other states and so we and we have closed as of the end of October 1698 cases that we discovered the individual had deceased
Speaker 554
3:44:06
we in the last year and this this one initiative is specific to the snap program it's
Speaker 552
3:44:15
called the national directory of new hires and we are subscribed to that service fns requires it and for the last year we've been participating in that and that match every month we send our initial snap applicants in our recertification applicants to the national directory of new hires and they they send us back new hire information and they also quarterly
send us quarterly wage information and we use that to make sure that we knew about the income if we didn't know about the income we do a similar process we send notices if they don't respond it results in closure if they do respond then we evaluate whether or not they continue eligible And even though this is a SNAP-specific match, if they have related cases such as Arkansas Works or Our Kids, then we affect all the cases based on this information.
Once we know that they've been reported as a new hire, then we collect the information and take action as appropriate in all the cases. We are doing a Medicare match. This we also get from the CMS-TBQ file. And specifically, what I want to talk about with this match is related to Arkansas Works, because one of the requirements of Arkansas Works is that our clients in Arkansas Works may not be eligible for Medicare.
So we close cases monthly when we become aware that they have become eligible for Medicare. This is something we check for at application, but this match helps us to know if someone becomes eligible after the fact, after we've approved them and as of October we've closed 4,424 cases this year with the Medicare match. Single streaming is something that we put in place. I'm sure as you're aware we are currently operating the Medicaid program out of two different eligibility
systems. Our MAGI Medicaid is in one eligibility system and our more traditional Medicaid is in another system which would include long-term care and SSI individuals foster care those are some examples of what are in our legacy system having both of those systems sending information to MMIS was creating a problem and overlaps and errors and we've had single streaming we call it single streaming so that any information going to interchange goes in one single stream through
one system so that we do not send conflicting coverage or overlaps. Those are resolved before they actually go to MMIS, the claim system, and that's been a, excuse me, has been in place since June of 2018. I want to tell you also about a couple of new things we're looking into this year. One is along the lines of address verification, and what we mean by that is beyond address validation. We already have software. If someone enters an address, and you may be familiar with
it, if you have filled out forms online or things like that, if someone says my address is 100 Main Street, this service will say, oh, did you mean 102 Main Street? You know, it looks to see if it can validate that actual address and then suggests alternatives if that's not an actual address i happen to live in hot springs a lot of times when i do that i'll put hot springs is where i live and it'll come back and say did you mean hot springs national park it's it's that kind of
service um but this this would be beyond that this would be if i put in 100 main street as my address is a service that says does mary live really live there does mary does it look like mary pays bills there or gets deliveries there or is there evidence that shows that that person lives at the address that they've given us so that is something that we are testing and we have done so far one match for that service where we sent 5,000 random Arkansas Works clients to see if
verification service agreed with the address that we had on file and 1,200 of those we will end up sending notices to just because it didn't, the service said it was questionable that the address that had been provided was for that individual. So we will be sending notices and planning to do one more match or the next match with a little bit higher of a number of around 10,000 to see what kind of result we get from a second look at this service.
one other thing that we are working on is a it's a proof of concept with a company that could lead us to an enhanced incarceration match as i mentioned earlier we do a daily match with arkansas department of corrections but it is it is limited to arkansas arkansas prisons this proof of concept is with a company that has contracts in multiple states to provide
booking software for local and county jails as well as state department of corrections in other states so with this match we can we can test to see if we are missing anything in our daily incarceration match here with department of corrections but also see if we're missing information that we're not currently getting by not having access to local and county jail data and of course other state department of corrections and we we sent a thousand files in this particular initiative a hundred thousand excuse me and twelve hundred and fifty of those
files came back as a potential match for a client that we have in arkansas works who who is apparently incarcerated so we are at this point going through that list manually one by one because it's not verified upon receipt we need to verify is that really our client and are they really in that facility before we take action but we are working through that now I also mentioned just one other process it's not on here because it's not an extra thing we do it's not an
additional accuracy thing but because we process changes and reported information when we get it but just so that you're aware we do get reports monthly from our carriers our insurance carriers in the Arkansas Works program if they have become aware of a new address potentially out of state or when they are paying out of state claims we get that list and we we send notices to those individuals every month and again that is not an indication in and of itself that they're not
eligible but it we need to find out more information and so if those notices are not responded to then we close the cases but when they do respond we're we're asking questions to see was this a temporary thing are you seeking treatment out of state do you have a job that requires you to travel and that's why you're getting claims out of state but we address the issue and resolve it if they're eligible they remain open and if
Speaker 557
3:51:44
they're not we go ahead and close and with that i will
take questions okay so i have is it so i have 50,345 closed cases
from the front page is that correct i mean you're adding so all the all the highlighted numbers are closed cases is that correct senator ervin
you and i came very close because
Speaker 552
3:52:05
i came out with 50,355 so we were within 10 of each other and okay I'm not my math could have very
well been off well it could be mine either but okay so but those are closed cases of
2019 yes so what is that so that's 50,300 and I'll redo it but um that we closed all that
are not no longer in Medicaid or
Arkansas Works both both programs right this is a number of people who were closed and were not reinstated now so from medicaid or arkansas works both
Speaker 552
3:52:42
and about 752 of them are actually snap cases with the national directory of new
hires right okay so they've moved off the program okay and then the potential would be in an additional 22,450 with your enhanced efforts um okay and so then what does that leave our total well i guess that this is this is medicaid
and arkansas works combined so yes this is magi
Speaker 562
3:53:11
medicaid did okay gotcha yeah okay that's
all senator hammer thank you madam
Senator Kim Hammer
Unverified
3:53:17
chair on those that were taken off um how many of those were Or do you
have the breakout as to why they were removed, such as income, incarcerator? Can you just send a summary report? That's not on the sheet we have today, is it? I'm just missing it. So I
Speaker 552
3:53:38
can tell you, I mean, these reasons I've outlined, there were individuals who were closed as a result of these matches.
The reason they may have closed could be different. It could be for failure to return information. It could be because their income was now over the limit. or because we received information, they moved from state. So this is something we put together to show how the accuracy initiatives do impact our closures. But I can tell you this is not all the cases that we have closed to date in 2019. Just to share that number with you, we have, as of November,
we had closed 100,758 closure actions in our Arkansas Works program. And of those, 14,822 were closed because we were unable to locate them or they had moved from state. Those closures often result in the mail we get returned to us. um we had all and also 27,246 um were for failure to return requested information so that could
have been from a combination of these accuracy initiatives could have also been just normal processing we asked for additional information to process an application or a change and don't get it back and then income increased we closed so far in 2019 17,024 cases because their income increased so they no
longer were eligible for the program that's correct if you can send all that information to mr price we'll
get it out to everybody will do have you
Senator Kim Hammer
Unverified
3:55:25
identified now until you take action you're still sending the payment to the insurance company am i right or wrong on
that on that's correct so what's the gap time would you say between because what i'm trying to do is narrow the time so we minimize the payments that we're sending to the insurance companies so what's what's the gap time are we within a month or two because we can't bring that money back
Speaker 552
3:55:52
once we give it to them right um well there's a couple of death now we do recoupments in the event of death and so I think that it for the quite where you're going is once we know about
these things how long does it take us to to take action and then therefore stop stop the eligibility if it should
Senator Kim Hammer
Unverified
3:56:15
be stopped yeah through all the systems that you've implemented have we improved the
time that we are paying the insurance companies to as close a real time because to me that's that's just free money we're giving them
Speaker 552
3:56:28
well yes sir we have we have actually improved quite a bit when when you read this summary or one of the things i put in this summary is where we had been able to automate a process that was previously manual.
Previously, it was just a file we got that we had to have staff go through one by one. But we have been able to automate the Paris match in our MAGI Medicaid program. Our DWS new hire match is automated. The incarceration match is automated to the point where every day our list creates tasks in the eligibility system for workers to just go and pull the task and work. The death match is automated for Magi Medicaid. So we're closer to real time.
Right. So that means the system gets the file. The system checks to see who I need to send notices to. The system sends the notices, and if they don't respond, the system actually closes the cases. So we're not having to look through in each one of those accuracy initiatives that we've now automated one by one. And, you know, as humans, as caseworkers, having to physically take
Senator Kim Hammer
Unverified
3:57:37
those actions one by one. Okay, and what's
the response time for when people get their notice?
How much time are you allowing them to respond before you make the decision to kick them
Speaker 554
3:57:50
off? Our notices are 10 days. They are allowed 10 days. and then we we we
Speaker 552
3:57:56
add an extra two days just for mail time and and processing time but um so total of 12 days but and are you are
Speaker 556
3:58:03
you keeping track of those that call you
Senator Kim Hammer
Unverified
3:58:07
after that and say hey i didn't get it because my calls have gone down as far as people saying i got kicked off so i'm just
wondering do you guys track that data as far as you make the decision kick somebody off and then you get a call a few days later say hey forwarding mail that kind of thing or are you guys even keeping up with that?
Speaker 554
3:58:26
Well I don't I wouldn't say we keep up with it but
Speaker 552
3:58:30
we do react to it if we hear from our clients even after the notice expires and we're able to resolve the issue they may be
Speaker 152
3:58:37
reinstated. Okay thank you Madam Chair. Senator if I can just add one thing to
Speaker 55
3:58:41
that just to underscore the the job that Ms. Franklin has done in leading the division you may not
remember but back in around 2014 in those early days when we had all the trouble the eligibility system just about I think just about all of our case closures were all manual back then and and so we that's that's how far we've come since then in automating all these things and so I just want to brag on Ms. Franklin and her leadership for that. I'll register the same so it's just we've stayed within that amount thank you representative brown yes very
good job i i just wanted to thank
Speaker 468
3:59:24
to mark and i want to say this correctly white yeah about this very issue because i had a constituent that had kept pounding me it's already what are they doing about all that because i think early on and i don't believe it was a public health meeting it was some other meeting where the numbers and the dollars were reported and it uh i think was shortly after arkansas works was implemented and there was so much um well the report that day indicated that thousands of people who didn't even live in arkansas were receiving
medicare benefits and so or medicaid benefits or benefits they weren't eligible for so that had been I had not ever heard a report in response to that saying things had you know had been resolved and and I really do commend you because it sounds like you're doing a great job but keep trying to keep track of this and and not pay for things that we aren't responsible for thank you thank you
yeah I appreciate that and that they can have the claims data information now is so very important I
I'm not sure if y'all all don't realize that when we passed this program, DHS, we were paying the premiums for Arkansas Works, but we could not look at the claims data. And
we did change and fix that to where now they actually can look at the claims data. So they're actually seeing, they can see what we're paying for. But before that, it was a little bit of
a helter-skelter mess, in my opinion. and so we've done a lot to clean this up.
Thank y'all so much. Thank you. All right, last item on the agenda, and we are so sorry, but it's a long meeting, but we had a lot to discuss. Item P. If you will state
your name for the record, you are recognized.
Speaker 567
4:01:49
Michael Grape, Department of Energy and Environment. Okay, go ahead.
And then I think White River Planning District, if they can come to the table as well. Solid Waste Management. Is there
somebody here from that? Come on up, because it's late.
I might as well, I'm just gonna get everybody up at the table
Representative Richard McGrew
Unverified
4:02:21
that needs to talk about this. Okay, Mr. Grape, as they're coming up, you go
Speaker 569
4:02:45
ahead and then as they're coming up. So I had a request from members of this
Speaker 570
4:02:51
committee to be prepared to answer some questions today
regarding the overall tire program, how much money we've made, et cetera. So I'll do that very briefly. over the last
Chair
Unverified
4:03:05
10 years the tire program treats or processes about 3 million tires a year and has been average so it hasn't changed any prior to the tire program change in 2017 we averaged around five and a half million dollars a year to six million dollars a year
and revenue after the tower broke program was passed in 2017 we generated an extra million and a half dollars in 2018 and we're on track to do a little bit better than that in 2019. so we're generating more money and we're treating the same amount of tires basically so i'll be glad to answer any questions okay
senator caldwell you're recognized thank
Senator Ronald Caldwell
Unverified
4:04:03
you madam chair this comes up because of an
incident we have in woodruff county a small town of cotton plant we've got about 800 000 tires over there and we're trying to determine uh who owns it uh the question came up while i was over there with the mayor and the uh county judge as to how much money we are generating on the tire collection fee and uh what we're spending that uh that money on uh mr group a has been involved in that for a while and we're trying to find a resolution to it uh one of the issues is uh
we're looking at somewhere between a million dollars and three million dollars to um to clean this up and find out how we as a state ended up allowing or not providing oversight to arriving at the situation we're in right now and so anyway that's that's kind of why we're here what we're doing to give everybody a little bit of background white river planning district is involved in it because they may or may not own the land over there they've been involved with
some grant money with some businesses that have tried to run some businesses on this piece of property the real issue is how to address the problem that we have and what we might be able to do with it so there may be other issues around the state besides this one that come into play and and uh for the record uh i've told mr groupay uh cotton plants not my district it's
actually senator disbang i have about 85 percent of woodruff county but i don't have i don't have cotton plant but the fact that judge dallas uh asked me to come over the other day obviously i did but it it is a uh situation we've got that we we need to find some type of resolution to uh but but again uh i want to put on a record of what what we do have with the tire money what we were told on site and and everything is is is talk but when we come over here we can actually look
and see exactly where we are and try to find a sense of direction to find a solution so So I'll leave it with that in case someone else has a question about the amount of money that we're taking in with the tires and the amount of money we're spending. I can't read the back. Mr. Grappay, I can't read the back very well. Okay. I'm getting old. My eyes are failing me.
The lines are gray and darker gray and maybe black. Could you tell us
Speaker 570
4:07:07
what that graph is, please? yes sir that graft is actually a composite of the 2014 through 2019 by month tire fee collection the revenue from the tires so for instance in 2000 and let's just take December if you look at it the first in 2014 was the second highest revenue year I can see now you're
Senator Ronald Caldwell
Unverified
4:07:34
comparing each year per month that's correct do you have any information on expenditure you're showing us income on the tire what are we doing with that money no the expenditures I
Speaker 570
4:07:46
don't know sir the expenditures are managed by the solid waste entire districts and then I assume I don't know if you report them I don't know how that's done senator they can tell you probably
Chair
Unverified
4:07:57
better than That's what I will ask. So, wait, wait, wait, wait, hold up.
Representative Richard McGrew
Unverified
4:08:07
So you're collecting, let's just go back to 2018, $7.5 million. Yes, ma'am. In tire fee collection. Yes, ma'am. And then
you're taking that money and sending that money to the solid waste districts? 75% of it, yes, ma'am. 75% of
Speaker 570
4:08:28
it. Yeah. the rest five percent goes to the tire generator okay up to three percent goes to dfna seven percent goes to um the agency to manage the program okay ten percent supposed to be set
aside for tire abatement and then the remainder goes to the tire district okay
ten percent goes a tire abatement five percent
Representative Richard McGrew
Unverified
4:08:52
goes to the tire dealer fee and then three percent goes to df&a right yes ma'am and then what else
Chair
Unverified
4:09:09
to the agency seven to the agency yes which amounts to
Representative Richard McGrew
Unverified
4:09:13
about 450 500 thousand dollars okay so that's 15 so that's 25 and then
75 goes to the back to the solid waste districts okay all right thank you
Speaker 84
4:09:23
if you'll just state your names for the
record in the mic for me and then you can proceed my name is Jan Smith
Speaker 585
4:09:37
I'm the executive director at the White River Planning Development District we serve as staff to the White River Regional solid waste management district okay I'm Tracy Wallace the manager of the tire
Speaker 586
4:09:51
program used tire program in our district okay
do you want to make a statement or just answer
Speaker 585
4:10:01
questions I'd be glad to make a brief statement um we operate a waste tire monofill at Bald Knob that's where all of our tires have been going since about 2001 2002 the tire monofil is now almost full and we are needing to look at an alternative option to get rid of the tires in our 10-county region this has been one of the most difficult programs that we've
we've dealt with over the years there's not a lot of good things to do with waste tires if you are on the edge of the state possibly low close to Oklahoma there's some opportunities over there on the east side they're sending their tires up to Champlin in Kansas. Liberty Tire is another entity that would take tires but they we've talked with them a couple times they've been very uninterested in taking our tires so this has just been an ongoing problem for the 10 tire districts that are in the state and I think White River has
has really dealt with a disadvantage we're very rural most of our counties are in north central arkansas except white county which is here locally and so the tires generated mostly that anyone would be interested would be here in white or in the white county area their volume is high so it's more cost beneficial to deal with those tires versus the tires that are in stone county isard county fulton county the very rural areas we also have to deal with the transportation costs which are very high to move those tires around to other locations we've been working with with mr
Grape and ADEQ trying to find an alternative I'm not sure that we've come up with one yet but we are hopeful that with the help from ADEQ we'll find another thing other than a monofill to be placing our tires we do have the situation of a huge tire dump in cotton plant Woodruff County we have worked with ADEQ over the years we worked with the two different property owners that have purchased the property from White River in the city of cotton plant and and so far we've not been able to resolve the issues or find a place to go with those tires.
I think it's an issue that the state, ADEQ, and ourselves need to look at and try to find a resolution because it's a very dangerous situation. There are two buildings there, and when you go in the buildings, the tires are almost up to the ceiling. And over the years, the property is a three-acre property. They have almost been covered up with waste tires and pieces of tires. and others other items that um are really of no value but we just need to be able to take care of that it's an interesting story that goes on for quite a long time beginning in about 1981 but the
industrial park road that this site is located on just on pass there is one of the marijuana growing facilities so this also poses a danger to them and just the city of cotton plant if If something ever happened with those tires, if they ever caught fire, it would be a tragedy for the entire state and not just Woodruff County. So we need to figure out a plan and see how we're able to deal with
Representative Richard McGrew
Unverified
4:13:09
this situation. Yeah, so I'm familiar with this situation.
And, like, if that burned, I think you could
see it from space. I believe so. Like, I just want to put this in perspective for people. like seriously if somebody decided to light a match to that I mean we would be
there would be national headlines about the environmental disaster that occurred in Arkansas it's a problem it has to be addressed it's got to be figured out and so you know and I mean I live
in this area I live in these this county I mean I live in this area but it I suppose you know what I don't want to see happen is attention given to environmental issues in the state of Arkansas where there are people that live in those areas of the state and we'll pay attention to those areas of the state and then there are people that live in other parts of the state that we don't pay attention to and i don't want to see that be our public policy position
Senator Ronald Caldwell
Unverified
4:14:14
senator caldwell could you tell me how much money you receive from adeq uh for your tire abatement
Speaker 585
4:14:26
program for our tire abatement i mean there's two different we receive a reimbursement rate of two dollars and 38 cents currently that money is for us to collect and process all the waste tires that are in our 10 county areas we have collection sites in all 10 counties we also work with all the tire dealers to remove all the waste tires that that are generated
the abatement money has not been available the last year and a half because um from what we've been told from aadq that money is being sent out to the districts for the actual collection systems and processing of those tires and so they have not been setting aside the 10 which is is allowed by law because it's taken the full amount to operate the programs statewide Mr. Corpett
Senator Ronald Caldwell
Unverified
4:15:15
do you still have do you know what the balance is of the 10% retainer
of the waste hire money tax that you get zero the
Speaker 570
4:15:24
balance is zero because we've been given the additional 10% to set aside for the tire abatement we've been given it to the districts to operate representative ladyman
Speaker 15
4:15:41
thank you michael are you aware of any uh is there any federal programs federal matching anything like
Representative Jack Ladyman
Unverified
4:15:48
that out there or uh tire manufacturers
programs anything you're aware of no sir um
Speaker 570
4:15:55
there's no as far as solid waste is concerned solid waste or tar abatement has said there's no money set aside for that okay all right thanks senator hammer okay so we don't have
Senator Kim Hammer
Unverified
4:16:11
a catastrophic fund or anything like that that a portion of this is going into in order to have the money available to take care of situations situations like this
and just out of curiosity how many other situations like this in cotton plant exists around the state that
Speaker 570
4:16:33
we've identified several we I don't know if you remember but part of the neighbors landfill which was a issue in Ozark Mountain we had a about a million tires we had to manage there as well I think it cost a million or two to fix
Chair
Unverified
4:16:53
that we have Pitts Road or the Combs Road issue in Southwest Little Rock it's caught on fire a couple twice in the last four years we have several thousand
Speaker 570
4:17:05
that would you're found in Jefferson County so we're we have a lot of old tires that we're finding we have a great number in Faulkner County that Tammy Hynum who is the director of the tire program was with the sheriff's department today visiting an old site that
Chair
Unverified
4:17:22
has received many new tires so okay and the
Senator Kim Hammer
Unverified
4:17:28
the money that's turned back to the solid waste districts i remember did we put in that legislation that those uh have to be audited and those audits are turned over to are they turned over to you because what i want to do the money goes down to the district and then it becomes the district's responsibility to manage those tires and dispense of them dispose of them whatever is allowable correct so what I wonder is of the money that's going back say to y'all's district how much of
that is operating cost how much do you have that is surplus funding do you have any at all are you operating at bare bones minimum with
Speaker 585
4:18:07
the money that's coming in to you we pretty much operate a bare bones um we have a collection system where we have 55 trailers they're they're like 26 foot long cattle trailers that we've used all the years that we've run the program we actually started the program in 1994 collecting the tires we have about four or five trucks that we run going taking picking up full trailers and taking empty trailers within the 10 county region we
don't pay high salaries to our people our trailers some of them actually do date back to 1994 we have maintained them kept it you know we have to keep them on the highway so we have to make sure the brakes work the lights work all these systems work on them we keep a maintenance we have a maintenance shop where we do most of the maintenance ourselves most of our trucks I have I would say have over 300,000 miles on them so we we don't we try to be very efficient with what we do we don't have a high administrative fee um we try to be very bare bones with that part of it as well
we collect a lot of tires we do um collect like we do small tire piles and try to get the property owner or the the dealer to provide some you know like we'll drop a trailer form and and they will load the trailer themselves or hire somebody to fill the trailer and then we go back and get it so we do try to do cleanups all throughout our process and if any of our drivers see tires somewhere that they aren't supposed to be tires we'll try to find the property owner and and do
the cleanups but but the cotton plant tire pile is so massive that that we would not have the funds or the ability to go in and clean it
Speaker 584
4:19:50
up without without assistance who um what's your cash balance and your what's your
Senator Kim Hammer
Unverified
4:19:53
cash balance on hand do you know we've been running at
Speaker 586
4:20:05
a deficit for some time i guess this last quarter we had a surplus for the first time we're not talking about just the problem we're not just talking
Senator Kim Hammer
Unverified
4:20:15
about the problem in comp plant we're talking about the problem of how long can you go if you're operating in a deficit and this turns into a bigger problem with what and madam chair it's too late and they probably have this lengthy conversation but i'd be concerned about you know the the waste districts becoming insolvent not being able to operate and then what we do with all those last question who owns the property and cotton plant you mentioned trouble finding the owner do we not know who that is or that's a fun conversation that's one of those conversations that
could take some time that's all right then I'll talk to you offline about that but it just amazes me we can't find
Speaker 585
4:20:55
who owns the property or well we currently have we have um a quick claim deed and we do know who the owner is and we've done i'd say i'd say we've gone through three or four abstract companies and they've pretty well come up with the same answer all
the way through okay all right thank you thank you madam chair
yeah it's a mess but i mean bottom line you could go back and try to recreate that but the fact of the matter is it's on us and we we have to deal with it i mean this property owner but adq gave them the permit
Speaker 570
4:21:27
to do this back then that's not correct oh it's not correct it's not correct okay sorry go ahead never given them we have never issued a permit for them to operate that facility we were unaware of facility until uh we got a complaint about the tires the only thing we have permitted was the owner of that facility to transport tires because his original business was supposed to be exporting those tires to third world countries
okay so you gave him a permit to transport tires to go
Chair
Unverified
4:22:04
and collect them from the tire shops around uh arkansas and then did y'all ever
inspect inspect like this place well it was he was transporting them we
Chair
Unverified
4:22:13
didn't know that he was transporting them to his own place we thought he was transporting them from
Speaker 570
4:22:19
point a to point b and then when we found out what he was doing we revoked it i believe but if for the real information i guess we can get tammy heinem up here and
the next meeting we may have to have a meeting about this we'll
put this on the agenda for january um because i think
there's i mean you know i just go back to this i mean we we put money towards the stump dump fire in bentonville arkansas right right there are some environmental issues that we've got to take
care of this is a huge one and i don't want us to treat different areas of the state I agree differently with that, thank you
alright guess what guys, we're adjourned Thank you.
Agenda
A. Call to Order
B. Comments by the Chairs
C. Consideration to Adopt the September 18, 2019 Meeting Minutes Consideration to Adopt the October 30, 2019 Meeting Minutes for Marshall and Jasper Consideration to Adopt the November 4, 2019 Meeting Minutes (EXHIBIT C)
D. Status of Provider-led Arkansas Shared Savings Entities (PASSE’S) Reimbursements to Providers
E. Review of the Arkansas Tobacco Settlement Commission (ATSC) Quarterly Report for January, 2019-March, 2019.(EXHIBIT E)
F. Review of the 2019 Annual Status Report for the Prevention of Unplanned Pregnancy on Campus (Act 943 of 2015) (EXHIBIT F)
G. Review of the 2019 Annual Status Report for Sexual Assault Prevention on Campus (Act 563 of 2017) (EXHIBIT G)
H. Arkansas Employee Benefits Division-Decision Regarding Disabled Dependents Eligibility of Being Covered by the Parents Policy and Report on Findings of Act 1089 of 2017 Requiring State and Public School Life and Health Insurance Board to Explore Emerging Therapies and Cost-Effectiveness of Treatment (EXHIBIT H)
I. Report on Medicaid Expansion Beneficiary Case Closures in 2017, 2018, and 2019 (Beneficiaries that are deceased, moved out-of-state, income ineligible, etc.) (EXHIBIT I)
J. Arkansas Department of Human Services (DHS), Division of Medical Services, Review of Rule Hospital 3-19 Spinal Muscular Atrophy Newborn Screening. This rule change is to comply with provisions of Act 58 of 2019 which adds spinal muscular atrophy to the list of metabolic diseases for which, all newborn infants in the state must be tested.(EXHIBIT J)
K. Arkansas Department of Human Services (DHS), Division of Aging, Adult and Behavioral Health Services, Review of Rule regarding certification in Deaf Mental Health and provides for culturally affirmative and linguistically appropriate mental health services to deaf and hard of hearing persons. This rule implements Act 644 of 2019.(EXHIBIT K)
L. Arkansas Department of Human Services (DHS), Division of Aging, Adult and Behavioral Health Services, Review of Rule which establishes reasonable charges for costs of treatment. This rule implements Act 567 of 2019 by expanding the permissible criteria for waiver or postponement of a charge to include when a patient has a court-appointed attorney because the court has found them to be indigent.(EXHIBIT L)
M. Arkansas Department of Health, Center for Health Protection, Review of Rules Pertaining to Communicable Diseases-Tuberculosis. This updates the Arkansas Department of Health (ADH) rule to be consistent with the Centers for Disease Control and Prevention (CDC) guidelines for screening and testing healthcare workers for tuberculosis (TB) in the United States.(EXHIBIT M)
N. Arkansas Department of Health, Engineering Section, Review of Rule which increases the public water system service fee rate by $.10 per water meter per month and updates references to two disinfection standards published by the American Water Works Association in accordance with Act 788 of 2019. The rule also removes the word regulation and consistently uses the word rule in accordance with Act 315 of 2019.(EXHIBIT N)
O. Report of Arkansas PANS/PANDAS Advisory Council (Act 878 of 2019) Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS); Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) (EXHIBIT O)
P. Regional Solid Waste District-Tire Recycling Action-Woodruff County-Arkansas Department of Environmental Quality (ADEQ)
Q. Other Business
R. Adjournment
Documents
Speakers
Senator Missy Irvin Chair
Unverified
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Representative Jack Ladyman
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Senator Linda Chesterfield
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Senator Jimmy Hickey, Jr
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Senator Kim Hammer
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Representative Michelle Gray
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Senator Bill Sample
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Senator Breanne Davis
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Representative Lee Johnson
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Representative Johnny Rye
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Matt Gilmore
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Representative Richard McGrew
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Representative Vivian Flowers
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Chris Howlett
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Chair
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Senator Ronald Caldwell
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