Public Health House & Senate and ALC-AR Health Insurance Marketplace Oversight Meeting Jointly
Video
Transcript
11 documents
Machine transcript
May contain errors. Verify important quotations against the official video.
About transcript accuracy
- Source
- Whisper
- Model
- ggml-large-v3-turbo.bin RTX5060
- Processing date
- October 7, 2026
Okay, I wanted to welcome you all to our meeting today. Appreciate everybody coming out today. We don't have as long an agenda as we did our last meeting, so hopefully we won't be here as long, but we'll get started on that. Got a new year going, so we're ready to get going. I do want to say that Senator Hickey and Senator Caldwell are the best listeners in this group.
When I gave you a two-minute warning, you guys went and sat down.
So, appreciate that, guys. All right. Did you have any comments? Yeah, thank you, Representative Ladyman. Members of the committee, I just want to thank everybody. The last meeting that we had in December, we invited Blue Umbrella from DHS to come and participate. And they set up a pop-up shop in the lobby, and just in that short time, they sold over $400 worth of products.
All of that money went to those folks that are residents of our human development centers that made all of those items from the Blue Umbrella store. So I want to thank you for that. Also, I wanted to thank you for participating in the Christmas in the Capitol. It was probably one of our largest that we've ever had, and that was great. And just to note, there are some future, February is Heart Healthy Month. It's the American Heart Month. That began in 1963 to raise awareness about heart issues and heart disease.
So we will probably, I'm working to schedule a public health committee meeting at the Arkansas Heart Hospital in February. So there will be more information to come. and hopefully we'll have some free screenings and other things that we can participate there in there at the at the heart hospital um with that just happy new year happy glad to be here thank you thank you senator and i'd like to add a thank
you to that blue umbrella event that we had and if y'all didn't make that they have a store over at the dhs headquarters that you can go by there and they got a lot of good stuff in there
so if you're over in that area why stop by and take a look okay uh first thing on the agenda here is item c we're down to item c consideration to adopt the minutes of the december 9th meeting need a motion have a motion second have a second all in favor signify by saying aye motion carries moving on to item d latest information on the health insurance marketplace enrollments for 2020
by the health department. Would you all come to the
Speaker 12
2:53
end of the table and introduce yourselves? Good afternoon, committee. I am Alan Kerr, the commissioner of the
Ryan James
Unverified
3:00
insurance department for Arkansas. Ryan James, Government Relations, Arkansas
Insurance Department. Okay, Alan and Ryan, if you wait just a second, my
co-chair has comments. I just wanted to let our committee know, our insurance exchange committee, that we agreed to meet jointly with public health because we didn't see any need to have the insurance department come and repeat the same information.
So they very graciously put us first on the agenda. So if the insurance exchange committee needs to leave after that agenda item, you know, you're welcome to. If you want to stay for the rest of public health, you're certainly welcome to. But we just didn't want to inconvenience the insurance department any more than necessary. But thank you all. And we really appreciate the efficiency of the committee. Senator Wallace, I don't
want to leave you out. Did you have any comments? Okay. All right. Thanks. All right. You may proceed.
Speaker 12
3:52
Yes. Again, good afternoon and happy new year. Let's jump right in and talk about the money first. Okay. The financial report, the red banner on
Speaker 22
4:06
the top. Now, your first sheet there, right after the header
Speaker 12
4:14
sheet, shows the money we collected, excluding the federal technology fee. We are now a total of, our account's got a total of $4,313,000 in it.
And I just want to point out that that is about the maximum we're going to have in that account with some reconciliations that because we're no longer collecting that fee from the from the rate payers that the AM fee no longer collecting that as of this month. And that money, that $13 million that was being collected to support this entity, went back to the rate payers in the form of lower rates.
So that's good news. On the second sheet there, AHEM 2019 operations. We took over AHEM on March 15th. And the first three months there is what they had collected. or, I'm sorry, that was their expenses for the first three months. Therefore, their point on April on through December were our expenses. Okay?
Total $1,286,000. And, again, that includes AHEM's, the original entity's first three months in there. The next page kind of shows what we've been spending the money on. And, again, this is basically a snapshot of our checkbook. You can see down through there what's been spent since we took the entity over in March. The largest expense was AFMC, which is our call center, and they pay those, the navigators
and the people answering those phones to help those
Speaker 22
6:02
people find insurance for themselves. Okay, and then our
Speaker 12
6:13
ending cash balance for 2019, $4,641,842. This is estimated, and keep in mind that, and again, this money is going to stay in this account. Our budget is $500,000 a year.
We don't anticipate spending that much, but that is our maximum budget. money that we collected up to this point, that we're no longer going to collect any more fees, that's going to run our shop in this particular entity for the next eight or nine years, we hope. Now, there may be some reconciliations that we have to deal with with CMS. There's some reconciliation on premiums and so forth that they have warned us that may have to be done as soon as they do those
calculations. But we should be in very
Speaker 25
7:03
good shape for the next eight years anyway. And
Speaker 12
7:09
the last slide there is the ones you've seen before. Our staffing in that division prior to March 15th and where it is today. Fewer people, leaner, meaner, much more efficient. ALL RIGHT. THE NEXT SET OF SLIDES. GO AHEAD. THANK YOU,
Ryan James
Unverified
7:33
WE'RE GOING TO GO OFF THE BLACK BANNER,
RATE INFORMATION. ON PAGE ONE YOU HAVE
SOME GENERAL OBSERVATIONS ABOUT THE MARKETPLACE. ONE I WOULD LIKE TO THROW IN TO REITERATE A POINT THAT THE COMMISSIONER MADE. BECAUSE OF THE CHANGE FROM AHEM AS AN an independent group, coming over to the insurance department, and the elimination of the user fee for plan year 2020, we ended up, because of that elimination, it ended up lowering what premiums would have been. Okay? I've got to be careful how I say that. What premiums
would have been in 2020, we lowered that $13.1 million. Okay? The projected premiums for For all the rate filings for 2020 totaled $1.05 billion.
When you factor in a 1.2% user fee that the former AM used to charge carriers who sold, that results in a net $13.1 million reduction. That not only means lower rates for policyholders, but because Arkansas Works policies are the same as the private marketplace, it results in cost savings on what DHSOs on the Arkansas
work side. So when you combine those numbers together, it totals of $13.1 million. Okay. I just want to be clear on that. For 2020, all companies that exist in Arkansas are offering all plans throughout all counties of the state. IN PREVIOUS YEARS, WE STILL HAD FOUR COMPANIES, BUT IN CERTAIN COUNTIES, ONLY THREE PRODUCTS WERE BEING OFFERED, WHEREAS ALL 75 COUNTIES ALL HAVE THE SAME PRODUCTS AVAILABLE TO THEM. THE RATES ARE PREMIUM. THE PREMIUM RATES ARE UNIFORM ACROSS ALL THE REGIONS.
WE HAVE SEVEN REGIONS IN ARKANSAS, AND THEY'RE UNIFORM. WHAT ONE COMPANY'S POLICY COSTS YOU IN PULASKI COUNTY, IF YOU'RE A CERTAIN AGE, WILL COST YOU THE SAME IF YOU LIVED IN BOONE
COUNTY. There's no differences. Plan year 2020 offerings, you can see what plans the companies are offering, from Ambetter to Arkansas Blue Cross, Qual Choice and QCA. Taking it over to page two, this is usually what folks want to report on.
THIS IS THE CHANGE BY PLAN YEAR IN AVERAGE NON-TOBACCO SILVER
POLICIES FOR A 40-YEAR-OLD. THAT'S KIND OF THE BENCHMARK DEPENDING ON THE AGE AND IF YOU'RE A TOBACCO USER PRICES WILL GO UP AND GO DOWN ACCORDINGLY. BUT YOU CAN SEE THAT IN 2014 WE STARTED WITH $330 AS A PER MONTH PREMIUM. WE
ARE NOW AT 399, WHICH REPRESENTS A 1.1 INCREASE OVER 2019'S RATES.
IF YOU GO TO THE NEXT TWO PAGES DETAIL THE PRICE PER MONTH FOR VARIOUS PLANS AT THE SILVER, GOLD, AND BRONZE LEVELS FOR EACH COMPANY, AGAIN, THESE ARE BASED ON A 40-YEAR-OLD NON-TOBACCO user and this is the price before subsidies. Okay? Different people get different levels of subsidies so we can't compute that, but this is what the baseline charge is. And those are covered over the next two pages. When you get to page five, it is information
that we previously shared with the subcommittee back in August. It is informative one sheet that we provided consumers when the rate filings came in. The only thing that we've changed with this document from previously is we approved the rates. So, for example, on page five, the Ambedder requested a 1.90 rate increase and we approved a 1.90 rate increase. And the rest of the pages in the report detail the changes. One thing that I would note in
each justification paragraph, which is at the bottom of each one of those pages, each company noted that its premium request for plan year 2020 was based on
the fact that the 1.25% user fee would in fact not be collected. And that's one of the benefits of the action the legislature took to put it under AID. And it's one of the things that we've communicated consistently that we would not charge that user fee in future.
Speaker 35
12:13
And I'll pause right there if you have any questions on either
Speaker 22
12:24
the finances or the rate information report. Seeing no questions, you can go ahead and proceed. All
Speaker 12
12:30
right. The last set of slides is the marketplace enrollment. As you can see there, the first page is the most important one, one with the red graph on it, and I want to point out that as of December of 2018, there was 51,998 enrolled,
and as of 2019 December, 51,383, a pretty much flat effect that you have from where AHIM was managing this compared to the insurance department at $13 million less. AND
Speaker 25
13:01
I WOULD DIRECT MEMBERS TO THE BOTTOM OF
Ryan James
Unverified
13:10
THAT PAGE, YOU WILL NOTE THAT IN THE FAR LEFT HAND COLUMN WHERE IT SAYS CMS FINAL OE PLAN SELECTIONS, THAT'S THE WEEK 7 SNAPSHOT THAT
CMS PROVIDES. IT IS NOT WHAT WE CONSIDER TO BE THE
EFFECTIATED ENROLLMENT IN ARKANSAS as of today. We just got that information from our carriers late last week. We haven't had a chance to verify the information so we
do not have a starting point that would reflect what we had previously in the chart above. But I will say that according to CMS plan selections totaled 64,601. You will notice a drop off usually between the plan selection
metric from CMS and what AID considers an effectuated. During open enrollment, if, for example, a person moved from one insurance company to another during open enrollment, CMS would count that person twice, A
as a holder of a policy for the current plan year and selecting a policy for the next plan year. So that's why we wait for the effectuated number that we're still computing
right now. Like I said, we just got that information late last week. THE REST OF THIS DOCUMENT DETAILS COUNTY-BY-COUNTY BREAKDOWN OVER THE LAST PLAN YEAR THAT WAS
REQUESTED OF US FOR THIS MEETING, AND I WOULD BE HAPPY TO ENTERTAIN ANY QUESTIONS WITH REGARDS TO THAT. SENATOR HAMMER, YOU'LL
RECOGNIZE FOR A QUESTION. Thank you,
Senator Kim Hammer
Unverified
14:51
Mr. Chair. Let me go back to the finances for the first
question. On the navigators, the cost of the navigators on page 3,
there seems to be some months that are pretty consistent, and then the numbers
spike up in August and September. Is that correlated to the open enrollment period? Yes, sir. That's open enrollment. Okay. And then in October, it dips down pretty low, and then it comes back up in November. So looking forward, will 19-584 be the pretty consistent constant number associated with the navigators?
Speaker 46
15:38
Yes, Senator. That would be correct. You've got a period in time where it spikes
Speaker 25
15:44
up for them getting ready for open enrollment, and then you've got open enrollment itself. But the 19,584 is going to be the pretty consistent average number. How many navigators do you all have? We just have the one company. The number of navigators depends on the volume. Let's call the number of people trained to answer those questions. They're not necessarily navigators per se.
They're just trained to answer questions in that particular market. So, you know, during open enrollment, they're going to have three, four, five of them there at any given time. Keep in mind these people don't, the ones that are trained, don't work specifically, consistently on our phone calls eight hours a day. They do other roles with that particular agency. But when they get a call coming in for one of these questions, they go to one of those people that are automatically trained.
So, I mean, they may have one or two during times that isn't open enrollment. They may have three, four, or five of them there trained to handle a higher volume of calls during open enrollment. Okay. Senator, just one
Ryan James
Unverified
16:56
more item to add on the navigators, because this has been asked previously by your committee. We have a total
of 10 people that are licensed to be a navigator in the state of Arkansas. Now, whether our vendor employs all 10 is up to the vendor,
but in terms of people that are certified to be a navigator in our state, we
Senator Kim Hammer
Unverified
17:23
have 10. Okay. You recognize for a follow-up. All right. And then on the enrollment, if I'm interpreting the numbers right, we've got a steady decline throughout the year. I noticed in a couple counties there was a turn-up in enrollment. Can you tell me why it is that they're going down in the majority? Do you expect that trend to continue?
Or what would be your expectation, best
Speaker 25
17:48
guess, looking into next year? There are a lot of reasons for decline. I mean, the unemployment rate in Arkansas is as low as it's ever been, so you have to assume that a lot of these people are getting jobs and getting jobs with insurance. um they're they're finding uh insurance in lots of different venues you've also got the health sharing ministries out there that are competing with the insurance market in that respect and
and their sales have spiked in arkansas as well okay on
Senator Kim Hammer
Unverified
18:20
that subject do you know how many um i tell you we talk offline i'll talk about the health share and see how many are actually moving over to that. Yes, sir. And they are not able to take the dollars associated with this, though, and pay for their health-shared ministry costs. No, sir. They can't take the
Speaker 46
18:38
subsidies and things like that and pay their health-share. That's correct. All right. We'll talk offline. All right. Representative Ferguson, you're recognized for a question.
Thank you, Mr. Chair. How many of these are auto enrollments? Do you know what percentage? Madam Chair,
Ryan James
Unverified
18:57
we can probably get that information. This isn't broken down at that level, but we can fish around and see what we can get for you on that. I
was hoping long term that the stability would partially be due to people already being insured and auto-enrolled. Do you have any idea of what percentage are below 200% and how many
are below 200 to 400? I believe we
Speaker 64
19:30
can get you that information. Okay, thank you. Senator Rayburn, you're recognized.
Senator Jason Rapert
Unverified
19:34
Thank you very much, Mr. Chair. Commissioner Kerr, I was looking on the first, the financial report. I don't think, yes, it is numbered, page two of the report. We're talking about the expenses. Yes, Senator. And, of course, I caught this, but I was looking there.
So the total expenses, if I'm reading the chart right, of the total expenses of $1,286,000, $1,123,000 of that actually came in the first three months before the transition. That's correct. That's right. That's correct. And so all of that is net real savings to the state. Absolutely. Of those fees. And, of course, the $13.1 million reduction because there's no AM fees as well. I just wanted, Mr. Chairman, to make sure to say to thank you to the commissioner and the staff,
and thank you to our chair of the AEM committee and all the members. It was a bit of a tough lift, especially when we started getting some outside information, but I think it's pretty clear that this was the right thing for us to do, and I've not been hearing any complaints about it. If members have, I'd love to hear it, but I just want to thank your leadership in that and definitely the staff of the Insurance Commission. Thank you, Mr. Chair. Thank you, sir. Senator Irvin, did you have a question? Thank you.
On the numbers per county, is
Speaker 70
20:55
that a total per month or is it a collective? That's
Ryan James
Unverified
21:02
per month. We collect information on the 1st and the 15th of every month. Okay. I will say
what those are. So the total, like Boone County, June 844, that's... 844 lives were covered in Boone County
ma'am. Okay, it's not addition. No. Okay, these aren't new enrollees.
No, ma'am, it's a running balance. Running balance, thank you. Okay.
And those are marketplace numbers, correct? Yes, sir. It has nothing to do with Arkansas
Works? No, ma'am. Right, okay, thank you. Just wanted a clarification. All right,
seeing no further questions, thank you. Thank you, committee. Okay, moving on to item E, DHS, Division of Medical Services,
review of rule to be effective February 1. Y'all would come
Speaker 80
22:13
to the table and introduce yourselves. Thank you, Mr. Chairman. Mark White, Chief of
Speaker 81
22:19
Legislative and Integral Affairs for DHS. Janet Mann, Director
Speaker 80
22:23
of DMS, DHS. You're recognized to proceed. Thank you. We have two rules for you
Speaker 83
22:27
today. This first rule are some changes to our Medicaid provider manuals,
and they regard the availability of tobacco cessation products and services. There was some legislation that you all passed in the last session, some of that related to scope of practice around the prescription and provision of these products, and also some legislation related to Medicaid specifically. And so what we've done is we've gone to clean up these manuals just to make sure that they accurately reflect what was in those changes that you all had already made in relation to tobacco cessation in various areas of Medicaid.
answer any questions. Representative Debra Ferguson, you're recognized. Thank you, Mr. Chair. I was reading this, this tobacco cessation, it says counseling if a parent or guardian smokes, that they will cover counseling visits. What if the child is vaping? Are counseling visits covered by our kids if the child needs counseling for vaping himself or herself?
Speaker 81
23:33
Vaping is not listed directly, but it is a form of smoking, so it would be
covered. So if a child is vaping and the physician or provider recognizes that or pharmacist, then counseling visits would be covered to help them? Yes, ma'am. Okay, thank you. Representative Warlaw, you're
Representative Jeff Wardlaw
Unverified
23:56
recognized for a question. Thank you, Mr. Chair. Representative Ferguson almost stole my question.
What is the cost that we think that's going to cost? Because when you read you guys' question number one in your response, it seems like this was not in the statute, but it is something you guys decided as a policy decision. So what is
Speaker 83
24:21
the cost to the agency for this? I mean, we looked at it
Speaker 98
24:26
at this point. We don't anticipate any significant added cost to the Medicaid program. We certainly can monitor that as it goes on.
Representative Jeff Wardlaw
Unverified
24:33
We just don't expect anything. It's not a separate billing. So do we see a higher instance in smoking and the reason we're doing this counseling and sensation products from kids that
Speaker 102
24:48
come from houses where smokers are? In addition to, we've seen an increase in
Speaker 81
24:53
smoking in general. So we're not trying to open it up. We're not trying to just, if you smoke or you don't, or the household smokes, but it's open to anyone
Speaker 104
25:03
that is associated with smoking that wants the counseling.
Senator Jimmy Hickey, Jr
Unverified
25:07
Okay. That was not what I had to say. Senator Hickey, you recognize? I'll be honest, I had circled this before we started in that same question. The way it reads, unless I misunderstood you, You said it's open to anyone in the house, whether or not the parent smokes or not? Because that's not the way
it actually reads. Because it says that we're going to allow children to request the counseling if a parent or guardian smokes.
Speaker 81
25:47
was for the children to have access to the cessation counseling. And to be honest, personally,
Senator Jimmy Hickey, Jr
Unverified
25:54
I think that makes more sense. Just because a parent smokes
or doesn't smoke, if you have a 17-year-old kid that wants to request the counseling, I don't really know why we would limit it just to someone whose parent smokes. But the way the rule is written, it's only going to allow that.
Speaker 117
26:16
Where it says question one. Senator Wiggins, we'll certainly go
Speaker 83
26:30
back and double check that. If that's not included, we'll certainly look and see at the possibility
Speaker 98
26:35
of coming back to you with some additional changes to reflect that. So that it would allow
Senator Jimmy Hickey, Jr
Unverified
26:40
any child to request it, not just that. Okay, but you will bring that back to us if it's not done correctly?
We'll go back and take a look at that, yes, sir. Thank you,
sir. Okay, so you will get back with the committee with an answer on that? Yes, sir. Yes, sir, we will. All right.
Thank you. Senator Urban, you're recognized. It's a good catch because we don't want to limit that. So I think, is
there a possibility that you can change it between now and ALC rules and regs subcommittee so that this can move along?
Speaker 83
27:28
Let us check with the lawyers in terms of how
Speaker 98
27:31
much flexibility we have to make the change since it's in the middle of the promulgation process. But
we'll certainly look at that and get you an answer back
on that. Okay, because, yeah, I mean, if required, I want this to move along, but I think it's really an important catch if the wording is problematic and limits it. We obviously don't want to limit that. And then to Representative Ferguson's point, I think if vaping needs to be defined or outlined or included in the language,
then that might just should be added. Yes, Senator. If the
Speaker 83
28:09
lawyers give us the okay, we can add that in at this point. We can do that. And if not, then we'll look and see what additional process we need to do to get that added in.
Okay. Just be in contact with us and Mr. Price. And then if we need to call an additional public health committee meeting to look at that language and review it, if it doesn't affect the promulgation, the public comment period, and all of that, if we could get that done before ALC rules and regs subcommittee, that we can move this along, but making sure that the language is correct.
Chair
Unverified
28:36
Certainly. We'll do that. Thank you. Representative Deborah Ferguson,
you recognize. Yeah. Along with that, I just have a concern that we continue to frame everything as tobacco cessation when really what we need to be, the wording needs to be nicotine cessation in all of our legislation. But I'm not sure tobacco cessation covers vaping. That's a fair point. We'll
Speaker 83
29:01
certainly keep that in mind as we go forward.
Okay. Seeing no further questions, this rule will stand as reviewed. no wait wait no no what no we're sending it back sorry we are
Speaker 135
29:23
sending it yeah because it's not correct sorry we will be
Speaker 99
29:39
sending it back and you'll be bringing it back to us yeah yes sir
So we'll get those answers back and we'll get with
Speaker 98
29:44
staff and with the chairs and see which direction we need to go. All right. Thank you.
Speaker 77
30:11
Okay, moving on to item F, review of a rule
to be effective which would revise DHS policy 1088, so you all are recognized. You need to introduce yourselves. Thank you, Mr. Chair. I'm
Speaker 143
30:25
Jim Brader. I'm with the Office of Chief Counsel at Department of Human Services. And Mark
Speaker 80
30:35
White, DHS. All right, you may proceed. Thank you, Mr. Chairman. This rule relates to our participant exclusion rule.
Speaker 83
30:41
This is the rule that we use when we find a bad actor who should not be involved in the state's business, that we're able to exclude them from participation in DHS programs, including the Medicaid program. This rule's been in place for many years. As I'm sure many of you know, the Office of Medicaid Inspector General was created back in 2013. It was carved out of DHS and made into an independent agency. Of course, now it's part of the Department of Inspector General. And so now we've had several years of experience working with OMIG and working through those with these instances.
We've worked with OMIG to go back and amend this rule to make it more clear, provide some additional information and definitions related to who is a related party, how does this relate to not only an excluded provider, but other entities that may be controlled by that provider. And so we've made number of changes related to those exclusions, to the process, and then just reflecting the lessons we've learned in working with OMIG over the last several years. This is a rule we developed in consultation with OMIG. Ms. Hammer-Harrelson from OMIG is the president and is available to answer any questions if the committee has any.
And then, of course, we also have David Sterling, who is our chief counsel, who is also available to answer
questions on this. Senator Hammer, you're recognized. Would the OMIG representative come to the table, please, and introduce yourself? Good afternoon. Would you introduce
Senator Kim Hammer
Unverified
32:16
yourself, please? Yes. My name is Tamara Harrelson. I'm Chief Counsel for the Office of Medicaid Inspector General.
Thank you. Senator Hammer, you're recognized. Thank you. Would you just, in a nutshell, tell us, A, is this going to limit you or is it going to expand your capabilities? And as representing
OMIG, are you in agreement with everything in this? Yes, we are in
Speaker 153
32:41
agreement. We worked closely with DHS on this. It really expands our ability to, well, I guess it does expand the ability for us to include more providers than were in the original rule.
What we've done is basically capture what we have been doing and also what the federal rules provide. Okay. All right. Thank you, Mr.
Chair. Okay. Seeing no further questions, this rule will stand as reviewed. Thank you, McAvoy.
Okay. The next rule is Exhibit G, Department of Health.
Speaker 158
33:28
Y'all would come to the table. If y'all want to introduce yourselves. Thank you, Mr. Chair. I'm Laura Hsu. I'm general
Senator Kim Hammer
Unverified
33:48
counsel for the Department of Health and I have with me Terry Paul, the branch chief over environmental. And we are here today to present our rule regarding body art establishments as part of our revisions that we're doing with occupational licensure.
We added specific authority to artist trainers and hours for artists and training due to Act 910 of 2019. We also added changes to reflect the military and veterans licensure provisions under Act 820 of 2019. We added language with Act 426 of 2019 pertaining to reciprocity and temporary and provisional licenses. We provided notice in the paperback in August. We filed it with the Secretary of State in September.
We had a public hearing in October. We received a few comments and responded to those. There seemed to be some confusion from some of the constituents that attended the public hearings. We had a follow-up stakeholder meeting in December to allow them to have time to ask some questions about educational provisions in schools. We followed up with them. We are here today to ask for our rules to be reviewed, and we'll be happy to answer any questions.
Chair
Unverified
35:05
Senator Hammer, you're recognized. Thank you. How many are currently licensed in
Senator Kim Hammer
Unverified
35:12
the state now to do body
Senator Bill Sample
Unverified
35:18
art? To do body art as a whole, there's probably 700, 800. I'd have to look. but
Senator Kim Hammer
Unverified
35:25
that's pretty close. And as far as who goes out and regulates them, and how many
are involved in going out and regulating them and handling complaints?
Chair
Unverified
35:39
Senator. Okay. All right. Thank you. Senator Urban, you recognize
for a question. thank you one of the things I've asked DHS to do is to attach a copy of the legislation to the rules if it's from an act and then to so if you could do that in the future that would be helpful I think certainly so that we could reference back to the legislation and then
also to contact whoever those lead sponsors were of that legislation just so
they have the opportunity to review the rules and make sure that it matches up with their legislative intent and that they're aware so they can be at the meetings. I just think it's a good follow-up process issue. But I understand, you know, I know one of them was mine, the reciprocity, whatever. Thank you. Thank you. I cannot say that word. Anyway, for the military licensure. So I know that one is just
the immediate license to be able to get these people up and going so that they have employment within as quickly as possible. On the other act to pertaining to artist training requirements, can
you describe that one just a little bit more? And I'm trying to pull that act up, but can you, I know some, you know, we're undergoing occupational licensing to try to streamline that and so can you can you refresh my memory on that act if possible with regard to the
Senator Kim Hammer
Unverified
37:15
artists in training we added the specific language from the transformation in title 20 to talk about the artists in training that is something that is ongoing as far as drafting future rules to deal with the schools that the school aspect was passed to us during transformation with regard to the reciprocal licensure. That's dealing with Act 426. Right. And that is going to be granting the temporary or provisional occupational licenses. It's my understanding that currently we already
grant some temporary licensure for certain body art exhibitions. And so that's something that's currently being done. And so we're using the language from the act specifically in our rules, but also what we currently do to help facilitate
that. So follow up, the Act 9-10 is the Transformation
Act? Correct. So, I gotcha. Okay, so Act 9-10 was the big transformation bill? Yes. And so that transferred that authority over to Department of Health?
And it currently was at higher ed?
Senator Breanne Davis
Unverified
38:21
Correct. Is that why? Just for the schools. We oversaw the body art establishments, and in
transformation the schools came over to us also. That's correct. Okay, gotcha. And then, okay, and then Act 990, prohibiting the offenses. That was the making sure you had criminal background checks and preventing people with those, with, I believe I read it in here. Could you just repeat that
Speaker 158
38:49
for me? The Act 990, actually, upon further reflection, we removed that
Senator Kim Hammer
Unverified
38:53
part out of our body art establishment rules
because as we were working with other attorneys in the executive branch and the attorney general's office, we were trying to make sure that Act 990 was used for occupations in Title 17. These body artists are in Title 20. So we originally had that in our original draft of the rules, but subsequently have removed that language because it doesn't apply.
Okay, so they do have to do a criminal background check or not?
And do we grant a license if they have a
Senator Breanne Davis
Unverified
39:31
felony? I believe with the schools, they already do the background checks, so that actually transferred
Senator Kim Hammer
Unverified
39:37
over to us, not pursuant to the Act 990, but from previous practice. And do we issue licenses
if they have a felony record, criminal record? I'm just curious. I would have to follow up
Senator Kim Hammer
Unverified
39:53
with you on that specific question, just because I think that the school language
is still being worked on right now. Gotcha.
Okay, thank you. Senator Sample, you're recognized
Senator Bill Sample
Unverified
40:08
How many schools are there in the state? When we took over, we received about 41, 42 school packets from Department of Higher Education. So why
Speaker 181
40:19
did they call these schools? Because I'm not familiar with them.
Senator Bill Sample
Unverified
40:24
Now, they are apprentice programs under, they were under the Department of Career Education, I believe, some time ago.
And then it got transferred to the ADHE. There is a certain amount of hours and curriculum that's to be established for those schools. And I guess that's the best way
Senator Bill Sample
Unverified
40:47
I mean, are they called body art schools? or are they part of the
cosmetologist or what? Are they a stand-alone type school?
There are some that are stand-alone type of schools that have an office front
and have as many as 20, 30 students, I believe. You said there
Speaker 181
41:09
are some. Not very many, but some. But the other part, the
Senator Bill Sample
Unverified
41:15
ones that are not stand-alone, under what? I mean, are they with cosmetology? Well,
again, we just inherited the schools in the Transformation Act, so I can't tell you with great definition of exactly how those schools appear.
Some have national accreditations, as I understand. Some are more local. Okay, thank you. Thank you, Mr. Chair. Senator
Chair
Unverified
41:40
Hickey, you're recognized. Thank you, Mr. Chair. Mine's going to be on the first
Senator Jimmy Hickey, Jr
Unverified
41:46
page on comment two. And I just have a question, and I will have to admit, I struggled with this legislation a little bit whenever we passed this in the session. However, we went ahead and did it, of course, as a help to the military spouses. My concern at the time was that those spouses, you know,
if they had substantially less education than was needed in this state, you know, if we were doing the right thing. However, I see on, like, where somebody put number three, it says evidence that the applicant is a qualified applicant under 5.3 to .4. What does that actually say right there? What makes them qualify under three? Do you know that? I'm going to have Chuck Thompson. He's our
Senator Kim Hammer
Unverified
42:31
managing attorney, and he assisted with all the occupational licensure language, and he should be able to help answer that question for you.
Senator Jimmy Hickey, Jr
Unverified
42:38
Just one more before you get started. That is something that you added within the
Senator Kim Hammer
Unverified
42:47
Is that correct? Senator Chuck Thompson, Arkansas Department of Health. That is actually part of some language that we worked out with, including some other executive agency attorneys. What that reference is, is evidence that they are, in fact, a military spouse or their spouse was recently discharged. That's what that's referencing. That's ensuring that they were catching the spouse, were catching all the requirements as it relates to who is actually a returning military veteran.
Senator Jimmy Hickey, Jr
Unverified
43:14
And that's basically what it's limited to. There's nothing else in there that they would have to meet to get that qualification.
Senator Kim Hammer
Unverified
43:21
No, Senator. All it is is ensuring that they are a military spouse as
dictated by the act. Thank you, sir. Senator Hammer, you're recognized. Thank you. I'm trying to pull up a conversation. One of y'all may have been in with one of my constituents who's a body art, runs a shop. The requirements for somebody that's going to do mobile tattooing versus a stationary, are they the same?
They both have to go through the same schooling. They both have to go through the same amount of hours in order to offer that, or is there a difference between the two? it's
my understanding that they're the same obviously in an establishment situation there would be other guidelines other rules that they would have to comply with with a building but as far as the training they would be
the same okay so does so what we're about to pass applies to
whether you're doing a mobile body art studio or whether you have a stationary body art studio is that correct that's correct thank you
Chair
Unverified
44:36
thank you ma'am mr chair All right. Any other questions? Senator Sample,
Senator Bill Sample
Unverified
44:43
you're recognized. So, I'm going back to the last year because that's something that's kind of odd to me.
So, if a military spouse moves here from a state that doesn't have any educational requirements, then we're going to just grant them a license just because they're a military spouse. Is
Senator Kim Hammer
Unverified
45:08
that correct? No, Senator. The particular passage we were talking about was evidence that they are, in fact, a military spouse. They still have to hold a substantially equivalent license from the other state. We're not making it. We're ensuring folks that are military and military spouses that have substantially equivalent licenses
from other states can get licensed quickly here in Arkansas per the legislative intent. It's not making it easier for them to get licensed. That license would have to be substantially equivalent, which means that they have to have similar educational requirements to Arkansas. So it's still whatever their training was needs to be kind of reflect what Arkansas's training is. It's not making it easier. It is ensuring to put them on a level playing field, ensure they can quickly get a license since they were, you know, So since military, they're not necessarily moving here on their own accord
or just get them up and practicing in their profession, as Senator Urban said. Thank
Senator Jimmy Hickey, Jr
Unverified
46:07
you. Thank you, Mr. Chair. Senator Hickey, you're recognized. Well, just
let me ask, and I'm not being, but who's going to make that? Who's going to make that decision on whether or not it's substantially equivalent? And let me just throw out something. And, again, I know we passed this, so it's on us. But if
somebody was required to have 2,000 hours worth of training for some profession that they were doing in Wisconsin,
and we're requiring 4,000, are you going to consider that substantially equivalent? How are you going to make that determination? Senator, I think
Senator Kim Hammer
Unverified
46:47
you're going to find a lot of very similar language coming before you, not just from us, but from other state agencies regarding occupational licensure issues. Like I said, there are other state agencies. The attorneys talked regarding this language. If you look at the act themselves, the intent, it says, our intent is not to count hour for hour. That is explicitly in your legislative intent in the act.
So there's a level of the program people with their expertise determining that a license is substantially equivalent. We've discussed this internally. at the Department of Health with the myriad of programs we do with the occupational licensure for cosmetology to massage. And we've talked extensively with our program people. And generally, our program people are familiar with these industries, know these industries, and they can take a look at a license and tell you, or they have their national standards, and they can look and say, this is really
truly substantially equivalent. We often have advisory committees that can tell us the same of people out in the community that are governor-appointed, like M-TAC, which is the Massage Therapy Technical Advisory Committee, or C-TAC, which is the Cosmetic Advisory Committee. So there is a level of our program people having to look at this without turning into, as the legislature said, not an hour-for-hour count. And there's some art to it, I'd have to say,
as to an experience and an educated experience in making that determination. So,
Senator Jimmy Hickey, Jr
Unverified
48:18
and one more. So, are you telling me that under each one of these
decisions that a committee will actually determine if it's substantially equivalent? Or is there going to be like one individual person that's going to make that determination? And I'm sorry,
Speaker 190
48:33
Senator. I hope I didn't misspeak. Some of the boards and commissions under the
Senator Kim Hammer
Unverified
48:38
Arkansas Department of Health have advisory committees. Some are strictly under just our program staff.
Regardless, in those instances, it would be program staff who are very experienced in these issues and in these industries. Other ones, it will be program staff in consultation with these committees. The legislation covers all occupational licensing under Title 17. So the occupational license under Title 17 looks very different depending on what you're talking about, what program or industry you're talking about. So some would be with a committee.
Some would just be programmed. But we're always getting the input of stakeholders and always getting the input of the licensees that we deal with. So there's a level of that as well.
Senator Jimmy Hickey, Jr
Unverified
49:22
Okay. And, again, I believe the legislature, you know, heart was in the right place in doing this and that this is something that we want to try to do to support our military and their spouses as they come in. I'm not saying that. But I would encourage you all that as we do this, that whenever you find those flaws and if we need to tweak on this, I think that it would be appropriate, you know, to try to bring it back because I do see where there could be cases where things could get so subjective or, you know, politics gets involved.
You know, I call you and say, it looks like to me that it should be an equivalent-type license. I mean, at that point, somebody's going to say, no, Senator, I don't think so, and I know that gets a little tough. So just, again, I would just encourage you whenever we do see the tweaks that need to be made that we bring it back, because I do think it's a good bill,
but we also need to caution a little bit with
Senator Kim Hammer
Unverified
50:14
it. We will do that, Senator, and this is a work in progress. I know the Red Tape Reductional Occupational Licensing Group still meets, and we're part of that. Department of
Health is part of that, and we've had these very discussions, what you've just mentioned, and I think there's a level of learning to it, and we do, and I think there's things that we would like to discuss
with the legislature going forward. Thank you, sir. Senator Irvin, you're recognized. Thank you. I just appreciate Senator
Hickey's comments. It was my bill, my legislation, but I don't disagree with him. I think our intent was to make sure that that was an equal license and that we weren't giving licenses out to people that were not qualified to have them
because my first and foremost priority is the safety and the health of our citizens. So I do appreciate Senator Hickey's comments, and I agree with him. And so, you know, as those move forward, we're keeping a close eye on that. So I appreciate the work that y'all are doing on that with me and our subcommittee as well. Thank you. Representative Deborah Ferguson,
you're recognized for a question. Thank
you, Mr. Chair. Once their license is determined to be substantially equivalent and they receive an Arkansas license,
do they then have to meet all of the continuing ed and requirements for whatever that licensure would be going forward? That's
Senator Kim Hammer
Unverified
51:40
correct, Representative. Once they have that Arkansas license, they still have to meet the continuing ed
requirements in Arkansas. Okay. Thank you. Senator Hammer, you're recognized for a question. Thank you. So, what about the appeals process if somebody disagrees or is there a change in the appeals process if somebody disagrees and they don't get a license?
Senator, for any of our programs, there's no change in any of our appeals processes. Most of those go through the Board of Health to make a final decision. At that point, they would have an appeal to the circuit court of Pulaski County.
Okay, thank you. all right seeing no further questions this rule without objection this rule will stand as reviewed
thank you okay we'll proceed to item h uh miss you if you want to go ahead and
Tamara Harrelson
Unverified
52:34
if y'all would recognize your would introduce yourselves lara
Speaker 158
52:42
shu general counsel for the department of health and i have with me jamie turpin she's the Administrator for the
Senator Kim Hammer
Unverified
52:52
Prescription Drug Monitoring Program at the Department of Health. You may proceed. We are here to present our rules pertaining to the PDMP, and we have for you today the description of all of the changes that were made pursuant to acts in 2017 and 2019. We do have
general authority to revise these rules under Title 20, and we had approval by the Board of health in august of 2019 and we published notice in august and september filed it with the secretary of state we had a public hearing in september of 2019 and we received some comments and responded to those and after the approval ended we are bringing it to you all for review and ms turpin can explain to you the specifics on the 2017 and 2019
Speaker 216
53:39
acts good afternoon some of the corrections
that we made in the rules were on the cover page. The branch was incorrect. Our PDMP has moved to a different branch at ADH, so it's updated to the Substance Misuse and Injury Prevention Branch. The proposed amendments from legislation start from 2017. Act 46 of 2017, we inserted language allowing access by the Arkansas Medicaid Prescription Drug Program.
Act 688 of 2017, we inserted language regarding providing information to insurance carriers for the purpose of verifying prescriber or dispenser registrations with the Arkansas PDMP. We also inserted additional language regarding information provided for research. Act 820 of 2017, we inserted language for mandatory usage of the PDMP by prescribers. We also added two new members to our Arkansas Prescription Drug Monitoring Program Advisory Committee.
Inserted language for development of prescribing criteria for controlled substances and reports to be generated to prescribers, dispensers, and licensing boards based on this criteria. inserted language for implementation of real-time reporting by the Arkansas PDMP if funding and technology is available inserted language regarding the penalty for failure to use the PDMP and we move forward to 2019 act 141 of 2019 we inserted language adding allowing access of
the Arkansas Office of Medicaid Inspector General. Act 315 of 2019, we removed the word regulation throughout the rules. Act 605 of 2019, we inserted language allowing for the exchange of data between the Arkansas PDMP and federal PDMP programs. And then from the public comment suggestions, we decided to add a definition for hospice or
hospice care that is consistent with the ADH hospice rules definition and the definition for palliative care that is consistent from
Arkansas Code 20-8-701. Any questions? Senator Hammer, you're recognized.
Senator Kim Hammer
Unverified
56:03
Thank you. Can you tell me how many are not complying with the mandated usage of the PDMP? That
is something I would have to look into to get a number. Are you wanting overall prescribers? Are you wanting specifics in physicians, PAs, nursing,
Speaker 216
56:24
just so I know what
I'm looking for and how to get that
Senator Kim Hammer
Unverified
56:28
calculation? I'll tell you what, if you're not prepared to answer, let's just talk offline and I'll get it from you offline. Yes, sir. Second question, do you, maybe you don't know this, we'll have to get this offline too, but do you know how many are registered but are not checking it and how do you go about determining if they're not checking
it if they're registered? Currently, we're in the process of getting a module that'll help me determine if a prescription was filled and to see if the prescriber who wrote the prescription
had checked, but we don't have that capability just yet, but we're working on getting that. Estimated time for when you'll have it? We have a contract with our, that's something I have to into to see how how quickly this
this update can be done be my
Chair
Unverified
57:16
vendor. Okay thank you. Representative Deborah Ferguson you're
recognized. Yeah what is the penalty for failure to use?
Speaker 135
57:27
Is it a listed dollar amount or hold on one second.
If a prescriber comes to me and asks me about it, I try to educate on how to use
Speaker 216
57:56
it and when to use it and to let them know of the laws that are in place. But per the Act 820 of 2017, that is subject to disciplinary action by a licensing board.
So will we be getting those rules from the different licensing boards about what the penalty is?
Senator Kim Hammer
Unverified
58:15
Those rules have probably come before you either in 2018 or they're coming before you now as far as their revisions for the specific boards on how they deal
with those folks. Okay, thank you. Senator Irvin,
you're recognized for a question. Thank you. Do we know how, do we know how the, when we provide the information to insurance carriers for the purpose of verifying prescriber or dispenser registration, how that information is being used by insurance carriers?
Do we know how this information is being
used? I do not. I can look
into that. Can you look into that? I'm not sure if there's anybody still here with the insurance department. but you might want to consult and talk with them because I'd like to know how that's being used. And you said something about, we have talked in the past about this being in real time. If funds were available, is that what you said? Yes, ma'am. And technology. Yes, ma'am. I'm sorry, say that one more time.
Technology and funds. If technologies and funds were available. So can you give me an update on that? We are
Speaker 216
59:27
not in real time? No, ma'am. Our uploads are next business day for pharmacies and veterinarians have 30 days to upload their controlled
substance dispensations. Okay, so when a physician goes to check the PDMP before they write a prescription and it's not posted until the day after, is that correct?
So it's not in real time. how if so how do they know if the I mean they don't know correct then if that information is real time or not so if it's not posted until the day after and it's not in real time and they go ahead and write the prescription and then the next day it's posted that they got a prescription from somewhere else who's held accountable for
Senator Kim Hammer
Unverified
1:00:23
overprescribing? I think all of the prescribers are doing the best they can with the information that they have. So if there is some question about any sort of penalty for overprescribing, then obviously that would be taken into account. But I think it's, it has definitely, our studies and our research has shown that this has assisted with the doctor shopping situations. But obviously a real-time situation would be
best. I understand that. But again, you You know, we had this discussion for a long time.
How much money, it says if funds are available, how much money and what technology, how much money is needed to make this a real-time system, number one. And number two, is the technology available to do it, yes or no? Do we know that? I don't have that with
Speaker 158
1:01:12
me today, but we can certainly follow up with you and get back to you as
soon as possible on that. Okay. And then my final question is, can you give me a list of anybody and everybody that has access to this information?
Because we've, over time, when we passed this legislation back in 2013,
I believe, there was questions about HIPAA and about access, and patients were concerned about that. And so at the time, we had discussions that this would be a limited access to this information, But over the years, we have opened up access to this information, I mean, through legislation. Now, so I'd like a list of where we started and who had information at that time that we passed the legislation
and who has access to this information now. And I think we need to look at how it's being used. So I just need a list of who all has access now that we, after we review these rules. Yes, Senator Irvin,
Speaker 7
1:02:17
we'll be happy to provide you with that. Thank you. Representative
Boyd, you're recognized for a question. Thank
Representative Justin Boyd
Unverified
1:02:26
you, Mr. Chair. I just wanted to ask a clarifying question on the real time. When you go back and you study this over time, how often do you find that, say, you know,
Marsh Davis has had multiple prescriptions filled from different providers on a different day? I mean, is there really any, does the database as it currently stands reflect that investing in real time is really going to make a difference? Or is it such a rare occurrence that someone would have the same type prescription filled over and over on the same day where it wouldn't have been caught? You understand what I'm asking? You're wanting to know who's
doctor shopping in the same day, so who's getting multiple prescriptions.
Representative Justin Boyd
Unverified
1:03:04
So is that really happening? I mean, does that show that in the state of Arkansas we are really having doctor shopping on the same day?
24 hours. I'd have to look into that. I do know that Dr. Shopping has gone down, depending on the threshold of whether
Speaker 216
1:03:17
they see five prescribers or five pharmacies within 90 days, but it's going down. Follow up? Yeah, you recognize. Could you
Representative Justin Boyd
Unverified
1:03:26
either give back to me or the committee and let me know? I mean, do some, generate some kind of report to see if there's actually value in it before we start investing money? Thank
you. If y'all would send all that information to Mr. Price, and we'll get to every one.
Senator Kim Hammer
Unverified
1:03:43
We will do so. Senator Hammer, you're recognized. Thank you. With regards to the investigation, when there's been a report or indications that there's been a failure to check, are those investigations by the individual boards that oversee that medical profession or do y'all have any involvement in
the investigation itself? The boards get the information from the PDMP. Sometimes there are subpoenas issued by the DEA.
It just depends on the type of investigation that
is being initiated. And at what level does it become knowledgeable to the DEA that they would go and visit a physician or a prescriber?
On usage? I don't know. They get information from various sources, but they do ask for regular reports from the PD&P. I think the high prescriber reports, is
Speaker 216
1:04:43
that correct? The comparison reports is what they ask for the most.
Senator Kim Hammer
Unverified
1:04:47
Okay. And to Representative Boyd's question, somebody would have to be strategically planning to show up at five physician offices on the same day and get five different prescriptions theoretically in an illustration form in order to beat the system because it uploads every night. So in other states, do you know how many other states are dealing with real-time systems versus a one-day delay in the upload?
The majority of PDMPs are 24 hours of next business day is their frequency. Oklahoma has something close to real-time. It's within 15 minutes is what I've talked to their PDMP administrator about. So the vast majority of states are dealing
Senator Kim Hammer
Unverified
1:05:32
on the same system we're dealing on as the state? Yes,
sir. Oklahoma is the only one I know that has a shorter frequency of their uploads compared to ours. I'd like to request some
Senator Kim Hammer
Unverified
1:05:44
information, Chair, that if you would add it to the list they're sharing or passing out.
What I'd like to find out is the number of investigations that each one of the medical boards have done regarding failure to check the PDM and how many disciplinary actions affecting the prescriber's licensure was actually taken. So I'd like to, you know, if the department wants to get that or we'll get the staff to do that, but I'd like to have that information as far as number of investigations
and the actions taken by the board against the prescriber, and I'd like to get that information, please. Thank you. Can you all provide that? We will work on that. We will need some time
Speaker 158
1:06:36
to get with our boards and their attorneys and
Senator Kim Hammer
Unverified
1:06:38
see what is actually able to be disclosed at this time. Obviously, if there's an ongoing investigation, we would not
be able to disclose that. But I'd make it clear. I don't want names or anything that's going to
violate HIPAA or anything like that. I'd just like numbers, and I'll develop it offline with you.
Thank you. Thank you, Mr. Chair. What a question. Senator Irvin, you're recognized. But do the boards have the ability to do that? Do they have the capability of going in and checking when somebody looks and not looks? I thought you said
that there's a module that you haven't purchased yet. Well, the module is to tie a specific prescription to a filling, like a prescription
filled at a pharmacy to the written date of the doctor
and to go back and see how long it was they checked that person. The boards can subpoena me for what is called a query report to see what all a provider has checked in the PDMP, and they can match that up to prescriptions that were filled. Does that
make sense? Yeah, I got you. Okay, and quick
question on the veterinarian issue. So that's if they dispense the medication, is that correct? That's if they're acting as a pharmacy. Okay, okay. But if
Speaker 222
1:07:57
they go through a pharmacy, then it would be next business day.
Yes, ma'am. Okay, thank you. Representative Deborah Ferguson, you're recognized. Thank you, Mr. Chair. I know what a lot of other states do, which is an important component of reducing the administrative burden for providers, is they have integration with EHR. Do we have the capacity to do that if we had the money to do integration with the electronic health record? We do have the
capacity, yes. And the Department of Health was awarded a CDC grant. It's called Overdose Data to Action. And we have some funds in there, and we're working on doing that, hopefully, in the next year
Speaker 216
1:08:34
to try and integrate with all the EHRs, pharmacy dispensing softwares in the state. Okay, good. Thank you.
Okay, seeing no further questions, without objection, this rule will stand as reviewed. Thank you. okay committee um i'd like to
go back to item e and i think dhs has an answer to the questions that we had earlier so if y'all would come to the end of the table and introduce
yourself thank you mr chairman mark white with
Speaker 83
1:09:16
dhs okay you're recognized thank you mr i think I've resolved the issue, and I apologize for the confusion. Looking back, I think on that question one, I think our staff had misread that question, so our answer wasn't as clear as it should have been. The rule as it's written does provide for tobacco cessation counseling for any child who's a Medicaid client. The confusion comes from that we will also pay for counseling for the parent
of that child if the parent smokes. I think that's where the confusion came
Speaker 98
1:09:44
from, but for any child they will be entitled to that counseling. Okay. Are there any questions? Hold on
Speaker 257
1:09:52
just a minute. If you would, bear with us just
a minute here. So no one has a question about the vaping issue that was raised earlier. That being included, we talked about the language, but does anybody have an objection to the way it's currently written?
Speaker 98
1:10:53
Mr. Chairman, if I can mention it, the language that we use in the manual is smoking and tobacco use cessation. And so we interpret that to include vaping. Okay.
Senator Kim Hammer
Unverified
1:11:09
All right. Senator Hammer, you're recognized. Maybe this is too far out of the box for right now, but I'm just curious, and maybe you're not prepared to
answer it now. Recreational marijuana goes through, is that going to be considered smoking, or how are you going to handle that?
And are they going to be able to access this number in order to get it? I'll have to get back
Speaker 262
1:11:33
with you on that one, Senator. All right, thanks. I'll find out. I hope so. All right, I
know we've had a lot of debate on this, but without objection, this rule will stand as reviewed. Thank you. Thank you, committee.
Speaker 77
1:11:57
Okay, moving on to item I, overview of
Medicaid behavioral health transformation. Would you all come to the end of the table? And, committee, this is just a presentation by DHS of one of the programs, and hopefully we'll do more of this to get information out. So if you all would introduce yourselves.
Yeah, you all have a handout that was just passed around, so you can review that. If you introduce yourself.
Speaker 143
1:12:35
Jay Hill with Division of Aging, Adult Behavioral Health Services.
Speaker 265
1:12:39
Patricia Gann with the Division of Aging, Adult and Behavioral Health Services. Thank
Representative Justin Gonzales
Unverified
1:12:48
you. You may proceed. Good afternoon, and thank you for giving us the time to come and talk about some of the things that we think we've really
Representative Nicole Clowney
Unverified
1:12:54
accomplished in the last year. So our presentation today is going to be the first part of the presentation.
I think this will continue in the next session. But what we're going to talk about today is our beneficiary support and forensics. So in August of 2019, we launched our behavioral health support line. That is for persons who have been impacted by or suffering from mental health or substance abuse addiction or issues. And that line is open Monday through Friday from 8.30 to 4.30 p.m. If a person doesn't have Medicaid or they don't have private insurance or any way to pay,
They can also call this line, and they can be directed to one of our contract providers who will provide services for those beneficiaries. The helpline number is on your next page. And like I said, any Arkansan can reach out and receive help in locating a provider in their area. And some of those services that are available would include individual and group counseling, substance use and addiction counseling, medication management, help during a mental health crisis family counseling or under our new outpatient behavioral
health program we now provide counseling to the under four population it's called infant mental health and so those are services for children and those are dyadic services so they are provided to the child and the parent so it's a dyadic type of counseling on the next page what you'll see is the flyer. This flyer was distributed by AFMC to our county offices. It was also sent out and distributed to our primary care physicians. We can continue to print these flyers and send them out.
We also, at the bottom of that, you'll see there's a website, and you can get the information for how to contact someone to get access to a behavioral health provider on our website. we also want to talk about thanks to our legislative changes that sunsetted our old program under the OBHS program there are no caps on providers and the ability for providers to be certified in the state of Arkansas it was one of the three pillars I believe to behavioral health
transformation was that we wanted to increase access to services throughout the state of Arkansas. So please note that what we say is that we have an expanded network. We also want to really state that it is an expanded network, but we continue to want to expand this network further. We certainly know that within the state, we still have areas of the state, particularly in the Delta and also in some of our more rural communities where it is more difficult for persons to access services than it is in others. So if you'll look at your numbers what you will see is in 2017 we had
31 independently licensed practitioners. We currently have 292 certified independently licensed clinicians in the state of Arkansas and we had 253 behavioral health agencies and we currently have 312 behavioral health agencies that are certified. Those are specific sites throughout the state of Arkansas. We do know that we have some counties, there are approximately 10 counties, and I apologize that I can't name them right now, where we have less access than we do
in some of our other counties. However, we do want to point out that our community mental health centers are required to have a site in every county in the state of Arkansas, and so therefore we know that under our community mental health center contracts, we will have at least one site within each county where persons can go to receive behavioral health services. And that is the end of our update on our behavioral health services in our beneficiary support line.
Senator David Wallace
Unverified
1:16:56
Senator Wallace, you're recognized. Hello, ma'am. Could you give us a list of the ten counties that are struggling right now? Yes, sir. I'll be
happy to. Thank you. Yeah, you can send that to the staff. Yes, sir. Senator Irvin, you're recognized for a question. Thank you so much for your report. I mean, I think it's so important for the members of this committee and the people that are out there watching or listening to understand, you know, how far we've come.
I mean, and I know this is the first part of this report, and it definitely matters on the back end of this report, too. But for folks to understand where our capacity was and where it is today and how it has expanded, and we're not there yet because we definitely have holes across the map of Arkansas where people can't get services, but this is a big, big, big deal. And, you know, I requested that they give this report to the members of this committee and this information because of all that we've gone
through as a state and that there was really a stranglehold, in my opinion, there was a stranglehold on this state.
and which did not allow us to expand these independently licensed practitioners. And because of the actions that have been taken and a lot of other events, we've really been able to
expand this, but we're not where we need to be. But this needs to be clearly understood because it is so integrated into everything that we talk about and everything that we do, and it just, this is something that's so integrated into our judicial system and our justice system when it comes to what you'll see on the next back end of this report.
But when you talk about DCFS, when you talk about Division of Youth Services, when you talk about people with mental illnesses and substance abuse and behavioral health issues, this is a very, very integrated and complex issue. And so, you know, I want folks to really look at this and ask questions and know it because it's really important for us to know this as we represent the different areas across our state. So I just want people to really know where we've come.
And so you might want to
Representative Nicole Clowney
Unverified
1:19:25
emphasize that one more time. Thank you so much, Senator Irvin. We certainly know that part of behavioral health transformation has really been the ability for us to expand both our behavioral health agencies and our independently licensed clinicians. I just want to also say that I think that it's really important to talk about the addition under our behavioral health transformation of substance abuse services now being paid for, counseling for substance abuse issues now being paid for under Arkansas Medicaid.
And so that really opens up services. It's going to open up services on the side of we now, Medicaid now pays for counseling for those beneficiaries who have Medicaid, which I think allows us to much more efficiently use our contract funding, and so certainly we want to look at how we can expand those services throughout the state. We do know I've been a provider, I was out in the provider world for 25 years, and so what we know is that for years there was no reason for someone who was licensed to go
ahead and get their substance abuse certification, their substance abuse license, because there was very little funding. Now Medicaid will pay for that, which is going to, we hope, begin to get our clinical staff to go ahead
and get their substance abuse certifications and be able to provide those services. So just
to be clear, I think you made it fairly clear, but so everybody understands, many of these services that are listed here were not covered under Medicaid previously, but they are now. Is that correct?
Speaker 265
1:20:56
That is correct. Previous to behavioral health transformation in the outpatient behavioral health
Representative Nicole Clowney
Unverified
1:21:01
services program, substance abuse counseling, standing alone outside of having a co-occurring behavioral health diagnosis was not paid for under Medicaid. So now someone can walk into a counseling clinic and say, I have a substance use disorder and I want to get counseling and they will get that as a standalone diagnosis. And that was not allowable. And then our infant mental health program, which I think we're very proud of, is for us to be able to do some early intervention
and prevention with our little bitties. Those are children under the age of four bringing parents into that counseling, dealing with trauma issues and those issues early
on before they get into school and before these become serious issues. And again, one of the
difficulties that you all have is to communicate this and get that word out. Is that correct? Absolutely. We
Representative Nicole Clowney
Unverified
1:21:53
want to get the word out that these services are out there, these services are available. you can go to the beneficiary support line.
The closest provider may not be in your county. The closest provider may be in the county next door, and you may not know that those services are there, that you can access those services. So we certainly want to get them out to beneficiaries, but we also really need this information to go out to our primary care physicians because that often is where individuals show up. They usually show up with a physical illness when they have depression or when they're not really sure what's going on. So we want to make sure that this number and this information is in the hands of everyone
so that they're contacting our providers and getting the services they
need. So is it fair to say that we want to catch these issues or these problems earlier so that it doesn't develop into a bigger problem like change the oil or blow
Representative Nicole Clowney
Unverified
1:22:53
the engine kind of thing? Is that correct? That's absolutely correct. Like, the earlier that you can
Speaker 265
1:22:59
intervene when someone is beginning to have some behavioral health issues or mental health issues or substance abuse issues, the higher the rate of us successfully being treated.
Representative Nicole Clowney
Unverified
1:23:09
So you want to make sure that we're getting people into services early on in that process, especially around psychosis or schizophrenia. What we know is that we can identify people early on, first episode psychosis. If we can identify them early on in that process, there are treatment, evidence-based treatment protocols that will then greatly improve the outcomes of those beneficiaries who are developing those disorders. Senator Urban, you're recognized. And
members, I want you to emphasize the money issue here.
Because before, we were paying for these services through contracts. And so there was a limited number of people providing these services based on contracts with Medicaid. right? Is that correct? That is correct. And those contracts were how much in state general revenue approximately? Give me the breakdown between of those contracts, what was straight 100% straight state GR and what was federal? Senator,
Speaker 281
1:24:14
it was about 20 million SGR, roughly
13 million federal funding. Okay,
and so now we say you bill Medicaid first and use the contracts afterwards, the Medicaid is what in the breakdown of state and federal? 70? Yeah, is it 75? 70-30? Thank
Speaker 4
1:24:38
you. It's around 70-30. Yeah, I know know
the answer to the question, but I just want, I want to make the point, though, is that this is
financially, this is the right thing to do. So not only does it probably save us money in the long run, it also opens the door for more people to be able to provide those services outside of the people that had the contracts to do this exclusively. And it's financially better for our state. Absolutely. And it's been more beneficial to the people that we serve. Thank you. Senator Hamer,
Senator Kim Hammer
Unverified
1:25:19
you're recognized. Thank you, Mr. Chair. Tell me about the, well, first
of all, for the number of licensed practitioners, do you know, do you know how many
of those are actually seeing individuals? They might be listed as providers, but are they actually seeing people. Senator
Representative Nicole Clowney
Unverified
1:25:43
Hamer, what we have done for the beneficiary support line is that we have a form, and we actually call those providers quarterly, and we ask them who they're serving. And so I can certainly get that report to you for who is accepting new clients,
if you would like to know that number
Senator Kim Hammer
Unverified
1:26:01
specifically. I'd like to know that because you could have a thousand providers, but if only 200 of them are actually seeing people, It's kind of given a skewed perception of the matter, number one. Not that it is or not, but that report will tell
me. And how many providers are currently waiting to be
Representative Nicole Clowney
Unverified
1:26:22
approved? Are we? I don't know. What we are counting is our certified providers. So once they get certified, then they're able to go ahead and provide services waiting on their Medicaid number.
And so I cannot tell you at this point how many of those providers are waiting. Are you asking, are they waiting to be certified by the Division of Provider Services and Quality Assurance? Yes. We're waiting. Okay. Yes, sir. We
Senator Kim Hammer
Unverified
1:26:47
can get those numbers for you. Okay. And then when it comes to auditing the independent licensed practitioners, what's the process for auditing to make sure that the work that they're doing is complying? Is that OMIG's responsibility? Is that Charles? or who does that jurisdiction rest with,
and how has changing the system improved the reduction of fraud or potential fraud? I certainly can't
Representative Justin Gonzales
Unverified
1:27:12
speak for OMEG. Under DMS, there is a contract whereby both the independently licensed practitioners and
Representative Nicole Clowney
Unverified
1:27:19
the behavioral health agencies will undergo clinical review of services, and there is a percentage, and I am sorry I don't have the information right now, the percentage of claims that are pulled for each individual provider, and those claims will be
Senator Kim Hammer
Unverified
1:27:35
reviewed. Okay, and then the last thing is the, and I'll give you a scenario. You tell me if I'm thinking correctly and it matches what we're looking at. So like I've got the counseling clinic down in Saline County, and we've got independent licensed practitioners that are kind of popping up and opening up shops, okay? And yet, if that independent licensed practitioner chooses not to see somebody for whatever reason they choose not the fallback is going to be on the counseling clinic to see that person but it's also going to be on the counseling clinic
to go to the local jail and deal with you know that population am i thinking right and is that what we're talking
Representative Nicole Clowney
Unverified
1:28:20
certification and certainly the division of provider services and quality assurance is not here today and so those regulations are under the certification regulations, Senator Hammer. But under the certification regulations, both groups of people are required to have 24-hour emergency services. So, and like I said, again, that division
could certainly speak more clearly and probably more intelligently to the specific certification regulations. But both groups of people are required to have 24-hour services. What our contractors are required to do is they're required to do crisis services for individuals who are not in the past and individuals who have no payer. All
Senator Kim Hammer
Unverified
1:29:00
right because independent licensed practitioners that's that's just free market is no way I'd say that okay but I don't want to see the structure eroded to where these clinics that are expected to take people because independent licensed
practitioners choose not to take them there's a there's a balance there somewhere where we don't put them out of business because then who's going to be getting called to the county jail at two o'clock in the morning to deal with somebody. And that's what I want to make sure stays in the discussion, is that we have that balance as far as how we protect those stable entities in case these practitioners start going away all of a sudden. Yes, sir.
Thank you. Okay. Thank you. Thank you, Mr. Chair. Representative Brown, you're recognized for a question.
Representative Karilyn Brown
Unverified
1:29:46
Thank you, Mr. Chair. And Senator Hammer may have hit on part of my question. So if somebody has a substance abuse problem and they want to call and get services, that's one thing. What about the people who are in the court system and they, you know, they've got a substance abuse problem, they've got a traffic ticket, and they're required to go for this mental health counseling.
Are they advised or is there some way to communicate to the court to share this information with those individuals that may be eligible for the services under, I assume this is under Medicaid? Yes,
Representative Justin Gonzales
Unverified
1:30:27
ma'am. It is under Medicaid. And also, I think that Director Hill can also talk about our contracts and
Representative Nicole Clowney
Unverified
1:30:33
the services that are offered under our contracts. And so, I think when he actually
talks about the forensic program, we'll discuss more about how we are reaching out to our law enforcement and to our
Speaker 281
1:30:45
counties. Yes. So, for instance, the example you gave, someone who
may be picked up on a traffic violation at the UI through our drug and alcohol safety education program, the DASAP programs, that can be court ordered for an evaluation. At that point, the DASAP program can make that recommendation to the courts that this individual needs further treatment. They need counseling. This is a substance abuse issue, not just alcohol. It may be a narcotic issue, for instance. It could be any myriad of issues that they can make that referral so that they can enter our system and receive the treatment that they need.
Speaker 288
1:31:22
Follow-up? Yes, you recognize. Oftentimes I would think
Representative Karilyn Brown
Unverified
1:31:27
that a lot of these individuals may not be very good about signing up for services ahead of time and, you know, taking care of their paperwork. And, you know, they've got problems. So is there, when you reach out to these individuals, if they haven't bothered to follow up and get their insurance coverage or sign up for it or whatever, is there someone there who helps them do that or are they just lost?
Representative Nicole Clowney
Unverified
1:32:02
I'll give you an example of a call that we had a couple of weeks ago. I had a grandmother who called me that was in tears because her granddaughter was in jail on drug charges. She was very, very concerned that she was going to be bailed out by the very people who she was using drugs with. So she reached out to us. We were able to go to Jimmy McGill, who manages our peer support under our substance abuse contracts, and we were able to get a peer support person out to the jail to talk to her.
That peer support specialist, that peer recovery support specialist, talked with her, assisted her in getting into a treatment program, and they facilitated her going to treatment. What we know is, and what I know as a licensed professional, is often people aren't going to listen to me. But they will listen to peers. And so I think that's one of the wonderful things under our peer recovery support specialist, under our contracts, is that we have the ability to get them involved in that and have them reach out. We can't make people come and get treatment, but we certainly have some tools that we can use to try to get them into treatment.
Thank you. Representative Deborah Ferguson, you're recognized. Thank you, Mr. Chair. Do the insurance companies pay for comparable services for the
Speaker 289
1:33:24
Medicaid expansion population? I am sorry. I do not know the answer to that question. but i will certainly find out for you thank you okay thanks i'm
sorry okay seeing no further questions thank you for the report oh i'm sorry go ahead jay you're
recognized i lost my place here thank
Speaker 291
1:33:50
you mr chairman uh just just very briefly i want to touch on a very
Speaker 281
1:33:54
important component of our behavior health uh division and that is the management of our state's forensic evaluation system. And so today I just wanted to kind of give you an update as to where we are with that. I know many of you get phone calls from your local detention facilities about
Speaker 291
1:34:09
individuals that are awaiting evaluations. So I would tell you Arkansas ranks third nationally per capita in the number of forensic
evaluations that are ordered. The state hospital gets about 2,000 orders a year, which it's quite a tremendous load that comes through our doors. In your packets, you have a handout, and what you see is this is a three-year snapshot, the evaluation overview page, and that shows you that in three years, the hospital has been responsible for seeing 4,698 forensic evaluations completed. Now, at ASH, Arkansas State Hospital, we have, right now on staff, we have three evaluators.
We accomplished this by partnering with our local community mental health centers who are under contract with our division to provide services. And they have done, along with the hospital, an absolutely tremendous job this year to help us work on this problem. I cannot emphasize enough what a valuable resource the community mental health centers have been to us. When an evaluation order comes through to the state hospital, we'll make a determination if that order needs to be pulled in. For instance, it may be a case that
is complex enough that we know that it really needs to be handled at the state hospital, whether the court may prefer it that way. It may be that we have evaluators with specific areas of expertise to handle those evaluations. So about 25% of all forensic evaluations get assigned here at ASH at the state hospital. The remainder, we will assign out to the community mental health center whose jurisdiction the case falls in. The community mental health centers
have forensically trained evaluators on staff, and then they will in turn see that that evaluation is completed and the report is generated and submitted back to the state hospital. Currently, we have 450 open cases. 360 of those are considered what we call actionable. And we've done, when we began to clean up our backlog, was what we began to work on this, the first step was to determine if we had good data.
And we spent a considerable amount of time working through these cases, in many instances following up on them individually through Court Connect and calls with jurisdictions case by case to determine what our real numbers were, where we had issues, what size of monster we had to tackle. And so presently we have 450 open cases, 360 actionable, and we divide our cases into what we call actionable and non-actionable, meaning there are those that have simply disappeared.
There are individuals that have been court-ordered for an evaluation that may have absconded. They've left the state. They can't be found. They've moved. changed their addresses. There's an active warrant out for their arrest. It's not an individual that we can with certainty lay our hands on or the community health center can locate. The remainder what we those that we call actionable are those that we have contact with and that we are in process in the process of getting those evaluations completed. Evaluations is a bifurcated process now.
They follow ACT numbers, a 327 and a 328. So one is a fitness to proceed. One is a responsibility examination. And then we follow those with a 310, which is a restoration examination. So those are the three main areas or numbers. Those are the three main evaluation types that we speak of. So when we began this to revamp our system and change the model, the way that we handled and conducted this in March 1st of this year, What you see on your, let's see, what you see on the second page
shows you where we were when we began the process. We were sitting at 465 overdue evaluations. And by definition, overdue means 60 days past assignment. So when an evaluation is ordered, the court or the state hospital, the evaluator, we have 60 days to conduct the evaluation, to write the assessment, and get the return to the court unless we have an extension granted. We had 465 overdue evaluations, which is a large amount. And now I will tell you that number has been growing year after year after year.
This has been an ongoing problem that State Hospital has been dealing with. We started a new program, and I'm going to kind of go through just very briefly through some of the details of the enhancements in the way that we've changed our systems. But this morning, in less than a year, our number is at 92. So we have reduced that backlog from 465 down to 92 actionable overdue evaluations that we are pushing through to eliminate. I'm very, very proud of the hospital.
For the first time ever, we've had 12 consecutive months where our output has exceeded our input. We have completed and exported more evaluations to the courts than we have received at the state hospital. And I would tell you, that is a monumental feat. It's never happened before. But for 12 consecutive months now, we've been on the right side of getting this project tackled. Some of the things that we've done at the hospital is we looked at the way that we reimbursed for evaluations.
And our system was really old. It had been what it was for quite some time. And so we have creative incentives to help our community mental health centers. We have increased what we pay for an evaluation when it is completed timely. We have an administrative fee that we will pay to a community mental health center in return for, upon receipt of an order. They will get us a date scheduled back within 48 hours. So we know that we have something in hand. And we have case managers now at the state hospital where we've created four new positions to handle the state.
We've divided it into four zones, and we monitor each of these evaluations individually, uniquely. We hold biweekly calls with community mental health centers to discuss their evaluation load, where they are, what's going on. Is there anything that needs to be done differently? Do we need to pull those? There are times we need to pull those evaluations back into the state hospital. The individuals may be not in a condition to complete an evaluation. We request extensions of the courts. but is that communication piece that was lacking beforehand that we have really worked hard to improve now
to stay on top of what our load is. We've hired an attorney at the state hospital and two paralegals, and our legal staff communicates with courts directly by telephone, through email, through written letters, but we keep our judicial districts updated on what the status is of the evaluations in their districts, and we let them know and we answer questions of the courts and we now have a number and a face and a person that a judge or a prosecutor or defender can call should they have questions
and they can speak with to get information about that particular case and we've seen that's that has really helped made a difference in the relationships that we have with our courts as i mentioned we we looked at our data and our data was really antiquated we we didn't have a good grasp of what was actually out there. We do now. We've created dashboards, which we now have a public-facing dashboard, and we use this daily. Our forensic staff at the state hospital and at the division office daily, we look at this. We have an updated numbers that kind of show us
each day and what our trends are, what we've got hanging out there, what we have that's coming due, and it's all used hand in hand to eliminate our backlog and get us to a state of current, and that is our goal. In addition, we've also done something a little bit different, and this kind of falls more into Tricia's area of the house. We have a treatment recommendation report that we now generate for individuals that are referred for evaluation. So very often we find
that the same person will be ordered for an evaluation 60 days apart. In one case, I can tell you in one case we had we had one one offender that had four evaluations orders in 45 days so and it's i don't uh these are these are persons that are frequently violating the law they're getting picked up not always in the same jurisdiction and order after orders being generated our goal with the treatment recommendation reports um and let me say a court evaluation
is not a treatment recommendation it's not a diagnosis if you will it's a determination of fitness or it's a determination of responsibility, but we follow that with our community mental health centers and at state hospital with a clinician to look at this person to say, this is what the problem may be. And we have found, particularly through, for instance, through our crisis stabilization units, that if we can intervene and if we can stabilize, help a person become stable, very likely we can prevent them from having interactions with law enforcement and entering
this forensic system, thereby reducing the number of valuations that are ordered. It's a win-win all the way around, and we can help individuals become stable and stay stable and be productive in their communities and avoid these touches, these forensic touches. And so this has been a very exciting component of our program. We've never had this before, but we're seeing some very positive results and some great stories come out of that. We have some diversionary efforts. We've been working with courts. We do have some diversion courts in the state.
We do not have enough. We would like to see more. Deb Inman, who is our state's forensic system administrator at the state hospital, she's a former deputy prosecutor here in Pulaski County. She's working with the courts. She's partnering with the AOC. She's out making the sales pitch. And we have judges. We have prosecutors that are very interested in working with us on these diversion courts. To do just what I said, keep individuals who are frequent flyers through the system to get them the treatment they need, to get them the services that we now provide in our state,
and in an effort, or by that effort, to keep them out of our system. So that is where we need to be in behavioral health. We need to be serving those clients, those patients, those beneficiaries, and helping them have a better quality of life. Our collaboration, we work with jail administrators now. We're partnering with sheriff's associations, as I mentioned, the AOC. We are working with our prosecutors, with our public defenders, all in a concerted effort to reduce the number of evaluations that are ordered within our system.
As I mentioned, 2,000 a year is quite a load, and it is difficult to stay on top of that. The number of forensic evaluators, forensically trained psychologists that we have, that's a very limited number. And so our desire is to see that number of evaluation orders reduced. allows us to stay on top of the orders that we get in a much better way, makes it a much more manageable number. But we've seen some great gains this year. I would tell you that with the contracts that you have with our community mental health centers,
what we have found this year is we have exhausted our forensic funding on several lines with our contracts. I'll be coming back to ALC in January to ask for additional funding for our community mental health center contracts, which normally when we're back asking for money, it's not always for a great reason. I'm excited for this. We're in our final push to eliminate this backlog, these today, 92, that we have overdue to get us to a state of current, which in my tenure with DHS I've never seen.
So our goal is to add the funding that we need to not only handle our current load for this fiscal year, but to also complete our elimination of our backlog and be in a state that the hospital has not been in. So I would tell you I'm quite excited. I'm very, very proud of the gains that we've made. I'm very proud of our community mental health centers and the way they have stepped up and partnered with the hospital
to see this project through. Well, Jay, congratulations to you and your team on what you did.
Thanks, Senator. On that backlog to get that work down. And I know from your presentation it was not easy, I can tell, but congratulations on that. And also I am happy to see that you're coordinating and working with, you know, the local clinics and police and also the crisis stabilization unit, you mentioned that, and we have one there in Jonesboro. And I think these things are a big improvement. but so how much communication through that system have you had?
I mean, is that a big part of what you're doing or a
Speaker 291
1:47:20
small part? No, the CSUs report their data monthly. We're in constant communication with them. They're all still relatively new, and we work hand-in-hand. Three of the four are partnered with the Community Mental Health Center. The fourth here in Pulaski County is partnered with UAMS. They do a phenomenal job of stabilizing persons and preventing them from being charged criminally, and they're doing great work.
We're seeing some of that relief at the state hospital. As I mentioned, we've been ahead for the previous 12 months. We have completed more than what we have received. I believe that is in part due to the success of the CSUs and their early interventions and, as I said, keeping the persons that they're coming in contact with, those beneficiaries, out of the forensic system. That is a big accomplishment. Absolutely. Congratulations. Yes, sir. Senator Hammer, you recognize
for a question. Thank you, Mr. Chair.
Senator Kim Hammer
Unverified
1:48:17
So as far as making an improvement, because I think part of the problem is sometimes the courts just send people down to ash, and if a county judge has somebody sitting in their county jail that is backlogged, waiting to come to y'all, the judge kind of gets the end around on that deal. And so how are the communications? You referenced it, I think, a minute ago, but I want to clarify. How are the communications going with the judges out there, and are you able to track specific areas where you don't have cooperation among the judges?
Speaker 291
1:48:52
We've seen an improvement, Senator. We do receive fewer 24-hour admit orders. than we used to. What we find now is that we get phone calls first, very often, from a court, from a prosecutor's office. They are, the courts have recognized, in large part, the efforts that are going in to improving this system. And so I would just tell you that, by and large,
what we have found is it's been much easier since we've We've had our new systems in place than it was prior to, particularly with the leniency that we get from the courts and their understanding that when they have somebody that is decompensating, for instance, in their jails, and we recognize they need to be admitted to the state hospital. This is a person that needs to come out. Well, we're full at ASH. Our census there is typically 100%, and so for us, it's a one-out, one-in. When we discharge a patient in the morning, that afternoon, we'll follow up with an admission.
It's an ongoing process. And we're very good to work with the courts. And our judges now understand, too, that they may have somebody that's on the list that needs to come to the state hospital. But they also very often trust that if somebody jumps ahead of them in line, it's because that person in jail is acute, is a danger to themselves and others, and that they are just sick to the point that there is no place for them to go and they need to come in. And so we've seen the cooperation among the courts has really improved, and I'm very thankful for that.
Senator Kim Hammer
Unverified
1:50:31
Okay. And then I want to do a follow-up while you both are still sitting at the end. If you get a call through the number on the first part of the report we got, what's the determination as to where that person is referred to, say, a community mental health center versus an independent practitioner? How do you all assign people or how do you, so that the distribution is equal and fair? So the way
Representative Nicole Clowney
Unverified
1:51:00
that people are, so when someone calls the beneficiary support line, they are given six providers that they can call.
So they're given the information. If in that particular county there are six providers total, they're given all six of them. If they call Pulaski County, where we have 91 providers, then they will be given in a rotation. So AFMC rotates those providers so that they're giving out six providers at a time. It also is based on whether or not that person requests a specific type of provider. So if they say, I would like to go to a behavioral health agency, then we'll give them only behavioral health agencies.
If they request only independently licensed practitioners,
we will give them only independently licensed practitioners. And you keep a report that shows
Senator Kim Hammer
Unverified
1:51:50
the distribution by practitioner as far as the ones that are referred out. So
if I called you up and said, hey, I want to see you in Pulaski County, you had 100 calls.
Representative Nicole Clowney
Unverified
1:52:04
I will certainly check with AFMC to see if that reporting, how they manage that. Senator Hammerin will get that report. I just want to
Senator Kim Hammer
Unverified
1:52:11
make sure it's fair and equal and nobody's getting a loaded up deal.
Absolutely. Thank you. All right. Seeing no further questions, thank you all for the report. Thank you. Committee, we're losing a lot of people here, but I think it's important if we look at these programs that we're doing to see what the progress is and the accomplishments, also where they're falling short. So we're going to have some more of these program presentations in the future. So, Senator Urban, I'd like to recognize you. Thanks.
Speaker 274
1:52:42
Just before we adjourn, I wanted to give
the members of the committee a few follow-ups.
And just FYI, the state of Mississippi only got 43 referrals for forensic evaluations. We got over 2,000. And my information from DHS is that Mississippi lost their court battle, and the DOJ took them over. So that's why it's incredibly important. We don't want that to be taken over. But just on last meeting, the provider-led Arkansas Shared Savings Entities, the PASS issued that, from my understanding, that language was added to those agreements and they were agreed upon.
So that's just a follow-up from our discussion that we had, a very lengthy discussion that we had from the last committee meeting. So from my understanding, that was accomplished. Secondly, the EBD decision regarding disabled dependents eligible for being covered by the parents' policy, that I understand decision was reversed. And so those dependents will be able to stay on that insurance. I think there were a few that you want to add.
I'll let you add to that. I know that Representative Ladyman worked really hard on that. So I think we need to give the update on that. But that issue that we brought up at that committee meeting, it was reversed. Yeah, let me insert
something right here before I forget. Senator is correct. It was reversed. But as you all might remember, there was a long discussion, and that decision was made late or mid-December, late December. And I don't know whether you all have received
calls about this. I had a couple of people that called me that the payment for their insurance was not taken out on January 1,
and their adult children were sick, and they wanted to make sure their insurance coverage was still effective. And calling the secretary, I found out that some of the paperwork was not processed in time to reverse that. So if you get calls about that, that insurance is still in effect. But they did not withdraw that money for the premium. So these individuals will have to pay that premium, but their insurance is still in effect.
Their cards are still good. So that decision was reversed, but there's some paperwork issues
there. Thank you. And then number three, the PANS
Panda Advisory Council, that met last week. I think Senator Hammer is going to chair that. Is that correct? And I'm vice
chair of it. And Representative Les Warren. So I would just encourage everybody. I was not able to make that meeting, but
if you would go online, all the items from the agenda are posted online from that information from that meeting.
And then lastly, the issue with the Solid Waste District Tire Recycling Action, I know that is still ongoing and in the process is that correct ADEQ and so we'll have information about that as a follow-up on a future meeting is that correct okay because I had people asking me about that if that was going to be presented today and it's not but it will be in future meetings so if you'll just let me know so that I can make sure that those individuals from that area in that district are notified so they can attend that meeting right okay that's it thank
Tamara Harrelson
Unverified
1:56:10
you all right can be that's the last thing on the agenda we are oops sorry senator hickey just one it won't be in a second i'd like to
Senator Jimmy Hickey, Jr
Unverified
1:56:19
ask would it be would it be hard for us to have a copy of the of the entire rule attached to each one of these now if there was to be a 20 or 30 page rule i mean we could just have one copy maybe at the desk but if there's i would like to have the entire rule on each one of these is that is that something that would be hard you're talking about about the bill? Well, the rule itself. We have
a synopsis of it, but we don't have the actual
rule. It's kind of like a minute ago whenever we were talking about the tobacco and the younger people. If we'd had a copy of the rule, we could have thumbed through there right quick and just seen what it actually
said. Yes, staff can get that. But it may, and again, we may need to put some parameters in that if it was to
be some rule like that, you know, I'd hate to have 80 pages and attach it to each one of ours. Good suggestion. Thank you, sir. We have one copy.
I mean, or something that we could have to have. A couple copies. Well, I guess if it's a large one, we could have one copy that people could review if they want to. But if it's small, just attaching it wouldn't be much better. Alright, thank you, committee. We are adjourned. You
Agenda
Call to Order
Comments by the Chairs
Consideration to Adopt the December 9, 2019 Meeting Minutes of the House and Senate Public Health Committee. (EXHIBIT C)
Latest Information on the Health Insurance Marketplace Enrollments for 2020, geographic breakdown of enrollments, insurance rates being charged, number of plans being offered, and the names of companies offering the plans.
Discussion by the Subcommittee and the Committees.
E. Arkansas Department of Human Services (DHS), Division of Medical Services, Review of Rule to be effective February 1, 2020 which would revise the provider manuals to comply with Acts 651, 652, and 959 of 2019. The purpose of these acts are to increase services and medication to Medicaid eligible beneficiaries. (EXHIBIT E)
Discussion and Action by the Committees.
Arkansas Department of Human Services (DHS), Division of Medical Services, Review of Rule to be effective February 1, 2020 which would revise the DHS Policy 1088 which is the Participant Exclusion Rule regarding Medicaid Providers. The rule would clarify that the Office of Medicaid Inspector General (OMIG) is an entity that may exclude Medicaid Providers pursuant to ACA 20-77-2506 and implements Act 951 of 2019. (EXHIBIT F)
Discussion and Action by the Committees
Arkansas Department of Health, Center for Local Public Health, Review of Rules Pertaining to Body Art Establishments. Updating a rule to reflect requirements of Act 315 of 2019 to remove the word “regulation” and added language pertaining to Artist Trainers and hours for Artists in Training which was in Act 910 of 2019. (EXHIBIT G)
Discussion and Action by the Committees
Arkansas Department of Health, Center for Health Protection, Review of Rules Pertaining to Arkansas Prescription Drug Monitoring Program adding legislative amendments from 2017 and 2019. (EXHIBIT H)
Discussion and Action by the Committees
Overview of Medicaid Behavioral Health Transformation
Discussion and Action by the Committees
Other Business
Adjournment
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH WELFARE AND LABOR COMMITTEE - SENATE AND HOUSE, Jan 6, 2020 | Agenda | 2 | Official source ↗ |
| EXHIBIT C 12-9-2019 DRAFT MINUTES | Exhibit | 5 needs OCR | Official source ↗ |
| EXHIBIT D INS. DPT. Enrollment Report | Exhibit | 21 | Official source ↗ |
| EXHIBIT D INS. DPT. Finance Report | Exhibit | 6 | Official source ↗ |
| EXHIBIT D INS. DPT. Rate Filings Report | Exhibit | 9 | Official source ↗ |
| EXHIBIT D INSURANCE RATE INFO | Exhibit | 8 needs OCR | Official source ↗ |
| EXHIBIT E DHS PROVIDER MANUAL REVISION | Exhibit | 13 needs OCR | Official source ↗ |
| EXHIBIT F DHS POLICY REVISION | Exhibit | 12 needs OCR | Official source ↗ |
| EXHIBIT G DEPT. OF HEALTH RULE REVIEW BODY ART | Exhibit | 11 needs OCR | Official source ↗ |
| EXHIBIT H DEPT. OF HEALTH RULE REVIEW DRUG PROGRAM | Exhibit | 10 needs OCR | Official source ↗ |
| EXHIBIT I DHS Public Health Presentation | Exhibit | 10 needs OCR | Official source ↗ |
Speakers
Representative Jack Ladyman Chair
Unverified
Senator Missy Irvin Chair
Unverified
Speaker 12
Ryan James
Unverified
Representative Deborah Ferguson Chair
Unverified
Speaker 22
Speaker 25
Speaker 28
Speaker 35
Senator Kim Hammer
Unverified
Speaker 46
Speaker 64
Senator Jason Rapert
Unverified
Speaker 70
Speaker 34
Speaker 80
Speaker 81
Speaker 83
Representative Jeff Wardlaw
Unverified
Speaker 98
Speaker 102
Speaker 104
Senator Jimmy Hickey, Jr
Unverified
Speaker 82
Speaker 117
Chair
Unverified
Speaker 135
Speaker 99
Speaker 77
Speaker 143
Speaker 153
Speaker 158
Senator Bill Sample
Unverified
Speaker 169
Senator Breanne Davis
Unverified
Speaker 181
Speaker 183
Speaker 190
Tamara Harrelson
Unverified
Speaker 216
Speaker 7
Representative Justin Boyd
Unverified
Speaker 222
Speaker 257
Speaker 262
Speaker 265
Representative Justin Gonzales
Unverified
Representative Nicole Clowney
Unverified
Senator David Wallace
Unverified
Speaker 281
Speaker 4
Representative Karilyn Brown
Unverified
Speaker 288
Speaker 289
Speaker 291
Speaker 274