Task Force on Autism

That's what okay. Call this meeting of the Arkansas legislative task force on autism to order I would like to get first let so sore check is everybody of either audio or video or we all in good shape if there's a problem raise your hand I guess. Okay we've got Melissa who's got we have a number of people that are raising their hands we know they're audio is working. let's see so. Sherri hill. A. I can hear you Sir I just can't see here well in many cases that people would say that's a positive. All right we ready to go we that is great before we get started I would like to introduce a Representative marsh Davis marshes been appointed to take Justin boards position as co chair of marsh is of the finish up his first term in the house of representatives he is of a pharmacist and more importantly of he understands is committees seating well and what our goals are you he has a seventeen year old son that has autism so he has real life experience represent Davis would like to welcome you to committee would you like to say a few words. Of I would think Senator. Introduction. and marsh Davis the. And like he stated that their go Representative board spot. Wow me well what he said my son Jackson Ellis Davis is seventeen and was diagnosed with autism when he was too so I have a very close interest in this subject I'm proud to be sitting here hope to meet all of the all. And hope to get a lot of lot accomplished. Yes of thank you Representative Davis with that let us move into approval the meeting as of October thirtieth of two thousand nineteen is there a motion I guess we we're raising hands is that what we're doing could we raise a hand to approve the minutes if there are no additions or deletions to the minutes by October thirty. All in favor please signify over there we have a motion we have a second all in favor please signify by saying aye all opposed. Let's bring on our next item D. is our covert related telemedicine practices of Melissa I think you were going to sort of bring us up to date on that. Thank you thanks for having me on the intended today so I will be brief Janet me and is also on the phone and see is that division director for Medicaid so I'm she might have some follow up comments but and back in March kind of one because of its first started and come in on the radar here in Arkansas we did a lot of policy changes to our current practices to allow more flexibility for our providers and I just wanted to everyone to be aware of kind of what we did around autism so you know I DHS we ran two different onto them programs we ran autism services under our and EPS the team. The regular Medicaid state plan and then we also ran an autism waiver for those of you not familiar with that which is that very intensive waiver that requires. involvement that partner spring please if you needy September net and administer waiver for **** so and we worked with Karen I'm trying to come up with solutions that were appropriate and around ought to use them for total did it so that we can keep services going when families where either you know fearful as I'm taking kids to day treatment centers are private clinics or even having people in their homes when because it started here so I'm we did a couple of things we're we're allowing I'm certain clothes that prior to this we're not telemedicine codes so we are allowing telemedicine to you and to enter that field of autism four kind of that and that will continue until the governor declares the health emergency to be over here in the state of Arkansas and and the other thing that we did that was related to autism are a BA therapy was we went in and and. Extended evaluations and prescriptions. So if you had a valid prescription or an evaluation or and eighty eight therapy on March the first we have not asked you to go get another one right so we're just keeping that balance so that those services do not have to stop because you will really didn't want to go. Yes and the pediatricians honestly we reach out to them. Didn't want them to come in for that reason right they were trying to treat sick patients so they want to focus on not and they didn't want well patients really in there and in their buildings if they didn't have to be said that pre interest and where Very happy that we went ahead and extended those prescriptions and evaluations and that will continue as well until and thank you at ten ninety days until I want the governor declares because we know there's gonna be some time to have to get get those items re opt so there's are some of the things we've done in Kobe and Janet probably once touched on this more seems more in charge of this than I am but you know because it's really taught is that we can do some some more expansion of telemedicine in a really strategic way and so we have and we have it telemedicine workgroup at DHS we've been and asking providers to come in and present proposals for some long term. Solutions and strategies around telemedicine and I think we are having an autism presentation at some point as soon and we've had one police get from the occupational speech and I'm physical therapist that was really well done in so our hope is to have a comprehensive DH asks telemedicine proposal that will be able to bring Senator Ingram to the legislature this next session that makes sense for all of our programs so we're actively working on that and I don't know Janet did I miss staff or state thing you want to add two one nine. He said the only thing I would add is we have invited outside stakeholders different physicians and different legislators and interested parties to help us we've also included the department of health so we're not trying to do anything that is isolated and we are focused on the continuum of care and the many different definitions of telemedicine in what is the appropriate delivery of telemedicine or the future that the statute that was past several years ago and gave us a great base and things that we are trying to look at we we can't guarantee that we will need a lot of a lot of legislative changes we may need a few more tweaks to the legislative statute and then and then finished with rules so we're trying to work collaboratively with I'm all interested parties from hospitals to any additions to the speech there Hester different therapy providers and behavioral health you just look at the continuum of care we in public health emergency has taught us a great deal and we would like to The able to continue that. Of. The lesser Janet of the telemedicine component of in order to utilize telemedicine unestablished relationship has already taken place between the doctor and the patient before their that is allowed is that correct. Yes that is what is in the statute in the governor's executive order gave us some some broad authority to really help that but not make that be a sticking point to not be able to deliver care seven we have worked with a lot of existing patients to get them the appropriate care and then there's emergency circumstances work when there's not and a current relationship that we are. Would you like that aspect of that established relationship because telemedicine cannot replace in person care but it should augment you should have the hopefully the flexibility to go in person to see your healthcare provider or do an appropriate form of telemedicine. Be assigned call our audio visual component to have that care delivered a. Go ahead unless. As Janet said we we took a looser interpretation during Kobe you know because it hit suddenly and we have to act quickly I would say for for autism services for a BA services as long as that as an evaluation had been conducted and in person with that provider and we counted that DDS as an existing relationship at that has been a bit of an issue that if you're new to the program we still need those things to be done in person the first time Which many of the conditions in here probably touch on this. Is we still think it's best practice to. Sort of relationship be no but specially with children I mean you need some basis there said that's been the only kind of pushback is people didn't want to do that initial evaluation and we wouldn't allow telemedicine and less that initial evaluation with that person. Any questions. A have we operated it long enough to get any feed back to see what our of parents to the. Any any anecdotal comments regarding telemedicine. Your life friend and from here is that are getting T. PTN speaks I back here and that and partners get feedback on the autism services in particular. Okay Senator Ingram what we've not had any complaints at all and when we when Kobe first here that we had course families were you know afraid we have teams of at least three or four people go in in the people's homes some of those teams are working in multiple homes and began about if the families at the beginning that even with the option of certain of our services being done through telemedicine I wanted to put their services on hold and we said you know we I talked with list in ways that you know what I try to penalize anybody for that so I wanted to hold their services that's what we did but the vast majority of them all that about ten have come back in just services and did so after just a few weeks we had a number of children and our families that have had positive and so those are held pretty much now but we've not had any negative feedback at all about the components of our program in the waiver that have been offered through telemedicine I think people were grateful that we could at least we still have our our lead therapist line therapists going into the house because there's just some things you can't do by distance but even though the to minimize the number of people that a with face to face is that a good thank for them. Okay of any other questions or comments for Melissa Janet. All right then let's move along to discussion regarding the B. C. B. a licensure. Karen I think this is a sort of got your name underlined on this. I'm just I don't really have a dog in that hunt where the others I didn't know that it's that an issue that has been sort of kicked around and people have talked about it for a number of years in the list and I had a discussion about it no several weeks ago and my only point and to her was just to say that I thought everybody needed and now that through the national certification through that the AC B. that behavior analyst certification board there is a mechanism if their work you know if there were to be a complaint that a family or someone wanted to finally get someone even though there's not state licensure there still is that mechanism through the be ACT eight are those kind that complies to be filed and investigations to be done I know the issue that came up in that previous went a couple legislative sessions ago the question people are asking was yes which if without some sort of state licensure they didn't realize or didn't think that any of the folks with the background checked but everyone who is a Medicaid provider has and background checks as many as you can possibly do and they're done very often so there Medicaid vendor they have lots of background checks done so I don't see that is an issue either so I don't know with if that something that's important for the state to do or not. Of thank you begin alarms that you know who knows which direction it would go but so Lois to now if somebody has a complaint regarding of an analyst but who we do they go to word it word word is that complaint directed department of health or where. Yes Sir I mean just kind of like if we you know we we get random complaints I mean they come through various places you're at the exact and they're going to send those over to me if it autism related so that was really my reach out to care and was kinda like. What you know what and I haven't received it I'll tell you that but what what do I need to do if I get one of these I'm just trying to get some advice from higher because we had we get some on and TVT and speaks I was a frequently but we did get some that we do turn over to their licensing board so we were having a discussion about not having a licensing board here for this time this type of clinical programs and what my options were as this you explain to me the national when I felt better about it because she's that may actually do investigate it and follow up on it so luckily we haven't had to cross that bridge at. Any thoughts on the committee regarding the B. C. B. a licensure. Okay Go ahead sorry. Hi my name is the murderer either analyst in northwest Arkansas. I know this is something that we've discussed where Arkansas association for behavior analysis. Like I was not I did not know this is beyond under discussion a state and prepare anything back I think it's important to consider licensure so we have a. An entity within this state that is local and a legal authority to address consumer complaints that they're right and so that there this is the place for people to go to if they have issues but more importantly and license for offers an additional level of consumer protection ACT not afforded I'm when there is not licensure and paste and all that the ACT as have excellent standard and guidelines for preparation and practice as your analyst and they do investigate complaints it is. One entity at the national level that doesn't have the same level of support that a little why state authority would have an addressing any concerns making sure that people practicing need right now is ask are you Heber analyzing have the appropriate training and certification and there's a lot to be said on the topic but I think one thing that would be. Meaningful for the committee to hear as that both to be here and it in all right to be ACT and that association professional behavior analyst I have model licensure act. And we as an organization at the end of last year when we started exploring this a little more or as an something to consider pursuing in our state. Adapted that license for that model ACT. For Arkansas in the process. No one is that one of the issues with implementing a license or. Programs as the process FOR licensing people on how that can become. Maybe even cumbersome I don't know if that needs to be that strong a word back. Because I have the certification process to be ACT hive it would really be a matter as. Following up and ensuring that they are certified in the means being that certification they complete the required continuing education requirements and then checking out off so there are ways to make that. When I'm getting out of that fact. I could certainly be more prepared to talk about it at another time if and you wanted to continue that discussion sure it is something important our server to protect. Tiffany your last name is is could you spell it for us. It's M. R. L. A. missing about M. R. LA okay. Of the lady it is the certification off for the C. B. A.'s of it states not having them more common than states that have it or we are out wire or is is it more common that that that states require licensure. So I have not looked at the numbers recently but what I recall is thirty two states have licensure Emplate and I think there are twelve additional states that are in the process of creating licensure intended in an event not too long ago that went over those details and I can all that I reference. If you want me to send you something but. It's becoming more commonplace to have that place for different states because they be ACT doesn't have any local authority regarding complaints. They provide the certification but there's not much that they can do in terms of. Follow up for issues that might arise with practitioners and and our state again I didn't look up that current numbers to see how many certified behavior analysts we have in this state but I'm we are growing very rapidly and when I started my program. Early years ago there are less than ten being a very analyst in this state and now were summer close to a hundred and probably over that. A pretty close at this point especially when you start adding an assistant behavior and last so. And. And I know we just started a program that watch time after this behavior now says the master's program and the university of Arkansas AT there's now for several years and this year I know they had over thirty people start in echo park over at this all. So access to speaks and the number of behavior and a last in future be here and we have in state and given those numbers it is something we would want to. Continue to provide additional oversight or. Senator Ingram yes care eight in terms of and at the authority that the B. A. C. Beattie has the national licensure group as I understand that they had the ability to suspend the license if there happened to be some agree just sort of a infractions thank and require and people to get additional training I mean there are things they can do because they are the person who holds a license for them so it might not be necessarily state authority but I do have some strings on people that they can can pull if need be so just just want to make that clear. Thank you and eight definitely can require with gold certification insights but they aren't one small organization providing oversight across the country so not at all I. I I and I think I'm that person yes if I can be ready I apologize entering Graham and I think I'm the person who opened that can of worms but I and that. Okay. To you and licensure Eight eight eight in their benefit to licensure of the B. eighteen B. encourages eight to personnel licensure however I'm it is a double edged sword in some cases our state and stayed at licensure and other financial professional here not me eighty eight. I'm having I argued exactly that they need to be included I ask why I think. behavior analyst in this state and so you know that complicate matters that at certainly from the perspective that did the eighteen be that is not appropriate and you know as if you're licensing and behavior analyst in the state of Arkansas them from that perspective and to be eight the bees and national organizations that as is is recognized as well as nationally and internationally as part of the credentialing organization banker now at I'm here from their perspective licensure name here to recognize the a BA certification. I'm primarily the other issue with licensure that everyone needs to consider and back in and state proceeds licensure there is also a licensure I'm in a state then you know if a complaint times kids that and be a C. B. they're gonna they're gonna have perceived that day. And they are going to get to this state if there is that a board date date licenses the CBA behavior analyst and in this state if there's a complaint in the thank you I know and it complicates matters in time and risk back I thank. But the B. eighteen B. and courage as thanks to pursue licensure for the very reasons that That I can't means that I have laid out which is that they are one I'm relatively making model organization and and fielding complaints by the I'm from as within the United States and from around the world I'm. But there are pitfalls here it definitely and that we need to be considered not believe that where it. At that you know we can't have. And number and other. Financial professional not meet the V. eight ACT other professionals who work and other related behavioral health field he says that they should be able to prepare at an opportune file I meant. At for as behavior in on. At. Theory of issue that we need to be considered you know whether or not. Members as behavioral health professions and when Wade that. When when. Make that a person. And I don't know if that would be the case and I in Arkansas it happened in a couple of state and It may be really complicated so. I honest I'm neutral on that on that Argument I can I can carry their way and and it does make complicated I want thank you made I understand that it is not. It's not without some really significant at all to perceive that. Okay. issue states that at and and some difficulty getting licensure laws ask for that very reason I'm I think that. If I can recall its and didn't review my notes and then most recent role weapon are and licensure but I believe that states that have the biggest issues our current currently have legislation in process to address those one state being New York where I had very specific limitations on behavior analyzed to only work with individuals with autism may think North Carolina. As currently in the process and not not remembering off of my head where they are at this point that. In order to be a licensed behavior analyzed in North Carolina you had to practice under the supervision of a state psychologist which created some significant barriers are practitioners. Those are all things that we we spent some time last year gathering information online and and had put everything on hold and in terms of having further discussions about it and this was not at legislative bill year. But I think there are some. Some there are definitely some tools available to help address the potential pitfalls and when creating the licensure and also to make sure that we include professionals that have the appropriate training and education and experience working in the field but may not be license of the beaver analyst to have some additional. Wastes that seventeen license or if appropriate. And that is built into that model act that we had developed and and with all of our talking points that we created. It definitely is something that worries that I know when this first came up a few minutes ago and since then my heart has kind of been finding a little bit because it is definitely a concern when you start talking about licensure and then at. You know other groups might be concerned that they won't be able to continue practicing what they've been practicing. And it's locked before it even gets started so that something that we haven't really had a whole lot of discussion about outside of our group just install. That's fine. Was Iran and I met with a few other people last year we your first talking about it. All right hundred and fourteen now in Arkansas I just looked it up so we continue to grow in my that number is continuing to grow that's just an extra level of protection. Any other thoughts from the committee. Okay of then one all we. Take up of the community and employment support waiver what's the to discuss that Karen Melissa anybody. Want to visit that. Is that an issue is our problem I mean it's on our agenda year community and employment support waiver. I didn't know why so maybe I don't know if there is a problem I'm happy to talk about it We have a Speaker at On Thursday the government's gonna do a press conference announcing that we're about to release more sly we haven't told me by that. In. yeah I'm really excited so that. It's gonna believe any Avenue right Right we're. Yeah yeah. Six hundred regular slot and then a hundred set aside for DCFS foster can we give them their own lives so yeah we're really excited about it and he's gonna be a press conference at ten o'clock and on Thursday morning. In a hurricane. That will grow again is there yeah. What about is that. Is there what about on the pavement structure incentive own home based integrated services any information or updates on that yes I was going to send you a power point actually so I know you would you asked me about you know you we were doing kind of the sea in a pass for the HTC staff to try to give them more pay and then give them more of that career ladder we're doing and requiring see an eighties on the HTC side and we're opening see in a school that each one of that age the season we're going to pay for it so that we can pay them we can pay them more he's are starting I think starting salary right now for the direct care worker is about twenty three thousand dollars so and see in a is that a higher grade. And they'll get paid more than not on that on the house side of the house so on that on that home and community based services We are standing up any provided tight and we are finalizing the draft impact actually this morning so we're hoping to put that in place January one cities waiver slots will be available December one and then the new provider type January one and we have to put those two things together because you know when we got this to back us lots a couple years ago I guess in sixteen it's as three years this bill that's why it wasn't because we weren't working we just you know we don't have that providers out there to provide this service so. Then a provider type is gonna be really cool and we're hearing these additional spots was standing at this new provider tie hoping to incentivize people to kind of an open up their book of business and and served DD client and then the IDT providers will also be able to serve behavioral health clients so taking down that barrier so you can start by sat. In in that requiring specialized training. For best domain so specialized training for behavioral health and IDT and an autism module is written in there now Taylor as a required topic and one of the passes has come forward and saying that they would like to pay for that training for all of that providers with some of their community investment dollars that we allow them to spend each year so we think we're gonna be able to but that's requirements and and then it will be no cost the providers that that past Wesley pay for it so and we're really excited about it. Right that's a win win what is the waitlist speaking of the DD water water water is our wait list numbers do we not that I'm it's right around three thousand five hundred right now is. Just. Okay any questions regarding of Melissa and. I have one question an offense I ate I send I know that my organization has done some training or. Yes staff with regards to you know if they indeed it they received rave waiver support that they have significantly challenging behaviors and had a lot of staff turnover. And I just wondered if there were any plans zero either and and I don't know if this is what you were just referring to that either allow I behavior analysts to provide that type of support directly through waiver I'm we've done it just as an extra help our planes and Lee is but I know that can't be expected state why but I know it would be very beneficial probably to and number of clients that are recieving waiver services and their staff meeting staff turnover and collaborate. And I'm here support plans and. And that this morning is there is not and let me tell you why so the way that this works I'm the past. Ms as set up under a series of waivers all right waiver services and you can only ask the federal government to allow you to perform waiver Sir this is it is not available under your Medicaid state plan so like to think of it this way so like position does it Medicaid state plan I can't have that under a waiver personal care actually it's the state plant service so I can't have that and paid through under the waiver and that's the same thing with autism it's under EPS ET says not under the waiver program since this particular a provider type we're talking about is the providers who are going to perform all of those services under the past program so think of it like for an employment supported living in helping people get housing and Behavior well there is a behavior assistance Service so you know there may be a way for you not to look at it billet under what you're used to billing but look at the services that are available well under the past and see how you could fit into that and then become this the provider type ninety six and probably still use your skills that. We give away you're just not you're not feeling for it like you have been in the. Yeah I know that that's a really good thing for me to look up I know we have just done it for free because that wasn't something you could bill for but I was just thinking right across this state most people probably can't do that or don't have the resources to do it and it might be beneficial for you also brought at the supported employment and other things so I think I would love like not today obviously but to have them member stations about ways that we can integrate that support for adults and and continued act have discussions about potentially and. Adding as a state plan amendment or whatever it would be not I'm not up on all the terms appropriately back regarding an artisan are AT A service as FOR individuals with autism outside if he yes the TV has one thing that we rent run into at our organization is I'm and I know everything was was new in the last year with eve yes the snooty service of and I've been beyond excited about the additional support we've been able to offer our families to that. That for instance we had. I recently discovered that one of our clients we weren't able to Bellamy kept getting the engineer getting the generic the Nile. For them and we finally got everything my and they were. Okay all the different type one and type two they weren't the type of Medicaid. Plan that does not cover ETS ET service which I don't think any of us knew exist and and so now that plant and we discovered a few others because it was something very hard to find even after getting the pre approval and pre authorization and providing services our minds find out thank you receive services and we had to do so and yeah let me say on that so I have any non that that I printed that I was going to hand walk over to Janet actually today so I I talked to her about that so you're right and we are working to you page providers for the services that they did perform and under our kids be even that was not allowable because we didn't catch city so I appreciate got stopping is not allowable service but we don't like it's therapy not be reimbursed there was. Stop mechanism in place that I appreciate that I just worry more about those those those that are getting mass but like I said I know we've green's a much wider population now and I am so grateful for that because we are not able to offer summons murder in leased even those that had taken out a third insurance plan for instance so that they could get eighty eighty four is covered under Medicaid so we've we've even families and that way I just. I always worry about those that are getting against and those that are over age Ivor seven or the waiver they're not able to at that. This I don't have any idea how to use and you can to estimate how many children that is but I know if my one little tiny organization northwest Arkansas as six and it's probably. A large number because we just we're just word of mouth and I said it just so happens that we have iris thinks that having either as a primary or secondary. He or. Any other comments regarding this. if not then let's talk a little bit about this is so our meeting we have a report that is due to go to the legislature recommend recommending any possible legislation for the upcoming session I think we can sort of the general in nature and what we sore one attorney and hear the end of August and work on it I would suggest we have another meeting schedule sometime mid October is we get ready for the session some of the things that we've discussed and you should get have gotten a copy today is restraint legislation by states there were about five states Wisconsin's was pretty broad Kentucky sees is is is operated very much more tightly drawn and Massachusetts is sort of in between I have not gotten the Mississippi she at but issue no we we and I will send everybody copies of the guidelines we have guidelines of the state of Arkansas but not any not any legislation I will also send those guidelines is that something that we feel is important to move forward do you want to look at this and re visited and October of what's the will of the committee. I and I both. In order. I think that would be something very important for us to look at I thank the suggested guidelines that the department of education put together and put out to the schools are very well done I'm just not sure that that very many people are taking those since their suggestions. That personally I would love to see something like that the started right and put in place. Nine. I I I'm I'm very I I think that it is wrong in that in addition and the department of education that thank you not promulgate regulations around the if the restraint because they didn't have statutory authority and they are and so they did put out the guidelines the guidelines are excellent the government that bears the name plate is excellent if there is not a requirement for school district you follow that line and and and you know. And. Reminding the department of education and we have the statutory authority to promulgate these regulation and and doesn't mean that you don't you don't have to provide an you know at the base of the and the legislation about the regulations and you can get the care of the department of education and the ability that day what I needed to do really in decades I'm. Otherwise might my fear is that a child at a dating is going to get seriously injured or one ninety eight and FOR and an improper use of restraints. And that is what is the mentally land they're they're regulation things like other state I don't one Arkansas to wait until that happens. All right well I've included or Alice in his included five states and we can sort of if the committee would take a look at some best practices and then will also send out the Arkansas guidelines to everybody and if we're comfortable with them then we can we we will include that in language of of recommendation and then we can finalize it when we meet in October. Of are there other items of of recommendations that we wanted to make for the next session for potential legislation. Did we ever what did we up with doctor Barnes and eighty E. what did we ever did we ever get any information back on the ability of families it would of that were trying to work with children in school but schools one allowing them to do what did we ever what was ever resolved about that. Does anybody of the committee no. Give me this is doctor she lets me at them to be hammer support specialist coordinator and actually aided with at C. span unit and are we have a group that meant and April zero with at stake holders several on this task force to work on a guidelines that is more of a guidance document for districts to be more informed about the services that behavior analysts provide in the state of Arkansas and with Calvin and school closure arced our focus had to shift to provide services to our districts into our students so that is something that we are bringing back to the table to work on we did look at Pennsylvania has a great draft of a document that we felt like we could adopt and revised to meet our state needs but it's something that we are continuing to work on it's just not completed at this moment okay docks with those yeah those guidelines of I just wanna make sure that you all may at and if if there is a gold standard out there and we can follow an adapted certainly we should utilize it and certainly understand you've had one or two things to do with the with since the go with fire struck of other anything else that might be of brought before the committee. If not of. Missed cochair anything that you might have a way that you want to talk about. Nothing in particular Mr chairman at this time. Well Alison will be back in touch we will attempt to up schedule a meeting in mid October and the the the things we discussed here today we will try to bring them into clear focus of what we won't come January. So with that if there is nothing else no announcements or anything else we'll get back with the date everybody please stay safe and we will see you in October. Thank you.