ALC-Administrative Rules

Call the meeting to order the administrative room subcommitted or so legislative council june reminders if you are here and wish to comment on a rule to go ahead and please sign in sign up sheets or right down here in the front and be sure to specify the rule of which you wish to make comment. And we'll be taking up those sign in sheets momentarily. I don't be on our general reports from executive subcommittee we have one report this month concerning the review and approval of emergency rules. That is in your packet. Is there any questions on that. Seeing no questions without objection to report will be filed items see we have no reports this month from any of the alc subcommittees concerning the review of rules. Moved item d rules far pursuant are so code ten three three oh nine this is the agency's rules for the month. So we'll call each of the agencies to the table and they can present their rule will start with state insurance department. If you'll identify yourself for the record you present your rules or good morning while okay i'm dan honey with the arts and insurance department we have here of proposed rules sixty nine which is a promulgated as required by act five eighty of two thousand twenty three. What this does is it develops an audit prices for qualified payment amounts under the new surprises act which is a federal federal law and requires methodology of the qualified payment amount to be found in the policies and we are basically folding our auto process we already have market conduct authority and we are folding this in under that and also requires when we do have an audit we are required to submit that to the federal hsum have any questions thank you sir members any questions for mr honey. Seeing none there without objection the rule is reviewed and approved thank you for your next we'll bring up article sentencing commission. Experience. I'll identify yourself the record you may percent your rule good morning tony ral director of the arkansas and it's in commission. Um what we have here and the packets a lot sicker and probably makes things look at work a little more complicated than it is after every four legislative session since nineteen ninety four the sentencing commission reviews all the newly created and modified offences and assigns them a seriousness ranking that's the vertical call them on the first page of the rule that one through tan that does impact transfer eligibility but this is pretty standard like I said after each legislative session anything that's created or modified has to get a seriousness ranking error. Everything was pretty much in line with what we expected you know more serious as pencers tend to be in that seven through tan and then lower offences tend to be through six and I can take any questions members any questions from israel on sentencing commission. Seeing no questions in without objection the rule is reviewed and approved thank you. We'll go to d three. The department of education. The. The. Good morning sir i'll notify yourself for the record you may present your rules. The. Hey go again good morning chair members of the committee manager some grace roads and the chiefly on council for an apartment of education we have two rules before you today the first rule is the desirable governing special education mediation and hearings rose could you poor that might just a little bit closer to you yes sir is that yes or perfect thank you thank you. Will the permits amending this rule to mere federal regulations by us deployment of education. In the us department of education performance audit and found that our rules contain provisions beyond what the idea which is the individuals with this abilities education act authorizes primarily the us department of education stated a provision that allowed a hearing officer to grant an extension to an expedited hearing was not in line with the we've removed that language performed some clean app to bring the rules and compliance with federal regulations so the highlights include a requirement for school districts to provide written verification for resolution meetings to the department at removal of language requiring a meeting to encourage mediation before the actual mediation occurs which is usually more informal than just having it two former meetings back to bag and then lastly removal of a confidential only pledge not required by the idea some of these provisions were required under federal law under and law that proceeded the idea but had been sense removed so we're just again updating the rose comply with federal regulations and i'm available for questions okay. Members any questions for mr roads on three a. So you know they were that objection the rule is reviewed and approved you've got a three b thank you chairman the second before you as the desky rule governing school safety these new rules incorporate acts from twenty twenty one and twenty twenty three regular sessions and one act from the twenty twenty two special session the department initially probably get it emergency rules on december sixteen twenty twenty two to affect you the school safety program the stable of education prove these rules for public comment I notice ten twenty twenty three and approve the final rules on october thirteenth twenty twenty three these rules are march one existing rule which is desk rules governing duty to report student criminal acts and in our previous emergency as well as twenty twenty three session changes and to this permanent neighborhood are available for questions in members any questions on that item for missed roads. Setting no questions that objects to the rule is reviewed at approved thank you changed roads members will go to item four a DF and a. And the obvious of intergovernmental services. Good morning good morning your mike is up if you all identify there you go feel identify yourself for the record you make percentage my name is jam bartland and general council for the department of finance. And i'm expecting door a smith they have a division to be here but I can proceed without her. So the purpose of the rule is to promulgate procedures to administer the pregnancy resource grad program in accordance with x six twenty two of the twenty three regular session. Dfa is responding to the requirement of the general similarly to administer the credit program. Members any questions from his barclay own four a. Senator hammer you're recognized thank you mister and thank you for being here this point i'm just huge do you have to know. The. Do you have another bounce of the money that still they are born with us spend all that it is at your wheel stance for my understanding is that no money has been dispersed yet. There's a million dollars a smart understanding of those are considering right but but with application of this rule with with a passage of this rule then they'll be able to start playing correct that's my understanding in the smith is here to answer those questions good morning my smith you'll identify yourself with the record and then you could help answer the question please thank you good morning and doris me I am the administrator of the officer in a government services. Okay and there's a million dollars wait to be span these rules that have gonna allow that to have begin to be applied for correct correct okay. The best way for the centers to be able to find out how to make application for the grant would be what we have we have advertised agrees arm a lan are really in a lot of centers have been notified of the finding it is available applications have been submitted received a toll of twenty nine applications to those twenty nine exceed the million dollars the applications though but we're in a review process and we will calibrate it back down to me and hours last question during how much above the million dollars to twenty nine approximately ninety six thousand over so it's around one point one million in total our request okay thank you. Members any other questions. So you know they without objection the rule is reviewed and approved thank you for being here this morning got adam five a department health. Yeah. Morning gentleman you'll identify yourself with the record then you may present your rules on i'm russell burns and the director of the state board of acupuncture and related techniques. I'm sure thompson with adh legal mister gilmore could not be here today so i'm standing here and instead thank you you may begin sir alright the state board of accurate puncture and related techniques is making one change in the board rules due to legislative number one thirty seven of twenty twenty three. This act allows the board to accept relevant and applicable uninformed service education training national solid occasion or serviced issue credentials when can considering an application for initial lacenter a public comment period was conducted and there were no comments received during the period. Okay. Members any questions for mr burns. See now they without objection rule is reviewed and approved they thank you. Good item six digital department health. State board of physical therapy. Again chuck thompson eighty h is worth in with the with the board is coming up to join me again mr gilmore cannot be here so i'm here in his. Good morning. Good morning I am nancy were then the director of the arkansas physical therapy born and visit the european board is making one change in the rural dutable registrator of at one thirty seven and twenty twenty three this is the consideration of national certifications toward initial occupation on license in the application the spouses and we received no comments in the public comment period thank you. Members any questions from his worth and this rule. See no question of that objection the rules reviewed approved thank you thank you go to item. Seven. Department health state board. The. The. Chuck thompson eighty eight illegal. Jamie turbine the prescription drug monitoring program administrator cricket smith attorney for department health item seven a thank you mister chair what you have before you is update to the pdmp rules these are all pursuant went to legislative act in particular act sixty seven of twenty twenty three which was by representative johnson senator boyd and senator urban the main the gist of this act was we added we we added meas as individuals that could access directly access pdp information before that before this act that the mess the medical damage had to send a paper to us and that we would send paper back and then they could get the information from the PD m p simply reduces a bureaucratic red tape for them to access it for them to do their for their official duties we also added in added applicable mortality reviews including if it mortality reviews paranado mortality reviews and any other mortality reviews as recognized in the law including arkansas child death review panel this was to ensure that we could they could access the PD and p information that's all confidential to see what bearing would have on their case reviews that is that is the gist of it i'd be happy to take any questions this did go through public health as required by arkansas statue joint public health last week with unanimous approval. Members of the questions for mr thompson on seven a. The. Seeing none without objection the rules reviewed and approved we'll go to seven b. The. Yeah. The. Jackets mount the branch shape with the arkansas department of health go. Go into chuck toms and arkansas department health cricks with a turning for organs or department health and. We're here to present the new rules for pertaining to youth injury mitigation that information courses for athletic personnel and coaches uh these rules are pursuing to act six forty two of twenty twenty three to inact requirement for coaches to take certain classes for high risk use activities idiot has tasked worth approving the courses pursuant to the categories outlined in the act for each coach or personnel that it be required to take by the association there was a public comment period of public comments were made and was approved by a joint public health last week thank you sir. Members any questions for mr smith on seven b. Seeing known without objection the rule is reviewed and approved gentlemen thank you for being in the small picture. Got a item eight eight ADH s. The. The. Meter our stuff staff dhs good morning janet may and deputy secretary for programs and state medicaid director dhs good morning melissa weather ten director of medicaid specialty populations jay hill with aging adult behavior help with hs. It's good morning so the rule we're presenting to you here is really a two part rule one of the first piece of this is the continuation of the american rescue plan act funding that the agency received under ninety eight seventeen and this is the work for stabilization instead of planned but the agency is partnered with a cbs providers across the state which takes you poor that might just want to closer to please part missouri so the continuation of the rule allow us to continue utilizing those fines past its expiration date under the original appendix that was far to CMS and take the authorization to continue providing money to state providers through believes march of twenty twenty five. The second component of this proposed rule is to allow us to continue using the appendix camera see right for assisted living providers in the state presently their permanent daily reimbursement rate is sixty seven dollars and twenty five cents. Under appendix k that was filed by the agency we have we raised those rates to eighty one fifty nine four urban based providers and eighty five sixty seven four rule facilities that rule would be would have been set to expire however cms is now given us authorization permission to extend those rights for the duration of the waiver so our presentation do you today is to allow us to continue utilizing those rates the eighty one eighty five rather than allowing that right to revert back to sixty seven dollars for those providers thank you so great for questions. So to over your recognized just one question so this will suffice for any type of a rate review a for them I know we've gone through rate reviews for everybody so this will suffice for that rate reviews time assuming that there will be no request for rate review after we. We've increased this pretty dramatically is that correct. Name i'm we are currently doing some cost reporting analysis in a response to a bill that was passed this past session and so depending on the results of that in decisions being made there could be additional increases we just don't have that data back yet to present to anyone and so we felt that it was more prudent to continue the emergency rates as a permanent part of the waiver as opposed to having a decrease and then coming back with a potentially another increase so at this time I don't know that there will be and I don't know that there won't be another increase coming. Okay but but we went I had an extended thursday without the data. Yes ma'am we did we did extend it we had some data I believe back to twenty twenty two when this rate was put in to your fact over the past four or five years there have been some dramatic increases and decreases in this rate and I believe pre twenty seventeen they will correct me if I get this wrong pre twenty seventeen there were a tier rates with an average around eighty one dollars in new data came back and it was set to decrease in multiple increments in when the public health emergency started we delayed that decrease and then as we have seen some increases go inflation and other things in the minimum wage increase we felt prudent to maintain the emergency rate okay and then is there a deadline on when they need to submit this information to you the deadline has passed most of them complied with the deadline to submit this information and I do believe our last cost report came in on friday november the tenth and we have a contractor working on that cost analysis and we're trying to have some information in early january okay so you don't need any more data submitted to you per the legislation that was passed by law yesterday and that is all that okay so now it's just as an analyzing it great okay thank you for the update on that thank you. Emerge any other questions. Thank you how long did it take you to get approval back from d h or can you talk about the time frame as far as approving the continuation. Approval from cms on the waiver well maybe I misunderstood you feel market for them michael or closure that yes. Did you have to get approval from CMS on what we're debating here today yes sir we do have to have approval from cms and I believe that we have not received any question yet but jump in here we had a call with cms yesterday on these appendix case we had a deadline with cms that we had a submit am a permanent waiver prior to november eleventh or all of our covered exceptions including this rate and our work for stabilization funds would expire so it's setting with the mass they have some a couple of questions more around the work for a stabilization they need us to insert some additional language we not see any issue with getting approval. Okay but the process from the time you ask to the time that you got approval back from cms was how long. Two so we don't have official approval back yet what they told states was as long as you submitted something prior to the eleventh they would keep the covid flexibilities in place while we worked with them on official approval okay then let me ask you this question. Just give me some understanding the education on what's the difference between the way this has been handled and say they aren't going discussion about the rate surrounding assisted living any comparison any difference it seems like this is getting treated one way and that might be getting treated the other way so clear that up and just help me understand please. So there are there are some differences a waiver amendment change can there's really no set time line from cms when but on the other side of the coin when we submit a state plan amendment for a regular service we they're usually try to approve that within ninety days because they try to keep it contained in a quarter cms always has the option to work they can do is take everything off the clock and let it go as long as they would like if they have questions or need anything so we try very hard when we submit to be able to have all that information there so that we can get it approved within the ninety days if it's a state plan waver amendment have been a little different because they don't have the ninety day clock so that's why I mean I can't give you a strict timeline that they adhere to with a waiver service and so the assisted living rate crosses both. Um populations it's in a waiver and it has a state plans service so we would have to do both sides of that if any increase is were to come forward after this thank you. Emergency in room eight am seeing none into that objection the road is reviewed and approved will go to nine. The. Good morning i'm very franklin director of the division of county operations with dhs. The first rule we have for you is an update to the community service block grant manual in this update is. Um. Mainly clean up a lot of cleanup and clarification of how income can can be calculated. Are removing some outdated terminology just updating to more correct terminology that is now used and um we didn't have a public hearing on this rule that was on october fourth there were some public comments they all singered around looking at the funding reallocation for the csb grant between the fifteen community action agencies and our response to those comments was that we will resume the discussion we had begun it prior to the pending did not continue it during the pending but we will resume those discussions. Send a meeting to start those discussions in that the whole process will be done according to csb federal regulations as we discuss that. Be happy to take any question is franklin members any questions on nine a. See now then without objects in the rule is reviewed and approved got a nine b. No I mean this is a snap role related to their snap employment and training program we are bringing this rule to comply with the federal requirement what this rule does is give an employment in training provider and what I and ability to let us know if we've referred an individual or an individual has said I want this type of training and we've made that referral and when the provider meets with them they determine for whatever reason that that particular training is not appropriate for an individual to let us know that so that we can reassess find a different provider or defer the individual if needed if they made an exemption that's what this role does. There is a fiscal impact it's one time and it's related to just system changes that are needed in order to implement this rule. Be happy to take any questions thank you members any questions or nine b. Seeing none without objection the rule is reviewed and approved i've got a nine c CO does may get a question on nab right around nine c. Nine c is this is a medicaid this is a medicaid rule and this is to also to implement a federal requirement that we provide continuous eligibility to children in medicaid for twelve months which means if they are approved at application they would receive services for twelve months even if at some point during that period they became ineligible and the same would be true between renewal periods once they are renewed in determined they continue eligible that eligibility again would continue for twelve months there are some exceptions to when we would close those cases such as the death of the individual the individual moves out of state or they turn nineteen nine uncle considered a child there is a fiscal impact to this based on um historical information on um closures and what the expenses would potentially be for those children to continue for twelve months be happy to take any questions members any questions for nine c. Seeing known there without objections the rules reviewed approves or dismantled at a question. The. And it was really just if you can provide an update I think we've had a conversation about the asset limitation increases kind of where you all I mean i'll I want you to speak to yourselves about it where that stands right now and I can think what the next step is yet so this the snap asset limit has been updated we have implemented it we have um updated the roles in our system and we have raised the income limit to comply with the federal rules for this federal fiscal year um earlier this week when I told you we were behind we are behind on the policy but we have actually raised the limit the update to the state eligibility policy is behind but that will be coming to this. Rolls committee very soon good what and I think in more specifically used maybe a conversation you've not been in from the sounds of it you all have they have updated the website also which was also behind and i'd think what you'll see is an emergency rule to kind of play catch up and so just as a heads up that should be coming in enough a final rule would be a little bit later on but that would allow them to do what they've already done but i'd spect that number you can speak to them correct yes we're working on a a an emergency rule right now our plan is fast track it and try to get it out this weekend honestly if we can make it happen so we're working on that. And a janet signed at this morning so it should move quick alright perfect thank you. Representative cabinet yes thank you mister chair question center this mine was asking sold when we raised the asset rate what about those senders i'm talking in particular that got denied because they had too much as said it put him over the limit i'm all used my example the guy was over twenty dollars so how do they have to reapply how to they. Because once we raise the asset limit they'll be where they can qualify and then get their benefits back so how do they go about doing that so yes anyone that was denied before being over the limit but they believe they are under the limit we will certainly take a new application they can apply anytime. The change where is that for regular nine disabled household that asset limit is now twenty seven fifty for the assets we have to count for the snap determination for an aged and disabled household it's. Forty two fifty now it was it raised significantly but it did raise and it could make more people eligible you are correct but they have to reapply. And week well and we can also run a report and see if those that we denied if the change in the asset limit could have made them eligible for an increase cause we just need a I know i've had three constitution once I need to know what they need to do I mean they're gonna I mean they're gonna this is going to affect them so I need to know do I need to tell them to reply or will it be an automatic but yes ma'am and if if you could send me those names offline will be happy to follow up individually with those those individuals but we can also. Do a query of our system and identify people who may now qualify but we're denied but we're now within that limit that it's alright thank you so much representative barrier record asked for a question thank you mister chairman so do we have the procedures in place to ensure that we don't miss this again because mine are saying we didn't have the adjustments for a couple of years so are we gonna make sure that we do this every year going forward that is certainly intention when when we do bring this policy one of the things you were going to see is moving that asset limit to an appendix so that we reference the appendix in the rule so that we can update it. More agently in the future I can tell you in the past it didn't change as often as it has likely but it has been changing and part of it is just making sure that we have better controls in place to make sure things don't slip through the cracks that need to get that as part of what we will be putting in place to make sure we don't want to track things absolutely thank you thank you mister sir members or any other questions on this topic. So you know thank you for that information as franklin members will go to ten a. DHS division medical services. Representative you have a question I really finish on tin. T and a tna will get to that yes man. The. Good morning good morning elizabeth pittman director for dms no ready when you are yes man because it's tna yes sir the first rule is that update to third party liability this rule was done in compliance with a federal requirement by CMS it does not change anything substantively at updates the language in our state plan and insurers cms that we are collecting third party liability as we are supposed to that includes insurance and and tort liability anything like that and there was no public comments on this rule it has been approved by cms and there's no financial impact i'm happy to take any questions members any questions on the AC n n without objection the rule is reviewed and approved we'll go to ten b. This is the role for and phase two of electronic visit verification you may remember we brought you phase one for personal care and attending care services back in about twenty nineteen this implements the same the same visit verification for in home home health services it is a federal requirement by cms again no financial impact that was taken when we implemented face one and we received no public public comments on this rule and we are in the process of communicating with providers on how we will implement this phase right now and happy to take any questions thank you any members any questions on ten b. See now without objection to rules reviewed and approved ten c. A ten c is for a long acting reversable contraceptive reimbursement this came out of an act that was passed during the last legislative session and it are requires as to pay for larks or long acting reversable contraception as a car about to the impatient hospital payment so before this and that was just included as part of that global payment to physicians and hospitals this cars it out and pays it on in addition to that so that hospitals were having to reschedule the woman to come back after the delivery and most women were night doing that and so this allows them to do that at the time of delivery to insert that there is a small financial impact but we do get a ninety ten match on this as it is financial fake family planning so it's two hundred and eighty thousand state general revenue per year at we only receive positive yeah that is an estimate we only receive positive comments in this has been approved by CMS. Thank you members any questions on t and c. Seeing no need without objection to the rules reviewed approved ten d and this is also came out of an act for them the last legislative session moving authority for the life choice's lifeline to DHS at this implements that this only implements it to the minimum requirements implement that act and get right now there is no financial and we receive no comments on this one any questions on ten day seeing now without objection to the rule is reviewed and approved members without objection i'm going to skip over ten e and f. Thank you. The. Wedding just identify yourself again for the record that we could present yes more as the weather ten director of medicaid specially populations and I have director hill with me as well so on ten it's the name of this policy is developing all screens it's a little broader than that at this point so we are beginning at medicaid to pay physicians papcps to perform developmental screens on old children who were on medicaid start in january one we also have been paying a vendor name option to do a but tell screen for any child who might stew enroll and an early intervention day treatment program. We are not going to pay two people to do the same thing so we have like option now that we will just continue the use of their contract and we will move towards the children going to see their primary care provider to get the belt male screens so we went in to the our kids may know on the eps d to make those changes that we can now pay the physicians in the pcps and then we went into the independent assessment manual which he guys and I was pretty much optimised manual that outlines everything they do and we inserted a net that effective april the first they'll no longer be paid to do that service and we're going to transition. While we have that manual open we receive several comments from our personal care providers asking for as to a line between our three specially populations they ask for tell a health capability for the aging independent assessments in the personal care assessments we went in and added that they now can be completed via teller health for re assassments which is very consistent with how we treat clients with intellectual disability and how we treat connects with behavioral health I will say that they did initially ask that we also do tell a health by initial evaluations we had a disagreement about doing that at this time but we've been working together to come up with other solutions and we had a call with them on monday late on monday and I think we're in a good place I guess I will know in just a second if we're not so but I think we came to a resolution on how they moved for it so appreciate all in the i'm happy to answer any questions members any questions are on ten f. The. Representative cabinetly that you yes thank you mister soul since we want to be using option for them evaluations is that gonna make it faster because I know there had been some delays and being able to get those evaluations are we we're gonna be able to do this faster so there's not gonna be a further delay. On their children going to an early intervention the other is some fear that this at the beginning will slow down because we're changing processes and now we're going to be directing those children and families with their primary care provider but we had delayed it until april to derobate training with those providers and rather than start it january one so i'm hopeful that with the curriculum that we're working on with the training we can get everyone up to speed so we don't see delays okay thank you. Represent a flowers you're recognized for a question thank you so much. So the primary care provider says what kind of. Communication have you had with them and what can can you give us a sense of what that training has and will look like and what the timeline will be exactly for that as you can so we put together a work group of eddie t providers and family practice doctors and pediatricians to help us design this rule this at this time you'll be seeing this come back before you erm in march they don't outline more of the details on how this will affect eighty t was before you today is just the authority to go ahead and start paying pcp's today the screens and then that language notifying that we're going to quit using option and april. Yeah so right now we are paying for three screens for children between the ages of birth and three or or bringing back before you in march will out of fourth screen to make this more effective for eighty t providers and those children were your contracted with amc there are primary vendor that does pcp training so we're working to develop that curriculum so that we can launch those trainings in ganuary they have mumpling meetings with positions doing lunch and learns they send out a newsletter every month we're gonna expand it to not only talk about the development screens but also work in some of the things we're doing around depression and mental health screens as well and and kind of knock it all out so that everybody understands everything that we're doing across medicaid that's new and that will be now available to pcps and will this would this. Make when with the um reimbursement sheft. Change where because it it sounds like you're wanting the review to day to begin the process for training and everything but with the reimbursement shift be immediate so that makes it maybe I think i'm being confusing so starting january one we will start paying pcp's on our power screen basis and have primary care physicians. I guess let me just express my concern my concern is that the availability and accessibility of pediatricians in the whole of south arkansas is extremely. Minimal and and so the access to physicians anyway is already what it is. And limiting this these testing. This testing access to just. Pediatricians for children you know rather than maybe being able to reimburse both depending on accessibility is my my largest concern absolutely so when I say pcpe it stands for primary care provider in under medicaid that includes pediatricians that includes family practice doctors that includes APRN there's a laundry list of who can be a pcp so it's just who the medicaid client determines and enrolls with that pcp but it's a match broader less than pediatricians so we let me then let me say this the shortage of providers in south arkansas is lacking and we know that too we know it's especially difficult for for pediatricians so mean just that issue in general it what about areas where the access is not there. Or is lacking or families have to travel a long way to reach a provider particularly a pediatrician but a provider. You know we know what it is not just the delta but just everything south of palaski county what about that so we did look at that data so we've been working very closely with in a strong note to call her out i'm sure she's ear. Um with the arkansas of pediatrics and she's been pulling data for us because we wanted to see how many children are getting their epst well checks already very high number of medicated children are hitting their markers on getting their well checks this developmental screen will correct correspond could correspond whether well check visit or a visit but it were seeing very high a numbers of getting those cheques which tells us that we do have children able to see a pcp across the state. Thank you. Consider seller than you recognized thank you mister chair just a real short question through when you say there are some disagreement over tell a health with different providers could you give me with it what is the topic of the long definition what's the disagreement I feel like I might shut myself in the phone being over over a transparent no i'm kidding service oven so they had asked that we look at doing telehealth for the initial assessment and we don't do that for any population and so we just ask to maybe table that for further discussion at this time. The. Okay represent about your recognized thank you mr chair I want to come in jail and thank you for this I know that and our mental health working group we have talked a light about access and worrying about children not being able to be seen soon enough to get the screenings that they need I think adding this in. It's not just one step with adding adding a great big step for for kids to be able to be seen an evaluated much sooner than what they were actually being able to be done right now I know a lot of discussion was about. What a representative flowers was talking about was the access but according to our working group this route here does help fix the access problem across the state email true is that true is that really kind of what we discussed in our mental health and is that question correct. Thank you so yeah I would award agree that the biggest push that we've been working line with you guys a network group in it d h is trying to continue to get our children to see their primary care provider it's better for them we're going to start doing the mental health screens that oppression screens now develop minimal screens and we really feel like this is a step in the right direction on early intervention and prevention that we have not had in place recognized this will also help with the parents. Correct like if a parent is having trouble the. The family doctor could actually see that and maybe help that parent out in the situation that they might have going on that is it not a two fault thing that's will be happening yes may I miss downs coming up in just a second and there was a lot more about that but yes it's my understanding that matters can also be screen for depression why they take their children to the child's pcp thank you thank you mister members any other questions on tnf sender hammer. Yeah. The. Okay there goes two quick ones is this part of the integrated care model that we talked about recently is as a component of that separate issue from there. However and lever politic answer that when she comes up here next okay okay I want to be wrong in there then the second question is going to be on the cost savings are we going to experience cost savings on the optimal contract because were minimising down in and water the other in limitations we had the ability to terminate that in april and what's projected cost savings absolutely so you don't see cost savings before you today because you'll see it when we bring the second version of this to you in march but on that document to stop the opt in but tell screens and move towards the pcps is estimated to be over one point five million annual and savings very good thank you. Seeing the other questions that objection the rules reviewed and approved members will now go back to t and e. I'm police down I work with and the department of human services the director of the office of substance abuse and mental health services in the rule today has three component parts to ensure that my guest will be closer to you please. So the rule has three pieces to their said this is our outpatient councilling services so and we have an outpatient councilling services manual and as representative said before our working group met for many months and we've restarted that working group but this came out of that in part so back in october of twenty two we worked to have a new rate study done for counseling services and counseling services are delivered in the outpatient settings in clinics and they include individual therapy family therapy group therapy all delivered by a professional so a master's level professional and so looking at those counseling services we work with the group to say how how do we reset the rates and so we looked at other states in pulled other states we came back to the work group they said you know we have some other states we think would be better comparison states for us to look at their closer tests they're more southern states so we pulled the additional states we looked at those we did then come back and say let's look at a percentage of the medicare rate instead of doing state comparisons we think the most fair thing to do is to look at those comparisons to medicare and so the counselling rates for outpatient counseling individual and family were well below the medicare rate so he raised those to eighty percent of the medicate and met a care rate to eighty percent and then we saw that we had a couple of outliers which was group therapy and group therapy was well over two hundred percent of the medicare rate and so we said we would need to lower that to a hundred percent of the medicare rate so in doing that we were able to in october of twenty two on an emergency basis go ahead and raise those counseling rates for individual and family counseling to that new rate of eighty percent. Our we use the disaster spot that expires on december thirty first in what we said was we would take those group rate decreases into income in criminal steps down to a hundred percent of medicare we did not implement that first step in october of twenty two and said providers got this new rate of those increases and have those until now and we are now then and doing that permanent work which is increasing thus rates and decreasing that group rates were back to that same piece of this. And that other part of that again is about access and we are providers and that was lifting the pcp referral requirements for outpatient counseling services so that is the rule is the rate changes as well permanent rate changes as well as the pcp role. The. So I would like to add to that just in summary this is something we've been working on for well over a year we did the increase first we held off the decrease during the public health emergency in now bringing forward to you the decrease in the rates in the permanency of the increase in the rates and a hundred percent of medicare is what it's being lowered to so or happy to answer any questions I feel that there will be several representative to recognize for question thank you mister you said this has been an process for how long well over a year I believe that mistone stated the first rate increased when in october of twenty two there was a power point we went back through the notes that pre dates my job coming in in january of twenty three and then we have been working with them and then we held another meeting on october thirteenth where before it went to public notice that we told them that we were moving forward with the decrease as originally discussed we had missed the first timeline to do the first decrease so we were therefore implementing the entire decrease since we had delayed it so that was in october thirteenth of twenty three and can you tell me who was that who was in the room collaborating on this there were several others i'm getting a deferred amount stone. So I sent out the when we did the powerpoint presentations as an hour out of every provider that is enrolled in medicaid pretty much and said they were able to attend an online presentation so that was both in october of twenty two when we did the initial and talked about you know the corresponding rate decrease and then we did another one in believe it's october thirteenth of this year to say we were making those rights permanent so and then obviously the conversation that we had at all of our work group meetings were multiple conversations throughout one more for all so. You recognized thank you and can you tell me how you read about it to lower the rate and put the rate will be at how you have how you got there i'll start and then i'll stone fill in some of the details so I believe they looked at several states may be up to even twelve for comparison purposes in a lot of differences were seen and so we have looked at medicare rates with all of our rate reviews in historically in using medicare we are on the individual rates we went to eighty percent of that which gave them an increase so we said that at eighty percent of medicare and then looking at the group rate it was well over two hundred percent of medicare so we lowered it to a hundred percent of medicare and that's how those decisions remain I think mistone can add some details if I missed anything thank you thank you mister chair right members no other questions on the board at this time we do have four that are signed up to speak. Yeah. About the rule so we will excuse you for a moment misman may I add one last comment apart yesterday conversations having ongoing II don't want to mislead anyone with the providers and with DHS and so while we are working on some interim solutions for the delivery of care in having business models evolve since group there needs to go down we are also looking at trying how do we launch a pilot as quickly as possible in the summer and we're looking at june so those are ongoing conversations with the providers I just for transparency it's not a one conversation in and done it was as late as nine thirty this morning members have had two three questions that are popped up can we hear the testimony from those that are here to speak. There was a bringing back. Right. Said thank you mister chair and light of what you just add about full transparency I want full transparency about the group therapy code and how out of line we were with all of the states in the southeast region that the medicaid inspector general found and brought to our task force on health care reform and urged us to immediately address and lower it to get it in line with every other state I want the entire history and I want the inspector general to weigh in the group there be code and what we were paying was way out of line and we were paying an exorbitant amount of money. And there was a lot of research that was done via inspector met the inspector general of medicaid which moved our health care reform task forced many years ago to get that code and that price back in line. So we're gonna have full transparency we're going to have full transparency and we need the entire history many of these legislators were not here at that time and they need to know thank you we will get that pulled and incent to the body represent cabinet can you wait till I bring it back. She got cheers representative barry can your question wait till I bring them back. Well II guess my question is what I was going to mention may alleviate some of the witnesses coming to the table if I may is now working that we're going to have them come to the table and and provide test okay right thank you you sir are you refused for the moment will start. Joe land or no. Next will be carol I believe with them. You will be ready when he's finished. You identify yourself for the record you begin your testimony thank you mister chair of my name is joe landrano I am executive director of the arkansas council for behavioral health. We are a provider association of twenty nine behavioral health providers in all corners of the state excuse me and i'd like to speak today in favor of the rule changes and express a couple of concerns as well as missed stone pointed out the rule accomplishes three things it eliminates the pcp requirement for outpatient paper real health services which of course we welcome it does increase the make the sput does that respond increases for an individual and family counseling services permanent without which they would revert back to what they had been which was of great concern to us so it's a relief that that included as well with respect to the group rate cut senator urban is correct there is an extensive history with this and this was a a rate structure that was set up by a medicaid that leadership long in the past and it was used as a for variety of things to fund services that really didn't have anything to do with group therapy it was done in a residential setting i'd so that there was basically no residential component in the medicaid provider for chronicly mentally ill individuals that has been fixed with the therapy to communities on the outpatient side it really hasn't been fixed and to some extent the out of the group therapy rates do under a under rate underscore the outpatient day rehab programs that are necessary for a small number of the people who are in the medicaid program we have expressed our concern about the effect that the group rate cut would have on those problems and asked DHS to explore options for how rehab date services could be funded some other way they have made some commitments to examine pilot programs as you heard misman mentioned that would look at what a day rehab service looks like for the chronicle mainly ill and find a way to fund that as well our concern of course is the time frame. Because these rates are scheduled to go into effect on january first the council acknowledges that the if when looked at in isolation the group rate looks outrageous the problem is that it is being used to fund other services and their needs to be other funding mechanisms for important services to people who need a greater level of attention than just individual therapy every week or other every other week and are and it affects a lot of our providers that expect effects some more than others we have one particular provider whose service array is almost entirely this is she's located in little rock and she she is here today she's the next witness on your list and she's a good idea how this rate could would affect her we have had some conversations with the passes for forty one thousand adults I had build group therapy we're talking about a sign a tiny sliver of that group about three percent about fifth our council estimated twelve to fifteen hundred people that were talking about who are in the day rehab programs DHS came up with the number thirteen seventy which sounds plausible it sounds like that's exactly what we're talking about so for three percent of those people we need a different program that addresses their daily chronic needs and so our concern is is whether not we can get something agreed to with the passes that can keep these programs viable while it takes the time that during the time it takes per dhs to get these pilot problems up and running we are we're confident that that that would happen became less confident at this week which is why we we do have some people here who would be affected by these group rate cuts like I said we acknowledged that the rate itself in isolation is outrageous. You have the rest of my comments all reflected in the record as far as that goes so that's why I say that we speak for in favor of the of the rule changes there's more here that we need then then then we don't need but the one change on the group rate has a catastrophic effect on a small number of people and we'd like you if you could to to lean upon the passes and on on all the part parcels part persons affected to fine ways to to fix that gap take a question certainly representative you're recognized thank you I missed their when you talk about other services you're talking about not group services right correct and not necessarily professional services we were talking paraprofessional services as well such as you know lifeskills development and that sort of thing and then can you tell me again how many people are and group therapy do you know a number of what the number paula gave us on tuesday was in all of medicaid there are forty one thousand adults who have received a group therapy service there was only about fifteen hundred or so maybe a flight less and that who have received group therapy and life skills development in the same day which would suggest that they are in one of these you know four to six hour programs these are problems where our providers operate vans to go pick up people with their houses and bring them to the clinic for eight days worth of activities and then return them to their home in our meeting tuesday mistone also mentioned that they had run some preliminary numbers on the emergency department and hospitalization rates for that thirteen seventy and thought she thought that it looked like the data showed a lower rate of hospitalization for the group of people who proceed these services remember these are people who are getting all the van so these are cooperative patients and so that might it's it's a level of of support that a certain number of people need to maintain functionality in the community can I continue sir. Yes go ahead thank you so how many people do you have in a group at a term. I don't know miss with and would probably have to answer that she has a program of about a hundred and ten clients and I don't know if she divides them or are half a problem works but she's going to be here momentarily completely do you think some people that are put into these group therapies are there because of how high the rate was actually being paid and that they probably really need more individual and not necessarily group therapy I think they probably need paraprofessional and some professional oversight and group therapy rate was just the way that that that was used to make the problem financially viable it wasn't it's not financially viable without it. I'll get out of the queue and come back so representative cabin all your recognized thank you mister chair I want to make sure I understand what you said so we were using a group right. Right a group therapy rate to help cover expenses of other tabs that there be that challenge I think that's a fair statement representative cabin on like it's and this is this has been a situation that's been the case since before the health care reform process is that night illegal I to bill medicaid for a service you're. The people were getting group therapy. But you just said you were using the cold for group therapy to cover other services we were using the code for the group therapy to provide group therapy. But the the rate at which it happens makes the entire days worth of programs financially liable and what's being looked at now is to put together a sweet of services that would conconstitute a days worth of services and then establish a per damn rate for the day okay but I want to but that's not what you said what you said is that you were doing other services and you were using the group right. That the group therapy rate for the cover though that's exactly what you say what the group therapy rate does is make everything else financially viable there are no group therapy rates every service of race that billing that happens when group therapy doesn't happen. So you were people going into group therapy it didn't need to be a group thirty similar to what represent device was saying is because the rate was artificially high I don't know. Okay well I have some concerns thank you. Send your sale of a new recognized thank mister chair so um. We've been bounced in this pingpong bar back and forth with dhs and providers for well over a decade would you agree with their yes and it seems we agree upon a rate and then we change the rate we agree upon a process and we change the process that we have integrated services then we went to the path program and those have considerable problems are so what you what i'm hearing you hope your goal is that this will be the final solution we want to be debating back and forth and bouncing the rate in the processes over back and forth for another decade yes yes enter thank you thank you to chair said a garage in your recognized. Thank you I just I think it's important to that must stone address that comment that you may about ER visits and that data i'd like to see that directly from dhs and hear that from them and for one number two. I understand about funny at all viability however it's about therapy it's about it's not about the business owner it's about the person and if the person's not getting effective therapy to help them then the I don't want to pay for it. And so we need to be very careful about the way we're speaking about finding until viability for a provider versus if it's actually gonna work if it's something that's going to work I want to pay for it and I want to pay for it you know adequately and make sure that the people that are providing that can continue to provide it but at the end of the day i'm not going to make my decision and based on funding at all viability I want to make my decision based on effective therapy. And so I just think as you are having these discussions and as we were looking at other states and things like that we've got to make sure we're focused on therapy that works. And pay for there be that works and if it's not going to work then we don't need to pay for it or we don't need to and flight a code in order to. Make it financially viable for a provider that's that's an appropriate net that really is borderline medicaid friday and and I don't want to go down that path and we've had people that have gone down that path in this state and so I don't I don't want us to go there I want to make sure that we're being very thoughtful we're being very deliberate and that were understanding and looking at the entire. Country to see what is working and what is not working and also talking to medical professionals that can help inform this decisions not just business owners looking at their bottom line on their books so I just I want to make sure I make that statement very very clear as you're going through these discussions thank you for your testimony under hammer you have question back home a day when I used to work in a mental health firm I was a case manager with therapist we had team of therapist then they would take and they put about twenty people in group the european that was really maximum billing for them on that particular day and that was one thing you could do during that and then you know case managers would follow the kids out the school etc so it's what's been done here and in what the setting I just described is that change from that model now and what we're what we're effectively talking about is in that group there be were lowering the reimbursement range two to that setting is that correct yeah I think group terrible still happened in that setting but part of I think what needs to happen with the talk of the pilot program is to discuss what is that they look like what is the service they look like what kind of interventions work what kind of interventions has senator urban says do we need to pay for what kind of settings have an effect on keeping people stable and keeping people evident institutions and I think that would be the goal of certainly the provider side of any of those conversations yet I think would be too because based on the therapist some some were motivated for one reason somewhere motivated for the other and that's individual thing but at the end of the day you know the the group there be has to work for the benefit of the individual member while they do group there be but not necessarily be a money met manufacturer correct have it a role to play in therapy not in business liability thank you. The. John if you were imagined a slide over representative dobbies in the her question may be for you but she had a step out just a moment as carol with them to come to the table we can begin her testimony and joe if you're just stay there and then when. When representative dobbie is back for questions not to you then will excuse you. If you're identify yourself for the record and then you may begin your testimony before that mike read it close to if you would please may have try not to get emotional but that's just who I am coin polite straight forward my name is carol with them. And the ceo of inspiration day treatment. I'm gonna address this in a different way i'm speaking about the lives of individuals that are living with the mental illness on a daily basis. And a master speaking as an owner who has absolutely received zero dollars on a personal level for a medicaid funding for a day treatment services. So for me it's not about the funds it's about the viability of keeping my day treatment doors open to serve the most vulnerable population limit go into. We are provider that serves the one percent of the population living with a serious middle illness. In all transparency words to express the impact and responsibility regarding the decision that you guys make today. Is one of the hardest things i've ever had to do. By writing my thoughts and all it has twenty four hours I found myself steering at the computer changing sentences. Re writing in them. And asking for guides help second honor the him beings around me that your decisions will directly impact. Today you won't be gifted by getting the experience the individuals is lies you're directly impacting. Look round. How could I just sit back without encouraging it to see the whole story. The story of stability and recovery. The members room couldn't be here without legislators like you. Those who helped pass lots. The. Sarcry. To protect the most vulnerable populations in our. The legislators and I only cared about those who took their legislative duty with the honor. But they recognize their constitutional duty to care for the seriously mentally ill. Fortunately throughout the years legislators have preserved a treatment centers throughout arkansas just like inspiration d treatment which serves a small group of this more population. Day treatments and earth partner with the individuals living with a brain disorder to maintain stability. Takes the team for this population. C. Can't when you live with them and all illness stability is the only way you can live without major cards and quinces. Consequence that such as incorrestoration homelessness hospitalization and or becoming a victim of a crime to listen to you. These consequences not only affect them but every single one of us in this room. And those living in their communities. Date treatment provides daily assessments to clients who symptoms very widely from day to day. When small changes appear day treatments to afghan intervene to provide theoretic medications education center stabilization our staff insurance clients pay their bills to keep a roof over their heads ensure that eat to avoid illnesses help resource triumph to revert acting out behavior and provide risk but care for family members who desperately need support in the community all towards the gold insuring the greatest level of independence in the community and i'm think for for families being here today to. As they caught a break or an exacerbation psychotic symptoms as expensive to treat in a hospital but the cost is much greater for the client whose brain will never fully recover to baseline. These are the other consequences and caused and mentioned before are part of this the tall of inadequate care are clients have committed and displayed inspiring dedication to stay well our team sees that dedication sacrifice each and everyday some individuals right on a van hour and a half to get to date treatment center. Because they know their lives are better for the work it takes to stay well. It's pretty inspiring to me. The recovery journey is a challenge most days. Let's be clear. A pray that one day were having a totally different conversation at their secure for this. But there's not yet. Yeah. Inspiration day treatment has a reputation in the state. For being able to treat extremely challenged in case it's successfully very proud of that. The state can attest to that. I encouraged them to. I can't account I cannot count the number of points we've admitted from the state hospital that can be discharged because no treatment provider would or could take them the idt. We provide services denied eleven clients who are court ordered a treatment and when their orders app case what they want to continue to stay because they understand the value of recovery and the value of what they bring to the communities. Clients in our program qualify for more restrictive environment known as they reputed communities these programs are vital for the state but there's just that point five percent counter will I see who create operational challenges like risk etc that would not fit the criteria for an admission. Without day treatment options these clients would be in the community with limited services limited act system occasion then the cycle begins again. There's not only human costs but are financial costs to our state in a day treatment setting given the option of the least restrictive environment where the whole listing approach has been extremely successful. It also has been less expensive than a twenty four hour care and if the reputed community remember all of our clients can fit criteria for that. Our interclinic is comprised of these complicated cases there's that many years in and out of the hospital state hospital and gel. Look at it now it can be more humble and proud steaming represent each of them. As you see my passion I want to clearly clearly mention this isn't about money or my business. Maybe honest. My family has never profited. From the moment we were certified back in oa and minds here we went through a moratoria. The challenge of becoming joe credited within thirty days ask any health provider with that would look like. But it was worth it and perseverance because our family sort of need and believed in the help of recovery of those living with the mental illness whom most people turn to blind it to. So years my ask. Please hold dhs accountable. To the time frame at their proposed per brussel and hold the passes accountable to developing services to bridge the gap. We will be out of business the end of january. If this has happened. These are the warrants that are being impacted. Please remember these faces. Her accounting on you. With their lives. Thank you. Representative flowers you have a question guess thank you mister share and i'm only asking to get really more of a saving to make the statement as I have to leave but I just wanted to number one think you and. Everyone who provides these services charm I was vulnerable our cancens in you know like represent sale of interest in it or something but when he was a representative too we saw these issues when we seen them for almost a decade as we make decisions not just today but moving forward I just want us to be mindful that. These issues are complex. And their costly. And working with our facilities now and the reimbursements and DHS is beneficial to our state as we get matching dollars when we utilize medicaid dollars to treat people on the front end rather than pay for it on the back and in the way of it the emergency room of limited state bears and i'll only state hospital or one state hospital and of course in prison and also be mindful that in south arkansas we don't have any crisis stabilization centers. There are two and northwest arkansas one in central arkansas there is one in northeast arkansas we don't have any. In pine left in the whole of south arkansas south of little rock so i'm grateful for those who were able to stay those members who are able to stay and hear out the folks who were going to talk about these issues in real life terms and i'm grateful for all of the are kansas who came today to hear this issue and to be represented on something that sell critically important and I wish I could say but thank you so much thank you mister chair friend does represent a voucher recognized thank you mr chair I command your work i'm right here I command your work sympathise with those that are dealing with mental illnesses or. The things it's gone on in their life whenever it's balance spiraling out of control totally understand totally get it my question he is at the beginning did you say that you don't receive medicaid money and if you don't want to you not receive medicaid money and then if you don't receive medicaid money than I can't understand I need you to explain to me why you're here at the table let me clarify the first start two years that we were functioning as a day treatment center back in a way. We receive zero finding because we weren't certified so there was no funding we were fully operating there is a commitment a long time ago. The clinic receives funding from medicaid medicare for the services that we provide me as a business owner my husband is a business owner neither of us receive any personal funding from the company. We have spared way more than we would ever be able to receive back this is a commitment that we've made this why it's not a business model then we stayed in day treatment yes we could have ground we could have done the reputer community we could have done a lot of things that it would have generated funds but we chose to do something that we felt was meaningful and and made an impact on many individuals. As well as impacting the state. I may have a follow up sir recognized thank you can you tell me how many people you treat at one time in a group therapy I believe it's a max is tense ten clients. Is that right and there's ten clients i'll get individual help or so yeah if yes how many times a. Weak or a month do they get individual and group it's based on their individual treatment plan each each individual based on what the doctor in the the reversed i'm come up with and I think it adds inflows b star and somebody stability if they're experiencing exacerbation of symptoms their group there are their group there of your individual therapy would increase case management would increase crisis stable says you would increase. More monitoring where their meds. So I think it's it's here based on need night necessarily all everyone gets a certain. The same cookie cutter treatment plan and one follow up so and i'll be down. Thank you so are you advocating for it to stay at two hundred percent. Are you advocating for us to stay above. Because II want to say dhs said they were going to do one hundred percent and what I hear you saying is that you don't want it to change even though we're weigh out of kilter from all the other states as senator urban brought it is that what you're advocating for it to stay at two hundred percent of. You want to speak to that I think the question made if you could go ahead and answer the question now i'm not i'm not advocating for that i'm looking for start gap processes services and that will improve the viability of the clinic staying open by increase in rds funds that would be that that would make sense to cover costs based on your staff that stab ratio requirements etc. Thank you ma'am thank you so much later no misdobbing message me she will not be back so you are excused thank you thank you sir for being here today representative cabin all your recognized question thank you mr chair thank you over here to europe and I do also want to command you for the works if you're doing for the the minimal health issues because we know and that's why we created the work group that we're in a minimum health crashes if we were to reduce the group rate therapy the group therapy rate down a hundred percent that would free us up the opportunity to create other types of payees great that could provide these services to other people is that not something that we could work toward that okay because we all understand they we need the services wages i've got to get it in the right top services instead of necessarily using a group there it be rate but that's something that you you agree that we need to do that's the best way to move forward for these clients because they do need this help and we do realize that we just have to make sure that we've got it then the proper way in what's the best rate and I would also suggest that as we move forward with our mental health work come to this group be a part of it help us find solutions to these problems that's my impact to you there's open to anybody providers clients whoever that way we can hear the real life situations I mean we would we would welcome you to be here and be a part of the solution thank you served or hammer. Would you just maybe I miss me while go yesterday do you take medicaid patience or you reimburse frave your services by medicaid yes we are currently okay and is it relates to this renew that we're talking about today how is that going to impact you then. I think in years period of time I think they calculate i'm not the financial person so I mean it gestimate around two hundred thousand dollars a year that that it would have a dozen monies would have to be filtered into other areas. Okay and. That is all related around the group there p billing rate that's under discussion okay and the business model that you operate because i'm under the impression a lot of other people are rumor okay with letters won't pay us in and I do appreciate of work to the mental health field before I appreciate which do you appreciate class come with you but i'm just trying to get my mind around. Why yours white why is years under threat of. Going out where others seem not to be is concerned about this rule going through in does it relate to the way you operate your business a great question. The difference is this is all we do. I don't work with children we don't work with you know we don't do out patient services we strictly do day treatment services other providers which will struggle in the net you know there's there's discussions there's other providers that have date treatment services that uh are going to be looking at discussions in the next couple months but they have right now other services that can have helped support the deficiencies. Okay so you got all your eggs and one basket this is your basket has been threatened. Kinda and it's not mine personally urgent but I do like saying that is how many clients do you serve. We serve approximately between hundred and ten and a hundred and twenty. Any idea where they will go pardon any idea where they will go I have no idea thank you simper oven you're recognized thank you you testify that you are in your husband don't receive any and come from this company so what what is your income from other companies. So I am c over research company I am her family and so forth and start going so you have a lot of crane bins that sort of that's where funding scam from to have multiple businesses zero. So. Um so I think. So you're asking what you're asking is from medicaid and dhs to kind of change their business model in their policy. And you have multiple businesses that you receive income from individually and personally. So why wouldn't you change your business model for this. So that you could keep it viable and. Continue to operate because you know how to do that with your either beta that you receive income from and you're asking medicaid and dhs to change their business models and policies for you why you going to change your own business policy and model for the company that you operate for these clients that are sitting behind you. So you know II feel like i'm a pretty smart and woman and the business woman in this successful business woman. You can't create this as a business arm I haven't ever figured it out in the last I don't know fifteen years that we've been doing this it's never really generated any money if it has we reminded van with it and things like that so I don't know call me stupid but I don't know how to do that if I did if I could are word you have a hammy bands do you have that do they pick up people. Approximately six seconds give sladomers over six millions that go every day and pick up people to come. And and where's your where's this located against and wesler west on iraq is it a building or cancel it's a building how big is that i'm just curious it's ten less than ten thousand that I don't know around ten thousand eight thousand ten thousand square feet. Okay it lives in there the whole time the holiday for fifteen years so eight to ten thousand square fee less. That's a pretty big building. And five or six violence okay well I appreciate that I mean I appreciate you come and appreciate the everybody's come with you and am now at the end of the day also these individuals need health care and they need to go see their doctors and they need to go see that therapist and someone were looking at medicaid and we look at medicaid funding it's really important that we have to look at the entire pa and so when one of the areas of the powers gets out of whack it affects everybody else so it's really important that these individuals have treatment for diabetes are congestive heart failure or any flu or anything like that and so if we give too much to why and then it takes away from another sometimes in medicaid so our job really is policy makers is to really make sure we look at that tire piece of the puzzle and make sure that individuals have everything they need in the entire spectrum of health care and that's really the job of what DHS is trying to do so I just want to make sure that we bring that to the table cause that's not just DHS job it's our job to as policy makers we have to look the entire spectrum of what has been delivered and what we're paying for and make sure that we have enough money to cover all the prescription drugs that they need every the doctor's business that they need every month they have chiropractor visits that are available to them if there are medicaid they have a lot of different services that are available to them I medicate and so in order to pay for all of that we've got to make sure other things are all captain line basically and so we've got to make sure that we pay for things that are effective and that we have good treatment for people that that we also have the ability to make sure that they can maintain the prescriptions that they get every month which is a light and to make sure that they can maintain their doctors visits that they get and we've opened up like I said that opportunity to carry practice and different types of levels of there before them outside of just the mental health treatment so I appreciate you coming today appreciate your testimony thank you senator hammer you're recognized for question. I know we're getting into your personal business but it helps us also I think. As far as what you built your business mile roll around was it built to the fall amount that you receive of medicaid or did you put a buffer in there you know say two hundred percent you're running your business said a hundred and sixty and you've got you got some buffer in there or you fully matched out based on what you received from from medicaid support to services were fully maxed out and I will also say that there are been many snary as well we've had to put money into the company for it to sustain. Okay specially with the cuts and again I know we're in your personal business and though I be step and happy to share okay so you drive absolutely as as a family then you is this a ministry to you you drive so no money out of this at all you don't go by cars and charge it off against the business rate that kind of stuff I down I will tell you. The. This. Carol said and do you have anything additional that would be a value to the issue or you're just here for support for her and to talk about. This issue. Okay you are more than welcome and if you'll identify yourself with the record then you may begin to test my everywhere as long as we're not just being repetitive to what miss carol has already said if you had additional things to air would love to hear what you're your testimony. Okay. Hi my name is desert and. I have been with inspirations. For almost fourteen years. And I do so. Because. They have saved my life. I was at a point. In my life where I couldn't even speak for myself. But I had a team. That helped me. And that spoke for me. With my doctor. I found out that I was getting lost in the cross hairs with my medication. And I was not getting the services that are needed. To help me. When my team and I mean my whole team that met the nurse. My case manager. And my therapist. And rds worker. All came in to speak to my doctor. To let him know what was going on with me. Because I couldn't speak for last. I couldn't contain a thought. Or complete. A conversation because I would forget where I was. That doctor took his time. And searched through his notes. And he found a medicine. That worked for me. Within three days of taking that no matters then. I had clarity of thought. Clarity of mind. Able to carry on a conversation. And understand what that conversation was all about. Because of this it gave me hope. More hope than I had ever had. I became a spanger. With the principles that were being taught. At inspirations day treatment. I couldn't help but soak up those new principles of living. So that I could learn how to leave in my community. And be a viable part of my commu. And I am that today. Be cars of inspirations. I. They saved my life. And I will forever be in their death. Because have it. Ah. When I first found out that I had a minimal illness. I played that blame game. I blamed everyone else. For what was wrong with me. Inspiration showed me that at some point I had to be responsible for me. And learning those new principles that they teach every day up there monday through friday. In rds. And with group and with individual therapy. I began to understand. What it means. To no longer be a survivor. To no longer strive. But to drive. And that's what i'm doing now. I am driving. Thank you. Thank you man for your test money in megan yet you'll identify yourself for the record my name is megan balts and the client of inspiration day treatment up in there since february two thousand three twenty three. Umm I have seen from both sides of the spectrum the importance of programs like this one in two thousand and seventeen I was a case manager at a day treatment program this included court order court ordered clients for the act not eleven without day without these day treatments I was provided for these clients they would not have the opportunity to reintegrate back into society they would end up in jails in prisons untreated in two thousand and eighteen my lifespiled out of controlled I found myself as a client at the same program that I once worked for while in treatment my symptoms improved significantly but unfortunately I did not realize how important the day treatment played a roll in my recovery and I quered the program again my lifespiled out of control and I became an act not eleven client. Without day treatment programs there would probably be no doubtedly be in my man a surplus of individuals with mental illness in prisons more acute hospitalizations in residential facilities we already have a problem with that the lack of services for people in cars rated these day treatment programs provide more resources and needs then just regular outpatient service. They linked the individual they they link individuals with mental illness to the support and resources of our population needs to become positive members of society they provide education help us with a daily learning about our daily activity activities of daily living they provide connection to resources like dhs services housing transportation to and from doctor's appointments in store and food banks and other important resources they see all in all these services are needed for more independent living in allowing us to become positive members of society rather than causing us to be a strain on the community this would not be possible without day treatment programs like inspiration thank you. Thank you said this manual recognized the question there is no other reps and of cabinet is queued in. You want to wet on her. She has a question robertson cabinet you have a question. You recognized. Thank you mister chair for the location that you're located at your address is really other business in that location or just the the treatment facility. So next time this is there's a compound formacy and then there's like a satellite so so we're in a complex with numerous different groups companies. Okay well the reason I ask is when we look at the address for your as it comes up to a pillar clinical research. Is that part of your organization seven hundred and keenest road suite too. Which is this is for some reason it comes up as it close so in january twenty twenty three to help support inspiration we did or did some outpatient studies there. And we have it started them but we plan on doing that to help supplement income okay so there's other company is one that's what I ask because that was confused because the same add or so this pillar research is also your company. Yes known and well partners in and that company i'm the ceo okay what does it do so pillar does clinical trials for individuals with different health conditions anywhere between and you know how pretention. Any of the cns disorders we have tobacco studies things like that there's just a wide range of you know arthritis studies things like that okay thank you. To urban you're recognized just on the tobacco studies do you receive funding from the state for those status studies now. So where do you receive your funding for the doing the outpatient. So it's it's specifically from a like a a sponsor it could be sleary on or you know some of those companies like that is independent other clients that you serve in your day treatment also part of the outpatient studies are they could just like they we refer out to four other different clinical facilities nearby have so if they fit criteria if they want to do a study they're allowed to I mean that's the the right right how many of your if your clients. Not very many. Not very many have participated in your outpatient drug research studies thank you. So no other questions in the queue ladies thank you very much for your testimony today members know other questions with that objection rule is reviewed and approved. We'll move on to item eleven a. Dhs visit provider services and bloody assurance. Yeah. Yeah. The. Okay. Yeah. The. The. Hmm. If you'll identify yourself for the wreck you may point percent good morning martinez smith director for the division of provider services and quality insurance janet man deputy secretary for programs and medicaid director midrest mitrous tuesday after address. Great thank you this rule is related to act three thirty five that passed during the legislative session that mandated there will be minimum dimension training requirements or individuals that work and assist it living facilities so changes have been made to the assistant living facility out one and two manuals we worked with a roller as well as the health care association and all timers association to make these changes as the rural prescribed as the prescribed sorry. Okay and presenting questions on eleven a. See no no objection real is reviewed and approved thank you got a twelve a department of the military. You'll identify yourself for the record you a present your rule. Good morning chair and members of the committee my name is britain it weren't saying the chief legal council for the arkansas department of the military. Good morning i'm lieutenant cornell james hollow field on the education service officer for the arkansas national group. The department of the military probably get a slight changes to the arkansas national card tuition waiver program which allows qualifying soldiers and airmented in state supported institution state supported higher education institutions tuition free. These changes were necessary to align the program with legislative changes from active seventy five and the last legislative session and they could be focused on breamer and the focus on the remain areas eligibility exception request and the co usage or doing roman dual enrollment of funds specifically the first change was declarify eligibility requirements to mirror the term of instant tuition eligibility under architects are code annotated six sixty two oh five. The second change was to set forth exceptional request procedures for when a service member service members education course exceeds one hundred and twenty hours or when the service member needs to drop more than six hours of classes for whatever reason in a semester the third change whereas to divide when a service member could use this to a show about program when they are duly enrolled at two campuses such as the satellite campus and a main campus. And also to clarify with a service member could use this program as well as other federal tuition assistance for service members. And without any if there are any questions i'm happy to answer them thank you very much any questions members from a sadwards on twelve a. Seeing none of that objection rules reviewed approved thank you for your patience and for being here today thank you so much will go to thirteen dps state police. Yeah. Yeah. Good morning my name is test bradford and i'm legal council for the department of public safety. Good morning I major roby roads with the administrative services division. I'm sergeant chase meldor over the interstate criminal patrol and canada thirteen a and we are here for the new rules from the twenty twenty three legislative session and under act one thirteen specifically rhinos law under rhinos law the department of public safety shall provide payment of up to twenty five hundred dollars per year for the cost of flute food. Flea and tick inform station prevention in veterinarian bills for retired key nines adopted by an esp canine handler. And we received no comments during the public comment period and without all take any questions. Members any questions for thirteen a. Thought you might have one representative I really didn't have a question I just want to make sure that the committee knew that this was not named after representative evans as a ring of that it's actually a dog the retired k nine I should actually go to going to compliment you on such a fine piece of legislation but not now thank you members no other questions role is reviewed and approved thank you thirteen b. And test for advert again with the department of public safety. I'm dust morgan a service that capped in the regulatory division. My name is local roper and imbe supervisor over the use motor vehicle thank you may present the arkansas state police to use motor vehicle dealer licensing roll two point twelve was revised pursuant to legislation passed in the twenty twenty three session and under act eight twenty one roll two twelve has been revised to fix grammatical errors and to act the language contained in arkansas code annotated twenty three one twelve six oh three. This provides the arkansas state police the ability to find an applicant or licensee in an amount not to exceed one thousand dollars for each violation of that subchapter. The. Language and a was added to clarify the director's ability to charge an application criminally under twenty three one twelve six o three in the second change in b is to address the fine. The fourth change added language b that's just to clarify the that's a separate subsection. The final change to roll to twelve fixed the gradical error. In addition to those changes the licensing role for has also been stricken in its entirety in that is on the man mandatory seminar. The mandatory seminar is not legally required and that arkansas state police has not enforced that rule in approximately ten years so we wanted to go ahead and update the rules to just strike that language thank you thank you miss bran for members any questions from his bradford or those present on thirteen b. Seeing none that objects in the role is reviewed and reproved thank you for your patience being here today members moved item e on the agenda this is in person updates from any agency that's not completed real making from the twenty one general session we have one of those day department of education. Mr roads. Thank you chair members of the committee and I switch to legal council for the permanent of education we have two rules in the report the first or the rules governing school safety that we present at this meeting earlier today and then the second rule that we had on the report as the rules governing professional development will actually be presenting this the state board of education tomorrow for release of public comment so then we should see those in the next sixty days back here yes sir that's not the beautiful no questions for members thank you for your parents in your update on those two go to item f. If an agency believes that the rules not necessarily the operation of newly enacted while they may come to this meeting with committee with written request that they be excluded from the age he's monthly written updates we we have one here today from state insurance department. Skips and. My name is the mandarins and i'm the managing attorney at arkansas insurance department. The background earned on this is act five twenty three men's the definition of a token gift within the rebate provisions of the insurance trade practices at previously the statute did not contain a dollar amount to define a token gift also previously adding had a couple of directives that defined a token gift as something a value worth twenty five dollars or worse. Act five twenty three raise that twenty five dollar cap to one hundred dollars by way of adding an explicit dollar amount to the statute and since the passage of act five twenty three add has are ascended there's old directives um act five twenty three or so ll's insurers to offer a pilot programs which are items of value offered to policy holders for purposes of enhancing their lives and for a loss mitigation and lowering claim costs some examples of pallet programs are offering smoke detectors and property in casually lines and also offering romance programs to long term care policy holders. The road making issue and and at five twenty three am that legislation is discretionary at says that the insurance commissioner may adopt rules governing these pilot programs ad does not believe for making as necessary but has insurers have offered these types of programs for a long time and they have always been regulated because they were filed with aids compliance division and that's the same place for policy forms and rates or filed as a side note these types of programs are not meant to be rebates because they're typically offered to current policy holders rather than as an indecent for a consumer to take out a new policy. In closing because these programs are already regulated ad does not believe a realist necessary to implement that we're just lation. Representative battery recognized for a question. Thank you missed chair I asked for a little latter to my my question specifically deals more with I guess a bulletin that came and was issued by the interest department and this is the first opportunity to have had to address that publicly and that bulletin would be bulletin seventeen twenty twenty three dealing with claim settlement for storm damaged roofs and it was issued on november the second of twenty twenty three. And I think that that their sporting has brought effects on our cansoms it is going to affect every property owner with their insurance and I know you issued are the the commissioner issue a consumer advisory opinions early in the year after the storms i'm storm damage and steps that the consumers can task specifically this bulletin address is that the department will now allow mandatory and separate wind and hail damaged deductibles and also that the department would allow a mandatory roof schedule endorsement for roofs. Seven years or older with notice and approval by the department and I would like some more information on that provided to council into the committee if you could get that you get that too as as soon as possible okay we can that that bottom is not related to this issue it's not at our star that we pay and I know with the other discussions that have been taken place related. To the increase charges and an expense for home ownership insurance and other things affecting property owners in the state even on the commercial side and with public education the other issues I think it's finally important to address the cause i'm not certain that the consumers know that this is actually happening because it's only going to be such that it affects them at renewal on their policy but if this bulletins in place now the companies have been notified and are kansas would be in effect in the immediately. So and also your web page there are four or four areas that the page and information is not there on on several of your bulletins and other things that are issued so maybe little update on that as well they write a better for your hole that thought I need a motion for the ages credit and emotion in a second all in favor of the exclusion. Thought if i've say I was nay as have it excluded from that report now reps is better if you would man if you will get with him out and excuse you if you'll get with him they can if you have to let her no specifically what you would like and then i'm going to ask you maybe on behalf the interest part if you would provide that information back to stay after she could circulate to to council yes of course thank you very much thank you missed you yes members will go to item. This is submission of monthly written up based by agencies concerning rule making resulting from the twenty three session those up data in your packets. If there's no question to know objections that will found the december monthly written updates see no do that will go to item h many of you recall at seven eighty one twenty seventeen and at sixty five of twenty twenty one established a systemic review of all agency rules to sure that they are relevant necessary to proper operation of each agency. Accordance with those act governor sanders has divided the remaining agencies into a new rule review groups and over the course of the next deaf you might be hearing from those agencies are signed to group too you'll have a report of that agency's rules divided by those rules that they wish to keep in those keep and enforce in those that they want to repeal in the list subcommittee will consider those rules and may accept and reject recognition sept or reject a recommendation of any agency to extend or repeal the rule. Members would encourage you to reach out any agency prior to the meeting if you have concerns or questions to discuss with the adc beside your package you'll also find the real report from the department of energy and environment in its divisions they'll be on next month's agenda so you have a month to prepare for that for this month but as the commissioner of state lands office to come forward and present the rules report as requested. And kill identify yourself at the record and you may present you testimony. I'm keliboan. Deputy commissioner state lands we have a single rule that the commissioner state lands office as you can see there are a number of. Uhm subsections under that rule we appear before this committee in june of this year and had the rules that you say before you're set before you approved and these are the rules we are completely revaluated our rules will do that on the two year basis and the rules that we presented in june rules we fill our valid towards operation of our office based on our code that is in effect at this time so you have one rule that you're seeking to to keep that is correct correct date members they have motion to accept mr state lands got emotional second got a second old they were I was na most carrying board thank you for being her day patience the next day to see is your son governor's mansion committee they have no rules currently in effect their full there's no action required by the sub committee but they are here at present thank you for your patience in being here today in case there was a question from any member of the operation. See no thank you again for being here today you're excuse members no other further business before the committee are meeting years adjourned.