ALC - Arkansas Health Insurance Marketplace Oversight Subcommittee and Joint Committee on Public Health, Welfare and Labor

Okay I want to welcome you all term meeting today >> change their money coming out today. >> We don't have a >> as long an engine as we did our last meeting so hopefully we'll be years long. The we'll get started on and >> got a new you're going. >> So we're ready to ready going >> I do want to say that Senator he Kian Senator Caldwell or the best listeners in this group when asked to give you a 2 minute warning. >> You guys one sentence so. >> Appreciate that guys. All right did you have any comments. Yet thank you represent of leading men >> and members of the committee I just wanna thank everybody the last meeting that we had in December we invite a blue umbrella from DHS to come and participate and they set up that pop up shop in the lobby and Justin that short time they sold over $400 worth of products all of that money went to those folks that are um residents about human development centers that made all of those items the from the blue number our store so I want to thank you for that >> I >> wanted to thank you for participating in the Christmas in the capital is probably 1 of our largest that we've ever had >> and that was great just >> at to notes there are some feature it in February is heart healthy month it's American heart month and that began in 1963 to raise awareness about hard issues and heart disease so we will probably I'm working to schedule a public health committee meeting at the Arkansas heart hospital in February so they'll be more information to come and hopefully we'll have some free screenings and other things that we can participate there in there at the >> at the heart hospital with that just happy new year happy glad to be here thank you. >> Thank you senator and I'm like to add a thank you to that lieu umbrella meant that we had in the field and make that they have a store over at the DHS headquarters itching go by there and I got a lot of good stuff in there so we took over in that area I stop by and take a look. Okay first thing on the agenda here's item see without items the consideration to adopt the minutes of the December 9 meeting the motion. Have a motion second second. All in favor signify by saying aye. Motion carries. Moving on to item the latest information on the health insurance marketplace enrollments for 2020. By the health department would John come the in the table and introduce yourselves. The. Good afternoon committee hi I'm Alan Kerr the commissioner of the insurance department Arkansas. Brian James government relations Arkansas interest part okay Allen right people you just a second cloture has comments >> I just wanted to let let our committee now our insurance exchange committee that we agreed to meet jointly with public health because we didn't see any nay to have the insurance department common repeat the same information so they've they've very graciously put as far stone the agenda so if the intrinsic trying to committee needs to leave after that agenda item you know you're welcome to if you want to stay for the rest public health certainly welcome to a bit of we just didn't want to inconvenience Senator smart many more than necessary but thank you all >> and we really appreciate the efficiency of the committee. Hi Senator Wallace I don't leave you and did you have any comments. Okay thanks but you may proceed. Yes again good afternoon and happy new year let's jump right in and talk about the money first gain financial report the red banner on the top. You're a. Your first sheet there. Run after the Hader she'd shows the money we collected. Excluding the federal technology fee we are now a total of our our accounts go total $4313000 Senate and just want to point out that that is uh about the maximum we're going to have in an account with some reconciliations that because we're no longer collecting that see from the from the rate payers that uh the A. him favor no longer collecting that as of this month and that money that $13000000 that was being collected to support this entity is uh went back to the rate payers and the form of lower rates so. That's good news. On a second sheet there. I am 2019 operations we took over a him on March 15 and the first 3 months there is what they had collected are I'm sorry that was their expenses for the first 3 months therefore there point on April on 3 December were our expenses. Can't. Of the total >> 1000000 >> 286 and again that includes of a hamster the original entities first 3 month Senator. The next page kind of shows are what we've been spending the money on again this is basically a snapshot of our check book. You see down through there what what's been spent sense so we took the entity over in March the the largest expense was AFMC which is our call center and and they pay those the the navigators and the people answered those phones to help those people find. Insurance for themselves. Kay. Then are ending cash balance. For 2019 uh >> 4000000 >> 641842. This is estimated keep in mind that and again this money is going to stay in this account are budget is 500000 a year. We don't anticipate spending that much but that is our our a maximum budget. This money is that we collected up to this point that we're no longer collected more fees that's going to run our our shop in this particular entity for the next 8 or 9 years we hope now there may be some reconciliations that we have to deal with we see a mass there's some reconciliation on premiums and and so forth that that they have warned us that that may have to be done as soon as a day do those calculations but we should be and in very good shape for the next uh years anyway. And a last a slide there is uh the ones you've seen before our staffing in that division prior to March 15 and where it is today fewer people later manner much more efficient. All right the next set of slides. >> Thank you Mr next aside we're gonna go off the the black banner rate information. On page 1 yes some general observations about the market place but 1 I would like to throw into reiterates appointed commissioner made because of the change from a him as an independent group coming over to the insurance department in the elimination of the user fee for plan your 2020 we ended up because of that elimination look it ended up Lorene what premiums would have been >> okay >> occur be careful how I say that what premiums would have been in 2020 we lowered that 13.$1000000 >> okay >> the projected premiums for all the rate filings for 2020 totaled >> 1.0 >> 5000000000 >> when you factor in a 1.2 percent user fee that the former AM used to charge carriers >> who sold >> that results in a net 13.$1000000 reduction that that not only to means lower rates for policy holders but because Arkansas works policies are the same as the private marketplace it results >> in >> cost savings on what DHS those on the artwork on the Arkansas work side so when you combine those when you combine those numbers together totals a 13.$1000000 >> in cap >> I just wanna be clear on that for 2020 all companies that exist in Arkansas are offering all plans throughout all counties of the state in previous years we still have 4 companies but in certain counties only 3 products for being offered whereas all 75 counties all have the same products available to them the rates are premium the premium rates are uniform across all the regions we have 7 regions in Arkansas and their >> their >> uniforms what out what what 1 company's policy cost you in Pulaski County if you're a certain age will cost you the same if you lived in Boone County because there's no there's no differences when you're 2020 offerings you can see where the where the count what. Plants the companies are offering every from and better to Arkansas Blue Cross call choice and to see a. Take it over to page 2 this is usually the you know what what what folks on report on. This is the changes by pop by pre by plan year. >> 4 >> in average non tobacco silver policies for 40 year old okay that's kind of the bench mark where everything based depending on the agent if your tobacco user prices will go up and go down accordingly but you can see that in 2014 we started with $330 as a per month premium we are now at 399 which represents a 1.1 increase over 2019 rates. You go to the next the next 2 pages detail. The price per month for various plans at the silver gold and bronze levels for each company again these are based on a 40 year old non tobacco user and this is the price before subsidies okay. Different people get different levels of subsidies we can compute that but this is what the baseline charges and the of the cover of the next 2 pages. When you get to page 5 it is information that we privilege previously shared with the subcommittee back in August is >> it >> is. In form of 1 sheet that we provided consumers on the rate filings came in the only thing that we've changed with this with this document from previously is we approve the rates so for for example on page 5 the am better requested a 1.90 rates increase and we approved a 1.90 rate increase and the rest of the repair just in the sport detail the changes 1 thing that I would note in each justification paragraph which is at the bottom of each 1 of those pages each company noted that its premium request for plan your 2020 was based on the fact that the 1.25 percent user fee would in fact not be collected. And that's that's a that's one of the benefits of the action the legislature took to to put it under a ID and it's one of the things that we've communicated consistently that we would not charge a user fee in future. And pause right there if you have any questions on either the finances or the. Rate information report. >> Seeing no questions you go it proceed all right the last set of slides is the market place enrollment. As you can see there the first pages the the most important one want to read the graph on it. And I want to point out that as of December of 2018 there was 50 >> 1000 >> 998 enrolled and as of 20 nineteen December fifty one thousand three eighty three a pretty much flat of the fact that you have from were a him was managing this um compared to the insurance department at $13000000 less. >> And I would direct members to the bottom of that page you'll know that. In the far left hand column where it says CMS final but we planned selections that's the week 7 snapshot that CMS provides okay is not what we consider to be the effectuate enrollment in Arkansas as of today we just got that information from our carriers late last week we have a we haven't had a chance to verify the information so we do not have a starting point that would reflect. We had previously in the chart above >> but I will say that >> according to see a mass plan selections total 64601 you'll notice a drop off usually between the plan selection metric from CM somewhat a ID considers affection waited during open enrollment if for example a person moved from one insurance company to another during open enrollment CMS would count that person twice a as a holder of a policy for the current plan year and selecting a policy for the next plan year okay so that's why we wait for the affection with a number that we're still computing right now like so we just got that information late last week >> the rest >> of this document details county by county break down over the last plan year that was requested of us for this meeting and VF entertain questions of with regards that. >> Senator hammer you recognize for question. >> Thank you Mr we go back to the finances for the first question. On the navigators the cost of the navigators on page 3. >> There seems to be some months that are pretty consistent and then the numbers spike up in August and September is that is that correlated to the open enrollment period or >> yes Sir that's open enrollment >> okay and then in October it dips down. Pretty low and then comes back up in November so is looking Ford will 195 a for be to pretty consistent constant number associate with the navigators. >> Yes Senator that's there be correct you've got a period in time where spikes up for them getting ready for open enrollment and then you've got open enrollment itself but the 19584 is is going to be the pretty consistent average number. >> I'm a navigator still have. Which. >> We just have the 1 company the number of navigators depends on the volume and or the number listed let's call in the number of people trained to answer those questions they're not necessarily navigators per se they're just trying to answer questions in a particular market so you know during open enrollment they're going to have >> 345 >> there it with any given time keep in mind these people don't the ones that are trained don't work specifically consistently on our phone calls 8:00 hours a day they do other roles with that particular agency but when someone they get a call coming in for 1 of these questions they go to 1 of those people that are automatically trained so they may have 1 or 2 and times it is in open enrollment they may have 345 of them they're trained to handle a higher volume of calls during during open enrollment. >> Okay >> usher Senator just want one more item to add on the navigators because it's been asked previously by your committee we have a total of 10 people that are licensed to be a navigator in the state of Arkansas. Now whether our vendor employees all 10 is up to the vendor but in terms of people that are certified to be a navigator in our state so we have 10. >> Recognize for follow up >> all right and then on the enrollment. Senator put in the numbers right we've got a steady decline throughout the year. >> As >> a notion a couple counties there was a a turn up enrollment can you check can you tell me why it is that. They're going down in the majority do you expect that trend to continue or what would be your expectation best guess looking into next year >> there a lot of reasons for decline you made the. Unemployment rate in Arkansas is as low as it's ever band so you have to assume that a lot of these people are getting jobs and getting jobs with insurance they're they're finding insurance and lots of different venues you've also got the hell sharing ministries out there that are competing with the insurance market in that respect and and their sales have spiked in Arkansas as well. Okay not on that subject do you know how many. >> Until we talk call flower talk about the hill shared and see how many are actually move over to that and and they are they are not able to take the dollars associated with this though and pay for their health shared >> ministry conocer day they can't take they can't take the subsidies and things like that sure yes correct >> alright we'll talk off line thank all right. >> Represented Ferguson recognize request. >> Thank you Mr chair do have many of these are auto enrollments do you know what percentage or. Of >> Chairman madam chair we can get we can probably get that information this isn't broken down at that point at that level but we can fish around and see what we can get for you on that >> yeah I mean I was hoping long term that the stability with partially be due to people are to be an insured not and rolled it do you have any idea what percentage are below 200 percent in having the or a lot of 600 and >> I believe we can get you that information >> okay thank. >> Senator a print you recognize. >> Thank you very much procedure. >> Mr Kerr >> I was >> looking on the first the financial report >> thank you and thank you yes it is number page to. Report talking about the expenses. >> Yes Sir >> and of course our called this bill I was looking there so the total expenses if I'm reading the chart right of the total expenses of 1000000 to 86. 1123000 of that actually came in the first 3 months before the transition >> that's correct that's right >> that's correct and so all of that is net real savings. To the state absolutely >> of those fees and of course the 13.$1000000 reduction because there's no way >> AM fees as well I just want to >> Mr chairman >> to make sure to say thank you to the commissioner and staff >> thank you to >> our chair of the A. him committee and all the members >> that was it is a tough bit of a tough >> lift especially when we start getting some outside information >> but I think it's pretty >> clear that this was the right thing force to do and I've not been hearing any complaints about it if members have I'd love to hear it >> but >> I just wanna thank >> your leadership in that >> indefinitely >> the staff of the insurers commission thank you Mr. >> Thank you Sir. Senator Jech question. Thank you on the the numbers per county is that >> is that a total per month >> or is it a collective >> that's a total per month that's the that's a per month we we collect information on the first and the fifteenth of every month I will say what Senator is hot so the total just >> so the total like being county >> June eight forty for >> that >> 800 >> 44 lies recovered and been county in total yes I its not >> addition at okay these aren't new enrollees part right no that members a running balance running balance thank you okay and those are market place numbers correct >> yes Sir. >> It has nothing to do with Arkansas works >> no ma'am >> okay thank you just wanted a clarification. All right seeing no further questions >> thank you. >> Thank you committee. Okay moving on to item he DHS division of medical services review of rule be effective February one bill would. Come to the table and introduce yourselves. Things chairman more quiet are cheaper legislative an internal affairs for DHS. A changed man director of DMS DHS you recognize to proceed. Thank you we have a 2 rules for today this first rule are some changes to our Medicaid provider manuals and the regard the of availability of tobacco cessation products and services are there some legislation that you'll passed the last session some of the related a scope of practice around the prescription and provision of these products >> and also much less related to >> Medicaid specifically and solely does we gone to clean up these manuals just to make sure that they act really reflect what was in in those changes that you all had already made >> again relates to tobacco cessation >> I in various areas Medicaid that'll be happy to answer any questions. Representative refers you recognize thank you Mr chair I was reading this this tobacco cessation it's is counseling if a parent or guardian smokes that they will. Cover counseling visits. What if the child is vaping are counseling visits covered for for about Arkansas were having or our kids if if the child these counseling providing himself or herself. Thank you thank you they being is not direct is not listed directly but it is a forma smoking so it would be covered. So if a if a if a child is by being in the position or provider recognize that or pharmacist then then visits would be counseling visits would be covered to help them yes ma'am stop okay thank you. Represented more law you recognize for question Mr represented partisan almost all of my questions. What it what is the cost that we think that's going to cost because >> when you read you >> you guys a question one in your response it seems like this was not in the statute but it is something you guys decided as a policy decision so what is the cost to the aid agency for this. I mean I'm I we looked at it at this point we don't anticipate any significant added cost Medicaid program we certainly can monitor that is because on we don't we still expect anything or not a separate because the record so do we see a higher instance and smoking >> and the reason we're >> doing this counseling is sensation products from kids that come from houses were smokers are. In addition to. We've seen an increase in smoking in general so it's not we're not trying to you. We're trying to open it up we're not trying to just if you smoke or you debt or the household smokes but it's open to anyone that is associated with smoking that want to the counseling. Okay. That was not. >> Senator Hickey recognize. >> I'll be on the side circle this before we started in that same same question. The way it reads unless I misunderstood you you said is open to anyone in the house with or not the parents smokes or not because that's not the way it the way it actually reads. I just is that. We're going that we're all allow children to request the counseling if a parent or guardian. Smokes I may I may have misspoken okay are and the the well the point was for the children to have access to the cessation counseling. And to be honest personally I think that makes more sense to just because of a parent smokes or doesn't smoke if you have a 17 year old kid that wants to request the counseling I don't really know why we would limited. Just to someone whose parents love session so but the way the rules written it's only going to allow. Where is question one. Server exert will certainly go back and double check that if that's not included we'll certainly look and see at the possibility of coming back to you with some additional changes to reflect that so that it would or would allow any child request is not just that okay would you will bring that back to is if it's not done correctly what about take a look at that yes Sir thank you Sir. >> Okay so >> you will get back with the committee with an answer on that yes Sir yes Sir will thank you. Senator when you recognize. I is the it's a good it's yeah it's a good catch because we don't want to limit that so I think is there a possibility that you can change it between now and a L. C. rules and rags subcommittee so that this can move along. A list check with the lawyers in terms of how much flexibility we had to make the changes in the bill the promulgation process of what will certainly look that and get you an answer back on them. Okay because yeah I mean if if required I I want this to move along that I think it's really important to catch if the wording is problematic and limits that we obviously don't want to limit that and then to represent a far distance point I think if vaping needs to be defined are outlined are included in the language than that might. Just to be added yes Sir if if if Lars gives the okay we can add that in at this point will we can do that and if not then we'll see what what additional process we need to do to get that added in okay just be in contact with us and Mister price and then if we need to call an additional public health committee meeting to look at that language and review it if it doesn't affect the promise you know the publication the public comment period and all of that if we can get that done before a LC rules Iraq subcommittee that we can move this along but making sure that the language is correct Sir we'll do that you. Senate member Ferguson recommends yeah out out along with that I I just have a concern that we continue to frame everything is to back assess session when really what we need to be the wording needs to be nicotine says session and all of our legislation a and but I'm not sure to back association color covers by of a that's fair point what will certainly keep that in mind as we go forward. >> Seeing no further questions this rule will stand as reviewed. >> Wait. No. What the old old. We're Senate back sorry we are sending you yeah because it's not correct. >> I'm sorry we will be sending it back in you we bring it back to this >> yes Sir will will get those answered back and we will staff and with the chairs and see which direction we need to go. >> All right thank you. Okay moving on to item if. Review of rule to be effective which would revise the edges policy 1098 see all are recognized need to introduce yourselves. >> Thank Mister chair I'm Jim Rader I'm with the office of chief counsel at department Human Services. And mark what digest you may proceed thank you Mr chairman how this relates to your participant exclusion rule this is the rule that we use we find a a bad actor who'd who should not be involved in the states business that we're able to exclude them from participation in DHS programs including the Medicaid program this rules been in place for for many years as I'm sure many of you know the office medic inspector general's created back in 2013 it was carved out a DHS and made into an independent agency course now is part of the department specter general and so now we've had several years of experience working with meek and working through those with these instances >> we worked with make to go back >> and amend this rule to make it more clear I brought some additional information and definitions related to who is a related party how does this relate to not only an excluded provider but other entities that may be controlled by that provider and so we may never changes related to those exclusions the process and they just reflecting the lessons we've learned in working with made over the last several years this is a rule we developed in consultation with Mick miss Senator hell Harrison Harrelson from make is president as a veiled answering questions that the committee has any and they were also David sterling your chief counsel is also available to answer questions on this. >> You recognize. Of the making represented come the table please and introduce yourself. >> Good afternoon. Yourself please yes my name is Tamera Harrelson I'm chief counsel for the office of Medicaid inspector general >> thank you Senator am you recognize >> thank you would you just in a nutshell tells a is is going to limit you or is it going to expand your capabilities and as representing make are you in agreement with everything in this. Yes we are in agreement we work closely with the H. S. on this. It. Really expands our ability to. Well I guess it does expand the ability for us to include more providers then bore a red in the original rule what we've done the is at. Basically capture what we have been doing and also with the federal rules provide. Okay start thank you sure. >> Okay seeing no further questions this >> rule. >> Stan is reviewed. >> Thank you correct. >> Okay the next rule is uh exhibit G.. Department of health >> bill would >> come to the table. Mr cells. >> Thank you Mr chair large shoe I'm general counsel for the department of health and I have with me Terry Paul the branch chief over environmental and we are here today to presents are rule regarding uh body art establishment as part of our revisions that we're doing with occupational licensure we added specific authority to >> artist trainers an hours for artists in training >> at due to act 910 of 2019 we also added changes to reflect the military and veterans lie Senator provisions under act 820 of 2019 we added language with act for 26 of 2019 pertaining to recess reciprocity and temporary provisional licenses we provided notice in the paper back in August we filed with the secretary of state in September we had a public hearing in October we received a few comments and responded to those there seem to be some confusion from some of the constituents that attended the public hearings we had a follow up stakeholder meeting and December to allow them to have time to answer asking questions about educational provisions and and schools and we followed up with them and we are here today to ask for our rules to be reviewed and we'll be happy to answer any questions. It was. >> Senator hammer you recognize >> thank you how many uh are currently licensed. In the state now to a new body art. Do body heart as a whole there's probably 7 800 I'd have to look with that's pretty close. And as far as who who goes out and regulates them and and how many are involved in going out regulating them and handling complaints we have 2 inspectors announcer Senator. Okay part thank you. >> Senator when you recognize for question. >> Thank you. One of the things I've asked DHS to do is to attach a copy of the legislation to the rules if it's from an act and then to so if you could do that the future that would be helpful I thank certainly so that we can reference back to the legislation and then also the contact whoever those lead sponsors were of that legislation to so they have the opportunity to review the rules and make sure that it matches up with their legislative intent and that they're aware so they can be at the meetings I just think it's a good follow up at process issue but I understand you know I know I know one of them was mine the refs recipe present reciprocity hot whatever actions thank you can thank you recognize say that word anyway for the military licensors so I know that when it is just the immediate license to be able to get these people up and going so that they have employment within as quickly as possible on the other act 2 pertaining to artists training requirements can you describe that one just a little bit more and and I'm trying to pull that act up. But can you at and I know some your work were undergoing occupational licensing to try to streamline that and so can be can you refresh my memory on that act if possible. >> With regard to the artisan training we added the specific language from the transformation in that title 20 to talk about the artists in training and that is something that is on going as far as drafting future rules to deal with the schools that the school aspect was passed to us during transformation with regard to the reciprocal licensure and that's dealing with act at 426 right and that is gonna be granting the temporary or provisional occupational licenses licenses it's my understanding that currently we already at grants them temporary license or for certain body art exhibitions and so that something that's currently being done and so we're using the language from the act specifically in our rules but also what we what we currently do to to help facilitate that so follow up with the act 910 is the transformation act. So I gotcha okay so at 910 was the the big transformation bill yes and so that transfer to that authority over to you department of health. And it currently without higher read correct that's why just for the schools we we are we're not all the body art establishments and 9 transformation the schools came over to us also that's correct okay gotcha and then. Okay and then acts 990 for having the offenses that was the. Making sure your criminal background checks and it's preventing people with those with I believe I read it in here could you just repeat that one for me. Back 990 actually if upon further reflection we removed that part out of our body art establishment rules because as we were working with the other attorneys in the executive branch in the attorney general's office we were trying to make sure that the act 990 was used for occupations in title 17 these body artists are in title 20 so we originally had that in our original draft of the rules but subsequently have remove that language because it doesn't apply. >> Okay so they >> said they'd. >> So. They do have to do a criminal background check or not. >> And do we grant a license if they have a felony. I believe with the schools they already do the background checks so that actually transferred over to us Senator >> I'm not >> pursuant to the act 990 but for from previous practice. >> And do we issue licenses if they have a felony. Record criminal record I'm just curious >> I would >> I would have to follow up with you on that specific question just because I think that the school language is still being worked on right now >> got to >> okay thank you. >> Senator sample you recognize for question thank you Mr Hey many schools are of the state. Would we took over we've we've received about 4142 school packets from department higher education. So one of the call is schools because I'm not for me you. That. They are they are of printers programs under they were under department career education I believe sometime ago and then it got transferred a DHD there is a certain amount of hours and curriculum that's to be established for those schools and and I guess that's the best way I know how to answer that. Well amend or the cold body art schools are of the part of. The card of Chester what the standalone type scoop I believe there are some that are stand alone type of schools that have a an office front and have as many as 2030 students ability you said there are some so not very many but some but the other part of the. The once Senator not stand alone order under what amended the road with Kassian county or. >> Well but again we just inherit the the schools in the transformation act so I I can't tell you with with great defendant with great definition of exactly how those schools appear some have national accreditations as I understand summer more local. >> Okay thank you thank you Mr. Senate he you recognize >> thank you Mr >> mine's going to be in a. >> On the first page Joan comment to. And I just have a question and I will have to admit I struggled with this legislation a little bit in uh where we pass this in the session however we went ahead and did it of course as a help to the military spouses. My concern at the time was is that those spouses you know if they had substantially less education than was needed and in this state you know what we were doing the right thing however I see Mike words might put number 3 this is evidence that the applicant is a qualified applicant under 5.3 to point 4 what what does that actually say right there. What what makes them qualify under 3 do you know that. >> And I'm gonna have at Chuck Thompson he's are managing attorney and he assisted with all the occupational licensure of language and he should be able to help answer that question for you is >> just one more before you start that is something that you read within the rule that was not in the statute is that correct >> Senator al Chuck Thompson are so department health that is actually that's part of some language that we worked out with including the some other executive agency attorneys what that riff references is evidence that they are in fact military spouse or their or their spouse was recently discharged that's what that's referencing that's insuring that they were catching the spouse were catching all the the requirements as it relates to who is actually returning military veterans >> and that's basically what is limited to there's nothing else in there that they would have to have to meet him >> to get that qualification Senator all in all it is is insurance that they are military spouses as days dictated by the act. >> Thank you Sir. >> Every recognized. >> Thank you I'm trying to pull up the conversation when the only been in with one of my constituents who's a body body art runs a Cup of. >> Shop. The. The requirements for somebody that's going to do mobile tattooing. Verses a stationary are they are they the same date they both have to go through the same schooling that both have to go through the same amount of hours in order to be in a order to offer that or is there a difference between. Between the 2. My understand that they're the same obviously and and establishment situation there would be other guidelines other rules that they would have to comply with with that of a building but as far as the training that would be the same. Okay so this >> is >> so what we're about to pass applies to whether you're doing a mobile body art studio where you have a stationary body art studio is that correct that's correct thank you thank you ma'am Mr. >> Hi >> any other questions. >> Senator sample you recognized. >> So he. We're going I'm going back to last year because the that's something that >> is. >> Can automate so for a military spouse. Moved here from state that does have been educational requirements the welcome just great them west coaster military spouses at court. >> I >> know Senator the that that that the particular the particular passage we're talking about was evidence that they are fact a military spouse they still have to hold a substantially equivalent license from the other state we're not we're not making it we're insuring folks that have substantially quote that our military that our military military spouses that have substantially equivalent licenses from other states can get license quickly here in Arkansas for the legislative intent it's not making it easier for them to get license at that that license would have to be substantially equivalent which means that they have to have similar educational requirements to Arkansas so it's still whatever their training was needs to be kind of reflect what Arkansas string is it's not going making it easier is insuring to put them on a level playing field and sure they can quickly get a license since they were you know if they're not since military they're not necessarily moving here on you know of their own accord or just get them up and up and practicing a profession Senator Senator urban set >> thank you thank you Mr. >> Senator he can you recognize for to just >> just let me ask so that and I'm not being at but who's going to make that who's going to make that decision on whether or not it's substantially equivalent and let me just tell out something if and again I know we pass this so it's its own us but if somebody will head. Was required to have 2000 hours worth of training for some. Some profession that they were doing in Wisconsin and we're requiring 4000. Are you going to consider that is substantially equivalent higher higher higher you go to make that determination. >> Senator I think you're gonna find a lot of the very similar language coming for you not just from us but from other state agencies regarding occupational licensure issues like I said there are other state agencies we the Chinese talked >> regarding these >> this language if you look at the act themselves the attendance says our intent is not to count our for our that is that is explicitly and your legislative intent in the act so there's a level of there's a level of. Of the program people with their expertise determining that a licenses substantially equivalent we discuss this internally the department health with the myriad of programs we do include with occupational licensure for cosmetology to massage and we talked extensively with our program people and generally >> our >> our program people are familiar with these industries are are no these industries and they can and and they can take a look at a license and tell you or they have there's national standards and they can look and say this is this is really truly you know substantially equivalent we off often have advisory committees I can tell us the same of people out in the community that are of the governor appointed like like like impact which is in the sauce there be technical advisory committee or sea tac which is a cosmetic the cosmetic advisory committee so there is a level of our program people having to look at this without turning into as the legislature said not our for our our account and there there's some there's some art to it I'd have to say >> as to >> to an experience and and and and educated experience and making that determination >> so when I'm one more and I so are you telling me that under each one of these decisions at a committee will actually determine if it's substantially equivalent or is there going to be like one individual person that's going to it's going to make that determination >> and and and I'm sorry Senator I but in the speak some some of the some of the boards and commissions on of the Arkansas department health have advisory committee some are strictly under are are just our program staff regardless if you the programs in those instances it would be program staffer very experienced in the in these issues in these industries other ones and we program staff in consultation with these committees that legislation the legislation is is covers all occupational licensing under title 17 so there isn't there the occupational license under title 17 looks very different depending on what you're talking about what what the programmer industry you're talking about so some would be it with a committee some would just be. Program but we're always getting them put a stake holders and always get the input of licensees that we deal with so that there there's a there's a level that as well. >> And again I believe the legislature you knows heart heart was in the right place in doing this and that this is something that we want to try to do to support our military and their spouses in the coming up I'm not saying that but I would encourage you all that as we do this the whenever you find those flaws and if we need to tweak on this I think that it would be appropriate you know to try to bring it back because I do see with there could be cases were things to get so subject to you before you know politics gets involved you know I call you so it looks like to me they should be should be equivalent tap lessons I mean at that point so Mize was I know Senator I don't think so and I know that gets a little tough so. Again I would just encourage you whenever we do see the tweaks in the to be made that would bring it back because I do think it's a good bill but. We also with that need to caution a little bit with that >> I we we will do that Senator this a work in progress I know the red tape reduction occupational licensing group is still still meets and and we're part of that department health as part of that in the we've had these very discussions what you just mentioned and I thinks it is uh there's a level to learn a learning to it and there and we do it I think there's things that we would like to to discuss with the legislature going forward >> thank you Sir >> Senator when you recognize. >> Thank you I I just appreciate Senator Hickey's comments it was it was my bill my legislation but I don't disagree with I think you know our intent was to make sure that that was as of an equal license and that we weren't giving licenses out to people that were not qualified to have been because my first and foremost priority is the safety and health of our citizens so I do appreciate Senator he keeps comments and at I agree with him and so. We are as as may Ford we're keeping in a close eye on that so I appreciate the work they are doing on that with with me in our subcommittee as well thank you. >> Representative Ferguson you recognize for question >> thank you Mr tear up once there licenses determine to be substantially equivalent and I receive in Arkansas license state ID and have to meet all of the continuing ed and requirements for whatever that licensure would be going forward >> that's correct represented once they have that Arkansas license they stopped me to continue and requirements in Arkansas >> okay thank you. >> You recognize for question >> thank you the what about the appeals process if somebody disagrees are the >> person >> is are changing the appeals progress process is somebody disagrees and they don't get a license. >> Senator for any of our programs there's no change in any of the R. appeals process is most of those go through the board of health as the to make a final decision at that point that have appeal to the circuit court of Pulaski County >> okay >> thank you. >> All right seeing no further questions this rule without objection this rule will stand as reviewed. Thank you. Okay will proceed to item H.. Miss you if you want to go ahead and. If you all would recognize your skin with introducer selves. >> Large to general counsel for the department of health and I have with me Jamie turban she's the administrator for the prescription drug monitoring program at the department of health >> you may proceed. >> We are here to present our rules pertaining to the PDM Pae and we have for you today the description of all of the changes that were made pursuant to acts and 2017 and 2019 we do have a general authority to revise these rules under title 20 and we had approval by the board of health in August of 2019 and we publish notice in August and September father with the secretary of state's we had a public hearing in September of 2019 which receive some comments and responded to those and after the approval indeed we are bringing it to you all for review and I Mr been can explain to you the specifics on the 2017 to 2019 acts. Good afternoon some of the corrections that we made in these of in the rules were on the cover page the branch was incorrect our PT in PS moved to different branches 80 H. so is updated to the substance misuse an injury prevention branch the proposed amendments from legislation start from 2017 act 46 and 2017 we insert add language allowing access of by the Arkansas Medicaid prescription drug program act 688 of 2017 we insert add language regarding uh providing information to insurance carriers for the purpose of verifying prescriber or dispensary distractions with the Arkansas PD MP. We also insert add language additional language regarding information provided for research. Act 820 of 2017 we insert add language for mandatory usage of the PDM P. by prescribers we also added 2 new members who are Arkansas prescription drug monitoring program advisory committee. Insert add language for development of prescribing criteria for controlled substances and reports to be generated to prescribers dispensers and licensing boards based on this criteria. Insert add language for implementation of real time reporting by the Arkansas PDM P. if funding and technology is available. Insert add language regarding the penalty for failure to use the PDM P.. And we move forward to 2019 act 141 of 2019 we inserted language adding allowing access of the Arkansas office of Medicaid inspector general. Act 315 of 2019 we removed the word regulation throughout the rules act 6 so 5 of 2019 we insert add language allowing for the exchange of data between the Arkansas PD MP and federal PNP programs and then from the public comments suggestions we decided to add a definition for hospice or hospice care that is consistent with the 80 H. hospice rules definition and the definition for palliative care that is consistent from Arkansas code 20 - 8 - 701. Any questions. >> Senator hammer you recognize thank you can you tell me how many are not complying with the mandated usage of the PMP. >> That is something I would have to look into to get a number are you wanting overall prescribers are you wanting specifics and physicians PA's nursing just so I I know what I'm looking for and how to get that calculation >> okay what if you're not prepared to answer let's just talk off line and I'll I'll get it from you >> all this time >> a second question do you. Maybe don't know this what to get this off line too but do you know how many are registered but are not checking it and how do you go about determining if they're not checking it if they're registered. >> Currently we're in the process of getting a module that'll help me determine if a prescription was filled and to see if the prescriber who wrote the prescription had checked but we don't have that capability just yet but we're working on getting that >> estimated time for when you'll have it >> we have a contract with our. That's a bit have to look into to see how how quickly this this update can be done be my Bender >> okay >> thank you. Representative person you recognize >> that yet what is the penalty for failure to use. Is it of the listed dollar amount or. Hold on one second. >> 2. >> The licensing board. If a prescriber if he comes to me and asked me about it I try to educate on how to use it and when to use it and to let them know of the laws that are in place but her the act >> 820 >> 2017 that is subject to disciplinary action by licensing board. So will we be getting those rules from the different licensing boards about what the penalty is or. Those rules of probably come before you either in 2018 or they're coming before you now as far as there were revisions for the specific boards on how they deal with those folks. Okay thank you. >> Senator mean you recognize for question. >> Thank you. Do we know how. Do we know how the we we provide the information to insurance carriers for the purpose of verifying prescriber or dispenser registration how the information is being used by insurance carriers. Do we know how this information's being used hi I do not I can look into that out can you look into that I'm not sure if there's anybody still here with the insurance department. But you might wanna consultant off with them because I've I'd like to know how that's being used and he said something about we do it we have talked in the past about this being in real time if funds were available is that what you said yes ma'am in the in ology yes ma'am I'm sorry say that one more time technology and fines if technologies and funds were available so can you give me an update on that we are not in real time no ma'am are up loads are next business day for pharmacies and veterinarians have 30 days to upload their controlled substance dispensations. Okay so when a physician goes to check the PDM Pae before they write a prescription and it's not posted until the day after or is that correct. 8 to so it's not in real time. How. If. So how do they know if the I mean I don't know correct then if that information is real time or not. So. If it's not pass until the day after and it's not in real time. And I go ahead and write the prescription. And then the next day it's posted that they got a prescription from somewhere else who is held accountable. Per script for over prescribing. I think all of the prescribers are doing the best they can with the information that they have so if if there is some question about any sort of penalty for over prescribing then then obviously that would be taken into it account but I think it's it's has definitely are are studies in our researcher Senator this has as assisted with the doctor shopping situations but obviously it is a real time situation would be best. I understand that but again you know I we have this discussion river we've a long time how much money it says if funds available how much money and what technology how much money is needed to make this a real time system number one and number 2 is the technology available to do it yes for now. Do we know that. I don't have that with me today but we can certainly follow up with you in and get back to you as soon as possible on that okay and and then my final question is can you give me a list of anybody and everybody that has access to this information. Because we've over time on we pass this legislation back and 20. 13 I believe there was questions about hip in about access and patients were concerned about that and so at the time we had discussions that this would be a limited access to this information but over the years we have opened up access to this information. I mean 3 legislation now SO I'd like a list of of where we started and who had information at that time that we pass legislation and who has access to this information now and I think we need to look at how it's being used. Sorry I just me a list of who all has access now that we after we review these roles Senator and we'll be happy to provide you with that thank you. >> Representative would you recognize for question. Thank you Mr chair I just wanted to ask a clarifying question on the real time when you go back in the study this over time how often do you find that say you know March Davis is had multiple prescriptions filled from different providers on a different day I mean is there really any. Is the data bases it currently stands. Reflect that investing in real time is really gonna make a difference or is it such a rare occurrence that someone would have the same top prescription filled over and over on the same day where it would have been caught in a similar mask. >> You want to those doctor shopping in the same day so who's getting also >> is is that really happening I mean it does that show that in the state of Arkansas we are really having doctor shopping on the >> 24 hour I have to look into that I do know the doctor shopping has gone down depending on the threshold whether they see 5 prescribers or 5 pharmacies within 90 days but it's it's going down. >> Is >> follow up >> yeah you recognize could you either get back to me or the committee and and let me know I mean do some generate some kind of report to see if there's actually value in a before we start investing money. Thank you. I feel would send all information Mister price and we'll get everyone. >> We will the south >> Senator hammer you recognize. Thank you with regards to the investigation when there's been a reporter indications that there's been a failure to check are those investigations by the individual boards that oversee that medical profession or do y'all have any involvement in the investigation itself. >> The boards get the information from the PD in Pae sometimes there are subpoenas issued by the DEA it it just depends on the type of an investigation that is being initiated. >> And at what level does it become knowledgeable to the be a that they would go and visit a physician or prescriber. On you 7 channel room. >> They get information from various sources but they do ask for a regular reports from the PD MP. I think that the high prescriber reports is that correct the compare Senator ports is with a yes but the most >> Kay and to representative boards question somebody would have to be. Strategically planning to show up at 5 physician offices on the same day and get 5 different prescriptions theoretically an illustration form in order to beat the system because it uploads every night so in other states do you know how many other states are dealing with real time systems verses a delayed a one day delay in the upload >> the majority opinion piece or 2004 hours a next business days their frequency Oklahoma has something close to real time is within 15 minutes this is what I've I've talked other PDM P. administrator about. >> So the vast majority of states are due on the same system we're dealing on yesterday >> yes there Oklahoma is the only one I know that has a shorter frequency of their uploads compared to ours >> I'd like to request amendment information chair that if you would add it to the lesser share in our passion out what I'd like to find out is the number of investigations that each one of the medical boards have done regarding failure to check the PDM and how many disciplinary actions affecting the prescribers licensure was actually taken so I'd like to you know if the department wants to get that or will get the staff to do that but I'd like to have that information as far as. Number investigations the. And the actions taken by the board against the prescriber and I'd like to get that information please thank you can you know provide that. >> We will work on that we will need some time to get with our boards and their attorneys and see what is actually able to be disclosed at this time obviously there's an ongoing investigation we would not be able to discuss >> that but I'd make it clear I don't want names or anything that's going to violate hip or anything like that I just like I'd like numbers and out of the bill put off line with you thank you thank Mr. >> What a question. >> Senator when you recognize >> the to the boards have the ability to do that. To do they have the capability of going in and check and. When somebody looks and not looks I thought you said that there's a module that you haven't purchased yet. Well the modulus to tie a specific prescription to a filling I get a prescription filled at a pharmacy to the Britain date of the doctor and to go back and see how long it was the check that person the boards can subpoena me for of what is called a a query report to see what all of provider has checked in the PDM P. and they can match that up hello transcription to or bill does that make sense to stay yeah I I gotta. Okay and that concludes quick question the veterinarian issue so they have so bass that's if day dispense the medications that correct at that their editing at the pharmacy if there okay okay that if they go through a pharmacy than it would be the next business day yes ma'am thank you. >> Representative Ferguson you recognize >> thank you Mr chair of I know what a lot of other states day which is uh important component of reducing the administrative burden for providers is the have integration with the HR it do we have the capacity to do that if we had the money to do it integration with the electronic health record we do have the capacity yes and my brand or the department of health was awarded a CDC grants called overdosed at action and we have some funds in there we're working on doing that hopefully in the next year to try and integrate with all the EHRs pharmacy dispensing softwares in the state okay good thank you. >> Okay seeing no further questions without objection this rule will stand as ruby thank you. Okay committee I'd like to go back to item he. And I think DHS has an answer to the questions that we had earlier so if you all would come to the end of the table and introduce yourself. Thank Mr more quiet with DHS. You recognize things directly of resolve the issue and apologize for the confusion up looking back up in the question one I think our our staff and miss read that questions are answered was as clear as it should have been the rule as it's written does provide for to tobacco cessation counseling for any child his Medicaid caught the the confusion comes from that we will also provide pay for counseling for the parents of that child if the parent smokes I think that's where the confusion came from but for any child I will be entitled to that counseling. Okay are there any questions. Hello Justin. If you would bear with us just matter certainly. So no one has a question about the vaping issue that was raised her. That mean clued in. We talked about the language but is anybody have an objection to the way it's currently written. Question if I can mention it the the language that we use in the manual is smoking and tobacco use cessation inside we interpret that include vaping. Recognize maybe this is too far of the box for right now but I'm I'm just curious. Maybe not pair dancer now. Recreational marijuana goes to that going to be consider smoking or how you going to quite handle. Thank you know they're gonna be able to access this number in order to get it. I'll get back will that once an art thanks I'll find out. I hope so. All right hello debate on this but. Without objection this rule will stand is review thank you committee. Okay moving on to item high. Overview of Medicaid behavioral health transformation. We joke in the in the table. In committee this is uh this presentation at DHS of one the programs and hopefully will will do more this information out so if you know within the district sales. Yeah you don't have a hand down the measure is passed around. Reading review that. Mr self. J. here with division of aging adult behavior health services. >> Patricia Gann of the division of aging adult might have a health services >> thank you may proceed. >> Good afternoon and thank you for giving us the time to come and talk about some of the things that we think we've really accomplished in the last year so our presentation today is gonna be the first part of presentation I think this will continue and and and the next session but what we're gonna talk about today's our benefits for support in forensics. So in August of 2019 we launched our behavioral health support line that is for persons who have been impacted by or suffering from mental health or substance abuse addiction or issues I'm and that line is open Monday through Friday from 830 to 4:30 PM if a person doesn't have Medicaid thank you or they don't have private insurance or any way to pay they can also call this line and they can be directed to 1 of our contract providers who will provide services for those beneficiaries. And the help line number is on your next page and like I said any are Kansan can reach out and receive help in locating a provider in their area and some of the services that are available would include individual and group counseling substance abuse and addiction counseling medication management help during a mental health crisis family counseling or under our name out patient ever health program we now provide counseling to the under for population is called infant mental health and so those are services for children and those are dyadic services so they are provided to the child and the parent hood said dyadic type of counseling. On the next page what you'll see is the flyer this fire was distributed by a FMC to our I county offices it was also sent out and distributed to our primary care physicians we can continue to print these wires and send them out we also if the bottom of that you'll see there's a website and you can get the information for how to contact someone to get access to a behavioral health provider on our website. We also want to talk about thanks to our legislative changes that sunset it are old program under the BHS program there are no caps on providers in the ability for providers to be certified in the state of Arkansas it was one of the 3 pillars I believe to the herbal health transformation was that we wanted to increase access to services throughout the state of Arkansas so please note that what we say is that we have an expanded network we also want to really state that it is an expanded network but we continue to want to expand this network further we certainly know that within the state we still have areas of the state particularly in the delta and also in some of our more rule communities where it is more difficult for persons to access services than it is in others. So if you look at your numbers what you'll see is and 2017 we at 31 independently licensed practitioners. We currently have 292 certified independently licensed clinicians in the state of Arkansas. And we had 253 behavioral health agencies and we currently have 312 federal health agencies that are certified those are specific sites throughout the state of Arkansas. We do know that we have some counties there approximately 10 counties and I apologize that I can't name them right now where we have less access than we do in some of our other counties however we do want to point out that our community mental health centers are required to have a site in every county in the state of Arkansas and so therefore we know that under community mental health center contracts we will have at least one site within each county where persons can go to receive the herbal health services. And that is the end of our at date on our behavior health services in our been fishery supportline. >> Senator Wallace you recognize. Hello ma'am could you give us a list of the 10 counties that are struggling right now >> yes Sir I'll be happy to >> thank you yeah you send that to the staff >> yes Sir. >> Senator Ervin you recognize for question. >> Thank you so much for your poor I mean I think it's so important for the members of this committee and the people that are out there watching or listening to understand you know the. How far we've come. I mean at and I'm not at this is the first part of this report and it definitely matters on the back end of this report to but for for for folks to understand where our capacity was and where it is today and how it has expanded and we're not there yet because we definitely have holes across the map of Arkansas where people can't get services but this is a big big big deal and I requested that they give this reports the members of this committee and this information because of all that we've gone through of the state and that there was really a stranglehold in my opinion there was a stranglehold on the state and. Which did not allow us to expand these independently licensed practitioners and because of the actions that have been taken and and all and a lot of other events we've really been able to expand this but we're we're not where we need to be back but this needs to be >> clearly understood because it's so integrated into everything that we talk about everything that we do and it just. This is something that so integrated into our judicial system and our justice system when it comes to the what you'll see on the next back end of this reports that when you talk about DCFS when you talk about division of you services when you talk about people with mental abuse >> mental illnesses and substance abuse and behavioral health issues this is >> this is and very very integrated and complex issue >> and so >> you know what folks really >> look at this and ask questions and no it's because it's really important for us to know this as we represent the different areas across our state so I just >> want people to >> to really know where we've come. >> And so you might want to emphasize that with conference **** up >> thank you so much Senator we we certainly know that party barrelhouse transformation has really been the ability for us to expand both are viral health agencies and are independently licensed clinicians I just want to also say that I think it's really important to talk about the addition under our bare for health transformation of substance abuse services now being paid for counseling for substance abuse issues now being paid for under Arkansas Medicaid and so that really opens up services it's going to open up services on the side of we now Medicaid now pays for counseling for those beneficiaries who have Medicaid which I think allows us to much more efficiently use our contract funding and so certainly we want to look at how we can expand the services throughout the state we do now I've been provide I was out the provider world for 25 years and so what we know is that for years there was no reason for someone who is licensed to go ahead and get their substance abuse certification their substance abuse license because there is very little funding now Medicaid will pay for that which is going to we health began to get our clinical staff to go ahead and get their substance abuse certifications and be able to provide the services. >> So just to be clear up I think you made it fairly clear but so everybody understands many of the services that are listed here were not covered on the medic Medicaid previously but they are now is that correct that is correct >> previous 2 barrel health transformation in the out patient beryl health services program substance abuse counseling standing alone outside of having a cow occurring and by real health diagnoses was not paid for under Medicaid so now all someone can walk in and to a counseling clinic and say I have a substance use disorder and I wanna get counseling and I will get that as a standalone diagnosis and that was not allowable and then our infant mental health program which I think we're very proud that is for us to be able to do some early intervention and prevention with our little babies those are children under the age of for bringing parents into that counseling dealing with trauma issues and those issues early on before they get into school on before these become >> serious issues. And again one of the difficulties that you all have is to communicate this and get that word out is that correct >> absolutely we want to get the word out that the services are out there the services are available you can get of the beneficiary support line the closest provider may not be in your county the closest provider may be in the county next door and you may not know that the services are there that you can access those services so we certainly want to get them out to beneficiaries but we also a really need these this information to go out to our primary care physicians because that often is where individual show up they usually show up with a physical illness when they have depression or when they're not really sure what's going on so we want to make sure that these this number and this information is in the hands of everyone so that they are contacting our providers and getting the services they need >> so is it fair to say that we want to catch these issues are these problems earlier so it doesn't develop into a bigger problem like. Change the or both the engine kind of thing is that correct >> that's absolutely correct the earlier that you can intervene unit we we earlier in that you can intervene when someone is beginning to have some behavioral health issues are mental health issues or substance abuse issues the higher the rate of as successfully being treated so you want to make sure that we're getting people into services are early on in that process especially around psychosis or schizophrenia what we know is that we can identify people early on first episode psychosis if we can identify them early on in that process there are treatment evidence based treatment protocols that will be the and greatly improve the outcomes of those beneficiaries who are developing this disorders. >> Urban you recognize. I thank the and members I I want to emphasize the money issue here because before we were paying for the services are contracts and said there was a limited number of people providing the services based on contracts with Medicaid right that correct >> that is correct >> and those method those contracts were how much in state general revenue >> approximately. >> State give me the breakdown between of those contracts what state what was straight 100 percent straight state G. R. and what was federal. Senator was about 20000000 S. G. R. roughly 13000000 federal funding. Okay and so now we we say he bill Medicaid first and use the contract afterwards the Medicaid is. Right in the breakdown of state and federal. 70 >> yet is it 75. 7030 >> thank you it's around 7030 yeah I know the answer the question but I just want I want to make the point though is that this is. Financially this is the right thing to do so not only does it probably save us money in the long run it also opens the door for more people to be able to provide those services outside of the people that had the contracts to do this exclusively. And it's financially better far state >> absolutely >> and it's Bennett more beneficial to the people that we serve. Thank you. Senator hammer you recognize. Thanks for share tell me about the well first of all for the number of licensed practitioners. Do you know. >> Do you know how many of those are actually seen individuals they might be listed as providers but are they actually seen people. >> Senator hammer what we have done for the benefit 3 support line is that we have a form and we actually call those providers quarterly and we asked them who they are serving in so I can certainly get that report to you for who is accepting new clients if you would like to know that number specifically >> but I'd like to know that because you could have 1000 providers but if only 200 of America the same people it's kinda given issue. Perception of the matter number one not that it is or not but that report will tell me and how may providers are currently waiting to be approved are we. >> I'm I don't know what we are counting is our certified providers so once they get certified in there and they're able to go ahead and provide services waiting on their Medicaid number in so >> I >> cannot tell you at this point how many of those providers are waiting are you are you asking are they waiting to be certified by the division a provider services and quality assurance >> yes waiting okay >> yes are >> we can get those numbers for you >> okay and then when it comes to auditing the independent licensed practitioners what's the process for auditing and make sure that the work that they're doing is complying is that makes responsibility such all served or who does that jurisdiction rest with and how has changing the system improved the reduction of fraud or potential fraud. >> I certainly can't speak for Meg under diem masters a contract where by but the independently licensed practitioners in the barrel health agencies will undergo clinical review of services and there is a percentage and I'm sorry I don't have the information right now is to percentage of claims that are pulled for each individual provider and those claims will be reviewed. >> Okay and then the last thing is the. And I'll give you senator you tell me if I'm thinking correctly that matches what we're looking at select have got to counseling clinic down and swing county and we've got independent licensed practitioners they're kind of popping up in opening up shops okay and yet if that independent licensed practitioner chooses not to see somebody for whatever reason they choose not the fall back is going to be on the counseling clinic to see that person but it's also going to be on the counseling clinic to go to the local jail and deal with you know that population 9:00 am I thinking right and is that what we're talking about here. >> So under the certification and and certainly the division a provider services and quality assurance is not here today and so those regulations are under the certification regulations Senator hammer but under the certification regulations both groups of people required to have 24 hour emergency services so and and like I said again the that division could certainly speak more clearly and probably more intelligently to the specific certification regulations but both groups of people are required to have 24 hour services what our contractors are required to do is they're required to do cross the services for individuals who are not in the past and individuals who have no prior >> right because independent licensed practitioners at that's just free market is in no way I'd say that okay but I don't want to see the structure eroded to wear these clinics are expected to take people because independent Liza practitioners choose not to take them there's a there's a balance there somewhere where we don't put them out of business because and who's going to be getting called to the county jail at 2:00 in the morning to deal with somebody in that that's what I wanna make sure stage in the discussion is that we have that balance as far as how we protect of those stable entities in Casey's practitioner stark going away all the sudden >> yes Sir thank you >> okay thank you thank you Mr. In a brown you recognize for question. >> Thank you Mr chair end Senator him or may have hit on part of my question. >> So if somebody has a substance abuse problem and they want to call and get services that's one thing what about the people who who were in the court system and they you know they they got a substance abuse problem they got a traffic ticket in their required to go for these mental health counseling. Are they advised it or is there some way to communicate to the court to share this information with those individuals that may be eligible for the services on your as soon as under Medicaid >> yes ma'am it is under Medicaid and and also I think that director hill can also talk about our contracts in the services that are offered under contracts and so I think when he actually talks about the forensic program we'll discuss more about how we are reaching out to you are law enforcement into our counties >> yes so for instance the example you gave someone who maybe have picked up on a traffic violation to you through our drug and alcohol safety education program the day set programs that can be court ordered into our for an evaluation at that point they said they step program can can make that recommendation to the courts this individual needs for treatment any counseling this is supp this is a substance abuse issue not just alcohol it may be a narcotic issue for instance a good be it could be any Meredith of the issues that they can that can make that referral so that they can be in our system and receive the treatment that they may follow up. Yes you recognize often times I would think that a lot of these individuals may not be. Very good about signing up for services ahead of time and he you know taking you know taking care of the paperwork and. You know they got problems so is there when you reach out to these individuals that they haven't bothered to follow up. And get their insurance coverage or sign up for it or whatever. Is there someone there who helps them do that or they just. Lost. >> I'm I'll give you an example of a call that we had a couple weeks ago I had a grandmother who called me that was in tears because her granddaughter was in jail on on drug charges she was very very concerned that she was going to be bailed out by the very people who she was using drugs we at so she reached out to us we were able to get you to Jimmy McGill he manages our peer support and or substance of these contracts and we were able to get a peer support person out to the jail to talk to her that peer support specialist at pier can recovery support specialist talked with her assisted her in getting into a treatment program and they facilitated her going to treatment what we now we as in what I know as a licensed professional is often people are going to listen to me but they will listen to Pierce and so I think that's one of the wonderful things Senator our peer recovery support specialist under our contracts is that we have the ability get them involved in that and have them reach out we can't make people come and get treatment but we certainly have some tools that we can use to try to get them into treatment. >> Thank you. Representative of Ferguson recommends. >> Thank you Mr chair to do the insurance companies pay for comparable services for the Medicaid expansion population. >> I am sorry I >> do not know the answer to that question. But I will certainly find out for you thank you >> okay. >> I'm sorry. >> Okay you seeing no further questions thank you for the report hello I'm sorry go ahead and take your recognize a lost my place it up thank you Mr chairman of just just very briefly I want to touch on a very important part of our behavior health division and that is the measure of our state's forensic evaluation system and so today I just want to kind of give you an update is to is to where we are with that I know many of you get phone calls from your local attention facilities about individuals that are waiting evaluations so I would tell you Arkansas ranks third nationally per capita in the number of a frantic about a which is that ordered the state hospital gets about 2000 hours a year I which it it's it's a it's a it's quiet a tremendous load that comes through our doors at in your package you have a hand out and what you see is this is a 3 year snapshot the evaluation overview page in that shows you that in 3 years the hospital has been responsible for seeing 4698 forensic evaluations completed. That ash Arkansas state hospital we have a right now on staff we have 3 evaluators. We we we accomplish this and up with about partnering with our local community mental health centers who are under contract with our division to provide services and they have done along with the hospital and absolutely tremendous job this year to help us work on this problem I cannot emphasize enough what a what a valuable resource to Camillus enters have been to us. When and it would an evaluation order comes through the state hospital will make a determination if that order needs to be pulled in for instance it may be a case that is complex enough that we know that it really needs to be handled at the state hospital with the court might prefer it that way it may be that we have evaluators with specific areas of expertise to handle those evaluations so about 25 percent of all the of all fringed valuations yes signed here at at ash at the state hospital reminder we will sign out to the committee mill hell Senator whose jurisdiction the case falls in. Committee will health centers have forensically trying to evaluators on staff and then they will in turn see that that evaluations completed in this report is generated and submitted back to state hospital. Currently we have 450 open cases. 360 of those are considered what we call actionable and we've done ex. When we began to clean up our our our backlog was what we called begin to work on this the first step was to determine if we had good data and we spent a consumer mount of time working through these cases in many instances following up on them individually through court connect in calls with jurisdictions case by case determined what are real numbers were. Where we had issues what what what size of monster we have to tackle. And so presently we have 450 open cases 360 actionable and we divide our cases in what we call action will not actual meaning there are those that have simply disappeared there individuals that in court order for an evaluation that may have a misconduct they've left the state that can't be found they've moved of change are addresses there's an active worn out for their rest it's not an individual that we can. With certainty lay our hands on or the committee bill health center can locate the reminder what we those that we call actionable are those that we have contact with and that we are in process in the process of getting those evaluations completed valuations is about for credit process now they follow act numbers of 327 of 328 so 1 is a fitness to proceed 1 is a responsibility examination and then we follow those with a 310 which is a restoration examination for those of the 3 main there or numbers those of 3 main evaluation tops that we speak of. So when we began this to to revamp our system and change the model the way that we handle the conducted this in March 1 of this year what you see on your let's see what you see on the second page shows you where we were we begin the process we were sitting at 465 overdue valuations and bout by definition overdue means 60 days past assigned so when the valuations or court that are the state hospital the by where we have 60 days to conduct the evaluation to write the assessment and get the return to the court unless we have an extension granted we have 465 over to evaluations which is it's a large amount and now I will tell you that number has been growing year after year after year this is been ongoing problem the state hospital it's been it's been dealing with. We started our a new program I'm going to go through some very just very briefly store some of the details of the enhancements in this in the in the way that we've changed our systems but this morning and less than a year our numbers at 92. So we have reduced that backlog from for 65 down to 92 actual over devise a way shins that we are pushing through to laminate I'm very very proud of the hospital. For the first time ever we've had 12 consecutive months where are output has exceeded our input we have we have completed and exported more evaluations to the courts then we've had there that we have received at state hospital and I would say that is a monumental fate is never happened before but for 12 consecutive months now we've been on the right side of getting this getting this that this project tackled. What we have some the things that we've done at the hospitals we looked at the way that we reimbursed for evaluations and our system was really old have been what it was for quite some time and so we have creative incentives to help >> our >> community health centers we have increased what we pay for an evaluation when it is completed timely we have a and and and and administrative fee that we will title to committee mill have center in return for upon receipt of in order they will get us a date schedule back within 40 8:00 hours so we know that we have something in hand we have case managers not the state hospital where we've created for new positions to handle the state we divided into 4 zones and we monitor each of these evaluations individually uniquely we held by weekly calls with community mental health centers to discuss their evaluation load where they are what's going on is there anything that needs to be done differently do we need to pull those there are times we need to pull those evaluations back in the state hospital the individuals may be not in a condition to complete an evaluation we request extensions of the courts. But is that communication piece that was lacking pro beforehand that we have really worked hard to improve now to stay on top of what our load is. We've hired an attorney to stay at the state hospital in 2 paralegals and. >> Our our >> legal staff communicates with courts directly by telephone 3 email through written letters but we keep our judicial districts updated on what the status is of the valuations in their in their districts and we let them know and we answer questions of the courts and we now have a number and a face and a person that a judge or prosecutor or defender can call should I have questions and I can speak with to get information about that particular case and we've seen that's that has really helped made a difference in relationships that we have with our courts. As I mentioned we we looked at our data and our data was really antiquated we we didn't have a good grasp of what was actually out there we do now we created dashboards which we now have a public facing dashboard and we use this daily our forensic staff at the state hospital and at the division office daily we look at this we have an updated numbers that kind of show us each day and the what are trends are what we've got hanging out there what we have that's coming due and it's all used in in hand to to to do to eliminate our backlog and get us to the state of current and that is our goal. >> See >> in addition to also done something little bit different and this kind of falls more into into Trish is area the house. We have a treatment recommendation report that we now generate for individuals that are referred for evaluation so. Very often we find that the same person will be ordered for an evaluation 60 days apart and in 1 case second day in 1 case we had we had 11 offender that had 4 valuations orders in 45 days. Set in and it's I don't to these are these are persons that are frequently violating the law they're getting picked up not always in the same jurisdiction and order after order is being generated. Our goal with the treatment recommendation reports they get in any side a court evaluation is not a treatment recommendation is not a diagnosis if you will it's a determination of fitness at or to termination responsibility but we follow that with our community health centers and it state hospital with that. With a clinician to look at this person to say this is what the problem may be and we 5 found particularly through Francis there are are cross stabilization units that if we can intervene and if we can stabilize help a person becomes stable. The likely we can prevent them from having interactions with law enforcement and entering this forensic system thereby reducing the number of violations that are ordered it's a it's a win win all the way around and we can help individuals become stable and stay stable and be productive in their communities. And avoid these these touches this these friends it touches and so this is member excited component of the of our program we've never had this before but we're seeing some very positive results and some great stories come out of that. We have some diversionary efforts we've been working with courts we do have some diversion courts in the state we do not have enough we would like to see more Devin who is our state set forensic system administrator at the state hospital she's a former prosecutor a deputy prosecutor in Pulaski County she's working with courts she's parting with the a OC that she's out making making the sales pitch and we have a we have judges we have prosecutors are very interested in working with us on these diversion courts to do just what I said keep individuals who are frequent fires for the system to get them the treatment they need to get them the services that we now provide in our state and. In an effort or a by that effort to keep them out of our system so that is a that is that is where we need to being behavior health we need to be serving those parcels clients those patients as beneficiaries and helping them have a better quality of life. Our collaboration we've we work with jail ministrations now we're partnering with the sheriff's associations with the as I mention AOC we are working with our prosecutors with our public defenders all in a concerted effort to reduce the number of evaluations are ordered within our system >> at >> as I mentioned 2000 year is quite a load and it is difficult to stay on top of that the number of love forensic evaluators frantically trying to psychologist that we have is and that's a very limited number and so our desire is to see that number of evaluation orders reduced. Allows us to stay on top >> of the >> orders that we get in a much more >> it >> might get a much better way makes it a much more manageable number but we saying some great games this year I would tell you that with the contracts that you have with our committee mental health centers what we have found this year is we have exhausted our forensic funding on several lines with our contracts I'll be coming back to rail C. in January to asked for additional funding for our communal Senator contracts >> which >> normally workable we're back asking for money it's it's not always occur for great reason I'm excited for this we're in our final push to eliminate this backlog >> these >> today 92 that we have over due to get us to a state of current which in my tenure with the H. S. I've never sing >> so >> our our our our goal is to add a to add the funding that we need to not only handle our current load for this fiscal year but also complete our elimination of our backlog and be in the state the state hospital has not been in >> so >> I would say I'm I'm I'm quite excited very very proud of the gangs that we made I'm very proud of our community health centers and the way they have stepped up and partnered with the hospital to see this project through. >> Well J. congratulations to you and your team on what you did thanks and on the back wall to get that working on an and I know >> from your >> presentation it was not easy I can tell. But >> congratulations on that >> and also I am happy to see that you're record dating working with your the local clinics in police and also the the crisis stabilization unit you mention that plan that we have one there in Jonesborough and I think these things are in big improvement. So it how how much communication through that system have you had I mean is that a big part of what you're doing or small part >> no wait wait this is used report reporter at a monthly we're in constant communication with them Ross still relatively new and and we work hand in hand 3 of the 4 are partnered with a community health center the fourth here until I see county is partnered with you I am mass they do a fan a phenomenal job of stabilizing persons and preventing them from having from from being charged criminally and and they're they're doing great work we're seeing some of that relief at state hospital as I mentioned we're >> we've >> we've been ahead for the previous 12 months we have completed more than what we have received I believe that is in part due to the success of the C. issues in their early interventions and as I said keeping keeping the persons there that are coming in contact with those beneficiaries out of the forensic system in that is a big accomplishment >> chapter regulations yes Sir Senator hammer you recognize request. Thank you Mr. The. So as far as making improvement because I think part of the problem is >> sometimes >> the courts just send people down to passion of county judge has somebody sitting in there county jail that is backlog waiting to come you all of the judge kind of gets in and around on that deal and so >> how are the communicate you referenced at thank may go by wanna clarify >> Howard communications going with the judges out there >> and >> are you able to track specific areas where you don't have cooperation among the judges. We're >> we've seen improvement Senator we we we do receive fewer 24 hour admit >> orders >> than we than we used to what we what we find now is that we get phone calls first very often from from the from from a court from a prosecutor's office they are dated >> the >> the courts have recognized in in large part the efforts that are going into to improving the system and so I would just I would stay that by and large what we have found is it's been a minutes it's been much easier since we've had our new systems in place than it was prior to particularly with the leniency that we get from the courts in our understanding that when they have somebody that is that is the compensating for instance in our jails and and we recognize they need to be admitted to the state hospital this is a person that needs to come out well we were full at ash >> our >> our senses there is typically 100 percent and so for us it's a one out one in when we discharge a client a patient in the morning that afternoon will follow up with an admission that's it's a it's an ongoing process and we're very good to work with the courts and our judges now I understand too that they may have somebody that's on the list that needs to come the state hospital >> but they also >> in a very often trust that if somebody jumps ahead of them in line it's because that person in jail is is acute is a danger to himself and others and that they are just to the >> to the sick >> to the point that there is no place for them to go and they need to come in and so we sent our >> the >> the cooperation on the courts has really improved I'm very thankful for that. >> And then I want to of a file for you both are still sit at the and if you get a call through the number on the >> on the >> first part of report we got which the determination is where the person is referred to say of a community mental health center >> verses a >> independent >> practitioner >> ideal assign people or how do you spell that so that the distribution is equal and fair. >> So the way that people are as to when someone calls the beneficiary support line they are given 6 providers that they can call so there given the information given that particular county there are 6 providers title they're given all 6 of them if they call Klasky county where we have 91 providers then they will be given in a rotation so I FMC rotates those providers so that they're giving out 66 providers at a time it also is based on whether or not that person request a specific type of provider so if they say I would like to see go to a barrel health agency then we'll give them only barrel health agencies by request only independently licensed practitioners we will give them only independently licensed practitioners and you keep a report that shows the distribution by practitioners farmers the ones that referred out so 5 call jumper said Hey I want to see in in place to county you had 100 calls and. >> I will certainly check with a FMC to see if that reporting how they manage that Senator hammer will get that report I just wanna make sure it's fair and equal and nobody's getting of of a loaded up the absolutely thank you. Seeing no further questions thank you all for the report. Thank you committee we're we're losing a lot of people here but I think it's important if we look at these programs that we're doing to see what the progress is in the accomplishments also for the fallen short so we're going to have some more these program presentations in the future so Senator been on like recognized thanks just before you adjourned I want to give a that members of the committee a few follow ups and just FYI the state of Mississippi only got 43 referrals for a forensic evaluations we got over 2000 and my information from DHS is that Mississippi lost their chords battle and the DOJ took them over so that's why it's incredibly important we don't wanna be taken over but does on the last meeting at the provider lead Arkansas shared savings entities the pass issued that from my understanding that language was added to those agreements and they were agreed upon so that's just a follow up from our discussion that we had a very lengthy discussion that we have from the last committee meeting so from my understanding that it was accomplished secondly the A. B. D. decision regarding disabled the dependents eligible for being covered by the parents policy that I understand decision was reversed and so those dependents will be able to stay on that insurance I think there were a few that. You want to add I'll let you add to that I know that represent a lady man works really hard on that so I think we need to give the update on that but that it is that it issue that we brought up at that committee meeting it was her first let me answer for you Senator is correct that was read burst but as you all might remember there was a long discussion and and that decision was made late mid December it was late December and do you all have received calls about this I had a couple of people that called me. That the insurance was not the payment for their insurance was not taken out on January one and their their bill children were sick anyone make sure their insurance coverage was still effective in calling the secretary I found out that some of the paperwork was not processed in time to reverse that so if you get calls about that that insurance is still in effect. But they did not withdraw that money for the premium. These individuals will have to pay that premium but 3 insurance is still in effect their cards are still good so that decision was reversed but there's some issues there thank you and then number 3 the pans panda Advisory Council that met last week I think Senator hammers gonna chair that that correct. And I'm vice chair of it and represented less warrants so I would just encourage everybody I was not able to make that meeting but if you we go online all the items from the agenda are posted online from that information from that meeting and then lastly the issue with the S. solid waste district tire recycling action I know that is still on going and in the process is that correct 80 Q. and so will have information about that as a follow up on a future meeting that correct okay because I had people asking me about that if that was gonna be presented today and it's not that it will be in future meeting so if you'll just let me know so that I can make sure that those individuals from that area and that district are notified so they can attend that meeting right okay that's it thank you. All right committee this last thing on the agenda and we are sorry Senator >> Nicki >> just wanna will be the second but I'd like to >> ask >> would be would be hard for us to have a copy of the of the entire rule attached to each one of these now if there was to be a 20 or 30 page >> rule I mean we could just have one copy maybe at the desk but >> if there's >> I would like to have the entire rule on each one of these >> is that. Is that something that would be hard you can but the bill that will not roll at the rule that was so we have a synopsis of it but we don't have the actual rule is kind of like a minute ago whenever we were talking about to to back to and the younger people put at a copy of the rules >> we >> we could of >> done through their rack we can just >> seen would actually say it. >> Right >> right get that but may and again if we may need to put some parameters and that if it was to be. Some rule like that you know I'd hate from >> pages and attach it to each one of ours but. >> Good good suggestion thank you Sir. I mean or something that would. Well I guess we have one copy that people could review if they want to put a small just attaching would be much better so all right thank you committee we are adjourned.