ALC-Employee Benefits Division Oversight Subcommittee

All right members will call the meeting to order Uh the first to. First action on the agenda is going to be Mr grant Wallace you want to come forward I think there was some changes the V. D. for a drug formulary that was presented to the state board of finance and if I'm not mistaken you had to hand out and staff is already lay that in front of everybody so that should be in front of you I believe they or the One of them is blue and other ones be right under it. Thank you Sir grant Wallace Director EVD. The first item is a change to formulate these are medications that are currently on the navis base for military. So just to give a little background with through the R. F. P. in the agreement that we have our formula airy as it existed on six thirty will be grandfathered for the first six months of the agreement so between seven one to December thirty first however navis does have a base formula area that they operate off of it that is out in known within prescribers in in that in that community so what we're trying to do is to ensure that there's no confusion no disruption no heartache is that we will. Work off of the base formula airy while grandfathering the existing formula airy that wait any new prescriptions that are written after seven one can utilize the neck the navis formula area as well as Max start to maximize the relationship that we have with navis so if you look at the top one that has the blue on it you will notice that there are some lines that are just plain text and some that are in bold that what the advisory commissions in the state board of finance approved or the items that were in plain text would be added to our formula airy the items that are in bold will be excluded from our formula airy. The items that are in bold or the more expensive ones that we already have an alternative on our existing formula airy and there really wasn't a benefits to adding them at that at this time we will continue to review this formula airy and hone it into the work over that first between now and December these are living documents this is something that we regularly review with the advisory commissions and that work will continue to go on we just wanted to make sure we had a good starting spot on July first and that there was not going to be any confusion or any issues come up with any new prescriptions or any non grandfather prescriptions that could potentially be written. Okay members as anywhere anyone having questions on the side of. Representative Wardlaw. Thank you Mr chair looking through the former Leri you give the treatment types down through here we had some discussions and a notice couple these are not better treatment types we had discussions of using drugs for part of the weight loss stuff and I do see there's one or two in here weight loss reduction is the treatment is that how what how is that progressing can you give us a kind of an update on where that's progress and we're starting those conversations Sir we really haven't dug into them deep to really get the study I know they're still work that the FDA is doing on that and that would still I am asking for a little bit more time to kind of get into more depth to get something more definitive in something more defendable to be able to present to you all right if and when we were ready to go down that path Mr follow. Yes Sir could you somewhat includes on us discussions and I've been in management plan as we go forward through that study that I I was thinking that that would be a good nexus and an opportunity to do that yet because they are related yes so if you can bring those up and and basically I wouldn't be in favor of do anything unless the call it was cost driven so just make sure that we are looking at the cost of the surgery versus cost of the medications and and what the benefits of each of the side effects please yes Sir. Thank you Mr. Yes Sir thank you. Are there any other. Are there any other questions in regards to this and senator after one but just some clarification Sir sorry I forgot when I was going through this is temporary approval of this from now until December the thirty first of this year right thanks thanks for a remind us of that. Anyone else okay I need a motion to approve. I got a motion to approve the got a second all in favor say aye opposed Like sign C. N. nine that motion is approved Mister Wallace you get now go to number two review of the B. D. contracts the first one of. it's going to be with the B. R. X. so if you want to begin with it okay you B. R. S. this is a an existing partner that we work with you may recall that they have been. For lack of a better term a kind of the controller over our net impact relationship they manage the rebate program they do they can they help assist us with the formula airy development and kind of get more into the weeds what we're doing now is involving the relationship more into a consultant role where he B. X. would advise obviously navis is going to be the entity that now recommends for military additions exclusions etcetera that they would be kind of are subject matter expert on our team to help us kind of navigate that and make sure we are making the best decisions they're gonna go back more to an audit role is well in auditing the rebates and the claims making sure that we're getting appropriate rebates and that everything looks valid and as it should on that work and then assist us over these and especially this for this year assisting us as we continue to on board navis and continue to roll out the implementation after seven one. This is only for one year and I'd be glad to answer any questions. Okay members are there any questions regarding this centreboard. You're recognized Sir. Like Senator hickory Hickey Mr Wallace I just had a question here so in regards to the navis contract individual pharmacies gonna have the opportunity to opt out or is this just thrown in as part of a national contract that they're not you know not gonna have an opportunity to opt in or opt out of like state what law should allow the they do have that so obviously the existing navis network that was within the state can continue to that's an agreement directly with navis so they can continue to have that relationship there was a list of those that were not that were already on that were existing within the E. B. D. a relationship that they have reached out and are working and negotiating with that but they always have of the pharmacist themselves as the option to engage with Navistar not to. Okay so what you're telling me is it when the new rates come and there's concerns about reimbursement that individual pharmacies are going to absolutely have the ability to opt out that is my understanding thank you. Thanks center board anyone else. Okay members on this one I have I have a motion that I want to read as just to make sure things are done exactly the way that the Committee walls thing is this is a ten ten point six million dollar contract over seven years as you heard to Mr Wallace say is for one year what we want to make sure is that this is coming back before this committee because the legislation that was created that you all that we did in special session with a kind of dictates that so that is the reason for this motion I move review of the B. D. B. R. X. contractor consulting services through June thirtieth twenty twenty four and requested prior prior to any renewal of this contract for an additional term the B. D. director bring the request for new before this committee for review and approval. I read a second on that all in favor say aye opposed okay that motion carries the next one with the mainstream technologies yes Sir mainstream is our existing technology partner there are development partner within the A. R. benefits portal which is our operating system that's how we communicate not only with individual members but within all of our vendors as well the T. P. A. R. TBM except for a. so this is a one year extension it is my desire that we would do a full R. F. P. and twenty twenty four it has not been done in a while and obviously it never hurts to open up the door and and kind of see what is out there and again this agreement was already in motion and we would not really have had time to try to do in our if he just in the ten year that I've been here but I did want to just go ahead and put that out there that would be it is my desire my goal to do an RFP for the services and twenty twenty four. Was anyone have any questions in regards to this one. This is C. two. Okay. Did someone say they had a question. Okay your motion will be to review and approve correct okay you're what you're recognized. Okay representative Wardlaw was motor motion to review and approve all in favor say aye. Any opposed. Okay that motions also passed. Now you have a report on connect your care services contract right connection here is our HSA FSA a vendor this is just one of their regular one year extensions off of the seven year agreement there are no changes in either the rates for the program. Okay members anyone have any questions in regards to this report. The way it was set up you just posted to thank you for that. Okay the next one if you're going to update own virginity the therapy's Act of two thousand seventeen yes all right so in full disclosure on this I have very limited information on on this particular act I was asked early on during the session to research and see what information was available that DVD had when the search that I did conduct. Did not result in really anything beyond Advisory Commission meeting notes internal procedure list that was created and an outline of the design of the program I don't have any information on the relationship with the blue tail who was the vendor that was supposedly picked I don't have any information on the study or the outcomes are anything related on that I do know this was a pilot program that apparently was not renewed or not extended after the pilot. Right. Someone from the house it S. S. cause to look into that so I said that's what this was about of I apologize I could remember who to ask us to do it so that's why this is on the engine. You're in C. thirty eight. Is that right okay representative breath you're recognized thank you Mr chair yes I was the the person from the house to raise this because I realized we did have some activity and I did attend some of the meetings but I know that. It did not appear that anything had materialized from that no real results. and. I don't know what happened to blue tail I know. There was probably an issue with them but this I don't know what to do with this legislation because it is enacted legislation in it it never really was in it you know follow through on it in my opinion and regenerative medicine is cutting edge and it does provide many benefits to patients and to insurers because the patients do not have to in every situation undergo invasive procedures and they don't miss as much work and the cost is not as high and I felt that this was really important legislation to follow up on. Yes ma'am mistrust map mask you do what you do I remember correctly was where the. Where the committees or was the subcommittee that that this legislature dissolved were they the ones that were tasked with with actually doing the study or do you do you remember looking at that sort of in twenty seventeen twenty eighteen yes of the committee is that whatever reason only looked at this I'm remembering the calendar correctly they would have been dissolved and the new committees. Right. So I think that was and now this is coming back to me a little bit but it whenever we had looked at this in a few weeks is passed or whatever I do believe that was part of it that you're correct the legislation was in place then the legislature actually dissolved to the who the entity was it was supposed to to actually look into it so you know at that point I don't know. In other if there's another Avenue you know if if this if this if this and we we could probably look at next meeting if we want to try to look at you know if this subcommittee wants to do Interim study on something like that you know maybe maybe you'd like to get with the members and kind of discuss that with them prior to to another meeting if they do you know maybe we can run that through here to try to get in on study so that. That if anything needs to be done before the next regular session at least that would help you get that in place thank you I will pursue that okay thank you Mr represent bro. Okay the next item is going to be F.. Okay so this is an update on the that scan approval process. kind of going back a little bit the this issue developed at the end of February and an issue came up where somebody was trying to get a head skin in the maintenance or follow up of a cancer diagnosis and they were denied. So we reached out to health advantage at the end of February and those conversations have eggs continued up through June seventh there hasn't really been a clear reasoning as to why the denials. Kept kept occurring or what went wrong we've been told that there has been a misunderstanding on the verbiage of the forms that providers fill out with an aim or Caroline who is the subcontractor that route that handles the prior authorizations for the services some unclear guidelines that aim slash Caroline might have been following or just a complete lack of understanding of the Arkansas law and how it plays in in this situation I did ask back in February for a root cause analysis and receive that in March at that time we learned that there were thirty cases that were identical to the one that triggered this whole investigation. we are still awaiting the details of those thirty cases and hope to have them. We'll I would have hoped already have them but obviously still waiting so we'll see. I also ask that health advantage established and provide written documentation that we got a copy of two aims last Caroline that updated and corrected the guidelines. For them I do have a draft copy of those guidelines and it does make it very clear what our expectations are and that there should not be any further denials when it relates to the provisions within this law we will continue to monitor their sisters this situation and it is a regular item on my touch base agendas with the meetings that I have with health advantage. Okay members you all heard that explanation does anyone here have any questions in regards to that. Senator Stubblefield you're recognized Thank you as far as precluding them from the. Being sent accepted I don't know the uniqueness because I haven't gotten the details that we kind of give me that it did additional information I just from what I have gathered at this point it would have been somebody that had a cancer diacritics cancer diagnosis and the provider was using a pet scan and the monitoring and insuring and just watching to see if there were any further developments and again it's coming back to the way that they're signifying that monitoring or the verbiage that's being used seems to be one of the triggers that is not letting this process work as it should be when it comes the prior authorization but as as far as a specific similarity unique thing that's going on with those thirty cases I don't have that information right now. So I mean we do hundreds if not thousands of pet scans every every day. One where these. You don't have any specific answers to why these were singled out other than there is in there were and forgive me I don't have the number on the top of my head but there were an additional few hundred that were appropriately denied it was that these denial should not have occurred because of that previous cancer diagnosis and that it was in the course of monitoring that and making sure that there was no reoccurrence or something like that that there is confusion or something going on between health advantage and their subcontract their subcontractor that that was not clearly communicated or set up or whatever what happy and they all had the same zip subcontract yes aim or Caroline they've just changed their name is the so conserve the subcontractor that health advantage uses for these prior authorizations on pet scans one in German. Okay. Senator Stubblefield your finish Sir Sir all right. Anyone else have any questions in regards to this. Okay seeing none will continue on to the. Next item is G. and I will have a question for you under other business just so that you know okay correct at this one hopefully should be pretty easy and straightforward what we're doing is allowing a spouse who is also a state or public school employee and on our insurance to participate in the bariatric surgery process currently without before this changed only the individual policy holder the O. one the the subscriber would have been eligible so I I don't know that this was really and I think it was more of an unintended incident where you have a husband and wife who were on state insurance but one of them is the O. two or dependent in the care and because of the way that the criteria set up that dependent was not allowed to participate we're just correcting it that the spouse would now be if they otherwise qualify to meet the other criteria they would otherwise be allowed to participate and they don't have to be the old one on the plan. Representative makes us so you have a question Sir you're recognized thank you Mr chairman I have a couple of its okay yes so you're just looking at the other criteria here one of criteria says has at least five years continuous employment as a state or public school employee as the as a criteria so my question there and I've got got a couple related to that is that full time employment part time employment mix of both and it's kind of ambiguous it would be full time okay so that's something you might wanna corrector to make sure that that says full time employment and then related to that the way this is worded is it's five years continuous employment as a state or public school employee so if I was a public school employee and I work two and a half years and then I switched over to work at a state agencies word I have to start all over again or for that two and a half years count towards right it would count towards okay so again the way this is says you have to be one or the other so you might throw in and or in there just to the clarify that and then my last question. Is how old do you have to be to become a full time state employee what's the current law that. Eighteen hours yes. The thing as anything okay so the reason why I ask that is doing a little bit mass or safe eighteen so you got to be eighteen and them five plus eighteen is twenty three years old so the way you have it you say the way it's listed here is you can use us twenty years old and be eligible well if you're twenty years old that means you would have had to start is a state employee at fifteen. So you can kind of say I and I and again I don't know that makes a whole lot of difference but just on that out there is you're probably won't have any twenty year old simply because they're not all in on that if you could get a five years and then that that time period so if you just look at those couple things I think thank you all be great thank you thank you Sir. Thank you for that representing makes. Anyone else have any questions regards to this. Okay so you know we're gonna go to other business representative Wardlaw you're recognized. You thank you Mister chair I had a member submit text this morning and not want to know how it would affect our retirees in this maybe information you get back to us on Friday to complete council but Conway regional is not renewing their contract with United healthcare and I think there's some concern on how that will affect our current retiree population it is on our Imedi plan my understanding is is that if they accept Medicare than they would accept the inmate a plan that's offered our retirees is that still the case how will this work out yes Sir and and just to give you kind of a little bit heads up the calmly regional to be quite honest I was given some misinformation originally this is been something that's been on my radar for a cut to two and a half months now and I I at first it appeared as though our members would not be impacted that has since been reversed but you are correct as long as Conway regional still accepts Medicare are in the PD members will still be able to access the facility it just goes into a different kind of reimbursement and and payment mechanism that hers it is my hope and I continue to impress upon United healthcare the importance of renewing this relationship it is with the facility only so if the provider does have a nother office or another area that they are working with it's not with the providers it's with the facility so again I am hoping that those conversations can still occur there weekly conversations occurring between calmly regional United United healthcare I'm getting updates on those on a weekly basis and impressing upon them the importance of renewing this relationship because we do have a substantial amount amount of retirees that are in the Conway area and utilizes facilities Mr can I make a request to the. Director please yes Sir I think I think the the right thing to do from here since we're seeing these type issues in the market is maybe monthly as we have that you B. D. subcommittee meeting at the end of the agenda you can update us on any network issues that you're seeing or hearing about in the public and this would be a good way for retirees to keep up with that and how its progress and so say for example if a Baptist health was having this issue that would be a major impact depending on how big Baptist health is throughout the state so I think it's important that we keep our folks up to date so as you're seeing these type issues if you don't mind bring that to the committee on a monthly basis so that we just keep up to date on it yes Sir thank you Mr yes Sir. The representative makes you're recognized. Thank you Mr just a just a follow up on matters because I have constituents on contrary who who have run into this can you give us some of backstory about what caused the situation as I understand it it is a disagreement between the reimbursement rates from the commercial side between United healthcare and calmly regional tax of money money okay all right thank you. But it did originally from the commercial plan not the Medicare advantage plan okay. Thank you Sir anyone else. Your any other business come before the committee. Seeing none were adjourned.