Public Health Welfare and Labor Committee-Senate and House
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Speaker 2
0:00
and continue to rise due targeting marketing and flavor products and Arkansas 44% of high school seniors have tried vaping. Flavors like fruit and candy appear directly to young people while social media makes vaping seems normal. Vaping among Arkansas students in now more than double traditional cigarettes is used.
We must act to protect young people
Speaker 4
0:45
from these influences. Good afternoon. My name is Ixiana Torres. Vaping does not only affect the user. Vape aerosol contains nicotine, heavy metals, and harmful chemicals.
Speaker 5
1:03
In Arkansas, over 10% of adults vape.
Increasing exposure in public spaces, children and families should not be exposed to these substances, and public clean air should be protected for everyone. Vaping is disrupting our
Speaker 8
1:21
schools. Students are using devices in bathrooms and classrooms, affecting learning environments. In Arkansas, 7% of 6th graders and 22% of 8th graders have already tried vaping. Schools are spending time and resources addressing this issue.
This is both a public health and education concern. Vaping harms your brain primarily through high concentration nicotine, which alters the brain chemistry, disrupts development, especially under age 25, and impulsed control while at risk of anxiety and depression and mood disorders. Addiction and removing nicotine and vapes changes the brain chemistry, creating a relance
on nicotine for pleasure. Dopname release, which leads to addiction, irritability, and rentlessness when not vaping. Nicotine increases dopamine, a chemical messenger that users feel awarded, creating a dependency where the brain requires nicotine to feel normal. Vaping can heighten stress and trigger and separate mood disorders, and users often experience brain fog, reduced concentration, and impaired memory.
Speaker 9
2:44
Many students feel pressure to try and do it, and try it, and some become addicted quickly. This is not just data. This is our everyday experience. We are asking for your help to protect students like us. Thank you. We respectfully recommend prohibiting vaping in all public indoor spaces, aligning vape laws with smoke-free laws, and increasing prevention efforts. Arkansas has made progress in tobacco control. Now we must include vaping. We urge you to take action to protect public health.
Speaker 12
3:22
Vaping is impacting the health and future of Arkansas' youth. We respectfully urge you to support legislation that prohibits vaping in public places. Thank you for your time and leadership. In closing, in closing,
Speaker 15
3:35
and I just want to take the time out to thank you all again for giving us time to bring this very important concern to you um it is um whenever i go and speak hit hit your button oh i'm
sorry go ahead we just want to hear
Speaker 15
3:50
you this is really new for me i'm just talking to gymnasiums full of kids
and i have a loud voice but yes this is a very important concern and we are so happy to be here today and let me just take a mention that today is april 1st but today is actually take down tobacco day so we are here to fight for our community in arkansas for better laws to help protect our future and our communities, we receive a lot of calls and complaints from people who are not able to enjoy movie theaters or public places because there are people who are vaping, and most people seem to think that vaping is harmless or less harmful as
normal tobacco smoking, but research and studies found out that vapes actually contain two, three, and up to four times, just depending on the brand of tobacco or vape e-cigarette that you're using, it has two, three, four times as much nicotine as one pack of cigarettes. For example, one vape pod has 40 grams of nicotine in it. One pack of cigarettes has 20 grams of nicotine in it, and some of them can vary up to 80 and 90 grams, which is the reason why people are becoming more
addicted to vapes at a higher rate because they're getting introduced to more nicotine at once and you know it's concerning when i get called to an elementary school because of fourth graders having problems with vaping and i have to offer cessation materials counseling and other resources that be well arkansas offers um through the arkansas department of health so we just thank you so much for listening to our concerns today and thank you guys project prevent we did it
thank you guys it takes a lot of
courage to sit at that table hey before you guys
leave i just again want to say our we are so grateful to you it took a lot of courage uh for you to come and speak to us you did an outstanding job articulating your position and advocating for your cause.
So thank you for that, and we hope that you continue to be successful, and we hope to see you back. If there's legislation, you'll have to testify for it in the
public health committees during the session. So make sure you're prepared to do that as well if the legislation that you're working hard on continues. But don't stop here. Talk to your neighbors. Talk to your communities. Get a lot of people on board and start building support for the legislation that you want to see passed by this General Assembly, okay?
All right, challenge is on. Let's do it. Representative Bart
Speaker 28
6:52
Schultz. Mr. Chairman, you had a request? Yeah, I'd just like to take a moment to recognize our friends from Leadership Batesville who are in the room. Members, if
you would, help me feel welcome. Make them feel welcome. Thank you, Representative. With that, we'll move on to the overview of the Rural Health Transformation Program.
Secretary Hudson and Brad and I. I'm guessing
the Secretary was scared you couldn't handle it, so he came to help
Speaker 35
7:37
you. That's exactly right. True. Afternoon, Mr. Chairman, Jim Hudson, Secretary of DFA. And, you know, number one rule in public speaking is don't follow cute
Speaker 36
7:44
kids. So I'm violating my number one rule now.
Speaker 38
7:48
Absolutely. Good afternoon, committee. My name is Brad Nye. I'm the director for the Rural Health Transformation Program, and
Speaker 39
7:53
I report up to Jim Hudson at the Department of Finance and Administration. So if I'm recognized, Mr. Chairman, first
Chair
Unverified
8:04
I want to thank you and I want to thank Senator Irvin. We've had lots of conversations about this program, and we thought it
would be a great idea for us to come over and just spend a little bit of time making sure that you have all the information you need to have about this new and very, very important program that we'll be launching here in Arkansas,
the Rural Health Transformation Program. I want to kind of really set the stages for a few minutes. I'm going to turn over to Brad. He's got the details. He is running the program out of DFA, and he's doing an exceptional job. Just a little bit of history. This came about through the One Big Beautiful Bill last summer, a program that was set up, you know, roughly $50 billion to be allocated amongst the states to have programs focused on improving rural health throughout the country, but, you know, especially here in Arkansas for our concerns. And, you know, we went through a process of soliciting some feedback from stakeholders here in the state.
We wrote a plan, submitted it to CMS in Washington, D.C., and then we got our notice of award of about $209 million for our first year of operation. And if we were to maintain those amounts through all five years of the program, that'd mean we'd get about $1 billion, $40 million, $1 billion, $40 million over those five years. My goal is for us to actually do better over time. This is a formula-driven project. So based on how well we do in our first year of operation, we'll determine how well we get funded in the second year and third year and fourth year and fifth year.
So we want to excel coming out of the gate, do a really good job, because I'd love for us to get more money next year. One of the things that I'm particularly sensitive to from your perspective is just thinking about what this program is and what this program isn't. For those of us who've been around for a little bit, we remember all the funding rounds that we did with CARES Act money and with ARPA money. And I think it's fair to say there was just at times just frustration about the process and maybe at times not enough transparency in the process and how do we get access to the money.
And I think different stakeholders felt like maybe they didn't have an opportunity to kind of get in there and get access to the money. It is really very, very important to the governor. It's important to me personally that we have a transparent process. And by transparent, we're going to tell you, we're going to tell stakeholders all throughout the state what money we're getting ready to release, what that money is for, and how you access the money, right? And the important thing that, as I'm talking to hospitals and talking to clinics and physician groups, is to draw a distinction.
You know, before when we were dealing with ARPA money and CARES Act money, the conversation was something like this, we have X amount in financial need, how much money can you give us? And that's a very legitimate conversation, but that's not what this program is. This program has very stringent requirements from the federal government as to what we can do and what we can't do. And one of the things that we can't do is just provide working capital needs to the hospitals and to the clinics and to the physicians.
We've got to be very targeted in how we approach releasing the money. And I would say that it's more focused on the overall health of Arkansans than it is being pointed at particular institutions. Now, we help the health of Arkansans by making sure institutions are giving them what they need to have better health. So it is a partnership. But really the focus is, what can we do to move the needle in terms of the quality of health outcomes in the state of Arkansas? And this really is one of those opportunities that is once in generation.
We may have to have a conversation at some point about, you know, the funds are tight. I'm just not expecting that's going to be the case. I really don't. I think the question is, can we spend the money fast enough, and can we spend it wisely enough? That's really what I'm dialed in on. so brad that's his number one job we talk about it all the time don't let us do anything stupid we don't want to do anything stupid let's make sure that we're moving the money out the door and we're really getting it to those things that need it and so big picture i'm just give you a couple things to think about from from your perspective as you're talking to members of
your community one if you look at our plan i encourage you if you've not read our plan please read it you can find that at dfa.arkansas.gov we'll make sure a link goes to staff and they can send it to you it's over 100 pages so you probably won't print it out just read it online but we're up front with what we're going to fund what our priorities are but there's a tagline that we have there that introduces that plan and the tagline is arkansas healthy connected local those three words are more than marketing they really set the stage what we're trying to do
the focus is on health you know we want to be able to say at the end of the next five years that the efforts we put into this program led to better health outcomes in Arkansas. For example, we struggle mightily in Arkansas with chronic diseases. What are some specific initiatives that we can do to help with chronic disease management? For example, helping people monitor their blood glucose levels, monitor their blood pressure. If they have congestive heart failure, the things they need to be able to do to be able to address that.
Those are examples of things we need to do. How can we leverage technology to be able to help rural Arkansas? The next thing is connected, and really that's one of the big emphases that we have. Right now, our health care economy is very fragmented. There are lots of pockets of isolation. What we have to do is figure out ways to better collaborate across regions, okay, so that we have multiple counties that are partnering together in order to be able to solve the health care crisis
that we're having to face in our state. So we'll be funding initiatives that really will encourage collaboration where you can have hospitals that maintain their autonomy, but they're also partnering with other institutions and getting some of the benefits of being part maybe of a larger system without actually formally joining a larger system. Those are the things that we're going to be talking about doing. And then finally, local. I'm not a health care policy expert. you know I live in the finance area the governor asked DFA to take a lead on this because we can
run the program pretty efficiently I don't need to take an admin share on this program so we'll be able to do that and maximize the amount of money that's going out the door but I'm very very concerned the governor was exceptionally concerned about us trying to impose solutions on local Arkansans we don't have the answers you have the answers your constituents have the answers they have the most at stake so we want whatever we come up with and what we're funding to be let those be locally driven initiatives we've got the money we'll vet it we'll make sure
it makes sense it meets the cms guidelines and then release the money and then let people go do what they're best at doing treating patients and improving health care in arkansas so with
Speaker 46
15:16
that i'm going to turn it over to brad and i'll be
Speaker 47
15:21
sticking around as well if you have any
Speaker 38
15:26
questions from me after he's done. All right. Thank you, Secretary. So just piggybacking off of what the Secretary just
Speaker 39
15:33
talked about, you know, we are extremely focused on local solutions, kind of a
ground roots, grassroots approach to health care. And in that vein, I'm just getting off of a couple of weeks ago a 10-city roadshow around the state where we did a little deeper dive into the rural health transformation program than what I'm going to do today. Today's more of a 15,000 foot level but at the end of my slide deck there is a URL for an Arkansas RHTP website and we'll have the more detailed slide deck there available so if a constituent in your district reaches out and
would like a little more information, you can certainly refer them to that link. But also, I'm taking, I think the Secretary just alluded to this, I'm taking meetings daily from hospitals, from community providers, from faith-based groups, from vendors, anyone that is in the health care space, to visit with them about their ideas, about where they see themselves fitting into the state's RHTP program and providing them a little back and forth technical assistance.
So I encourage you, if you have folks reach out to you along those lines, feel free to connect those people to me.
Speaker 38
16:52
I'm happy to have those conversations. So RHTP, as the Secretary alluded to, and I've got, again, a 15,000-foot level, kind of a slide deck that I'll go
Speaker 39
17:03
through. Jim's a much better public speaker than I am. i really prefer more of a back and forth with questions so i'll go through about 10 slides here fairly quickly i've been living and breathing this program non-stop the last about three months now
so if i gloss over something if you have questions with permission of the chairs i'll certainly entertain those at the end but thank you so as the secretary alluded to the rural health transformation program first came into being with an act of congress last summer with hr1 more commonly known as the one big beautiful bill act as he mentioned it was it is a 50 billion dollar set aside across five years for all 50 states to look at improvements to access
workforce, prevention, and sustainability in health care. $50 billion across five years, that's $10 billion per year, and each state was required by CMS to submit an application. And by submitting an application, each state was able to access half of that award money. The other half of the award money was a competitive process where Arkansas competed with all 50 states and then based off of how excited and impressed cms was with our plan they adjusted
our award accordingly so as the secretary mentioned we received about 209 million dollars which puts us in about the top one-third of the money that all 50 states have received so cms is excited about arkansas's plan they have high expectations for us and we're excited as well but as the secretary alluded to i'm not a clinician you know my entire career has been health care adjacent but i'm certainly not in rural arkansas providing
services we need this we need you to bring ideas to us back in october our governor put forth a portal asking for ideas around rural health transformation. We received a lot of great ideas. Some of those were turnkey projects, they were shovel ready and that's wonderful. Some of them were more think tank type ideas that still need a little bit of work to become an actionable plan.
And so what we've decided to do is those proposals back in October, we helped those formulate how we built out our plan and submitted it to the fed to the feds but we're treating that as an rfi and so what we anticipate doing and i have a slide on this and we'll get into it is we will issue a series of notice of funding opportunities no foes where we seek shovel ready ideas from applicants for each of our four initiatives i'm about to talk through and when we get those
applications in again this isn't a situation where money is a scarcity this isn't a competitive grant process we're looking for ideas that provide us with a solid plan a program narrative a budget and help show us where it fits into our four initiatives we want to get to a yes when we receive an application so there will be a lot of back and forth that i provide and that our team provides with applicants to help get to that point so let me get a little bit more into our vision
let me get into our four initiatives and we'll talk a little bit more about timing so arkansas's vision for rural health as jim said it can really be summed up as healthy connected and local i think that's a wonderful tagline i think that is the spirit of the plan but we're looking to redesign rural health care again not just about facility stabilization but really about prevention connectivity and long-term sustainability we are trying to tie the dollars we
used rhtp to the broader goals of healthier children stronger families workforce participation and local economic resilience we're asking folks that end up applying to be partners with us in this program to think of this not as a one-time grant not not like arpa not like cares but as a multi-year transformation opportunity five years with rhtp but then the goal of sustainability
post five years for true transformation in arkansas health
Speaker 38
22:02
care So CMS set forth some very specific goals that they wanted to see with rural health transformation and Congress also with the language of HR1 had similar requirements. So Arkansas came up with four
Speaker 39
22:18
key initiatives. Those initiatives very closely mirror what's required of us at the federal level but also lets us
put more of a local Arkansas spin on the way we deliver health care within each of these four initiatives that we'll talk just a little bit about there are 69 sub initiatives and so the way I lead off every conversation I have with a prospective applicant is exactly what Jim just alluded to have you read our plan we encourage folks to go out and take a look
Speaker 38
22:52
at it see which of these initiatives speaks to you that you think you can be transformative in and then have a
Speaker 39
23:00
conversation with me about about that idea the first initiative were i'm trying not to read the slide deck to you guys i've sat through plenty of presentations where i'm read to and that's just miserable so we'll we'll try to ad-lib just a little bit the first initiative is our heart initiative and this is really about prevention and community health this is really focusing on children families and chronic disease prevention within the heart initiative which has a lot of the
make america healthy again type language we're looking at ways that we can help people get access to healthier foods we're looking at nutrition healthier nutrition options for kids that's our grow kids initiative within that same initiative we're looking at school-based clinics school-based education that heart initiative has a farm initiative which is looking at how we can help arkansas is an agricultural state how can we help bring fresh produce into arkansans lives
and help them learn how to cook it helping arkansans do things that we've forgotten how to do like how do you grow a garden in your own backyard with produce that is suitable to being grown in arkansas and provides healthy options for you and your family where we have a move initiative which is about getting folks in rural parts of the state more active active healthier lifestyles we have a faith initiative which we're really excited about which is about engaging
our local faith leaders and places of worship as touch points for rural health. In many communities, there may not even be a clinic or a doctor's office, but there's a place of worship. And when I show up into a small town and I'm wearing a suit like this, it's that old adage, I'm here from the government and I'm here to help. But the pastor, the deacon at the church is a trusted member of the community. Folks already reach out and interact with them.
And oftentimes they know what a family's needs are in the health care space much quicker than any of us ever would. So very excited about that. A couple of other initiatives in there, again, we've got quite a bit to go through. But this is really school-based health, chronic disease, food as medicine, and value-based. The PACT initiative is really more of our hospital and clinic provider-facing initiative.
This is really around addressing access gaps in rural Arkansas. It's around care coordination, and it's
Speaker 38
25:52
around, again, financial sustainability. This sub-initiative includes mobile units using telehealth and technology
Speaker 39
25:59
to help bridge the gap for folks in rural Arkansas moving towards clinically integrated networks and regional collaboration for our hospitals helping them with economies of scale by partnering with
other hospitals helping them figure out what service lines make the most sense for one hospital that might make better sense for another hospital helping them align how they operate we have workforce alignment we'll address transportation issues in this initiative and then again shared services and hospital stabilization is within that initiative the rise initiative as you can see is really our workforce facing initiative we're doing a lot of
work there around establishing a training pipeline for health care related fields in rural Arkansas we envision starting in the k-12 level we do a really good job in
Speaker 38
27:04
the state of introducing kids to auto body and welding when they're in high school but I think we could do
Speaker 39
27:11
a better job of exposing folks in rural communities to the health professions that are available to them because I think we all know that homegrown talent, folks that have roots in a community, if they go off
to school and they get a health care related education, they're more likely to come back home to the community that they know. So we're very high on that idea. And finally, the Thrive Initiative is really our technology facing piece around telehealth, remote patient monitoring, electronic medical record upgrades, and
Speaker 38
27:49
really digital infrastructure as a whole. So rural health transformation dollars, there are some allowable uses of money and there's some unallowable uses of money.
Again, I'm not going to read to you the slide deck, but I think the key unallowable uses of money that I wanted to highlight, and
Speaker 39
28:14
Secretary Hudson, I think, already did a good job of covering this, is we can't pay down debt or just cover operating losses. This isn't one-time money. We're looking at transformation in health care, long-term sustainability. Nor can we cover routine facility maintenance or capital replacement, and we can't supplant existing funding.
I think one of the big disappointments for folks, as hr1 was working through and the rural health transformation program was being developed at the national level was a sort of a last minute decision was made to clarify the states that we cannot use this money for new construction and i know i've had a lot of
Speaker 38
28:57
conversations with clinics and hospitals and they're very disappointed in that but i didn't want to point that out as an issue one thing that we can do and happy again to do some technical assistance with whomever
would like to have it is we can do some targeted renovations so if a hospital or a clinic maybe
Speaker 39
29:15
has unused space that with a little bit of money and a little bit of sprucing up could then be used for clinic space we can certainly
Speaker 38
29:25
help with that so who's eligible to receive a sub grant through this program well it's it's pretty much anybody that you can think of that is health care related it's it's not just the hospitals or the health systems it's your clinics it's fqhcs it's
Speaker 39
29:43
your rhcs it's your ems providers pharmacist university partners dental clinics this list is not meant to be exhaustive it's just illustrative but what we are asking of our sub of sub recipients go out and read our plan we will be asking for alignment with our strategy cms has made it very clear to us that now that our plan has been filed and finalized with them we can't alter the plan so the four initiatives with our 69 sub initiatives are what arkansas
gets to work on over the next five years we're asking for a regional collaboration across all providers. The more partners an application has included helps us get a better idea of how collaborative it is and I think the greater chance of success and the more innovative an idea might be. We'll be asking for helping with data sharing and with performance reporting because as you can imagine this is a federal program administered by CMS. We have a lot of reporting that we have
turn around to the feds again a willingness to redesign care models back in my pact initiative we talked i briefly talked about clinically integrated networks clinically integrated networks are a wonderful platform to help with back-end support and to help with economies of scale but i think more importantly than that cms views them as a wonderful platform for hospitals to use as a base to look at different ways to deliver care and different payment methodologies
moving more towards value-based care away from fee-for-service and prospective payment systems and again i think i've said it five or six times already but we're seeking a commitment to long-term sustainability for health care in arkansas
Speaker 38
31:45
so let's let's talk about program timelines here momentarily yeah
Speaker 38
31:56
guys i hope you're hope you're thinking of your questions
so the high level program timeline there is on the screen you'll
Speaker 39
32:05
notice that spending for budget period one we are already in budget period one that began on december 31st of 2025. this is a five-year program but we receive five separate tranches of money and that money is tied to the federal fiscal year so the 209 million dollars that arkansas has to spend in year one must be spent by the end of the next federal fiscal year so by october of 2027. that is a very very
quick turnaround for arkansas it's a very quick turnaround that we're asking of our sub recipients but unfortunately that is those timelines are set in the legislation at the federal level and they
Speaker 38
32:53
cannot be altered um skip to this slide along with the budget dollars having to be spent by october of next
Speaker 39
33:05
year we must obligate all dollars by october 30th of this year obligating dollars
means we have to tell cms whom our sub-grant recipients are and how much money they're going to receive so as you can see this is a very quick moving program for year one with a very quick turnaround which is why we are are here presenting this is why i'm meeting with folks on a daily basis to hear their ideas and to start helping helping them come along so that when we get to the notice of funding opportunity process in may and june of this year
Speaker 38
33:47
we'll have many shovel ready projects
ready to go okay i think that's
Chair
Unverified
33:56
that's enough before we start taking some questions just real Real quickly, appropriation-wise, we will have an appropriation request before the General Assembly in fiscal session for $500 million. That will roughly represent about half of what we anticipate the funding to be. It's more than the $109 because we'll be crossing federal fiscal years. And so in FY27, we'll have two different awards we're trying to fund, so we need the $500 million. That'll come to you then.
Really stress what Brad said. if there's anything that i'm worried about right now you know we've gotten approval with our overall plan but cms still has some technical questions we're working through we don't have the money yet i hope to have the money in hand sometime in april really hope we have in april so we can really hit the ground running so we're going to have roughly six months to obligate 209 million dollars without making stupid decisions without being wasteful
actually moving the needle that concerns me and believe you me i'm talking about that with the team not only brad but we also have an outsourced uh administrator a bdo formerly known as horn they've got a whole team of arkansans and other folks who are backing us up the application process for the money is going to be completely online it'll be digital it'll be easy to apply and you'll be very clear on kind of how things are moving in terms of what your application is So we wanted to make it administratively easy for the applicants to be able to access the funds.
And with that, Mr. Chairman, we'll be happy to take any questions. I think my Senate chair
has the first questions. How did you know? Thank you. He does know me. So I think just a couple different things, and I've expressed this, but I just kind of wanted to say it publicly. When we talk about rural Arkansas, I hope, and I just want to say this on record, that we are sensitive to the people that are already on the ground providing rural health care so that we're not just dismantling what they have been doing
because they are there filling the space right now. So, you know, I just want to be sensitive to that. Sometimes when we have enacted policies at the state level, we have not been sensitive to that. We have not collaborated with them because they're working within the system they have. It's not their fault, but they're there actually getting it done and making it happen. So, you know, I think it's really important when we say redesign that we're sensitive to the fact that we're not redesigning it because what you're doing is wrong or bad.
And we appreciate that you're here doing this and we need more of it. So we need to replicate what they're doing. So I just want to say that because I think being sensitive to the existing infrastructure is really, really going to be critical. And I think when you say local, I think that's what you mean.
Chair
Unverified
36:52
Is that correct? Yes, ma'am, it is. Let me give you a specific example of how we're sensitive to the point you're making. So I've heard, you know, from numerous people who are pitching opportunities for, you know, mobile imaging, okay?
And obviously there are some deserts on imaging in Arkansas. But what we don't want to do is fund some imaging initiatives where you have outside providers come in and cannibalize a patient base right so we want to make sure that whatever we're doing is augmenting and complementing the health care infrastructure that is there and not supplanting it that's that's a big concern and then also just to ensure that you know if we're going to make an investment on something like a mobile imaging unit that we're approaching that on a regional basis so that we
have adequate utilization of that technology and it's not setting idle for an extended period of that we're moving it around to where it's needed so it is fully utilized you know over a month or over over a few weeks yeah
and i think the same is true with school-based clinics yes ma'am you know you can cannibalize your existing provide patient base and then your providers go out of business that are sitting there you know and so i think that's the same idea um so just kind of thinking outside of the box i'm hopeful that non-profits will hear this because i i want i
would love with physical activity and children for like an Arkansas soccer association to get involved or something to that to where there could be some more innovation and I there's there's one that I've actually been texting because to me the most transformative thing that we could do in changing a culture when it comes to food is building greenhouses and gardens on every single campus of a public school like if you think about that that to me would be the best use of this
money because then you're teaching these kids and then they're going to go home and they're going to teach how many how many of you have baked a recipe that your kindergartner brought home because they baked it in their classroom and they loved it and then they bring their little paper home and we have to do the same thing at home that would be incredibly transformative in my opinion where you could then have like build out an agri curriculum of gardening of you know I mean that's
that exudes the culture that I live in in Mountain View everybody's got a garden and there's tons of fresh produce but that's not everywhere and kids don't know how to do it unless they're in that kind of a community, or they're with a family member that just knows how to do it, and I just think, you know, building and teaching that level, I mean, it just, it fits into STEM, it fits into biology, microbiology, you know, molecular biology, I mean, all of that is encompassed into food
science and nutrition. To me, that would be your best bang for your buck in really transforming under that heart initiative um that's just my takeaway but i appreciate that and we've i've had the opportunity to visit with
Speaker 39
40:00
a provider that's already here in arkansas that's doing that in a couple of school districts the only reason they haven't been able to expand so far is they didn't have the seed money well we can help with that absolutely
you've got the seed money let's do it you've got the seed money you can pull the resources um and and we could do that on a
trans i mean that would be transformative i mean that would you know you can build in literacy curriculum into that whole idea too of teaching those kids and if it's open to the public you're reaching zero to five zero to six not just elementary school kids so teaching the parents and you're teaching the parents and you're teaching grandparents or whomever to come and be a part of that to me that fits so perfectly and i don't know if any other state that would like if we set a goal for that as a state how awesome and cool would that be okay sorry so and real quickly on
Chair
Unverified
40:55
the on the non-profits so you know cms you know was impressed and viewed our application as a differentiator and that we were leveraging the faith community yes they didn't see any other states that were doing that okay and so you know that's one of the things that we're really going to put a lot of emphasis to we do want to have kind of a community non-profit faith community roadshow where we go out around the state and we connect with them directly and just kind of tell the story of what is possible this money and then generate the ideas like farmers markets you know
we can provide we can't buy food but what we can do is provide the infrastructure money to get those things established additional money to kind of maybe help with the cooperative extension services they're already there 75 different counties to be able to leverage them yes ma'am yep to we need to
leverage yeah our extension services have got to be leveraged and we've got to figure out to and my last question though is on your program timeline so it looks to me that and you're going to focus on thrive first is that correct and then pact rise and heart is going to be the
kind of the second phase yes ma'am of the way that you're i mean as quickly as i mean it's it's one month and then the next month but you're going is
Speaker 39
42:11
that correct is that how we're leading off with with thrive which is the big technology piece because we think technology is a good platform upon which to build the other
Speaker 82
42:18
initiatives yes but all four should be launched
Chair
Unverified
42:21
in live by june yes yeah you just maybe varying amounts of money it may be heavier on thrive this year you may see like rise be more next year yeah of course rise and graduate medical education all those folks
are already matched you know for their programs for this year so we just need to do preparatory work this year do you want to really talk about ems very quickly because that's a very important platform you know some of this money will be able to be used to you know purchase vehicles kit out those vehicles so that they we can have a good fresh ambulance corps in rural arkansas and to be able to make sure we have all the equipment there that we need to have awesome thank you thank you mr chair
representative gramlet should recognize uh thank you very much um brad i'm
Speaker 86
43:05
glad you're here i'm glad you're the guy doing this job i think you know this this is good to have someone like you in this position even if you're not the best public speaker um
thank you i guess a couple questions just really broadly like i guess first off you know this is rural so like who who is rural like like i apologize like you know
i'm fort smith it's one of the larger cities in arkansas um do people or organizations in fort smith have a chance to
Speaker 39
43:31
apply no that's that's a great question um so the technically the definition of rural is the
HRSA definition with some additional metrics that CMS set but that doesn't matter CMS came back and they clarified Arkansas can determine what is rural so if a health care provider is in Little Rock or in Fort Smith or in a rural setting urban setting but we can show they serve and connect to rural people they're eligible to receive dollars okay so like so like we've got
Speaker 86
44:01
obviously we have hospitals in fort smith we service people south of
us 40 50 60 miles east of us 40 50 60 miles
because they live in rural environments we should be able to apply for grants i've had great conversations with your hospitals already i'm sure you have okay um and then i guess so when do applications open is that today or
Speaker 90
44:22
later this so uh end of this month early may is when we expect to see
Speaker 39
44:27
the first thrive application go live but we'd like to have all four live by the month of June. So basically as soon we're
Speaker 86
44:34
going to have, we need, we're going to hopefully have money in
hand in April and we're going to start as soon as we can start throwing in at projects that you all,
Speaker 90
44:45
you all approve. The, so the, so this is a CMS funded project. So
Speaker 39
44:50
as soon as the money is available to us, what we're envisioning is this will be a reimbursement based program. So as your folks are out there performing work invoicing us we draw the money down from cms and reimburse them okay no no more than i think a 30-day turnaround is what we're looking at
Speaker 86
45:10
okay and then um i guess there's two more questions so for us in fort smith specifically we're having some um some health care
challenges right now um could some of that money be used to open for new services in some of our our
Speaker 90
45:24
hospitals. Um, yes, I think, you know, the details there always matter. Uh,
Speaker 39
45:29
but those conversations are important to be having right now. And to be honest, we're starting to have those conversations now. Okay. And
Speaker 86
45:37
then I guess finally, um, you know, we have, we have a lot of new, uh, medical, medical schools opening up across the state, but we have a limited number of residencies. Are we, could that be used to open up more residencies? So our Arkansas,
medical school graduates can and will stay in Arkansas not only can it it will be used
Speaker 73
45:56
for a new graduate new residency slots in the state no doubt about that yeah thank you all very much thank
Chair
Unverified
46:05
you and the great thing about you know starting the new slots is we can we can provide the seed capital to get them going and then once they're established and the other ability to be self sustaining by just being
able to build for the services that are being provided representative bulbridge
Representative Jeremy Wooldridge
Unverified
46:19
you recognize thank you mr chair um you know i know it's a cms program so
they're setting a lot of the guidelines and the rules by which you're operating if i understand correctly the state can have a more stringent rule just not a
Chair
Unverified
46:33
more broad rule is that right i don't think that's that's not how i would frame it up okay we've got to operate consistent with what we've given cms as our plan that's so the plan really is you know
Representative Jeremy Wooldridge
Unverified
46:44
what we're having to stick to. So did CMS set what's not allowable for expenditures or did we set that? Okay so my question is and you said earlier there's no capital improvement necessarily for a rural
Chair
Unverified
46:55
hospital is that right? No I said there was no working capital. No working capital. So if somebody needs funds just to kind of you know be able to keep the doors open right not eligible. Brad's point was we there's no money to be allocated to expand the footprint or to build a new building But within the existing footprint, we can allocate money to repurpose space, to take space that was maybe closed down OB Ward and turn it into something else. We could potentially idle space, decommission it, and provide money for that.
Speaker 73
47:30
It could be that you have an HVAC that is out of date and they need to update the HVAC.
Representative Jeremy Wooldridge
Unverified
47:37
We could provide money for that. okay so not a ground up build per se but we can repurpose uh space but senator ervin to her point and i agree with a lot of what she was saying you were talking about you use the example of farmer's market you can't purchase the food but you could build the farmer's market building potentially the infrastructure infrastructure infrastructure around it so not the facility by which they operate but correct what would that infrastructure look like if we were trying to
expand that into rural parts of the state because i've had two communities they're talking about implementing a farmer's market so what would be an example of an allowable cost there
Chair
Unverified
48:09
i would say you know just talk to us have a dialogue with us about what you're thinking about and then you know we'll tell you whether or not it's workable i can imagine things like trailers um you know that are temporary stalls booths things like that it just couldn't be a permanent
Representative Jeremy Wooldridge
Unverified
48:25
fixture that's a new construction okay and then last question mr chair if you don't mind um the application process do of a committee that vets these applications? How does that work? Is that only DFA internally? Is
that local health care providers that are part of a committee who vets that?
Chair
Unverified
48:41
So the committee will consist of myself, Secretary Janet Mann, you know, with the DHS, Renee Mallory, Secretary of Health, Kay Chandler, who is the Surgeon General, and Dr. Ted Brown, who is the head of the State Crime lab those were that was the committee that did the work in putting the plan together okay thank you sir but i'd also say that you know we're having maximum dialogue with all the clinical stakeholders
and so we we want feedback on you know what what's working what's not working in the program Representative Bentley he recognized Thank
Representative Mary Bentley
Unverified
49:22
You chairman Again was getting back to healthy food with Senator Irwin. I'm just been proud to support our farm to school program. So Do the farm to school folks need to coordinate with the regional people to get funds for that? So how would that I'm just trying to curious what that step would be?
Because I know that getting seed money for some of these schools be great It'd be a good thing to get a school garden going So how do they need to connect with the local regional people as part of the
Speaker 38
49:52
application process or? trying to get that that step figured out yeah i think i think connect them connecting to to the
Speaker 39
49:58
regional um would make sense for me because i what we would like to see is you know big bold projects so the more more partners the bigger swath of the state that we're able to impact and and selfishly only me having to look at one application would be the preference i'm happy to
visit with folks and help make those connections um in fact during the application process if we see an applicant a couple of applications come in and they are complementary and it looks like well maybe there's a potential partnership there and those folks haven't talked yet it's apparent they haven't talked we'll work even at that point to make those connections and say have you considered pulling your resources and your ask and being more impactful with it
Representative Mary Bentley
Unverified
50:44
okay great I have one other constituent in Conway, a farmer there, called Healthy Flavors,
and they've got an FDA grant where they're working with seven schools here in Arkansas right now just getting food that the kids like to eat, right?
Speaker 117
50:56
They're working on recipes. So it's a great project. So I'll get them to connect with you guys too. I've met with them a couple of
Representative Mary Bentley
Unverified
51:02
times, wonderful people. Super, yeah. We've got some great things moving forward. I'm excited because we really can help with diabetes and health and so many things for generations. So thank you all for this work. It's great. representative
in it you can't touch your button after i'll turn it on or you're going to turn it off
Representative Denise Jones Ennett
Unverified
51:26
thank you mr chair i have a couple questions um my district is here in little rock and have parts of plasca county so i want to touch on what representative grimlich mentioned so my district is like little rock and so i sit on several boards i have our house um there's wolf street um jericho way there's several organizations here that are in that space they don't necessarily
touch rural pulaski county so how does that work they normally just touch people in the greater little rock area how does that work if they want to apply for something like this I mean I
Speaker 38
52:08
would like to have a conversation with them I mean I know maybe
Speaker 39
52:14
at maybe at first appearance they don't think they're impacting rural parts of the state but it's worth a conversation to see if that's actually true or not I would be I would be surprised
Speaker 38
52:25
if we couldn't figure out that they do impact health care in rural parts
Representative Denise Jones Ennett
Unverified
52:29
of the state and also there's a
St. Francis House here in Little Rock is for VA people, or people that are associated with the VA. Will that kind of fall in line with this initiative? So it really depends on what is the mission of that
Speaker 73
52:47
nonprofit. St. Francis House is a great institution. They do an awful lot of good in the
Chair
Unverified
52:54
community. I'm not sure how much of that is actually health care, you know that's getting delivered same thing you know our house i'm personal support of our house
i love it it's fantastic but we really need to make sure that we're staying in the health care space on this and the nutrition space so to brad's point just because the facility is not located quote in rural arkansas doesn't mean it's not impacting rural arkansas or it's not impacted by rural arkansas's health care struggles and so go ahead and be a part of a larger group where you're making an application and then we'll tell you whether or not you know you're eligible for for being funded don't don't necessarily remove yourself from the front end okay and i have
Representative Denise Jones Ennett
Unverified
53:36
another question so i do represent rural pulaski county as well um and so i have a lot of farms small farms in pulaski county southeast area so would this something like this help that area as well if they producing produce yes it could now we again we can't buy food
Chair
Unverified
53:56
yes that's prohibited by cms but as as we opened up with what i would encourage is you tell all your non-profits read the plan and ask the question is there something that i'm doing now or that i want to do
that aligns with this plan because i think what we won't be able to do is just say you know can we give you money well not necessarily it depends on whether or not what you propose to do aligns with with one of the initiatives, 69 initiatives, it's a pretty long list. Surely they can find something in there that they can say, yeah, we'll be a part of that. All right, thank you. Yes, ma'am. Oh,
Representative Denise Jones Ennett
Unverified
54:33
I'm sorry. Do you have contact information, Mr. Nye? I'll get that to you. Yes, ma'am. Okay, thank you. Representative Ladyman is recognized.
Representative Jack Ladyman
Unverified
54:43
Thank you, Mr. Chair. This kind of connects to what Representative Gimlick has just said, because Jonesboro is similar to that. But in Jonesboro, the NYIT program there at ASU, they have a mobile van and they go out to the, they try to serve the whole Delta all the way down south. So I suppose them trying to expand that
Chair
Unverified
55:10
program would be eligible. Is that correct? Yes, sir. So great question. Expansion of existing programs, it's allowable.
What we can't do is, you know, supplant existing funding. Right. So what they're currently spending, they have to continue to spend. But if they want to add additional vans to reach more locations, that's something we could possibly fund. Okay, St.
Speaker 133
55:29
Bernard's has the same thing. They have a
Representative Jack Ladyman
Unverified
55:32
remote van, and they cover parts of rural Arkansas. And one of the problems at ASU, of course, they're using their students. I think Fort Smith may be similar to this. I don't know whether they have a van or not. But if they do, they'd fall in the same category. But they use their senior students to go to these remote areas through this van.
and so it's also a training, and they get to these rural communities. I sit here and wonder why we couldn't do that at other universities. Fort Smith is an example. I'm sure if they're not doing it, they probably could with their school. But a program to connect like ASU to another university in southern Arkansas as an extension of their program or train
them in a program, Is that something that could work?
Chair
Unverified
56:20
Yeah, I mean, we need to have more coordination and collaboration across the whole health care system. There's no doubt about that. That is something that the systems, the teaching hospitals, need to resolve. And we're conveners. You know, we're bringing them together, and we're asking them to do that. So what we don't want to do is just have a conversation with NYIT, just have a conversation with UAMS, just have a conversation with Fort Smith, Because we're going to be incredibly inefficient if we do it that way. So let's figure out how we can allocate resources in a way across the whole system
Speaker 45
56:55
that comprehensively solves the problem and doesn't waste money. One
Representative Jack Ladyman
Unverified
57:00
of the other issues that ASU has told me they have, this van is huge, has a lot of equipment on it, but it's limited on the tests that it can run, but they need a brick-and-mortar building to do that. i don't know how you do that in rural community but maybe if there's a building there that they could renew that the city or county would yeah see your county might apply to turn that into a part-time clinic or something yeah so
Speaker 39
57:28
we can't can't pour concrete can't add to existing footprint
cms has said you know case by case basis that targeted renovations are allowed so if a community purchased unused space and wanted to try to use RHTP dollars to refurbish that as a clinic, that's a possible use of funds. Again, details matter. We would need to see the application, have some back and forth, but that's a possibility. And I think if you had that set up on the same
Representative Jack Ladyman
Unverified
57:55
day, Tuesday, Wednesday, every week, and they're there, it'd be almost like a regular clinic, but it'll be a two-day clinic or something like
Speaker 82
58:03
that. And back on the faith initiative,
engaging places of worship you know i've started having
Speaker 39
58:08
conversations with folks about doing like a community health sunday once a quarter where a mobile clinic can come down to a place of worship and can do some of the screenings and connect folks to health care like we're talking about i mean it's a great way of thinking through it
Representative Jack Ladyman
Unverified
58:23
one more question mr chairman for mike uh you know i we know what the problem is well we we don't we can't identify the problem we know we're bad we know we're 49th we just went to a meeting and that was brought up Arkansas is 49th what are you
guys doing well we're getting money that doesn't throwing money at it don't help if you don't have a good plan that's right so do we really
know where the problem is by county I mean I don't think in Craighead we have a problem uh have we identified what makes us number 50 you know what are what are the problems and where are they at is that something we've done or could that be something we want to do i again
Speaker 76
59:03
i'll go back to what i said earlier we're not the health care
Chair
Unverified
59:07
policy experts there are plenty around here um so i don't want to necessarily speak to that i would i would say this though i think we got the problem in all 75 counties i think we have needs in all 75 counties they may be the same level of needs but we have needs all 75 counties and so i think we ought to approach it from that perspective. You know, one of the things I believe in research, I believe in studies, those are good things to do, but that's not what this program is about. You know, we're looking for turnkey, shovel-ready initiatives
that make an impact immediately. And so I think, you know, to the extent that we know there are some things like management of chronic diseases and helping people to be able to check their blood sugar on a regular basis, you know those things will make a huge difference encouraging people to walk 20 minutes a day would make a profound difference in the health outcomes for arkansans i know i've had to start doing it myself yeah all
right thank you representative henley thank you mr chair
Representative Dolly Henley
Unverified
1:00:11
thank you for being here guys you know my uh my district has two rural hospitals and both certainly need help but i do have a few questions for you and mr hudson and this one may be for you directly, the Horn Group, who is now the BDO group. So did you – how did you come across those guys to help with this process? I mean, did they, like, bid on the job or something? They
Chair
Unverified
1:00:41
did. We had a competitive procurement for the administrator of the program.
They helped us just on a sole source to write, you know, the application. But in terms of being the administrator of the grant program, that was competitively procured and came over here for
Representative Dolly Henley
Unverified
1:00:57
review. I have some personal experience
when they were the Horn Group with the ESG program. It used to be operated from DHS, and now it's through the Arkansas Development of Finance Authority that nobody seems to know who they are. I'm sure you do.
So they were just very, very slow in the ESG grants applications from a year ago, two years ago, absolutely, when they took over from when DHS ran that program. I'm not aware that they're running the ESG program at ADFA. I know for a fact, sir. I'm
Speaker 73
1:01:32
just not aware of it. Pagan? I'm aware of Pagan, yes. Okay, she's
Representative Dolly Henley
Unverified
1:01:43
my contact with ESG. It's been very, very slow.
very very slow so the last deal was there was problems with the governor's office trying to sign contracts but now i think all that took care i just i'm just concerned about that i would like some um acknowledgement that that that's really going to be okay and that they're going to turn around those applications those reimbursements quickly enough for the hospitals to operate
Speaker 55
1:02:11
30 days is what you said earlier right yes okay yes ma'am well um they know the conversations with me the speed of execution is
Chair
Unverified
1:02:20
absolutely expected their contract is a deliverable based contract
Representative Dolly Henley
Unverified
1:02:23
so they don't get paid unless they accomplish the result and
they're paid by the state not by this grant program right no they're paid by the grant program okay so my second question is mr chair is um the applications that are due at the end of this month so you you're both aware of the severity of of my hospital situation and hope you know they they submitted an application back when you ask them to the state ask everybody to submit those applications early on let's find out what's
out there they came back you all admitted that you came back with some very good ideas you know y'all had that paperwork so i'm wondering why it's taking so long except that the fact we don't have money in the bank what's taking so long i mean this is april 1 so now we're going to go the whole month before you can accept those applications
Chair
Unverified
1:03:15
so you know representative henley it's not a correct statement to say that we solicited applications last fall we did not what we had was a portal
where we solicited ideas you know for how the money could be used but we were very clear that That was not an application, that the applications are going to be solicited all at the same time. It's not correct that the applications are due at the end of the month. We haven't even opened up the portal yet for accepting applications. That will start hopefully, you know, in early May. We cannot control the timetable in which the federal government releases the money to us. That's the pacing item on this. Yes, sir.
And I'm very familiar with their case down there. And as I said before, working capital needs, as genuine as they are, as significant as they are, they're beyond our control in terms of can we spend money on that. Now, if there are other things like HVAC that could potentially we could spend money on that can free up working capital to use for other things, we might be able to do that. And so believe you me, if they submit an application, I'll be looking at it as soon as possible. All
Speaker 73
1:04:21
right. Thank you. I do have another one.
Representative Dolly Henley
Unverified
1:04:26
Mental health facilities. Brad, did you talk about mental health and how funds can be used
Speaker 39
1:04:33
for them? Well, no, ma'am. Again, I tried to do a 10,000, 15,000-foot level today. Behavioral health is absolutely a need in Arkansas, and I'm visiting with and talking with folks in that space. I would love to see applications in that space. I think the HEART initiative, even though it's called the HEART initiative, really is around early intervention and prevention. I think there's a lot of opportunity, a lot of white space in our plan.
We do reference behavioral health in our online plan, if you go out and look at it two or three times. But there's not a lot of detail because, again, we're not the experts, but we do want to get feedback from the experts. And I've had some good conversations with a few folks around behavioral health,
Representative Dolly Henley
Unverified
1:05:20
and I'm excited to see where those go.
My last question, Mr. Chair. Our hospitals, because of our dire situation in southwest Arkansas, including Camden, Magnolia, Hope, Nashville, all of us down there,
they have been collaborating, and they have been meeting, and I think they're doing some great work. Can hospitals spend dollars together like that? Does CMS allow that? How do you see that really working in this process? One hospital will take the lead on supplies or
whatever they're going to purchase. Well, that's
Speaker 39
1:06:00
really where the clinically integrated network comes into place.
It's a separate legal entity. It's got to meet several FTC requirements to get around some federal laws that prevent or limit hospitals and their abilities to work together. But the CIN development and the development grants that we'll offer are really a good vehicle for hospitals to come together and work together. And Representative Henley, to your point, we're keenly aware of the situation with your hospitals. In fact, I'm coming down next Friday for another meeting to visit with them, and we'll do everything we can.
Thank you very much. Thank you, Mr. Chair. Madam Chair. just quickly i appreciate the gme conversation i think it's important that you know there's a there's a lot of us that have worked on this issue for a very long time in the policy space so that work is continuing with myself and others with gme and all the stakeholders and the medical schools in the state we don't want to leave anybody out we want to make sure that we've got a really good comprehensive plan so i just that was representative ladyman's line of questioning but um i think that's really really a huge opportunity and so we're working on that and
appreciate you all allowing me to and others that have been working on that policy for a very long time to collaborate on that on the move one um expanding access to fitness trails modular fitness equipment and recreation but that also includes like development of programs utilizing existing fitness trails right correct okay and then all right because i think that sometimes is a key whereas you may have a walking trail you may have this but you don't have a lot of level of
coordination or community outreach or whatever so i just wanted to ask that quick question about that one um and this is where i think the
Speaker 73
1:07:56
association of counties and municipal league yes can be engaged as well you know we can't build
Chair
Unverified
1:08:03
new trails right but you know can we develop programs to more you know effectively utilize the infrastructure that's already
there Well, exactly. And also like the recreational programs, you know, for, um, kids sports, but also those are adult sports too, you know, adult softball, whatever, getting people out and moving and off their phones, um, is, should be something that we should, I hope we're talking to those association of counties, county government, city government, because a lot of times, you know, they have the ability to really apply for these things more so than an individual,
but they could be teamed up with an individual and utilize the city or the county as the vehicle by which you apply, I think might be a good idea. So I hope we're having those good conversations with them. Thanks. Representative Woolridge. Thank you,
Representative Jeremy Wooldridge
Unverified
1:08:58
Mr. Chair. We were talking a while ago about the plan and you've referenced the plan several times. I know that that's been a collaborative effort over a long period of time trying to develop what that plan looks like but as you lay that plan over the top of applications
and and the reason i was asking a while ago who who is making a decision on who gets accepted who gets funded how does that translate into laying that plan or laying those applications over the top of the plan to make sure that we're connecting those dots to make a picture of what we want health care to look like in arkansas and especially rural health care i mean this isn't obviously like a first come first serve program so the criteria that's been set i guess this committee is going to take every application they're going to break that down and they're going to somehow look at
this plan broadly across the state is there anything you can share with us kind of maybe a 15 000 foot view of what you see that plan to be what do you want rural health care to look like in arkansas at the end of
Chair
Unverified
1:10:02
this window of time so again i think that the plan that has been prepared is our plan and and right finish we're not the health care policy experts you know we're here to execute the plan that we put together so i don't think it's up to us to say here's what
rural health care needs to look like it's what rural arkansas is going to say they want their preferred future to look like and if they can give us the ideas that they have that they'd like to see funded as i indicated before i don't think it's going to be a question of not having enough money i don't think it's going to be a first come first serve you know sort of sort of deal either we'll have a notice of funding opportunity that will be a public document the opening date and a closing date we'll take all those different applications together for that particular nofo
opportunity and make sure eligibility is being met and then i largely expect that we'll fund all those that are eligible if we don't have enough money for particular initiative then we'll make reductions to make sure that we fund what we can fund okay
Representative Jeremy Wooldridge
Unverified
1:11:03
who put the plan together i guess is what i'm trying to understand
Speaker 55
1:11:06
yeah it's what i indicated earlier a group of
Chair
Unverified
1:11:09
people who are doing the review they were the primary authors but this is the governor's plan you know she's the one who had the final say on what goes into it and then we also solicited feedback you know from legislative
leaders as well and then submitted to cms and we had to receive significant feedback and still are from CMS too. Okay. All right. Thank you. Thank
Speaker 58
1:11:32
you guys. Thank you, sir. Great presentation. Thank you.
With that, we'll move on to DHS. And I think we have Ms. Mary Franklin and Elizabeth Pittman with us today.
You guys would introduce yourselves for the record, and you're recognized
Speaker 168
1:12:01
to present. Good afternoon. I'm Mary Franklin, Director of the Division of County Operations for the
Speaker 169
1:12:07
Department of Human Services. And Elizabeth Pittman, Director for
Speaker 170
1:12:11
the Division of Medical Services. This afternoon, what we have to present to you is a rule that impacts Medicaid and CHIP. We are bringing this rule as part of compliance with Consolidated Appropriations Act of 2023,
and it relates to coverage for eligible incarcerated youth. The coverage that will be provided to these youth include care coordination services, targeted case management services, including referrals to care, and services available in the geographic region of that juvenile's residence. The juveniles who are going to be eligible for these services include incarcerated individuals in any Medicaid or CHIP category that are 19 to 20.
And if they are in the foster care, the former foster care category, they are eligible from 18 to 26 years of age. The length of the coverage that these incarcerated youth will be eligible for is 30-day period before release and 30-day period after release. and the other updates in the eligibility manual were grammar spelling formatting standardization type updates also want to mention that juveniles who have active medicaid coverage when they
become incarcerated and when we say that we mean fully adjudicated they've been sentenced we do not close their coverage their case isn't closed but the coverage is suspended for 12 months so that if they are released and the household still has active medicaid coverage we can add the kid back to the case without them having to reapply if it's beyond 12 months then they would have to reapply but initially we just suspend the coverage there was a public hearing
held on this and it was on january 7th of 2026 and we received no public comments and i'm going to pass it over to director Pittman to talk about the provider manual and state plan changes good afternoon
Speaker 171
1:14:14
as miss Franklin our director Franklin indicated and the services covered include targeted case management which we've added to our state plan as a service for this population it will be provided by a provider type that we're also adding and that is the
targeted case managers for incarcerated juveniles we're worth working with some community-based organizations now to begin providing that service for these youth and we're working with organizations that already serve this population but the provider type is open to any organizations that would like to be said do so and can meet the requirements and it also includes coverage while the juvenile is still incarcerated of screening services so that they are able to receive the appropriate services when they leave the carceral setting so they're screened for health and mental health diagnoses and issues so that we ensure that they
have the appropriate services when they leave most children that are involved in this program will go into pass upon exit as most of them will meet the tier two or tier three criteria however we will have some fee-for-service providers in place for those children that do not meet that and we're happy to take any questions are there
any questions members of the committee all right seeing none This rule is reviewed. Thank you Without objection
Did we now have the health department? We have Nathaniel Rowe and Matt Gilmore I'm
just wondering to coordinate with the other earlier presentation. Do you have anything from tobacco prevention
Matt Gilmore
Unverified
1:16:04
today? Mr. Chair, Matt Gilmore, I didn't come prepared to speak on that issue.
I'm happy to, if you would like. When
does the contract renew? Which contract? The tobacco prevention or smoking
Speaker 176
1:16:22
prevention. It's okay, Matt. You can go ahead and do the rules.
Matt Gilmore
Unverified
1:16:27
There are several contracts. You can present the role at hand. Okay. Again, Matt Gilmore, Department of Health.
Speaker 179
1:16:33
I've got Nathaniel, Lieutenant Minerdi's himself. Nathaniel Rowe, Director of the Speech Pathology and Audiology Licensing Board.
He'll give a quick overview. We'll take any questions y'all have. Yeah, so we're here with our proposed rule changes that take into account Act 517 and 966 of 2025 that expands the scope of practice of audiology slightly and also to change our renewal deadline from June 30th each year to October 31st.
Matt Gilmore
Unverified
1:17:19
i think that's a quick overview we uh had one uh one comment and we've addressed that but happy to take any questions y'all
have seeing no questions from the committee without objection i'm pausing for that objection this role
Speaker 57
1:17:39
could uh will be reviewed thank you guys thank you thank
you seeing no other business for the committee today we stand adjourn
Agenda
A. Call to Order
B. Consideration to Approve the March 6, 2026, Meeting Minutes [Exhibit B]
C. Presentation by Breathe Free Arkansas [Exhibits C1-C2]
D. Overview of the Rural Health Transformation Program (RHTP) [Exhibit D]
E. Department of Human Services (DHS), Division of County Operations & Division of Medical Services, Review of Rule, Health Care Coverage for Incarcerated Eligible Individuals [Exhibit E]
F. Arkansas Department of Health (ADH), Arkansas Board of Examiners in Speech-Language Pathology and Audiology (ABESPA), Review of Rule, Arkansas Board of Examiners in Speech-Language Pathology and Audiology Rules [Exhibit F]
G. Other Business
H. Adjournment
Documents
Speakers
Speaker 2
Speaker 4
Speaker 5
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Speaker 9
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Senator Missy Irvin Chair
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Representative Jeff Wardlaw Chair
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Speaker 28
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Chair
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Representative Jeremy Wooldridge
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Representative Mary Bentley
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Representative Denise Jones Ennett
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Representative Jack Ladyman
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Representative Dolly Henley
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Matt Gilmore
Unverified
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Speaker 179
Speaker 57