ALC-Hospital, Medicaid, & Developmental Disabilities Study Subcommittee
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- October 2, 2026
Representative Mary Bentley
Unverified
2:43
If everybody will find their seats we're about to get this committee meeting started everybody will and we're end our conversations and find a
seat. I appreciate it. are we readyjane all right we're going to call
this subcommittee meeting to order this morning I'm just going to briefly remind our
the members of our committee that we were tasked this subcommittee was tasked with a complete overview of Department of Human Services we started with Children Family Services we did county operations we've looked at tannf and a number of things one of our biggest expenses is what we pay for hospitals across the state so I've asked DHS to come and give us a presentation this morning covering all of what we do in our hospitals and then we'll hear presentation from the hospital association then we'll get
everybody together to answer some questions from this committee. I know a number of our committee members are not on public health so this will be new to all of you so I've asked them to kind of limit their acronym use and make it as simple as we can but if uhjanet mann will come forths Mr Eubanks will come forth from DHS we'll get get this morning started with thank you ladies so much for being here and I know I'll just briefly say as we were looking at a maternal health and across the board and one of the biggest expenses we have in our state is what we spend in NIU and if we can keep our children out of Niki we'll
save a lot of money and you guys will see that today but I just think it's really important for us to see what DHS is spending their money on so ladies we'll let you get started and colleagues feel free to press your button and we can stop things as we go. don't go too far along from your
Speaker 12
4:33
questions we'll keep this conversation going thank you. Thank you chairman Bentley Janet mann, DHS
Speaker 15
4:41
secretary Miss Eubank's deputy secretary DhS. thank you ladies please proceed.
Speaker 19
4:48
I'm I'm going to talk from the PowerPoint slides so please stop me at any time and I will try not to talk in acronyms. so thank
Representative Mary Bentley
Unverified
4:57
you for having us today we're here pull your
Speaker 19
5:00
microphone up a little bit closer. having no problem hearing me but thank you thank you so much. I appreciate your welcome thank you again for having us.
Speaker 24
5:08
Today we're here to talk about hospital payments in Arkansas Medicaid. so we do operate several different payment models the most the biggest one is our fee for
service model where we pay hospitals on a per diem we also have an organized care model called thepagra. We we also operate our home which is for the expansion population which is where we go out to the marketplace and we purchase insurance plans for our expansion population only. so if like we said beneficiaries not enrolled in the past program or our homeme receive most of their services through the fee for
service that is what FFS stands for in theowerPoint and in addition to the regular fee for service payments we do make hospital access payments and cost settlements. So I'm going to talk a little bit more about those a little further in the presentation so for SFy25 we put together all the payments to the hospitals in their different categories. We we have inpatient and outpatient claims
which accounts for688 million dollars. Our UPL payment or our upper payment limit payment ofper payment limit payment slot is473 million dollars for state fiscal year 25 our cost settlements is 2 4 $8 million and then we have some a small category of other payments which includes umgmE which is graduate medical education and DIH which is disproportionate share of hospital payments for the
uninsured that is about47 million dollars. so we're going to talk about a little bit cost settlements and some of the payments so hospitals are paid a per diem for their fee for service clients often equating to far less than 100% of their hospital cost. it is it is less than medicare also just for the record our dish payment or DHS we pay for those with in addition to cost settlements to eligible Medicaid hospitals.
costst settlements are lump sum payments to a hospital provider to shore up the difference between what it costs to provide the services to medicaid fee for service versus how much the hospital would have received from a different rate program. Per the Arkansas state plan and state statute DHS is currently required to make cost settlementpa payments to instate and out of state providers. the general fund is how these
cost settlements are funded for the state's share. I didn't OK it insys 2025 DHS paid72 million dollars in inpatient cost settlements in 176 million in outpatient cost settlements to get the total of 248 million which was reported on a previous page. This is approximately 17% of the total hospital reimbursement for the fee for service population
in the state required the state share required for those payments is about68 million dollars annually.
Representative Mary Bentley
Unverified
8:37
we can stop just a minute we do have one question
Speaker 31
8:43
from uhpresentative Carolyn Brown. thank you madamir thank
Representative Matt Brown
Unverified
8:45
you for being here M mann. I might have missed it but what is a cost settlement
Speaker 35
8:53
thank you for the question umpresentative Brown. a cost settlement is the difference
Speaker 24
8:59
between what we paid in a fee for service or a per diem payment to the hospital and what it could have cost to deliver that care. It is something that is calculated annually and paid to the hospitals. it's called a shore up payment quote unquote. I don't really like that term but that's how we refer to it
Representative Matt Brown
Unverified
9:21
so we're we're sort of reimbursing them for costs that we didn't incur
Speaker 37
9:26
no ma'am they are cost incurred by the hospital are per diem rates
Speaker 24
9:32
are are low compared to medicare and commercial payers so we use several different mechanisms one that we're going to talk about with private hospitals is the upper payment limit or assessment fee process and then another is cost settlement so we are we have found over the course of time we have found different ways to help the hospitals with their rising cost but our per diems have not changed. OK thank
Representative Rick Beck
Unverified
10:02
you get to it Representative Bec thank you madam chairir and if you're gonna cover this later on I can
certainly white but I'm looking at the per diem rights and they're substantially different between different is hospitals it's what's driving that difference I believe history
Speaker 24
10:26
so historically critical access hospitals which are 25 beds or less have been paid a higher per
diem and closer to their cost in the middle sized hospitals have just a flat per diem of about $850 a day for day one through 20 I believe. after that that per diem does drop and then some of our one or two of our larger hospitals being UAMS and childrenldren's have a different per diem structure to help cover some of their costs but that has been an established practice and actually for some of that more detailed history I'm I'm going to defer tojody
Representative Rick Beck
Unverified
11:06
andrit when she speaks from the hospital association right and and the the I'm just curious I mean
it's substantially different by a large amount and so you're saying it's historical it is based off historical are you saying it's it's based off a historical data or is it just it was
Speaker 24
11:26
it was established several years ago I don't know the exact year and what we have done is the cost settlements and the UPL upper payment limit payment programme
for private hospitals is how we have helped shore up the hospitals without raising the per
Representative Mary Bentley
Unverified
11:48
diems you you're welcome Thank you. so go over the UPL just a it
Speaker 37
11:54
one more time but we keep we'll move forward yes ma'am so the UPL program or the upper payment limit programme
Speaker 24
12:01
was established by federal by federal statute to be used by states I believe in the early 90s. so the upper
payment limit is is considered the medicare limit for each state and so for the private hospitals in the state of Arkansas we do an inpatient and an outpatient UPL calculation every year. the difference between what was paid with medicaid and then what is could have been paid through medicare that delta or that difference is determined and then we use assessment fees which is what's on your screen and the hospitals contribute through what we call access
payments to help fund the state's share of the upper payment limit payments. those are usually made quarterly to the hospitals in the state. I'll pause there for questions So
Representative Mary Bentley
Unverified
12:55
ask the question does every hospital pay an assessment fee so try and our or is every hospital paid an assessment fee from you guys or just private hospitals the
Speaker 37
13:05
the upper payment limit program or access payment programme is limited to the
Speaker 24
13:12
private hospitals currently it there have been conversations if that should be expanded or not we don't have that's a whole another conversation in rabbit trail we should not go down today but right now it's the private hospitals in the state in the inpatient category in the outpatient category almost all hospitals participate Childrens get to outpatient cost settlement so they do not
Representative Howard M. Beaty, Jr.
Unverified
13:42
participate in the outpatient UPL program. OK thank you Representative beatty thank you madam chairir. Just one thing when I was looking over the per diem claims and fees exhibit B1 that you provided that I think might be helpful and eye opening for for me I would like to see is does that report also can you provide us the number of Arkansans that were treated instead of just a dollar amount how many how many of our folks are being served by these hospitals
Speaker 24
14:14
yes sir thank you for the question. I believe so I can take it back to our data team and how they pulled this to see if they can tie it back to the claims to show unduplicated individuals that we're seeing
Representative Howard M. Beaty, Jr.
Unverified
14:26
right I think that would be that would be helpful for me yes
Speaker 19
14:29
sir and that will only be applicable to inpatient and outpatient claims yes sir I just wanted to be clear because
Speaker 24
14:35
the cost settlements in the UPL are not tied to an individual claim. I understand that. thank you you're welcome
OK, guess we can move forward thank you thank you. So as we were talking earlier, hospital assessment assessment fees are charged to the hospitals regardless of how many medicaid clients they see. so the fees are used as the state's share why it's important to note that the fees are charged to all hospitals regardless of how many medicaid clients they see is there's a clause in the federal regulations called hold harmless we have to
we have to have a broadbas and uniform fee structure that is approved by the feds to be charged to the hospitals to to then use that for the state's share so the hospital assessment fees totaled $119 million in state fiscal year 25 not like I have mentioned not including Arkansas's children's UPL paid through other funds in the public UPL paid through ITs to UAMs and three other public
hospitals and supplemental payments to hospitals after federal match totaled548 million dollars and no general revenue was used. and that concludes and the overall approach I was open for questions or additional questions All right Representative Beck thank you madam chair so
Representative Rick Beck
Unverified
16:18
the the fee that you're talking that is paid so so it's in it's it's independent of the the size of the hospital or the number of patients it's just that not that they're it's
Speaker 19
16:31
a standard fee yes sir I don't know if I would use the word standard it's calculated every
Speaker 24
16:36
year the the how UPl or upper payment limit worksc according to the federal regs is you take all the hospitals in in the category of private hospitals and you look at all of their
charges and then you compare that to what medicare would have paid that sets your upper payment limit and then then you have to back into what is the state's share oh excuse me the state share to fund or pull down those federal funds to be paid that state share has to be applied across all the hospitals in a uniform and broad-based manner. I can't the reason it's called ho hold harmless is because you cannot
ask a bigger hospital to pay a bigger share because they're going to get a bigger payment. the hold harmless is you contribute and you and you get reimbursed but you're not guar an te
Representative Rick Beck
Unverified
17:34
ed to be made whole follow up it seems like you know a lot of our small rural hospitals are struggling and this seems like it would be not hold harmless to them right they're they're overall budgets
would be smaller and the the the fee would be the same as as a larger institution
Speaker 24
17:58
a much larger institution it it could be I would have to go back and look at the model for the individual hospitals those lump sum payments come every quarter and some of the smaller hospitals do budget for those and that allows them to continue to do some things. I don't know that I can speak for every individual hospital I think I'd be more than happy to discuss that
offline with with the UPL demonstration model to show you how the contractors use it and then we do send it out to the hospitals we work with the hospital association on the UPL payment. they get they look at it the hospitals look at it get a 30 day comment period we do send it to Cms also Cms signs off on it as we're making those payments through out the year there's no easy
Speaker 25
18:47
way to answer Representative Beck. right it'll I'll be
Representative Rick Beck
Unverified
18:51
quiet for now for just a little bit
well let let me ask one more follow up so not a follow up just sort of a statement to see if I'm understanding this right so this fee that you're talking about it starts out it's the difference between what medicare would have paid and what Medicaid pays and then it takes the state portion of that right that the state would have to make up for the medicaid and it says ok now that's the sum and we're gonna kind of divide that out and distribute
it equally over all the private
hospitals within that category you said
Speaker 19
19:32
sir that's about 90% correct so no you no so actually medicare is usually medicaid is considered the lower payment medicare is considered
Speaker 24
19:40
the upper payment so the differences there is the total payment that can be paid to the hospitals and then the state share of that total payment is what the assessment fee is so the hospital's fund their upper payment limit payments
so that it is a it is a flow through of state funds to pull down the federal funds so it is no cost to the appropriated and funded budget of medicaid. at the state level thank you Representative Love mean Senator Love
Senator Fredrick J. Love
Unverified
20:22
sorry thank you madam chairir.mind me you're you're talking about the the payments. remind me why we we only apply that to the
Speaker 24
20:34
to the private hospitals versus all hospitals yes sir thank you for the question. So in our state plan we have an approved plan of the upper payment limit programme for private hospitals we have cost settlements and other in the in the per diems to the public hospitals and a little bit earlier in the slide deck UAMS and and then four other public hospitals get a get a cost settlement. OK.
Senator Fredrick J. Love
Unverified
21:05
what what percentage remind me what percentage of our hospitals are private versus public. May may I defer that toddydydiiann says she's gonna answer that so so madam Che I'll get back into I'll get back in the queue when jodyian gets insenator we'll have uhjody
Representative Mary Bentley
Unverified
21:22
Amp shortly from the hospitalstal association to add to the conversation you ma'am Representative McGruder Thank you
Representative Jessie McGruder
Unverified
21:31
madam chairir being that I'm not on this committee for allowing me to ask a
question I'm I feel like Representative Bec still trying to understand all this which I am a freshman legislator so I went through all this and I I see the pay differential so my my request is very simple I would like to be included in that offline meeting so I can get a better understanding of how this actually works more than happy to have a meeting. thank you Representative Mcgruder this is
Representative Mary Bentley
Unverified
22:07
my 12th year on public healthal committee meeting it's still a matter of figuring it all out so
Senator Jim Petty
Unverified
22:16
please don't take that bad at all senator Petty thank you madam chair so my question is more of
a curiosity question you may not have the answer to this but I represent a a a large swath of of rural communities and and so I'm just curious when you do have pushback on these assessment fees what's the nature of it other than the
obvious well this seems too high. I mean are they are they is there a a rational everybody's on the same page because of this or is it mostly the smaller below so many beds or just just kind of give me an idea of where the pushback come from on those
Speaker 19
22:58
yes sir I I will try to answer your question. historically in my tenure at at medicaid
Speaker 24
23:03
is the medicaid director and now the secretary the hospitals have not
pushed back on the assessment fees we have worked with ones that have come to our attention that needs some assistance on structuring a payment plan to make sure their fees are paid but we have not had any in general pushback on paying it because we what we do when we when we do pay it quarterly we're very conscious that we are holding other people's money so we try to send the assessment
fee details out and then we try to pay it the following week if not that week definitely the the week after we do not try it we do that try to have that practice with all of our assessment fees and provider payments to as we collect it then pay it out as
Senator Jim Petty
Unverified
24:00
quickly as possible thank you.ollow up madam chairirer so I guess then then the public comment period, what are some
of the nature of the comments that you receive and and who they they come from
Speaker 24
24:19
hospital association they will ask technical questions they have had conversations with the contractors in the past to ask some details we have made some edits when we've had that in years past we also always have a conversation of is there a way to enlarge it and so we we have those conversations back and forth every year with the demonstration. I would defer to the hospital association on individual hospitals comments
Representative Mary Bentley
Unverified
24:49
I ask a couple of questions on the
per diem right here so just to clarify when we see on your exhibit B1 there a large majority of those folks are getting $850 a day so is that per patient per bed is that how that's contracted. So regardless so I guess my question is does it matter whether that patient's in ICU or whether just having a simple surgery is it just a flat rate per patient per bed? Yes
Speaker 24
25:13
ma'am it is a flat rate per patient per day per 24 hours of the
census and we pay medicaid pays for up to 20 days at that rate and then it can be cut in half if they stay past 20 days. So looking
Representative Mary Bentley
Unverified
25:28
at children's hospital since I have that reference and worked there for a while so a patient that's came in and get a tonsillectomy a simple patient that patient per day is getting that3900 dollars a day the same as that NICU patient that's a 24 weekaker down there getting intensive care ma'am ok just to clarify thank you
Speaker 93
25:53
right. senator, I'ms Representative garner jumping the gun you madam chairir. I just have a quick question do
Representative Denise Garner
Unverified
25:58
we know the actual cost that medicaid is reimbursing the hospitals are we getting any what is the actual cost of a patient and do we have any idea what percentage medicaid is paying for that I don't know
Speaker 24
26:11
that I can answer that specifically I think I believe it's going to vary from hospital to hospital on cost and reimbursement. I do know that we are
lower than medicare and I'm trying to remember some statistics as I'm as I'm trying to calculate calculated in my head while I answer you and I don't have a specific but there are some general statistics out there on how we pay that I I can definitely pull for you and it will vary from hospital to hospital. I just like an idea just
Representative Denise Garner
Unverified
26:42
an idea of what what the difference is what the actual cost is and what we're paying and how the hospitals are making up for that and we will have to break
Speaker 24
26:51
that up compared to the fee for service and our home
population because different payment structures and different covering of costs yes
Speaker 98
26:59
ma'am appreciate it Representative Mcgruder thank you
Representative Jessie McGruder
Unverified
27:09
madam chairir. thank you Miss mann for
this presentation. My question is does the age of the hospital factor into this equation as far as equipment if it's newer or older no sir not to my knowledge this
Speaker 24
27:27
is a per diem that has been set to the age of the hospital would not be factored
Representative Mary Bentley
Unverified
27:34
in. thank you thank you madam chairir. you're welcome if you guys would do you have anything more
can we bring Jodan up and let her bring give her presentation but I want you guys to stay there to answer questions that
may come up so that this was very appropriate when we get ready for fiscal session for you guys to understand just really their budget even a little bit more so thank you jo di and if you recognize yourself you can proceed with your slideshow.
Speaker 105
28:00
we'll do it we'll see how much this Luddite can get to where I need
Speaker 105
28:14
OK. hi I'm actually really excited to be with you today. So I'm Jody Anne Tritt. I'm the executive vice president of the Arkansas Hospital Association and I want to personally thank the chairs for having this conversation and for letting us
be here so anytime we can talk about hospitals and the hospital industry especially when you all are going into the fiscal session and we've got the Medicaid agency to talk to us together in front of you I think it's a really good thing so I'm also happy to answer any questions that you all may have offline online however you want it so the first things first of course is to just show you where our hospitals are and then to answer some of your questions I know you were asking some questions about per diem rates and other things. Many of our critical access hospitals and
those are the hospitals with less than 25 beds that can't be more than35 miles from another hospital in our rural areas those hospitals sometimes have a a per diem especially in your spreadsheet that's a little bit higher which actually is an accounting mechanism that helps dhs when they are doing the cost settlements for whatever their costbased reimbursement is they can pay a little bit more upfront so that their cost settlements when they come in monthly quarterly whenever they need them they pay less of a bolus later on. It also helps with cash flow issues for our
hospitals in our small rural areas which as you all know many of you in the room have called me and talked to me specifically about the hospitals you represent some of whom have trouble making payroll and doing those other things so it's really nice to have a little extra money on your daily rate that then gets settled up later. an important thing to tell you about our hospitals is if you see one you see one which is really great because that's part of what's great about communities we're the only entity, the only healthcare in
entity that is available 24/7 for any kind of emergency that you might need. where it it doesn't matter if you have the ability to pay if the patient has the ability to pay we take care of you in our emergency departments we also do lots and lots of really great things we don't tell you about disaster preparedness we help a lot in public health and reporting we do lots of things with newborn screening and and other things. the list goes on and on about all the things hospitals do for you in your community. it is important and I'll go ahead and answer Senator Love's
question to talk about not for profit hospitals versus for profit versus governmental and I I'll show you this next slide even though I want you to always remember where your hospitals are on that one. so you can see the hospitals by the number I apologize that that is small. I do understand you all have one in front of you which is really nice but if you look at the fourth bullet from the bottom64% of AHA member organizations are charitable not for profit organizations 25% are private for-profit companies and 11% are public
hospitals owned and operated by city, county, state or federal government and so that's really important for you to know. Now let's go ahead and and confuse the UPL program even more. some of our forprofit hospitals are private and so they're in the private UPL pool so just because you see these percentages don't think automatically that only the hospitals that are not for profit private hospitals are in the UPL that's not it for profit hospitals anything that's private that is not governmentally owned is in the UPL program. one of the
other things I really like to talk about with hospitals is that there are a lot of federal designations that the state just has to live with if you will. Secretary mann as amazing as she is she doesn't get to make the determination about whether a hospital is a critical access hospital or a specialty hospital she doesn't even get to make the determination of whether the hospital's a state hospital those determinations are made by other entities and then she's got to play by the funding rule s that run along with those hospital designations so we have lots of different types of
hospitals in Arkansas our most recent type is a rural emergency hospital those hospitals have no inpatient beds they're an emergency department that has a lot of outpatient services the federal government sort of entices hospitals to do that especially in small rural areas because it's expensive to maintain the ready part of having inpatient services right you got to be ready for everything and then you got to be able to deal with whatever it is that those patients need who need an overnight stay of more than two days as that's gotten
more and more expensive across the country the federal government decided to allow hospitals that didn't have a census in other words lots and lots of patients who come and stay overnight and need that sort of extra care staying overnight in areas where specialty services have have sort of moved into more tertiary more populated areas the federal government recognized that the emergency department services were still necessary and required so they incentivize some hospitals to convert to rural emergency hospitals by giving them more than a couple
$100,000 a month and they give them an increased medicare reimbursement. Secretary mann and I have been working pretty closely not only among the two of us but also with other states to really try to maximize what thoser emergency hospitals can do for her population the medicaid population and that's difficult because you've got new federal rules that you all have to follow and it's a new type of program but we're really proud of the five rural emergency hospitals that we have in the state we're really proud of
the 27 critical access hospitals we have in the state there's another type of hospital called a PPS hospital. sorry for the acronym prospect ive payment systems hospitals so they're the ones you think of when you think of Johnson Regional Hospital in Clarksville or Baptist hospitals in littlettleRock and so the PPS hospitals are under even a different payment mechanism and once again Secretary mann has to deal with all of the rules and regs around critical accesses versus rural emergencies versus
the PPS hospitals and specialty hospitals can be a mix of those things so specialty hospitals can also be PPS hospitals we definitely have pediatric hospitals that are specialty you all know about those they'll be presenting later today we also have psychiatric inpatient hospitals that are specialized we have rehabilitation hospitals that are specialized we have the thehaal healthal psych hospitals that are specialized so the list goes on and on long term acute care hospitals we call themllttax in mypace. so
many hospitals provide many many services and then some specialty hospitals just provide the specialty services and focus on those and then use those larger tertiary hospitals as collaborative helpers if you will in the community one thing I can say about our hospital's experience with the public health emergency is the ability for them to collaborate and cooperate and work well together and share patience if you will in a meaningful way transfer them back and forth like they need to be done was
really really impressive in a state like Arkansas where our reimbursement from all sources are lower than all other states so it's really important that we work together and that we do things well and and we let folks who are really great at certain things do them but we need to be able to keep care close to home as much as possible it's very important to keep all those hospitals close close to home and and really create an access opportunity for pe for patients who need care especially if they need care at some time of night where there aren't other
services available to them it's very interesting to me sometimes other healthcare providers talk about hospitals and say oh well you want to do more of that so we don't do it. let me be very very clear. hospitalspitals need every community provider of every type to do his or her job their job to their maximum capacity because hospitals don't have all the capacity to do what we need to do now and when other providers fail or are unable to provide access to patients we know those patients
are still going to come to us in the emergency department usually sicker and more expensive so it's important that we're thought of and known and well respected as the backbone of the healthcare community because that is exactly who we are. We need all other providers to do what they need to do to enhance services and access for patients of all types I put a graph on here I know many of you in the room care so very much about economics so I just want you to see the economic impact of hospitals in Arkansas. I
apologize that this data is a little bit old. I will tell you uhpresentative Bentley if you want us to come back at some time we are doing an economic impact study that will be available statewide probably before the 27 session so we would be happy to come back and talk about those each of our member hospitals will get their own economic impact report that they can use in their own community for how dollars turn over and those kinds of things but it is really important to look if you go to the6th bullet
down hospitalspitals contribute 18 0 $5 billion to the economy each year. that's huge So I know when you all talk about the rural health transformation funds and things like that you think oh gosh we're probably going to get maybe up to a billion dollars over five years that's great that's not gonna be enough for us and we also fully recognize that hospitals are not going to be the only benefactor if you will of the rural healthal transformation funds so we're gonna have to continue to work collaboratively and I hope
you all understand that the financial strains and distress that we are under I had our our director of financial policy pulled some numbers for me. Last year the patient service margin for hospitals and it's all of them which I I understand mixes apples and oranges because you've got all those specialty types we just talked about and all kinds of different payment mechanisms but the margin for patient services for all hospitals in Arkansas last year. negative 518 %
so when you're trying to work through how do the funding mechanisms work? what do we need to do to enhance patient care those kinds of things when you recognize that on net patient revenue services hospitals lose money. it puts us in a precarious situation and Secretary mann hears me say this at many conferences where she she'll present before or after me medicaid is about a third of our funding problem medicare is about a third of our
funding problem. Commercial payers are a third of our funding problem we've got to have the patient mix that makes things make sense and it's really important that you all understand how it works together and the the sheer expense and the cost of care that really happens so can we take a break just real quick take a couple of questionsmember where
Representative Mary Bentley
Unverified
39:17
you're at right back to it right because the board is lighting up right Senator Love we'll start with you
Senator Fredrick J. Love
Unverified
39:27
thank you madam chair and so uhjodyian I'm looking at I'm looking at the the graphic that you have so you said there's 116 of all different types of hospitals OK and and I I'm looking at your your graph there's a lot of hospitals on here but have we has has a hospital association I know a year or so
ago we had to put in60 million dollars for hospitals and different things like that have we did an
up to date assessment of of where hospitals are as far as their financials cause I mean when you when you stated that you know it's a negative5. or5% or so I'm just I'm just trying to get an overall picture of the health of our hospitals and not only the health of them but why are they cause you know I'm thinking aboutcamden Hospital and in different rural hospitals so have we did an up todate assessment to where you can come and present it to us to
say this is the health of our hospitals as a whole this is what what this is what we're looking at
Speaker 105
40:35
and this is what we're facing. That is such a timely question yes as a matter of fact at our board meeting just Friday, just this past Friday our board actually authorized us to do just that type of thing to where we gather information from all the hospitals in the state and then really do a a survey that we'll be able to present those results to you and others about the the true health what does it cost
today because what it costs today to take care of patient take care of patients isn't anywhere near what the reimbursement mechanisms are so not to get too detailed but medicare pays us in that prospective payment system that PPS system that I'm talking to you about they pay us what they think it would have cost on a patient basis which doesn't even come close to covering the cost of care for that patient on top of that Arkansas is it very negatively impacted by a policy
called the aerial wage index at the federal level. Again it's not something that medicaid can do or help us do but what it says is using a zero sum game what it costs to take care of a patient in Massachusetts or New York that same provider who takes care of the same patient at the same sickness level gets paid substantially more money by medicare than in Arkansas provider and that's the area wage index that we work on with the federal level all the time if any of you talk with senator cottons or Senator Bozeman's office they'll
probably tell you that area wage index and talking about how medicare advantage disproportionately treats hospitals poorly. they'll they'll tell you every time they talk to any of our hospital members other than children's because they don't have medicare those are the top two issues that folks want to bring up all the time in that particular space. so we will get that data we're surveying our members we're going to start surveying our members and then we' ll be able to give you a lot better answer that's not old data right? like that's not from 2423 etc. to really make help us all make some informed
decisions when when do you think that report will be available? It'll probably take about 12 months which doesn't sound very fun but to collect the data, do the analysis figure out where we are get good information from the feds also about how those reimbursement mechanisms are working it'll take that long even with really smart people and outsourcing it to a an incre d ible third party it'll probably be a year before we've got anything ready to go
Senator Fredrick J. Love
Unverified
42:59
madam chair let me get my thoughts together on that and
Senator Dan Sullivan
Unverified
43:03
then I'll get back in the queue. Thank youir. Senatorulllivan thank you madam chairir. you said you don't know how much it costs well the bottom line how much will it cost you said we don't get paid
Speaker 104
43:19
enough how much is enough? that's a great question and that's one that's why you have the answer is the you always have great questions that's one of that's one of
Speaker 105
43:25
the reasons that we really need to do the survey too and to find out the resources that we have it's no secret the last time there was a change in hospital outpatient payments from a fee
schedule perspective was in 1992 and it
Senator Dan Sullivan
Unverified
43:37
was a decrease. OK, so bottom line we're not getting paid enough but we don't know how
Speaker 104
43:42
much enough is we're working on it. we
Senator Dan Sullivan
Unverified
43:44
want to be able to tell you what that when we paid enough we don't know how much is enough that's right ok now several years ago we passed Obamacare and we were told in hospital association was all behind it and pushed real hard and we said this will take care of all the payments and we won'tll it'll actually reduce cost hass that occurred?
Speaker 127
44:06
Having more people covered has absolutely reduced our uncompensated care cost
Senator Dan Sullivan
Unverified
44:10
that we have in hospitals I'm just asking a simple question we were we voted and we said it's going to
decrease cost has it as passing Obamacare decreased the cost but per
Speaker 105
44:24
patient which cost so that's a difficult question because expenses for drugs, personnel, all those other things have increased too. so the delta has been helped by having more people with a payer
source. it's it's an uncompensated care cost that has been reduced
Senator Dan Sullivan
Unverified
44:41
originally advocated for it nobody said this is a difficult question you said we know it's gonna cut cost nobody said it's a difficult question that we can't answer. Now you're saying it's a difficult question that we
Speaker 134
44:53
can't answer. I want to always be meticulously honest
Senator Dan Sullivan
Unverified
44:56
and it's when we passed the bill people were meticulously saying we're going to cut costs. We cut uncompensated
Speaker 105
45:03
care costs yes. are there other costs besides
Representative Aaron Pilkington
Unverified
45:08
uncompensated care all kinds of costs you go ok thank you madam chair thank you senator Representative Pilkington thank you I'm over here Jody Ann first off, great use of the term Luddite. haven't heard that in a while so but no and I think I was in the queue because I thought you were gonna finish working out on this but since we're kind of already talking about this, I'd really like to talk about commercial payers number one because we had debate about that during the last session obviouslybviously you know people come to us all the time we can't do anything
about Medicare but we're always asked to increase Medicaid spending we don't want to do that but I think a lot of people don't understand is we are the lowest commercially paid in the country and what sometimes feels like is we have large insurance companies that have taken advantage of us and our and our small hospitals that aren't able to negotiate the way that they can with some of these larger health insurance companies and so I'd like you to kind of talk about that a little more and kind of go into it because I mean my understanding if I get an MRI in any surrounding state whether it's
an expansion state or a nonexpansion state they still pay more in those states than they do here in Arkansas and so I can't understand why getting an MRI in Clarksville, Arkansas is somehow a different cost than getting it in Tupelo, Mississippi or Prior Oklahoma. So could you kind of walk us through that because I think it's helpful to the committee to understand we're always focused on the medicaid aspect but there's a huge, you know elephant in the
room that nobody seems to want to talk about which is that in many ways you know our commercial payers are are not paying what I think needs to be paid and unfortunately we're now having to eat the cost and then they're coming to the state wanting us to subsidize them. So could you go into that a little bit? I sure can and I apologize I should have put
Speaker 105
46:57
a slide together if if y'all have a pen and a piece of paper, I will give you some numbers and I'll I'll we'll get to staff a prettier picture of what I'm about to say. Thank you and if you want to go to your next slide and
Representative Mary Bentley
Unverified
47:11
take a little bit longer in responding to his question just feel free to do so we'll get the others when
Speaker 105
47:17
you get done so sure feel sure to take your time answering this so we pulled information in 2024 from the surrounding states on what their average payment was for a patient, OK? so keep in mind this is gonna have everything all cobbled together.comercial payers are going to be in there medicaid's going to be in there, Medicare's gonna be in there even when there's no payment it's going to be averaged in there, right? So
in Texas for one patient it's 17,346 dollars60 cents that that hospital would be reimbursed. In Oklahoma it's $14,567.20 In Tennessee it's 13,618 dollars60 cents In Mississippi it's $12,517.20. Louisiana $11,988.80.
Missouri 11,767 dollars40 cents Arkansas 8,842 dollars50 cents if drugs alone cost more than $10,000 a patient, much less personnel in a hospital because let's face it, the largest expense hospitals have as personnel and that's exactly the way we want it. It's healthcare heroes with servant hearts taking care of our patients that should be the largest cost in
hospitals it is the largest cost in hospitals but if every patient costs $10,000 then we're losing $1200 every patient and yet in Texas Texas is being reimbursed 17,346 dollars60 cents for that same patient. so it it is one of the reasons why at the end of last session we were so passionate about trying to get a little bit of parody in
the commercial payer space because in Arkansas insurance premium paid for by an employer and an employee sharing, right? it's almost the same in Arkansas as it is in Oklahoma as it is in Mississippi. So if your premiums are the same and what insurance companies measure is risk. then you had a risk tax every time your premium is increased because the hospital cost is pretty much the same even though expenses go up right? costs of
drugs go up, costs of personnel goes up, cost of drugs go up and and supply chain demands but if your insurance premium is the same, why in the world is your employer's money worth so much more to a provider in a neighboring state than it is to Arkansas. and and I think that's a hard conversation that we're all gonna have to have because guess what hospitals are the largest employer most of the time in communities where they reside. so we understand the cost of
providing insurance for our employees too. so there's got to be a balance that makes a lot better sense because hospitals aren't really managing risks we're taking care of injured patients and sick patients and trying to get them home as fast as possible and so I thank you very much for the question. it is something that we're all going to have to talk about and struggle through and have open conversations about and be pretty transparent about what your premium dollars are actually being used for
not just hospitals but our other collaborative providers can't survive on poultry rates anymore either, especially when we know there's not more money in medicaid we don't believe there's going to be any more money in medicare coming down to help providers so the only cost shift we have is to commercialpaers and if commercial payers are taking in about the same number of premiums in our state as they are in surrounding states then why are our providers paid so much less?
Representative Aaron Pilkington
Unverified
51:22
You answered my question with a question don't you agree would agree and thank you I think it's really good for people to understand especially some of the people who aren't in public health just kind of summarize that which is we're paying very much the same premiums as our surrounding states yet we're getting reimbursed less and so when you have that delta and that difference there starts people need to start asking a question why are we suddenly starting to lose hospitals and why suddenly are are why suddenly we're not reimbursed what we should and yet we're paying the same rate
we would if we were in a surrounding state and so I think it's a really good question that we as legislators need to start asking our partners our external stakeholders because at some point you know something's got to change so I appreciate the question
Speaker 105
52:09
appreciate the timell I'll add to from an upper payment limit perspective because that's a lot of what DHS presented on Representative Bec you asked the question about how do our hospitals feel do they do they feel funny if there's a
different rate being paid for their portion of the assessment right? The truth of the matter is the assessments that hospitals pay are based on a percentage of net patient revenues. So if your hospital has a lower net patient revenue than another hospital the percentage is the same but the dollar amount is different. and so that also answers Senator Petty's question. there have been a couple of hospitals in the past who don't see very many medicaid patients and so they get they get very irritated that they have to pay an assessment without getting a benefit of the
assessment back our argument to them is always well if you see medicaid patients you'll get distributions back because the money is distributed back to those hospitals based on their medicaid patient load and so you sort of you're trying to offset your losses and someone else asked the question maybe it was you Representative garner on the percentage like what's the cost versus so without the upper payment limit programme.
Hospitals would get about52 to53 cents of every dollar of costs they have in Medicaid with the upper payment limit program we get to78 cents so you're still losing on every Medicaid patient which then takes you back to the jodi Anne you've told us that we're losing on Medicare I haven't yet told you that we lose even more on Medicare advantage that may be a topic for another day but you lose on medicare and medicare advantage you know you're going to lose on Medicaid even when we're trying to do things to help offset the general revenue
expenses by paying for some of those state shares on our own behalf so that we can maximize the federal government's investment in Arkansas providers and in Arkans as patients like that's why we're willing to put that assessment up to get the dollars back so then when you cost shift commercial payers if they're still putting us in this ranch then we're really in a in a pickle but to answer your question specifically without the UPL it'd be52 to53 cents on every dollar of cost with it we get closer to78 cents per dollar
Representative Mary Bentley
Unverified
54:29
of cost which means that we're still losing
Representative Denise Garner
Unverified
54:37
almost More than Representative Ggarner you can ask another question thank you very much actually thank you for
the question about the commercial lenders that was also a question of mine and I would just want to add y'all talked a lot about it but I would just want to add that what provider is going to stay in Arkansas when they can go across the state and make twice as much money and so how many providers are we losing because we're not reimbursing for
adequately for services and that's rhetorical but hopefully we'll get some answers to that and the other question is as y'all are talking to the other states obviously medi obviously the federal reimbursement what what is different besides the wage piece of it from the federal side and then what are the is there anything that the states are doing that are helping in any way that we could look at as well so yeah I'm just
Speaker 105
55:33
clawing for something to help our hospitals and trust me I love that me too I live and breathe trying to help our hospitals every day you know healthcare financing is a patchwork quilt and it really is a patchwork quilt here in Arkansas because we have cobbled together and sewn together as many programs as we can to make it make sense without costing general revenue dollars. we fully recognize how much money goes into the
medicaid program and to us from the hospital industry perspective even though it's a large expense it's I don't know are we the the highest are we the highest no no not not the F map from the overall medicaid budget we're about $2 billion of that from state general revenue of your Medicaid budget? give or take yeah
Speaker 149
56:24
so sorry we that's what happens when we
Speaker 105
56:27
communicate right? but I think when you're trying to put that patchwork quilt
together. other states have come up with waivers. we use waivers here our pass program is 1915 sea waiver. we have 1115 waivers for the expansion program we'll try to get waivers which is basically hey let us do something that's not the letter of the law to try to maximize the federal government's investment in us and still save taxpayer money whether it's federal tax dollar state tax dollar or even a local one I know on the previous couple of slides I think one of the points is 24 of our local communities have a local tax to try to help
their hospital too. that's in addition to all of this stuff that we're talking about so people in states and associations are constantly looking for opportunities to figure out ways to maximize government's investment in taking care of our people and we're going to keep doing that we're working on UPL now to try to say ok is there something else we can do to maximize it because in the one big beautiful billhr one there were some changes to how people can participate how states can
participate in UPL programs anyway whether that's UPL state directed payments they didn't really bother intergovernmental transfers much but we do worry a lot about lost opportunities when the federal government makes overall decisions that say hey this program that has been working for you we're going to change it it it disproportionately hurts states like Arkansas that already don't have a lot of revenue sort of embedded in our programs to help patients have their care covered
Representative Johnny Rye
Unverified
58:05
Representative Rye yes ma'am thank you Mr Chairman on the commercial care and medicaid and medicare the reimbursement time frame on on each one of those can you kind of go over a little bit of that and and say exactly how long it takes to get reimbursed for each one of those particular or
Speaker 154
58:26
all three of them really you want to go first? this
Speaker 25
58:30
is where I get to brag right thank you for the question. I'll start
medicaid pays weekly and what we try to do is if a claim is received by a certain time during the week and it is processed goes through the edits it is paid out the following Friday. so we do that every week and so we we do have a mechanism that if a claim is suspicious or doesn't meet the edits we have to work it within30 days according to the federal regs if it does fall within a a bad category of suspicion of fraud we can hold it indefinitely so and we work
with our other partners on that but historically
Speaker 156
59:13
Medicaid pays every week. that's that's very important
Speaker 104
59:17
and Yes we say that a lot medicaid might be our lowest payer but it's
Speaker 105
59:22
our fastest. and then medicare pays on they have all kinds of different rules medicare has all kinds of different rules we really have a lot of trouble with medicare advantage plans and some commercial payer plans because they may say their rate is higher than traditional
medicare might be but it costs us a fortune to try to get it because it'll be denied originally or have prior author organizations or they'll have different rules for which doctors can review the paperwork to determine whether what we did was urgent emergent and how much money it should reimburse the provider for for the care that was provided and so we have many people inside a hospital who work in revenue cycle and it's their only job is to track down money that we know is owed to us
that's their only job and and that's expensive and that's an administrative cost that we don't all often capture
Representative Johnny Rye
Unverified
1:00:19
and and talk about thank you ladies ok thank
Speaker 117
1:00:26
you Mr chairman you're welcome Senatorve thank you again
Senator Fredrick J. Love
Unverified
1:00:29
madam chair. sojodyian you were you began talking about the reason why I guess the the difference
Speaker 117
1:00:36
in the the payment mechanism as far as
Senator Fredrick J. Love
Unverified
1:00:42
as far as the commercial curious now you you began to explain it but I kind of got lost in it. so basically tell me just tell me exactly what's going on so that so that our understand in plain language exactly what's going on with our commercial carriers and while we are not being reimbursed versus the surrounding states like just tell me just flat what's going on that's definitely
Speaker 105
1:01:07
a question that I'll hope you'll keep for commercialpaers but from our
from our perspective they're managing commercial payers are managing risk and so that they assign premiums based on risk of how much they believe it's going to cost to to reimburse providers to take care of drugs to get people to do to behave better right so that they're less expensive later on those kinds of things commercial payers have private contracts with hospitals with other providers etc. and in those private contracts it's not just the payer rate that becomes
a problem it's how much money it costs us to get paid what we know we should be paid because of the administrative burden of going through the paperwork that the commercial payers put on us do we have the right medical record? did the right physician sign the document a lot of that is justified in wanting to make sure that you're paying for the right thing at the right time but some of it is administrative just to be administrative because we'll we'll take prior authorizations for example if you go to the doctor today and the doctor says Senator Love you
needX procedure. It may take us a week or two to get information back from the insurance company that they'll approve the procedure. then after they've approved the procedure you've already gone home. you're better, right? It may take us in the hospital world another 2 or3 weeks to get paid what they told us they would get paid when they gave you us permission to do the procedure on you in the first place and if they drag it out even longer than that in some cases with the workload with everything else that's going on what insurance companies really
like to do is paperwork us to death to where we just give up it's just not worth it anymore to go after that bill for you Senator Love, even though you've paid your
Senator Fredrick J. Love
Unverified
1:02:56
premium the whole time. OK so from from commercial carriesers now to medicaid what's what's the the rate why is the rate so low. I think the medicaid
Speaker 105
1:03:06
rate's low because it's whatever the state's investment can be in the medicaid program, right? the rate is what it is the last time we had a rate change for inpatient in medicaid was in
2007 we and that's where we went from the baseline of675 dollars a day to the baseline of what you see as 850 a day and of course you can see some of the fluctuations there it's just about an investment in in what the state has enough money to do and and the decisions that you've made on how you want to make those investments. OK. all right. thank you. thank you madam chairir. you're welcome Representative Bec Thank
Speaker 117
1:03:35
you madam chair we talked a lot about the
Representative Rick Beck
Unverified
1:03:48
commercial payers right and you you mentioned everything did a great job of it I I like it but the one thing we didn't talk about is are they is there a corresponding profit margin for them in ourkansas versus Texas versus Louisiana Missouri the the other ones that you mentioned there are are they actually well I think in the case of cases of excuse me of Texas it was more than double so are you
saying that they would make double the amount of money ensuring someone in Arkansas because they would pay half the amount you you see I'm try you see what I'm trying to get here I'm following you right so it's like it it seems like that would be a pretty easy number and as I understand it insurance companies have to pay a certain percent for for services that they so anyway it did it see all that's not lining up the stars aren't lining up for me there so
it it seems like that would be an easy target or I'm
Speaker 105
1:04:53
not understanding so I'll go down that path with you I I think you're right I think you're referring to what's called the medical loss ratio and the medical loss ratio is a requirement that insurance companies have to pay a certain amount and providers or quality improvement versus what they take for their administrative fee, right? So remember I told you hospitals net patient revenue margins on the whole right? apples and oranges mix in all different types some who do well some who do poorly it's a
negative5.18%. Insurance companies if they have a medical loss ratio of 8515? what does that guarantee them with their 15%? because they're 85 it's what they have to spend or at least what they have to say they're spending on quality improvement initiatives and direct care for patients. So a quality improvement initiative may be that an insurance company has a subcompany that does something that they say is quality to where you can put those funds into that 85% for their medical loss ratio. it sounds to me like Representative Beck you
might be interested in a medical loss ratio transparency bill in 2027. because then you could really know where your premiums are what's going on how they're being spent and really how the administrative overhead gets captured in those insurance company plans and then passed on to providers and increased premiums Representative meeks thank you ma'amir I have two questions. One, I think you'll
Representative Stephen Meeks
Unverified
1:06:16
be able to help me with the other one. I might catch you a little bit off off guard but
first off my my first concern is you know the federal budget is39 trillion dollars in debt and sooner or later that bill's gonna come due and obviously as you know, Medicare and Medicaid are large sections of that and you know at some point something's gonna have to give right and unfortunately it's probably not going to be pretty when that happens. at the same time the the cost of healthcare as you know based upon these discussions not only are individuals paying for the healthcare and the hospital system but we also have the
additional costs of trying to support this insurance complex up here which is a huge huge driver telling you something you don't you don't already know. So my my first question is is because of the issues that are that you face with the insurance companies do you as a hospital have the ability to go directly to the employers in the community and set up an insurance program directly with that employer and say you pay you know so much a month for our premiums and
your folks can come to our hospital and we'll take care of it and basically you get rid of all that paperwork. I don't even know if that's legal or not but is that something that has
been considered I know certain doctors will do that with patients but the hospitals have that
Speaker 105
1:07:44
opportunity does anybody ever done that? Is there benefits to that or hospitalspitals really don't have that opportunity as long as they are willing to accept Medicare and medicarecaid patients so there's a whole playbook that hospitals have to play by called the medicareditions of participation
so in order for you to be a hospital who is eligible to receive government payments you have to play by their rules and play by their playbook. So because ofimmtala which really requires all patients are screened and if you have the ability to take care of the patient regard less of their ability to pay you still have to do that we would have a a really hard time saying we're only gonna see the patients that we told you in a
Speaker 170
1:08:20
community we would see because we've worked out a payment structure no no no I'm not saying that I'm saying
Representative Stephen Meeks
Unverified
1:08:26
you you still see everybody that comes in but you would just offer this
service to and an employer within the community so instead of them having to go out and shop to get insurance from you know whoever they could just get their insurance quote unquote from that hospital. So now granted their employees would be limited to only visiting that hospital probably or within that hospital network but it would allow the hospitals to control those premiums and those costs and to make sure they're reimbursed at the correct rates versus having to depend on an outside organization so like I said I don't know
if that's a possibility for hospitals to consider or if they could set up a separate entity business entity with you know related to the hospital to offer that to employers because I would think that they could offer a smaller rate lower rate to a local small business get their people taken care of and it would be a win win win all the way around so I don't know like I said if that's something that's even even possible. there would have to be a
Speaker 105
1:09:25
lot smarter lawyers than me look into antitrust anti- k ick b ack s stark claws all those kinds of things that may
Speaker 107
1:09:32
violate having special privileges or special treatment for one group of folks over another in the hospital world. well
Representative Stephen Meeks
Unverified
1:09:37
it might be worth hiring those lawyers though to try to figure that out if they're because it it could it could pay for itself in the long run. the second question I have the one that you may not be able to answer is as you know the growth of technology has exploded with AI over the last couple of years and I'm just wondering there's there's so much potential there as far as patient out com es and to help solve some of these issues that we're talking
about where are the hospitals in our state at implementing these technologies and bringing these technologies to our state. Are we keeping up with the technology or are we going to be last or where where are we at about because if we can bring these technologies to the state, better outcomes to our patients obviously would help drive some of these costs down. Yes, Representative
Speaker 105
1:10:24
meeks it's all over the board. Our hospitals are constantly looking for ways to improve the healthcare delivery that they do whether it's you have a
product that's better a service line that's better something that's more affordable on down the road I will say with the low reimbursement that we've had over time some of our hospitals in Arkansas are significantly disadvantaged compared to hospitals in other states because any sort of reserves or extra dollars if you will that we would have had we've had to spend on routine patient care. So it puts us in the predicament and and I'll give you an example of lady I know went to a hospital in a neighboring state for
emergency department care had a very different experience with her phone with the app on how long your wait's going to be when you're going to be in this room when you're going to be in that room then some of the opportunities that we have here in Arkansas part of that is the hospital and that other state the hospital system in that other state had the ability to invest in that equipment because there was enough money in its system to be able to do that so I can assure you that hospitals are definitely looking into that the rural health transformation dollars may give us some opportunities to have some
startup costs that we wouldn't otherwise have especially in the telemedicine space so we're really looking forward to opportunities that we'll have to to be able to advantage those systems I'll tell you that this one of my systems that's in multiple states right now took all of its Arkansas patients who had about the same number of patients in Arkansas as they had in Missouri and pretended all of those patients had the exact same pair that they had in Missouri versus an
Arkansas payer. It was $100 million different so that's where we're going with the we want to invest in technology but we're just going to have to have the revenue and the resources to do it. So we're we are looking at some opportunities any opportunity whether it's grant funding philanthropic funding, private public partnerships anything we can do to try to find resources which is why we're we're we are looking forward to the rural health transformation funds even though we recognize it's one time funding and it's very prescriptive you know all the
Representative Stephen Meeks
Unverified
1:12:36
things it's sure it beats not having any Sure definitely and does the hospital association try to keep an eye on what's going on to provide the training to the local hospitals so they know what's
Speaker 104
1:12:47
out there and available. You got people looking at that we sure do we have a whole arm called the
Speaker 105
1:12:52
Arkansas Hospital Association Services inc its whole job is to find services vendors group purchasing arrangements organizations supply chain management, any kind of help with data gathering and control to sort of give a good housekeeping seal of approval to those vendors to
Speaker 104
1:13:06
help our hospitals know which ones we've already vetted to save them some time.
Representative Denise Garner
Unverified
1:13:14
perfect thank you thank you all Representative corner thank you madam chair and this question's for you quickly if is this the time and place to ask about our home and the passes update there or will we have another meeting for that or not really at this point that's ok
I'll I'll get with y'all but I do have some questions about how the passes in our home are affecting Medicaid services and
Senator Jim Petty
Unverified
1:13:44
you senator Petty thank you madam chairir. So I want to go back just a little bit and and Representative meeks was kind of touching on the subject a little bit and that is this wage report that sets the rates umm I I suspect I know the answer to this question but have we I mean looking at data from for for various reasons from surrounding states
the numbers don't make sense and so have we had do we have an opportunity to have someone look into that at the federal level so we can maybe get some sort of adjustment maybe there's an outlier, maybe there's an outlier in Arkansas that weca I mean have we do we have that opportunity and can we can have we
Speaker 105
1:14:28
done that in the past the answer is yes unfortunately we have a a game of votes that matter at the federal level. Many of the states that benefit
greatly from an area wage index have a lot more population which means they have a lot more members of congre than Arkansas does. So even when you put West Virginia, Arkansas, Alabama, Kansas Mississippi the states that don't have a better wage index altogether we can't climb that hill to where we have more than half of the435 votes that we need in Congress to change the net neutrality provision of the area wage index policy at the federal level.
we get it that we've got two senators just like every other state but you still have that other chamber where you've got to get over that vote threshold so you've got a just a very logical numbers game problem even with all the states sort of circling together we can't come up with a number of congressional votes even though our entire con g re s sion al delegation
Senator Jim Petty
Unverified
1:15:32
is supportive of us in this manner. ol low up so it's not just a simple analysis of the wage so to speak
it's it's voodoo math it sounds like but we really when when they do make an adjustment do they continue to make adjustments you know for the haves and and and make that gap between the haves and the have nots
Speaker 105
1:15:55
even farther yes unfortunately states like Arkansas that are pretty efficient in our care that have done more with less for a very long time we get punished for our efficiency in the area wage index game. thank you thank you Representative Ryan
Representative Johnny Rye
Unverified
1:16:14
thank you madam chairman now want you to stri me out on this one OK Texas how much is the right 18,000 maybe
Speaker 183
1:16:24
they need to be looking at what we're doing here OK if
Representative Mary Bentley
Unverified
1:16:33
Shea Olson from Children's we had that on there if you guys will all stay where you're at we're about about to finish this. I appreciate your patience.h's been very helpful
for our committee to get to hear from everyone. So, I know maybe you'll know that I asked to have an audit included in our pack today to from childrenn's recently. So I think it's perfect timing as we've looked and seen I was just saw on the paper this past week where El Dorado is having to combine with Baptists to survive so we see a lot of our ho our small hospitals struggling but somehow children's is is not so some of the information we've seen today probably will bring some revelation to that we'll have some more questions I have for
Senator mann I mean Secretary mann before we leave sorry about that but I just want to give you an opportunity Shan if you had something you'd like to say about children's at this point or if members have questions we can ask those as well but I want to give you an opportunity since
Speaker 186
1:17:31
we had you on there to come and speak. thanks thank you Sheena Olson Arkansas Children's vice president for government relations. I don't have anything specific I think that we are I think that they've already pretty much illuminated the differences between a pediatric healthcare system that has very few
medicare patients and it's more a medicaid patientba and per mix versus the adult care hospitals that are very different in all of their patient mix and who they see and the community patients and things so I'm here to be helpful. right, I'll start with
Representative Mary Bentley
Unverified
1:18:05
questions if any other members might have some questions. So Secretary mannel we look at the per diem rate is that anything in statute is that Cmsd driven so we're does the rate that we
Speaker 19
1:18:18
get for our per diem rate come from thank you for the question. I believe it's driven by our state planning calculations. it does have a tendency to change at times. I would I can pull the specific formula for you OK I think
Representative Mary Bentley
Unverified
1:18:33
it might be helpful for memories if we could see what is the what drives the difference between the per diem rates on there because I'm just honestly this is a as a person who loves
transparency and loves all of our hospitals to be successful across the street. I have heartburn want to see the children's want to look at their
audit and they've got a 10% increase and I have hospitals that are barely surviving and we look at the per diem rate it just anyway it would be helpful for us to know where that came from and why. I just didn't know if it was in state statute
or not but it's pretty by rules so anyway ok has anybody else have any other questions before we we end the day all right thank you all very much I think it's been very helpful, very eye opening will make us better ambassadors so as we move forward to help our hospitals across the state so thank you all very much for being here today. We appreciate
it. oh wait wait wait wait wait Secretary mann who we need that one more thing. thank you. We need our update of our reimbursement rates for Livinghos
Speaker 12
1:19:32
and assisted living thank you very much yes ma'am thank
Speaker 24
1:19:35
you for the opportunity. before you is our monthly letter and it was dated March3rd. we are in the process of doing our cost reporting for for the past 12 months that ended on 1231 of25 in the letter it's dated
March3rd. we had no current updates but I do need to update you that one assisted living has announced its closure. They announced it on313. so we are working with them. it will be closing in the next3 0 days can you tell us which one that is or
Representative Mary Bentley
Unverified
1:20:03
is it public knowledge well they they did send it to us so
Speaker 190
1:20:09
it is I would think that it would be public I'm looking
Speaker 19
1:20:12
for the name. thank you. here comes Director Hill. he can probably tell you the name. We all need help. thank you know where it's located. I
Speaker 194
1:20:21
just don't know the name morning madam chairman the facility that is closing is the pillars of the community located in Crossett
Representative Mary Bentley
Unverified
1:20:32
androssit OK yes ma'am thank you so much and I appreciate you guys an update on them. so we'll have a we'll have a
plan together to help those patients move to another place so we
Speaker 197
1:20:42
have a plan in place for that. yes ma'am
Speaker 194
1:20:45
we have 9 clients that are living choices waiver clients in the facility Our DHS staff, our field nurses, our RNs
that work with them on an individual basis or working with the commun with the facility and the facility itself is also working with the families and all of the all of its residents to transition to a location of their choice whether that be another assisted living back to another HCBS service to to any other institution that is appropriate for their setting thank you thank you
Representative Mary Bentley
Unverified
1:21:12
all very much we appreciate sorry we have one quick questionpresenting beatty thank you madam chairir.
Representative Howard M. Beaty, Jr.
Unverified
1:21:19
I with with the idar's notice that that
we received and and a lot of calls from constituents and and concern in the community as well as several providers on on the reimbursement rate
do we think when will we have that that updated rate study? thank youpresentative the current
Speaker 198
1:21:41
cost reporting period will run through April30th. we are working with our providers
Speaker 194
1:21:46
to to get those cost reports returned it can be a delay if they are tardy on getting those to us by the end
of the 90 day statutorily required
Speaker 198
1:21:57
reporting period to get that in our our expectation is that with timely reports being returned they are compiled as they come in and so it's not a it's not a matter of our our buyers andtafer which is our contracted actuarial service that puts this together for us they take that data as it comes in real time and puts it on a I call it a spreadsheet puts it into their programs to begin the cost reporting process and so the anticipation is if we can
get those returned to us by April30th that we would have a report generated for secretary's office for review prior to the end of
Representative Howard M. Beaty, Jr.
Unverified
1:22:34
the fiscal year. thank you second question kind of a follow up how how many of the service providers have closed in the in the last last year I believe
Speaker 24
1:22:48
in the last 1el months this is the first one. I know there have been some chows or change of ownerships but I'm not we can I can confirm it but I
don't believe in the past 12 months we've had any that have closed.
Representative Howard M. Beaty, Jr.
Unverified
1:23:01
All right and you said that there were 9 that were on the living choices at at this facility yes
Speaker 202
1:23:07
sir there are 9 clients under our waiver program at the facility. thank you Senator Gilmore
Senator Ben Gilmore
Unverified
1:23:18
thank you madam Chair and just to follow up to that thank y'all for being here I know in the past with these r studies there's been difficulty in
getting these entities to submit not just timely but to just submit right? And so I see you nodding your head in agreement to that has this facility always filed timely and or do you have that off the top of your head and have
Speaker 194
1:23:43
they participated previously yes sir they have participated senator to my knowledge and my my recollection we've not had a difficulty with this facility reporting timely it was not one of our stragglers last year. OK perfect that's what I need to hear thank you
Representative Howard M. Beaty, Jr.
Unverified
1:24:00
anyone else Representative beatty just while while we have the secretary at the table our our our state Cms plan maybe a year ago a little bit longer we were told that you were working on a new plan and where do we stand on that mayy
Speaker 25
1:24:27
I ask specifically for assisted living, sir or
Representative Howard M. Beaty, Jr.
Unverified
1:24:32
something in in the the overall plan for the the waiver plan we had talked about that at one time and and I just kind of
Speaker 24
1:24:40
see where we stood on that yes sir so we are in the process of drafting and trying to look at what we do in the next iteration of the waiver. it does expire later this year we will be preparing and bringing before y'all some options and some some considerations to do the next waiver
Representative Howard M. Beaty, Jr.
Unverified
1:24:57
and at what point will we see that?
Speaker 24
1:25:00
Probably not until the summer till the
Representative Howard M. Beaty, Jr.
Unverified
1:25:04
summer yes sir so I mean my my question is that we've we've heard the the thunder but kind of ready to feel a little rain and see what it looks like. Yes sir I understand. thank
Representative Mary Bentley
Unverified
1:25:17
you all right thank you all very much this meeting is adjourned.
Agenda
A. Call to Order
B. Overview of Department of Human Services (DHS) Hospital Spending [Exhibits B1-B3]
C. Update of Reimbursement Rates Under the Living Choices Assisted Living Waiver Pursuant to Act 213 of 2022, Section 15 [Exhibits C1-C2]
D. Other Business
E. Adjournment
Documents
Speakers
Representative Mary Bentley
Unverified
Speaker 12
Speaker 15
Speaker 19
Speaker 24
Speaker 31
Representative Matt Brown
Unverified
Speaker 35
Speaker 37
Representative Rick Beck
Unverified
Representative Howard M. Beaty, Jr.
Unverified
Speaker 25
Speaker 58
Senator Fredrick J. Love
Unverified
Representative Jessie McGruder
Unverified
Senator Jim Petty
Unverified
Speaker 93
Representative Denise Garner
Unverified
Speaker 98
Speaker 105
Speaker 106
Senator Dan Sullivan
Unverified
Speaker 104
Speaker 127
Speaker 134
Representative Aaron Pilkington
Unverified
Speaker 149
Representative Johnny Rye
Unverified
Speaker 154
Speaker 156
Speaker 117
Representative Stephen Meeks
Unverified
Speaker 170
Speaker 107
Speaker 84
Speaker 183
Speaker 184
Speaker 186
Speaker 190
Speaker 194
Speaker 197
Speaker 198
Speaker 202
Senator Ben Gilmore
Unverified