Health Services Subcommittee - House & Senate

Date Will serve the agenda with comments by the chair of leave their nine for me or Senator Hammer so we'll do a consideration to approve the November first meeting minutes do I have a motion to approve the minutes. I have a second. Second. A motion approved before we begin our discussion on the study on mental behavioral health which I know is a big chunk of what we've got going on today we're gonna real quick to item easy in terms of the proposed an act modify the coverage of continuous glucose monitoring this was an ISP that wasn't that adopted by the public health committee however there were some representatives who wanted to come and speak on it and if Shannon Hey would would like to come to the front. She's I have some comments you like to give on that a while she's coming up of this little brief history back in the two thousand nineteen session myself and Senator Davis passed the contents because monetary legislation the I. S. P. that we found was not a scope change but just a change to help fill prescriptions faster and make it cheaper but I think or pharmacist is Hey would can operate on that and the importance of Of this legislation He's introduce yourself and your gas. Hello my name is Dr chan Hey would I just want to say hello good morning want to say thank you to the chairs and to the members of the committee that allowed me to speak on this issue today I want to say thank you a representative Pilkington for taking on this issue from a family standpoint and from a patient standpoint as well little bit about my background I'm from the big city of rector Arkansas. I own pharmacies along with my father in rector on record on home drug and pick it on pay get pharmacy I'm a pharmacist pharmacy owner but I'm also a mother of a top one. he was I have an eighth grader that is a type one diabetic and he was to my knowledge the first pediatric. Top one with the CGM. So. It is definitely helped us with A. one C. it's helped us with hypo hyperglycemia issues it is kept him out of the hospital more times than I can count and because of this kind of device he's able to be a normal child. so with that I can't thanks the Makers of this enough All other insurance as far as I know all other insurance programs in the State of Arkansas cover this device as a pharmacy benefits arm. And it's used in conjunction with insulin and with his devices on the part that he uses it's a closed loop system so it regulates his blood sugar like a pancreas would As a matter of fact right now he's at basketball practice for three hours he's been playing basketball with the normal blood sugar and so that allows me some relief as a mom to let him be safe and to be a kid Making this benefit available through the pharmacy program would greatly increase access access for patients access for rural communities and for the underserved communities I know that Medicaid has always been on board with you know taking care of those type of patients so I think we're on the brink of of getting that done here In my opinion right now the program is a little dated as far as using the stuff that is available as a standard of care for. Diabetics for. Vaccines such as pneumonia hepatitis for omni pod which is also It is. His blood glucose meter his insulin pump. It is covered as well on most insurances as a pharmacy benefit as well Right now I feel like it's not ideal for patients in Medicaid that's the lowest income and the most at risk citizens to have fewer benefits and less access than commercial insured patients a few additions to the pharmacy coverage I think would benefit them usually and improving their health equity and and decreasing unnecessary emergency room visits hospitalizations and preventive care so with that I'll just kind of say thank you for allowing me to speak and I'd be happy to answer any questions. Sure. You. Senator Hammer you're recognized thank you Mr do you of by any chance have you tracked over the years or over the time that he's had the device as far as savings that potentially might have occurred because if that of that you know that avoids trips to the hospital you know hospitalization other things you haven't kept any that are anything has so I can tell you like even last night for example his blood sugar got up to three hundred and fifty in the middle of the night it alarms me and he did have small ketones which from a medical standpoint I have five hours to get rid of those or he goes to the hospital so just net last not alone it prevented hospitalization I can probably count thirty to forty times in the last two years. And which for instance if you get a virus they are extremely susceptible to going into diabetic ketoacidosis which leads to comma From being you either fluid restriction or something like that. Your five hours and you have to go to your well in my area there's no where that will take a pediatric patient that has diabetes. I would have to go to little rock. So from just my rule area alone. It's innumerable the amount of times that I have prevented or been able to prevent him from going to the hospital just from a virus okay Mr could we get DHS to table the appropriate time please sure are there any other questions for missed. C. nine is someone here from DHS that could answer a few questions about this program. Please come up at the entity shows thank you thank you for testimony. Good morning representative to attend I'm sent the new hospital in the Division of Medical Services the pharmacy director. Fantastic Senator Hammer thank you if I'm understanding the I. S. P. right it's request to ask Medicaid to pick up to cover the cost of this do you know what what what's the position of DHS on that request as of this time if you don't mind please thank you Sir we are already looking into that base based on this currently is a DM me or a to a medical benefit on a different but you know on the medical side so we are already looking into it as what it would take to get it moved to a pharmacy claim okay and do you track the cost associated with the diabetes disease referenced in the eyes P. of as far as what it costs Medicaid based on the testimony we just heard I wonder if they can't turn out to be a cost savings to Medicaid by doing it but do you have a data that would show how many you know what's expenses were occurring now or could we begin to track that we do track various disease states and diabetes is one that we are definitely moving towards getting some very definitive dashboards and we could definitely track where we are currently with the CGM's in the in the medical side and we were already starting to work with our finance department of modeling where would be and potential savings on the pharmacy side so we're definitely really looking at the details of the proposed study and moving forward with that so we've been meeting on this a lot already thank you thank you have a ready by January when we go into session yes okay thank you thank you Mr. Any other questions for DHS representive. C. nine thank you thank. All right Any other further discussion on this ISP. C. nine will move on to our next agenda item which is items at the discussion of the report of a study on mental behavioral health required by Act two oh eight of twenty twenty one representative thought. Who has impeccable timing. Please introduce yourselves are self. Thank you Mr chair representive DM Vaught District eighty seven now. So whenever we started this group I wrote this legislation to sessions before I voted actually this is my third time and this time after co but I think everybody realizes how bad mental health truly had become in our state I'm is something is very dear to my heart have been has been very dear to my heart for many years I'm I'm I'm someone who's kinda lived through quite a bit of mental distress in my life and so it was something that I think a lot of people deal with secretly and there's a lot of stigmatising around it and people are willing to come out and truly talk about mental health issues I'm I was hearing from providers that there was. There wasn't a good bridge between them and DHS and so I thought the best way to handle this is all come together in one room and do the very best we can to try to move mental health to the top of a people's list for the state of Arkansas and my my thought is we should be a flagship for other states to look at. To how we tackled a mental health in the state of Arkansas I'm I'm pleased to say we had a hundred and fifty people on our list we would have between a hundred seventy five hundred people at almost every single meeting which I think is a standing that everybody was willing to come together and work on this issue I appreciate every legislator that took time out of their busy schedules to work with their working groups or to come here and work with a big group I did try to do the best that we could for our citizens and our state I think today will show that. We've made great strides there are still a lot of strides to be made but I do think that we've started building bridges in our state as to move a mental health in a direction that's more positive for our citizens and it has been a pleasure to work with each and everyone of these people behind me I give all the. Accolades to them for showing up out of their busy schedules also to help us tackle this issue and then again I want to thank all the legislators who took time to work on this issue with me and and for you all heart and desire to also make Arkansas the flagship and in in the United States so with that Mister chair I will allow you to go forward with the program if that's alright thank you representive bye I think for those comments can we have representatives from DHS to come and present their presentation. I think we all know who you all are but please feel free to introduce yourself and your role with DHS. Thank Mr remark what secretary DHS. Hi good morning Melissa whether ten division director for developmental disabilities services. Polished stone I work with behavioral health both with the Division of Medical Services Arkansas Medicaid and division of aging adult and behavioral health services. Patricia Gander deputy director division of aging adult bearable Health Services ever behavioral health thank you. the rental technical problem with getting up on the screen but the presentations been passed by most if you just want to go ahead and again while we're working on getting the power point out that be great our thank you Mr we appreciate that so I'm just going to speak very briefly since I have experts here to talk and your time is much better spent here the experts than from me also say thank you to represent Vaught and all the legislators to participate in the task force those who let subgroups or participate in the suburbs US been a good experience I think self help is good to a much better place helped us develop some good ideas and some good proposals that a matter coming for to you all such appreciate all the working as well as the providers that participated in their Cooper Cooper spirit and their time they invest in this process thank you and I'll pass this over to our experts. So we we have been very honored to be part of the behavioral health work group we've been working with it since the beginning and this project is really to talk about how we've used our policy and our rate setting to support some of those activities. So we'll start with this slide in this really gives context about Arkansas Medicaid. In the lives that we serve with the behavioral health population so we have traditional Medicaid in traditional Medicaid we have children between zero and two hundred eleven percent of federal poverty level so we have about four hundred and seventy six thousand children that are eligible for Arkansas Medicaid or currently have Arkansas Medicaid traditional Medicaid. And then our adults in traditional Medicaid or almost three hundred thousand so for those traditional Medicaid beneficiaries we can do outpatient counseling we have that set up we're individuals and agencies can roll and provide outpatient counseling in office clinics or school settings they also can get medication management. In this program and if they need to be stabilized in the hospital they can get acute hospitalization and then connected to outpatient counseling and medication management. We also have a population of behavioral health beneficiaries that have high needs and those needs are based on a functional deficit so they have a mental health diagnosis. And they have a functional deficit related to that for those individuals they going to the pass and of those were a little high right now in the past because of the public health emergency right now those individuals coming through the have a health door. Our third about thirty four thousand children and almost fifteen thousand adults for our intellectually developmentally disabled population that's also in the past we have about sixteen hundred children and almost six thousand adults so those individuals are not responding to outpatient counseling. That they've been getting they have both functional deficits due to a mental health diagnosis and they need something that we call home and community based services and that's how my community based services are generally delivered by pair professionals overseen by professionals we also have individuals that are. Our home beneficiaries and they are receiving services through thank you can't receive services we have a health services and those are paid by the qualified health plans they have a full range of counseling services that they offer for substance use disorder and mental health. So now I'm going to go over the continuum of services so services and behavioral health or are really seen and continue on meeting again does it need a outpatient counseling can outpatient counseling the most important thing around that outpatient counseling is that those services are accessed quickly. Been provided with high quality services and I think everybody understands individual counseling family counseling group counseling we also have a service call crisis intervention that Medicaid reimburses never children and youth those that are going into the past also get home and community based services and that's how my community based services are really targeted towards managing behaviors in those settings They also can get residential services and so psychiatric residential services and we have one that's a home community based service called residential community reintegration program that's a step down or step up they haven't been responding to those services in home and community settings and they go and have twenty four seven treatment this is an unlocked building. Children and youth go to school in the community I am really have the extra support in higher up on the continuum is psychiatric residential treatment and then the highest thing on the continuum is treatment in a psychiatric hospital and that can be a long term residential setting. Crisis services underpinned this always for the children and youth so anybody can get a crisis service we do not want to limit this crisis services based on. the pay or or based on if you're a pass or not pass. We also have the same continuum for adults so for adults as individuals can receive counseling services individual family group also want to make sure that there's an understanding that outpatient services can include those services for substance use disorders so counseling family counseling and those services can be provided for individuals who are have Medicaid. Then we move on to our home and community based services those services are provided by a pair professionals in their provided in home and community based settings or team based setting such as the start of Community treatment which is a service that is team based led by a professional. We don't have an Medicaid doesn't pay for transitional housing however we want to keep transitional housing on this power point presentation because we hope at some point to be able to look at some transitional housing in the state transitional housing is not reimbursed by Medicaid however we do have a program called money follows the person and money follows the person is a grant program which allows us to pay for some expenses such as deposits first rant and setting up a household and so we are working to get providers in the B. H. and place to be able to provide some of those services and to be able to get some transitional housing in the state we then have two levels of therapeutic communities we have a level one level two level one is secure level to is highly monitored so those are your residential programs for adults for adults can go for a period of time to help gain the skills necessary to move into community based settings and then always we have inpatient psychiatric units in general hospitals that can provide acute hospitalization. So now we're going to the counseling services and that we have our continuum set out in our payor set out we'll talk about the changes that we made in each of these areas. So today to remind everybody this is outpatient counseling services paid for traditional Medicaid the Medicaid reimburses for the services as well as pass that's our payors for that so that we have that individual family and group counseling and the changes that we made based on all the work that we did together through this workgroup as we updated rates. And so that right update was completed and was going it went into effect on October the first record back to October the first and what we did was look at those outpatient counseling rights those rights have not been adjusted since twenty fourteen and so we took a look and the method we use for testing that's rights was looking in other states and then looking at a percentage of Medicare so with the comparisons with the states in our region. And then when we went back to this workgroup the ask that we expand that and do some other states that some of the stakeholders felt like a good comparison states and so we added those what we determined was to adjust the rates for individual and family therapy in the psychiatric diagnostic evaluation service which is a service that everyone gets my comment is that intake is the place where people get that diagnosis and determination that they need counseling services. And we raise that to eighty percent of the Medicare rate. Looking at the group and multi family group we were welly well above what other states were doing on that rate and so we also are digesting that rate so we're moving that rate down to one hundred percent of Medicare. We'll take two years to do that and we'll start that in March. And then some policy changes that have happened over the last couple years and twenty twenty one there is legislation passed and we made from three sessions before a PCP was required PCP referral was required to ten sessions prior to the need for a PCP referral. In some other policy changes that we implemented based on this work group and and this one is out in our big policy package I think we have ten policies that are out public comment close last night at midnight I think we were getting comments and I think I latest when I saw came in at eleven forty last night so people are up late but one of the things that we did was add the counseling because to the physician's manual. So what we had done back in twenty seventeen was we allowed the current providers Medicaid enrolled counseling providers to provide services and they could co locate in a physician's office and they could use that as a location of service instead the physician's came back and said I in addition to that publication we would really like this service to be something that we can deliver so we can employer on councillors I have those individuals that are working for us manage them and so to accomplish that goal we did add counseling because the physician's manuals are primary care physicians Can employ counselors our hope is that this is very much going to help with our access issues across the state and we know that we and people commended physician's office for either a sick visit or well that's that they often tell physicians what's going on with them with depression or anxiety and some of those others in the earliest earlier we can catch it the better. And then for outpatient behavioral health counseling services manual first of all we change the name the name was the outpatient behavioral health services private counseling services manual and we change that to counseling services manual which really we believe better represents what is in that manual. I'm we heard a lot about lack of services for individuals with substance use disorder so we have added provisionally per excuse me we've added provisionally licensed professionals back in they were taken out in two thousand seventeen and we really have I dress try to address this workforce shortage that we have so for those individuals who are going through social work school they can then get provisionally licensed and provide services under this manual until they can become fully licensed we also heard about a lack of services for individuals with substance use disorders so we've added master's level licensed alcoholism and drug abuse counselors LA DC's and or counseling manual. We've also worked with UA UA him asks and the Arkansas infant mental health and representatives to update services for infant mental health and mental health services are services that can be provided to children between the ages of zero and forty seven months so that's kind of services that can be provided to take care givers and two children so that we can get services and early. And then behavioral health screen I'm sorry Paul and added intensive have added intensive outpatient substance use treatment and crisis intervention stabilization services back in this manual to allow us to have and increase our continuum of care. So we also added screenings into the positions manual so that physicians can now be reimbursed to screen for certain conditions anxiety depression and some of those things I'm our next step so one of the things we talked a lot about is we make lots of changes to manuals we put policies in place we work really hard to get all of that operational and then we we try to look forward to the next step so we really wanted the document on all of these slides what our next steps would be to say that just because we have the policies in place doesn't mean that we're finished with our work and so we wanted to hold some time out for twenty twenty three of what we're going to do next so. We'll continue to work with our primary care physicians on integration of services so the primary care physicians I think that there will be a number of individuals that come up and speak about this but really looking at some additional codes for and case management kinds of codes that will be looking towards if those can be added and how they intersect with our current patient center medical home program. So we have a health crisis services are and the next area that we're going to talk about so we did add rates and a code in our hospital manual so we started out looking at rural hospitals and adding a service called acute crisis unit beds And we expanded that to also serve children and youth we we did that down the H. four we have a lot of individuals that come to in the and the emergency department and the General Hospital I and need services and we don't have those services available there and sometimes people sit and wait for psychiatric bed to open up or for crisis intervention to occur in so we wanted to open up this service in our manuals we do not have a lot of hospitals that have been rolled in the program but we do have some that enrolled in children said they don't have to re enroll is in a provider type their hospitals and they can just begin providing the service And we set a right for that service. We're also looking for crisis services and let's all talk a little bit more about this but we've use American rescue plan act funding to look at an integrated crisis system so we've got lots of different crisis services across the system and looking towards how to integrate that and have one single crisis system so we've got operationalized as part of our next that we also received a over five hundred thousand dollars in middle health what grant funds to look at children services and will be using that for mobile crisis and we still need to recruit some of those hospitals open acute crisis unit that. I'm gonna talk a little bit about how making need based services and as Paula profusely mentioned we provide are we reimburse three the passes for home and community based services for past recipients. So we spent a lot of time over the past six months doing data analysis to see what services are being utilized within our home and community based programs and which ones are not and this is just a visual for you guys to see kind of what we've been looking at determined policy changes so DHS staff and stakeholders identified in a major challenges related to services available to pass members especially for those with complex care needs meaning those who have some significant behavioral health or those that have intellectual disability and have needs and behavioral health support and you'll see in the graphic committee members receive what they need we believe that the past program which right now His fifty about fifty five thousand members we believe the mass majority of these members D. are available and receiving services they need but we also are seeing that some members are receiving services that are I needed that are not matching their support need or that are not beneficial and improving their quality of life or making them and making their functional deficit better and then as part of the promulgation packet we have inserted several services because we identified services that were needed but were unavailable so many services that meet member support needs are not provided and either not available or they're not in the right amount or duration or at the right time for when the member needs them we often say we're catching members too late they're coming through and the three of our door and there's it's already a crisis and so we're not and catching them with home and community based services are really and I. And then we also have on the far right bottom under utilized services and we actually are analyzing report right now from an outside vendor that we asked to show us the most under utilized services within the past program and the preliminary data is showing us what we suspected so we are seeing and services that we think would be beneficial to pass members but yet they're not being utilized. To continue talking about how many community based services some of the other things that we have done over the last year is we updated the rates for therapeutic communities and therapeutic communities is that adult residential facility the one that is secure and the one that's not secure we updated those rates and Roger that backed up to October first of twenty twenty one we've added new evidence based practice services that use a team of para professionals led by professionals and those are a day right service and we're setting comparison rates this is really important because what we know is that we continue to need to address for work force and one of the ways that we can address workforce is by using our professionals to lead teams instead of having are professionals can providing services one on one so if there You leading teams we can better provide home and community based services to individuals in the community the first of those is assertive community treatment which is a team based approach for the treatment of adults is particularly useful for individuals coming out of institutions are out of acute care who need a high level of monitoring and support in order for them to keep them in home and community based settings you'll just say we've got a question from representative vice. Thank you Mr chair I'm not sure that I had heard about the five hundred thousand dollars for that pediatric mobile crisis units can you explain to me what opportunities are available with that or what we're gonna do with that money please thank you. Absolutely so we got an additional amount of funding through our mental health what grant and there were different areas that you could use that we have to have that fully formed and sent back by December first and so that funding can be used to implement crisis services mobile crisis services for children and youth so that is how we want to use that money so what we have we have to get the Information back to Sam some. by December first and then we would implement and work on that during and twenty twenty three. Yes. Sorry about that Mister chair thank you so when you say mobile crisis units so are it's not like a set place it's going to be moved is that what you mean when you say mobile. So what we're looking at in and we can talk a little bit more about X. were also using our American rescue plan act funding to assess what we've got going on in the system right now so we're trying to tie these two things together and use our money wisely so what we know is going on the system is that people either call nine one one they call and employees go out I mean we've heard this in our in our work group over and over we we have people coming at this from a number of different directions and so what we want to do is to analyze and we have people going out doing surveys right now and talking to different stakeholders to say exactly what are you seeing I using nine eight eight what are you saying as a community mental health center what are you seeing for your clients we know you M. S. is running the air connect line so what is it that people need and then looking towards how we integrate all of those into one service said that mobile crisis would be how do we get people to go into the community and we can use this money on the topside and how do we get people in a standard way to going to the community and intervene in the goal of that intervention is to try to keep children from going to hospital settings as a try to stabilize that in the community setting whether that be in their home or in the school so really looking towards how do we get that and that's where I was headed was is this going to be something that's going to be beneficial for our schools because we know enroll Arkansas according to our work great there is just hardly any services available in those areas and so I was I was my concern was it was is going to be something that would be able to help our school so I would appreciate I appreciate that thank you Mr. So I think we're back to slide eleven we're we're talking about sending support and we are going to get into more of what Paul is talking about them the funding under the American rescue plan ACT so we're utilizing two types of art and I think and just want to clear that up we applied back in the summer of twenty twenty one and as a state through Medicaid to receive a specialized group of finding called ninety eight seventeen fines under our ninety eight seventeen fans are very restricted and they can only be used for home and community based services so under bill at one we're we use in our containing two years ninety eight seventeen art finds to direct payments to home and community based providers that they could use to recruit retain and recruit and retain staff we had we called it the work for stabilization incentive program and so far we've put out a hundred twelve million dollars. Okay just to slide fourteen get on with it yes. Thank you placed back into the room so we're doing five workstreams under this specific ninety eight seventeen funding so the one I just mentioned is the first box it's the work for stabilization incentive program and so far we've awarded a hundred twelve point five million in this guy's this went out to not only am I DD providers and behavioral health providers but it also went out to personal care providers those providers to support our aging and are physically disabled population in the home and the community and we're about to do a second wave that we expect to send out two million dollars more for some codes and providers that were inadvertently messed so we're doing a clean up there so that will be coming shortly next you'll see we picked to deal with transition work streams and I should have added some of the stipulation on this specific findings could not be used to supplement things that you already had in place it had the only be used to expand homing Committee based programs so you'll see all of our boxes have to do with the expansion of what we already have expansion are brand new so under transitions we know that to an enroll in a waiver program so a program that allows you to remain in your home rather than going to an institutional setting it takes time and we've been working for quite a long time at DHS to cut that timeline down said that it didn't take ninety days for people to fill out the paperwork and be approved for a waiver because ideally when someone is in a hospital or an institution and they want to go home we want them to be able to go home so we're working closely with our vendors on this initiative to better our transitions not only make them quicker but also put more home and community based services in place that. There's a place to transition to. The middle which I think is really impaired up to things we've been talking about and in the B. H. task force meeting is educational campaign you know why timely spent in those meetings it was very clear the Medicaid's very confusing we don't do a very good job of educating the public our clients legislators providers I'm just basic Medicaid and then how those programs build on each other and often times we start from like and and and mid sentence approach and no one knows what we're talking about so we are going to be using American rescue plan funding to do a pretty robust educational campaign and for our Medicaid programs. We have a technology work stream so there's a lot of states that are doing really cool pilot programs with technology across this nation we are looking at other states and what they're doing but we are building out a specific technology provider type we will and build out the program pilot the program and then our goal is to permanently implement that provider type into our waiver programs that provide services in the home and the community and then last but not least what Paul is talking about impalas actually over this workstream so I am going to defer to hire to talk a little bit more about what we're doing around and community based crisis response. So I think this program again back to to what representative Vaught was asking is we know that we have people that are in crisis in in multiple settings we know that people are going out they may come to the hospital they may come to an acute crisis unit name may call the police may come out and transport someone to juvenile detention or to to jail I and so really what we're trying to do is create that integrated system where we're looking and people are being treated and having access to those services so we're looking at our best method for implementing that for our Medicaid beneficiaries and using some of this funding from this workstream to do so. I'm not back up real quick the big piece of our work that we did for our home community based service and I think most of did a good job of describing him and community based services is creating this new certification tight so we all had so had and the certification in this provider type and we didn't have as many individuals or any as many agencies enrolled in this provider type and we created this provider type to serve both those individuals that have an intellectual development developmental disability and those with the behavioral health condition so we've talked a lot about home community based services provided by a pair professional and this is our past members only and really looking at what they need so we've been doing pass we started pass in in twenty eighteen with the care coordination only and then we went full blown past with with that full risk in twenty nineteen and had a a good view during that year it was it was quite a busy year would pass and then we really looked at what's happened since passes rollout even though we had a pandemic in that and in the second year of passive really changed things a lot we've been able to get back to say what are people needing and what we hear every day all day is home community based services to keep people out of institutions and how do we structure the services and then how do we get enough providers that are able to provide those services when we have somebody workforce challenges across the state and looking towards that we know that we're rule states and and we do have limited work force and we have people that have needs that are are similar. While they may not be exactly the same for a person with an intellectual disability but somebody has an intellectual disability and has a behavior that needs to be managed I is is needing some of the same kinds of services that somebody with a mental health diagnosis needs and we're we're saying that over and over I and we've had a really difficult time because we have policies in place in most states have policies in place prior to the past we're the behavioral health providers serve the mental health population and the IDT providers have intellectually disabled population and we were very strict about that Medicaid is that you really shouldn't be serving somebody that did not line up with what you did which really had some limitations and in our ability to meet the needs of individuals I and so we combined those services into one home community based provider type we have not requiring all of the providers to join this provider type but we are encouraging providers and then we sort of those home community based services into three levels that base level. Is a level that has been provided for the intellectually disabled in some of the have a health population for several years now but it's not really need that professional oversight that intensive level is what we're looking at what people have some pretty significant behaviors is looking at how do we treat those behaviors and how do we keep people either moving from an institution back in the community or remaining in the community instead of going into institution this is a list of services many of them we've already been reimbursing for and then Trussardi talk about those two new services so a big piece of the policy that we're moving forward beginning you bring that publication process or answering questions is is in this certification this new certification tied out lots of questions out there continues to be confusion about how do we work together I had a we make sure that people are getting their needs met Baltz while still maintaining I am each provider's identity if they came to the through the door of behavioral health or through IDT and so working through that and really looking towards that honoring our work force and making sure that we're moving our professionals into a place where they can supervise pair professionals I and instead of providing counseling services and then looking at ways for counseling services to be at. What we really want to come back and say is that what we heard was that regulatory purgatory so we took the manual so if you look at this at the enhanced in intensive level providers can become certified and they can provide intensive level they can provide all of those services plus the base services but they can also provide counseling services so there's a single certification that allows them to provide all the services and then of the enhanced level the first three services required to separate certification so if you are an outpatient behavioral health agency you have to go and get another certification so we've kind of combine this into a single certification at the enhanced level and these are facility based services so you don't have to go and get multiple certifications we made it much easier under this program to do this. Hammerless get really quickly to psychiatric residential says we got the continuum of services residential is an institution will skip out I had to that thank you at a residential is for Children and Youth only we have a rule Medicaid rule called institutions for mental disease and we cannot have psychiatric residential treatment about sixteen beds for adults so this is for children only and the work that we're doing here and psychiatric residential treatment there's two types of psychiatric residential treatment for children you one is a treatment facility so it's freestanding facility and one as a bed in a psychiatric hospital so that is more residential bad debts for more long term stay most of these days in a psychiatric residential treatment facility or a center have are about four to six months we see some people that stay longer some use that same longer but one of the things that happen is looking at this we understood from our stakeholders that the purity of comparison rates had not been changed for a second or residential treatment facilities and about twenty twenty five years and so one of the things that we have the opportunity to do under the past program because it is under it's an organized care model is instead of doing rates like we would in published rates like we would for a Medicaid service being reimbursed through traditional Medicaid we can develop comparison rights so we've been going through an activity for several months now where we've been surveying those peer TF providers and developing a rates we are very close to announcing that right and so we've got a meeting that should be scheduled for next week and then we'll have those rates that will be able to publish in December really looking towards what the needs of this population are. there's also inpatient psychiatric hospital and as rates are being replaced with a hospital rates I will also be doing a directed payments to the psychiatric residential treatment facilities for work force recruitment and retention and training Arkansas Medicaid beneficiaries our next step for all of this work is updating the inpatient psychiatric services manual. And that's our Medicaid program manual that regulates the service to some degree there's other pieces regulation so we'll be updating that manual and twenty twenty three. And just a little bit about forensic services we have the Arkansas State Hospital which primarily has individuals who are ordered there for some type of forensic service were for services after they've been found and veteran restore herbal forensic services are reimbursed the Medicaid for some services or medically necessary outpatient inpatient basis but then also most of that is contracted funding through the state. So what we're gonna do is we're going to begin to to develop some Services we've created a team call the court involves screening treatment recommendation team which will ever say that forensic program out of the Division and it's also going to look at other individuals who are court involved when individuals are found not fit to proceed then there is an evaluation that comes back to us and that we what we will send to the courts into the judge's treatment recommendations from our clinical team on what we believe effective restoration services will look like and we want to improve the quality of our forensic evaluations and we're shifting the staff to the division and will have a lead psychologist there who will be reviewing and doing quality reviews of that is forensic evaluations and some of the next steps that we want to look at is looking at possibly a secure or jail based restoration program that counties can use search uses an alternative to restoration within their jails are getting some of those individuals moved into a program that is specific to that which has shorter turnaround times for restoration we want to establish stronger criterion are contracts to ensure effective efficient restorations. We have some arpa funding for training monitoring supervision and certification of the start of Community treatment so that we can get individuals in the community based services more quickly and then as I said earlier we're going to use money follows the person to recruit our behavioral health providers to help individuals transitioned into community settings from institution. And then just very quickly when I go over our home so I think you all know that while there are our home of industries in Medicaid pays that the policies and regulations as well as the rates that we have just talked about do not apply to those are home members because Medicaid pays the premium for those are members and are qualified health plans of the ones that deliver the services but just to call out and looking at the our home our qualified health plans are now required to meet an annual health improvement targets I and that is being reviewed and in his ongoing review of that and one of those targets is with behavioral health care so those qualified health plans also provide incentives are members to encourage health improvement activities and some of those activities around behavioral health and then there are required to submit those annual quality assessment and performance improvement strategic plans so that's how Medicaid involved behavior health delivery of services for the qualified health plans for our home beneficiaries and then last we have our life three sixty homes is alive three sixty homes or something that Medicaid is Is producing and so those are hospitals can enrolls in the provider type II and there are three areas and I think all three of these areas all three of these life three sixty homes touched on behalf of health issues so maternal life three sixty homes R. for women with high risk pregnancies but home visiting is what's going to be delivered to those women active until the child is age to that can deliver the services and home visiting has been shown to decrease the amount of children going into child welfare custody improves the health and mental health of the mother as well as helps with that bonding with the child is really an early intervention prevention activity or will I three sixty homes are targeted specifically to individuals with behavioral health conditions and those are all hospitals and then our success like three sixty home is for young people most at risk of long term poverty and also with those individuals there will be some behavioral health conditions it will most likely be addressed real quick on that slide set I had a quick question it says services in hospitals may choose committee partners provide services is there any pram are what services they cannot. Kind of partner with them to provide so for the life three sixty home the service that they are providing the only service that they're really providing is intensive care coordination and so they can partner with and most likely with maternal life three sixty homes they'll be partnering with a qualified home visiting program and so they can sub every every bit of that out to them if they want to and say you can pay for all the home visiting and they the hospital can keep the. Do the administrative work or they can employ their own so there's really no limitations with the rule they could employ a local behavioral health provider to do that intensive care coordination is needed and with success like three sixty it is more of a a group that has worked with that population and so looking towards like a a good will or salvation army partner instead the hospital's koncept any of that. Mr yeah and and Paul just when they're about twenty emphasize that are intended for the partnerships not be just healthcare services or just Medicaid reimbursable services we want them to partner with community organizations providing other resources as well no outside because we know those no will call social determinants of health we know those impact individuals and their ability to recover and to do well so that's housing or employment or education we want hospitals to find those partnerships with those community partners and help direct folks as they need and as thank you. When other questions Senator Hammer. Thank you Mr refresh my memory because of a member legislation three but what are the measurements to determine success of the our homes program if when we give the money to the hospitals and what what's the measureable six. What we're gonna have to measure success. So I will be looking at the outcomes so if I'm for maternal hospitals we will look and see do we see no fear incidence of preterm births do we have for your children admitted to the NYC use hello we'll look that across the program certainly but also in working those hospitals to see the outcomes they have in their areas during a call back in the event they don't produce outcomes that we expect because you know you're doing populations and sometimes may not be cooperative or whatever so is there potential call back if the it doesn't produce. Not for the hospitals and we can if if there's if they're not producing will want to work with the hospital see why that is and see that they need revised or model thank you to read this practices and witness take that on on going basis to you know as we evaluate and revise what that partnership for the Q. H. P.'s you know we were going to hold them to those and whilst that's what we have to develop over the coming years is how do we enforce that what actions do we want to take if they're not making if they're not meeting those outcome measures okay thank you. So our last flight it just sorted out all the policy and rate work that we've done from Arkansas Medicaid and for DHS related to the work group said just divided this out by the workgroups and added the policy pieces or the right setting pieces that we put into place or are in the process of putting into place related to each of those subgroup side there are lots of people involved in these that a lot of listening and having conversations after those work groups occurred and then really look towards how do we develop policies and other programs what levers can we pull at DHS to really support delivery of we have a whole services that far our last slide. Are there any other questions. Senator Hammer. Yeah let's go the others first I've represented Ladyman you're recognized for a question. Thank you Mr this is way back I think it's live three. We're thank you talked about this transitional housing which is not covered currently With that require a waiver from CMS to do that I know that takes a long time like the our homes to. Year of so in this I mean it that looks like a good thing that we need to look into but without requiring waiver. So Medicaid doesn't pay room and board so I think that's one of the issues that we're going to have is that I don't know that we can allow for the payment of transitional housing. And I'll just add to that the other CMS is that improvements more persons in other states where they're taking some steps towards trying to. It says but get around the prohibition on room and board still provide some assistance with housing notion discussions in DC around maybe adjusting that staff for prohibition yes we may see some legislative movement there are Ristolainen. Thank you. Any other questions Senator Hammer you're recognized thank you Mr with all the of financial increase with all the suggestions that are being made what's the financial increase that's going to get the Medicaid budget or do we have any way of knowing. And is that going to be in second be reflecting your budget when you present to up budget this week. So there is a financial impact on the counseling services and I know that that happened the other services are comparison rates that would be absorbed into the pass. So would we expect a request for a rate increase from the passes in. I would think that that would be a good expectation but you know that those are actually really sound right and so I think that we're working that through as we and this our first time to do comparison rates and so looking at how that would impact the passed budget because that's right or not one one they're not public yet but also looking at some of those services would be an office that right so what we're looking at is particularly to those home community based services what you expect to see as an offset an institutional services and so how that's calculated I think it is important and it will be I'm sure quite a hot topic were for the next couple months okay. And and to that point. What what tub. What software program what mechanisms you have in place. To track that is actually going to offset I mean in theory it all sounds good and I think it will work I just you know at some point down the road somebody's going to look back and say we spent we cook Quitman money over here we started spending over here we have better health outcomes but also it was you know cost neutral to the budget board increase so talk about how we're gonna be tracking all these proposed changes in the measurables that we know it's gonna be successful. So Senator Hammer we track the past and utilization and spend several manners but we do a lot with self report but we also have the ability to track through encounters so when the passes pay for a service we can see the provider that payment the beneficiary the code and we pull those on a regular basis to cross match it with self reports so we're able to see year over year what services are being heavily utilized which ones are being under utilized and see trends with that software. Okay. Couple more human what if I can just. No go ahead if I just add to that is one of the point keep in mind no we have our Medicaid management information system which is this isn't that tracks all Medicaid handles all these transactions we're coming up on the in the seven year period for that will be deciding what to do next in terms of preparing your new system eighteen of this system but that's one of the elements that we're looking at is making sure we've got the right analytics place so we can get all the data run these transactions all the data from passes a primary counters so have everything to do to make those judgments. When you have a representative McCollum colossi thank you recognized. Thank you Mr chair just on that last slide I think nearly every work working group was covered all the subcommittees I think we're covered on that I just wanted to to also say that I would you guys agree that a lot of these things will also positively affect the suicide prevention subgroup also. Yes and I think particularly that crisis all that crisis work that we're embarking on and we'll be continuing yes great thank you. Senator Hammer I know you had a few more questions shocking thank you love you The the integrity when we talk about the integrated care and the PCPs be more involved in that one discussions was about psychological evaluations whenever they come and have a working relation with a psychologist bill get that done more expeditiously do you have that accounted for and everything that you just presented that the cost would be reimbursed or how will that be covered as far as if the PCP is expected to do more. Yes so one of the things that the PCPs will be able to do when they employ and they they could employ a psychologist if they if they so chose to do so but they're most likely in M. away someone mean trash so the master's level clinicians and they can do assessments there the PCP offices I and complete those assessments if they can employ someone I'm I think if they can also refer out or they can have a psychologist that they have for that more extensive testing I and then I know the work is being done with a couple of different groups is that That is what we know we have a psychiatric shortage now we have a a significance workforce shortage with psychiatrist to prescribe psychotropic medications and so really working with those positions to become comfortable with being able to prescribe those medications as well and at and work with the counseling services both in both places then the last question is on page seventeen you talked about updating the manuals when you update the manuals is that all going to have to go back to CMS for approval or is that something will do in state not have to get. Where to be delayed. Yes CMS is not have to prove our manuals most of the changes that we made in those manuals were updating and providing those three levels of service delivery with our new CSS P. provider tight we did add a couple of services and those services did have to go to CMS as well as we have to send that rates the counseling rates the CM mass or weight setting methodology thank you to bless your. Representative Ladyman you're recognized thank you Mr I have a question on the forensic evaluation services that page. And I was reading that I mean it looks like some good improvements there but you know one of the issues with this is. While in jail who who need to go to the hospital. And there's no beds. And also people in jail who ask for this evaluation and don't really need it but it's a way it's good for them so these steps that you're taking here with that help speed up that process I don't see it written here but I mean with that speed up the process so those can be done quicker and maybe those people could be moved on to the treatment they need not spend ninety days in jail clog up the system. Absolutely we're hoping that we can speed up the process so we are currently looking at our forensic evaluations during covid the court shut down and then we when the courts opened back up we had a lot of forensic evaluations that came through and we are working through the backlog right now to get those completed and we've worked with our contractors are community mental health centers develop plans for getting caught at and then to St timely in timely is that those evaluations are completed within sixty days that entire process is completed within sixty days so we're working diligently to get that done and then if we can get some more focused restoration and we can believe we believe we can speed that process up as well. We'll I'm talking to the sheriff's association thank they say that one of the problems is not enough people to do the evaluations and I think that may that may not be and then you can do about that but I mean is there a way we get more people either certified or get on working in this area. Absolutely absolutely so we sent out we did a procurement to send out to request allow psychologists and psychiatrists to wish J. Cooper forensically trained to come onto a list so that we can use them as needed if we're behind we also are willing to do that training for psychologist or psychiatrist at any point in time so if someone's interested in doing that we reached out to the Arkansas psychiatric association and the medical board to say if anyone is out there so we've gotten the word out as much as possible for individuals to see if we can recruit some additional individuals to complete these evaluations in the other place and that is also going to be I think part of it is reducing the number of valuation because we we deal with a large or people who come through the system and failed you know to be fit and look at that comparing our numbers other states it's clear that we we have more than we really need coming through that system so I thought I know there's a discussion going on arrest legislation I think could help address that can help reduce those numbers but the point I sliced wanna emphasize because I think this is a critically important point in the Arkansas state hospital it is our highest acuity most restrictive environment for treating individuals like this and we know we have people in the system that they need some help they don't necessarily need that highest level and so that's why we're focused really more on expanding capacity as some of the less less restrictive options so they can get the treatment they need they can get restored but a not use of that most expensive hospital that would also be not considered legal trouble by keeping people environment that's more restrictive than any. Thank you. Any more questions for the ages. C. nine thank you for your presentation. All right. next up and we have a few more people who represent. In a strong. S.. Jitney Senate map announce that right. Thomas Richey and Shauna burns. President is yourselves and then I think what we'll do is we'll go left or right your comments on the report anything you have to present to the committee if that works out. I would sit on the left. My name's desk anti I am a provider in East Arkansas and I own and operate an outpatient behavioral health I company as well as an early intervention day treatment facility I also I represent a group of providers IDT and behavioral health who serve this state in the in the past models really we were created to join in power and I'm also the chairman of the board of empower so it's kind of blur together but when they announced that they're going to task force I got really excited because. You know we we working behavioral health at ten so compartmentalized for so long this task force gave an opportunity to bring all of these people together who you knew existed but. Didn't really interact in here everyone's point of view and I think it's been really really effective in identifying and addressing some of the continuum of care issues that we have so thank you to represent Vaught represent Cavenaugh hours eleven F. everybody who has participated in this process DHS unit from from my point of view. The biggest issues were around what Paul and interest discussed in the regulatory purgatory is a provider in a day to day business staying open with manuals are conflicting certification manuals policy means all of these different things that are working together was our biggest issue and so coming into this that was kind of my personal number one goal was to kind of clean up this foundational is kind of broken foundation of our behavioral health system. Been putting my past had on you know wanting to seeing the issues and and difficulties of I guess what you call continuing fluidity the lack of step up and step down services in our model also became kind of in in my in my radar and on and and doing the things I want to address so you know I'm a very much apply this workgroup again because it did bring DHS to the table and brought the stake holders the providers the legislature and we actually did some really good stuff I mean you know all of those manuals took an ungodly amount of work I think we think there's what non manuals that are up for public comment or just closed issue none of the stuff I would argue is groundbreaking but it is massively important in cleaning up the foundation so I look forward to kind of next steps of where we're going but really just wanted to say thank you and I was honored to be part of it so thank you. Right good morning I am a strong I'm the executive director of the Arkansas chapter of the American academy of pediatrics also served as a co lead for the health piece of Arkansas's excel by eight organization that works on services for expanding and improving outcomes for kids prenatal to age three in our state so and I echoed just that thanks for being here and the things representative Vaught and all of the subgroup co chair of a committee chairs I think this is been an incredibly positive experience of bringing people together to really talk about how we can collaborate to improve outcomes and it has been a privilege to be part of this work so in representing pediatricians I will just say that they like many of the people in this room are also very impacted by this current behavioral health crisis and they are really spending the maternity so many of our pediatricians report spending the majority of their day working on behavioral health right now it is not in a behavioral health care setting but we are we do really feel that pediatricians are kind of holding back this title wave of people that would otherwise be in there be seeking that therapy and psychiatric care that is so already limited in our state and and really even further stretching that already stressed system and so our members do struggle with that with access to behavioral health care for their patients and they were to report that patients with Medicaid struggle more than other or those with other coverage types to access therapy psychiatric care here in central Arkansas committee report about a forty six month wait for to get into long term therapy services in rural areas it can be even worse so we are set I mean that is just an exceptionally long amount of time well I'm for a child who might be in crisis are heading toward crisis circumscribed to really access that care that helps them improve in the long term I mean I will just say that this group has really provided pediatricians and our written organization the opportunity to learn from all of the behavioral health products could get behavioral health care for. There is an Arkansas I have learned a lot about opportunities for collaboration opportunities for improvement just had a conversation on Friday with several of the people that we've met through this working group about how we can work together on some things that may come in front of you as part of the recommendations from these work groups I'm aware we are particularly excited about the Medicaid changes that would allow employment and integration of behavioral health care providers rather than just outside contracting and co locating for behavioral health care in primary care this will help help with that tree team based care so you don't you don't have fragmented electronic medical record systems you don't have fragmented supervision and oversight and constant turnover that can make can occur when you have an outside person who could just decide to pick up and move rather than an employee who may feel a little more part of the team. and I just like to wrap up with just some thoughts on that the prevention and early intervention subgroup which representative ought share chaired it can sometimes be a little bit difficult for us to really in a room full of behavioral health care providers who do treatment all day every day to get back take a step back and really start to think about prevention and what that really means and how we as a group of people a providing primary care providing therapy providing eight more Q. services can really step into that prevention space and support families before they enter into crisis. And so I really didn't feel like we have some incredible conversations in that group and we brought forth some ideas for you all to potentially consider an upcoming legislation as well as some all and the other team that the team from DHS mention such as integration in primary care the screenings the Arkansas then of one of a handful of states that hasn't cover those screenings for behavioral health in the primary care space. we're excited about being able to move forward on and expecting our providers to put to provide those screenings and services on a regular basis to all their patients as is recommended by our national body the American academy of pediatrics so the group did really focus on evidence based recommendations which I appreciated we do want that science behind it somewhere to say that we know this is the solution is going to work and senator Hammer I know you talk a lot about what are we going to get out of this and being able to look at programs that have been proven to have the outcomes we want to have I think is a really great way to move down the road on that and we also focus on some of this in places such as community schools in primary care for those kids who don't yet have a diagnosis they don't have they don't have a diagnosis diagnosis of depression or anxiety yet but they may need a little help to avoid going down that road. I will say that one gap that remains that I hope that we can address through after all of the great manual changes that are happening is really true preventive services for behavioral health for kids kids under the age of four in particular is something that I know excel by eight is really interested in but also just use across the continuum without who don't yet have a behavioral health diagnoses so establishing the ability to have perhaps an enhanced rate through Medicaid through the primary care program or something else as some other Avenue that would help make sure that primary care can address some of those universal universally offered to every patient that comes through the door team based enhanced primary care services for young children instead making sure that they are offering a screenings and also the the connection to services which I think is just sometimes is overlooked we say oh we'll just. Make sure you make of develop this partnership for make sure you can get a kid into this housing program or the student's security program but that doesn't happen easily takes work and so being able to support the time that that primary care offices are spending on that kind of work is really important healthy steps is one example of that kind of program is currently being demonstrated in seven clinics across Arkansas in different areas and different types of clinics which there are a host of great partners working on that effort here. and then I'll just shout out one more thing which is that maternal depression screenings caregiver depression screenings for moms and dads or foster care givers others who may be taking their child to their primary care appointments those are really important screenings that are not been paid for in Arkansas up until this time representative Pilkington I know you've talked about that a little bit as well that paying for those through a child's Medicaid because maternal depression does not just affect the mom it affects that entire family and the growth and development of that mom and of that baby and any other children in the home and so being able to address that on the front and connect to the services that are out there and communities is really important that I will wrap up with that note on just to say thanks again for the privilege to be a part of this conversation. All right well first of all my name is Shanti burns and I mental health professional licensed professional counselor and licensed alcohol and drug abuse counselor I represent a health therapists in our state and also I'm in a small mental health group practice owner so I just to start off with I I can't tell you how grateful I am that we all were able to come to the table and do this I have been in the mental health field for about twenty years and I have to beg for the opportunity to just be heard on behalf of those of us who are on the frontline of the battle field in the middle health world in twenty years we have seen a massive increase of suicide our state Arkansas in Arkansas and suicide is the second leading cause of death for middle school high school students in college age youth and I can tell you twenty years ago was not that way so it once again just to be here is huge because I feel like we are at rock bottom with mental health and so when your rock bottom that's the best place to start building and I'm so grateful for representative Vaught for doing this like I cannot tell you how grateful I am for bring us to the table representative eleven Cavenaugh Garner you guys have been amazing and just to sit and these groups for you all to hear us and represent us is is is wonderful are DHS true I wanted to say thank you so much Paul Elizabeth Trish Melissa you guys have been wonderful to hear us and I a already have seen amazing changes within the manual proposed changes as far as not being on call twenty four seven as in the whole therapist with Medicaid that may not seem like a big deal to a lot of people but as a mental health therapist up to this point I know there are several in the state he would not bill Medicaid because we were on call twenty four seven literally with the crisis hotline number that had to be given. To every client and that is a huge responsibility on our shoulders especially when we have families at home and knowing that if something happens to your client and you didn't answer the phone at three o'clock in the morning I don't know that I could live with myself so there been several small changes I'm already in the proposed manual that we have been heard and just from speaking out about. And those little small changes may not seem big to a lot of people but for those of us on the frontline of the battle field they are huge so I'm just grateful for that there are and other proposed manual changes that we're excited about just the regulations of Medicaid and everything you have to go through we've spoken about this before when the meeting's first started it's it's such a significant pay difference to work with an adult with private insurance in the state as opposed to a child sixty to seventy dollars difference in our and that something with the increase of the Medicare rate that has been wonderful just being able to know that that there there's more resources than that Hopefully we'll see more people in the mental health field and work with the Medicaid work with children because it's for equitable C.. Takeaways once again just to be invited being being invited to the table and collaborating with everyone it was so eye opening for me not just as a mental health therapist you know we all come usually with our little tunnel vision right like I'm here to hear all the mental health therapist but I was able to hear from those in the prosecutor prosecuting attorney's office the sheriff's the pediatricians the pharmacist like it's been wonderful for me and opened my eyes to see not only is there a mental health crisis in our world there's a mental health crisis everywhere and that we're all saying the same thing we need resources we need help we need to be heard so that's another thing that's been a huge take away what's the one thing I'm looking forward to is the future there's been a lot of proposed ideas I'm I'm still over here rooting for at the boards to come together the psychology board that therapists the mental health counselor board the social work board there are so many little things little changes I believe that can be made to bring all the licensure boards together to look at because there's several several and regulations that prevent more people from getting license in different areas and I think there's just some things we can all come together and look at it they could make could open up the work force in Arkansas and that's huge right now because there is a shortage really there's a shortage in the U. S. but Arkansas is is our home and we've got to make sure we take care of us and finally just want to say you know in the mental health field we are weary I think we all are but in the mental health field we are weary or tired or exhausted and we are on the frontline of the battle field there's not enough of this we got into the field probably the majority of us to save everyone and when you have wait list of three to four months and some agencies had have wait list of six to seven months when a child to suicide. Idle in crisis and they cannot get in to get in for help that's too long once again we have to do better so I've heard a lot of hope with these work force meetings just coming together sharing ideas and discussing ways that we can move forward once again it's just has been has been absolutely wonderful last thing I want to stay in the know has is I just want everybody to know how much hope there is in in the health world many of us are from that we think left brain always they were from the the descendants of the Great Depression error you know pull your but **** straps up go to work hush your mouth and go to work right get over it it's okay I have wonderful parents but that was how I was raised right because we all years ago basically you go to work you don't eat and I think now we're at a place and time where we have to pay attention to mental health and I want everyone to know that it's not as scary as it seems you know it when you break a leg you know you go to a physician they know how to set it they know how to fix it a lot of people have the perception of mental health that it's four in all we just have to keep managing the symptoms they're not really curable there's really not much we can do will just keep on trying to keep on you know a lot of people go in but in the mental health world there is so many things that we can do to not only help people get better that state better completely overcome their problems there's so much research research we see clients all the time who completely get over PTSD major symptoms there so I just I want to leave everyone with that thought a mental health is not that foreign and scary there are many things that we can do to get people not only better but out of the system in change future generations so that their children their grandchildren will be veterans and be healthier also. So at thank you again for all that you all have done to bring us together thanks John. What is Thomas Richey I'm a licensed professional or professional counselor I started at a counseling group that serves the communities and white and load of counties and I will say that that we we started this I started this this group to one focused on continuing to serve the communities that were around to do that we knew we had to open our doors to taking all the various types of insurances and it's what we've been committed to doing also to provide a place for professional counselors to come server continue serving these communities in a different setting other than an agency setting which is where most of us have come from what most of us agree through we need every type of provider out there all hands on deck for the crisis that we're facing right now it is been such an honor to be able to be at the table with each person in this room. And I would say that the that the part that stood out to me something that stood out to me in this process is the the amount of transparency involved with these meetings has been a hundred percent no I don't know that ever will be but the fact of the matter is that the doors been OpenText in the room to come in and have a voice and and that's something that I've never experienced before and it was a great honor to be a part of that I've seen humility in our leadership to say that we may not get this exactly right but we're not going to stop from trying and I think that such it that such a missing piece today people often avoid stepping up because they want to have exactly the right answer and come with such pride to know that they've got it figured out but unfortunately there's still so much to figure out this is a very complex system and I appreciate representative Vaught for not backing down even when she didn't know all the answers but to say we're gonna stop on everybody's toes just get used to it we have to get the word out there. and and last of all just the amount of collaboration that has also led to accountability from having these groups this is so important from legislators to DHS large and small business owners and even pay your sources all sitting around the table these are people that often times outside of these rooms are are are fighting on a regular basis to to get their say and but instead of rubber to the table to say how can we get this to work because the way it's been done just hasn't worked it's not working for the for the state of Arkansas is not working for the citizens of Arkansas. So just showing up people showing up is a huge huge step I will say it has shown a mention the one group that had that we still need that the table is going to be these licensing boards it's been disappointed we have been able to bring these together and and these are groups that I hope that each of you guys will continue to poke to say Hey guys they're talking about you right behind your back that we're all we're all licensed by these organizations that that that aren't talking and and frankly maybe sitting on on decades old rules and regulations that are keeping many things from happening we have a tremendous workforce shortage it doesn't matter which person you talk to in this room we all sit at companies that are having a workforce shortage and yes I understand this is an economic reality for many lines of business and it is it is still true for us as well that every policy it in the world can be changed and every rule in manual can be changed but if we don't have workers to actually do the things that we're talking about what good is it and this is where I hope to continue to see more collaboration conversation happening to as to what we can do to open the door and and and make it a more clear of what people can do to get into serving the the clients and the people of Arkansas who desperately need this type of help thank you all for this time I I you courage you the the whole committee to listen to the legislation that comes out of these work groups I know that we've all given a voice to what we're seeing from our little corner of Arkansas and in alternately we don't a lot of us don't even know how to write a bill nor anything about writing a bill we're trusting those who have been in these meetings to do the work and and I just want to plead that the legislators as a whole listen to the things that happened because it is it's as close to a a United voice is we can get and the time that we've had and I hope the. That's heard when it's presented on the floors next year. Thank you for that do we have any questions for gas Senator Hammer. Thank you this is a from a strong if you would. Your you represent the pediatricians is that what I understood about four hundred and fifty of them across okay or you for the conversation about integrated care and I heard your comments so I'm curious about do you think that the PCPs would be prepared to deal with what we are asking for proposing looking at placing at their level and I just like your sponsor please. You know we we have had several conversations with DHS over the past year so with our with some of our members who are in primary care many of whom have tried to contract and have co lake located in a rural health services because they desperately need that and they need they need access better access for their patients and the co location has just not worked out I don't off the top of my head no but a handful of folks who still have that model in place and so yes they are very excited and interested in employing employing behavioral health therapist as well they're also interested in things that don't require necessarily to have a therapist on staff I mean just the screenings alone you know those I'm really required staff and infrastructure to put those in place so we have actually some funding we had a couple of really small grants that we've kind of cobbled together to do what we're calling mental health echo it's a type of training will offer eight sessions on everything from common behavioral health diagnoses and medication management and some of the other pieces of what we want to happen in primary care and I don't want to give you say too much because it's not matter but I believe Arkansas children's also read it recently and UAMS received a grant in that space to to help continue that over a multi year period and I I think I'll be part of the advisory board on that from what I understand so I'm very excited about opportunities ahead to engage and train our primary care workforce in. Further addressing behavioral health on site and and then also continuing to refer out to their partners in the community I mean that's where kids will receive continue to receive care in the long term and kids with higher needs will go there this is really kind of that stock at to try to prevent them from going and hope that answers your question it thank you okay one more yes and I'm sorry you Lee I didn't get your name on me yes ma'am Sean of arms John let me you made a comment while ago about not having take call at three o'clock in the morning you're you're practicing independently is that correct yes yes okay so what's your understanding what happens to the kids if you're practicing independently and you're not taking calls at three o'clock in the morning then for those kids that are looking or somebody that's looking for help for those kids at three o'clock in the morning what is your understanding of what happens to them that if you're practicing independently you're not available then what is a great great question so we have nine eight eight in the state we have a national number that no private insurance requires you to every private insurance allows the ninety eight numbers there are crisis numbers across the U. S. it but for years the regulation with billing Medicaid was that the clinician had to be their own crisis number so it's kind of all of this the children will still have a number to call it just will not be my personal cell phone number it makes sense okay I'd be curious to hear providers moving forward what you think is providers need to be changed in the manuals that you reference from your respective boards often times there's push back from boards whatever proposed changes are made so I'd be curious to see moving forward Charles recommendations would be that you'd like to challenge the boards with thank you. Any other questions for this group. Thank you for your thank you very testimony I pass over one member Rusty Hollweg. Are you here. They are. I don't you think I forgot about you. Please introduce yourself and the organization or with. At. I serve in your life. Hi my name is rusty Hollweg and I'm the chief executive officer western Arkansas accounting guidance center we are a I'm proud to represent a community mental health center and also probably a C. C. B. H. C. which is through an expansion grant we've been in business since nineteen seventy two I we've had three CEOs and and I'm happy to be that lucky number three in the in the state and happy to be here today first of all I have to say thank you I know you've heard thank you thank you thank you but I really can't say it enough representative Barton Cavenaugh and representive and McCall and Senator Hammer everyone here and who has taken their time. To express the sincere interest in what we deal with every day the front lines of behavioral health a representative McCall I had the at the at grade at. What sort The ability to to be with you previously about the crisis stabilization unit we also were the first opening crisis stabilization unit in the state of Arkansas for the purpose of jail diversion they're very proud of the work we do. And I have to has I come before you with the shaky voice have to acknowledge what an intimidating forum. This can be right you are our authority that we look to and so when we have challenges when we face whether it's keeping our doors open or how we need policy injured we need your voice you know I pray that we can find favor with the you're our authority so thank you for hearing gas thank you for allowing us to be heard Your representative on a conversation I really didn't know is gonna be on the panel today I had no idea it was going to be eight and Speaker until Chicot pointed out to me and I know that during conversations representative Vaught that you had asked that you want some of us to come together really talk about what the process is in line and and you know I think it's been a little bit like life in general County you have an expectation I think we all come together with expectations and what you really live out is a little different than the way you saw it playing out and. The the things I appreciate the most are having that sincere interest having so many different groups from within behavioral health being able to come and talk to you about all the challenges and the the and the great things the outcomes that we experience because we change lives we save lives every single day of the week we probably as community health center are dealing with probably ten to fifteen crisis today coming through our door we truly are like the behavioral health urgent care you're just come on with the crisis will help stabilize that we try to get people to the right placement I really love them as we do and sometimes the people we deal with the very complex mental health issues or sometimes those are are hard to take care they're very challenging very hard Community mental health is a little different in that we are the safety net we truly take care of those who you mention the crisis who's going to take the calls at three in the morning we will community health will do that our own area we we take behavioral health crisis for anybody that falls in behavioral health crisis in our catchment area we don't ask questions we just say come on we're going to we will respond to your crisis and we do that we're we're piloting right now with mid south health systems has the other R. F. P. award working on mobile crisis right now it's really exciting we have it we're called here to help we have an automobile now we're start work with law enforcement first responders and going out into the community to homes to try to help people and take some of that right white off the law enforcement that you know so they're not responding to every single behavioral health clients you know call that comes out to so many things going on a representative eleven in your suicide prevention workshop thank you for including me and then I think some of the great things have come out of that is an legislation to try to lower the age of consent we heard from college students who had lost so many friends to suicide and so this is been a very productive work we're looking at other states things are working in other states to try to reduce that age open the access granted it's going to have its challenges right because of your payor sources an insurance but I the other states have done it so we don't have to completely reinvent the wheel I think we're moving in the right direction you know behavioral health really needs modernization. It is unfortunate that Arkansas is ranked forty eighth in overall health care. We have been at the bottom of the barrel when it comes to behavioral health Servilius time for modernization One of the things I kind of was reluctant To speak about I think I will since I have your ear and the opportunity is I'm currently a member of the mill well we were the mental health council of Arkansas now we have joint we have twenty three outpatient behavioral health providers and community mental health centers you know all of this in one organization Arkansas behavioral health council. And I'm so proud that we have come together we have so many common interests now to take care of the people in Arkansas and we cover all of your areas there's everyone of us planted in in the areas that use our and so also you know when when we first for learning about in about C. S. S. P.. What I wanted to bring up is I kind of felt like we got a little bit of a bad dig for having reacted initially but I just want to remind everyone that what we were hearing initially when the CSS he was first proposed. What we heard at that time was that we have we're going away from behavioral health model to strictly an ID D. model. So what it did for us is it really scared us because we provide psychiatric and behavioral health care and so to think that we're gonna lose our identity and the skill of professionalism that we have to something different it's very scary tass so if we had not reacted I think something would be wrong with us right so since then moving on since then collaboration has been so Kate and I'll speak to policy stone Tristan I came around personal to have conversations because they know in the past we made transitions we almost and keep our doors open by the grace of god our doors are open but really there's a fear of losing our identity L. losing our businesses and so they they truly came around you know we talked and it turns out we can provide as you've heard today behavioral health care within this model and also adding home and community based services which is a good thing so you know it takes that collaboration and I'm really helpful more than ever with Secretary wide and all in Trish Melissa that will continue that kind of collaborative effort because we as providers we want to be better and we face the problems on the front lines and we come up with solutions that's what we do if it weren't for problems I wouldn't have a job and so we come up with solutions every day and we have ideas you know our expansion grants for CCV H. C. that's really what introduced assertive community treatment the ACT teams I think we had one group originally have done who have provided act for many years but it was a C. C. H. C. the hot the innovation of ACT teams come back alive and so Anyhow what I really just want to say is thank you and let's hold our feet to the fire to continue to be collaborative in our efforts because that's how we were bested for synergistic and our efforts we can accomplish so much more together than we do in silos and the relationships here that we built built are incredible You know workforce we've a group of us I think at Tristan they're having conversations with you CA and doctor are Glaspie and ideas for building a workforce again for the psychological evaluations and how to bring more people into the workforce and I think they need to be even more skill so you know considers continued work to be done they're working with education the crisis system we had a fantastic conversation with and a strong and the pediatricians group on Friday and working to some ago she action on a common sense solution to PCPs and PCP referral issue and so it's so great if we can have those collaborative meetings and have that happen off you know so that we don't have to bring it here and say please help us please help us were desperate for change so with all that being said I hope I resent representative the Committee mental health centers and those outpatient behavioral health agencies in the council and hope I representative well and just thank you thank you for the opportunity thank you for testimony are there any questions Senator Hammer you're recognized. So thank you for your presentation and don't feel intimidated when you come in front of us by any means of thank replacement intimidated with the professionals in the room but the question I have for you is having sat here and listened to all the discussion today and you may be the the shift in directions that are being proposed or talked about is there anything you've heard today that causes you of concern or fear that would threaten your structure as to how you all for mental health services in Arkansas that's a big question. An. You know I I think everything is been laid out today are all the things we've been hearing about I think the question is going to be you know the sustainability it really will come we learn more about rates and we see the manuals and you know when we get a manual and and there's a change we have to shift to what somebody said of a billing code in our electronic medical record is a huge process so there will be an undertaking of just changing workflows changing policies to then make sure everything matches what's being laid out so at the work begins and then if the rates are there you know. I'm a fiscal conservative. And what I also know knowing as a fiscal conservative you get what you pay for. And we really really have to invest as long as we know we're investing in outcomes right and that's what we as providers want but to answer your question I think we just don't know. Until we see the the whole plan through the whole match if that makes sense. It does this okay. If if you know there might be a shift in the way the. We've been doing things. I just. Wanted to hear your voice as far as if the shift occurs and maybe even you might have to adjust your model when the shift occurs do you think that you will be able to make that shift provided that the manuals and the reimbursements you know our R. comedy eighty two to meet your needs you think that shift as possible as as the realignment we'll call it occurs I do think it is possible given the fact that we're able to continue to maintain our our role in identity and functioning as a behavioral health provider as long as we can continue to provide psychiatric and behavioral health care the way we know it with the modernization yes I will tell you based on my experience when we made other transitions from the wisdom of previous CEOs I am going to be taking a line of credit. So that I don't have to fall into any you know a little bit of research we have So that we can make sure we keep our doors open through the change god willing we don't have to use it I'm going to hope for the best but I'm gonna prepare for the worst okay thank you thanks very much. Any other questions for against. The. C. nine thank you for testimony thank you very much the next for the agenda or the reports of from the working groups I think what I'm gonna do is just have all the chairs come down representative Evans represent a column a representative Cavenaugh and representative Fite. I know we're running a little late on time and so I just figured everyone being down there we can presents and then at the end if you don't mind going last to kind of sum up all the committees and talk about next steps thank you. Divid you Mr softened research self in day you're working group and. Representive. Thank you Mr my name is represented to be McCullough and I'll have been sharing the suicide prevention awareness working group. Your committee go ahead or do you want to standardize first. I think it's go ahead if that works. Okay thank you I just want to echo the thanks to everyone who showed up to these whole group and subcommittee groups in a House complicated issue and I think by working together in this collaborative way we're gonna help provider Kansans with resources and policies that's gonna make a difference in their mental health and I certainly want to thank the people this table with me along with everybody else that's participated suicides also complicated and devastating the reasons as happens are varied and often triggered by crisis of some sort lots of times there's a stigma associated with suicide and they're obviously should be there are conversations we we had about as many questions as services we had answers we're still researching many of those questions we know we can do better as a state and lowering our suicide rate and we're dedicated to that go into working on what we might accomplish this last legislative session. We were able to have the four meetings within the bigger groups we met on July six August twenty ninth. Let's see September nineteenth and also on October tenth we were also able to participate in the governor's proclamation suicide prevention a press conference which was great. suicide in Arkansas just to give you an idea of what is going on around us in our region we have the second highest rate of just our surrounding states Oklahoma is the only surrounding state that's rate is higher than Arkansas there six and we're Levin. then after that it goes let's see Tennessee's twenty first Missouri fifteenth. Mississippi thirty first Louisiana thirty second in Texas thirty six so that's that's where we are we can do a lot better. What are meetings with a lot of brainstorming and lot of questioning of each other in our first meeting on in July we brought up using a brand representive eleven product technology and apps that could be used to prevent suicide and we know that we need to shorten the time between someone having a crisis and and negative reaction to that crisis we we know that depression anxieties straining this screenings they'd be covered by insurance we want to look at ways to help empower kids to help each other perhaps even a buddy system once again it Cabot. Cabot high school upper representative Evans represents there's a Cabot lifesavers group that's a really good program. advocate for school counselors be better trained send out emails tailored to students teachers and counselors increase awareness on who's trained for each kind of situation federal funding on cell phone providers for to sustain call centers we also try to think of ways to get more groups involved in our subcommittee meetings we try to add a little more diversity we had a minority is come in and the elderly veterans we wanted to better educate pediatricians with suicide awareness and prevention. I get also of the Arkansas department of education involved in our meetings which they they did come in also the Veterans Affairs involved in more nurses involved we also talked about ways to get the message out three churches suicide prevention and that's been done a little bit also with the American foundation for suicide prevention here in Arkansas we also talked about how to better consolidated efforts the governor's challenge the big stigma associated with suicide we talked about safe storage of lethal means and lethal means for suicide that comming guns drugs chemicals all kinds of things Texas has an outreach campaign concerning that talked about gun locks work force for nine eight eight never training for teachers we know that there's a shortage of mental health professionals and In general. And the the department of education next meeting joined us minority health commission we had some young people that went to cap it high school that are now in college that added to our conversation that in September we talked about the governor's challenge group and how they are expanding into Baxter Garland Hot Spring counties. We also talked about faith leaders a little bit more so she added with that than in October we had some first responders a firefighter come in representive eleven was able to connect him with the a good group that was going to help he told us that there's more firefighters lost to suicide than actual fire this PTSD is a big problem there's thirty five percents the suicidality depression sleep susp substance abuse he mentioned mention representative weighing in mental health training in dealing with the stigma that work that he has done. We talked about the suicide prevention week in schools school safety commission and what they're doing and if it crosses over any with us there is a certified schools idea schools that are doing a great great job a suicide prevention that's being done in Louisiana and Florida talk about safe storage stuff that's being done in Tennessee. talked about how substance abuse crosses over. Not having a non English therapist the LGBTQ community. and and set aside with them. Of we also taught high school presented that would do a great job for about their social emotional Sir curriculum that they use they had also bought a therapy dog that's been very successful in their school they have a mental health podcast and they have a change bring change to mind group. So some potential legislative ideas that have been raised as to offer suicide prevention certified school that's being done in Louisiana and Florida and we're looking further into that requiring a survey to for existing law implementation status that's being done in Louisiana. Require school suicide prevention intervention and post vention policies that's required in twenty five states and Washington DC. Talked about we've looked at some legislation in other states about excuse mental health absences for students. And Requirements for student education and suicide prevention mental health as part of the health curriculum we're also looking at some laws about nine eight eight performance metrics and the Arkansas department of health and reported an eighteen percent increase in just one month following the launch of nine eight eight and another idea was safe storage tax holiday proposal that's being done in Tennessee right now. in closing I just want a quote I came across from Dr Smith's former secretary of health who summed it up really well he said no one organization can tackle suicide prevention we need multiple systems working in a coordinated way to reach those in suicidal crisis where they are. Think we have a group of dedicated people her committed finding coordinated ways to lower the rate of suicide and Arkansas and we were excited about continuing that work and that's my report Mister chair. Thank you representative of any questions. For this report. C. nine a representive at eleven. Thank you Mr chairman president of eleven from district sixty eight. Mayberry honor to work with a very collaborative team and I appreciate very much representative Vaught asking me to chair the workforce development subgroup over the last several months our group has met in our group consisted of legislators state agencies educators providers both through agencies and independent practice. A professionals and mental health stakeholders to address the growing mental health and behavioral health crisis in the state of Arkansas most especially related to the lack of workforce. our regular meetings have provided much insight to regulatory barriers that keep our state from moving forward with the diagnosis treatment support rehabilitation of those suffering from these diseases. A committee those barriers were heard an address by DHS and I commend them for their updates they're making to their manuals I appreciate the proactive approach that they took in joining in this effort. there is one statutory issue that we need to be addressed with the change in legislation the came from our workforce development subgroup I'd involves the licensure of psychological examiners and I think is we have heard that testimony this morning multiple times different groups have mentioned that this is a huge barrier for us and state. Although this will be a minor repeal of language Max five all five of the regular session of the eighty six General Assembly we believe that it will be a critical step in moving Arkansas Ford in mental and behavioral health practices and I SP has been adopted on this topic in a draft bill is prepared we will be ready to file legislation as soon as early filing period begins Mr chairman committee that semi report and workforce development subgroup. Thank representative Evans is there any questions on this report. I would just like to make a comment I. I appreciate y'all looking into this and and having changes and I really look forward to your I. ISP office a lot of things that we want to do can't be done if we don't have the work force to do it and I just want to really commend you all because you guys are operating not a vacuum and there's workforce demands on every single sector in Arkansas and I I appreciate the thoroughness you did with this report thank you representative Cavenaugh. Thank you Mr chair a representative Cavenaugh district thirty sixty now will be thirty so and I was honored to be over the right sufficiency and better availability subgroup one thing that I will like to say is as we start this conversation about rates and availability and efficiency it's just the beginning we are starting at the bottom level and that is to allow us to build up to the others because we're going to be talking a lot about people that need moderate to mild intervention but we cannot forget those that need more intensive intervention that's that's going to have to continue this is just the beginning as many of state at the state Arkansas is is in a mental health crisis and as brought out earlier we've hit rock bottom now we're building ourselves up so to do that we have to build a good foundation and in this subgroup I I do want to thank all the providers the passes DHS coming out and they were brutally honest with each other and I think that's what we had to have during these meetings they had to be brutally honest and say why what they were doing was not working what was the obstacle I think this group also brought together and and also let providers kinda understand some of the things that DHS can do and some of the things DHS can't do it also allow people to see the different tiers that they have to go through to get something approved is not just DHS I we're going to do it they have to come to budget ask for money they have to come to get the rights so I think that was that that was good to make all the providers everybody understand how that process works because when you're asking for something and it takes longer than what you expect you know anybody will get frustrated with that so I think that it opened some eyes to people about the process that we have to go through but in the flip side I think it also opened the at yes Is that when it special we talk. Out rates and where we're at and what providers whether they're agency providers or their individual potters are actually facing and I'm yeah I'm glad to say that they were able to communicate and luckily there's a lot of stuff that we can do that it require legislation in the subgroup so that's that was great so we're working on the rights we've seen some changes we did get more money to be able to keep the therapeutic communities of light up and running because we have to have them with there's no doubt we have to have those facilities we also. Figured out that rights basically touch everything else because if the providers not have enough right to be able to stay in business it affects everything it also will allow them to be able to have more work force because right to pay competitive wage and different things so this was all encompassing I thank I will say as we went through this and especially with the manual changes I was really optimistic and am optimistic about how the providers the passes and DHS were working together to implement these changes and I think that's a game changer in the state I really do think that's one of the biggest things gone come out any of the subgroups the one thing that we're gonna be bringing legislation out of this particular subgroup there's others it'll be bringing about the other this particular is a problem we uncovered that we personally did not understand the magnitude of the problem and the issues that we're facing it with the staff with the state and that has to do and if you've ever listened I'm always harping that we have to have a place to put these children that need intensive care thank you aftercare we're we're staying at influx of these kids whether they're coming in from private or they're coming in from DHS or DCFS if they're coming in from the dish Airy we're seeing many more children much more aggressive. At a younger age and they're having more mental issues and we're not talking about minor issues with these children we're talking about severe issues and as a state we really don't have a good solution for those children we don't have a good answer how we number one protect them so that they can get the treatment they need they're protected from the sales and then they're protected from me and not harm anyone else and going through that. We discover that we cannot have a situation for that but the situation that we have. Is not working and it's pretty high be honest with the horrendous of what's going on in some of those facilities and that is a state we have to address those and so I think we went that we found something that we didn't want to find but I'm glad that we did find it that we know that we have this issue and that we can change it and move forward and through that we're working with DHS on legislation to kinda help us address that current situation that we have and at the same time find a way to get these children the care that they really need because that is we talk about early intervention everything else we have got to do something to help these children and so that's one of the biggest things I think that will be able to do as a state in my opinion is to help curb some of these issues that we say is if we can do early intervention and this will be able to allow us to do that and then I just want to thank representative Vaught represent eleven and represent McAuliffe for just being in there put the working in and all the providers and DHS because this is this is an issue it's not gonna take one session to fix is going take several sessions to fix but hopefully as we go through this we'll find more policy changes we can make that doesn't require legislation that allows us to get stuff done quicker thank you. Thank you represent Cavenaugh of any questions from the committee I just have one on the legislation your working with DHS on have you all filed and I. S. P. at or is there a draft we'll see soon are I'm just just curious we should see the draft someone we just met with DHS about week and a half ago. Over the concerns that we had found and how we want it we had some legislation drafted but once we begin to see the issues that we had we realize that what we were envisioning was not and so as we reached out to the H. S. they were able to give us more insight and they're working on that legislation okay fantastic thank you. A representative Vaught thank you for bringing home. Thank you Mr chair representative damn Vaught a District eighty seven I'm we did have some chairs that couldn't be here today they did have meetings they did so representative Gazaway I sent me something and if it's okay with you Mister chair I quickly go over it I'm his. We've been meeting since February just so everybody kind of understands this group has been meeting for quite a while now and they put in a lot of work all of these subgroups have miss Marlow had stated that there was a hundred twelve master leveled clinicians under the Arkansas substance abuse certification board the problem was that they can't bill for insurance and that was something that they were looking into to see how they can get because of the work force shortage how we can use these individuals also help with this growing problem that we have in our state I'm also we found out that this great found out that they were leaving lots of federal money on the calendar on the table because they're under reporting opioid deaths in the state of Arkansas and that's a corner issue and I know that representative Clowney has been working on this corner issue so that we don't leave all of these federal dollars on the table representive county is also working on licensure for a behavioral analyst to serve children with autism and developmental disabilities so that group has been meeting they've been doing a lot of things representative warns group also has met several times he didn't send me a report I'm sorry I'll get that to you although whenever he gets it sent to me I'm the group that are. I was working with was the prevention and early interview interventions that great I've been saying since the beginning if we find these children at an earlier age and help them much sooner we would have less people in jail in prison and and the crisis of needing to go to some place and stay or the suicides so those kind of things all wrapped into if we can find them sooner and help them sooner I'm I'm something that I had been asking for the whole time was a school screening a screening per week it starts you know in kindergarten just a quick assessment of how they're doing we have identified one of those programs. We're trying to get it put into all of our schools they're doing some research on that right now I try to figure out how the best way to get this into our schools most schools have what they call a bell ringer every morning and it's how teachers take their role and this could be a quick bell ring or four five questions to help identify if a child is hungry if there have been an anxiety problem or if they're mad because they had a fight with their mom on the way to school or whatever's going on and it'll be a good way for a teacher to figure out a child's need much sooner rather than later it's all in a quick time it's all. I immediate time so I am Mr son brought up several times about board combining this that legislation has been written it is ready to be filed. To combine those boards and there's also an oversight board that the members on there are like twenty most of them have been on there for twenty plus years we're looking at combining that board into a different board for oversight so that's that's a couple of good things I think that several of the groups would be excited to hear about is that we are we are moving forward with combining of the boards and a couple of other things that we talked about was in our group was enhance opportunities to train behavioral health clinicians on early childhood mental health and development experience expertise in evidence based approaches to supporting young children and families I think that something that we've all talked about and all of our groups is evidence based we want there to be a way to show why that there is some kind of progress happening also with these with these children I we looked at creating a DHS position charged with licensing collaboration across key state agencies to identify and implement best practices for mental health promotion prevention and early intervention what we found out is a lot of these groups had no idea what each group was doing. And maybe if we had somebody that was like in charge of that then those bridges can be built much faster than what they're being built right now I there's been a request for an interim study proposal focused on approaches to increase identification of children with early emerging emotional and behavioral concerns to the expansion of routine standardized screening and I think you've heard a lot about screenings today and I think DHS has done a pretty good job of trying to open up some of those screenings as so that these providers can be reimbursed for those screenings which before they were not being reimbursed for any I'm not that I say that right okay they were not being. None of those screenings were get reimbursed. And. We've also requested an insurer of. A study on the development of a network of family resource centers consistent with models with which have been shown to reduce risks of maltreatment and based on a nationally adopted standards of quality for family strengthening and supporting we've talked about different apps that we could use their there's been a lot of talk in our in our ours because in reality it's where everything starts that zero two three Page three and beyond and if we can catch those students are those children much sooner I think it would. Really eliminate a lot of what goes on down the line so and with that Mister chair I'm going to close if that's okay with you. So whenever I started this process. I knew that I was well over my head I had no idea really what I was doing I'd only been to public health committee I think one other to I am a besides presenting for these ISPs that I wanted to start this this working great. At I started off by telling everybody I was about to play in their play pans and step on everybody's toes and not everybody was going to get what everybody wanted those going to have to be a lot of give and take if we wanted to truly move the needle somewhat in the State of Arkansas. Everybody seems to play pretty well with that of course there were times when they were like represented by I don't like that and I would read you remind them I told you I was going to be playing your playpen I was going to be stepping on your toes and not everybody was going to get what everybody wanted but if we truly wanted to improve services if you were truly serious about wanting to improve services you would find a way to live with what we're proposing or what what we're wanting to propose. I'm I think that you can tell there's been a lot of work done in these groups and a lot of things have been accomplished since February. I want to personally thank DHS I they've worked very hard a long hard hours on policy changes that had to be in by a certain date. And sometimes they would look at me and say representative bottoming that's a tall order and we're not sure that we can get that done in time and I just kept reassuring them that I believed in them that they could and would get it done in time. And I think that that I approved you to be correct. So I want to I do appreciate all the long hard hours a Tropidion on policy changes instead of making us write legislation to make those changes they stepped up to the plate and they implemented the changes that needed to be made by policy do I think there's more policy changes that can be made yes I do and I will think that there's always policy changes that can be made one are manuals were as out dated can I say that correctly outdated as as badly as they were outdated that shows that policy changes need to happen more often than what they were happening and I appreciate their willingness to do that. A I do believe that this group they will everything that we've done has built bridges that were not built prior to I think now more people in the audience know of services that are actually available that they didn't realize were available before and those bridges need to continue to be built I don't think that we're through building those bridges. After this session I have been asked I would we please continue this work I think this work is not finished I think it's just the beginning it's the tip of the spear and I do believe that we have to continue this group after session to continue to move the needle in our state and I told I think a totem at the beginning that this was a game of inches this was not about a hail Mary touchdown this was about a game of inches and the only way we could do it is content to any of the work that we have started I do want to thank every provider that was here that actually gave input that actually helped helped us figure out what needed to be changed and I want to thank every chair again for your hard work and. The chairs of these committees were not paid to do this there was not per diem for the S. and I appreciate all the long hard hours that they put in and this is just the beginning Mister chair and I look forward to as a truly moving the needle this session in our state and I truly do hope that one day our state will be the state that other states look to and we're not the forty eight or forty ninth state that were up there and people are looking to as how to how to fix a mental health and behavior health in their in their states and I appreciate this opportunity. Thank you representive bought are there any final questions for our groups. All right see none of that objection the Health Services subcommittee recommends that representive box with the assistance of staff and members of the working groups summarize the discussion from today in a report to the Arkansas Legislative Council by December first as required and ACT eight oh two of twenty twenty one. Thank you and with that we are adjourned.