Task Force on Autism

Break good to see everybody today of. President Davis of any comments before we get started. Thank you Mr chairman. I just like to say committee you know my story my son Jackson Ellis Davis was diagnosed with autism in two thousand four. two years old so I'm also the pharmacist. And prior to that believe it or not I. Was pretty an educated as far as autism. fault of my own I guess. And so I thought about what I want to say Dismang brief for for everyone in here today. I just like to say thank you for caring thank you that. Most of these kids are non verbal as everyone knows and so they can express their sales they can't tell us they're paying their happiness my son's nonverbal he's twenty years old. So I thank you for everybody that's that's trying to help this population of people. Thank you representative Davis up with that of let's move along to of discussion on the autism clinics across the state and Melissa if you would bring us up to date on that thank you. Thank you Melissa whether ten AM development disabilities director. So Karen Burnett and I have actually had several conversations about this what what started let me get some background. So when we started the autism waiver here in the state of Arkansas we operate that for many years prior to me being in this job and when it came up for renewal the federal government sad and you need to you the state of Arkansas Medicaid needs to offer an. Applied behavior analysis therapy for any child on Medicaid that has a diagnosis of autism so and we're not we will not re approve your waiver unless you do that so we quickly stood up a process for enrolling ABA therapists as Medicaid providers and we mimicked how we set up occupational therapists speech therapists and physical therapists meaning they bring their license to Medicaid enrollment it doesn't come to my office at all they enroll either individually or as a group and so the difference is they are all there is state boards of or those entities that is not the case for a BA therapist ABA's therapies have a national and licensure process there's no state of Arkansas Board so we said at the same set up in the same way so if you're an ABA therapist you can take your national certification go through it Medicaid in Rome and roll either individually as a group. What we're seeing through. Claims data and through our vendor who does prior authorizations is we have a very large amount of children receiving more than forty hours a week of ABA therapy now this would not be asked concerning. If it was children six and below so because if you are if you're under the age if you're five you can get a kindergarten waiver and you can still go to one of our early intervention day treatment clinics and ABA therapy is performs their and I'm and so that that was not concerning to me so when I sorted the report and and laughed seven in above ages seven up to the age of seventeen year old children receiving more than forty hours a week of applied behavior analysis it still is substantially large number so. I think what's happened is. We did not run into this issue when we set up OCPD speech because kids what TPP speeds go there for maybe a hundred eighty minutes a week they're never there for hours every week rate like this there's two things that bother me and I will not speak for care but I think she'll type in. We need to figure out why they're not at school. And what how they're going to the clinics for that many hours in lieu of school. And then the second thing is is that they're not licensed because the way we set them up so I licensed and early intervention day treatment programs right where kids get over forty hours a week there's a lot of restrictions around nine AM because they have five or more unrelated children for more than ten hours a week there statutorily required to get a daycare license so what's happening with these we're getting a large amount of calls I read that pass I would say six to eight months and we're having to send out Tonya Williams daycare licensing licensure staff to say aye if you have this many kids here for this many hours you need a daycare license in accordance with state law but other than daycare license and there are not there really are any more restrictions in terms of from the Medicaid agency on these clinics so I think you know I would like to know more before I move it make any kind of recommendation on what we'd like to meet with them and you know the schools and figure out we know what do we know what areas of the state this is happening and we know what counties and I can see who has these kids and who doesn't you're in the school day and just try to do a little bit more deep dive into what's going on but I did want to make you aware of it and so that you know that we're looking at it and when I come back with some more information you understand what what I'm talking about. Melissa would you with the hours that we're talking about just you what what what got your I guess you when you said you know why are they in school these are so many hours of what are we talking about in a in a week's time so would ask that Bender to pull was twenty hours or more a week so you know you can a Sam. You know forty hours a week is amended normals eight to five right so twenty hours a week my reason I ask for that the assumption lies well they're not obviously in school full time and able to get twenty hours a week but what we saw on the report was there getting some are getting much more than twenty hours a week and and so twenty hours a week in itself is concerning but the ones that are receiving forty to sixty hours a week is very concerning and the ages associated with them are definitely school age children okay. All questions. Questions rules Karen is there anything that you want to. But may as well. What what we started to see and we were here in this because of our involvement initially and operating that a PST T. program people still call and ask questions even though it's being managed a different light now but what we were hearing was that families had been advised to still the schools that they were home schooling their child and then sending them to these ABA clinics for the full day where they would have been in school and I think what's happened is they've been and we've heard it in this task force over the years lots of families who would come to the task force with frustration and concerns over school issues and that's what even prompted the seclusion restraint kind of activity but I think it's become a way when there is a situation that a family is not comfortable with rather than to work through that with the schools through the due process proceedings and whatever might be available or pull in some of the and technical assistance people the department of education has is families are just so I am allowed to solve this problem and then I'll send them over here and I honestly think they're being advised to do that by some of the some of the practitioners and so there may be you know part of my concern is not only the school age children but the grouping of children it's it appears to be just children with a S. D. and and a group of children who may be really having some pretty significant challenges in other settings and so I have a concern about putting all those children together varying ages and you know and whatever so I I would like for us to was not looked at it and would like to look a little more. Anecdotally do we know I mean I I heard you say that above five obviously obviously it is a they have to have a day care license of do we have any anecdotal evidence of how many could be children could be in one. Setting. Five six seven hundred and I have to do is take the the less that shows the clinics names and then I'm gonna have to pull specific claims data on those clinics how I had a moment right right at this time Senator was I just asked him to pull back client name age County and provider so it's not a core is not sorted in a way that lets me see one clinic how many there are at the same time. Judge. Other questions. Yes you're recognized thank you Mister chairman and you made the cover this for a walk and how many total kids we're talking about June was that information available well I tell you that in total before you take out the the five and six year olds assuming making the assumption they're going to an early intervention day treatment program it was seven hundred before up pull those kids out. I cannot remember and Karen I don't know if you do I can remember how many want to pull those kids out were more left but I can get that for you thank you won't call Mr DO how many locations how many facilities as well you made a commitment to cover that no that's just and then I don't know yet is how we had it pulled the first time. And and the kids are kind of off my radar is one of the. Any other questions. All right let's move to discussion on the expansion waiver of Melissa. Yes Sir thank you have a Salem. In addition to the autism waiver. That that goes through and my division we operate what's referred to as the DDS waiver but it's the real name of it is the community and employment supports waiver and I guess you guys have now and we have had a substantial waiting last for many years we were able to add and five hundred slides several years ago with tobacco funding settlement funding that was redirected seven hundred flights with the the premium taxes if it passes pay to the Arkansas Insurance Department that many of course that moneys you're mark to go to this program and then most recently and and Senator Ingram was there for the announcmenet which I really appreciated and the governor and the legislature voted for the budget if to add approximately three thousand more slots so. M. with that giving asks about thirty seven million more dollars of on going state general revenue to match the federal portions that we can serve those people and I'm we filed the request with the federal government and it was approved on August the first and then the legislature it goes through and several committees here and the legislature approved and approved it as well in September so I was able to send out an email we have released the last I heard we released a hundred fifty slide sense we received final approval and We will keep releasing a slice it is our goal is to have all of those lots released by an in the next three years. Questions. Yes. Thank you Mr chairman we have an accumulation of the number of individuals that are way now after this last announcmenet announcmenet three thousand slots so the last I looked we had not been built back up so it was saying consistent at about thirty one hundred people. It is the in the slots that are or being released are are they in order of how they were taken is that the way we're approaching yes Sir. Of could you also any other questions regarding this yes represent Brooks thank you Mr chairman allulose lots to know or spectrum folks. I would have to go back and look mean that's one of the qualifying diagnoses but there's five qualifying diagnoses and I don't keep by less based you know it's it's like Senator Ingram was saying the way that we have federal approval in the way it's written the waiver is once you meet the criteria of medical criteria you go on the wait list and it's first come first serve. Other questions. Of one of the things that I think the task force we really need to to look at with the upcoming budget is it's great to have the slots but we're going to have to people for our services in home services and if you do you know whether well the budget to be released in November but is there of it do you know whether there's going to be any attempt to raise that of salary level to make it competitive so that we can have of will in lieu got slots now but then they're not even people to serve those slots. Yes that's I see okay there's a couple of components to that that I've been talking about lately so all of these clients or in a pass program and the passes receive a per member per month payment based on. Region that the state based on Medicare and Medicaid if they're on both and based on Children I doubt a DLE and members on at ID D. versus behavioral health says that's how the primer apartment her might payments are designated as a managed care program. We have to have a as CMS approved actuaries set those rates and they actually are just now setting that twenty twenty three pass rates. And so I've been in those discussions and it does not look like the ID D. per member per month rate itself will increase but of course they'll get an additional payment with every new member that moves into one of these flights so and overall budget I do not think we are coming forward asking for additional funding for that program based on what I'm hearing and these I think at this point we have the money an appropriation to pay what's projected for twenty twenty three they didn't take into account though things like this committee members moving on of course it won't be the total three thousand but they do have projections on how many each month will come on and whether or not they're already in a pass if there are any an impasse thirty getting a payment for that member but it'll increase when they get a slide M. O. whether or not these are new to the program all together and this is whole new funding so because you know some commercial incentive on the wait list aren't getting any Medicaid service at all so I am actuaries looked at all of that and knowing you know winced once you all pass legislation that we could pay for it and that was all and looked at when they develop the twenty twenty three rates so is the anticipation that of three years you not to list out roughly it's a it's a hundred a month is that sort of what we're looking at I think where we're aggressively doing a hundred a month because like you said we we have to have the work force to actually do the service and so you can't release five hundred flights in a mind and expect people to find a service provider that's one of the reasons on this amendment we went in and changed the rule and asks see a mass and then you guys for approval to allow parents and legal guardians to be paid staff to try to beef up that work force and and because we know that we. Can you know help alleviate what's happening if we a paid legal guardians and and biological our parents are not biological parents to and be paid staff that they go work for a provider I'll tell you it leads into the next it believes in the item eBay. You know we're doing a lot around home and community based work for stabilization with all of this American rescue plan funding and that I would love to talk about and including dealing a term. The landscape with data analysis on on our work force in general in that space and where we need to go strategically to stabilize it over the next two years knowing that is not only direct care workers but it psychologists and it's there it's behavioral health counselors and it's a it's a whole group of people that are are serving this population that we've got to. We've got to have a strategy around stabilizing at. Questions about care. Not really questions Senator but a comment that and I'm glad you brought up the work force issue because it's hitting us on the autism waiver now as well and we didn't have as much trouble initially you know sometimes it's easier to find folks to work with really young children easier than it is when you got teenagers and older individuals but now we're sitting at a place where about twenty four percent of our children who are in slots in the programming don't have programs running because of our inability that providers inability to recruit people. Yeah so it's starting to really hurt us and at some point we're probably gonna have to look at the issue of ours is time limited so they get three years worth intensive services and we're going to begin to have those questions I'm sure where a lot and get my three years because I nobody had a line therapist and you know and that's true that's true so it's gonna recalling and have to take a look at what we do in those kind of circumstances and interestingly initially we had trouble in the very rural areas we've had referrals and kids all over the state which were really thrilled with all seventy five counties and will work hard to get it in some of those areas you know some of the work done over the Helena area to get families over there but initially our our challenge was recruiting train staff in those areas now it's not in those areas it's more of our urban Central Arkansas northwest northeast where there are lots of jobs available to people that pay more than what we pay. So it's it's hit us to. Questions. Roger Marshall questions all right we'll Melissa wanna chew of let's now move on to where we started on our performance of thanks bye are all day. It can to. But not bad or bizarre but this little bitty B. the R. M. this is Adam what what they've asked me to be ever DHS is and a very specific funding stream under American rescue plan act is called ninety eight seventeen finds it is earmarked only for home and community based services for Medicaid clients and we had to apply for it so I applied for the funding and by writing up a spending plan in the summer of twenty one and our spending plan was approved and it's a flu a document thank goodness because things got come and go and we see well that's not gonna work right now so we get to go in every quarter and amended but where we are right now as we have an sixpack workstreams that this finding is allowing us today the first was I think I've talked about the work for stabilization payments so we were able to get out of a hundred twelve million dollars to providers. And if that take care of clients in their homes that are physically disabled aging elderly and intellectually disabled or have behavioral health and how behavioral health needs and so all of those services that are done in the home and community which includes schools and so and those providers what are and they had to apply and are put into an algorithm based on their paid claims so providers who had a large amount of claims and also have a large amount of staff and they received a larger amount of allocation amount and because the only thing they can spend the money on is recruiting and retaining the staff that they have and and so far and the ones that reported back it's been very successful and especially helping them recruit new staff and in their areas we are about to start doing some audit functioning around this money so that I can actually gets a matrix to see if it's working so we are going to be asking the providers who receive the funding to report back on how many new recruits they have how many work that retention bonuses at a given out and things of that nature now they have to use the money by March thirty first of twenty twenty four so there's a big fear out there that when date the money is over or that their discount apply tell again and we agree with them so what correlates with that is a work stream that is this home and community based landscape looking act and our work force in that arena seeing where we really are right now and accurate data analysis of where we're short where were not what we need to be focused on and developing a strategic plan so that we don't plateau when the money ends in twenty four. In addition to that we have a workstream that were launching on assistive an enabling technology. Because we're not doing a lot of technology here in the state where other states are doing a really good job of bringing in technology for people to gain independence so we will be launching that initiative and actually they started launching it today the contractors are on site and then we're gonna be doing a huge educational campaign so that people know what's out there because that's a big barrier that people don't even know really it's very confusing to be able to understand it and then and last but not least and policies down your committee on apala of our behavioral health she will be leading this workstream and they are working to develop and as statewide crisis continuum sending we've been trying to do for many many many years. Where we are working with Committee paramedics and local law enforcement to stabilize people in their homes and not take them to jail and and not take into them to the hospital so and I will not just be for past members or Medicaid members we are working on trying we'll be bringing in and our large insurance carriers to build out a system regardless of whether or not you're you don't have insurance I have Blue Cross or have Medicaid it'll be a statewide system for all callers so and the plan is to have that and implementation M.. Plan in place by the end of December or early January that we can all start working on it together. Of would you describe this you talk about I mean we know that that need is a tremendous need and and when their pick up and put into the of a jail living their way from their medication I mean it just it sets off a spiral that of it when you're talking about the technology assistance that's new that's available for lay people could we sort of talk about what that technology assistance this act so it's differently for different needs and different populations like New York is piloting something really cool right now it's them and a I type of piece of technology that you can have in your home that learns and learns that elderly persons and routine and have full blown conversations and the longer it's in there the better off the conversations are and then they and and it's to combat loneliness so I'm actively watching New York to see if it's working they're using American rescue plan funding to deliver this technology for clients intellectual disability what I think would be helpful is you know they have automated and pill dispensers that can administer their medication for them so that all they have to do is is take it for our clients that are able to do that and they use a lot of and your pieces and and smart watches to help people get into the workplace they don't want a job coach with them but the job coach is in their ear and on you know we're talking to them the whole time there at the office I mean at the job and they're able to gain independence so weird you know I think here for a long time with the IDT Committee we talked about and communication boards and and stuff on your stove and to keep you say but I think it since we've had a whole new level of what's out there that we're not tapping into that that I think could keep. Client safe and could bring a lot independence not not all clients rate I mean it this is not going to work for everybody some people still need someone there all the time and but I think it can work for clients who want that independence you don't want a worker sitting in their house. Well that's that's fantastic the questions. Any questions. Of you know with the art of funds. You know we've got a million or billion six roughly and the first half of it the first tranche was pretty simple I mean it it was going to hospitals for COVID and it was going for broadband and and and and sore water and sewer that so needed in in the state I think that. Most of the legislature everybody agreed on it I think what you saw with this last round of of the eight hundred million was more of a. G. I. F. everybody's got a great project and we'd like to get it funded up I've written the governor and and one of the things that I would like to see done and I think it could be done fairly quickly is to put together of a small task force of you a mass of DHS department of health of doctors Association hospital association and use the eight to nine hundred million is left up with a comprehensive medical plan for the state what we could do with things like this that all goes to one thing medical related and I've see that is the future I see that as an investment for the future I fear that this eight hundred million once all these are favors projects that are being presented it's going to be spent we're not gonna have any long range calendar being any better than what we are will you know we have rural hospitals that are just trying to meet payroll if there's nothing that we're investing in that is long term in nature that you know saab's long term problems so of this fits right in with what I was thinking I mean these these are great things in and hopefully something could be derived out of these. Somewhat once in a lifetime opportunity with these fun. Other questions up here. This is the is the part that Paul is over I'm going to include that are this might be the other are profundity the defending that and I heard Cindy Gillespie actually presented to the Arkema the about the hundred teams that we're going to be around the state to do intensive home is that something different from what you just okay can you explain it tells a lot about that. So what you in center Ingram are talking about is that what what I call the big are right they went to the state of Arkansas not this little amount and that I'm working off of but but I would love to join forces. But Bigard is what you're talking about this and Secretary Gillespie had had gone forward with them that proposal to and put I think it was five million dollars to train teams in evidence based practice for assertive community treatment which is a service that is evidence based that for adults with behavioral health needs and then intensive in home services for children. You guys will see that's in a packet right now that's about to be run in them and newspaper and go through public comment it's a huge policy packet that we just finished that'll add those two services to the past program and. We were we were doing and. Sunday announced on the pastors right now there's about fifty six thousand members of the pass and the thirty four thousand that our children and when you look at our service package or the past there was not a lot of services and built for families and and we all know that we have to teach families M. as well as children I think that's why the autism waiver works so successfully so intensive in home is meant to keep kids out of residential treatment by sending in a team and that's overseen by a clinician and that tracks these children on a very intensive level it'll go the opposite direction on unfortunately there already in a residential type psychiatric placement they can transition out of those placements with this intensive in home team to come in and teach the family and be in just this short burst of wraparound services in the committee that Cindy had requested last five million would go to towards training these teams so that these providers one role as is provider type and start providing this service for us that'll be available in January. Just one follow up who are you you who are you looking at what disciplines on those local teams are you looking for so hello okay so is Paulo is here because she would have alot better these teams right now on that training are very behavioral health heavy and we have got to once this is glad it's over we've got to sit down because I think the same type of approach would work for people with intellectual disability in a an ad with a little twist on it because this is really a recovery based model is how these and those two services are set up and we need to look at more of an ability of model for our clients but I think once we get the set up for them I think we need to quickly turn around and do the same or similar services for ours that's not to say that our clients could not participate in this if they have some significant behavioral health needs it's just it's marred M. geared towards behavioral health at this point. Any other questions. All right Melissa thank you for an excellent presentation thanks as usual of I think that we probably have one more meeting this year of in the budget will be out in November this set up legislature will meet in January and I think that if there's anything in particular that this body would like to address any of it either he ate legislation or funding of we need to think about that here before the next meeting so that we can get that into the legislature so it be considered the other thing is representative Davis and I both or sort of like I guess macarthur we're sort of fading away of and there will be a new leadership group I think representative Brooks I I hope that of that he will step up and and co chair this This taskforce you've all the Lindsey started this then was the impetus behind it and and and created something I think that's had meaning full effect on the families of in Arkansas and so there will be someone in in the Senate that will be co chair it and I think I know who who is interested in doing it so will will maybe take that up at the next meeting of anything else representative Davis. Anything else anyone yes. Yes please up identify yourself. Hello everyone my name is Dr rocky hands I'm a doctoral level board certified behavior analyst and I live in northeast Arkansas and the pair go Brooklyn Jonesborough area in I actually I'm just returning to Arkansas I grew up here and I laughed I did my training now Illinois and Florida and I decided to return here back to the role part of Arkansas so I could work with families the opportunity just not reach by so many people that are in Mar up the urban areas so I've been spending a lot of my time getting to know the services that are available to individuals with autism or autistic individuals the Northeast Arkansas but I also specialize in working with youth who have emotional behavior disorders and working with families to ensure that they stay intact to keep children out of residential facilities but I want to just present a couple things that are really important to the field of behavior analysis in the state of Arkansas currently the Arkansas Association of behavior analysis has been working with the subcommittee on mental health to hopefully pass licensure for behavior analysts in this state and we're hoping that will come up in this legislative cycle we do know that that's a long process I'm not here representing the board but I think it's important and I'm component considering the topics earlier about the need to ensure our consumers are most protected in our state I also happen to work within and eat it facility in support individuals with autism and one of the things that I find that can be challenging at the early intervention day treatment centers is reaching the full therapeutic level of ours for individuals due to the limited hours available whenever you factor and T. PTN speech so I would just present to you is you're analyzing the US statewide data on the factors of autism clinics that that's something to think about because I think the currently the intervention day that whenever you look at literature reviews suggests for a population of individuals with autism ensuring higher a number of. Eighty eight therapy verses a collective group of OTP ten speech combined with that and that's something that the therapist as the team have to figure out how to best support those families another area that I have found that is a little bit challenging expressed specifically for kids that are over the age of five which is my specialization up into the teen years and northeast Arkansas I received many calls from families trying to figure out how best to support their children who have been put on hold down from their local school districts because there are limited resources available for the school district to be able to support the families and often times they're trying to figure out how they can support their child in the community in too often those families have lost their jobs because they're having to be the full ten caregivers so whenever analyzing the data at the state level of kids over the age of five that are receiving services some of them might engage in pretty severe problem behavior I currently have many many many clients that did come out of the waiver program which really worked heavily on their language and communication and the ability to follow routines but we're still seeing extremely high rates of problem behavior it's not uncommon for me to get pension that pays on average over a hundred times a day trying to help our clients navigate that daily routines of their lives while I'm hoping that they're not experiencing stress up I it would encourage people to factor that in as well I have reached out to numerous school districts and Mary the stay out of respect for them I prefer not to name any names but many of them have stated they do not wish to have any support for my clients and the only time I know bided to any meeting as if it's the I. E. P. meeting that I'm showing up as an advocate to support my clients. Watson not least I would like to end on a positive note related to the technology that you were discussing earlier really I think coming important area of supporting individuals with disabilities using virtual reality to teach safety skills related to all I'm getting the online transportation using stoves responding to abduction responding to people trying to take advantage of them what we see is that utilizing virtual reality decreases things IDF the individual in allows them to generalize those skills to Knobel areas whatever you're speaking to being able to fade out home care givers so I do thank you all so much for today and I look forward to seeing how he continued to support our families across the state especially in my area which there such limited resources thank you are there any anybody have any questions for doctor Hines Hines. Populous I would just say that I and rocky and I have met and Polish several times words actively trying to recruit him to M. six oversee these intensive family services under our new provider type so because we do think it would be helpful to have a skill set like an ABA therapist that knows disruption to track these children we do think that's when things were missing and kind of re utilize our work force a little bit in that space I want to thank you for reaching out to me in in provide me information as well as a driving down driving down here today to attend the task force meeting of. Melissa do we if The the certification for the the the the HA use of is that. Do we have to have that before the session or is that any modification you know we get into things in our own medical that that if there's any change it can be done during the session it's got to be presented I think thirty days prior to the session does this fall under those that category. I do think he's talking about a scope of practice I have not seen but it would be a change we don't have any state Arkansas licensure process for ABA therapist so this goose scope of practice I was searching for that I just couldn't pull it out and that. So this would have to be done with what do we know or status of this. I didn't know they were doing this ma'am not against it I meant only find out more about it. Okay Sir sign in to a doctor Haynes de novo status of of what you talked about about the licensure process. The board updated all of that member is there what you are the Arkansas Association B. analysis updated them our members that they had met with the Senate committee for our mental health policy covering the exact title in that they were meeting to decide whether or not they would be able to draft a law to regulate the practice of being houses in the state of Arkansas okay with that be aware that that that is something that will have to be of by the first week of December will be completed and out to be considered in this legislative session. Thank you Melissa anything else no Sir I've been attending those meetings I think they're led by represented by M. and center Cavenaugh and represent about eleven. M. I'm I'm happy to circle back I think represented by is actually looking at a different issue or a similar to putting several licensure boards under the same umbrella. Okay the map that I think that I know that's going on I didn't know but behavior health. If we could follow up and I'll call represent followers will and ask or of anything else. Well once again thank you all so much for attending the meeting today and with that we stand adjourned.