ALC-Administrative Rules
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the administrative rules subcommittee of the Arkansas Legislative Council will come to order I'd like to remind
those that wish to comment on a rule to go ahead and sign in be sure to specify the rule on which you wish to comment and then we'll be taking up those sign up sheets momentarily Cocheian comments before we
get started right we'll we'll move into our agenda first we'll be with at we'll take up item
B these are the agcency's rules for the month and first up we have that B1 department of commerce statesurance department if their representatives will come to the table may have a seat
and if you'll each of you will introduce yourself
Speaker 25
2:48
you may present the rule el Anderson deputy commissioner forinancial regulation Arkansassurance department. you yeah there you go you
Speaker 28
3:20
amandaRose Arkansassurance department associate counsel ri Irwin, chief
Speaker 29
3:24
analyst Arkansassurance department. all right you're recognized
Speaker 28
3:34
to present the rule this is an amendment to 23CARartine formerly rulele 1f it's an amendment to our holding company system rule it's a national association ofsurance Commissioner modeldel regulation the companion model law was passed during this year's
general assembly it's actct261, the law and the regulation work together to establish new tools for financial regulation of insurers and are that are a part of a holding company group a holding company group is defined as two or more affiliated entities one or more of which is an insurer. The models require the filing of a group capital calculation by the ultimate controlling person in the holding company group there were some formatting changes made but the substantive change to the rule made by this amendment is the addition of the
group capital calculation requirement again that became law this year the model regulation also provides direction on how to proceed when an insurer in a holding company system is placed in supervision seizure seizure conservatorship or receivership. Both the model law and this model regulation are national accreditation standards this year the amendment provides guidance and instruction to insurers on how to comply with the new regulatory tools established in
Act261, which will allow for more effective regulatory oversight this rule is necessary to provide insurers and regulators with direction regarding implementation of Act261. Membs you've heard a presentation of the rule are
there any questions Seeing none without objection, the rule is reviewed and approved. thank
you thank you for being here today
Next up we move to item B2 state board of election commissioners you
would have a seat and introduce yourself to the committee thank you Mr
Chris Madison
Unverified
5:44
chair members of the committee my name isri madison I'm the director of the state board of election commissioners. Jonathan
Speaker 41
5:50
Kendricks attorney for the state board of election commissioners thank you you're recognized to present the rule thank you Mr chairir we have two
Chris Madison
Unverified
5:57
rules for the committee's review today the first rule is amendments to the rules on poll watchers vote challenges and provisional voting principally what the proposal is is kind of gives a little more defining on what poll watchers can and cannot do within the poll we had some issues in the last election of some confusion about that and some conflict and some polls so we wanted to define it a little more and also lay out the lines of communication if poll watchers observe things that are not being necessarily resolved in the poll they can contact the poll supervisor or they can
contact the state board and I'm happy to answer any questions about that rule sevencar part 91. any
questions from the members seeing none without objection
the rule is reviewed and approved. you're recognized to present the second rule. The second
Chris Madison
Unverified
6:45
rule we have is the amendment to the appointment regarding certified election monitors the state board selects monitors and sends them out to observe the conduct of elections one of the things we
ran into is keeping monitors and one of the reasons we have a hard time keeping them is we were paying them $100 a day so they would go work anywhere from 14 to16 hours and we were paying them $100 so this basically changes that to300 dollars plus it defines the training pay the observation pay and then the report writing pay and with that I'm happy to answer any questions any questions from
the members seeing none without objection the rule is reviewed and approved thank you for being
here thank you Mrir thank you members of the committee emb ers we're gonna move to item B3 treasurer of state Arkansasinancial Education Commission if you would introduce
Michael Harry
Unverified
7:55
yourself to the committee good morning uhmi Harry the chief compliance officer and director of
government affairs for the treasurer of state right you're recognized to present the rule our rule is pretty simple what we did is we took out the requirements and the membership requiring I guess DEI requirements so we're just changing our rules to be in compliance with the act 938 right members any questions seeing no questions without objection the
rule is reviewed and approved. thank you for being here
members we're gonna move to item C and I would ask let's see C1 is department of education and we're gonna without objection we're gonna hold this over for a month members this is a request to be excluded from reporting requirements And previously we had given we'd granted such requests to the department of commerce
there's a little bit of an issue as to who should write or implement the rules so we're going to hold this over for a month to see if we can have some further discussion and also next month we'll have both the department of Education the department of commerce so without objection we're gonna push that for a right we're gonna move to C2 Department of Human Services
Speaker 56
9:48
Good morning Janet mann DHS secretary. and Elizabeth
Speaker 57
9:52
pittman director for division of medicalical Services. and just
as a reminder for the benefit of the committee and the public as well in those instances where an agency believes that a rule is not necessary for the operation of a newly enacted law of actct595 of2021 allows the agency to submit a written request notifying the subcommittee of its intent to not adopt the required rule and requesting that the rule be excluded from
the agcency's monthly updates on rulema and so that's what we're
here on and I'll recognize the department of human services to present their request thank you sir
Senator Missy Irvin
Unverified
10:30
our request today as we sent a letter in December of 2025 we have 124 acts that were passed in last session that we have indication from
Senator Breanne Davis
Unverified
10:39
our federal partners that we will not be able to implement as passed therefore we feel that we may not be timely or not be
able to effectuate some effective dates of 91 and 11 for certain bills so we sent the letter with the intent to inform y'all as we work through the process of what happens next. Did I miss anything if you could could you just go into
a little more detail. I mean I know you've laid it out in the letter but just for the benefit of of the committee as a whole and and the public as well if you could just kind of go through in detail the mechanics of what exactly has
happened and what has brought you to
Senator Missy Irvin
Unverified
11:25
to make this request yes sir I'm gonna start and I'm gonna ask umrector Pitman to also add some of
Senator Breanne Davis
Unverified
11:31
the details so the first act in our letter is567 which is the diagnostic labervices annual capp charge for chronic pain and pain management. Cms has indicated that due to a comparability section of the federal statute we cannot implement as passed we're trying to work through with them on different options that will still fit but we just
don't know what that looks like yet it also has an effective date for rules of 11 which is why we felt the need to include it in this letter. The remaining acts568967 and 1025 are all dental related they have various components that Cms has given us feedback in writing I believe we included those letters and emails on those of what some of their concerns were I believe the
largest one was Act 10:25 which was dental rate and annual limit increase. they have said that we cannot due to comparability cannot create a separate group and pay at a different pay scale and so that leads us to what do we do next they gave us three options in an email and a letter to consider after meeting with the dental association and others there was 1/4 option thrown
Senator Missy Irvin
Unverified
12:50
out that was late last week I believe. so
Senator Breanne Davis
Unverified
12:54
we are working through that process of what to do and then act568 and 967 relate to specifically anesthesia and past dental which 11 of those acts has not formally been put on RAI that they have indicated they have concerns about limiting it to academic institutions so I'll stop there and ask Director Pitman to add additional details thank you that was very well
Chair
Unverified
13:27
three of these A B and C have comparability issues per CmS the issue primarily being that under comparability you have to offer the same benefit and services to all all individuals eligible for medicaid and we're tying these two a special diagnosis in the case of the diagnostic lab service to chronic pain or in the case of the dental bills to having a special needs diagnosis or developmental disability diagnosis that's the crack of crux of the issue with Cms they have presented options in
Senator Breanne Davis
Unverified
13:56
the dental area whereas in the lab area it's a mandatory service by Cms you have to offer it to everyone that is eligible for medicaid so there are fewer options there. and so that's where we are with Cms in those discussions and we are trying to work through how to best proceed with all of these trying to maintain the spirit of the bill and meet the federal regulations at the same time unfortunately because of those timelines I don't know that we're going to meet the statutory time frames of I believe it was 91 for the rate bill for dental
and January1st for the lab bill and that we obviously won't we're past all of those deadlines for the the lab and radiology bill. and one additional
question and I know we're gonna have a number of questions from members but you mentioned
that there are three now maybe4 different options that you're looking at and if you could just help me to understand what those options are and then the my 22 kind of sub questions to that are are those
options in your opinion allowed under Arkansas law and secondly do they would they accomplish what is intended by the act that was passed by the general assembly. ir I'll do the best I can to explain some of these
Senator Breanne Davis
Unverified
15:11
so Cms first let me say is very form over substance so they list all options even if they sorry to interrupt but I I think that we're
probably gonna have some questions for the dental association as well and I would I would want them to be thinking about the the same types of questions so we can try to figure out what's what between
the differing opinions on this so they
Senator Breanne Davis
Unverified
15:32
list all options whether they actually think they're viable or not just because they say this is really an option so let me start with that so they gave us three written options the first one is to create a limit an expanded limit for everyone that receives dental services so in the bill you said to move the limit from500 to1000 for those with a special needs diagnosis only adults we're talking about adults they said give every adult in Medicaid the
additional500 dollars and then use medical necessity criteria to determine who can get that expansion and who can't that by definition will mean more people will get it than what you had originally intended in the act which is going to be a higher fiscal impact than what we had originally anticipated The second option would be to create a 1915C or 1115 waiver for dental services for special needs populations there is nothing that would prohibit that there's a couple of issues with
that it is a very time consuming process to do that and so it's it's about a 9 to18 month process depending on how backlogged Cms is and there is no ability to retroactively apply any of those waivers. so there would be no ability to get a retroactive date for those it would only be going forward that is something we have a call scheduled with CmS to discuss the viability of that option I would say there are there are a lot of parameters around that typically with a waiver you have to limit it to those that meet institutional level of
care. you offer slots you have to be eligible to get that slot before you can actually receive the services so you you can't retroactively apply those services either there's no retroactive eligibility in a waiver so there's all kinds of of limitations on that that we don't typically see in a dental service. That said it it is an option we are exploring. the third thing they mentioned and this is the one where I I gave you that caveat they even said they don't love this option but what it is is to take your optional dental benefit because we do not have to offer dental benefits to adults
we could create our entire dental benefit around what we think the special needs population needs so sedation dentistry therefore everyone would get sedation dentistry based on the medical necessity of sedation dentistry that also doesn't seem like a very great idea in our minds because then we're taking our entire dental population, the majority of which do not have special needs and trying to fit them into this bucket of people with special needs so that is the third option it's probably the least doable
Chair
Unverified
18:05
so but that is the third option that Cms offered. The fourth option that
Senator Breanne Davis
Unverified
18:10
came out of the conversations with the dental providers and representative mayberry was to actually split the rule into basically two pieces take the rate increase for children and oral surgeons dental services going ahead and move that forward and then figure out the special needs population dental separately in these other conversations thank you
all right so we're gonna go to questions and myself and the cochair we've agreed to allow nonmembers to ask questions but obviously as this goes on there may come a point where we have to rein it in to just the membership so I just ask everybody to be mindful of that let's seepresentative Mayberrry, you're recognized for a question thank you and thank you
Representative Julie Mayberry
Unverified
18:58
for the discussion last week and as as you see we came up with option number4. so um, I'm hoping that maybe you had some more
information to share on option number4 and I'm still kind of hearing just what we discussed last week and so can you bring us up to date how quickly could the pediatric portion of this be implemented to get at least that part going. can you give me more details? That is one of the questions that we
Senator Breanne Davis
Unverified
19:26
have posed to Cms about splitting it up how fast we could do that and then the second part of that question is can we preserve the 91 date. that's what they've not answered
us on because when we put out public notice to preserve the 91 date and then did public comment on the entire rule if we break it apart we would like to try to preserve that as much as we can. I don't we don't have an answer. we have been in contact with Cms back and forth and they asked us who should be joining the call to which option would you like to discuss and we said we want to discuss all of them plus this so that's why we don't have any additional follow up information I do believe you asked us also last week what
would it cost if the adult benefit went from500 to1000. I do have that in an estimate on that today it would we spend approximately 20 to24 million dollars on adult benefits looking at last year and what has been spent this year and doing some estimates
Senator Missy Irvin
Unverified
20:28
so it would be approximately a 10 to12 million dollars increase in totality. OK so if I'm understanding if
Representative Julie Mayberry
Unverified
20:39
you if you chose option number one and option number one allows us to go retroactive to the September date that was out there allows everything to move into place but increases the cost by about 10 to12 million dollars and my understanding that correctly that's the most expedient option that's out there. I understand it's a more expensive option but it's the most expedient option that keeps the
intent of the bill to preserve higher dental dental rates for our dentist. Is that, am I understanding that correctly? I believe som I'm cautious on
Speaker 85
21:22
most expedient because it's Cms so that's why I'm hesitant they will still have time to review and comment and what we don't want
Senator Breanne Davis
Unverified
21:28
them to do is completely make us start over. OK. And if they do make us completely start over with a state plan amendment that's 90 days and I do realize $10 to $12 million is a lot more. I think
Representative Julie Mayberry
Unverified
21:43
that the original cost we were estimating about32 million dollars we're talking about a whole lot more
Senator Breanne Davis
Unverified
21:48
yes that would be 10 to12 million above the a portion of the th32 that would be tied to the pediatric rate increase that I don't have broken down between the entire bill so it would be more than the original32 million dollars estimate that was given
Senator Missy Irvin
Unverified
22:03
during session. OK. so let me let me follow
Representative Julie Mayberry
Unverified
22:07
up with this. I know at the end of last session we set aside $100 million for Medicaid
hass that been utilized yet to this point and are there other things that you plan on bringing up in the next month or two that would require us to use that money so in other words this money is set aside right now. Can we utilize that money right now to to
Senator Breanne Davis
Unverified
22:39
fill in that gap. So to this date we DHS has not asked to access the $100 million that was set aside for Medicaid. that
process to ask and request that money is actually above my pay grade so I'm going to have to defer on that part. We I would have to work with the partners at DFNA and and obviously the governor's
Speaker 30
23:02
office on accessing that rightpresentative Mayberry if if you have further questions we'll get you back in the queue if need be
OK? uhpresentative Eaves you're good Representative wooten you're recognized for a question you Mr Chairman. miss mann
Representative Jim Wooten
Unverified
23:21
is background information. how long has it been since the dental group have had an increase c
Senator Missy Irvin
Unverified
23:29
according to their emails it's been 18
Representative Jim Wooten
Unverified
23:32
years.18 years. my question would be in contact with CmS did we just make a request or did we or were we emphatic? did we give them factual information and then
make a a plea that we had to do something to help our dental
Senator Missy Irvin
Unverified
23:57
profession sir didn't mean to cut you off with your question. apologies. yes sir we submitted the rule as the act was written we've we've had conversation back and forth we've had ongoing conversations with the dental association we started getting questions during the 90 dayy time period that they have to approve a state plan amendment and early December in email we we found out they were not going to approve it they made that official either December 8th or
December fi5th so yes sir we tried to enact what was passed to get it implemented it had an effective non1 date we put it out for public comment the day before which is required with Cms because it would have a rate increase then we also put it out for public comment for the entire rule as required to to implement a state plan. so we did in in all good faith effort put that rule plus these other rules plus our other rules
Representative Jim Wooten
Unverified
24:58
with with CmS did they how how quickly did they respond? will defer
Senator Missy Irvin
Unverified
25:03
torector Pitman. so during conversations we we
Senator Breanne Davis
Unverified
25:06
had early indications there were going to be some issues it took quite a while for them to put those issues back in writing to us formally so that we could actually see our options and understand the issues it was
Representative Jim Wooten
Unverified
25:20
quite a while CMS sent it back what about the waiver? Is that a is that a viable
Senator Breanne Davis
Unverified
25:30
alternative is a viable alternative it just takes longer to get it approved and it would jeopardize the 91 date of of the of some of the rates and so that was one of our concerns that we can't we can't honor the 91 date so we needed to inform this body. Did I understand you correctly it takes
Representative Jim Wooten
Unverified
25:49
18 months to get to get a waiver Yes sir it
Senator Missy Irvin
Unverified
25:54
can take anywhere from 9 to18 months depending on their backlog. there's
Senator Breanne Davis
Unverified
26:01
a lot of public comment period at the state level and the federal level that takes approximately60 additional days and then they can take up to6 months to a year to review any type of waiver so we in our past experience we've had waivers pending for multiple years so we're just trying to it I would love to say that we could do it faster. I I just can't
Senator Missy Irvin
Unverified
26:24
guarantee it Representative we'll let you get back in the queue. we've got
a few people lined up here up go to
Senator Missy Irvin
Unverified
26:36
Senator Irvin you're recognized for a question. thanks thank y'all so back to what p re s
ent ative shepherd was talking about the language and the legislation. So on option four does the law that we have passed allow for what you're talking about to split and go forward with part of it but not the other part. it ting my lawyer hat
Speaker 75
26:58
on, yes, I believe we could sever severability under the the
Senator Breanne Davis
Unverified
27:02
language of severability we could treat the provisions of the law differently and going ahead and move forward with the rates so we are looking at that the main issue is will Cms allow us to use the public notice we've already done for that rate increase to get back to the non1 date and that's kind of what's pending with
Senator Missy Irvin
Unverified
27:19
Cms right now and the part of this bill though that you said could go forward was the which part the pediatric one the pediatric rate increase for
Speaker 101
27:26
children's dental services and then that I think there's a provision to raise for oral surgeons dental services is the
Senator Breanne Davis
Unverified
27:33
language of the bill oral that's what'm looking at those two pieces I'm not entire we don't are not sure about the language around special needs dental rate increases but that's again tied to a diagnosis so that would need to be
Senator Missy Irvin
Unverified
27:46
fleshed out with Cms as well you know because you can't do carve outs right OK. so on so so what you're saying though is you could say dental services for adults
that we would be able to pay for anesthesia services for all adults, for all adults yes ma'am but clearly some adults would need it and other adults wouldn't but there's no way to just limit it to people with special adult special you can't type the category you can't tie it to that diagnosis you
Senator Breanne Davis
Unverified
28:22
can tie it to medical necessity criteria but that is by definition going to be broader than a diagnosis. OK so you could do medical
Senator Missy Irvin
Unverified
28:30
necessity is there any type of a process where
currently we're allowed to authorize that service with an existing Medicaid patient is there a process that you could yes ma'am we're using a single it's called a single case agreement
Senator Breanne Davis
Unverified
28:49
process right now we're doing it primarily withuaMs we have done it with a few other dentists but it's primarily being done withuAMs where we enter into an agreement for that particular patient, medicaid client primarily special needs and then they do the dental services for
them for beyond the dental limit. OK. OK, so so
Senator Missy Irvin
Unverified
29:10
in order for that we would just need to change the legislation we're doing that now with with UAMS and we also have done it with another dentist
Senator Breanne Davis
Unverified
29:19
I'm talking about this bill yes ma'am for this bill
Senator Missy Irvin
Unverified
29:24
we would need to rewrite this bill to allow for the existing process to occur. yes ma'am but that could or could not have a fiscal impact. I mean initially you could have a fiscal impact that assumes that every adult would then get
sedation but that's a you know I guess that's the only way you would be able to calculate that fiscal impact is there a different way to calculate that fiscal impact? I don't know I mean that's just something to think through. you don't have to answer. on the other one, and I just want to make sure I'm I'm understanding this correctly with the diagnostic lab services annual cap for the chronic pain and pain management is that another case where we're creating a carve out based on a
Senator Breanne Davis
Unverified
30:09
diagnostic code yes ma'am because it's tied to the the diagnosis of chronic pain management and they're not offering the only option there is to give everyone a limited increase or do nothing because it is a mandatory service so we can't offer it in a waiver or anything like that. right OK. OK. that all right thank you Representative
Chair
Unverified
30:29
Johnson you're recognized for a question thank you Mr Chairman. so a couple of things on
Representative Lee Johnson
Unverified
30:34
the on the 1025 the costs that you're talking about man it seems like
I'm talking really loud. That feels really loud man. So like the 1025 I'm understanding you're saying it's an extra 1010 to12 million estimate on top of the calculations for the pediatric extra costs is
that right that that's just based on raising the cap for every adult, right the way I read that bill that bill doesn't carve out any special needs and that that well it does but what you're saying is we can't carve out special needs the only way to
accomplish the bill would be to go from500 to1,000 for every adult. that was yes sir that was one of
Senator Breanne Davis
Unverified
31:11
the questions we were asked last week when we were meeting is what would happen if the entire adult population went from500 to1,000. so we did ask our finance and our data team to run what was spent on adults only for Sy25 and then up to last week on for Sy26 and so we took that annualized it and came up with that estimate of what would happen if we doubled it so that was a rough estimate yes sir to be clear that didn't have anything to do with sedation dentistry
Representative Lee Johnson
Unverified
31:42
that's just dental costs for adults right so so if you look at the other 2 bills568 and 967 those are the other two bills onceces to pass and once the if I understand your issues with those I I I guess I don't understand the issue with one of those but one of those the issue is by they don't like that we wanna send them just to dental schools academic institutions how do we define that yes sir that was one of the problems that didn't have anything to do with special needs or adults or that's just this dental school issue so that
Chair
Unverified
32:12
bill I think I can't remember the number's yeah yeah I believe you're right and that bill had two distinct issues per CmS and we never formally submitted that to CmS full transparency we were having the conversation around 10:25. I mentioned that bill to them and they preliminarily told me it was going to have problems to be to specifically one being because you were giving the extra3752 individuals with special needs or and I am terrible at saying this cranial maxial facial that's what we did in that bill so we define high
Representative Lee Johnson
Unverified
32:44
complexity dentistry or something like that we we created a new definition
within that act around high complexity now special needs was a criteria of that definition but there was
also for all these cranial facial things right yes sir and
Chair
Unverified
32:55
because it was tied to those two things they they did indicate that would probably be an issue. They also indicated it was a a freedom of choice issue among providers if you limited it to only academic medical institutions and so that we would need in that case a basically 1915b waiver to say you can only go to these certain
Representative Lee Johnson
Unverified
33:15
providers that issue seems easy to me. I mean that's that's an easy issue I mean the reason that came up in the session because these were the people that
raised their hands so they were willing to do it right? I don't I don't think you're gonna see a flood of people raising their hands saying hey we're willing to do this work so I think that issue's easily solved. you just say OK, everybody can do it. I don't think the fiscal impact for that's tremendous because again the the reimbursement compared to the you know the pain of the process of providing the care it's not gonna balance out you're still gonna have the same people doing it I guess I'm getting back to this idea that we were adding a definition around
and I forget the exact words high complexity and then I think if you look at the other bill the 967, all we were doing there is we went in the pass act and we added a definition of sedation dentistry and then opened up that for claims what wascms's issue with that act I don't know that I don't know that
Chair
Unverified
34:05
they had an issue with that with that when we've actually put it into the past contract today we've implemented that today that they
Senator Breanne Davis
Unverified
34:12
cover sedation as part of the dental so they don't have an issue with that one
Chair
Unverified
34:19
ThecmS doesn't have an issue with that they don't
Representative Lee Johnson
Unverified
34:23
have an issue with us putting that in managed sedation dentistry and is there a definition of sedation dentistry in our medicaid act or whatever whatever wherever we put in this ha complexity definition. I guess what I'm getting to is like we've created this definition of sedation dentistry and we've said we're gonna have a charge for sedation dentistry that's
within the passes do we have something similar to that within fee forervice Medicaid
Chair
Unverified
34:50
don't mean we we offer sedation dentistry to anyone in Medicaid that needs it up to our limits and necessity and I don't
Representative Lee Johnson
Unverified
34:58
want to get down to the weeds but what I'm trying to get to is like if their issue is with like we're parsing out special needs in the adult in 1025 to some degree because they require sedation a lot of folks with this this issues require sedation more complex right? and ifcmS doesn't have an issue with us creating a different fee schedule around sed
ation dentistry it feels like there's a way to create a separate fee schedule right that doesn't that would be fine for adults if they met you you mentioned medical necessity I mean we have that ability within DHS to say who is you know who qualifies medical necessity for sedation dentistry right? it feels like that's a way to maybe get to this in a cost containment way that doesn't single out special needs adults any adult that qualified for for sedation dentistry and the same
way with this high complexity care I just it is is that something you think we could look at is that yes sir do do we can look at
Chair
Unverified
35:58
it and that is we we are actually meeting with finance to talk about how we could look at this differently I think it becomes how do you define medical necessity and like I said it's by definition going to be broader than what you put in the act because it's going to be anyone that qualifies not anyone with this particular diagnosis but you don't have an idea of the cost if we
Representative Lee Johnson
Unverified
36:16
were to just limit it to say sedation dentistry as opposed to open it up to every
Representative Jeremy Wooldridge
Unverified
36:20
adult. No we haven't looked at that yet that's what the meaning we're we're gonna set up is about. OK thank you
Speaker 157
36:30
appreciate it Representativewooldridge you're recognized for a question.
Representative Jeremy Wooldridge
Unverified
36:32
Thank you Mr. chairir. my question you I remember us talking about this in committee and you said a while ago it's been 18 years since our dental partners have had a rate increase so it's my understanding that currently or I think I remember this correctly from committee that less than half the dentist in the state will see the Medicaid population client so if this rate increase doesn't go through
and that diminishes even further what's DHS's contingency plan to get dental services to this population if we if we don't have any dentists in the state that are willing to continue to provide the service. I'm not
Senator Missy Irvin
Unverified
37:07
quite sure I know how to answer your question because I don't know about50% or less that are seeing Medicaid patients
Senator Breanne Davis
Unverified
37:13
I don't have those statistics to be able to answer that part I will say that we did transition
dentistry out of managed care and back to fee for service late last year I believe it was November of 24 and we have seen those expenses continue to to be level and grow we've not seen anything diminish so and then to to expand on the 18 years they were in managed care for7. they also have had at least 2 to3
Senator Missy Irvin
Unverified
37:53
right in rate reviews the most recent rate review showed approximately3 to5 codes that would need to be adjusted to be in the averages of other
Senator Breanne Davis
Unverified
38:03
states so while there's one school of thought that it's been 18 years since they've had a rate increase we have done the right reviews to show that in previous years they have been in line with other surrounding states also removing the managed care removed and
administrative level that now we are spending on being able to spend on paying claims and so I I will just leave it at that. OK I guess I'll
Representative Jeremy Wooldridge
Unverified
38:34
clarify that. I appreciate your response and I'll clarify that maybe with the ental association if they come up to testify but I guess my understanding I visited with with dentists around the district that I serve and that's my understanding that there is a diminished group of of providers that are willing to continue to see that population and I just have concern that if this rate
increase isn't implemented as the legislative body passed it and the governor signed it that that would probably shrink not grow but thank you Mr chairir. Representative Eaves
Chair
Unverified
39:06
you're recognized for a question thank you Mr Chairman this may be a question
Representative Les D. Eaves
Unverified
39:11
to you Mr Sher we got a letter apparently from a law a law firm and it's probably the same or similar letter that we got from the dental association and there's two paragraphs that I wanted to kind of reference
here. It sayscms's december 15 correspondence does not conclude that Act 1025 is incompatible with federal law to the contrary, Cms's comments reflect routine SpaA review concerns and identified specific compliance issues with the proposed with the proposal as submitted that may be remedied by DHs there's another paragraph that says criticallycms did not state that the underlying policy goals were impermissiblestead Cms expressly referenced alternative approaches including medical necessitybas benefit structures and waiver authority as potential path to compliance
taken together the Cms letter supports the conclusion that sufficient and lawful pathways exist to obtain federal approval of the act's changes if pursued through appropriate mechanisms so it seems that the if I'm reading that right the dental association and this law firm have a different opinion on what's actually happened here so and you mentioned earlier that we may get the dental association or someone to come up so at the proper time I'd like to ask them some of those questions or at least respond to those two paragraphs yes well we have asked them to be available
and to answer questions and so we'll we'll bring them to the table at at some point in this process still have a few questions here in the queue senator dismaying you're recognized Thank you Mr Chairman and really
Senator Jonathan Dismang
Unverified
40:43
it's just about the precedent of where we are right? I mean like so there's oftentimes we will pass legislation directing the DhS to do something and the and then that's how we get to the end result
you know that the legislature wants as far as policy direction for DHS. and during the session on many many issues members were begging for input from DHS about why this different items not just this particular area certain things may work or not work or the cost may be higher or not higher and and that sort of thing in which DHS did not really provide much of any information or engage on a number of different issues my concern is we've got through the process there's a bill that's
passed and we're saying you know what despite the bill we don't want to run the rule. I appreciate you not saying it it's better than letting it drag out and never running the rule because I've experienced that for two years before not too long ago and I think it was because DHS didn't want to implement the rule regarding the law that I hadn helped pass in the legislature so I get there may be problems that Cms may say no and maybe there's things we don't understand but if we're not even going to attempt
then I think it's going to be an issue for future issue you know future policy issues that we may have that we're requesting or demanding that you know that y'all take a particular action so I guess historically my question is is I mean how often do we say you know what we're just not going to run a rule in relation to a law that was passed by the general assembly don't know yes sir I don't know that we get that option we have
Senator Breanne Davis
Unverified
42:29
to implement the ax we can't implement the act currently as the law was passed with an effective date of 91 and during session we did testify at about this bill that it could have issues with Cms we also testified about the lab and diagnostic that we felt that Cms could have issues with implementing implementing this so really with having to implement all the rules and it takes a long takes a year for us to implement rules sometimes to get them
through long yes sir yeah I'm very well aware of that one unfortunately but we I guess I didn't want to get to june and say oh by the way this is causing an issue we're pivoting and doing this we've worked with Cms tried to implement what was passed and when they said no and had to say it formally because we could not work it through the 90 dayy process they took it off the clock we'dHS felt the need to inform
y'all that we probably going to have to pivot and it may take longer than the 1el months to implement something that and I can't guarantee or DHS cannot guarantee excuse me that we can effectuate the 91 date or the 11 date. So really wedHS was trying to come out of an abundance of caution for the rules is is why we sent the letter in December to the rules committee but the goal is still to have full implementation of the law
Senator Jonathan Dismang
Unverified
44:01
and the rules you're just going to punt the dates down
Senator Breanne Davis
Unverified
44:08
a conversation with Cms and we can do the severability the question is can we keep the 91 date for the rate increase without having to start over while we pivot to the to the waiver for the special needs that's one question I do and then the other option at the very first option was could we do something else which I don't remember right now I apologize but a waiver will never have a
retroactive date. I'll never DHS will never be able to honor the non1 date. so if we can break it apart we and try to honor that 91 date if Cms will allow it and then move forward on the waiver that's one option then the first option which I'll defer torector Pitman to bring up again hopefully we we will be able to honor the 91 date that
Speaker 125
44:55
was the applying the increased limits to the entire population with medical
Senator Breanne Davis
Unverified
44:59
necessity criteria. I think the only issue there for for the 91
day would be if we have to redo so the 91 date is related to the rate page when you change your rate you have to put it out for public notice for the providers to comment on so we have to put it out at least a day before the rate takes effect. if we have to change that right page we may lose that 91
Chair
Unverified
45:19
effective date for that. Other than that we should be able to preserve it that's a conversation we intend to have with Cms. Representative
Johnson you're recognized for a question Thank you Mr Chairman just to
Representative Lee Johnson
Unverified
45:34
clarify so it does look like you're asking for ability not to promulgate rules on four different acts one of them I don't think there's a problem
with I'm just trying to clarify that 967 which is the one where we define sedation dentistry in the past act and then now tell you're telling me the password do I don't know that we need rules we don't need rules just questioning it's in this packet so for clarifications point we don't need to do anything on that one people the the people that are in the passes right the
people that are on the the the waiver right now they are open to get sedation dentistry services from anyone in network with any of the passes willing to provide the services for adults kids anyone with special needs that ququalifies for the waiver can get those services through the passes right now yes sir we've defined sedation dentistry in the past agreement
Chair
Unverified
46:26
what they will cover what fee for service covers all of that has been outlined in the past agreement and we don't need a role to improve that
Representative Lee Johnson
Unverified
46:35
population standpoint when we're talking about in in 1025 adults
with special needs what percentage of those adults with special needs are are I mean how many people do we have outside the waiver in that population. I have that number not on me todaypresentative but I have
Chair
Unverified
46:53
pulled that for this purpose because we initially planned on using the past to define that and then realize there's a group of adults that actually have special needs that are attending
our adult adult day treatment facilities that are not in the past and so I have run that number and I can
Representative Lee Johnson
Unverified
47:12
get it to you it feels like the sentiment of the general assembly
was to provide dental care for these people with special needs right and and it feels like that that is a higher intensity service than the average adult in Arkansas needs for dentistry and it feels like that was surrounded by this idea of sedation dentistry and we already are doing that now for a large percentage of the population of Arkansas through
the passes if we have providers willing to do it in network with the pastors right? So figuring out what that extra population is and can we get them into the passes right? iss there opportunity to move them in because it sounds like we're in good shape in the passes iss there opportunity with that small population to define something like sedation dentistry and reimbursed for that differently. it just feels like the cost doesn't have to be we raised the bar to every adult in Arkansas not that I'm not for that for my dentists out there, right? Like I think all of the providers in Arkansas and the
medicaid space are looking for increased rates across the board. I'm not saying you don't need a rate increase for adults across the board I'm just saying it it it feels like we're making this more complicated possibly then we have to and certainly you know estimating costs at a higher pace than it think that I think we may be need to all that said I have one more question about the cost if we did just go with the simple idea of we're gonna raise the adult rates for everyone from500 to1,000 that extra 10 million that's future cost right? I mean what fiscal
year would you anticipate those costs hitting your budget if if everything if you went ahead with that process that extra $10 million when does that when are you gonna have to start paying claims on that got it we didn't have to retro yes april think
Speaker 101
48:58
would be the earliest of this fiscal year right and I'm assuming that would be a
Representative Lee Johnson
Unverified
49:01
ramp up so most of the costs that you
would incur would be in the next fiscal year and I think we as a legislative
body will have an opportunity in the fiscal to to decide whether that's in the budget or not right? I mean that's our responsibility as legislators so if it's our intent and we want to raise adult dinner rates we don't have to necessarily dip into the $100 million Medicaid set aside we could put that into the next fiscal budget is that I mean that would be a logical way to pay for this as well. I think that would be up to y'all right but if we did that if we did that you wouldn't have to necessarily dip into the
all that thank you all right members we're we're getting back into I think most everybody's had
an opportunity to ask a question we're gonna bring the dental association up just momentarily and then we'll bring DHS back up but before DHS goes for their break before we bring them back you know one of the things that as I look at this there's there's kind of the practical elements of it as far as what was intended and the the benefits to be provided I
also have a concern just from and senator dismay I think touched on this as well is like at the end of the day we passed a law and so when you look at these four acts I think there's4 acts that are implicated by this discussion they're relatively short now I understand that much it's changing definitions which ends up being a much bigger issue but just quickly I just wanna I wanna walk through each of these and
if you could just give me just the the kind of the short answer of what the issue is now I think that what I understand from senator from Representative Johnson's question is Ac 967 concerning the definition of sedation dentistry that can be implemented that that is y'all are able to that is something that you can implement you can promulgate rules to take care of
that no we don't need rules we have
Chair
Unverified
51:12
implemented it through the past agreement by defining sedation's industry inside of
the past agreement so so you can comply with 967 all right ok good so
then that leaves three acts so there's let's see567 which relates to diagnostic lab services and it just it changes the dollar amounts and then it has basically you're supposed to codify rules so what is the issue with being able to implement this that is the comparability issue it's lab
Speaker 155
51:42
services are a mandatory service by CmS every Medicaid state has
Chair
Unverified
51:49
to offer them and because we're tying the increased
Senator Breanne Davis
Unverified
51:52
limit to a diagnosis of chronic pain management it violates the comparability provision of
CmS OK so that's that's the issue with
that one so then we go to568. this is relates to high complexity oral health care it provides a definition of of what a provider is I think Representative Johnson asked about this and it provides additional language related to the reimbursement rate so what's the issue with
Chair
Unverified
52:19
this act? there's two issues with that act Cms is stating that we are tying to a diagnosis based on special needs and cranio facial maxx I can't say that word but the
Senator Breanne Davis
Unverified
52:30
the disorder the cranio facial issues and then the other issue is limiting it to a certain provider. academic medical centers. OK. so that's
the issue with that act all right and then finally 1025 this relates to adult with special needs dental services cap and it provides for an increase in the reimbursement rate
Chair
Unverified
52:53
what's is it similar issue with that yes sir it's tied to the limit being increased from500 to1,000 for a special needs
diagnosis and so that three of the one of them can be implemented it is implemented hree of them you have issues because of what CmS will or won't allow and and then you also have a timing issue as far as trying to work out if there's another way to accomplish that and so it's a it becomes I mean some of the comments I'm hearing from
folks are like if you know it's almost like picking do you violate the law from a timing standpoint you violate the law by not implementing but I think it was important to look back at the ax because at the end of the day that's what no matter what everybody's intent was this is what we passed all right I'm gonna ask the ental association come to the table and then we'll we can bring DHS back to the table after their time so they'll come forward and introduce themselves and I
believe we have some questions for them.
Billy Tarpley
Unverified
54:14
Chairman shepherd, Chairman dees members of the committee my name is Billy Tarpley I'm executive director of the Arkansas State Dental association and have been for 29
years. I have asked our attorney Trevor Hawkins and also attorney Jayden Atkins to join me here it was Trevor andjayden who prepared the letter that was referenced earlier in which we tried to make it clear that the dental association believes that there is a path forward to implement Act 1025 I can't necessarily speak to the others but but certainly on actct 1025 and I think to to try to bring a little more clarity to it that
that act very clearly had two separate components to it one was an increase for medicaid fees for the pediatric portion so when we say pediatric portion that means zero age ze to age 21 which is more like 18 but it but that's the pediatric portion that is the regular routine dental care that you that you receive as well when you go to the dentist so that's one component the c the second component dealt with setting a
separate cap for dental services for regular adults versus special needs adults throughout this last legislative session it was very clear that there was an interest among legislators to do something for our special needs population and that's where the separate cap came from now the adult program it is true Arkansas or any state does not have to do adult medicaid well over half the states do in fact only a very few do not cover
adult in some form we have a not a comprehensive plan for adults we have a very limited plan for adults when this program was written back in the mid2000s it was written without input from the dental association and it's continued to be problematic but you know what that that's the program we have we tried to to work through that to make it better but separate and apart from that issue it's been our understanding that DHs has not moved forward on implementation
in fact they've even asked you for permission not even to come talk to you about it but they haven't moved forward on Act 1025 because of a potential hang up on the cap for adults without any reference to what to to the regular medicaid which is gonna affect the large number of dentists who work and function in your communities so at any rate we when we saw the letter from the from the secretary it very
clearly to us said we we don't we don't only want to be released from coming to report to you but it clearly says DH S does not intend to adopt rules for the identified acts just not going to so what that said to us alarms were going off in our head and our phone was blowing up from Denists who were saying wait a minute I'm I'm prepared I'm willing to stay in the program if this fee increase comes along because I can't continue to go broke doing medicaid dentistry so that
that became a a hot button issue for for all of you so so having said that I'm depar ting for my regular remarks because we have heard information today from DHs that has not been delivered to the dental association in fact we had to to reach out to DHS to find out anything we didn't even know they had contacted CmS until we asked that in early December and we were told well yeah they they don't like some of it so senior
administration is going to talk about what next steps are without any input from the dental association at all did they have to reach out to the dental association they don't have to but boy howdy look at this dog and pony show we're all having to go through when this could have been worked out before the legislature even convened we we asked DHS for a formal meeting you know roundtable meeting legal and and everybody else was there to say we have a big problem with our
dental fees no matter what you may hear from surrounding states we have a big problem and we're reaching the a critical potential critical shortage situation so at any rate we did our best to work within the agency we only came to you when it became obvious that there was no other option for dentists to try to say we're trying to to save this program remember dentists are the boots on the ground in medicaid dentistry it's none of us I'm not a dentist I don't do dentistry but dentists are the
boots on the ground they are the engine that drives this program and all dental care in the state of Arkansas they were the ones who were coming to say we we have a problem and we need to try to to solve that issue so Mr chairman if you don't mind I think we already have some questions. I'm many recognize the co-chair for a problem and we need
to try to to solve that issue so Mr chairman if you don't mind I think we already have some questions. I'm many recognize the
Senator Tyler Dees
Unverified
59:23
co-chair for question thank you Mr chairir and thanks for being here today and thank you for your your comm opening comments just two quick questions for you and and Billy I forgot your last name tellll me your Tarpley Tarpley thank
you Mr. Tarpley so you you just mentioned that you reached out to DHS asking for a roundtable discussion on rates when when was that
Speaker 192
59:44
roughly that was months and months before the legislative session before before these acts were approved ok thank you
Senator Tyler Dees
Unverified
59:51
for that timeline and then going back to your response to the
Cms response to DHS has has the association submitted
their recommendation for the rulemaking on on these have you submitted in writing case in point what you believe would allow them allow DHS to comply with the statute and to comply with Cms concerns have you sent that
Billy Tarpley
Unverified
1:00:22
to DHS? Yes sir we did that through Mitchelllastock law firm who Trevor represents so in in his comments to Secretary mann it was addressed to secretary mann so hasHS responded to your recommendations?
not to not to our knowledge no sir thank you yes sir so I I have a question and y'all were here during all the questioning of DHS and you heard I think my initial question I referenced it to ask that you guys be prepared to answer as well so you've heard that they're I guess are four options that or3 that were referenced by Cms one that I think has been discussed with thepresentative Mayberry and with various stakeholders so can you tell me is there anything you disagree
with how DHS responded to that and if so can you identify what that what that disagreement is and what's the basis for how you feel differently Mr Chair if
Speaker 199
1:01:16
you'll allow I'd like Trevor to answer that thank you
Speaker 200
1:01:21
all for excuse me this weather's got my allergies all messed up but I thank you all for being here and the broader context of this the reason we're here today to is to stress that act 1025 is workable. and we're put we put our name on
that we're gonna we're gonna help or or willing to help DHs in getting through that and implementing a law or implementing policy changes that enactcts 10:25 now the sort of discussion about options and and what to pursue conceptually from the day that Act 1025 was signed by the governor there's two overarching things there the rate changes and then the cap change
DHS is given the mandate from the general assembly to pursue whatever mechanism they can federally to get those things those two things approved and so there's there's branching logic or options to enact each two separately but what they chose to do here is implement them as one ball you know one group to CmS they submitted that they informally to them and just got some routine feedback questions he what about this he did you
consider that there's nothing in the letter to Cms that says anything that they've refused to approve any of these changes nor is there anything in there that says that the intent of Act 1025 can't be effectuated I think here you know hindsight's 2020 they should have pursued them separately they should have done the rate change first separately as an SPA like they did and that's what they're
they've vindicated to y'all that they're trying to pursue keeping that that way so that they can keep that September 1st date the comparability issue that they mentioned that's that's lumped into the rate cap the500 dollars to $1000 increase that doesn't apply to that first half that's the one where there's there's room for us to discuss and and figure out what the route is in my in my opinion kind of highle looking at it
it's either working at through a medical necessity option or an 11fi5 waiver that's that gets rid of that comparability requirement it it doesn't apply there so Cms wouldn't reject that and and and they said in their letter which was attached as an exhibit I think it was important for y'all to see Cms's letter and that there's not anything in there that says hey you know we're not going to approve this it's we need follow up and and
the truth is the reason CmS sent this letter in December 6th is because they were asking these questions inoctober and never got a response as far as we can tell and so they had to send this formal response asking for these follow up questions and this starts in 90 day clock if if DHS doesn't respond to this formal letter December 16th they've got through March 15th Se masters quits considering these things and so that's why we're here today pushing for continued oversight and accountability that they
continue working forward respond to CmS effectuate these changes and and we're willing to help
Speaker 202
1:04:52
in any way we can. Senatorrvin you're recognized for a
question Hold on let's see there
Senator Missy Irvin
Unverified
1:05:09
you go right thank you on the issue as it relates several different ones on act 967
I think what was said by DHS was that it was tied to an academic institution and so that's why that one could not be implemented under what Cms replied. Can you respond to that Senator I wish I could we we were not part
Billy Tarpley
Unverified
1:05:35
of the inner workings of that that doctor Ashley Mcillan from theyon College of Dental Medicine is here if you wanted to ask that question specifically do we can come back to that
Senator Missy Irvin
Unverified
1:05:46
but I do want to talk about that because when
you're talking about high complexity dentistry it it's only going to be you're not going to be able to do that in a general dentist's office. I mean you're going to and I think we've got to understand what we're talking about here these are cases where you absolutely have to sedate somebody and and perhaps even put the I mean to put them to sleep in order to do the dental care that's necessary so that's that's most likely and correct me please if I'm wrong
but what are the necessary physical things that you have to have in your dental office to be able to do that. Do you have to have an anesthesiologist or a CRNA to do that. do you have to have an operating room? Do you are there specifics about sedating a person and putting them under general anesthesia within I would just say a clinic
Speaker 28
1:06:47
for dentists could you answer that that would
Billy Tarpley
Unverified
1:06:50
be a very clinical question for a practicing dentist and
and I'm not one but that but but we actually have a general dentist and a pediatric dentist here in the audience and either one of them may be able to answer that along
Senator Missy Irvin
Unverified
1:07:03
with Do McMmilan so I mean I know oral surgeons obviously do this because they have to sedate and put you under when they are removing wisdom teeth, things like that and do an oral surgery and so and and I know that so what I'm getting at is really trying to understand the true fiscal impact of these types of of of situations you know outside of
academic I would love because not everybody can travel to academic institution and I know that they're already doing this so I'd love to hear from them about that and then I'm gonna move to my second question. so if that's allowed on the issue so you're specifically asking for DHS to continue to pursue a rule on specifically Act 1025 of the portion where there is no issue
Billy Tarpley
Unverified
1:07:57
is that your asku our ask is is twofold that's certainly the first part to go ahead and move on the pediatric portion of of Act 1025 separately from that is the we understand that a waiver would be could be required for the special needs portion in increasing the cap to1,000 vsus500 for everybody else totally understood which is why we wrote into the bill the the the need to file for a waiver or any other
instrument of assistance to be able to secure that but there's no reasondhS can't act on the pediatric portion and then deal with the waiver for special needs it's a separate issue is is that accurate? Yeah I just the both parts
Speaker 200
1:08:41
of actct 1025 are workable and there are meaningful paths forward to pursue both parts it's just one might take a little bit longer than the other and that's hard to say it's you know CMs under the previous Trump administration was actually really quick at approving
waivers 1115 and so it'sdHS needs to do everything at the state level they can to get it approved and then CmS that's out of our hands you know but there are things that they can do to pursue both parts of it it is entirely workable as
Senator Missy Irvin
Unverified
1:09:13
written OK so I'm just trying to understand our action here as a committee and miss Mr Chery you might be able to talk through this with me but are we the action that we have before us what are our options?
to accept the letter or do we can we make an action that reflects pursuing and directing one of the options what what's our that's what I want to
know So as I understand it the they've DHS has made a request
under actctive 595 to be excluded
from the rulemaking requirement we have the authority to exclude them from that rulemaking authority and so I mean that's simply would be the question if there is a motion to exclude them and that motion passed then they would not be required to promulgate rules if if that motion were to fail or if there was no motion then the the law they still are under the obligation to to promulgate rules consistent with with with Arkansas law
Senator Missy Irvin
Unverified
1:10:35
all right thank you. I may have
questions later but thank you and and and those rules promulgated would come through our committee through the normal rulemaking process. Representative wooldridge
you're recognized for a question thank you Mr Chair
Representative Jeremy Wooldridge
Unverified
1:10:50
and thank you all for being here. Same question that I'd asked DHS earlier it's my understanding after visiting with the dentist in the district that I served that less than half the dentist in the state are currently accepting Medicaid patients I guess I wanted to ask is that
your understanding is that accurate not accurate or there more than that less than that yes sir thank
Billy Tarpley
Unverified
1:11:13
you for that question that that is our understanding the at one time the last figure I saw was64% but that was pre pandemic and every year that that number has declined because of the increased cost post pandemic of providing dental care for everybody not just medicaid patients because medicaid gets the very same care quality of care that regular private pay patients do but
probably the simplest way and this may sound a little trite it is not meant to be tri but probably the best way to answer that question is to call the dentist in your district and ask how many of them are medicaid providers and I think the answer will be shocking I really think it will be not because they don't want to be but because there's a certain amount of margin in any business at which you can say I'm willing to break even or even lose a little money there is a humanitarian issue to this and that that's why dentists have remained in
the program so long after an 18 year drought without any increase at all in in in a perfect world there would be a built in annual increase to to so we don't have to come back and do this all over again and that that's dentists don't want to come and bother you they just want to take care of patients and take care of their staff and take care of the of the practice and keep moving on this is this has been an unnecessary interruption in their time and your time didn't have to be
this way but yes sir it's our understanding it's less than
Representative Jeremy Wooldridge
Unverified
1:12:45
half Well I appreciate that response and I guess my one small follow up question if allowed Mr Chair would be that it sounds to me based on your testimony that that there's been an effort for a collaborative relationship between the association and DHS you feel like that maybe that's been one sided or not reciprocated but I just want to know on the record you are willing to work with the department on behalf of the dental association to figure out a way for us to move forward with this because ultimately I
think we all share the same concern that we want our Kansans to be able to receive access to the treatment and to the care that they need especially in rural parts of the state where you know dentists aren't on every corner so I just want a commitment from you all that you're willing to work with DHS to find a way to move forward yes sir Representative Wooton you're recognized
Representative Jim Wooten
Unverified
1:13:34
for a question thank you Mr Chairman. I want to pursue p re s ent ative Woolridge's question
are you are you telling us that64% several years ago accepted Medicaid patients but today it's it's the percentage has decreased to the point where that half of the dentist in Arkansas
are not taking medicaid I understand that correctly yes sir that's our understanding yes sir and and
you contacted DHSs you said several months before the last session so in 2024
several would be several months in 2024 you made contact with DHS and he explained to them the problem that Denists were facing in
the state correct yes sir that's that's correct and that's correct yes sir and then you you stated I want to be sure about this
you stated that you have met with DHS or a roundtable or a task forcece or whatever you want to call its discussion but you heard things today from DHS that you haven't
been told is that correct as a representative
Billy Tarpley
Unverified
1:14:51
of the dental profession in this state that that is correct and I want to be really clear about about the comment that they've stayed in regular contact with us regular contact means that we have reached out to try to get an update and very often it it's it's too late now now everything has worked according to requirements we had the webinar we've had public input we participated in it we had a lot of dentists who participated
in in that webinar so everything has gone along there but we just don't want to repeat what happened in the mid2000s when we came up with an adult dental program without input from the dental community we don't want that to happen again this is a this is a benchmark of where we are right now and we didn't have to be here if we had gotten proper response from DHS now basically in the early meetings we were told we can't do anything because there's no money back in the
days of medicare correction of managed care we will go to DHs and to talk about the fee issue DHS would say we'll go to the two MCOs you have two MCOs running Medicaid go to them tell them that that's where the money is go and talk to them we go and talk to the MCOs they said no we're on a set pm p and we can't do anymore go back todHS that ' s 7 years wasted right there of trying to say what we're in we have a critical problem looming on the horizon
if we don't take action so we've come back again and now now we're sitting here andpresentativein you've you've been in this process long enough when you think those of you who are a little more seasoned will will know that dentists are not in a habit of coming to the legislature saying we need more we we simply don't do it Dennis the philosophy of the dental community is let's identify a problem let's recommend a solution and then let's get back to work taking care of patients that's just the
way the the dental mind works the large majority of dentists in Arkansas are sole proprietorships that they run their own business they are that they they do intake they do exams they do treatment and they do discharge out of the very same facility and so dennis by necessity are very business minded and it's hard for a dentist to understand how we could have gone through all this process then be told no you have to go to the legislature we've come to the legislature and and and look at
this look look at what we're having to do simply because it's been 18 years since dentists that have had a fee increase a modest fee increase is all we ask for60% of the50th percentile now I'm telling you that that's pretty low we talk about comparing it to surrounding states look at the new information the only state that pays less of a percentage of the dentist's normal fee is taxes that every other state Mississippi is very close to us you know there we are a
neighboring Mississippi but we're very close to that but you know what your constituents don't live in Texas. They don't live in Mississippi or anywhere else Oklahoma is lower I'll do that we'rearkansas we're are Kansans trying to take care of ourkansans and that's why we're here to say the increase that's asked for and was approved by the legislature and signed by the governor she signed it on april 22nd to create Act 1025 provided for a very modest recommendation and a solution that the dental community
Representative Jim Wooten
Unverified
1:18:26
needs so in reality what DHS is proposing goes contrary to what the pay grade upper pay grade said that the agreed with when the governor's office and and then the contrary to the law that we passed they're doing the opposite they're denying
it but between April22 when it became Act 1025 and
Billy Tarpley
Unverified
1:18:46
until the the the next time there was any activity was inoctober so however many months that is is how much of the dead
zone we had when waivers could have been filed when we could have been moving forward in preparation to meet the September 1 deadline date to implement the rate increase so now we're you know we were told after that time keep seeing medicaid patients and we'll make sure your payment is retroactive to September 1 in the meeting we in the team's meeting we had with DHS that representative may be your
requested we were told moving forward we don't even know if we can do we don't know if we can go back to September 1 and so obviously you know that that's not what you say that's not what you approved in Act 1025 so I guess as much as anything from the personal point of view if you allow me that if I'm told if I'm told by my bosses to do something and I don't do it they invite me to clean my desk out now I I retire in two months they had two months to do that and maybe they will but at any
rate the the implication is that you made a directive the governor approved it it was supposed to be done and it hasn't been done and here we are just now hearing more new information the option four would be great that they talked about option four would be wonderful move forward with the pediatric
Chair
Unverified
1:20:14
portion let's deal with the waiver on special needs later so yes sir yes sir Senatorhammer you're recognized for
Senator Kim Hammer
Unverified
1:20:21
a question. Thank you Mr Chair I'll give a layman's interpretation
of what we've heard this morning sitting here listening when DHS comes up
they can counter whatever you're gonna answer what I hear is we passed a piece of legislation we gave it to DHS typically agencies would respond by writing the rule that would implement this but they have said that DHS has or feds have signaled that we can't do it on the basis of that they're coming for and saying we can't write that rule then my response to that might be something along this line you don't know until you ask for it so if we get the if we get the rule written and get it sent up
to them that's when we're going to find out and if it's something we got to modify and change then we can modify and change based on what an actual rule written would be presented to them that's layman's term from everything I've listened to this morning my off bases or my on target. Go ahead. senator Hammer
Speaker 200
1:21:17
you are on target and and the the point here is that Cms was asking these questions these routine follow up questions about how it's being
shaped by DHs in october and as far as we can tell they never responded to those and that's the impetus for this December 16 or 15th letter from CmS setting those formal questions and those are just routine follow up that any any state agency has to deal with and work through and so you are on point thank you p re s ent ative Mayberry you're recognized for a question. in passing
Speaker 108
1:21:50
this bill we made a promise not just to Dennis
Representative Julie Mayberry
Unverified
1:22:00
but to parents to patients to people with special needs that we hear you they were here and I can't back down on that promise. I can't look at him in the eyes again and say I'm sorry it didn't work out. I know we promised it. so we've got to do what we can and so we were really clear in the bill in the writing and and I want to read to everybody the last three lines
and it says the department of humanman Services shall apply for any federal waiver medicaid state plan amendment or other authorization necessary to implement this section so not only would did we give them the authority you would agree with this because giving the authority is just a May statement. We didn't say May, you may do this. We said you shall, which says do anything and everything possible
and that's what we told Dennis and dentists and and I'm gonna ask you to explain in a minute some things that dentist per people may be that they've hired recently to or have kept on because they knew that this money was coming but then also to the to the families that are affected by this who were saying we need this. this this was a promise and I just want to point out the shall statement. so if there was concern that we needed a waiver
that could have been started a lot sooner, correct? it could have been started in June or July and maybe we would be further along maybe even to the very end of the process at that point. would you agree
with that and can you also tell me what some dentist perhaps have done to um, expecting these
Billy Tarpley
Unverified
1:23:54
new rates yes ma'am thank youpresentative Mayberry some some dentists particularly those in in rural areas where these services are needed desperately some have added on an operatory it's not an expensive to add an operatory in a dental
office because there's so highly regulated some have hired additional staff and told them to to start September 1 now they're four months into it paying people when there's really not enough to do but they want to keep the staff and they don't wanna they don't wanna fire someone so they're they're looking for quick for quick care but but to drill down a little farther on that Do Jerry Frin who's a pediatric dentist in conway is seated beside me in the audience
as a pediatric dentist he said if if any if anyone could come and look in the faces of the children and the parents when they bring their kids in for care or if any of you could come to our Arkansas Mission of mercy where we will treat close to 2000 people over two days and look into the eyes of the people that we're talking about here it it it cast it in a completely different light so I know we're not talking I know we're not talking the the human it ar ian side we're talking
numbers we're talking dollars but we're also talking intent and purpose and use the legislature passed for intent and purpose Act 1025 which spoke to these very issues and issues and amounts that were brought forward from the dental community to say that this is this is where we are this is what's needed Dennis desperately want to continue in this program but again as we talked about earlier every business only has so much margin and
therefore reduced income reduced revenue reduced profit everyone can bear a little bit now we've gone too far now we're talking 18 years and it's it's just too much it's time for action and and that's what the dental association is asking for thank
Representative Julie Mayberry
Unverified
1:25:57
you and and thank you for legislators being here and being a part of the
discussion. I hope that what we are able to do here today is to put a pause on on accepting this letter and continue
discussion and and come back and maybe find some other solutions. I know DHS is listening and they also need to hear from legislators what our our wishes are and I I I hope that it's been
loud and clear that that we want to make this work thank you Representative Senator
Speaker 227
1:26:28
Love thank you Mr chairir and I wanna I wanna
Senator Fredrick J. Love
Unverified
1:26:33
go back to just a few things.umber one, now Mr Tarpley is it your testimony because we heard from DHS that there have been three r reviews
in this time period of 18 months is it your is it your testimony that there have not been any right reviews cause you said there hasn't been any change in 18 years as far as the the amount that dentists are receiving so I just want to try to clarify and bring that together yes
Speaker 213
1:27:03
sir senator loveve I I can't contest that
Billy Tarpley
Unverified
1:27:07
there have not been dental rate reviews I'm sure that there have been rate reviews the last one that I recall that occurred I believe before we went into managed care
and I'm not certain about that and I don't want to misspeak but but the last rate review that that I recall revealed that Arkansas dentists were being paid in an amount that was similar to surrounding states since that time surrounding states have been having this same conversation they've been raising rates and we have not and so what at one time what eight years ago to to appeared to be a very favorable reimbursement rate for dental medicaid has aged like anything
18 years old would do and so at any rate I can't say that they have not done rape reviews they have not been annual rate reviews to my knowledge that they haven't even been biiannual rate reviews so I can't say that they haven't but but I don't believe anything has been done recently certainly we have data that's prepared by the American Dental association that rakes every state according to reimbursement rates in a variety of different levels and the numbers I quoted earlier were from that statistic and
Senator Fredrick J. Love
Unverified
1:28:21
then the the the second question I have for or just to wrap this up you all you you're coming before us so what is the ask cause you're you're turning your attorney said there's two things that could be done. so could you restate that the the two things that you're you're des designed to
Speaker 208
1:28:41
be done right now yes love there's it's it's the overarching that there's there's two
Speaker 200
1:28:47
things that actt 10:25 asks or shall directs DHS to pursue
that's the one is the rate increase two is the cap increase for adults with special needs the500 to1,000 dollars our ask generally speaking to DHS and what we want to support them in is is separating those two things effectuating the rate increase now rather than later and then pursue what is likely going to need to be a waiver a little bit longer process for the cap the500 dollars to $1000 cap
increase and so our asks today is the pretext of what we're here for is this letter told y'all that we intend to not adopt these rules because CmS is going to refuse to approve them we don't we believe that to be patently incorrect and we're asking for y'all to maintain oversight otherwise you know we're talking about 18 going on 19 years for a rate increase it's gonna be 20-25 years and so y'all's oversight an accountability measures and and there and there's you know the
just the fact that we're here talking about options says that y'all need to maintain oversight on this and so that's our ask is to not accept this letter as true and and continue oversight and ensuring the DHS pursues Act 1025 and these other acts that y'all y'all have passed all right thank you thank you Mr chairir. all right members think
that's all the questions we have right now thank you to the ental association for being here and answering questions I've had a number of members that are I think wanting to make motions
we do have one member of the public that has signed up and has and so come forward
Speaker 44
1:30:30
thank you chairs and committee members thank you thank y'all
Faulkner welcome torural subcommittee y'all are free to have a seat it just it probably be easier to to be closer to the mic if you will hit the button and introduce yourselves and then your welcome to make
Speaker 239
1:31:12
your comments. OK I'm Leslie Faulkner and I am a this is my daughter Skyler Faulkner. she's 23. I'm also a retired special education teacher and now my new job is beacon of hopepe and I help adults with complex disabilities
find resources in Garland County. thank you all for working on this because it's so important to our friends, my former students other people with intellectual disabilities, physical disabilities when y all were talking about the waiver and how many people are in the past or in the waiver. I am finding that there are so many adults in Arkansas that have not even
signed up for it. The waitlist to get on it3 to5 years. So these people are having dental issues and need this. so even if you say we're going to do only the people and when to pass there's still many Arkansans that need so much dental help and I would hate to see that it's not those people are not being benefited by this as I don't know any questions thank you for your for your comments. does anybody have any questions?
seeing none thank you thank you for being here today right members that's that's all we have on public comment I did say earlier I'd bring DHS back to the table as I mentioned there a number of folks wanting to I think make motions does anybody have a question for DHS or does does does DHS want to come back to the table or are you all right if there's p re s ent ative Eaves actually do have a question
Representative Les D. Eaves
Unverified
1:33:00
fordHS I'm sorry I'll be quick Yesir. welcome
back specifically regarding 1025 and you heard the testimony of the dental association saying that and if I get this wrong feel free to correct me but that it appears that DHS was using the two ideas in that bill the rate
change and the cap change together it it from what I understood the dental association to say is that those could be broken apart and looked at individually is that something you did or that you can do because we need to do whatever we can to get this population taken care of and so we need to sort of look outside the box a little bit. I mean I know the bill contemplated a lot of different things but can you address that? Yes sir so actually I
Senator Missy Irvin
Unverified
1:33:58
think we're all talking about option number4 which is the same thing
Senator Breanne Davis
Unverified
1:34:04
of breaking it apart that is the option that came out of the phone call that we had withpresentative Mayberry and the ental association and I believe a dentist or two there are5 or6 people on the call late last week so that became their request and we add and we said we would add that to the list from the other three things that had been listed and that we would reach out to Cms which we have we have done in trying to get those answers. So yes sir so you contacted CmS about option four and splitting
that those two apart yes sir we have contacted them about exploring all of those options and we added number4 to that. they gave us the first three in their letter and then we said we would add the fourth one and discuss it with them. Any idea I've
Representative Les D. Eaves
Unverified
1:34:50
heard some time frames regarding a waiver and I know that takes a long time but specifically regarding I guess we're calling it option number4 what kind of time frame are we looking at to get an answer from CmS? so that's what one of the
Chair
Unverified
1:35:05
questions we have pending with Cms right now we have submitted that state plan amendment the way thatcms's time frame works is once you submit they have a 90 day clock so I don't we submitted in September so we had a 90 day clock from September when these issues arose they they arose orally that was accurate and we had a conversation they said they would put options back to us in writing. We waited for quite a while to get those options back when we finally did they actually put this pa on what they call requests for additional information which means they've
actually taken it off that 90 day clock so they currently don't have a time frame for us on that spa. Is that good or bad? I mean
Speaker 145
1:35:44
does it's their way of preserving that 91 effective date while we work through issues right that's fine thank you
all right I'm I think that's all the questions Representative gonzalez do you have a question? right a quick question from Representative gonzalez.
Speaker 250
1:36:01
thank you Mr Cha. So how do we get to this being option number4
because from the dental testimony it seemed like this should have been option number one how did these things ever get combined? I'm not that familiar with the bill but it's seemed like maybe it was a legislative intent that they that they were separated and went as two different things to start with and now here we're talking about this is a a final option yes sir I'll start
Senator Missy Irvin
Unverified
1:36:27
andrector Pitman will, um, add on but thank you for the question cause I would like to clarify that this state plan
Senator Breanne Davis
Unverified
1:36:33
amendment went out for public comment and the
dental association did comment on this but never brought this up until the until Cms raised some questions about breaking it apart so we took the act as a whole we did communicate with the dental association in April after the bill was passed about buying the book that they had used for some of the rate increases to then start the work on drafting the rule and looking at our system changes we then did communicate with them that it was going out for public comment
and through that process so through the biweekly meetings with Cms when they began to tell us about some of the issues and working on that and then put it in writing that's how we've progressed to where we are today and I'll just add that the
Speaker 155
1:37:23
bill the way the bill was written it it the 91 effective date applied to the whole thing and so DHs whether rightly or wrongly assumed that the
Chair
Unverified
1:37:30
entire bill needed to move forward as a package when we submit state plans to Cms on a subject we like to do it all at one time because you don't want to open
the same page multiple times and be confusing so we we did it submitted as a package wanting to move the whole thing together because we believe that to be the intent
Speaker 67
1:37:48
of the legislature for that 91 effective date to apply to every provision in that bill and so we wanted to try to preserve that for everything that was there and so that was our assumption rightly or wrongly and we do realize now that we do need to split them apart to be able to move one piece forward separate from the other. all right
Speaker 26
1:38:15
give you they'll give you a follow up
Speaker 250
1:38:17
all right thank you Mr Chair. Did did you know or have reason to believe that that would cause things to to hold up or to slow down and
Chair
Unverified
1:38:26
get denied no sir did not we knew that there may be issues around comparability around treating different populations differently but to know that the limit versus the rate would
Speaker 67
1:38:34
be an issue. No sir we didn't we did not have that information. p re s ent ative painter you're
recognized thank you Mr Cha. I have a motion
Representative Stetson Painter
Unverified
1:38:48
let's hear your motion.motion is to not exclude DHS from reporting requirements for acts567568967 and 1025 of2025. OK just to be clear that motion is is that applies
to their total request that's all for us we have a motion
is there a second? we have a second. is there any discussion Senator Urvin you're recognized for discussion
Senator Missy Irvin
Unverified
1:39:20
thank you I think being able to hear from the academic institutions from private dentists and so forth that we should bring this to public health and kind of really work through these issues that we'll we'll make that happen as far as discussion on this, I think I think right to I think it is important to have the reporting and the oversight from this committee. I do I do want to though express there are there are some clear problems with some of
these bills and I mean I'm a sponsor of one of them but and so you know, however that is reported to this committee, I think is important and then I think on 967 Act967, my suggestion would be just to have a separate report on 967 saying that there are no rules required for this to be enacted and then stating in your report to the subcommittee
next month on that one particular bill that's my suggestion to you guys is to to make that your report on 967 which at that time I think then would be accepted by the subcommittee on567 I think for me personally I knew that to be an issue during the session and I can't remember if that was brought up in testimony or not but I think it was in the public in my committee it was that that was going to be an issue because
you can't just you can't provide $1800 in diagnostic services just for one provider and not for every provider and that was clear to me when we were voting on that bill. and you know we try to communicate that but it we weren't successful at communicating that when it was voted in. I mean just to be fair, I'm just letting the legislature know that and so I think those are real clear and so I would just break these apart and have a report for each
one of them as to like where we are in the process and for discussion purposes, I support the motion. this was the discussion I kind of wanted to have because at the end of the day it's about collaborating and working with you guys and with us to figure out how to do this because we definitely if I pass a bill or any of my colleagues pass a bill we expect it to be implemented we expect there to be a process in place um, but we also expect you know that all stakeholders are engaged and involved on the front ends of
how these things are crafted and as they move forward, obviously. so that's my discussion on the those are my suggestions and for the benefit of the legislators and the sponsors of the bills and all the stakeholders we will have a th or ough public health committee meeting on these options and how we can proceed with them and what that timeline looks like as well as hearing from any private dentists that may or may not be able to provide these services so that might be more clearly defined in the process
that we already have for authorizing sedation with adults that kind of thing which we already have in place and to be able to hear from our academic institutions. I think that would be important. Thank you Mr Chair. any other discussion Hearing
none all in favor of the motion say aye any opposed the motion pass thank you to DHS and the Dental association and for all that
we're here to testify today thank you members we're gonna continue now we're gonna move to itemd this is a continuation of our review of the group re agency rule reports under Act781 today we have the vision of higherducation its report is in your packet the report outlines each of the agency's rules and it is categorized into the rules that they are recommending to repeal and those that they recommend keeping and continuing to enforce with someone from the agency
please come forward to present the report
Speaker 260
1:43:40
good morning still morning. Courtney Salisfod for the Department of Education division of higherducation and yes as you stated we are here to present our report on the current rules in effect for the division of higherducation. we have32
rules in effect we're asking that three of those be repealed. um, two of them because they've been replaced with new rules. the third one because of the removal of authority for the rule and conflict with other current law and asking that we be allowed to continue with the other 29 rules to continue administration of higher ed programs and scholarships and I'm happy to take any questions. any questions
seeing none have a motion motion to accept the division's request is there a second so
we have a motion to accept the division's request to repeal three rules and keep and extend its other rules as outlined in its report with the repeals effective upon adjournment of the legislative council meeting Friday January16,2026. is there any discussion hearing no discussion all in
favor say aye any opposed the motion carries
thank you thank you for being here Members we're now going to move to E these are updates concerning rulemaking from the 2023 regular session we have representatives from commerceor corrections andation here to answer any questions that you may have about their outstanding rules written update from each was provided to staff as of January1st and is included in
the agenda does anyone have any questions for any of these agencies seeing no questions We thank the
agencies for appearing but seeing no questions we'll move forward and then finally
item F we have our monthly written updates by agencies concerning rulemaking
resulting from the 2025 regular session these updates are in your packet are there any questions related to those? Hearing none we will file the January1st monthly written updates is there any other business to come before the subcommittee co chair all right hearing none we are adjourned we'll be right back
Agenda
A. Call to Order
B. Rules Filed Pursuant to Arkansas Code § 10-3-309
C. Agency Requests to Be Excluded from Reporting Requirements of Act 595 of 2021
D. Evaluation of Rule Review Group 3 Agencies Pursuant to Act 781 of 2017 and Act 65 of 2021
E. Agency Updates on the Status of Outstanding Rulemaking from the 2023 Regular Session Pursuant to Act 595 of 2021
F. Agency Monthly Written Updates Pursuant to Act 595 of 2021 Concerning Rulemaking from the 2025 Regular Session
G. Adjournment
Documents
Speakers
Representative Matthew J. Shepherd Chair
Unverified
Speaker 25
Speaker 28
Speaker 29
Chris Madison
Unverified
Speaker 41
Michael Harry
Unverified
Speaker 56
Speaker 57
Senator Missy Irvin
Unverified
Senator Breanne Davis
Unverified
Speaker 67
Chair
Unverified
Representative Julie Mayberry
Unverified
Speaker 85
Speaker 30
Representative Jim Wooten
Unverified
Speaker 99
Speaker 75
Speaker 101
Representative Lee Johnson
Unverified
Representative Jeremy Wooldridge
Unverified
Speaker 157
Representative Les D. Eaves
Unverified
Senator Jonathan Dismang
Unverified
Speaker 93
Speaker 125
Speaker 178
Speaker 146
Speaker 155
Billy Tarpley
Unverified
Senator Tyler Dees
Unverified
Speaker 192
Speaker 199
Speaker 200
Speaker 202
Senator Kim Hammer
Unverified
Speaker 108
Speaker 227
Senator Fredrick J. Love
Unverified
Speaker 213
Speaker 208
Speaker 44
Speaker 239
Speaker 145
Speaker 250
Speaker 26
Representative Stetson Painter
Unverified
Speaker 260