Public Health, Welfare and Labor- House & Senate

Right and if you take your seats. Chair sees a quorum. Right. hope all of you had a great Labor Day it's good to see you to this morning of. Chairman Ladyman do you have anything you'd like to say all right we'll get right to our meeting. A I need a motion for the minutes of July the fifth to have a motion all right second on all those in favor say aye. All those opposed all right. Yes all right let's see the. Get to the very quickly and I'm very excited about having a doctor the entity hill who is deputy state health officer an infectious disease physician from the Arkansas department of health and don't to Joe Thompson who is director of the Arkansas center for health improvement he would come down to the table please introduce yourselves. And we're going to be discussing a long covid and I think that certainly has been on the minds of many people in the state and space in those that are involved in health care and welcome to our committee meeting and Dr Patil would you like to introduce yourself and then doctor cops. Thank you madam chairman there is a gentleman of anybody else deputy state health officer Arkansas Department of had. Jett Johnson CEO of the Arkansas center for health improvement all right thank you thank you for being here does the other microphone work Dr Thompson. In in and bring that very close to you if it does both of you this at work. Okay there you go our elites have a microphone today all right of who would like to start I'll start if you will appreciate the. The conveyance presence here at the chair ask for an overview of kind of where we are and specifically the impacts of long COVID because we continue to deal with that I I want to start off with some context you have been leaders through the first true worldwide pandemic over the last two years so we're still in that we're still learning from that much of what I'm going as described for you as part of that learning process but want to be able to give you an update you in that historical context I think it's important to remember that we have been through three waves of this virus first the parent COVID nineteen that you remember hit other places first in March of twenty twenty but then hit us the Delta variant the progeny of mutation if you will from the COVID nineteen it is in the summer of twenty one. Then the more chron variants another mutation that hit us in the holiday season first of the year and twenty twenty two and now we have the B. A. for the B. O. five BA five variant that are at the predominant variants that are causing infections across the United States and in our state. Here in our state we're somewhere we have a smoldering of these infections going on it's not zero we have two hundred and sixty to three hundred hospitalization people in the hospital and each day we end up with about five to ten deaths per day so this is continuing to be a cost to the population I don't with all due respect to the health department I don't look much at the test at the new case rate because we have so many at home tests they do not get reported and we have many people that may have symptoms that don't do at home test for official test so I think the hospitalization rate is the number one artist indicator along with the death rate and so that's what we're tracking in the testing area there is concern that you are positivity rate if you do get a test is over ten percent whether that's a PCR test or managing test twelve percent for PC are sixty percent for indigent so so this Paris and its variants are still present still causing infection still causing individuals to be sick be hospitalized and to die vaccination rates a nationally we've got about seventy nine percent of eligible individuals with any vaccine sixty seven percent the completed that first does thirty three percent one out of three that are fully boosted so again we have some protection is not full protection and that's leading to the continued spread in our state over sixty for those over sixty five fifty five percent have received a booster which is a good number over fifty percent nineteen sixty four twenty two percent in for younger kids with the booster less than eighteen four percent so again we've got opportunity to provide protection. Now we have new vaccines coming on not many new therapeutic strategies and I think we're likely to see a small spike here as kids go back to school and transmission occurs that comes home infects others are probably not the spike that we saw a year ago. The questions that have shared with you before when we have an imitation of what to ask you know is this new variant more infectious I think what we've seen is each of the new variants has been more infectious in displaced the previous predominant strain a delta replaced Makran they'll to replace the parent on the current replace delta B. four B. five replaced over crime how deadly or clinically serious is it locally so far each mutation has been a little less clinically serious so that has been in our favor. Doesn't evade our protection the BA four B. five variants were the first variants that really looks like it evades the. Preventive aspects of getting infection from the vaccines the vaccine still provide your body with an early warning system when it's infected to avoid bad outcomes but the BA four B. five do appear at least for the original vaccines to be able to penetrate into re infect individuals that's why the new vaccines that were just announced last week targeting more to the B. four BA five variant have been added I would add a fourth question and that's what I was asking was focused mostly on is what are the long term impacts of each of these variants each of the variants were different if you member micron or if the parent virus deep respiratory infections predominately in adults the delta virus deep respiratory infections it had spread to kids the Makran virus more upper respiratory infections less pneumonias and that's what we're seeing again with the B. A. four BA four five variant is more upper respiratory infections although individuals with pre existing conditions or conditions that make their immune system not be responsive can still have serious you know full body. So long COVID or the official name post acute COVID syndrome has a number of symptoms of these some of you may have experience I know many of your constituents have experienced these include headache extreme tiredness of fatigue loss of taste over the long term sleep problems heart problems chest pain a rhythm is and probably one that is it's the most attention is this pervasive brain fog or you just can't get back up to where you were before from a neurologic or or cognitive perspective but over two hundred different symptoms have been implicated let me just say there's a difference between a symptom and a diagnosis and that's where we are right now we have lots of symptoms we don't have clarity yet on what the diagnosis of long code is and have good treatments we have to have clarity on the diagnosis we can target treatments for specific issues in part of our challenge is in definitions the CDC has defined postcode conditions as conditions after you have a COVID nineteen and section that worked there previously that are at least four weeks after the infection and and at least four weeks after the infection and the start of when the post code conditions could be identified so if you have COVID nineteen you're over it it's a month later the world health organisation requires it to be three months later so we've got Division on terms of the diagnosis of when the symptoms are it makes it even more difficult to say what the diagnosis is so we've got this being batted around in October of last year there was a new ICD ten diagnosis added so that clinicians could code post code conditions it said I use zero nine point nine is called post code condition unspecified so again that just leads to the lack of specificity in what the exactness of the diagnosis is these are symptoms. What the impact is from this is is fairly broad and and is not certain what is certain is that at this point probably millions of Americans and tens of thousands of our Kansans have some form of long term health effects from COVID nineteen your estimates early on were. Our estimates currently from Kaiser that three to five percent of those that have been triple vaccinating of the words boosted may have long COVID symptoms up to fifty percent of those with no protection meaning not vaccinated nor previously infected if they get infected they may have at your early studies suggested between five and sixty percent might have long covid kind of the working estimate now is about one in three if we just take a conservative perspective unless a severe codes going to have a severe long cove it's going to happen in one in twenty with its if if that estimate is one in three Lesko conservative one in twenty that would estimated about four million US individuals will have long COVID or about forty thousand our Kansans will have some form of long code symptoms that affect their own going functioning both hospitalized in non hospitalized individuals can get this so it's not totally associated with the severity of disease when you first have it and reinfection does appear to increase your risk of having long code. The mechanism for this condition of the symptoms is of consolation examples of probable mechanism studies are starting to be done inflammation of the blood vessels that serve certain tissues damage organs one that I think is emerging as inappropriate activation of the auto immune system your immune system gets revved up within it cross reacts with normal parts of your body to then cause problems these cause problems like diabetes vascular problems like heart attacks strokes pulmonary embolus there's a small United study that's been completed that has a documented inflammation of the blood vessels because of this antibody cross reactivity that led to the brain fog so we're we're learning one of the things that makes it difficult is you have different variants and you have different re infections and you have different levels of vaccination so it's really a complex are our efforts to mount a emergency response to this on the front end makes it pretty complex to study what's going on now we have of different severities infection we have different vaccination statuses at the time and reinvest reinfection. It's under way now to discover the pass to to understanding the in H. as a large funded project called recover where they're trying to enroll forty thousand adults and children to study the effects of long term effects of covid it's almost a billion dollars over four years Omicron delayed that deployment and it's still in its nascent phase I think they have less than two thousand individuals currently enrolled if they are following so that's going to be a a delayed result on the clinical trial stuck together over two hundred studies registered these are drug companies and others that are wanting to study what they might bring to market to be able to affect long code of those two hundred only seventy four percent have initiated you know the recruitment of individuals so again I think we're at least two years away and some of this depends on what the federal food and drug administration does an emergency use authorization and some of the other decisions that they made when we were in the queue phase of COVID whether they make that in the in the long cove in. I think we're gonna see results unfortunately from you know foreign research efforts because many other countries have a more integrated healthcare data system and they can monitor their population for long COVID symptoms diagnoses outcomes costs and impact as I think as those emergent think we should look to those for guidance to make sure that we take advantage of those results and that would guide the research effort here one of the things that are center is doing is using your health care transparency initiative the all payer claims database to look at diagnoses and how many there were of different types before covid and how many there are now after COVID to try to get a sense of okay are we missing anything that's popping up in terms of what individuals are going to four ACT clinical care also will be able to look at the costs associated with long covid which will not be insignificant if you've got tens of thousands of individual seeking care and going forward. Things to anticipate I would anticipate a number of your constituents will have long COVID and will turn to you for at least guidance if not complaints one of the challenges here since there's not kind of a single constellation of symptoms it's hard to stand up along COVID clinic people are presenting to their primary care physicians with different symptoms in those primary care physicians are referring to specialist whether that's a poll monologist a neurologist or cardiologists so it's not coming together in one place it's kind of spreading out in there may be opportunities to bring that together. We do see and it is being reported impact on the ability to work I think we're gonna have increased numbers of individuals that are disabled by long COVID and national studies have shown individuals with severe long code about fifty percent I have cut back on their work twenty five percent have stopped working because the symptoms that they're having obviously the healthcare costs because we have a new condition driving new utilization will increase and and will have many kind of suggested treatment regimens that have not necessarily going through the scientific review process so I think you know that the delay on the medical research is going to open the opportunity for treatment recommendations that may not be fully that it. I wish I had more specific information I think it is a real issue for again thousands if not tens as tens of thousands or Kansans it does severely affect their function it is a real and new issue I think in parallel we have some mental health issues that are emerging and particularly depression and an increased issues around mental health some of those may be related to long code some of those may be related to individuals who went through the code pandemic and didn't have long cove effects you have no social effects of isolation with job loss other impacts from that. I'll be glad to answer questions I again I think the. The takeaway here is I think it's real it's going to be present it's going to be impactful we're gonna have to manage through it with limited concrete information but will bill that as we can we'll try to find treatments that help bring people back to the high level of functioning as they possibly can thank you madam chair all right Dr Patil. Thank you ma'am I thank god on the Thompson was quite comprehensive but I would like to add a few points as some studies coming out of U. K. as Dr Thompson mention they have a better database what they have shown as the date that we have had more of a long call we patients compared to Omicron ten percent was is five percent but again the sheer magnitude of infections in all macron may drive more large number of people that long COVID because it's much more infectious and so it database involving also played in the data showed that vaccination detail implementing long covert symptoms so also did that affects people who took I medications for according to that and how that is and so these are all pretty many data that show especially ready help putting kids in for a vaccination you know long COVID was much less that in that population so our data is evolving that a lot of studies that I'm going on toward the lord and I think just like we have other diseases we just have to wait and watch it's it's almost three years now come this November since COVID began in China so um I think we'll get more data in the in the coming coming years and months all right we have the. Someone on the a queue for questions but to I'd like to ask Dr Thiel this you've spent your medical career studying contagious diseases as a. physician and so maybe it maybe this is premature to ask this but do you see the of COVID being something like the Asian flu or something like that that we take shots for. Of for ever means you just you know get in line to get your flu shot so is that something on the horizon that we would take a shot for covid. if you know as we do you know like I said the flu. Yes ma'am I think you know this is at a very interesting disease and and right now that in the pandemic phase so once once people us through this and more and more people are infected or the lower I think they'll be endemic phase that that you know we may have the sort of plausibility and several vaccine manufacturers are looking at the combined vaccine for cold and flu and hopefully that will be developed in the near future so this is quite a distinct possibility as as the as the disease involves and binding keyboards K. in I did here Dr Thompson you said or maybe you said it Dr Patil that the vaccine was effective in do you like to add more to that yes ma'am these at all at the end of the study some that came out from UK and other countries that and it showed that the vaccine did have some protection against long COVID a compared to unvaccinated population so vaccination how to use of people who are vaccinated had refused long COVID a kind of symptoms and number of a cases compared to the people who have not cracks in it and so you would say that Even if you got it if you are if you contracted covid if you have been vaccinated your chances of having a lighter case would be good is that is that right yes ma'am okay all right thank you all right to Senator Solomon you're recognized for a question. Thank you madam chair. we have a quick discussion over ivermectin but another reason studies come out the set ivermectin is a very effective could you all speak to the. Senator selling a randomized control trial on ivermectin did not show clinical benefit in prophylaxis which was what you know was originally kind of proposed your ongoing studies that I think. Continue to look at the different drugs I don't think the jury is in that ivermectin is a positive benefit. Okay and also do we know what the injury rate for the vaccines were. extremely low in terms of the reported side effects it was our percentage of Menlo Committee lot of different things as our percentage of him a lot of different numbers come out I can get that for you I believe it's far less than one percent. Okay thank you. All right to senator Hammer you're recognized for a question the thank you ma'am chair the on the subject of flu and also covid the Are there do you anticipate that because of people either getting COVID or because of people taking the vaccine for COVID that it does or does not have a direct impact on the rate of the people there getting the flu are those because we just don't hear about the flu anymore and so just the similarities or can you answer that please. Let me start no be glad to ask for the professional I think a large part of the flu reduction is actually some of the physical issues that we put in place increase ventilation distancing hygiene you know flu is a respiratory transmitted virus just like code so any of the any of the protections that we put in place against COVID work very effectively we did not have much of a flu. experience over the last two years is we loosen some of those physical complaints we did see some infectious waves of of children's respiratory infections this summer but I'm I'm not aware of any cross protection of COVID nineteen vaccinations providing benefits for flu protection. Follow up manager yes thank you go ahead I agree with Dr Thompson stat these are two separate diseases and again doctor things defend mention actually did because introduction in the number of cases and deaths from flu in twenty twenty and twenty one but as soon as those measures be taken off that would actually increase the number of cases especially in children diseases as Beijing diseases that are much more common during winter months we have seen somewhere to but again vaccine people can get bored with over ninety two ACT seem to get that they can be administered simultaneously and we are hoping that our citizens will do so that led them up even from with the diseases are at and follow manager is thank you and based on other and and I remember I heard what you said about this being the you know the of pandemic of of our lifetime. We gave a lot and maybe don't want answers to the questions I will give you pass on it but we gave a lot a liability free protection in the beginning of this because it was so new baxeen hit the market real quick you just testified is one percent lower rate so reaction. Is there a point. That we should introduce or bring into the discussion liability either for pharmacies or for other entities. As far as dealing with a pandemic and the reaction to what's being introduced into the discussion based maybe on previous history going way back when or what would be your opinion as to when we can say okay we study this enough we got enough report now anything moving forward there should be some liability attached to decisions that are made about. Liability of the clinical providers or liability of employers. The other part one of throwing to broaden it and say all of the above. You're right we've never we've never had to deal with the liability issues of an infectious disease like this before if the magnitude for either clinical providers or employers I think we see in this virus that it rapidly mutates so far it's becoming more infectious but may be less severe clinically doctor Patel's comments if you in fact a lot more people you're going to have a lot more effective if the effective smaller so that's what happened with micron long code on the crime was much a magnitude more people infected then delta or or the parents are. Senator hammer to your direct question liability I think you are going to wrestle with this I think. Maybe less so on the liability side and more so on the disability side individuals that have contracted COVID through a place of work a contracted COVID that did not get vaccinated for maybe applying for disability benefits the cost of that you know flowing through the system whether that's on social security or Medicaid on others I think you have to deal with both liability which I think it's going to be harder to do because the science is going to continue to evolve and it's gonna be hard to nail down what liability that is now that you're gonna be dealing with on the disability set of individuals with long code over time. Our thank you thank you after all right the senator Gil. Thank you madam chair and just a circle back on that question asked by Senator Hammer on liability I think that to your point it might be a little bit premature in open into a big can of worms do you would you agree in that statement. I would defer to your decision points but I don't know how to help you staff a liability decision with the treatments in the on the kran evolution that we have now on what to do with either clinical providers or employers yeah I understand thank you but going to my main question and that's on flu what we seeing with flu season as far as variance and things of that nature where we tracking at this point do you all have any sort of data Dr Patil. Thank you senator Clark yes we do you know we we scattered cases in the fullest all day yet but much more prevalent during the winter season when transmission is as much more frequent we've been seeing flu and again you all might have seen some news that portable to handful of cases of of the flu which is a mixture of all the swine hand human flu so those are separating just a handful of cases here and that the CDC's monitoring and we are also following we do expect the flu season this yet I just like the previous yes and it all depends on the severity of the mean that those kind of things but nothing unusual is predicted but always within sight and sound just like on the ground and experienced any variant of the flu that has a bird a common interests wine complement that can endemics and because much more C. reading fiction or what we do in mortality is always a concern thank you for manager yes Been in the news recently monkey pox being the issue here in the state and I'm not sure how many cases were up to this point I know back in middle of August is the brown fifteen or so I'm not sure where we are what what we seen emerge with this. Yes Sir as of this morning we had about forty three confirm diagnosed cases in the state and again these are known cases many people that might the symptoms may not have been diagnosed or are up sought care for diagnosis but as of now we have forty three and and we have been prepared we have a vaccinations to prevent monkeypox we have exhibitions to those who are exposed and people who have been diagnosed and web CVS symptoms we have medications that will reduce the severity and complications so we had a of entities in that regard thank you Dr Phil procedure to produce. All right I need I'd like to ask questions of the that one ninety or maybe both with half of a comment to make do you feel that the COVID nineteen Max and nations are accepted to a greater degree nailed an early on. I think the political discord has quite and and I think individuals are probably making more informed decisions now based upon their own health needs to the question about monkey pox I think it's a it has gotten a lot of visibility but forty some odd total cases is different than a thousand new cases of Kobe nineteen that'll happen today that we know of and it's probably multiples of that that we don't know of because people are going to the health department's testing manner I think as people no more people that have had covid that have had serious bouts with COVID and that have long code I think people reassess and I think people have more access to accurate information now I would encourage and ask for your help to help us diminish Mr disinformation and let people make good decisions themselves informed by what we do know and what we don't know. Yes ma'am I think up the number of people accepting vaccinations is gradually increasing as people get educated and more knowledgeable and I I sincerely hope that the new bivalent vaccine that's we need to be used people do take it as specially are seeing is that negatively because they need the protection in the coming winter months so I hope by the being greased up tick among got most of a number of publications thank you madam chair if I could go to the his comment on the bivalent so the new vaccines that were approved last week. Have basically two heads of their strike one is against the parent COVID nineteen which the B. A. for NBA five run out from under my third question does our protection still protected B. four BA five have shown that they can re infect us and if we have a serious condition they can make that condition or have a more significant negative effect on hospitalization death so the new vaccines have to attack points one is the original COVID nineteen and then what's the been designed for this most recent area we may have yet another very I think we will likely have another variant in the future and so this is going to be an ongoing kind of battle if you will against this new infectious threats. Thank you all right to a representative Bentley you're recognized for a question. Thank you chairman Dr Thompson I was speaking to restore their purse that the day that time when he see the huge increase of a for him anyway of mothers losing eleven at twenty weeks. Vaccinated and accessing that you've seen in take an increase of and I know this is totally different from other but he said it is really was concerned about increased number of twenty week infancy seem lost in the past year representative and I have not seen anything along those lines I'll be glad to keep our radar screen up for that it will not surprise me if as these viruses change they throw some curveballs you know this virus is looking for and protected individuals we knew early on that mothers particularly with the dealt of ours were particularly at risk of losing their their unborn child in so it I think you will continue to monitor this and see if these new variants have a new twist particular with those that are are most at risk. Thank you. All right Senator Solomon. Thank you manager we have a profile a risk profile remove the year two years ago we came out with this we thought everybody kind of face the same risk but as we have gone on what is the risk profile now. Rest just to clarify this provide for long covid. Yes are there certain populations that are at a higher risk of long COVID of people as a woman not at higher risk and up people with pre existing diseases lung diseases heart diseases and diabetes are at much higher risk because they're already at the tipping point so that much more hi it is with that be similar to COVID also. So what would affects all ages what is the severity of the symptoms that differs based on a pre existing condition yes people what a day especially apples sixty five people who are unvaccinated people with diabetes are much more likely to have and second from obesity and heart disease and lung disease AS mortalities in that population okay thank you Senate so let me just add I think in in our dialogue it will be important you know there are individuals who have more severe outcomes because of pre existing conditions because of age for the infection itself of COVID nineteen they are then individuals that have these long code symptoms that may have had a little bit of cognitive problems a little bit of heart disease a little bit of you know pre diabetes that code pushes them over the edge and and I think it's going to be challenging to see for those individuals how much of that is COVID related or how much of that was progressing on its own in individually and that's that's where this uncertainty about you know studying getting a diagnosis of long code so and so you have it let's study it and let's find a treatment for verses you Mr maybe recovering from code but it's not long because. Thank you just would like to also add that COVID has brought forward diabetes you know as exposed people with diabetes more diagnosis of diabetes is being on must make covid and also seven auto immune diseases especially related to information of the in this state so we have more cases of autoimmune disease is being diagnosed for school the dogs or which which occurs from other viruses too so that's a cause of concern and again one of the mechanisms add up with arms and I talked about is how we hold as long COVID come about one of the mechanism is body develops autoantibodies and and you know we have an autoimmune syndrome that double up so that's that's also a cause of concern. All right The chairman Ladyman. Thank you madam chair of. Treatments I have a question the the visor in the Madonna treatment they came out I think was released in July around that time the regiment I can't remember the name apologize for that but I've talked to people that have tested positive and have taken that regiment. had a couple actually both of them as a positive the lady took the regiment the man did not but the response was about the same so my question is do we know or is there enough time to know the effectiveness of these treatments as regiment that came out in July. I think these medications came much earlier in the game last year and the two bills you might be talking about is the fact Slovik and the mall the bit of it backs though it is from phase that and acting on the part of it it's a month these are to bills and dilated Bills against the vita's so the an anti this and other studies performed backs of we did very well almost eighty to ninety percent it prevented CVA disease and hospitalization in patients of the month but I'm on a bit of it initially shortly going to affect you in this and seventy percents but actually data showed that it was effective thirty to fifty percent and what I would say is you know every person is different everybody's immune system is different hold it as part of the same way as may be different like the couple you mention one person might have had in mind a disease that the personal took might might have had CVS symptoms and taking the medications did not prevent severe disease maybe that might be the cause but these drugs are highly effective I myself had to delete the vehicle the last month and a two packs loaded and it was really helpful and I would I wondered what would be the case if I had not taken those medications I couldn't get up out of bed I have no medical issues nothing but still it was so it was pretty easy in and I'm sure backs of the detail in that and these are great drugs and we should encourage that is no shortage of drugs it's available to all the state in most pharmacies and I highly encourage all our citizens to take these medications if they'd to double up COVID and are in the highest category compared to other non population. Right thank you of. Representative bill and you're recognized for a question thank you madam chair my question is this we have a lot of our campuses that are taken CoV test at home so how can we adequately or accurately track what the COVID numbers are in the state of Arkansas if these people are testament home and we don't have no way of reporting it to see if that that turn and I'm also to the state health department of a year man so high how can we track the. Well I think you know your your question is spot on at the health department doesn't have an eight hundred number I believe that people can self report if they test positive I doubt the phone number rings very often so we have a broad swath of in yokes at home testing for which we do not have line of sight and that's why you know the health department's daily update on new cases while I think important is not necessarily reflective of the level of infection pick your number take that number multiplied by three and that may be what we have out there maybe five it's not the number that they're putting out reflecting the actual number of new infections that's why I'm tracking hospitalizations and deaths those are hard outcomes those are people that are having severe illness or having the worst outcome and and those are not subject to you at home testing or non testing is I think it's happening a lot of please follow so does that mean that the database being reported is not accurate. I would say the data that's being reported as accurate for that is being tested through the clinical system. So it's accurate for what goes to a professional lab and gets reported to the health department it is not reflective of what is going on across our communities. One from a so it is true that is the the data that's not. Being reported could that be driving the numbers in the state of Arkansas because we don't we don't actually know. I think the level of infection or driving the hospitalizations and the deaths those people who are sick enough to go to their physician and get tested or what reflected or those individuals that are going in for a surgical procedure that are still being tested preoperatively is what's being reflected in the health department's numbers the representative called stiff of those test is twelve percent for PCR it's around fifteen or sixteen percent for a rapid antigen tests of those that's a high number and I think we have many folks that are testing at home finding themselves positive not reporting to the health department because it's it's not required to report to the health department and therefore didn't the number of the the reflection of what actually happened here communities is under represented by the data that the health department report now we don't have another way right now to do it this is not a fault of the health department but it's an interpretation of the results that I would encourage you to consider in that whatever the health department reports it's it's a fraction of the infections are actually happening in our communities. Thank you. I just want to add a laboratories and up other healthcare entities are mandated by the health department to report COVID tested so they do report to us and again as Dr Thompson said you know people at home do red lead report to as and again compared to the data and other mediums the symptoms out so might some might just be having it on the nose of its light source told date they don't test or even if they do test the they know that positive they might take all the precautions to stay at home but may not seek medical care go to the physician on other things so that's why the numbers might be in on lower compared to what I actually the number is not in the committee. All right to a representative run. Yes ma'am thank you Mr chairman sure even though we're we're really keeping the rates acrid own what's going into the hospitals and things like that the folks at free to speak about representative Freddie the folks at home that are self testing okay that information may not get back totally to you guys and you know these folks would be able to spread that. Even though they're not recorded. Was a real big hard on the state level with maybe the projections that you guys sale I can see how that may be a problem. Of an accuracy but I think it's a problem for saw we're in a new space and and as is as Dr hill said you know this is a this is a less serious infection when you get it so I think we have a lot of folks that probably were infected and never home test we have another group that home test and don't report then we have those that are clinically sick and see care as long as we recognize that and we make decisions with that understanding yeah I think I think we have to manage through this in the best way that we can thank you thank you Mr. Right of one of the questions of when we talk about long because of it you mention the post acute syndrome. It It is there a timeline for that at some point do you say okay I've had it. Now I'm tired of it and I don't want it anymore. Like most people have a pretty short time line on statements that I think we're learning about how long the symptoms can last and it does appear that in some individuals it last for a period of time and then it kind of resolves in others because it's of recent development we don't know how long it could last it could be a permanent impact that we do not know for some of these individuals and that's why I think we're going to get into some of the difficult questions around disability and ongoing support for individuals that have had long COVID that persistent doesn't resolve. Right and that patients will map might have been positive any symptomatic and still develop these symptoms weeks two months later. All right thank you we have no other questions I want to thank you to you for being here and I think we've had a good discussion on long because of that and we know a lot more about what to expect so thank you so much for being here thank you for that thank you all right to ladies and gentleman of the committee if you would go to an empty and I just have a little note of that item II of we have the responses from each of the passes to the question of of home or in a versus a a name brand rather versus generic and the total care has answered the questions but they're on a separate page and it's up and form of an email from Mr price so you have won a one page with a most of the here it is six it's title exhibit E. and then you have another one that has Mr price's name at the top and so for those who are testifying today I would as they come up Jack hi Hopkins Corey comics. Mitch Morris Brad nine if you come up to the table please and introduce yourselves. And who you represent. I think we might get another chair someone's coming up now okay Senate all right. All right infused into dishes since morning madam chair committee members my name is Mitch Morris I'm the CEO within our healthcare solutions. Members of Medicare my name's Corey **** I am I represent care source. Hey good morning madam chair and members Jack Hopkins on record government relations for Arkansas total care and I apologize about the confusion as an oversight by me The delay to submit to fill this morning that's fine. Good morning madam chair members the committee my name is Brian I'm the government relations director for summit community care not thank you so much for being here who would like to start. So madam chair I I'm not sure that we would have much to add to the responses that we send it to the committee The passes each all four of us via the pass agreement between ourselves and the state are bound to follow the state's PDL. so there are a few exceptions to that that I think we highlighted in our response for the most part I think at least for some it's behalf just open it any questions from the committee. And a lack of that word again skews me can read to all of you would you mind pulling the microphone up as close as possible. Okay eight years is not owned. Yes it just after that I think that we're all kind of in the same boat as far as our the agreement with the state and that we are all for individually collectively bound by the state's up for drug list. I would echo the same in. Agree not only other thing I would add is absolutely agree with the comments and so we are bound by the rules and regulations and we our number one goal is to operate within the rules and regulations we do you know see to support our members are primarily as we work through those rules and regulations but also our provider partners as well who are obviously critical to our members receiving the care in the services that they need and so when individual issues arise we certainly look for opportunities to to be flexible within the rules and regulations and not enough any feedback to those conspecifics there is a very helpful and sometimes we have the opportunity to introduce some flexibility and sometimes we just all and so what we have absolutely value those provider partners and always look for ways to be flexible and to and to improve the collaborations that we have. All right thank you senator Hammer you're recognized for a question. Thank you Mr. The being bound by the stage preferred drug list tell me the pros and cons from y'all's perspective about that limitation. Sure Senator Hammer I will I'll head from I guess a high level point of a. I think for us at the planned the other often times when being able to authorize the generic verses the preferred name brand drug obviously we can realize some cost savings there so for us that that is something that we would be interested in looking at doing you know we understand that the in the State of Arkansas by having that PDL and being able to retain some of the drug rebates that there somebody comes back to the states in that manner but. Exploring options for those savings to come back to the plan might help us you're better our member experience overall generally. Right to one you'll have to turn off your Mike for the one to light up yeah I I think the pro there's just consistency across all four passes that the expectation of a member were to switch from one class the other that they would have the same understanding about their prescriptions obviously the con is. Or a potential con is our our ability to manage our own preferred drug list. Follow up manager yes we did. Make it any more of a competitive market that would benefit the state in any way if that requirement was removed so that maybe all would be more. Inclined to be competitive to the best care of the patients thank you about what ultimately we want what's best for the patient for the clients. It also are we limiting a creative environment among the passes were by maybe the state could even read greater benefits for the patients get better quality care then what this restriction is prohibiting you from being able to do. You senator Hammer I would I would respond carefully by saying you know I think you've made a valid point you know I think that by being able to manage our own formular at the plan level. We do have more flexibility there that being said we don't have a lot of insight into the states PDL as far as the re baiting the money that comes back into the state to that mechanism so I can only tell you just from our perspective what we've seen in other markets and and what works well for us in other markets and that's being able to manage our own formulae aree but there might be some unique differences here in Arkansas with the way our Medicaid program works that I'm aware of. Thank you thank measure. Would you want a response from others. A. All right anyone else want to say anything on it I mean I can say it better I think that you know there's there's advantages and disadvantages to both things also stayed has the benefit of those rebates by requiring that we all are bound by the for drug list. it but talking about the whole health of the individual on the specific cases especially in this hi Cutie Bobby elation perhaps that there could be a benefit there we all manage our own four million but that's conjecture can anyone else. I would I would just echo that wouldn't have much to it. Okay okay okay thank you all right to senator you threaten. All right of center Gilmore you're you're recognized. Thank you madam chair in a if I could I'd like to hear from from all of you guys thanks for being here to it was mentioned a little bit ago and I member which one mentioned it but you off all the PDL. With some exceptions maybe some deviation would you talk about the please. Sure thank you Sir you more that that's a great question I didn't really expounded on those exceptions I'm so there there are going to be times when for example on the clinical side a provider might indicate that a name brand drugs contraindicated for a patient or the maybe at a time when a provider would indicate that perhaps a patient is allergic to it inactive agreement name brand Jett drugs that's not present in the generic so in content in circumstances like that the provider can put in a prior authorization request to the passes to seek a generic on the other side there's more of an administrative prior authorization that works as well so if you have a a preferred drug that is unavailable or there's limited availability then the pharmacy At least on the on someone's side the pharmacy through. the care coordinator that's responsible for the care of the member or the pharmacy by directly reaching out to our pharmacy team can get a plan level administrative authorization that case because. More than anything we want to make sure that our members are getting their needs medication so if the name brands not available it's a very simple process to get that junior court in place and that's the same for Arkansas total care it just the differences it might on a case by case basis the prior authorization process in my differ between each pass individual pass. And we're exactly the same. Yes I measure of flexibility and so they're I think they're good well it will make comments that there are ways that we can streamline that prior authorization of process when it makes sense and in partnership with our DHS partners and there's effective ways you can do that kind of on a case by case without undermining the yep ET AL. Follows manager yes thank you for the response and that that kind of goes back to my colleague Senator hammers question in the sense that if needed a physician or provider could request through prior authorization but I think maybe just mentioned about streamlining that process because there's probably also savings when streamlining that process is well for the provider one of the key things there is utilizing less time on the providers part so there's there's probably cost savings there what have you all identified ways to streamline that process. Yeah I don't know about specific cost savings but but certainly like I said I think the goals that we're trying to bring to the table is to is to support did state defined preferred drug list and to administered appropriately but to introduce those flexibilities on a case by case scenarios make sense and so I don't know that you want to. Easily of bypass the prior author is prior authorization procedure in every case because it is defined in and and implemented in order to support administered at PDL as defined by the state so in in case best case situations when it does make sense we do have those options yeah and and I'm by no means indicating by passing that because I do think there's there's benefit there obviously also do believe there's benefit and and when you can streamline that process because I know providers spend a lot of time on the phone with prior authorizations trying to you know make sure they their patients the care that's needed and that's time spent away from other patients so I would hope that maybe there's there's ways to to be more efficient in that regard thank you. Just so that. I will be clear on this. Of maybe some others on the committee have the same questions but if you have a physician that is trying to get prior authorization and engineering drug has not worked in they want to. prescribe a cost of more costly drugs a brand name what is your protocol for that. yes it's really similar to any other any other service or or procedures that might need to be clinically reviewed the prescriber would just demonstrate medical necessity and that if it's the need of the presenting patient and our clinic or beers or take a look at it in most instances though during a previous okay is there a a great delay in that amount not to not at all all right thank you. Senator Wallace you're recognized thank you miniature. You know I I worry that some of the. Rebate the cost savings that would make at the state level or being placed back on the back of our small town pharmacies but another issue that they've got that I mean told is with some other brand names. They have to order a a larger quantity then they need that might need order or be required order let's say fifty pills. And not only use ten or twelve before the. The shelf life runs out. Do you all have any I know that's not your responsibility but you all have any suggestions or is there a way that. We can help with that. That's definitely something I'm not I'm not a the. Pharmaceutical supply expert but that's something that the we would be happy to look into that specific issue. Thank you senator. All right represented Bentley. Thank you chairman diskette back with a senator Hammer was talking about our constituents or the final but we're most concerned about right so is this direction with patient care when they're switching from one to the other worth it when there's a generic this much less expensive so I've got one as you know we have to use the PDL is the disruption to the patient. Worth it when every one the a lot of the plans allow the generic to be replaced if I make consents to this. The representative Bentley you you are makes sense and. Any any response would be conjecture from us I would say that in other markets time that my company operates and we we do manager on formula airy and if it does work well in those markets again there may be there may be issues here with the state Medicaid program and and re baiting and how they're set up that I'm aware of that might make that harder thing to implement but again we're always looking for opportunities to visit with our state partners about ways we can improve either the existing PDF formula area or we can smooth the prior authorization progress process except for a so what we have done those conversations. Just one quick follow up chairman I know that we've we've already talked about you want to streamline it will present testimony it being pretty difficult to get the prior authorizations or anything you guys is going to reiterate it and they can do to make it easier B. will be beneficial on that. Thank you. All right senator Hammer you're recognized for a question thank you thank you madam chair and Korea will come to you because the comment is in your goals response okay. And maybe this takes on Senator waltzes question because requiring independent pharmacies to continue to carry the substantially more expensive brand drug is shared by CareSource pass in our cost so when that drug is ordered that the independent pharmacy is having to keep in stock because that's what's required. Who is actually bearing the cost of that product being on the shelf is that the independent pharmacy or as a troll at what point is the cost transferred from one to the other if they certainly Senator it certainly. On the shoulders of the pharmacist and up until the point that we pay for at that point you know if we're paying you know it's like anybody else if you're paying for something that's more expensive and you have a budget which you know we do have a budget for each other each what's that is placed with us to for us to take care of if we're paying more for the cost of medicine for that it's that's a cost that that the that we encourage that we end up often times when you're talking about a thousand dollars for for a drug and we get. Somewhere between two thousand three hundred a month in two thousand five hundred a month you know we've made up a large chunk of the money that we find that we get to take care of that person eventually if we go over that two thousand five hundred or whatever it is for for the the person that starts to eat into to You know into our or money so you know you try to manage within that that money that you get from the state and so any increased cost of with drugs where you can get something that's that's cheaper it's going to end up coming to us and NO a a I'm not sure. All the ins and outs of of one the the list is the way it is but but in over the state once these drugs and and we're okay do what the status is but it's doesn't mean that that You know there's not other things that we can do to to offset some of those cost that if you're bound by a contractor bound by a contract so we're trying to work around we're you know hopefully after this conversation we can all sit down and figure out you know are we hitting all of the the points that we need to with our prior authorizations is there something we can do with the state in order to fix some of these these cost but Yeah I mean you know we we are business we are here to to take care of folks that you know at some point higher cost story impact in this in a negative way and this is this is a higher costs so follow up manager yes. So a physician or someone orders a particular drug for patients under health care or and this statement would be applied all for whoever wants to answer it so physician or determinations made that a client patient needs a particular kind of drug that drugs are ordered. As ordered from the pharmacist who then has it set on their shelf until it's picked up if it's one of those drugs at its you know maybe they're carrying a surplus quality because they know the next month they're going to have to repeat it. That pharmacists bears the cost of that drug on the shelf until it is placed in the client patients hands at which time you'll pick up the cost is that an accurate description. Yes that's correct. And I'm not sure how much we can do about the the the quantity that's delivered or determined to be delivered to the to the pharmacist necessarily. Okay I think that be something we have a deeper dive on to try to figure out that the flow of medicine and how that costs can be reduced if specialist that's going to drive the the prices down of providing quality care or. Just makes a little bit more fission so okay thank you manager. All right of a cake chairman Ladyman. Thank you madam chair of thank you all for being here we're getting some good information from you but had a question in your responses here as pretty much in everybody's response but it says that you if requested there can be a one time override for the generic tablet that's under care choice but the other three are similar to that so you can request from DHS to use the generic. instead of the name brand drug in this particular case my question is you know how often do you do that I mean are you getting a lot of those kind of request where you have to ask for that approval and do you get the approval when you ask or is it ever denied. Can you are you able to answer that maybe not. So representive Ladyman I have one more I think for at least with some of the response or talking about that one time approval more really meeting is it a case by case basis and on the the clinical are authorization for example like I mentioned if someone's allergic to something in the preferred in the generic isn't have that that's that's the decision made at the plan level not the state level and if it's a authorization under ministry of authorization because the preferred not available that's also something we can do at the state level we don't ask me the plan level we don't have to go back to the state in those circumstances as to the the numbers I would have to get back with you I'm I'm really not sure how often that happens it in the same same for for us Arkansas total care it's a decision by US based on the availability of a brand name versus generic and we would make that determination we wouldn't necessarily go to DHS that approval and that's a one time basis until the brand or generic becomes available depending on what's on the for drug drug listed DHS And then aside from that it be the incidence rate or the the the amount of times it's happened since it's not significant by any means but it's definitely something that we're attuned to. Thank you all right of senator Wallace you're recognized for a question. Last the. Session we had DHS. So they would approve authorizations for a longer period of time. Six months twelve months I believe so the passes are still have a short term thirty day periods of time are you all going to expand that to what DHS has recommended. I guess the first thing that comes to mind and fund so that question is is the authorization time frame just very alive depending on the specific service or need or drugs in certain circumstances such certainly fits a long acting medication to the period of authorization will be longer so I don't have specifically if you have a specific service or drug you have might be happy to take that back but I do not own this okay we'll. Yes Sir I mean I guess again my thought is just that what we try to do from our physician reviewers are clinical of your perspective is to take a look at what the prescribing physician or the treating medical professional is requesting or recommending and and look to agree with it and the vast majority of cases and if there are times when our physician reviewers don't agree to make it clear what what the disagreement isn't to to engage in that discussion if if the interest is there I to try to find a common ground but in most cases prior authorization requests are approved in the front and there's not a significant delay or administrative burden in many cases in most cases and so again I guess my primary response that question just it varies a lot depending on the specific service. Q. manager. All right senator Hammer. Thank you ma'am sure couple quick ones refresh my memory the the date the reimbursement rate that shall receive includes a pharmaceutical cost in it or is that treated separate items. Thank you senator is a great question of the the pharmaceutical rate is included in that monthly capitation payments based off of what the actuaries for the state put together for the average cost of care for that individual so yes it's included in that monthly payment is that monthly payment rated on pharmaceuticals at the preferred drug grade or at the offering great. It would be based on what the preferred drug is on the on the H. S. formular. So if you. If you require if you ask for substitute over a name brand. And you get a approval for a generic. And it ends up costing you less of what's being reimbursed at the monthly rate at the preferred at the up name band brand drugs do you do you keep the different center house that get back to the state. Or does it. Senator I don't know the answer to that question I don't know that from the the usage that we're seeing at the plan level for these prior authorizations I don't think you'd be any substantive amount of money at the perfectly on Senate okay well that that's a good answer of at any of if the pharmacist is asked to order drugs and then that changes like from one month to another because you're trying to adjust is that independent pharmacists compensated any back for the drugs that they have had to order put on the shelf and then maybe it ends up not being used for whatever reason or because the pharmacist end up having to eat the cost that drug is not used it because there was a change in medication order something happens that the quantity they were asked to have on stock and it didn't get used because they're bearing the cost based on testimony will go there bear any costs that product sitting on the shelf to transfers to your patient is there significant costly independent pharmacists are very because they're they're caught in that transitional period. I would have to look at the incident rate for that specific scenario I to be Frank I don't I don't have an answer to that question right this second that is something I can look into and see if there is something significant there that we need to develop a work around okay if we could find out those two things I'll get off line with thank you meant you thank you right seeing no other questions we appreciate all of you being here I think it was a really good discussion and a we appreciate it thank you so very much alright ladies and gentleman we're going on to item health and we have the mountain Matt Gilmore. we're reviewing the Arkansas tobacco settlement commission's report. You get settled you can introduce yourself for the record and of ladies and gentleman you see this report. by annual evaluation report and lighten read on your desk. And then we're also we have a handout UAMS centers on aging as well. All right you. Ready thank you madam chair Matt Gilmore department health for the status of the Commission. I'm Emily over to McCoy the director for the U. M. S. centers on aging. I'm Emily Landin the project director for the tobacco settlement commission of valuations at UCLA all right thank you for being here Mr Gilmour we're ready for you to tell us what's in that report. Thank you madam chair you seen similar reports to this before this is for the twenty twenty one years of the tobacco settlement commissions programs it's a lot of information I know you've been here a while so I won't go into a lot of detail but there are some things I'd like to point out as you know COVID has impacted a lot of these programs and a lot of their activities a lot of these programs are education focused and have lots of our actions I do with the public so do COVID and some of the things that we. impacted and that were impacted because of COVID those have decrease in some ways I think the numbers will come back up in certain areas just due to the nature of the programs how they operate but a couple things that I did want to point out that are down a lot of that is around the community interactions and educational encounters just due to as I said the way these programs operate and then again The of the screens are down as well and those are important as these programs go out in the community and provide a health and health education and screenings to individuals amount of their current health data in providing some helpful information of them to make some decisions moving forward to improve their health. Something's there up on some of the populations served through Medicaid those numbers have increased which is a good thing this is you know not unlimited the dollar amount that Medicaid receives through this but they address those dollars to impact more individuals another thing this up is the amount of leverage funds programs have received that's through grants that's through a private donations and then just donations as well so those are numbers that are up there a good thing at this time of the year because the work programs are doing. There are a few other things like to mention I think that's been good over the last couple years the programs have done a good job having to just react and find ways to establish new partnerships but also engage in things that were typically wouldn't do like a lot of that was around code as far as vaccinations and testing those are important so that had to be nimble and to you know flexibility to do that to engage in certain populations they're entrusted with I think another possible use of technology telemedicine's minute a big factor all the programs of utilized and doctor of ten court may speak to that a little while with her a brief overview the she's gonna provide but I think that's been helpful also just the use of electronic presentations and reach more individuals across the state through the work and education these programs or engaged in so I know that was quick but same time I want to leave time for miss doctor over to the core issues of the year make you a master's on aging and she can tell you about their program I know last time presented Charlie minute asked we have one of the programs here to get a little more detail and provide more but in depth look at what's in the program status alternate documents over to Igwe. All right. Thank you know it's a pleasure to be here and to share with you know what the U. M. as centers on aging is doing across the state we have been here since the beginning of the funding of the Arkansas tobacco settlement and so if you there is a hand out a brochure that you all received we have seven centers on aging we cover every county in this state and we focus on to improve the health outcomes of odor our Kansans and of course we're all aging and right now we have a large population of voter adults and so we want to improve that through innovative educational programs as well as inter disciplinary clinical services throughout our state less than one percent of health care providers are board certified in geriatrics to serve the expertise of clinical care of older adults that are aging in our state and so one of the things that we do is that we help be sure that clinicians across the state have the knowledge to provide the specialty care even in the rural areas to odor adults across the state every year we said health priorities to be sure we're addressing the needs to the odor adults and of course as Mr Gilmore addressed we hope it did affect some of the things that we were addressing and how we address those and we're all constantly measuring outcomes as we set those health priorities and so and two thousand and sixteen. One of the priorities that we noticed is that we were fiftieth in the nation of senior hunger and so we started working with multiple community partners our health care providers and addressing this need with oder adults and their families as well as the Community and clinicians and B. insure we were addressing this and right now we are thirty ninth in the nation so we are moving the needle we ask the opioid crisis in as Mr Gilmore address that with technology we with COVID we try to be sure that we are keeping Notre adults active and we're doing this through evidence based of physical activity such as tai chi we continue to offer these programs also drums a life which is the evidence based physical activity program we even continue to a walk with these with technology either I cross wherever oder adults could meet and feel safe during the pandemic and we are getting some great outcomes we're seeing that in showing oder adults that they can reduce their pain non formal logically and be more effective and showing that we can also help them to redo the third fall risk so in two thousand and sixteen our state was fiftieth in the nation and false and false is costing us in this is a and a non traumatic fall no fractures is costing around three thousand dollars Justin basic health care that is no fractures nothing and so we are now thirty eighth in the nation as we have focused on reducing falls across our state and again that's with that interdisciplinary focus and education with caregivers and the community and reducing fall risk and we have shown in the programs that we're doing pain management by a fifty percent reduction in our participants and getting them more active and showing him no non pharmacological ways to manage their pain and these are just a few examples and we're always looking for ways to leverage the funds that we receive from the Arkansas tobacco settlement as we are indicated by the law to continue to leverage the funds and so we just received a half a million dollars from the administration of community living because they are have taken notice to some of the programs that we have done to reducing your hunger in the state of Arkansas and how we are utilizing technology to the con to explore how we. We had kept me a road map for the nation in using this technology and working with home town Hauter adults to I get a technology into the home to reduce social isolation addressing your hunger and reduce suicide among our odor adults so we're really excited to potentially be and a room of model for the not only the state but for the nation and so we just receive that funding and were eager to move forward in that project in the next three years. All right the we have some questions go what did you want to say anything. I'll just be here for questions if needed all right of representative Bentley you're recognized for a question. Thank you chairman thank you doctor record for being here can you have cover Perry County il cans of a remote errors so how we able to reach those my constituents with what you guys are Dan. So the I believe that county falls under our sh meeting center on aging. I was thinking of Fort Smith is trying to figure that out of this question troll yeah I think it I think it actually falls under our sh meeting but I can get back to you I can actually run a detailed report for you and get to you on what all we've done it in that if you would like for maybe like in the past five years if you would like but we offer programs we do go to every county a minimum of once a quarter of course sometimes with through the pandemic it was three technology at but we have community partners and three the if you look in the brochure these are just a few of the examples we offer to every county in in each county can ask for certain individual programs that we do set those health priorities and we tend to focus on those each year a follow up chairman that's okay yes so do you go to the senior center is at that point either partner with the senior centers maybe it's churches maybe it may be a ladies group it may be that a local library may be the of local pharmacy is wherever oder adults or care givers may be needing and like I said we do work with the health care providers we also work with health care students so it's where air for in the community there is a need and like I said we are all eighteen so we never turn anybody away. Thank you okay I have one other question Jammu's. Mr Gilmore can we I really liked her data give us some feedback and things that are making a difference for the money they have do we have any that kind of data for the other programs that you reporting today some good outcomes for what we've money invested. As far as I'm not leveraged yes yes ma'am so if you look in the report. Each one of the there's a section to have reached one and I can get you more information as what they need to leverage for each program but there is a indicator that they're exposed to track the the amount of money they receive with that federal whether that's through grants with Esther donations we can pull some numbers for you of what they've gathered over the last couple years if you like and and provide that to you but that is an indicator that they were required to show improvement in. Thank you thank you chairman. All right senator Gilmore you're recognized. Thank you madam chair and I have a couple questions if I might ask for latitude. So on on this flyer I see the the tai chi and the drums alive and maybe some other programs on here what what sort of engagement are you seen around the state and as this where is this particular done as a senator Singh homes is this and just community events like what what we were we seeing engagement and are we seeing agent with those programs. Yes absolutely we are seeing engagement of course during covid some of the engagement was strictly through technologies such as through same blackboard Facebook live or even face the now if it was through Facebook because it being overrated taltz we are very limited because of safety as to what we would not put on if we could not watch them to control the safety of it but senior centers a lot of time like I said churches nursing homes. If we cannot go on a regular basis to where we're going to be able to make a impact of the physical activity. That may not be the best return when we're looking at outcomes so we may want to look at the long term care facility as to where it's a train the trainer type concept such as also with senior center so it varies but it's just again it's wherever the community is that we're going to go to sometimes it's our rural hospitals and they may have seen your groups coming to the rural hospitals so it it just buries it basically depends on where that community meets is there a certain dollar amount that's spent on these programs that you know of a fine out there absolutely is but we can never go over what we are given through each year from the ATSC So it varies from year to year as we only received eight three percent of that settlement each year and then we have to leverage that amount through the use leave donations or grants and so a lot of times the communities are very kind and do not charge us to come in and offer or use facilities so that is also where we obtain sometimes it and then if they're in evidence based programs such as these are it does cost to get our staff trained in to recertify annually so such as tai chi you could be looking at four hundred to seven hundred and fifty dollars annually to keep your staff trained for one person mmhm okay and I see a lot of other programs that that are offered there that you know I think certainly have have value like the the diabetes education and things like that things that that have a lot of X. you know extra or external externalities there negative externalities there move moving on on page if I'm a manager yes on page eleven of the report Read. Has a info graphic there Arkansas biosciences institute I see a lot of research projects research presentations publications etcetera how is word getting out on this opportunity for students because I look down at my district and I see one one dot is there a way to I guess the question would be how our students being reached in his or waiting Chris up. Sure Senator Gilmore so these are typically students from those counties that You know go to one of the different universities and there's five universities across the state that engage in this and so that's how that's tracked there as far as you know the the university's leverage those funds use those funds and then try to secure funding for each one of projects so it would be not so much a student that's you know actually living in that county the time there from that county to go to university and get trained so and there's opportunities of those universities when they leverage these funds so I think that you know. For the different universally to reach out to various populations across state with us through high schools and and community colleges and and so forth but The actual research is done in the university so I think that it's students to actually from that county to go to the university so as far as out reach they do that through recruiting we can and we can get more details on that I'm not sure if Mr question they're not sort of so does the dot representative student or his or not represent a and the institution that's where they're from this their home town okay so represents a student correct okay so as you see and there's some other places the Texarkana areas but is obviously doesn't have any side I just hope that we're being very intentional of of making sure that were reaching out because I know there's I have quite a few bright students in my area that might be interested in this program if they know about it and perhaps that that word is getting out I don't know but if if you all could check on that and then I think one final question if I may Ballinger yes on page thirty actually thirty one of the report the Arkansas minority health initiative. So how much money does the minority health commission receive do you know offhand. So for FY twenty and twenty one combined it was about three point five million okay as I see some areas on the map that are White I'm assuming white there's no. Reference to what white means I I assume that means of the county they didn't touch I think that's correct you know the mental health commission is is heavily engaged in outreach through in person through screenings they also do some things remotely through presentations but a lot of this is targeted toward minority populations and and there are many reasons for this case is not reference but also some other programming was reduced due to covid and their ability to get out what they normally do I see a report a more recent than this keep minus twenty twenty one it looks a lot better this map so I think a lot of that has been reduced to code it just there ability to get out and restore populations okay and then I see paid TV radio ad social media impressions of course social media impressions are a little bit subjective and and how that's tractors you were probably where so what is what is money being spent on with pay TV and radio ads. so that was pushing the or you know making everywhere instead of Act signs getting your normal check up with your PCP it's of rotted from things that bring awareness is particularly in COVID that a lot of that also just you know different awareness of the ants around specific you know privacy is in the State also make the people aware of different events in their area where the Commission may be coming to present and provide information so the variety of different things they also do some TV answer things around to ask the doctor which is definitely bring a doctor in and provide individuals a chance to call and ask questions and that's just in their bigger media plan they also do Lots of a lots and lots to do some TV as well so it's a variety of different things but I think most of the social media is bringing awareness to different events different conditions a second of minority populations and then just a lot of awareness as well. Okay thank you manager. All right senator Hammer you're recognized for a question. Thank you Mr are you allowed to carry forward funds from one year to the other. And is that by individual a program that is offered or a total dollar amount carried forward. The programs to hear four dollars if they don't use and some of them do that due to co they're not using as much as I have in the past but they can carry forward yes Sir you know what the total carry forward announcmenet is as of the last fiscal year the procured from last year to this year I am not aware of talking to him but I can get you that I know the Medicaid expansion I think they're of a carry forward I think also the minority health commission as well we can get those carried forward dollar amount I'm not sure that all the UAMS programs can we can get just cared for dollar amounts okay on page twenty six what drew my attention to the questions on page twenty six. Sure I'm not misinterpreting anything. The bottom page twenty six. The indicators not been met the FY twenty one data showed that two point five million was awarded to C. O. P. H. with an additional two hundred forty five thousand carried over from the previous fiscal year so what I'd like is an accounting of the carry forward funds however it's broken out if it's a lump sum amount or if it's by programs what to carry forward funds worth you would please yes Sir and I've it may be on this one with the college of public health at UAMS they were engaged in contact tracing quite heavily was with higher education institutions and that may have been some money they cared for but we can get you a detailed record for okay and then the second question would be supportive how do you support the data that is presented in the report is that an internal process external what's the auditing process to not I'm calling you question just wanna know what is the processor how do you support the numbers are put in the report. So in the tobacco settlement proceeds active twenty twenty twenty twenty twenty one there are specific indicators that are outlined in the act program supposed to engage on and so the children proof and it's also required for us to hire a third party evaluator which is what you see As You okay and so you will notice in the report. They show. An indicator they list out what the what the requirement is it goes up or down and then you know periodically doesn't care to change if a if data is outdated or if there is that something that they can't track any further or if they've shown improvement there and there's no need to you know word as it was in the past so we working with you see a working with the commission and these reports extract you know quarterly basis but also annual bi annual basis I think we're showing progress I think you know Mr docking Cory mentions of those things as well you know I think when smoking for started in and you know we for started doing our work around smoking and and prevention you know I think we were in the high twenties and start smoking right we're down now to you know the low twenty eighth right around twenty percent which is you know it's a it's not we need to be but it's moving in the right direction I think there's other areas where we you know have improved as far as like Well she mention two things I think about diabetes diabetes no LBC there's room for improvement there as we all know I think we may have slid some there but overall I mean I think that the reports will show that we're in we're moving the right direction in a lot of different ways and we tracked that like us on quarterly annual and biannual basis manager can have one quick one yes thank you what's the process for determining that a program within. What is allowed for the money to be spent on is no longer producing beneficial results for the money that's being spent on it and you say you know what this one isn't working because you get people on the payroll you get you know six cost establish that can be a hard thing to to shut one down do you have a history of shutting down any and. How do you go about making that determination this one just as a given the the return on investment and a short answer we good sure thank you so. As again as I said they look at these programs on a quarterly annual biannual basis we had it shall be the programs down these programs from what I've seen have happened but improvement and increased and their efforts in the things that they engage in work on an ingredient I know several years back there was somebody that was not being utilized due to some legislation and things that around Medicaid population and that money the commission got together with the governor's office there's legislation passes for the wait list with the wait list and providing some slots there so that was done there's no other tweaks here in there typically though in Arkansas to be honest with you it doesn't rank real well so there's always room for improvement I think the programs just enough money they leverage show the kind of work they're doing and secure the kind of grants they receive so I think there's evidence there but also Yes I think the commission what is a very closely as well as recommendations again to the governor's office and to this body as well our thank you thank you measure all right. Senator Gilmore you're recognized thank you madam chair so how how much fun do you and they may be in here and I apologize how how much is leveraged using tobacco settlement funds so on the first the pager to I think it's actually the. Not number. Thirteen the rampage ten or eleven. Is an infographic. It looks like this right here. Okay on the bottom of the right side bottom right. The green box there that was over the twenty twenty twenty twenty one so that two hundred thirty nine million dollars leveraging outside funds brought in the state that's a good amount using utilizing these funds correct and they and they use the funds for a right of different ways I mean there's there's positions funded through these leveraged funds there's also scholarships you know. Programming so it's it's not just you know money being given opportunities it also helps supports the operation institutions of these programs and the work they do which brings me to my follow up how much is spent on administrative costs of of that let's just take that number than two hundred thirty nine million you have offhand how much money is spent and administrative of of all these these programs to to pay administrative costs to you now we can look and see we come up with keep in mind this is these are established programs in this is funding they receive on top of what they do with or the normal operations so it would we can try to break that out it may be a little difficult winter break out see what parties brought in other leverage funds used for Mr because we can see we can do there. The interesting C. thank you all right of chairman Lehman eighteen. Thank you madam chairman Matt thanks for bringing you a M. S. to take a deep dive into your programs and doctor McCoy thank you for being here and telling us you know the successes I'll try to be brief because we're getting short on time I could talk a bit longer but when you talk about a couple of your programs where we were fiftieth them we went to thirty six and thirty eighth and I hope the news media is listening to this because when we're fiftieth it always hits the front page and I want to highlight when we're doing good even if it's only one of your programs but to go from fifty to thirty six I don't have the time frame that's great we need to celebrate those things and we and we need to look at how it how are we doing that what are we using and you cover that very well I think the challenge with aging and I I read a report the other day that in a few years our population of over twenty percent of our population is going to be over the age of sixty five and as you know our total public health program is ranked I think right now like forty fourth we were fiftieth so we're doing better but when we address that group of people which is a a fourth phone most of our population in their large users of the funds for public health that makes a big impact so thank you for your report numbers a good appreciate you being here. Thank. Thank you. All right I just wanna also kind of a. Tags. What we're talking about with the aging population of more and more we're seeing older people that have food in securities and I noticed in one of your examples you were of you having classes and have to prepare when you Tricia's food and all of that and other than of meals on wheels hand do you help the older population have more nutritious meals and that kind of thing plan their lives on a limited income. Well again COVID did influence as to learn a great deal and one thing is that we focused on really educating oder adults and families on how to utilize shelf stable and Michael Massa healthy as possible and so we have been working with the USDA and with some of the grant funds that they were giving out and doing a lot of education and how to make shelf stable recipes and making those as healthy as possible and encourage you to go to our Facebook page and check us out and we have some healthy demonstrations we do it once a month we also have local community foundations that give us funds to buy of the actual food to do the recipes we do porch deliveries to odor adults where we partner with other community entities to help us with that so that the odor adults will learn how to utilize some fresh produce with shelf stable to make it go as long as possible each recipe served as four to six servings so they are also learning how to store and maybe freeze individual males through that process we're also working with rule hospitals that may be interested in how to utilize unused food at that may be in there or from their service line or their Food line that may have not been sold or distributed and training their staff their case managers how to identify oder adults you may be at risk of food in secure and so once third dish charge they are just charged with at least four meals to go home to give that case manager a chance to get some resources when you look at our referrals and our health outcomes are snap referrals are very low and so we're trying to educate on how to raise those referrals up and get those snap Services upping teaching older adults how to maximize those dollars and so partnering with other like harps in Walmart and teach you know adults how to shop and maximize in utilizing farmers markets and in different resources have been a great alternative ways to really maximize the dollars of course inflation has been a challenge but we have really tried to maximize our resources with other community partners that I do want to stress it's not been a so long it has been very much a collective effort and so the meals on wheels in the senior centers with the through the older Americans act in DHS has been a fabulous partner for us and they will could be a partner with us in this grant that I just mentioned that we received through the administration of community living and we're really excited about that partnership one Preciado all of that I think we especially you mentioned to inflation and I think many of our older of our Kansans are going to really. See that that does make a difference in fact one one of them said with inflation I wonder if I'll have enough money to buy food you know so that that is on their minds with the county and and let's make this a short answer because I see this agenda but I'm so interested in what you're talking about with the county health office not be a good place for seniors to go if they had needs of most of them are aware of the county health office offices and they've been there before four of you know back to nations and and for help the issues of so would that not be a good place for food distribution or some of these classes. Absolutely and and that's a great place in our centers on aging do work with some of the health units and so well will encourage them to continue that okay thank you all right to senator Hammer let's have a quick question and then we're going to go on to the next item thank you manager general primary care physicians are limited in being able to share food insecurities that they may find out in a visit to their doctor because of hippa violations or if you all ever taken on the discussion of utilizing a primary care physician as a point of reference for food in securities. So that is something that they can do absolutely and I can do a referral but it because of hip the it's really up to the patient to follow through on that referral of a community resource such as a go into the food banks as far as following through with the snap application then like a social worker case manager the nurse can a system that does that answer what you're asking it did I just wonder the level of embarrassment sometimes especially for the older one should work all their lives but they're getting squeezed if there's anything we could do to remove any barriers and maybe address it in hip a to where it could be a more direct point we can talk off line about that well I don't have it is it with you thank you thing Mr came thank you seeing no other questions we so thank you for being here this is been so interesting and to appreciate it all right back to the ladies and gentleman we're going to Adam G. and we're going to have more quiet in his team come up. And without objection this report stands as reviewed. While we're waiting for them to get to the table of members of the next meeting of the public health committee will be October the third and we're going to meet at UAMS they've invited us to have a meeting there and we'll have more T. details later but mark your calendar of October the third at UAMS. All right gentleman thank you everyone introduce yourselves for the record. Thank you madam chair mark what for him services. J. hill apartment him services aging don't have health. John Finkbeiner us to assistant director department you can services just Director aging all right thank you mark we're ready for you thank you madam chair of this first item this is a renewal of one of our Medicaid waivers this is the living choices waiver this is the way for the provides assisted living services for the frail elderly and also for younger adults with physical disabilities are these white Medicaid waivers they all have a clock on them typically last no more than five years server five years would go through a process and that's what this is for living choices now I want to be clearly we brought this to you last year and and going to review it was submitted to CMS as with a number of items that were submitted COS last year CMS took many months to review this until it finally gave us approval to move forward they did ask for some changes though they're more technical changes cleanup changes nothing that have a significant impact on beneficiaries or providers but because they ask for those changes we have to come back for review so you'll have a chance to review the final product before it is put into place I as a promulgated rule and so with that be happy it will I'm sorry one additional point I should make was I know I'm sure many everywhere that were working through a new rate for assisted living services that is a separate promulgation they'll be coming to you all I expect either in November December for review but we're in the process of pulling that together and saying that CMS we just be clear that is not included in this document for you all right thank you senator Hammer referred questions thank you manager and that was what is going to ask the the new rate review has the new rate in it this is this have the old rate in it or what Rachel's toe associate with December passion today this is the old rate and and so the new remote come through as an amendment to this way for to implement that new rate as of January one and the turnaround time. I am you're expected on that based on I know it's CMS but give some measure of hope that one that one should be much faster because the only change in that package we just implement new right and I know there is simply a conversation CMS and we've been sure they will get that in and get that out to us quickly there's some comments on here your response can short to the point taken under advisement the the consist of one seems to be about assisted living is having to get independent audit we're as other institutions entities do not can you speak to that please sure we're we're happy to visit with you about that and we consider that this language is been in this waiver as long as I know of have not been this a new requirement there wasn't much about the cost of it the course that cost is you know that was reflecting the cost surveys which were used at the rate so this technicality for in the right that set for the providers that auditor third requirement or state requirement as a state or so we could address that could we within the state that would have to apply going back to CMS to address that right it's we would have to go back to seeing this just because it's it's it's contained in the waiver but is also the same as required to be a waiver we stuck at their permission to take it out which I imagine assuming that we make that decision that's appropriate that's not something they would obstruct thank you thank you Mr K. Singh no other questions without objection this rule stances would be right next is H.. Thank you madam chair this next item this is the renewal for the our choices a Medicaid waiver this is our waiver the provides in home services again for the for elderly and for younger adults with physical disabilities this is a similar set up that this is the every five year renewal we brought to all last year since CMS this one CMS did take many months for them to review the seamless also did one more substance changes in this one I we had a lot of back and forth with them the key substantive change the CMS wanted we have some language in there that allow for individuals to exceed the budget announcmenet for receiving care if they'd already been getting that level of care so in other words the the waivers that certain amounts depending on the condition thank spent up to that amount waiver services and we have some grandfather language in the in the waiver that allowed folks who are already above that amount to stay about that amount Seimas told us they were not willing to let us keep grandfather language so what we done instead is we place language in here that allows us to make a case by case determination based on need to grant those exceptions and allow people to exceed those top level dollar amounts as we think that's a good solution that satisfies the mess the still allows for individuals who have unique needs where they need to have more services to the bill to stay at home they have a way they can access that will have to answer questions all right. All right chairman Ladyman. Thank you manager Martin you have a question about what you just talked about I mean or what is the product there's a couple of comments in here about that I read those in detail in they seem to be concerned about the process so and it refers to sections in here which I couldn't really find appendixes but can you just briefly I mean or what is the process exactly what parameters how do how do you are you gonna do that. All as they briefly and then Mr Miller Mr thing by my work spent on that specifically is nurses within DHS review that request and they look to see if the if it's medically necessary for that individual to have that that additional care above and beyond that budget amount deal at a detail. Yes it can be either the DHS nurse or for the family the the beneficiaries physician can request that increase above that service budget maximum if it is determined that that that additional funding is needed to prevent individuals from being institutionalized and they can make that application DHS they're granted a sixty day temporary extension of that benefit up to a higher budget level while an independent assessment is conducted and DHS reviews that documentation to make that change permit. All right go ahead the with one of the considerations be how long someone's been at that level of service how many years on a one persons in here was started in two thousand and two I was a different protocol different program then but I mean the look at the someone has been on since I was five years old and now they're in their thirties or something is that considered I think as a practical matter that that would be a consideration because the end of the day the question is what what is needed to keep this individual from having to be institutionalized and that's that certainly could be a factor there I think many of our beneficiaries as they age their their budgets to change their their level of care does change as they age. All right seeing no other questions without objection this rule of this rule stands has reviewed so right the next one which is I. Or a missed payment will join me for this next item. Okay. All right when you get settled in introduce yourself for the record. You'll be recognized good morning Elizabeth Pittman director for Division of Medical Services. Good morning unless the weather ten AM division director for developmental disabilities services all right. You're recognized. I'm gonna add to the nineteen fifteen B. portion of this role in the deferred to director whether ten for the nineteen teens question I bet this is both the package that includes the pasts and nineteen fifteen be managed care waiver changes and you'll see there's quite a list of changes there majority of them are cleanup changes just to make sure that we were following the proceed that waiver reflected the procedures we are actually using in the past the two major changes were to the addition of care source as the fourth pass and then as well and moving the our home happy population who tier two or tier three into the past everything else is primarily clean up around I'm just making sure that that information is provided correctly we did include a requirement that Marshallese B. and a language that they provide materials and in line with what we had done around TCO policy and happy to take any questions on that portion of it all right seeing no questions. A. We will. Is is it well it's a little confusing so I so nineteen fifteen see waivers only last for five years so what you're seeing an army is I was required to go ahead and renew the waiver and then what I'm gonna talk about and J. is an amendment we immediately filed to the wafer so for the I. A. and that we're talking about right now this was a renewal and that was federally required that went hand in hand with the pass and nineteen fifteen B. that had no changes and so I can get the renewal in place and that's all for this and this section all right thank you senator Hammer you're recognized for a question thank you measure of no son a couple the should have gone through on the on the of financial impact the cost of the current fiscal year did you all have these budgeted in the current fiscal year and if not we're going to get the money to take care of the cost. So I guess we always use our financial team and we're developing its financial impact said they they are always aware of them and built into our budget for this year and our projections moving forward so these are part of those projections and and budgets okay so this started fiscal year started. July first correct so you are working on this in the last fiscal year and it is built into the current fiscal year's budget yes this nineteen fifteen B. has actually been six months in the making so yes we were very aware of the financial impact and included it for this year okay thank you the manager thanks in no other questions without objection this rule stances Review so going down to J.. Yes thank you so this is the M. comedian employment support waiver amendment after we had the new renewal put into place and this is the exciting waiver that adds the three thousand slides that and you guys approved during budget session the additional funding so that we could eliminate the wait list as it stood in December of twenty twenty one so you will see that and I've done I think I've done this power points in several committees but it's also on our website we have added that parents and legal guardians of adults can be paid care givers if they're hired by the Medicaid provider and pass the background checks and drug screening go through the same training as any other employee in an attempt to alleviate the burden we're seeing across our state or in the workforce challenges so we knew that we were going to add three thousand people over the next three years we do not currently have the work force to take on that kind of an announcmenet in seven now we are allowing and those family members to be paid staff if they meet the criteria and we received very positive feedback on night from family and providers who are also concerned about a capacity issue an CMS approved the amendments with all of the additions back in August and so we've been doing some preliminary work to go ahead and reach out to people on the wait list and said they renew their information and we will begin releasing this lights after today if you all agree so we're excited and I'm happy to answer any questions all right Senate senator Hammer. Thank you ma'am sure what's the percentage of the cut that the Medicaid provider receives for basically being the middle man or can you that real quick so they won't they won't be the middle man so they will hire parents in M. and guardians just like they would any other employee and will be up to them what they pay them and how many hours they work and how many they request they will be they will be treated like no other type of employee. It's just we had a restriction in the waiver previous to this this that they could not hire family to be employees okay shut up to the constituent. They've got a son that is on this program they've been wanting to be the primary care givers this will allow them then to actually be the primary care giver and be able to be paid for staying at home to take care of him is that correct yes Sir if they go work for an approved provider so like for example if they go work for Easter seals or if they go work for pathfinders or access so they have to be approved Medicaid provider certified to do the services and they'll be an employee of that provider will be a negotiated rate they could be varying from maybe the Smith they're taking care of their child verses the hammers that are taking care of their child that's gonna be a negotiated rate or is our consistency so that the Medicaid provider may be making more off one then they would the other he's provider runs their own business and they can negotiate rates with their employees we see a varying degree of what they pay employees across the state okay thank you thank you Mr attentional. All right representative Ladyman. Thank you manager of. If you're adding two hundred more slots for children in foster care yes and I think this great of the what kind of is that a major increase or what kind of percentage is that is that a big increase for those children or the small increase so Mr Martin is DCFS director in our appointed around the same time and that's when that and the designated slot started being requested so I think right now they have filled three hundred slide so we have added three hundred slot specifically for children in foster care for the year years and this is two hundred additional slides you have to remember that once you get a sly you have it until death essentially so we found that the slots really help kids be adopted because it's a huge support to adoptive families and it helps with reunification if kids can go home safely and so mission continues to pay towards the slides and for the duration of that person's life. Thank you. I have one question you these parents do have to meet the qualifications of. Anyone that would be hired is that right you don't make yes that's what I heard you say and I just want to make sure everyone else for that this will all right to a representative Perry. Thank you madam chair canopy back off that how long does the training take. So am each provides a little differently but there is some standardized training they must go through these of course any kind of health safety so CPR first aid and then there's client specific training that they also undergo as well as mandated reporter training how to and how to call in an incident that the federal requirement so I would say each provider set up their training differently Center in person summer heavily online right now so I would be hesitant to to give you a time frame but it's not if it's not too comprehensive it's not like month to month no Sir okay great all right thank you. Seeing no other questions without objection this rule stances Review thank you and then going to the next one. Our manager final rule us out and K. this is is a profit right to council's emergency rule and passed out this summer and now we're just in the permanent version of the rule following up on that what this rule allowances for that when hospital set up acute crisis unit to provide services to individuals who are having Heber health crises they can also open these units for children and this is what we are seeing unfortunately seeing a much larger and larger number of kids who are showing up in hospital emergency rooms with significant behavioral issues as of this is another tool for hospitals be able to address that provide care for those kids that have to answer questions all right seeing no questions without objection this rule stances Review and I believe that in C. you're part of the thank you so much for being here and I appreciate that report all right any other business to come before the committee. Seeing none I do want to remind you again that the October the third meeting will be at UAMS and you'll get more details and we are turned. This.