ALC-Executive Subcommittee

I have full committee but. I know. Mr anywhere you of. Ring representive shared Shepherd on telephone his name by phone. With that we'll go ahead and call the first agenda item Department of Human Services to table mark white. In your present your mercy rule you are recognized after you introduce yourself to committee. Thank you Mr Clark what or refuse services Elizabeth Pittman Division of Medical Services. So we're bring before you today this is an emergency rule concerning Q. crisis units in hospitals these are units in hospitals that can provide services to individuals who are in a behavioral health crisis provides an opportunity so less restrictive smothered with an opportunity for those individuals to come in get stabilized and then be transferred out for additional treatment before now AC use the well means a written is for adults we've had some folks who approached us and said why don't you makes available for kids and given the growing number of teenagers and unfortunately even younger kids that were seen show up in a hospital ER's with significant behavioral health issues we recognize that yes there is a need here to allow for Q. crisis units to serve individuals who are under the age of eighteen and so we'd start of the process of doing a rule but we've got to hospital one hospital that is ready to open as soon as this rule is is is approved another one that we think is going to be ready to open very soon and because again because that significant need him because they were kids that were seen show up with the significant member health needs we thought to be appropriate to ask for mercy approval so those hospitals can go ahead and move forward and get these AC's open represent Dotson you're recognized for a question. Thank you Mr chair I think this is a good idea overall just curious about the safeguards of adding minors into the into a population of adults with baby Act behavior health issues Just does this rule cover. Those types of You know separations I guess. Okay yes that's an excellent question so this rule is part of our hospital rules to all of the safeguards that apply to hospitals today will apply to this unit as well it's not to be licensed by the health department under this inspections this unit just like any other unit of the hospital will have to meet those criteria so and then and then we of course can go back and look at any provision of service to determine whether it was appropriately provided or not and take action so so do those rules I don't have those in front of those provide for that separation of minors and in adults and not the hospitals themselves do not and I don't know that we have required that the adults be separate I do know that one of the the hospitals that is interested in moving forward is going to have a children's units it will only be certain children. And is there going to be more than one or is that this would cover all of them I yes this covers all of them in as as Mister white stated that will initially was only for those over eighteen because of the rates that we've seen we decided to go down to the age of four a hospital would you just like they do for all their other services so they may not have a specific children's units but they would have to be able to provide care for children in the hospital appropriate care to be able to provide the services no. that something that I never even thought about before until you're talking about they have or health issues and and then merging them together so that may be something we need to make sure look at if you're going to be serving minors that there is definitely a separate content for the miners thank you we we can. Stalking staff and this is a concern I I tend to agree representative Dotson could you change the language in this rule to where it states that they must be separate and and we can approve that Friday and full council. I'm otherwise we would have to have a second meeting of the store and one that's ready to go for today I know that would not be a problem with it all and I don't know if that would prohibit smaller critical access hospitals from providing the service that may be something to discuss and because they may not have to separate units to be able to provide that service I'm but I think we can do it for the purposes of the emergence as a larger service unit a separate room is what we're asking. They would be in such yes we missing language for the yeah yeah we can make sure that just make sure they're not in the same room yes Sir absolutely. Okay and and members I was advised by staff that if that changes substantial we would have to have a meeting at eight thirty Friday morning to make sure that we can adopt that change. Senator Irvin you're recognized she. At the location can you share with us those locations. The the hospitals they they have indicated their intent does they have not made an official and so I think we're a little hesitant to name them into they've officially said they're going to do this if you like I'd be happy to visit with you afterwards and and talking about those are talking to yes I just wanna make sure again that the language or however this rule is implemented does not prevents this from being at every hospital no matter the size or location because you have. You have a lack of these you have a lack of services and you have a lack of providers in rural parts of the state of Arkansas which is why the emergency rooms I've I've I've said this I don't know how many years. We're emergency rooms become this because it's either the jail or the emergency room and so it's very very prevalent in. in rural parts of the state so I just I'd like to to know that and then how is this this seems to be a correlation to our life three sixty home model because we have focused on an additional needs in this area so how are these two things working together. On the line for sixty home piece that's and we're going to need to work for a little more to finalize the details we're we're still in negotiations CMS around a lot for sixty homes are working to get their approval there's there's some internal issue going on between CMS and the office of management budget that's affecting the timing not related directly to us but is indirectly affecting our request their absurd will take that into account and I'll add that with we have emergency rule we moved for a permanent rule to implement this and so I think we can do is we can add some language to address this room issue today lease for these two hospitals and for the permanent rule will make sure to consult with critical access hospitals and others to make sure we get language that is flexible enough to allow them to serve those those folks and if I may and add to that when we did the original rule for eighteen and over we spoke to the health department who licenses hospitals hospital is not required to get a full psychiatric unit certification to provide the service so we intentionally designed this to be at for critical access hospitals that couldn't do a full psychiatric okay yes because the other there's just they wouldn't be able to meet that criteria okay thank you. Member center for the questions. Okay start represent Dotson thank you Mr chair that this is just a point when you're considering the permanent role unnecessarily for this one here but when you're looking at those miners there is a difference between I see this rule says for to foreign up there's a difference between four and five year old as well as a teenager so you might go up double little bit further in that permanent role to make sure that it's not just minor separated from adults but but also Elementary and teenagers separation as well yes in that thank you. So center for the questions if you guys can get that language changed on the rooms before Friday we would get this out so I'm not going to read this adoption until we have that language change on Friday yes Sir will get that to you thank you thank you thank you so with that we'll have the. The Arkansas Insurance Department. Was rule one eighteen. If Mr Burr fan now Mr Reiter will introduce yourself you're recognized presenter role. Thank you Mr chair both ran with the Arkansas insurance department. Thank you I generator Arkansas insurance department general counsel. Thank you Mr chairman not for use of Arkansas and your support rule one eighteen if. If you're interested now this is the rule that governs all the PBM activities that we regulate the state of Arkansas opts for we are before you because we're asking this committee for approval to issue an emergency rule the reason why is because the insurance commissioner last fall winter issue series of bulletins that has helped pharmacies make complaints appeals to PBMs to speed up the process is the problem with the bulletin is bulletins are you're not rules and they're not forcible they're just guidelines one of the amendments in this rule adoption commissioners bulletins it was issued in the fall the winner of this year and that's one reason why we have an urgent request for an emergency rule here to to adopt those bulletins to help speed up pharmacy appeals and complaints also we are following this rule is a permanent rule as well as an emergency rule there is a hearing scheduled for July nineteenth this summer so that the PBMs will have to be able to respond to the rule language request the other items this rule or simply adopting standards related to audits that were mandated in acts six sixty five twenty twenty one to rule adopts a statutory language to help pharmacies and protect them from audits by PBMs the proposal also adopts on application of the standards of licensing to self funded employer plans consistent with that sixty six sixty five twenty twenty one and removes obsolete language and so I'll be glad to answer any questions if you have. Seeing no questions without objection the proposed merger rules reviewed and approved and the review and approval shall be effective at twelve or one midnight on Thursday June sixteenth two thousand twenty two thank you Mr thank you so committee we have one other order of business in this discussion of the July twenty twenty two A. L. C. meeting dates of because of SLC and when an associate scheduled it is scheduled during our normal time so proposal that we want to propose to the executive subcommittee is is that we move council week back one week it has been brought to our attention that is as chairs there's quite a bit of business we had talked about before just doing it with subcommittees have a final rule well by looking at the state of business that we have it looks like we probably need to bring in full council that Friday to make sure that everything is vetted to its full proper extent so without objection we will move council meeting to that following week and have full council week that week. See no objection that will be reported to council on Friday. See no other business we stand adjourned.