ALC-Employee Benefits Division Oversight Subcommittee

Thank the center for Russian is on her way but I'm not sure I'm not saying you're but to DO presheaf her leadership as co chair here and appreciate everyone look forward to going through our work like to go ahead and. Asked the committee for. If they have any questions related to the consideration of the rules for the committee they're pretty basic understanding is these are basically the rules we operate in a most the other committees the thing about has any questions on that please say so chime in. And All right I have a motion to adopt the rules for the committee do I have a second. I have a second all those of favour say aye. All opposed no and the motion carries thank you committee for that and now the word Adam D. and like to recognize Jill fair for presentation of the consulting services contract with a single group you're recognized. Thank you Mr chair Jill they're pure of Legislative Research M. I. was asked to provide the cochairs to just provide you all with a little bit of information and background on the work that's been done by the executive subcommittee at this point on and the EBT at oversight and changes to those programs and let you know also what your duties and responsibilities are as a new subcommittee of the Legislative Council and then following me you'll get to hear from the Siegel group. So I'm sure you'll all remember last year and you passed a law that abolished the State and Public School Life and Health Insurance Board which was the oversight board for EDT and at that time the powers of that board or transferred to the board of finance and they had been handling all of those decisions for EBT and up until this past session. At in March of twenty twenty one the executive subcommittee began a study on EVD and employee benefits and general in the state and in March of that year they released an RFP looking for consultant services to assist them with their study we received six proposals in response to the RFP and the Siegel group was selected as a consultant to help and the executive subcommittee the contract with the Siegel group was approved by the Legislative Council in may of last year and they began immediately working with the executive subcommittee on their study and they worked with them from may to November of last year I working towards a final report and recommendations. And the sale was asked to review multiple issues related to and member and plan data for the and our Arkansas state employee plans and the public school employee plants that are overseen by AB day they look to all funding sources for the plans the administration of those plans plan design and benefits they examined recently passed laws in Arkansas that might impact the plans to advise the subcommittee on on changes that may need to be made and then also provided information on best practices in other states. And so working through all of that over those six months last year the executive subcommittee I'm received recommendations from Siegel in seven different categories and Siegel's going to go over those with you in their presentation acts. M. but out of that the executive subcommittee came up with the final report and they added four additional categories beyond the recommendations from Siegel including creation of a new governing board structure for EBT and ongoing legislative oversight which resulted in this subcommittee at changes to the PSC which is the public school employee finding. And institution of minimum participation requirements for retirees in the plants. The Legislative Council heard this report in November of last year and adopted all of the recommendations so after that see we'll continue to work with executive and with leadership within the General Assembly to work towards legislation for the fiscal session and during this legislative or the legislative session this year you you all past ten acts which includes two appropriations and then also a concurrent resolution that amended your joint rules I'm just gonna touch briefly for you on what those are and. ACT one eleven change the method for PSE funding decisions ACT one fourteen created a new governing body structure for ABG leaving in place the state board of finance and creating to advisory sub boards and that are appointed that will advise the finance at board on AB de matters there were two appropriations pass that provided for stop ins for those appointed members as well as mileage reimbursement for this fiscal year and next fiscal year. And ACT one twelve required that fiscal impact statements be done for all bills that will impact employee benefit plans in the state. And also set a bill filing deadline of filing bills that do impact those plans within the first fifteen days of a regular session instead of voting requirement for if you would like to introduce a bill of that nature and a fiscal or special session otherwise those are not to be introduced. And you passed house concurrent resolution ten oh two which amended the joint rules with the identical bill filing deadline language that was in the act. ACT one oh eight dealt with binding triggers and created an optimal reserve balance for the plans and set that it fourteen percent this subcommittee will hear from the EBT director and regularly regarding main maintenance of that balance and any and deviance from the balance lower or higher. ACT one oh seven created a minimum active employee participation of five cumulative years in order to participate in the plans as a retiree and grandfather in current employees. ACT one oh nine it reinstated the bariatric surgery program which had expired at the end of last year. ACT one ten remove the cap on monthly state contributions for budgeted state employee positions and then finally ACT one thirteen is the legislative oversight act and it included creation of the subcommittee. So after April I Legislative Council meeting you all it's opted an amendment to your Legislative Council rules that officially created the subcommittee and sat out all of the duties and responsibilities and and I'm gonna just briefly go over those with you and all of the recommendations from the study that the executive subcommittee. Undertook over the last year that resulted in this legislation Including worked at Segal is doing right now on to our fees for a B. day are now in the hands of the executive branch and you all now are the first layer of legislative oversight for those new changes and the ETC's were going for it on these plans. So. Under the new Legislative Council rules the duties of this responsibility are that you will hear all matters related to these two plans that are under the purview of ADD and that includes items that normally would have gone to other subcommittee such as at contracts that would normally go to the review subcommittee today you're going to hear two contracts from eighty day and you have review power over those council still has the final authority but it doesn't have to go through review anymore those come here and similarly with rules it's a little bit different you will hear all rules before they go to the rules subcommittee so you will hear them you can take public comment on them. And you have the power to review them or to vote not to review them and the report that to the rule subcommittee who under the law still has the power of approval and then council has the final authority over those. And you will get proposed M.. Any proposed changes to the plans after they've gone through the board of finance they will be brought here for your and inputs and advice and oversight attentional funding changes to the plans will be brought here and and as I mentioned earlier information regarding the reserve fund balance will be brought to you and the immediate director Mr believe it will be bringing quarterly reports to the subcommittee that include information set out in the Act. And then in addition to all of those duties you're also signed a study and those in the Act and in the Legislative Council rules and where in you will look at the feasibility of creating a diabetes management program for the two plans and under the law EVD will you be the director will assist you with this and under our contract with Segal they will also assist you with the study and. In January of this year we entered a new contract with eagle you'll have that in your packets I believe in front of you and the purpose of that contract is. Has two purposes one they are currently and have been for the last few months working with EBD to assist them and to procurements that were recommended by the executive subcommittee one is for the MA PD vendors and one is for a new prescription vendor for the plans they're gonna talk to you about that but they're also going to come here and give you monthly updates on their work with EBD and that's to include the progress of those two procurements implementation of the new contracts once those are entered and then as we go forward with those new contracts they will come and talk to you about the savings if any that are being realized under those contracts. And I believe attachment C. to the contracting your packet sets out the word that they'll assist you with on the diabetes management program study. And under that steady you all are to look at the feasibility of. Instituting in this new program and then provides a recommendations for possible legislation for the twenty twenty five session so it's quite a an extended time period Siegel's contracted with the bureau through the end of twenty twenty four to help you with that so and with that I will take any questions. Members do you have any questions I do see least one Senator Hammer you're recognized for thank you Mr thank you Jill by any chance do you have everything you just said written down that you can give it to us that we could have for a file I do and I can probably I can provide that to you mind it being in my notes format that yes Mr that be okay if we get a copy that just it's a good summary come to be a point of reference for sure may please yes thank you. There was any other questions. See I don't know if it's Senator Irvin or not who is. Senator Irvin yes you're recognized thank you Mr chair I'm on the implementation of the fiscal impact of the legislation will they have a time frame so that we can kind of include that I would think it would be a good thing to a kind of include that within any kind of orientation that might occur after the November elections. I do you mean the fiscal impact statements on the bills that are required then nice to have something that the since that's going to be in New a new requirement I just think it would be a good thing to to have something before any type of an orientation occurs with new members in the house and the Senate yes with the Senate and house after the after the the November election so it's just it's a recommendation that I think would be nice to have absolutely and that is actually something that I'm working on and because we are gonna need that for our staff as well and right now we're in the process the executive subcommittee just authorized release of an R. F. P. to find an actuary that will provide those fiscal impact statement for you all similar to that actuary use for your retirement committee so it'll all be a part of that so yes I'm we will have something like that thank you so much. Right. Members any other questions for since their last election a co chair. Okay. Thank you a thank you Mr chair of on that talk about the fiscal impact statements that I I am a little concerned about how those will be evaluated of for one thing and that Senator Rapert and I have been going in coral and Texas has done of what they call a gold card for prior authorizations that in other words prior authorizations is one of the biggest problems with particular Medicare advantage plans in that it's about delaying and denying care so what they're saying if like ninety five percent of your prior authorizations have been approved as a provider then you get what they call a go cart and you don't have to go to the prior authorization process for a year but there's very little data out there to show the fiscal impact of that so I guess I'm I'm concerned about he just actuarial doing it and not someone that's released the. Early designated to medical billing issues. Yes ma'am and the R. F. P. is specifically geared towards health benefits actuarial statements included in the scope of work and that type of work that they will be doing and what we're actually needing from them and I believe I can't remember I think at the end of June is when the proposals are due back and then the executive subcommittee will begin hearing that and they will at a certain point and by two to three vendors and to present and that be a great time to be able to come in and ask them questions about their expertise in that area so we will have an opportunity to question the data before they say it's in other words we have an opportunity to question the data not just take it at face value is this is the fiscal statement. Yes and the as similar to what happens with the retirement committee those and it is in the scope of work that whatever actuaries selected will need to be present at committee meetings to present those so you would have a chance to ask them questions then about the fiscal impact statement in there be an opportunity for them to revise that according to any concerns we have I would think so yes yeah. I definitely think. And co chair that the Committee has a full power just like any other LC Review Committee to be able to do this and so I from what I've gathered in red talk with staff I don't think there's anything off the table in terms of what we ask for any other questions. Seeing none Mister do you have anything else. No Sir thank we appreciate the overview and that helps I think give everybody center on where we're at thank you very much members were Adam E. now and we're going to have an overview of employee health benefit study in an update on current EBD procurements from the Siegel group and I'd like to invite all four of their members if they're here and if someone could help arrange for a fourth chair that would be great. And. It members you should have they're gonna have. Powerpoint presentation I believe that they've given you a copy in your packets if they have not you want one we can have staff prepare one for you And that would be exhibit II. So thank you for being here what I'd like to do is go ahead and have you introduce yourselves that we we've got all your names and and what capacity you're here in an who you represent. Hello can be with single. I could answer speak up will be there sure it red sign right okay can beer was single okay thank you. Patrick Klein was Siegel right. Persons that significant your button but I think we got I heard you Kirsten Schatten with Siegel thank you. Hey good morning Jennifer Slutsky with Siegel right we appreciate all of you for being here and look forward to your presentation you're recognized. Okay so as Joe mentioned we're gonna talk give a brief overview of the project last year and then we're going to get into some status updates on the to our piece that we're currently working on this first slide this provides a timeline of the work we did last year so you're hired may twenty first and our final report was delivered at the November board meeting and as you can see there is a lot activity in between so we attended monthly board meetings and presented on various topics you can see those below on some of the highlights at the July meeting we did a full benchmark study so we looked at your benefits versus other neighboring states as well as national comparisons and one of the key things we like that was vendor savings opportunities so what's available in the market where could the plans to be more efficient so our focus there was on them eight PT and the PBM markets so we'll talk a lot about that today. Not in August we talked about funding and reserving we have follow ups on a Medicare advantage will look at your medical vendor and then in September he came with all our initial recommendations more follow ups and then like I said in November we delivered our final meeting. So the report was adopted as Joe mentioned several over recommendations became an Bills So we want to go over some of the recommendations in more detail in made a high level gonna talk about plans and contributions reserves and funding strategy the M. APD medical pharmacy clinical and we had some adhoc ones communication and additional items. The first thing we look that was your plan designs how we leverage our benchmarking. To compare your plans versus other states we we found that your plans we're in line with other states they have a nice spread if you look at the table below you got three plans a high value medium value lower value plan I've got an HSA eligible plan so From a recommendation standpoint we didn't feel that it was a high priority to make many changes on the plan design any changes would really be just cost shifting to to employees. And retirees. So then the the next section we look that was some of the funding so the the plants funded through state contributions as well as employee contributions on the first piece that we look that was simply contributions we again leverage our benchmarking study to look at what employees are paying relative to you know your other states neighboring states in other plans and we felt like they were in line and twenty twenty one and then twenty twenty two there is some significant increases on the employee contributions that put EBD el little higher than benchmark so. From a recommendation standpoint we didn't feel like this was an area where we wanted to generate savings by increasing costs to employees any further. So I guess just like a couple summary things on that after such earlier the plans that you're offering within the competitive and pretty much consistent with the market so we were kind of okay with that no real changes recommended the contribution aspect of it if you look at the numbers like thirty percent versus fifteen percent is a pretty good spread your your employees are contributing more than the averages so over time we're open you can merge or on the state side maybe back off some of the employee contributions of possible so that was in general the recommendation. Yeah it. Do you and your study of and I want to ask ask on that. You have any further deeper comments on the head in terms of of how that are obviously we know out occurred decisions were made and that's what happened as you ended up having employees shouldering more of that so where does that rank did you I don't know that it specifically stated. Here were were we ranked in that. Yeah. Yes so we did a full benchmark study and we could provide no that's been published and we can provide that that shows all the details of the ranks for each different component off the top of my head I just know that you know you guys were on. More towards the back half than. Thank you be good for the for the committee actually to have that just for those that have the time in the interest that they can look at it because as we go forward I think it's important because ultimately all of this will come down to a bit of a public debate for all those involved so them having that information would equip them better than just a statement that the the employee for shouldering more than the average yeah we're trying to figure out a good balance of what you want to go over because when we did three months of report and lasted a whole session and after the port three produced has every presentation in there the the I know the president of the LC and LC adopted it may be that it's in one of these previous we just have staff provided whatever the case will be happy to have that do you have a question from Senator Ingram of yep to follow up on what Senator Rapert wished all make can remind us that the the benchmark is that are peer state groups. Yes Sir yeah eight the once it touches surrounds I think it was seven states around yeah okay I thought this thank you thank you and it showed that you know in general your plans or similar the design of but it showed that the funding levels were from the state or were lower than funding levels of other states so it's like a little bit of a leveraging some or to make that money employees pay a little bit more than the other states so and I think with a lot of bills you passed latest session that was you know trying to fix a lot of those things so yeah thank you. Which he per she. So the next section is on that we looked at was reserves and future funding I think this is probably one of the main reasons for the project itself because historically there's been financial stress on the plan Your article you through time and you know one of the main reasons that we saw this was because there really wasn't a long term strategy in place so short term planning causes reactionary decision making and I think that got the plan in some trouble in the past so. I'm one of our solutions was two aid you a long term strategy so look at things not only the year that we're and but project out the next three years. And then also set a reserve policy which is very common and the other states that we work with. So typically states a set some money aside for an IV in our and then also adverse claims and so we looked at different states we looked at your risk tolerance and made a recommendation on the reserve level. So as Joe mentioned we recommended a fourteen percent target we have a range there too so if you ever death below twelve percent we recommend that action needs to take place immediately so we don't fall underneath that twelve percent threshold and also the way the funding we sat through the state on a seaside was capped at five hundred dollars. So we recommend that we remove that cap so there's flexibility and they really need to be regular increases to that amount that's one of the reasons why the plans been in trouble in the past because that's been caps and we haven't seen regular increases. Any questions on any questions on the funding peace I think you guys did pass legislation to do a. Of a court order is tolerance and all that so I think it was passed. The representative makes or someone is seated at represent back I move around sorry sure thank you and I'm relatively new to the committee and I saw this question. So it looks like your your target what you said was fourteen if it gets ball twelve you you recommend and get that twelve you recommend that we take an action it obviously it's sixteen percent so so you look like you're targeting targeting a change of two percent or two percent down and then later on it says that your ranges. claim fluctuations would be Four percent so that seems like that's the you know you're saying your claims. Yeah fluctuation to go four percent and that withdraws out of the trenches are a my missing something so the I. B. and R's fairly easy to calculate so that's kind of a site number there's no range on that so that's eight percent and then the claims fluctuation is where we have the rain so if you add the eight percent plus the four that gets you twelve the low end of the range and then the eight plus the eight gives you the sixteen on for the Highlander I thank. Okay members any other questions. These recommendations. In a see also on here that you stated Are you stating there on the increase for state employee rates twenty three through twenty five. That was the the five five point four percent of the. As a baseline with no changes so we got these are fees going on which will impact all those rates but that was a baseline he did nothing of this what we anticipate you need to have a plan so just to I guess put a finer point on this to meet the annual funding increase their the annual funny increase needed to hit your target on reserve would be an increase of five point four percent right for the state and state employee rates yeah based on the current funding levels I'm not sure if you pass legislation to funded differently since we presented back in November and would it seems to me that the legislature would have to consider when you make the statement that we are funding at lower levels than some other states in terms of the state contribution that needs to be a consideration in terms of what you ultimately you're going to impact those rates or any increase on the employees correct yes correct in all right I've got a couple questions here who is in forty four Representative right I'm sorry I didn't see that yes Sir thank you thank you Mr chairman. Because this five point four percent increase will that be. A one time situation that will. Began at a certain point and then go that way toward the future when it be more than that will just be a five point four saying the twenty fourth year. I mean all your substance came out it was exactly what we we projected then yeah you would have five point two I think it was right five point four yeah but I mean I know there's like for example you're going to have PMR PNM a PDF P. which will affect the funding levels there's any other changes this is the baseline projection and that would be annual so every year you need to plan an increase of five point two and that was to put the target in that range so if you have a good year and say your claims only went up three percent. You can adjust that rate going forward so you would need a five percent the following year so it's kind of like its it's always projecting out three years and you're kind of trail and that's what you get your experience you just that five point two the five point two it's all based on right now. But it's you know as experience comes in that would change. Follow things yes Sir but the five point four once that's establish would there be added phase on to our percentages on top of that through the years would just be that from that point forward that would be the amount Ford five point for each each year. I want to follow up on that and and I know I'm bash the put this on the table just for for chewing on it all right. I know that if you take it the plan as it is and you're looking at the five point four percent increase a. Have you got a number that if the money was there right now to establish that reserve what that number would actually be or what that five point four percent of your step wishing the reserve how much that's going to be is or anybody get get that number. Yes I think we looked at it last year but we could take that as a follow up and and reason I'm asking that is that if it's a richer Reserve right then the whole idea is that you keep in that pot of money as that reserved for the health of the planet to take care of any unexpected expenses correct yes and so the idea there is that reason I'm putting this out there on the table for discussion is that we have an enormous surplus that that is going to be discussed pretty soon here in this legislature and my question is would it be beneficial for some of that to be placed in it might lower the need for such a rise on a consistent basis and and what it because you don't want to use one time money if you're still going to have to do that but if you're status you reserve which the whole idea is not to be using it in less emergency with that how would that affect the Bender however that affected need on your increased so we're doing the projection we're projecting out three years so if you want to fund that increase today which is kind of your sample more money side then yeah that would be a lower number that's right but it doesn't change when you're in your for that's right and you come out of it all so you might need an extra line of I think that's kind of what you're judicial maybe did the past two you have a much money put in there and you'd be good for a few years and all the sudden you come out of it because transitioning catch up in passing but that wasn't always reserve that was simply adding money to keep it from blowing up and and so anyway this is something that would be I think helpful Senator hammer you first on list again there sure thank you Mr in your calculation is projected cost increase or savings and I know what I think we're gonna get to a couple things here in a second in the presentation and then comparing us to the states around us in our region did you incorporate into your evaluation any. The innovative ideas that could be implemented in order to help keep the cost down are we just doing what everybody else around us is doing with no innovative approaches to doing something different. Yes we did the you want all the I mean we have a bunch of things on the clinical side we have the the MVP program which you have been put in place at that we're recommending we have the pharmacy program that we're looking to redesign and implement those are the main things and and the clinical sciences with the. Five or six main things okay go ahead yeah I just wanna clarify by the five point four that's that's a baseline number so that doesn't include any of those items that can just mention. So so it's five point four status quo. But and I is that going to be in the rest presentation what you're about to give as far as the comments or questions asking. not exactly following but the five point for the baseline we actually in a report we did do excuse me just a minute make sure to pull that close couple male having trouble okay hearing you clearly sorry the five point four is the baseline and in a report we actually said if you did this this and this this would have been your increase related to that so there's like opposed to doing the things the number would be that was in there today we're going through the three main things that That we we are implementing or we're trying to implement the have the biggest savings and our there's no takeaways offer members it's benefit Hanson's primarily for this others try to get the things that were win wins for both sides the state would save money the members would have you know either no impact or a benefit handsomely. Okay but again the five point four that is the subject of conversation that's before what you're recommend so with that five point four actually come down and is that gonna be covered in the rest of materials that were look at today yes okay the final thing and and the five point four was also done last November so if there was legislation passed the change in the funding level since then that five point four maybe a different level. So it is going to go down but we don't we haven't gotten the final results of the bid so we're in the process of it so we don't know that true savings that we're working through that so no there won't be we won't have a slide at the end that says now is one point two because of explains the eventually will have that but not today our thank you okay members get two of them want to recognize just so everybody knows we're on page eleven of nearly a forty two page presentation so we'll take these two questions and then if you would hold on a minute let them get through some more the information and may end up answering your questions represent Lowery. Thank you Mr chair just have a a series of questions are probably just to kind of help me catch up. I remember through the years of discussions in Education Committee that there were disparities between the amount that is paid out in plans for state employees and for teachers have these as this all been merged now into one or they're still separate pools in terms of actual pay out of health cost. Yeah it's it's still separate pools is still separate pools is part of your Contractual obligation terms of making recommendations looking at what those disparities are what's created because I know that there is a disparity and as we've seen through the years that there's higher cost in the teacher read the teacher pool as opposed to state employees is that something that you actually look at and. Do a deep dive on. And so we did a deep dive but we did look in our prison Tatian you'll find some exhibits on the financial impact of merging the two groups together okay and that's later in the presentation it's in our final report so this is this is really just kind of highlights of the recommendations. Reddit Lowery a yes I want to interject because there's been multiple reports done on that and I would be happy for staff to provide you with some of that data it because they have done multiple reports on that they've gone down of the differences in the ages and the and demographics of each of the groups all of that that's been done pretty much every year since I've been here not every year and death but it's been in cycles of the sessions because we're always wrangling with that and so I think there might be some some of those reports would be helpful if staff could just provide those and then we can do that and she of rent is also meant to barbecue means also so that we can get the final report sent to members that you're talking about okay all right so would do that thank you thank you represent Lowery eighty six two we have here. Senator Chesterfield you're recognized thank you Mister chairman is very quick question if we've already gone over and I'm happy. The most concern that I've had expressed by both especially by retired members as Medicare advantage plan and their fear that they're going to be made to become a part of it could you speak to that or is that for another time. We're gonna go into the Medicare advantage plan now. It goes all right thank you senator you're recognized that the said members let's let him get through some of this a little bit because we've got forty two pages so thank you. Okay so so yes in response to some of the questions the Medicare advantage and part D. plan is a recommendation for savings and just to let you know it will not be a requirement. So a Medicare advantage and part D. plan is a fully insurer plan offered by a private carriers it combines all of the benefits into one plan so today what you have is Medicare covering the medical side Blue Cross wrapping around those benefits after after they've paid what they pay with Medicare and then separately a pharmacy benefit. And so this is going to pull all those pieces into one plan it is not an individual in APD Plan under people of heard a lot about individual PD plans this is a group plan it works very different it's not a closed panel it is what's called a passive PPO so members can go to providers that accept Medicare anywhere and they get the same benefits in and out. We presented a lot of the benefits of these programs in the July and August meetings but the way it works is. The the plan gets capitated payments from CMS that is based on the average fee for service for these different counties on the medical side and so if you have coordination for these members and it's not to deny care it's actually to coordinate care so members when they get to this point have a lot of conditions and there's not a lot of coordination going on so so physicians don't often have people in their in their practices they can coordinate all of the care going on so the pop so the issue is to coordinate for them to make sure that they're getting all those things coordinated together so there aren't readmissions things like that and when they do that it reduces the cost of care so that's on the medical side the big thing I think on that the remember the Kirsten mention was I mean this is a. Under percent different than an individual in the product so an individual in the product I have a close network panel real tight you have to go to those providers in this plan this group passive PPO plan Medicare is your network so if you provider accepts Medicare your member in this plan will have the benefit of seeing that Dr so got it definitely differentiate individual versus group because they're separate things here this is think of it as you know a massive network that the medical management company. You know helps patients to help them get their care so like Christmas saying they're getting manage now mean before in the Medicare system there they go to their doctor and it's like it's it's Bedlam half the time so I mean they really get organized the network is huge so they're not gonna be denied service because of a certain doctor same as Medicare. And if I may make a quick comment with respect to the network ninety nine percent of providers ninety nine percent plus do accept Medicare so for your members they will be able to truly see anyone who accepts Medicare in the plan but that's at ninety nine percent number and I just wanna share that. Okay the represented person. Thank you at let me let me. Share a little reality with the committee about that yes mmhm at the red white blue Medicare almost all doctors take and it's great but what happens the patient comes into the office someone's talked them into changing to a Medicare advantage plan and then the doctor can see them but they had but they usually refused to because they don't take Medicare advantage they can see them and I'm not sure exactly how this plan works that of they'll come in and they'll say yeah you could say but you'll have to file as at a network is that how this is going to be a will the paid they can see the patient but if they're not a United or whatever company you choose provider will they be seen as a out of network provider. The way that it's set up in a passive PPO is the the carrier will have contracted providers you know in an out of network but then they will also have providers that accept that are not necessarily contracted and then for the members of benefits will be the same whether it's in or out of network and it will be up to the Kerrier to work with all of the providers and they have that information that we sent out with the RP so that they'll know exactly how to how to file those claims so for the member it won't matter and they'll make sure all of that is smooth and by the way the member cost sharing all this in almost every single services zero zero I understand the medical I understand that you're saying it's same for the member but I'm just telling you that there are lots of physicians purchase particularly subspecialists that will not see a Medicare advantage plan and because I mean you can say what you want I mean cannot cannot go off a little bit what happens with these Medicare advantage plans so the committee understands this if you're because if you're not in a doctor's office you don't understand the way they make money is mining records for money they come in they audit your records and I want to make sure that you're up coding everything to make the person the patient saying the most chronically ill is possible because they get paid a management fee based on the acuity of the patients in day where you A. out auditing records and coming in a questioning your coding it up coding and mining records for money so that's the one that's why providers won't say these Medicare advantage plans particularly subspecialists I just I mean I know this decision's already been made but I think we have to do a lot of education with patients. So that they understand what they're getting I mean you get what you're paying for it's going to be less but the care and the ability to access care is going to be substantially less. I'd. So as part of our procurement and and we put this in the many states and there's always skepticism at the beginning always and there's always happiness once they understand how the plans work and the carriers not only will do education with the members throughout the state and hold hold meetings throughout the state they will pick places that are easy for people to get to make sure that all that's available but separate from the communication that goes on with the members there's a whole communication that goes on with the providers and we've we've gone into states where many of them where is the first time moving from that the current system wraps system over to an inmate PD and yes there is a lot of communications and all that go on with the providers as well I mean they have. On the ground people visiting they have people calling and making sure they understand they have put together a hundred and fifty different U. tubes to make sure people have it at their fingertips but it's very much designed to make it simple for the members also to make it simple for the providers to understand how this is a different product this group product from what you see in the individual market yeah I mean I don't want just the managed care company to come in and educate the patient I want someone that has an alternative view of Medicare advantage to let them know what they're giving up when they go to a Medicare advantage plan that's going to be our challenge is gonna look they're gonna look at it and say the costs less but that doesn't mean they're going to get care but anyway sorry current but but and correct me if I'm wrong. We're not saying that the retirees get to now just go out and find your Medicare advantage plan you're providing this as a as a directed Medicare maybe use that route this is the alternative plan for you Russia's role of a group correct I thank of it as I know yes I've had the experience that represent first talk about with family member and they came and they come in they get sold and the next thing you know they get a coverage problem they got it all these kind of issues and that's how you back I'm out of that is so I I absolutely sensitive to the frustration that anybody would have there but you're trying to articulate that should not be the experience it's a directed situation correct yes this is a plan that's going to be designed with your members in mind and only those members that are retired teachers or working for the state can access this plant so when we put out the R. F. P. we took into account the current benefits you had now and made sure that the prospective contractors that were bidding on it would at least mirror the current benefits and in many cases of what we'll see throughout the presentation is that they will have the ability to offer supplemental benefits they're very beneficial to that member so beyond what Medicare allows maybe additional vision or hearing benefits their benefits related to transportation meals after a hospital stay so the intent of this plan is really to provide the most optimal care for your members and to make sure where the care is coordinated and that their outcome show that they are either improving on their health status or at least staying the course and and to not get that far down the line towards the chronic conditions I think I think think of it as you know your active members the whole working career. they're using Blue Cross and they have a network so no they retire and they get on Medicare and nobody's mentioned anymore so now what will happen for these patients that select this is their network will be the Medicare network just like you have BlueCross networking I have Medicare network and yes some of the under contract total accept payments some it will be a different method to get paid but it's all going to be the same cost sharing so you can see any Medicare provider and you really have to differentiate the and many individual market versus group market there nothing similar okay I've got three questions and pending here Senator Hammer. Thank you Mr refresh my memory on the earth here we just going for one carriers are going to be multiple carriers they can participate in this is going to be one carrier okay second question is everybody's going to be put in with the option to opt out or everybody's going to be out with the option to opt in which way was. Going in with the option to opt out and how's it gonna be educated you talk about education while ago I just I'm what what's gonna be required of you dressed as a state or the carrier to educate participants what their choices they're going to set up meetings across the state and they're going to do it twice they're going to do it this summer so people can start to get get used to and understand this they're also going to have Videos and and everything you mentioned awhile ago plate letters from the retired association and all that stuff okay and when they do these meetings they will stay until every single person gets every single question answer okay there's also a period they cannot back out so if you're in January second and you realize the I don't want to be in that plan you can go back to your other plans that's right okay and real quick because I want to be real quick so if somebody goes they opt out and then they will be good Joe name with plan or something like that they're totally on their own on that they're gonna be separate because they had the opt out in order to purchase from somebody else other than the carrier this going to have the contract to handle population is that correct no they'll be they'll be still in the plan in the in the state plan of the public school plan so they'll they will be put in these plans if they opt out they'll go back to what they have currently okay and then the last question is this you have no idea or did you all do any actuarial work to determine how many employees might opt out. That would have affected the projected savings that you're presenting to us because we're going and maybe with the assumption that everybody can participate but we really don't know until they back out so how did you arrive at a defensible number as far as what the projected savings are with that I know we're assuming because they'll be put in this plan and then they can opt out we to we are estimating seventy five percent in the projections will stay in the plan and that's based on other states that we've seen that have had that similar structure. So that's where we came up with those numbers are thank you Charlie I was just gonna say. And they'll be a big incentive right as it will be less expensive part of its on the medical side part of its on the pharmacy side why that why they're so much savings there that we're gonna get gonna go through as well but they'll be a big savings to me to stay in this plan are thank you it also member on the PSC site they don't even have pharmacy benefits that was taken away but on the M. A. P. decide they will have pharmacy benefits reinstated. Senator Ingram. US senator Chesterfield had leave and asked me to of I ask this question if she could get a list of the states that are utilizing group plans for of of Medicare advantage and a contact to see if it is as glowing of review as of is being presented to the committee will be happy to provide that it seems that I had someone tell me that is it nearly thirty eight states is that right thirty H. is that correct so I had that sounds about right and yet so they'll be plenty of people for a call center I share your concerns I was on the hospital board in of it we had problems with Medicare advantage and I I share the concerns that both you and the coach your hand at now whether it was individuals versus group I don't know if that makes the difference but but I'm I'm very concerned about it is well thank you. In line so far have some confidence that the group situation here will be much better Senator Irvin. Thank you I think just to emphasize an echo those concerns from that chairs as well as members of this committee I would do the same there's a big difference between you know somebody who will see a patient verses somebody who will not see a patient because they may accept Medicare but they limits that because of they have to make a business themselves you know that those those doctors and those clinics they have to they have to pay their overhead they have to make ends meet right and pay their employees so they're limitations there but if since we are procured my question is since we are procuring this as a group Medicare advantage plan during the procurement process is there not a way to ensure that if there are you know a lot of and. Yes as far as audits of patients records and things like that that that would be offset when we were paying dispensing fees in addition to for pharmacists so could there not be an offset if that actually did occur could we not write that into the R. F. P. in the procurement process that if these companies are going to do that and make it such a pure you know and ministry of burden on those providers that they end up not seeing the patients is there a way we can write that into the procurement to either and sure that it doesn't happen or offset that administrative burden cost if it does happen because because these these doctors and providers don't have the office staff to comply with that and and I know speaking from personal is I mean this this is a very very big issue. So there are several things that go on there the so we talked about the fact that they can be under contract with providers and then they also can have providers that are willing to accept members but not under contract so when they set up those contracts with providers they are paying them more so if we start with the basis of a hundred percent of Medicare is the starting point so they're not going to be paid less but they do have bona structures for gathering other information and this and and yes while they do want to get the diagnosis coding correct they also need this information because they have star ratings I mean they have ratings that are based on the on how they perform in the care that they provide so if they're under contract it's up to the physician group or or the provider to accept or not accept the contract and they are set up to pay more for the things that they're doing now there may be some providers that don't want to go through those that are willing to accept because they're getting paid a hundred percent of Medicare and they're getting paid faster so as not having to adjudicate or someone goes into the office it goes over to Medicare judicata there comes over to Blue Cross is due to case there there's a the big lag in that so they may not want to have those other things that you're talking about but they still will accept because they go they know exactly where to send the bill they get paid very quickly so yes it's up to the providers whether they want to be in a value based arrangements I E. being paid more for doing some other things or if they don't want to go through those they can accept but not go through those. Thank you all right. Okay represent version. Yes I would be curious to know how many of providers can actually reach that bonus level at when I talk to my doctors it's it's almost impossible none of them get a bonus for one thing you carry what they call ghost patients they assign you these patients they've never seen them but you're responsible for their care even if they don't come to you and. It's just I'm just telling you doctors never I want to know what percentage of patients in the plane you choose actually get about this because it's an almost impossible task to to the chief and in that may be a different structure than what's happening in this plan it if they're not coming that I don't know if that's a bonus or capitation or even something like that but but you know besides that these programs have other ways of getting at the data that they need so they have a a program where they go out to members homes they can come in if the member wants to all of these programs are voluntary by the way the disease management programs they have care giver programs they have meals after you know when someone's coming out of the out of the in patient where do you go they're just trying to help coordinate all that care they have they even have if someone goes in into the hospital and they're released not only did they provide meals non emergent transportation but they also provide hours of care in the home that are that are not skilled nursing with helping with that Tate activities of daily living so they're little they're really trying to make sure these members are well cared for and they don't end up being readmitted. All right would like for you to proceed in a member's if you've got questions please write him down for a moment I'm or let them go for a while so we can get further through this thank you. Okay so so on this page we talked a lot about the medical side so also the pharmacy would be under the same plan and currently you have a PBM and you're receiving reimbursement from CMS call RTS retiree drug subsidy. RDS was set up when party was first set up it was set up under that construct since then the benefit has changed so ACA came in originally if you recall we had the donut hole it was set up under that construct but under a CA we close the donut hole over over ten years and it was also set up the manufacturers of the drug companies would pay fifty percent of the of the cost in the donut hole for brand drugs and then I think in two thousand nineteen it was even changed to seventy percent that money never came into the RDS program and over time as we've seen more specialty drugs come. Become available in these very expensive drugs war monies available under a party plan because they have more people out in the catastrophic so moving from a construct where you have already S. coming in and to all of these other subsidies coming in that's how we greatly reduce the cost for the pharmacy side of this so it's just leveraging federal money that's available manufacture money that's available to greatly reduce the cost of the plan so you put the medical in the pharmacy both together and that's where you get the real savings. like we said we've implemented this for many states that we did our first one in two thousand seven in my own home state where I'm a tax payer and we've we've done it for at least you know eight other states that we've done we're on second third generations at this point and all going very well and I think it's a good idea to give you some names of some of the directors from the states that have these plans because you'll you'll hear good things from them not only is it a savings on a on a cash basis on an annual basis if you think about her public liability you're projecting these things out and and and coming up with the liability on your books at this point in it will greatly reduce your of have liability as well. so we did a market analysis when we're going through this we're headed here in July and and coming gave an overview of the program and then we took some. High level data Senate out to some vendors came back talked about what the savings would be and at that point we said that the inmate PD rate would be roughly fifty percent of the current cost we projected some savings there and we also said that we expected those to be very conservative savings and if we went out with an R. P. we would expect much more competitive bids and we're in the process right now we can't say much about it but I can tell you that it's going to far exceed what we're expecting. So so like I said with a recommendation was to conduct a former procurement which we have done to be to go into place one one twenty twenty three providing not only you good plan options to make sure you have all the members have. Benefits as good as an even better than what they currently have we're going to get rate we have rate guarantees for multiple years there and also medical law loss ratio guarantees because we're moving from a self insured to fully insured plan if if it comes an even better we'll get some of that money back again plan design is better than it was and we talked a little bit about that this is going to be an optional benefit so members will be opted in this program they can opt out and can even said we we've worked out with the the carriers that we're talking to that if somebody gets in there and they didn't need to be the live and have some extra time to get out. One of the recommendations that we had made also was originally we had projected that it might be a cost for the PSE because we're adding pharmacy benefits back where there weren't benefits before and if that were the case we might recommend reducing the value of the PSC drug plan I can tell you that that's not going to be the case they have they will have the same benefits as the ASC and the savings came it will come are coming and enough that there's no reason to reduce those benefits. Okay see move under the medical. Sure can. For the medical side we basically just at a high level review of your current vendor which is your Blue Cross blue shield your administrator right now the two year Your medical network and development discounts provider reimbursement claims management all that kind of stuff And we went into our database we compared financially I guess Hall of the reimbursement for Blue Cross compares the all the other big networks that earned in the state and we did agree that I guess I guess Blue Cross was an aggregate discount levels they were the most financially beneficial to the states so we think that was a prevented him place for financial reasons there were two vendors that were fairly close to them so the gap within historically to be pretty big between Blue Cross and everybody else I think it's pretty much it's narrowing a little bit. We also look at the do you happen to know who those two or or the. The number. United healthcare and I think it was the other ones okay thank you. And then we do look at the A. S. O. fees which is the amount the paper across administer the plan and it was a twenty fifty five per member per month which was competitive for a large group so we thought that was reasonable as well so overall I think financially thank you now thank your for. In range we would expect for them and I think you know there were little bit had financially as far as aggregate discounts provider. Reimbursements. So that we do recommend that over the course of the time you will to have to an R. P. for that and put that out the bed and Studies and network database which we did I think you have all your claims reprise so the actual providers actual experience and have the reprise to get a more accurate estimate. we also wanted to maybe possibly look at other alternative ways to do so reimbursements total cost of care approaches ACO pays no networks things like that so I think in the future procurements one look at things like that there's also not a lot of. Foreman's cared guarantees tied in there so we recommend that you do have some working or tease you go forward. And then possibly which will talk about the medical management briefly later in this report possibly ways to pull up components of this maybe you want to have a separate diabetes management confirm do that pieces of this are I know you B. D. is looking at alternatives for that going forward so. Those that on the medical side. And then the pharmacy side. Right now you currently use you can only use a PBM which is not impact and you have a B. R. acts doing here for Miller a clinical review and they also do year negotiations FOR your manufacturer rebates. that impact is kind of like a DPA the processing claims customer service answering calls they do some management retail network. in general your generic dispensing rates really high ninety three percent which is higher than the market place but we caution against being too caught up in that because fifty three percent of your cost is in specialty drugs so you know we want to make sure your mention especially drugs component of that. One other piece you guys do is called reference based pricing which means you said a for a whole junior class you set a price for those drugs and as the state will pay acts for them and if they take a different drug in the same class the member picks up the difference it's not popular opinion to do reference based pricing so and and you are P. recommended actually allowing vendors they can bid that if they want to but we allow flexibility in that so they can offer different alternative. So the three main opportunity categories we recommended to look at rebates jumped out is a huge component in you know you know people like to talk about rebates but it's a big component of pharmacy spend. So you guys are but you're paying about eleven to twelve percent of your gross cost. all our state clients in the market place is more like twenty five to thirty five percent so there's a spread there that's just the additional reimbursement for the same drugs that were open procurement will allow you to get that reimbursement were in we were in the procurement so we don't have results back on that yet but we estimate that to be somewhere between twenty five fifty million dollars a year on the rebate spend. the specialty pharmacy side you use in a local specialty pharmacy which we want to allow alternatives that possibly so and are either going to bed that and it looks like you reimbursement unless is about thirty percent different than the market place so those are also another opportunity and the third place a third option is really to have contractor and he's in place which right now you have pretty much have no guarantees anywhere in the market place usually as guarantees by you know whether to generic brand whether it's a thirty day ninety day what kind of rebate you're going to get that across the board to get guarantees in place were hoping to get that through the latest procurement. Those are the three main areas and then our final recommendation was really the market. The put out an RFP the key of the marketing was to be completely flexible so this is the beauty of your program you guys can design it the way you want. So you can customize for military because the leisure rules The components are to make sure we have the appropriate rebate guarantees clearly define what the The rebate pass through will be including manufacturers rebates manufacture and fees all the various components. We recommend looking at independent pharmacies differently so to be different guarantees for them so when when the the R. P. went out there is a separate category for independence first nine independence so that's a recommendation. and then like I said before the reference based pricing allowing bidders to. either do that or not to it but make it more of an option not a requirement of the contract. So the question on those two sections from medical and pharmacy we do have a question of and I've got to more asking the specially pharmacy mentioned that you had should we use one of do you happen to remember the name of that one. Pardon. The specialty pharmacy was mentioned that you use one there there's not one right now okay as I said there is one or the you said there's not one is that what you're saying there's not one okay we'll I misunderstood that when you say I thought you said is that I could have said it wrong yeah. That's what I was that's reason I asked the question on that senator Hammer. Thank you Mr on the you know we battle PBMs all the time and we've got state laws here trying to build a shield. From some of their maneuvering in the contract what allowances are made or expectations or clarity is given of the expectation that our PBM laws which may be different than another state are enforced and our incorporated into the discussion of the contract would be awarded. Your laws must be enforced and and and they are aware of them I mean your laws or your laws and not to work in that construct. Right if you currently have a PM to see already have a PM so this is just. Allowing others to bet on it and if the goal was to do a real fair open honest procurement and you know they know all the laws and they see new ones every two or three weeks I think to get past so I mean against her where everything. Well there's some concern come across my phone for some just want that out there for clarification for the matter of record the the second thing is with regard you so they so the local pharmacy because of some of the local pharmacies were rolled state go away it's gonna be a real inconvenience to to some folks are retired living in rural Arkansas did I understand you say there would be something built into the contractor Tory built into the RP they do that at least give some measure of protection for the local pharmacy understand the free market and all that good stuff so could you expand on that just a little bit without going too long on as far as what's gonna be done for culminating them yes so so when we get guarantees and look at the reimbursements were separating independence from the chains so that it's up to you B. D. the state how you want to reimburse those so when we're looking we're going through a. A PBM R. F. P. we just want to see those things separately because at the end of the day you can pay what you want to pay their but as long as we can see them separately we can do that analysis separately they're happy to do how they work how you want to do it. Okay thank you Mr. K.. Centerman. Yes thank you Mister chair I had some questions you had on that specialty a question but. Is the dispensing fee part of the R. F. P. or is that paid separately. It's it's part of the R. F. P. it is going to be part of the R. F. P. what we want so we have approved that the already through a LC. So that means that will just be part of the R. F. P. we'll well whatever you approved this is what will be paid right if you have a certain dispensing fee so when we go out we do it we're asking for discount guarantees dispensing fee guarantees rebate guarantees. On all these things and we're asking for them separately so that we can do an apples to apples comparison and not take into account the differences between the as yet we don't want it all rolled together because then we wouldn't be able to pull those pieces apart right but is but work but is all gonna be paid through the PBM it's not gonna be a separate does that make sense is that correct takes shaking his head I just didn't know if. They were getting different female are payments from different areas or if it was all going to be going three one so the the main thing that we contract right now for our PBM with is to network with the pharmacies that relationship with the pharmacy where the they agree on how much they're gonna reimburse that pharmacist the R. F. P. that we have drafted and put out on the street has not yet been presented Dale C. for approval so it has not come to you all okay but the reimbursement structure that we have in there is identical to our existing contract okay and so in that contract has gone to ales okay and now the social compact come from the same place and then okay gotcha and a quick question on follow up will this state laws that we have in place that deal with prior authorizations and those things apply also to the Medicare advantage plans. I'm not sure okay if you could research that follow up with that I will that would be something very important that we would need to include an RFP yeah because they're just under CMS regulation but I will follow up with that right that but similar to the PBM legislation that we have worked hard to put in place we also have extensive prior authorization legislation. that we passed in the state at that needs also to be respected and those medical plans thank you I'm it's just CMS has legislation to some not sure how those two what we would need an answer on that yeah. Okay proceed. Okay so we're gonna go over the clinical section and this will be fairly quick because unfortunately our clinician wasn't able to be here so I'm doing my best to. Summarize what we recommended so. We went we went through and reviewed the wellness program in general high level and I think in general right now you get your screenings done and there's little actions taken I guess after that point so I think the recommendation on the next page was the do more of a More results based approach so more broader population health metrics so if you have the vendor have metrics that'll be related to you know how your how you population either gets healthier or screens or it's under so I think that was the major thing is the change the whole focus and have been more results based on that may be you know if your target in a certain population you have metrics that track that population and there's guarantees on the vendor that support that so This is a high level overview of the wells General. I have a good enough but unfortunately not a clinician that she did look at it and I think we're in agreement that that needs to kind of take the next step I think a lot of states that have that originally to just get your numbers and get your metrics and now that's kinda like next face to use those the health. The biggest one I think that we focused on and a lot of states been targeting and it's not new to anybody is the. The epidemic related to diabetes and the huge growth in diabetes across pretty much every state So there's a lot of a point solution vendors out there now that are offered in a real solutions that so there's there's in general before they get diabetes diabetes prevention programs that are fairly successful and then different approaches to diabetes management there's a lot of vendors out there now that have more targeted programs of hats very good success a lot of those programs actually get their members to completely could get off insulin so there's a lot of new programs like that and we look your diabetic population success of the other programs in the before and afters and savings and we estimated that if you get twenty percent your people to be engaged in these programs you have somewhere savings between ten to fourteen million dollars. Those on the diabetes piece. And then I'm college you I know our commission went through the during the pandemic a lot of the screens have been missed so and emphasis to get the the age gender specific cancer screens back on track and possibly doing sentence for that putting new programs in place for that and also doing a. Second opinions are now kind of like virtual so there's there's national oncology networks and and centers of excellence that you can tie into to get second opinions and cancers which is. Seems like over the last few years we've seen that emerge in a lot of the states so it's kinda like a best practice to get a second opinion. I was on a call the side Musco skeletal I think this was your your second highest one behind diabetes So a couple of getting in early on that for early interventions and get into physical therapy weight loss programs related to that there's a lot of virtual solutions out there now which allow people to you know do physical therapy on apps and other aspects like that so I think looking at digital solutions was that one of the major recommendations there's a lot of vendor partnerships as well with your local groups that she's recommended to get involved with. And then the last one was an onsite clinic and. This is been fairly interesting because I think the pandemic for so much to be virtual that unsafe clinics of really skyrocketed and it's not really used to be you have like a bricks and mortar locations that would be where I'd say clinic would be. And now it's like the way they're all tied in there's like of like almost like a hub and spoke approach and it's actually gets and all the rural communities so a recommendation really is the. The study that and look at options for that because there's a lot of emerging opportunity there. So there's probably a week discussion by me on the clinical side of it but that was the general approach the biggest I think with the diabetes program and that's something that I know that we're gonna be engaged our clinician be engaged with the your committee that walk through opportunities in that and I think probably the first couple be educating in utilization of your current diabetes population some statistics on look at the market place opportunity seconds the. The last thing we looked at in our study was we just briefly got our communications experts to come in and do a brief review your website. And they recommend some changes to it I will go into the details of that but they reviewed everything recommends about best practices look at with some sample larger states and clients are doing and I know that you B. D. mentioned you guys were going through that right now so you're in the process of redesign your website so I think we're in sync with that. All right. I think we just have one final recommendation here and some Joe mentioned before that we we recommended like many other states have a actuarial note that accompanies Bills they could have finding a financial impact on the plan and on the past there's been some changes to legislation where there's some unintended consequences so we made that recommendation I think there's an RFP out right now for that service. Share your question Sir I do thank you going back to the point I raised about the PBMs and then Senator Irvin raised a point in other states where you've implemented this. And there has been a conflict between state law and federal law whether that's deal with CMS Medicare whatever are you aware of any. Ongoing litigation where state law bumped heads with federal laws that would potentially come up as a result of the recommendations. I'm not. Okay I'm not but let us follow up on that if you don't mind because I'm just saying to Senator eleven point while bills we got state law and Medicare says this but our state laws from conflict with that are we set ourselves up for potential lawsuits and if this has taken place in other states where you brought these recommendations would like to know what their experiences are so we kinda be aware what might be coming down the pipe I mean the truth as part D. is for everybody okay right so an individual can go get a part can go into a party plan you have many in this state all of your PSC members retirees are in an individual party plan now so they would be under the same laws that would be under group. Under group program thank you. So from the recommendations made in the report that was accepted in November there's been legislation and on the forefront we've got a new contract that the just beginning January and the two main focuses now are what we're currently working through the PBM and the M. A. P. R. of peace so we're gonna give you a status update on those and then the next step is the feasibility of a disease diabetes management report and so that hasn't started yet but as Ken mentioned Joanna will be here and we'll get started soon on that. Members any other questions for. Presenters from Siegel. Saying no we thank you for your time we're gonna go through the status of the of peace okay United. I was trying to get only three slides little addendum okay I'll go through this quickly all right well I apologize. so as we talked about I'm gonna take everybody through that the status of the our of peas were on slide thirty seven on the monitor and crawling along in your packet so then the first couple of slides I want to talk about the overview of the process that apply to both the MA PD and the PMR of P. and then I'll go into more detail about each but again I'll I'll go through that I pretty quickly so to start off it was a very collaborative approach between that procurement office the Department of shared services in the office of state procurement EBD and Siegel to work together so we work together to develop initial proposal drafts which included technical cost proposal and all other items related to analyses that we wanted to see to make sure any kind of disruption with respect to providers with respect to formulate a disruption we're gonna be medicated so we provided those drafts work closely with. With the other organizations EBT NO a speedy and finalized a draft that we really finalized draft that we really thought would be most optimally your members and meet their needs the best as part of the process US Siegel also developed data we worked with your incoming carriers we worked with AB de to created data extract to go out with the R. P. because the cleaner and the more accurate the date is the better that the carriers can analyze your plans and provide more competitive bids and really understand how you plan functions and what the claims really look like. So I is noted at the bottom of slide thirty seven and and as we said here many times today we do have to or fees that are out in the market the first is one for Medicare and APD Services for the group sponsored national passive PPO plan and that is for the Medicare eligible retirees and Medicare eligible dependents of retirees and the second order of P. that is out in the market is for PBM service. So moving on to the next page once each solicitation it was ready and ready to be placed in the market the state procurement website A. R. by had that the or if the the appropriate RFPs posted a bidder's conference was held it was led by. Excuse me the office of the state procurement with AB de and Siegel participating and there's also a question and answer period that's part of the R. P. process and it this allows the prospective contractors to ask questions we take those questions back we confer with each other and then we develop question responses to questions and provide those to the bettors. Siegel managed an anti a process which is just a in. Nondisclosure agreement put in place to make sure that the data your data that you're releasing that we're releasing the RP is protected so we manage that process nobody received the date up until there was a fully executed. NDA in place. And then once the. Once the process was close bids came back and we received from all prospective contractors a technical proposal packet a cost proposal packet in any of the required forms or analyses that we had asked for and then we reviewed each of those packets. Someone slide thirty nine I want to go into a little bit of detail specifically on where we are in the M. A. P. D. R. F. P. and then I'll do the same for the PBM or P. before you do that does anybody have any questions about the overall process that I've described so far. Okay we'll keep going so again on slide thirty nine. presenting the two and A. P. and R. P. differently because the the R. F. peas are in different places so with respect to the MA PD of the bids have already come back evaluators and with help from Siegel an APD experts including Kirsten and myself we reviewed and evaluated the technical proposal packets they came in and we gave our feedback to OS P. and EDB with respect to what to look for or what were red flags over things we wanted to see. The at the evaluators as described in your procurement process completed an individual scorer worksheet and then the next step was to hold interviews and during those interviews specific questions prepared in concert with Siegel EVD and O. S. P. were asked of each of the carriers in the MA PD process and then finally there was a final consensus meeting and final scoring was record with determined and recorded on the technical proposals as well as the cost purples where we are today with respect to the MA PD is that we've identified strong prospective contractors and discussions with those contractors are currently under way and then once those discussions will be wrapped up the details the draft documents those will be finalized will become part of the contract and then Siegel will assist with negotiations will assist with contracts will get those questions answered with respect to state law and if the if anybody in the office of state procurement is interested we can assist with implementation of the plan as well. Okay slide forty is just a timeline of the and the P. D. R. P. if you look at the bottom third of the slide that's where we are we're between the discussion kick off in the final finalising discussions step we anticipate that the discussions will be finalized June first and then ideally the contract will be awarded on June fifteenth twenty twenty two and that will allow. Ample time to do the implementation to do a lot of the education that we've been talking about so we can really educate the retiree or the character really educate the retirees and get them comfortable with how the MA PD plant functions and that option. And then the last slide fourteen day is a time line of the PMR of P. as they said earlier this is in a different spot we're not quite as far along at on this the R. F. P. went out about a month later in the M. A. P. the R. F. P. and that's largely because a PBM R. P. is just very complex we wanted to make sure we incorporate all the recommendations that we talked about earlier so if you look at the top half of the slide we have completed answering questions that were posed by the prospective contractors and now we are waiting for the proposals to come back and those are due on June tenth twenty twenty two and then the next steps list out you know what I had talked about earlier in the process and again ideally the contract will be awarded for the PBM are iffy on August fifteenth twenty twenty two. Does anybody have any questions. Members you have any questions for the prisoners. We don't see any do you have anything else you'd like to state thank you thank you for your time and your work presentation for answer questions members we now have Jake believe it is going to come for discussion that can actually to contracts that do need action review. Come to the table. In order to they get me those meeting dates that I'm talking about okay. Thank you. All right Sir you're recognized you I guess formally just state your name and who you are for record Jake plead employee benefits division of department of transformation shared services all right Sir you're recognized. So under the legislation that was adopted at the end of the twenty three session and then excuse me to twenty one session and then again here during the fiscal session a variety of laws were adopted which change the governance structure for the employee benefits division one of those laws transfer responsibility for decision making and approval of our actions over to the board of finance that law then also Applied some pretty broad language stating that anything the board of finance really does or commits to do is to come before the Arkansas Legislative Council for for review that includes the review of contracts one of the things that employee benefits division does is review or manage a number of different contracts we've included an attachment to the quarterly report we sent over the committee here a few a month or two ago detailing just exactly all those different contracts there's big ones there's little ones there's everything in between. To those contracts are up for you all for approval for extension they are extensions of existing RF peas these contracts both expire on June thirtieth the of the current year. The first is a an extension of our contract with C. Y. C. or Optum this is the provider of our health savings account in our flexible spending account provisions which are provided to our members we provide these pursuant to the law adopted a few years back the administrative fee on these annually is about a hundred twenty five thousand dollars a year total so it is not one of our larger contracts they are not seeking any change in the contract or simply wish to continue processing HSA and FSA is for our members going forward. And the second one is the mainstream technologies which is at or means IT provider. Mainstream operates the portal through which are members in role in a receive benefits. most of our members about sixty percent of our members are course public school employees public school employees are not employees of the state so we are we operate outside of the State networking a lot of different ways. Mainstream's integral to what we do our portal is constantly being worked on and involving with different federal or state requirements so this is an extension of a contract that we have in place of mainstream we spend about. just a little over two million dollars a year on that contract they are seeking an increase of those expenses from one hundred twenty five dollars an hour to one hundred and thirty dollars an hour this is the first increase they requested in some time I was not happy about the increase I'll tell you that but I felt that we could afford it because one of the things we've done internally is we've really worked on our staff training we discovered that we had a whole lot of folks were calling the consultant when they needed to really just be doing their job. By doing that we reduced the amount of billable hours we were getting so although we are getting an increase in this rate for mainstream the amount we are paying for mainstream projection for the year is actually significantly less. And with that I'll answer any questions. Jake back to the the first one of the administrative fees would it be helpful to you think to the committee and to you all to break all these things down per member per month basis so that we've got bench marks that we can look at to see that are you structures or are you know fair sure and so the eight did connector Care the optimism is a dollar ninety five per member per month for the FSA the dollar seventy five per member per month for HSA. I don't have in front of me how that compares nationally on the market but it's an extension of what we got when we did. Offhand is that those numbers sound in line but that's great that I think you fuel include these with the report that that'll that'll help bring some yes Sir instead of just big numbers thank you. Members do you have any questions on these two items. Seeing none I have a motion from Senator sample for review these items is our second. I have a second all those in favor say aye. All those opposed no the items are reviewed and thank you very much thank you in anything further from the J.. nothing else reject thank you all right thank you very much. Members of the last Adam was a suggestion a meeting dates and. I wanted to you just given me right here do you have those I don't see those in front of me so. They're not there so. Do you have a copy of the meetings for you I don't have one for the chair. And I do see that and I just ask by the way for them to give me those dates on a bunch of almond so um you've got a the June fifteenth the only thing that they said was a state and provincial transit energy and environment conference and that that the twelfth and then as Senator Ingram notes the SLC Oklahoma City and then in court will starts and ends there in Jersey city. And you've got August doesn't look like an interruption there. September that mac could be an inter interruption for those of you on the energy council because that September fifteenth through the eighteenth. And I don't see that it's any other issues there so members on that meeting there in July representative Ferguson obviously is not officer in coral I'm ending my tenure there and so you've got With the SLC within core what do you prefer to do on that we've got a monthly meeting schedule so I don't know if we want to what kind of leeway to do we have Barbara on that. Senate. Six six. Well we can meet on alternative date. Yeah the Senator sample matches mission meeting and other time during the S. the A. L. C. meetings we've got so. We're we're this is a working session here let's figure this out. Right. Monday on that that would be the Monday of that week yes hello. Why. Council. June July so that. But we need but we have to meet regardless. No so we could just cancel the July meeting is that what you're saying. Shares I mean are we decision of the council chairs. Senator rice. I guess we'll wait to June to see if what happens but I know some of these membership fee schedule believe. So The staff just get with this if there's a solution will communicate that to everybody but I know that those two both probably have several people attending members or any other questions or issues for committee before we adjourn. Thank you for your time your efforts were Jr.