*Task Force on Autism

Yeah I guess we need to. Story of my life there we go. Of if you had a chance to review the minutes of the August twenty fifth twenty twenty meeting if there are no changes the chair would recognized up motion to dispense with the reading of a and approved as submitted. There's a motions are second Gramenet second all in favor please signify by saying aye. All opposed of. We will move now to an update on empower healthcare solutions many of these items that are on the agenda are the longtime carryover items that things that we were going to talk about of back maybe in in late last year early this year so of the Emily the army list was do you want to take a shot at this you're recognized a misstatement. Thank you are there any questions regarding this. All right thanks Liz with the appreciate to report up moving on to item the the Discussion on the Arkansas is in partnership the Medicaid waiver of Melissa. You're recognized. And that's what what thank you and that's what we're looking at doing we're just getting that data pool. So we can see exactly how many we think we need to add an in other than that I think. Can really correct if I'm wrong setting again Tommy talk a lot more about this than I do but I think we're doing some clean up around just some of the things in the renewal and we had talked about. Right now all the autism waiver that paperwork determine eligibility goes over to the office a long term care. We were looking and evaluating how much and work flow that would be if we brought that in house since we do and the comedian employment supports waiver already so we've been talking about doing that change and then we are going to be M.. Clarifying I think around the slides and then the actual spend and then making the telehealth code that we put in the K. permanent so other than that I'm I'm missing some of them. We have looked at a lot of the changes that were made were just clean up kinds of changes and and pieces that would make a some of it consistent between the C. E. S. waiver in the autism waiver not really substantive changes except for that diagnostic piece where we now can accept two out of the three disciplines where originally we had to have all three of those for diagnosis so that makes the I think a substantive difference in terms of how quickly children may be able to be moved and should help significantly those children who come from rural areas who had a lot of difficulty getting those three all three of those pieces right now we have a hundred and sixty children active a twenty pending which were waiting on financial eligibility approval from the Taffer units which would take us to our hundred and eighty maximum number point in time we have twenty one children on a waiting list right now and a hundred and twenty children who are in the process of completing their applications. What we're getting applications every week now which is up from all over the state which is a nice problem to have and since this waiver is different than the CVS waiver and it's a three year maximum service limit it does allow us to turn those applications much more quickly so right now all the people that are coming into the slots that are available have been on the waiting list for about two months. I'm sorry I and I missed because we haven't some technical difficulties up here with our live streaming of your we are addressing the two month wait right now and then then or of getting on placed after that what what is our time frame we're working. Right now. isn't well. That was great and on. we right now the the issue is that we're able to move those children but we are going to hit a place where we don't have a you know a number of slots to move them all in the children are being moved in you can get there pretty quickly but we've only got and you know it will if we add the sixteen more we've got twenty one sitting waiting right now. And then a significant I wouldn't typically we've only had about thirty in the whole pool and the fact that we have a hundred and twenty applications right now that families are in the process of completing they've sent us something in that they're missing a piece of information that's a significantly higher number than we've ever had do you credit that to vote we are doing a better job of getting out people where the program I think it's out reach you know Melissa and Tommy pulled in a sum of their title five people who are scattered out all of the state and they have been greatly assisted in helping families identified this and we've done a lot of outreach and the delta areas to try to pull in those children from places where we weren't getting any applications at all and we knew those children for their so some of the UAMS folks out in the regions have been helpful as well so I think now it's just and you still cross paths with people who've never heard of it so as much as we try to get that information out there there's still a lot of people that were we're just not reaching but the fact that we've received applications from every county in the state is very different than when we started. Millicent anything else. Thank the more we talk about so I think there's some confusion out there about and DD waiver and the more we go around talking about. No DHS has. Many waiver programs and and and and and we're able to talk about the autism waiver we've been trying to clarify some of that on social media as well so I think just getting out there talking even about that wait list on the C. S. waiver is helping bring awareness to the autism waiver. Representative in it you're recognized. Okay okay representative Brooks it's it shows up on here. You Mr chairman Act question just to clarify for me so here's twenty eight hundred sixty active. Twenty Pendine twenty one the waiting list what's difference between pending in on the waiting list. A pending are applications that have been completed everything's been process it is it's in the final stage of we're waiting on a financial eligibility determination from the tap for unit and then there services will start. Waiting list are those half have complete applications but we are we not able to process because there's not a slot available to move them into. Any stahn over here to my right Senator Hammer you're recognized thank you madam chair may ask her a question to the chair conditional right straight thank you. That what's the cost is estimated cost per individual on the waiting list or what are the what are the hindrances to getting them on the wait waiting list. getting them off the waiting list you know I I you said so slots but what we gotta do to get the slots open up is it like that the population what we went through on that can somebody explain that. Slights approved by CMS for the autism waiver we have a hundred and sixty in this life so we have twenty available. And I think Karen said on her numbers we have twenty that are ready to go into that slides and then twenty one more that are going to be waiting when there's twenty slots are full and then we have a hundred and twenty letters people kids that are somewhere in the process of filling out their paperwork so I mean I guess technically if all of those hundred twenty packets meet the qualifications we could have a waiting list of a hundred and forty one. once we get our waiver numbers full at a hundred and eighty. Hello Mister. Boyd. It's CMS is controlling the numbers or do we need to put a request in or is it just the money to take care everyone at one they open up just like the other issues we're dealing. Okay he's got a beat Arnold. Later in is the same situation so we we put up state general revenue and to the federal match I will say that this waiver is substantially less expensive than the comedian employment supports waiver substantially and and we are looking at the spend and looking at how many slights we could add now we weren't talking about a hundred and forty one but also the difference with this waiver the C. **** at birth to death waiver in like Karen was mentioning this is a three year waiver program said we do have a lot more churn ETC openings and like you don't see on the other waiver programs okay thank you thank Mr. Yes with the I. if you could see the script. Economy based on what's on the screen I'll just. ACT that's that's good she's signify more intelligent and I am so I will I'll take that without a doubt representative pock is amazing and so this is a question address lesser care need to one fifth if please as chair M. so related to them all the folks that are a on the waiting list so likely not to be approved for some time if we if we fill all the other twenty slots and then the hundred twenty people who are completing applications right now what's what's our communication to those families with our communication like in terms of expectations so this is coming from perspective of a family that has done this in the past so what what's what is that look like how we communicate those folks. Minimalist. as people send in an application if we get an application from a family that's not complete we immediately have correspondence back to that family that says we received your application this is what you have this is the piece that we need and they're held in that pending in that status until we get that other piece and then they're added to our waiting list in the order that they come so we have routine contact with those families we have an age limit on this waiver that is for children between eighteen months and I have to get entered into a slot before they took their fifth birthday so we stay in touch with those families sometimes with this hasn't happened very often but we have had a couple situations where a child would turn five while they were still sitting on our waiting list and those of the calls you really don't want to have to make to those families but we do have that contact to say and we tell now in the very beginning because sometimes we'll get an application from my family we have three months before their fifth birthday and we'll say right at that point to the family send us everything you've got as fast you've got it I will do the very best we can to get them and but we may not be able to guarantee that you're going to get a slot I've got staff that have gone out on a Sunday night and down home visit because a child is about to turn five and we get it through the DHS by that date and we get those kids and just literally by the skin of their teeth but we have had a couple situations where children would turn five and they would age out while they're on our waiting list but there is routine contact with those families from our staff as their their and and we tell him if you want to know how it's moving you want to call as they are assigned to a staff person they can have contact with that person any time I'd like to. Any other questions. All right then let's move on up Mr Tarpley anything you wanna add is there anything that you they are okay we're good UP next is of the Q. community and empowerment supports on the waiver list of lesser. Yes Sir and I maybe I'll send I'm sorry I'm. So it's comedian employment supports but it's highly likely I sent you the wrong name and. Because I was thinking about him power on the other bill I am community and employment supports them which is an iron are large waiver that you hear so much about and we right now are serving M. approximately at five thousand children and adults on this waiver we spend annually about three hundred million dollars back in December and Senator Ingram was invited and attended with we were so happy and Senate and spoke that the governor announced that he would be requesting approval of an increase to the Medicaid budget of thirty six point seven million dollars annually to add an additional M. three thousand two hundred people to that waiver over the next three years it the waiver is has been written it's and public comment right now and it will be formally submitted when public comment in on may the twenty nine so CMS has received a draft and they they said that it is definitely a provable and are looking forward to formal submission so it has the additional flights included and then it also has to new services and enabling technology which doctor Evans is out in the audience is a big an advocate and driver of that service is she will be heavily and called upon when we're building it and another service call monitoring and supervision for people who need assistance and cannot be left alone but don't want to work on a goal right don't want to train on something so those two and then we're also because of the E. and direct worker shortage that we're experiencing not only in this waiver but across the entire state for our. And home and they home home community based services so personal care in our our nursing homes are HTC's where it just it's and it's quite a shortage and so we are going into this amendment on the waiver and marked that and parents of children are now eligible and to be caregivers paid caregivers and legal guardians can be paid care givers legally responsible persons and providers and that is a eight and significant change right now all providers can be paid workers but now family can go work for a M. A. provider light Arkansas support network be hired on and meet the training requirements in the background checks and drug screens of course and be paid staff so we hope that this S. S. because we are concerned we're already seeing a shortage and then to add this many slights and. You know we don't want we don't want to add flights and then people continue to wait on service so trying to open that up as much as we can through some of the changes in the waiver. Lucy is the the the issue with care givers I mean there's huge we know there's there's a shortage of nursing I mean you would just go through the whole medical up system up with the reimbursement rates for care givers there rather on the low end is that a potential solution or is it I mean we know that you know a lot of our care givers it's a call for them this is something that is that is special to the two there are but of with that being said it is is there a belief that raising the rate for the care givers could have a positive impact for additional people that might consider it that might not now. Eight yes center I mean I think there's a lot of factors that go into I think we've seen that just raising rates particularly if the human development centers is not. Necessarily the golden key rate by in conjunction with other factors so raising rates definitely helps training helps our people feel more secure so I think we're taking on a multi pronged approach I know we're working to do on it subcommittee that represent a Mayberry was holding to talk about and a career ladder and a credentialing program for this type of work force and you might remember we put the HTC staff through we put them now for CNH raining to try to give them a career ladder and also as a mechanism for us to pay them better for them to see in a status so I am trying to do something similar in the home and community based side that gives a career ladder and and yes and I think a lot of and the messaging that we've been talking about is the the direct service workers paid for under this particular waiver all under the past program and so I think trying to work with the passes M. and through their contracts it's through different ideas on how to pay people and said that they see the value and paying differently you know especially once we'd set up a certification or training paying them based on that type of level of training so and I think one the things that but was but then I have been trying to talk to about the last couple of months at conferences is younger the managed care model it's very different how you set up. Rates so when we have actuaries that commends to set up the managed care per member per month payment that does not mean that I go in and say supported living is worth. Fifteen dollars a unit so this is not how we set our rates so our rates are set up in huge categories of service based on historical spending utilization so and and CMS has to go in and say your rate is actuarially sound for the program so and they have said that year after year that the rule the way we're setting our rates actuary sale actuarially sound and sign off on it and so it's not really a matter at this point of us going and and saying we we think the service is worth X. amount of dollars because we just don't stack them like that for this program but we are working with the passes and under the providers have been very up front with the passing is on and if you want us to continue to build to provide service we need to be able to pay more. We also just gave out I guess in March a substantial amount of American rescue act fines and will be sending an email tomorrow see the providers who are paid by the passes that and we should be able to tell the passes. M. the provider allocation amounts on July fifteenth so we have got that lined out so hopefully and providers will also be seeing a check from the passes and at the end of July for work for stabilization payments and those payments totaled a hundred twelve million dollars and they could only be used for and recruitment you can pay a thousand dollars per person to recruit and then up to fifteen thousand to the same person over the next several years for retention and and those payments went to aging providers personal care private duty nursing C. S. waiver behavioral health providers and so not to say one provider guide millions upon millions of by any means but and some providers got some pretty good amounts of money based on the amount of claims that they bill as in the passes so we are really hopeful that that money will help and will continue to work with them on the rates I think the best way we can go about helping with that is through and contract negotiations with the passes in what we expect and what we expect and and in terms of the timeliness service timeliness of service and I think one good example is. we did not have the foresight. When we once the program and I'm looking at Paul out there in the audience to know that we would ever be able to release three thousand CVS waiver slights so there there is not language in that contract that says and we expect service to happen within a certain amount of time a releasing a slight and so and that is right now what we are working with that passes on negotiating a setting that's timeliness standards of when we release this what we expect the person to receive home and community based services when it within a certain period of time M. and right now it's the contracts silent so I think we're coming about the worker shortage in a couple of different ways to Janice anything. How to make okay area got it I don't have to hit it or anything I know I think you covered almost I mean everything the only thing I would add is that and training dollars that we are looking at I'm with our findings as well the same funding source that we used to do the work retention and recruitment bonuses we have two other buckets one of them will allow us to provide some money for training so to your earlier point we feel like rates are a factor and we you know as you may know we are now under the executive order to look at rates every three years across the board and that does include rates that are paid through the past we just look at those as well since that a little bit differently and but we are also looking ads not just raising rates but also how to increase training and create a career ladder I'm incentivized we do feel like people also need to be supported in those roles it's not just a matter of what they get paid but also feeling supported and like they do have the opportunity to grow and develop a career in so working on training opportunities as a thing of at. UP Senator Hammer you're recognized. Thank you Mr just for make a comment I want clarification the populations under discussion on item Ian F. or actually populations served by the passes is that correct. Okay they've got ninety I am so the autism the children on the autism waiver are excluded from the past program. Okay. Let me look at the end of the three thousand that we took off the list we're gonna be able to take off the list how many how many does that leave on the list currently I know it fluctuates. We we don't have anybody actually that's been added as a at this point so everybody's covered that was on the. How many how many additional slots do we have before we get back to having people on the waiting list. We will be out anybody that signs at this point forward will get one of those attractions flights meaning we about a hundred fifty people that move out of state pass away each year but we will be cutting it very close M. if people start signing up we we have an. We budgeted and we added and not four three thousand two hundred. Okay the my question would be this is just simply give me explanation and other discussions. The the passes have been turning back in money that as I understand it ends up in the Medicaid trust fund which right now is route five hundred seventy five million I think. And that is generated from savings is that money before gets put into the Medicaid trust fund if I'm not mistaken available to create any more slots so when we hit the ceiling we can already have slots waiting for them or is that not possible based on the structure how it how it's set up. I'm sorry senator awkward and very hard to talk to you from the. I'd rather not go IT. Is there what we have there is a fund that is a can be used to generate flights and that is the tax the provider tax at the process Hey per the statute fifty percent of that provider tax can be used to create new DDS waiver slots the committee that we're getting back in there is court or as you correctly state it goes back into the Medicaid general trust fund that's used to pay the full Medicaid budget so it just goes back into the pot of money that used to fund all Medicaid services not in particular anyone thing. So is there any unused money from that tax that is being swept into the Medicaid trust fund either directly or indirectly or how's that money earmarked so that is not swept into any other Medicaid budget items but it is reserved to make sure there is a a building question to provide those additional slots that is a great question I'm gonna have to ask finance about I don't know barking I did not that that that the premium tax we added and seven hundred slides at the beginning of twenty twenty with the past premium tax now of course with premium tax everybody every single person we added into the program generates more tax rate and in that is factored in when we're coming up with our classroom with these additional three thousand would cost S. and but they do you your mark the past premium tax that's going to those seven hundred flights annually each year and I think and remember it's about fifteen million dollars no I don't know we will the outlook and ask if there's any more premium taxes come in. I think I don't believe there is but we look at the I'd like to get that to make sure that if that's what this for that is that it somehow another reserved to take care what we have but also if it creates the ability to build future research for future slot so we don't have to come back and get money from elsewhere and we get offline or you ought to get that for will get it for you are offline I my finance team has and I just don't know who I am and I would add to it and was it just said and she we did to it but once we say those seven hundred slots are funded by premium tax every year that amount of money from premium tax has to go to fund this lights in the premium tax has to increase to be able to add additional slots that are right thank you Mr. represent right you shop is represented Hillman on this so of Human Rights you're recognized as thank you Mr chairman I just wonder if there's someone here that could give us a definition of this sickness and who is responsible in the beginning of detection this section this was all folks that are affected. Was that are directed for. Is there a jump ball or is it just drag somebody in particular. Unless it would be fun all right let's see if you're if you're up. I'm sorry if the representative when you say sickness. You mean intellectual disability is that we're talking about. Okay so. I'm to be on the autism waiver on item Eads you have to have a diagnosis of autism and. Children are generally born with that and disability and it's diagnosed by a physician lands either a speech therapist or a psychiatrist psychologists sorry thank you looking to care. She really is our expert on this and then for the community and employment supports waiver those clients have a and intellectual or developmental disability they either have down syndrome they have Sliq epilepsy seizure disorder they cerebral palsy and they have and women in spina bifida or just a general intellectual disability that affects their daily living they can't they have to daily living deficits that they need assistance in everyday life and you can be born with a developmental disability intellectual disability or in some instances something can happen to you M. you know later in life that can cause you to be intellectually disabled we had a couple years ago a young lady who had a very warble an ATV accident it was awful she was thirteen she's a twin she had an old man and she was she was badly injured and ended up on our waiver program and because it she M. loss brain function and needed a a great deal of assistance so am I hope that answers the question it's. Okay. You're you're you're you're you're welcome is there You are there any other questions it might. Might be okay if not then let us move along to. Of let's talk of the discussion regarding the crisis stabilization and behavioral behavioral intervention of mistreatment. Does work if you hadn't. They're going to give a little bit of background on this is you know when we created the provider led Arkansas shared savings the past entities one of the goals was to break down the silos between the behavioral health and the developmental disability population we've historically serve those populations in two different mechanisms I'm and we found that a lot of our clients were duly diagnosed and we've also noticed over the past few years that the there's been an increase in and mental health and behavioral health problems and issues primarily I think due to what's going on with COVID we've just seen across the board including and the developmental disability population and so we're seeing an increased need for some crisis stabilization services that can really cross those two and silos if you will and really service population and so we've all come together Melissa and myself the Division of and Haverhill Health Services Division of adult and aging all of us a kind come together and try to brainstorm ways and to address this issue there's also a task force that representative Vaught has put together that that talks about this a lot as well and so a lot of stakeholders have come together to try to brainstorm some ideas and some of the things we're doing right now to address and crisis stabilization I'll go through and also tell you about some of the things we're looking to do going forward and so right now we have put in place and the Q. crisis unit inside of a hospital. For adults so it's right now only for those eighteen and older we are changing and through an emergency rule that agent will go down to for the purpose of this is to allow critical access hospitals or rule hospitals that don't have full psych units to to develop these crisis units there staffed at a lower level they do have they do have to have mental health professionals on call twenty four hours a day and that it allows them to go to have some crisis stabilization services in those hospitals where we don't have thank units or we don't have crisis stabilization independent crisis stabilization units. And like I said we are working to increase that decreased at age four because we have seen and some children as young as four and five years old sitting in emergency rooms because they had and behavioral health that crisis in the emergency M. T. taken to the hospital and now they're they're in the hospital can't appropriately treat them and so we're trying to address that and created a crisis stabilization within those hospitals that can help those children. Some other things were looking to do or to add some services and to the past model in particular assertive community treatment which is called ACT ACT I mean it's for adults as well as add children's model of that call children's intensive in home and these are intensive services their bundle of services that includes therapy includes care management includes in home care professional services and support but it also includes of a crisis components so the the provider of these services has to have a mobile crisis component to that service package and so with that individual receiving that service goes into a crisis they have to be able to adequately respond. And so we are looking at at impacts were riding a disaster spot to include those services in our and State Plan for past to cover as well and then we're also looking at and after they have gone into the acute crisis at center and they need some some acute services or some lower level services we're looking at some specialized IDT units within PRC aspen seven Q. placements that can serve these clients because there has been some concern over clients with developmental disabilities being housed are being placed in the general population of these units where a lot of children have M. seven fairly difficult histories and have some violent behaviors and so we want to make sure that there are specialized units for people with DD and and with people that have been trained to work with that clientele. And then on do you want to speak about consent under autism. And I think one of the. We we were able and I'm camber of Lisbon's on Paul and I know we're on and we had a presentation the other day from and. A psychologist that was talking about and the value of a BA and you know the longer we topped it it wasn't necessarily doing eighty eight therapy but it was more of the ABA model that we think we can work under consultation under the C. S. waiver what he was really talking about was following kids and making sure behavior support plans where appropriate and that people that provided support to the children were trained under the model and then overseeing every step of the way that that support plan was being administered correctly. So I did go in and change that serve as a consultation to try to clean that up and open that up a little bit better to be a Lau as to move in this direction M. because I was actually really impressed with that presentation and and I think a lot of us where and so and try to go in and make that a little easier so that we can follows M. and keep having discussions on what that would look like at I'm sure you all are aware of it and. Q. crisis units and crisis stabilization units across the state currently do not take people with an intellectual disability so if I sound a little better is because I I II and it's and that I'm I'm very open about it at work when we talk about this and get it and you need a separate kind of winning a separate and area I think it I think that's what their concern is by. I think opening up M. A. C. U. beds for children is only our first step and then like Elizabeth noted we will be then focused on we are focused and I think polished down you'll notice and I'm audience and is really taking the lead on a lot of this for us on these build out is and meeting with providers and getting them to set up wings for our clients and because right now we land. Like if doctor Evans has an issue with a waiver client her staff gel if they call the police the police are going to come pick them up and they're going to take me there to jail or they're going to take him to the ER. And there's really nowhere else to take our clients right now in either one of those places are appropriate Allen E. R. would be appropriate if they could move them to a winding in and I keep crisis unit but right now that's not an option so we are actively working on building out those programs were also looking at if there's any additional American rescue act funding and to build the foundation for some of this with that federal with those federal dollars so that we and we would like to see a state wide consistent practice and that's very easy for people to understand and concerning that in home crisis so in like and Elizabeth said working with the passes to build these bangles when we look at the past data and awhile back Paula pulled and then they recently pulled it again I think we have about forty thousand. Members of the past our children. Out of fifty four thousand right so that tells us that we really need to build our models for children and so it it makes us get our focus better and and I think a lot of what's being bill or has been bill or focus on is mentally ill adults and and seven we are trying to shift that focus internally to children and clients that are IDG that are having some pretty significant behavioral health issues maybe don't have a diagnosis which we don't have to have a diagnosis and it's just exhibiting behavioral health needs and so I am trying to focus on making sure that whatever we build for crisis takes into account all three of those populations and not just mentally ill adults. miss Pittman would you just remind us again of the locations that we have in Arkansas for the crisis stabilization centers. I will try and others one here in Little Rock believed there's one in pollinators Jones Jonesborough Fort Smith and. Fayetteville thank you thank you audience participation. You will of. Is it been difficult finding of providers or or the specialty to deal with that I mean you talked about of you know referred him in there being in there is is there that care available at all of these Facilities so those four locations operate standalone crisis stabilization units I'm so there are there are services provided there I believe only to adults though I'm so against as Melissa was saying we really have not focus on children and so we really are trying to focus on children and and we are looking at some of those locations developing a C. use using the neural so we are reaching out to those locations that already have CS use to see if they would like to expand and use the new As You rule to expand services for children we're also reaching out to other hospitals and to see if they're interested in opening up these easy unit so policies leading those efforts as was indicated but I am we have reached out to several of those hospitals to try to recruit but there is a shortage unfortunately particularly for serving children and that's that's really been our focus and where we're trying to recruit does of it is the reimbursement at a level that that hospitals me the feedback that you get from it with his many potential of patients is the is the reimbursement at a level that they can be successful so we recently and increase the reimbursement to a C. use using the same role and it's pay paid out I believe five hundred and seventy something dollars a day now that will also go to the standalone CSU's and you know the passes they will have to negotiate with the passes on their rates but for fee for service Medicaid clients that will that will be the rate and is there a we put that into the hot the ten into the manuals on and our state plan already so we have addressed that and that is significantly more than the rate that they were receiving prior to last year. At the risk of stealing a Senator hammer Stavanger on asking questions is this part of the our our homes initiative so it yes the AC use our part of our homes initiative and one of the things we are asking when we are able to launch the life three sixty homes which will be at hospitals so there's a there's intense care coordination services firm for individuals enrolled in our home at that have that or maternal child health and those that are living in rural areas with a severe mental illness and and those that are in this transition age so nineteen two I believe twenty four twenty six that are in and former foster youth former DYS at formerly incarcerated those groups and those like three sixty homes will pardon will be for in hospitals and hospitals are being asked for being given start up funds to be able to open up a C. use as part of the program. Thank you any further questions. The care. I just would like to ask what the and this is just a man was not to be surprised at this but with some of the young children I think at some point I know we've got a mess right now and you've got a lot of teenagers and older kids that have no placements and there have to be places where people understand that with some of these young children we have got to at some point get up to a place where we have some prevention pieces in place some intensive supports that can go into the homes so those children don't end up needing to be placed in a hospital unit someplace we've already got trauma we just continue to add more and more tron with everyone of those placement so what are we doing for sure real true prevention I'm going so we have a couple of things that we're doing and if I miss anything less I can take my might. Because it's someone and so in the straws out there we're working with the PD at pediatric association that I can never remember the name of less than they received a Pritzker grant and are able to do some integrated behavioral health inside of pediatrics offices we're looking at how to make things like that permanent within Medicaid so that and social workers other behavioral health professionals can co locate with the PCP and they can do warm hand offs to those professionals and do a team approach to providing that care so that's one thing we're looking at doing to do a preventative thing the other thing that I think Melissa wanted me to mention is and we are looking at so intensive home services that I described earlier primarily being provided in the past with their four children who have reached that point right we are looking out Sims home services that we can provide prior to that to be able to to prevent the children from reaching out level. And we are working on developmental screens as well as the inner and we turned the code on it's on right now so providers please encourage providers to bill at issue and now any and it's a no paid code right now what we're trying to collect data and CMS will require us to report on the developmental the number of developmental screens in the Medicaid population I believe starting in twenty twenty four and so we are looking at getting that payable prior to that date. Mr Tomlinson you're recognized for a question. M. have you start working on it your restraints inclusion protocol yet for these younger children and for the in home training service. So restraint ends subs a question is complete we don't allow seclusion at all in any kind of home can be any based setting or in our human development centers or in our state hospital to my knowledge so seclusion is it a huge no no Personal restraints are allowable and very specific types of provider types impala B. that the much better expert on this but for example on the on a DD client there on the waiver and they have a provider in their home they can do no restraints whatsoever so you can only do restraints in certain types of facility based care and it's highly regulated in terms of the M. R. certifications around it and who goes into review it once it is a card you an ad for. Maybe maybe not thank you well this is going to have my record on for me sideshow over here. So we are we do have to her point we do have a client at deb's whether device that Division of providers services and quality assurance they actually are the ones that go out on restraint seclusion complaints and do that investigation is actually of a contractor that they use but they go out and do that and we can they refer that back to us and if it is egregious we can actually then take action as the Medicaid agency and we have done in recent past. Any further questions any follow up regarding that. If not of let us move on to the tax equity and fiscal if the test for the the two African Afro Medicaid waiver of Melissa. Our. Lizabeth level. Okay I'll start in the second jump in and say we are renewing our to have for a waiver which you and said what it was but that doesn't actually tell you what it is so tough for is Adam are it's a tough for like waiver actually intemperate is what the federal government has put in place to allow Medicaid to serve I children who meet the institutional level of care it would prefer to be heard served in the home and so that is what to have for allows us to do and the income level is based on the child's income alone so we we determine eligibility based only on the child's income and we are allowed under this waiver to charge a premium the premium is based on the parent's income and there is a maximum premium that we do charge and we do not have a maximum income level on the premium I do not believe so and so so you know it once you hit that threshold you pay that Max regardless of what comes. So that is whatever is and once they are and determined eligible for tougher they receive Medicaid Services so that means if they are passed eligible they are enrolled in the past and and that means if they're not they receive the full array of fee for service Medicaid services. We are looking at renewing this and we're making some changes they're not very large changes to the program the program overall all has been very successful and so we're not looking to change it significantly and we are looking at changing how we do the evaluation historically the evaluation evaluation has compared and populations that don't necessarily match she was enrolled inside of tougher at the primary and population being served with effort is actually notices developmental disabilities population the men don't majority of children are receiving services like ABA therapy or physical therapy or speech therapy or E. IDT services and so we did want to you and change you were comparing to make it a little bit more apples to apples and instead of looking at the traditional Medicaid population. M. and then the other thing that I think parents will be very happy about is we are trying to reduce the frequency of medical region terminations so right now every child. Every child regardless of their diagnosis has to do an annual medical re determination and the biggest complaint we hear about tougher is that re determination and application process hands down the biggest complaint at lot of diagnoses don't really need an annual read determination some do but not everyone of them and if if it's one of the categorical dot diagnoses of Mullis's C. as waiver the ones you just listed out we will not require that annual medical restriction. Yes we're excited. It will really cut down on our complaints to Karen's and works. Is it every three years it will be every three years. And this is considered a public hearing for the tougher wavers a happy to take any comments. An I will try to answer any questions all their and I may not be able to. Are there any questions from the Committee regarding this. If not of are there any questions from the audience regarding this since this is a it utilizing as a public here. All right seeing none of almost Karen you're recognized public comment that says thank you god for doing that it's going to make it a lot faster it will I mean that really does help speed things along when it's just seems like it's an unnecessary something the child has autism and had it yesterday's gonna have it tomorrow. Thank you for that comment and our our eligibility team agrees they're very excited about this as well. And we don't get much at many nice compliment so we will be sure to write it down we will and this. okay if there's no further questions regarding that we move on to other businesses is Matt school here. He didn't make it will will try to get him here for the next meeting on a we've got some questions of through a D. E. and what's going on in schools regarding spark services for of special needs students is there any other business to be brought in front of the. This August body. If not there are you yes ma'am maybe you can identify yourself. Given what you just come to the front in sit at the table here and so the microphone can pick it up and everybody here up to if any contact me yesterday with a long list of of items that you want to discuss and so I knew today's meeting was going to run a bit long of it will take a couple of questions on this Tiffany and then we're going to have another meeting quite shortly in and try to get staff to answer a number of the questions you had and bring them up at our next meeting of. It to is there and with we've got a record we've got somebody come into there you go. I thank them please give me your name give give me your name and Where you're from. My name is Stephanie Marin I am when I'm Matt founder and president of sage baby here are health which is in Northwest Arkansas and northeast Arkansas I also have a few other companies. I thought I'd provide similar services on consultation based S. and then I'm I'm nonprofit that's getting started in any case just to try and is quick quickly as they can when we're talking about the autism waiver earlier I know that and the current. A waiver expires in December and the new application has been approved I was just wondering if the new application that will start in January of next year is aligned with some of the issues that are the only just one way out I'm with ACT six fifty six I think it was last year We removing age and other and diagnostic limitations that were in place for the waiver and that length of time they're allowed to be in the way for. Of Melissa. Seventy eight I'm sure Senator Ingram and I'll senate and share your questions you submit and I can actually respond more appropriately but I do remember you commenting on that act back when we that legislation was running we are making changes to the original which is the new waiver that's what we call sorry a renewal is the new waiver and that will align with that piece of legislation that only requires two now of the three clinicians but we do not have any changes to the ages in that waiver program at this time and but I'm I guess I'm happy to look at what you submitted and get more contacts to answer your questions. Okay it be great that's just our ACT six fifty six removed the length of time that an individual could be in a waiver and the autism waiver program as well as the age at which they can be admitted and I know that it depending on the application you submit to CMS what you require any given year but the act last year removed those three I have a reason for asking your bye bye that the act did not remove those for the autism waiver so there is a piece of legislation talks about the waiver and it also talks about ECS TT EPISD T. has different ages its birth to age twenty one but displays than May because like we have no record in our legislative lead is right behind you mark white we have no record of it changing the age M. the ages of the autism waiver. I'm I can just send you a copy of the of the bill that the house bill that passed and is now act when I mean ACT six five six straight And the reason I ask is because that very that act that I'm referencing removed a certain age and time and other quantitative treatment limitations from the state legislative legislation regarding the autism waiver however it didn't remove the same non quantitative and quantitative treatment limitations I'm in this section of that act that referenced a state autism mandate and I think that I don't think that does need to be required if we look at recent department of labor rulings and Federal Register rulings it's been quite clear that there should be no age. Limitations in terms of the provision of autism service as. Under arrest at and mental health parity laws so I guess that could be something perhaps that we could look at between now and the next committee to discuss further. Insured children are so able through privately funded and insurance to receive service has passed the age of eighteen because at this time they cannot. Unless it's a self funded planned such as Walmart has removed those restrictions but ours other of private health insurance plans have not at this time. That S. one of the fees a minute away he's a friend and I know. I'm. The other issue is all right so that covers the Federal Register and department of labor mental health parity issues than Medicaid specific and with regards to EPS T. T. service says I'm which has been a tremendous benefit to the population for our for that to have been resolved and so thank you for that but as as we move forward through that again we have this and of service says that when the child becomes an adult and as we all know if you have autism when dating someone Senate amendment you're gonna have autism the next state the level of severity of deficits and and I restrictions to daily life might change over the course of a lifetime but it is a developmental disability so as a child develops into an adult not adult continues development still there so I'm wondering basically short version is is there a plan to amend the Medicaid state plan to ensure that all individuals diagnosed with autism spectrum disorder receive services. Now and this is why so ETS ETS for all children and that are birth to twenty one and what the feds through waiver programs allow you to target a specific population in here in Arkansas we have two specific and we have many specific waivers for our specialty populations in a pretty robust waiver for people developmental disabilities and autism is a qualifying diagnosis for that waiver program and it is a birth to life waiver which is not nation wide so we do have services very similar to how we treat other disabilities so we I can't imagine S. pulling out autism in particular when we have other waiver programs for people that are elderly and aging and for people that have other intellectual disabilities as adults and we don't pull that a specific diagnoses out and just take care of those people under this state plan we have to look at our Kansans as a whole and all of the diagnoses that people are facing here in Arkansas autism is one of those diagnoses but as far as from my perspective I'm looking out for people with intellectual disability in general and making sure that we have enough funding and programs to take care of that population EPS duties a federal standard Arkansas did not set arbitrary and you know dates forward to how long we take care of children so we follow the federal law and under and EPA STT and I think I'd also like to note since we are doing Taffer as a public hearing and that waiver program allows us to serve about four thousand children that otherwise their families. Make too much money and I it was and my job was on the top for a waiver for a year and then I will be forever grateful for that service because we never would amount to pay for it and that is not an that is not nationwide and there we are one of very few states that offer such a service so I would just say you know I wasn't trying to be cold but no we don't have and on the horizon plans to change the state plan for one particular diagnosis for adults. I would agree that it shouldn't be for one particular diagnosis I just happen to be talking at the autism task force about individuals with autism not being able to receive the practice and depth of services that they should be able to receive being cut off at age twenty one because of the fact that word now following as of two thousand nineteen right now following the two thousand fourteen mandate to require those services to be provided through EPS D. T. however there are similar CMS requirements and regulations that indicate that those services should extend throughout adulthood and the department of labor and department of insurance have. I federally. Issued bulletins. To indicate that states should be following us mandate so that's just something that I was just looking at the short and long term plans for our state Medicaid plan to address. The provision of services and when those services are. Addressed to the state planets my understanding a waiver is no longer required I'm not sure if that's the case because I know our waiver provides a tremendous benefit to individuals across the state and there's no. Late. Eight they do a great job and especially reaching people in the rural areas where providers are less likely to move. And the big providers that committee and all of us that little little providers not to mention how okay so. I guess what I'm saying is that we we also have a population of five children with Arkansas within Arkansas that are part B. R. that receive services through a our kids be and which is a check plan I'm one way that I learned to provide services to those individuals since they weren't covered under EPS DTE the check plan I that Arkansas submitted. Specifically excludes all children. Receiving. Check plans firm receiving EPS D. T. service S. which is in itself a violation of that federal central Medicaid standards so we've been able to do it through past groups because the past groups are following all insurance regulations because they're privately funded it's not occurring under our Medicaid state plan or the provision of services through that E. PST T. loophole or it's not really a loophole it's what was required so that goes back to the question of the state plan and how to address children who are receiving services under check planned and to ensure that they're able to catch all appropriate services. So if I may and we have two ways we serve children as you just described on his A. which is our through traditional Medicaid state plan in Arkansas be purchaser through a chip state plan it is actually not Medicaid and I would call it Medicaid here it's it's different and and actually the same standards don't apply in a chip and you do have the option of not including the PST T. services which you are correct right now Arkansas does not include EPS east T. services and not ship spot. Thank. But they could qualify for tougher and if their income is if they change income brackets or change eligibility categories we move them as soon as they do. So I think maybe that goes with that public awareness that I think we could continue to work on to make sure families are aware because similar to people not being aware of the waiver program they're also not at necessarily aware of all of the different options that they have to receive services through private funding I'm. So I asked about that new waiver application autism waiver application because at that time extended in that program is extended in that program then additional services will be required for those that aren't in there to test this morning thank you for your list questions I think is that sent to you earlier we've covered a few of them here if we might be able to just submit these we we've got a copy of what you sent me I will give to staff to Melissa and up at our next meeting we can take up the remainder the sins or have of the answers that of your some definitive answers for you I certainly we appreciate the the committee does your interest and your driving down here from northwest Arkansas I guess just one last comment and thank you for letting me. Biney share those comments and concerns would just be separate from any Medicaid issue regarding the department of labor and Federal Register standards for private insurance F. as a subgroup of people could meet to discuss how we can address that through the department of insurance rather than having to as other states surrounding us and across the country have done as opposed to through legislation. Sure are I got those comments from you will certainly take a look at him and thank you once again up for your input of is there anything else to be brought before this brunch today if not I want to thank of representative entered for being here. This. Hi doctor Connelly I'm I'm sorry I. This okay yeah I'm Randall Hundley are representing Arkansas Blue Cross and I didn't want to. say this in the middle of the meeting because it was really just a parenthetical note but in regard to the crisis intervention able as a nation I have a daughter who's a psychologist and during your internship in Connecticut she. Was part of a state plan that basically has a number similar to nine one one that people call your committee if you're very familiar with this more than I am and they would go to wherever a person was that needed. Intervention I don't know whether included developmentally disabled children et cetera sector but. Thank you of we appreciate to represent inter representative rye of Senator hammer for of attending today's meeting and once again representative Brooks thanks for joining us we look forward to our next meeting we will schedule a meeting here very shortly because we've got a number of items that we need to address so with that we stand adjourned.