Public Health Welfare and Labor Committee-Senate and House
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Representative Jeff Wardlaw
Unverified
0:30
Representative Stamil, you mind opening this up with prayer? Thank you, Representative.
Members, do I have a motion to approve the minutes from the December 8th meeting? I have a motion. I have a second. All those in favor say aye. All opposed? Ayes have it. Members, item C, we typically refer these ISPs to the subcommittees. We have referred item C1 and C2 to labor and environment subcommittees. Do I have a motion to adopt them and accept the recommendations of the chair? I have a motion.
I have a second. All those in favor say aye. Aye. All opposed? Ayes have it. Item C will be referred to both items to Labor and Environment Subcommittee. With that, we'll move on to item D. I'll be looking for Jay Hill and Melissa Weatherton and Deborah Iman. if you
guys would introduce yourself for the committee and you are recognized to present your
Deborah Inman
Unverified
2:14
rule hi my name is Deborah Inman I'm an assistant director of aging at the Arkansas Department of
Representative Jack Ladyman
Unverified
2:27
Human Services. It's nice to meet you all. Hey, good afternoon. Melissa Weatherton, Director of Medicaid Specialty Populations at Department
Speaker 17
2:35
of Human Services. And Jay Hill, Division Director for Aging Adult Behavioral Health Services at DHS. Thank you, Mr. Chairman. We are presenting to you today revisions for two manuals at the agency, the State Plan Personal Care Manual and
then the state's arkansas independent assessment manual or the aria manual you may have apologies can you hear me okay now we are presenting to you to revise two manuals the arkansas state plan personal care manual and our arkansas independent assessment manual the aria manual this rule will repeal the current manuals and issue new simplified streamlined versions and i'll very briefly very quickly kind of go over the changes the additions for you and then certainly gladly take questions. Primarily, we are removing overlapping language with other
manuals, clarifying what we've got and restricting it to a specific program. For instance, in the personal care manual, we will be removing references to other programs and making references or inserting links to other manuals where necessary. Yes. So I didn't do my homework and read the agenda
Representative Jeff Wardlaw
Unverified
3:39
and notice that this was a personal care item. Since I work and have worked in the personal care field. I'm going to let Representative Woolridge chair this meeting from here. Yes, sir. Feel free to continue.
Speaker 17
3:57
Thank you, sir. Secondly, the revision of the personal care manual will implement Act 853 of the previous general session, 2025, which will move licensure and certification from Department of Human Services for personal care agencies, private care agencies, to the Arkansas Department of Health. Very quickly and briefly to summarize the updated manual for our state plan personal care, the changes will be this will reintegrate PCPs into the
eligibility and assessment process for individuals that will be entering the program or making application to enter into the program for state plan personal care. It will transition from a single assessment tool, which we currently use the Optum, our Optum contractor to perform the Arkansas independent assessment and replacing it with a more functional assessment tool. It will remove the independent assessment contractor from that process, as I mentioned, and reassign this task to personal care agency registered nurses. And so an individual agency that would be that would be selected to provide
those services will be the conducting entity for that assessment piece with a prospective beneficiary. It will also lengthen the prior authorization process, which is currently at six months. So every six months we are issuing a new PA to a benefit or to a for an agency to be able to bill or to file claims against services for a beneficiary. Our intentions are to lengthen that to one year. This will also save the agency funds by only having to pay for that that service
that function one time annually. It will maintain the current cap of 64 hours per month of services which is what has been traditional under our state plan our revisions to the arkansas independent assessment manual will remove references to state plan personal care so as i mentioned a big component of this is to make these manuals more user-friendly to make them easier to read and easier to understand and remove references to multiple programs which can be very confusing to whether it's a provider or a beneficiary any entity that read those we are to we are seeking
to clarify assessments may be conducted in person or through telehealth and again keep in mind this is for our aria manual our independent assessment manual it will delete language inconsistent with our current processes and create new sections to detail current processes related to referral tiering and outcomes in the arkansas past program that align with the current past manual so it is to seek to align those two manuals it will remove references to the patel development screening process and it will add additional sections new sections regarding assessments and tier logic for
other programs specifically the ar choices program the living choices program these are two hcbs waiver services and the pace program program for all-inclusive care for the elderly which do run out of the aging division with that happy to take
Speaker 26
7:01
representative will judge a few items it's been if you will recognize yourself for the record
Speaker 18
7:08
if you've not already i'm sorry melissa weatherton um just a few things that i think are pertinent to the conversation we have had several investigations into the personal care space over the past several
years um this is a service that we provide through medicaid but it's also a service that's paid for by the passes um the passes went to a very similar system to what we're trying to set up now which is reinserting physician and APRN PCP engagement to try to control what we were seeing on the past side and they are seeing great success in this. We also work very closely with the Department of Education. The independent assessment has been a thorn in their side for
school-aged children that receive personal care in schools since the moment we set it up. They're very excited that we're moving away from that. It has been delaying some care for kids when they start a school year under their IEPs. So they were very excited about the new process. And then I would also add that we did work with other agencies as well as extensive stakeholder engagement since June of 24, which is when we started floating the draft of these rules, was in June of 24.
So this has been a long time coming. The current process we have in place is not controlling utilization. So the Optum Independent Assessment, the percentage of approvals is 95%. So it is not weeding people out from being eligible for this service. Likewise, we have a prior authorization on this. For adults, it's an extremely high approval rate for a prior authorization. So we have seen a significant increase in personal care spend year over year.
We pulled the number this morning, and we're spending over $212 million annually on this service for about 17,000 people. We believe that putting the new process in place with very strict evaluation forms and prescription forms for physicians and PCP offices will significantly assist us in ensuring that the people who need personal care are the ones getting personal care.
So those forms, we no longer have to promulgate those forms, but to bring the forms, I'm happy to share the forms. The lastly what I just want to mention is our plan is to implement this like to come today and then go before ALC in February with a delayed implementation date because we do understand this is a very different change in how we are doing personal care and we need to properly train physician offices to make sure they understand so that we don't have any kind of delay in service.
so right now we're asking for these rules to be effective in April but we actually talked this morning our timeline has been extended longer than we thought and so we are open to the idea of even implementing those later in the summer if we need to allow more physician training so with that like Jay said we're happy to answer
Speaker 19
10:16
questions. Thank you ma'am I appreciate you all being here thank
you for that explanation I think that I do have a couple of questions and then we've got some questions in the queue so obviously we've had conversations about independent assessments
across the board there are some that are required because of the waiver process and then there are some that are not and apparently this is one that is not but I guess my question would be either independent assessments work or they don't so it sounded to me like I don't want to put words in your mouth but it sounded to me like that you're that you believe that they're not working or not controlling cost in this instance um so i guess i could assume that they're not controlling cost in other instances also but it sounds to me like we're admitting that there is somewhat of a problem
in this field with the growing cost so other than saving the cost of the contract how else are we saving cost or controlling cost in a growing field so i would
Speaker 18
11:17
say um yes i do think that if initially was controlling cost in the personal care field using the optimum independent assessment that we're no longer seeing those the cost effectiveness of that tool for this population it's required right now under optimum contract that we use a registered nurse which is highly
expensive we're paying about 497 dollars per assessment they are receiving those annually and like I mentioned earlier the percentage of people who go through it 95 percent are approved for the service so we're looking at a um an arsenal of different things one of them is brought to you today but we're also rewriting right now um how we do our utilization management contract right now we're using a centra but a new rfp has been out on the street and it's going to
be awarded and in that we're asking for a lot more detail in um how they are looking at retrospectively reviewing our providers including personal care providers so that we can see that everyone is following the rules correctly so we're coming at this from a few different angles but for for state plan personal care um representative will just correct there's a there's a federal reg that requires that an independent third party um that has no financial
incentive at all assess clients who are on our waiver programs but it's not required for a state plan and it's a highly expensive and and we don't we're no longer seeing the benefit of utilizing that cost well i appreciate that i don't want to
cut you off but but i think the point that i'm trying to make is we either agree with the process or we don't but i i kind of subscribe to that defending exceptions becomes difficult so either we believe in the independent assessment process
as a cost control measure and it holds down that or it doesn't work and I understand that some things are out of your control this is one where you can make that change but from a consistency standpoint I guess what I'm saying is that doesn't seem to make sense to me initially I'd like to have some more information on how that can how that will control some cost how that will make sure that there's still a quality of care because I think that we all agree we want to make sure that there's a quality service arkansans are getting exactly what they need but we do want some mechanism in place to make sure that the services are um are needed and assessed appropriately
so thank you for that we're going to go i want to recognize the chair the senate
Senator Missy Irvin
Unverified
13:54
chair of public health thank you sorry i was late i appreciate it um yeah i think for me um i need to understand again when was the decision made to decision to do this not through waiver but through state plan so it's always been that
Representative Jack Ladyman
Unverified
14:11
way yeah it's been that way since i've since i've been there okay but at
Speaker 40
14:17
one time we did study this through the health care reform task force correct i believe it was in the aging so yeah when
Speaker 18
14:25
we looked at all the aging programs as well as behavioral health and the recommendation at that time was to tier it the recommendation at that time for personal care was to put um an independent third party in place to determine eligibility and that's when we asked optum to step in and do a tool to determine whether or not someone should get personal care and that's what
Senator Missy Irvin
Unverified
14:47
we've been doing ever since okay and um on okay and so uh
okay so have how many times has that opt-in uh contract been up for rfp goodness um i don't i don't know that
Speaker 18
15:03
we've hit our seven years on that contract i don't think it's come back or i don't think
Speaker 36
15:11
we've put out an rfp i think the initial one was during the task force and we have not hit our seven-year
Senator Missy Irvin
Unverified
15:19
mark okay and so you're saying here you're saying today there's issues with that assessment i don't know that there's necessarily
Representative Mindy McAlindon
Unverified
15:28
issues with the assessment we use the you know we do assessments for the aging
Speaker 18
15:33
waiver for the idd population and for behavioral health and we used to do it for the eidts remember and we took that away and gave that back to the physician offices when we weren't seeing a benefit of paying for the service like now this one's a little different this is a tool that they're using to determine eligibility. Okay. In the DD space and the behavioral health space, we use it to develop a person-centered service plan. You've already been deemed eligible, right? So we're kind of using it in different ways. What we're seeing with this is it's a very expensive part of that
contract that we're not seeing the benefit of, it doesn't attempt to be controlling utilization like we were anticipating. And when we're looking at the spend, it is just increasing year over year and again um i mentioned the very beginning we also were seeing some significant issues and there's there's been ongoing investigations in this space on the on for our past clients getting personal care inappropriately yeah and so they moved um when that started
happening they moved to this method of back to requiring a doctor prescription um and they are seeing substantial improvements of now that we've reinserted the PCP back into the process. Okay. So I just want to talk with you
Senator Missy Irvin
Unverified
16:50
about that for a second. And I know we've got other people in the queue wanting questions, but I'm requiring the doctor is a PCP. Family doctors are not social workers. Okay. They provide healthcare. Okay. So, I mean, I can fully disclose I'm married to one
and he's like do not put me in the middle of this I am not a social worker it is not my job to do that okay and so that is my concern here is because who is educating the PCPs on them being the gatekeepers if we're trying to utilize the PCPs as gatekeepers who's educating them about how we want them to be gatekeepers or just or how is this being determined because I can tell you what's happening. What's happening is they want to be able to be attentive to their patients and
to those families who are beating their doors down going, hey, I found out about this benefit that I have and I want to be able to take advantage of it and I need you to diagnose my mom or dad or whatever with this so they qualify for it. So they have to have a client base. They have to have patients return to them and if they refuse that guess what they're going to go right down the road to somebody else I'm just laying the land of how it works in reality I think it's a good idea in
theory I just don't know if it's going to work and I'm just being honest with you I think we do need to control utilization absolutely I think that I am incredibly concerned by the enormous cost to state GR and the growth of this program um I think it's good and appropriate for elderly people that you know want to stay in their homes I see tremendous benefit for that but I also see where you're putting somebody kind of in the middle of something that they really don't have a lot of
knowledge about and that and who's going to educate them and my fear is it's either going to be the patients families that are pushing hard for it or the personal care providers you know who will uh who will be that and that could be exploitative to the pcps and i i am a little concerned about that and so i've voiced those concerns you know to your agency offline um but that i absolutely doctors need to be involved in their care we just need to understand this is
personal care is not nursing. It's not home health. It's not, it's not nursing care. They can't, they can't even replace a bandaid on a person if the bandaid falls off. So, you know, it's a completely different game. It's a different, it's a different beast and a different animal. I think it's absolutely great and necessary when it's needed. The, the thing that we have to just figure out together you know and I know that you're working to do that I really really do
I'm just saying I don't think that this is this is not going to be the approach that's really going to get us to where we need to go to but I think we just have to rethink the process a little bit and if this is a really costly part of the RFP why not cancel that part of the RFP put out a specific RFP that's more narrowed and specific and go that route
Speaker 18
20:23
first have y'all thought about that we we did talk about that the reason that we have gone this route um is because this is a state plan
service and we are treating it like we have been um trans uh transforming our other state plan services so it's the exact same process we have set up for adult day treatment early intervention day treatment otpt speech um we're mimic they're all state plan services and we're mimicking the exact same process so again so when we go out to train physician offices that are already familiar with the forms we're doing an evaluation referral and a treatment referral um so that
it all looks familiar because for the rest of our state plan services we're utilizing the same process do you do you have a and do
Senator Missy Irvin
Unverified
21:10
you have any data and this will be my last question i'll let you go to everybody else but do you have any data as it relates to like therapy therapy and is another thing that has exploded in my opinion so do you have any data that that says no this is denied by the pcps do we do we have data that
shows that the therapy has been denied
i don't have it like can i can totally pull that yeah let's look at that because i want to see if if that's you know no this child does not need speech therapy no this child does not need occupational therapy no this child does not need physical therapy i want to see how many times that's actually been denied or if it's been reduced by the pcp or changed in any way we could definitely pull that we could
Speaker 18
21:58
pull the we could pull the utilization when we had that developmental screen in place and then pull when we switched because that was a fear of the
providers only changed it for EIDT that they
Speaker 42
22:08
were going to tighten. The doctor was not going to sign them. Yeah, but the doctors
Senator Missy Irvin
Unverified
22:14
are so busy during the day and they're there to treat, you know, heart attacks. I
mean, I'm just, we just need to understand what people's roles are. And I just don't want to put somebody in a position where they're just signing something and they're not really, because they don't have enough time in the day and they're not making enough, family practice doctors are not making enough money for them to be able to spend that low i'm just telling
you like that's you it's an impossible situation they're seeing 40 patients a day just to cover overhead generally because they're dealing with medicaid i mean i can go down the whole rabbit hole but i'm just saying i we need to think through this a little bit thanks thanks senator All
right, we do have several members in the queue. We'll ask that you keep your questions concise and on topic. Representative Moore, you're recognized. Thank you, Mr. Chair.
I just have a motion at the proper time. Okay,
Representative Mary Bentley
Unverified
23:19
I'll come back to you on your motion. Representative Bentley. Thank you, Chairman. Thank you all for being here today. So I distinctly remember getting multiple phone calls of people so frustrated when we moved to Optum. So I guess my red light's going up. I haven't had a phone call in a long time. Things are going smooth. So why do we want to change it? I guess that's my heartache at this point because I remember so many phone calls, people being so frustrated. So can you just kind of clarify for me real quick?
So we're going to go, are you going to use the
Speaker 67
23:46
PCP in there during an office visit or are we still going to have someone come out to the
Speaker 18
23:53
home? I'm sorry. Can you go over the process for me again real quick? Yes, ma'am. And we still get a frustration calls, Jay and I do for sure, more from providers because they feel like it's having to schedule the Optima A and then the timeline for when they go out and that they think it's delaying treatment for when the personal care providers can get in there.
But I agree with you, it has died down substantial since we implemented it. It's going to work just like adult
Speaker 26
24:21
developmental day treatment is a good example. So going, oh, thank you. We have a PowerPoint on this as well. So, yeah, this is great. Okay, so DCO will still determine whether or not somebody meets Medicaid eligibility. That's not changing at
Speaker 18
24:40
all, right, just like they do today. The beneficiary reaches out to a personal care provider, as they do today, right,
asking um for the service um they will then need to um discuss with their pcp and have the pcp complete the evaluation referral and that evaluation referral um it goes back to the provider like it does for the adet and then that provider sends out a registered nurse to do an assessment that's
Speaker 42
25:10
routed back to the physician um to determine whether or not a prescription is warranted okay um follow up that's
Representative Mary Bentley
Unverified
25:21
okay chairman um so I guess I'm concerned
there because I just know what it takes to get a physician's appointment right so it could be three months before they even have time to be able to um to get in to see the physician to get that filled out I guess that's my concern there um and I appreciate you guys bringing before we can look at this today so why are we moving it from from you guys over to
Speaker 36
25:45
Department of Health can you answer that question for me that occurred during this session um you know before um this last session what they you would go to department of health and you'd get a private care agency license and you'd bring that over to our division of provider a dip squad and uh they would do a
Speaker 18
26:02
certification it was overly burdensome and it needed to go one way or the other okay and it went that way
Speaker 71
26:08
thank you for that that's all my questions
for now chairman so i do want to clarify something so currently Optum is sending someone out to do that assessment correct yes okay and they're being paid for that through this contract so if we refer that back to the PCP's office are they going to be able to bill to send a nurse
Representative Mindy McAlindon
Unverified
26:27
to do that assessment so it's not the PCP sending a nurse um they fill out the value the
Speaker 18
26:33
PCP will fill out the evaluation which basically just
It's a primary diagnosis and suspected deficit, right? Like this person cannot walk. This person cannot go to the bathroom on their own. Things that will qualify you for personal care services. And this is sent back to the personal care provider. They send out one of their registered nurses. And we've developed a standardized required tool. So all the personal care providers are using the same assessment tool. So
Speaker 59
26:58
we're actually mandating what's utilized. So right now, I just want to make sure I
understand, right now an independent nurse is being sent out for an evaluation.
If this rule goes into effect, the person that's wanting to bill the service will send a nurse out to evaluate whether
Speaker 18
27:17
someone qualifies for their service? So right now, Optum sends a nurse out, and they bill us for that, and they determine whether or not they're eligible. It goes to the personal care provider. They then, too, send a nurse out to do their own assessment. Right. And then, right, and so you're eliminating the opt-in assessment that's determining
Speaker 49
27:38
eligibility and asking that the PCP be the gatekeeper for that function.
Okay. I think that I would refer back to Senator Irvin's comments earlier that I don't know that they would have time to adequately do that. But we'll move on through the queue. Representative Pilkington, you're recognized for a question. Thank
Representative Aaron Pilkington
Unverified
27:55
you. And that current discussion, though, I just want to make sure I clarify. So we're going from three assessments down to two assessments with a PCP being the gatekeeper. Is that right? Was I following that along correctly? Yes, sir. So we're reducing some of the red tape. Okay. The other thing, and this is what I was curious about, just so I understand this financial impact correctly.
So we say next year we'll save around $6 million, $3 million in general revenue, $3 million in federal funds, and then another $3 million, bringing a total of $9 million in municipal government, state, county. So we've got a total of $9 million next year in savings for the taxpayer if we pass this rule. Am I understanding that financial impact correctly, or
Speaker 26
28:39
is that wrong? The financial impact, I've got to find the
Speaker 18
28:44
form. The financial impact, we are estimating a projection that will save $6.173 million.
And that's just based on, again, eliminating this part of the Optum contract. And then also right now, we're paying a vendor, Accentra, to do prior authorizations multiple times in a year, and we're going to move it to 12 months. Gotcha. No, I see where I got confused on. So
Representative Aaron Pilkington
Unverified
29:06
it's a $6 million savings around that. Okay, gotcha. I see where I double-edited a number. Okay. But if we do nothing, we're
still going to pay another $6 million next year, which will be no savings to the taxpayer if we do nothing on this rule, and keeping the extra red tape on. Am I understanding this correctly?
Senator Missy Irvin
Unverified
29:23
Yes. Okay, thank you. Mr. Chair. There's a difference between red tape and a personal care agency sending their own nurse out to do an
assessment for a service that they're going to get paid for. You are letting the personal care agency nurse send out, go out to do the assessment. And you don't see a problem with that. That's not eliminating red tape. That's not an independent assessment.
That is the fox guarding the hen house. i mean that's the way i see that and so i take a lot i see that you're saying that there's going to be savings in the opt-in contract i get that and prior authorization whatever but i don't know why you can't go ahead and have done that already and streamline your current process with your own contracted vendor i don't understand why you're having to have a complete rule change
when you have a contract with a vendor and if it's not working why didn't you go to the vendor and say you have the ability to do that because I have been all through procurement you have the ability to do that with your vendor and say this isn't working we need to find cost savings and we need to redo this process within this contract you have the ability to do that why didn't you do that you could have canceled that part of the contract and you could have said
we're going to create a new process that eliminates this and saves us money and
continue to have an independent process assessment with a new rfp why didn't you do that
Speaker 18
31:07
yes um well a couple of reasons number one it's not federally required and it the current one is not doing what we anticipate it doing and again trying to align it with how we are performing our other services outside of our waivers in our past program so we're mimicking the same process with with this
iteration that would that was just the route that that we went um to try to streamline our state plan services and how we try to operationalize them the same way
Senator Missy Irvin
Unverified
31:41
okay again i i i will accept that as your answer I don't agree with it because I think that we could have been a little bit more thinking forward and change what we were doing and maintaining independent assessment the health
care reform task force worked incredibly hard to get us to an independent assessment approach and it feels like today we are throwing all of that work out the window and I and I was here for that. And we spent a lot of time trying to figure out to get savings through the Medicaid program and savings to state general revenue. And so I'm not willing, I don't think that that's appropriate and the right thing to do. And I think you're taking advantage of PCPs and you're
exploiting them and you're turning them into social workers, which they are not, and they don't have the time to do that. And they don't have, they don't get paid to do this extra work for you to be gatekeepers. They don't get paid for that. They get paid according to your billing of Medicaid for what they come in for, RSV, a cough, a cold, whatever it is. That's all they get paid for. And you're putting these people in the middle of something, a nurse practitioner or
a physician that has no business doing that. And yes, they have a business treating them in health care but again personal care is completely different and they they are not the appropriate person to pursue that or to be that gatekeeper they just are not and and I think that you're exploiting them and you're putting them in the middle of something and I for one am not for that and I I think you've got to rethink your approach here. Thanks Senator. Senator Sullivan you're
Senator Dan Sullivan
Unverified
33:31
recognize for a question thank you mr. chair and chair urban I appreciate those comments they were spot-on it seems like in my years with this we have bounced back and forth between PCPs internal audits internal approval we do we try one and then we it doesn't work we try something else and none of them seem to work so how much confidence do you have if this goes forward today that this is going to work
Speaker 26
34:04
even though we've tried this before so i totally agree with you before we went into the utilizing the optum ia we had uh what was called the 618 which is a physician prescription yeah i've been through it
Senator Dan Sullivan
Unverified
34:17
all right i'm just asking you for a real simple answer how much confidence do you have that this is going to work so i don't think it's uh just
Speaker 68
34:25
this rule today i i think i started with that this is gonna this is
Speaker 53
34:29
gonna have to be a multi-faceted approach to control the utilization of personal care all right let me try one more time it's a multi-faceted approach
Senator Dan Sullivan
Unverified
34:39
we all get it it's going to take multiple changes if we continue down that timeline and that that plan how much confidence do you have that this is going to work even though we've done this before and tried it similar, how much confidence do you have it's going to work? I believe it will control utilization. Okay. And, Mr. Chair, I think the same thing is I'm really concerned about this PASS effort. This is the same thing. Is this part of the PASS? Are these groups part of the PASS?
Speaker 49
35:11
No. No. This is the manual that would do people outside of
Senator Dan Sullivan
Unverified
35:15
the PASS. Okay, well, Mr. Chair, I think PASS is do the same deep dive to look about how effective it is. We've had it for years. The initial reason that we did it was very clear that we have an audit that says, yes, what we originally intended has achieved. And I make that recommendation to the chair. I appreciate it. I'm not on the committee but been involved in this for a number of years.
Thank you. Thank you, Senator. I appreciate that, and I'll reiterate and ask for that as well in order of that system just to see kind of that effectiveness. That kind of goes back to the question that I was going to lead with after Senator Irvin's question. You know, to your point, this is a multifaceted approach. I think I want to better understand the methodical process that got us here today. So why this? Why this change? Where have we been? We now have identified that that's not working. how did we identify that and what are the processes that you've utilized the steps that
you have put in place to say that this is what's going to solve that problem because i agree with senator sullivan senator ervin and in the fact that it seems like we have bounced back and forth we've utilized pcps we've utilized an independent assessment now we're going back to pcps well if it didn't work the first time and we're now bouncing back to that what makes us think or what confidence can we have that it's going to work this second time so i think that's a fair request and i'd make that request of you in the agency as well to give us a snapshot or a look back at that to help us better understand why this is going to be a solution representative
Representative Denise Jones Ennett
Unverified
36:50
in it you're recognized for a question thank you
thank you mr chair i have a question so i'm confused um so i i am a parent who has a son with idd and he's on the waiver and so i'm familiar with some of this so how does this work for a parent that's coming into the system uh how was how would this affect them
Representative Jack Ladyman
Unverified
37:16
so representative in it so your son would be in a pass and say these
Representative Mindy McAlindon
Unverified
37:21
rules do not apply they're they're you know a managed care entity and they set up their own rules they have a
Speaker 18
37:28
very similar process in place to what you have before where
Speaker 42
37:33
they've reinserted primary care practitioners into approving personal care under
Representative Denise Jones Ennett
Unverified
37:37
the PASS program. But moving forward, the new rule change, how would that affect somebody that's coming
Speaker 18
37:44
into the system? It won't. I mean, you come in, you are deemed eligible in one of our various Medicaid eligibility categories,
And then you'd have to, you know, show that you meet the medical criteria to get personal care, just like it is today.
Representative Denise Jones Ennett
Unverified
38:00
So with this new rule change, will it delay services? We
Speaker 18
38:04
believe it will. No, we do not think this will delay services with this
Representative Denise Jones Ennett
Unverified
38:09
rule change. So because I'm familiar with having to wait for a referral and, you know, from the doctors and all this and that. So if I'm a new parent and I'm signing up for these programs, it's not going to delay me getting diagnosis for my child with the new rule changes.
Chair
Unverified
38:28
It should not. Okay, thank you. Senator Payton,
Senator John Payton
Unverified
38:36
you're recognized for a question. Thank you, Mr. Chair. So obviously every time we have a rule change or something suggested, there's pros and cons, and we're trying to weigh the pros and the cons. I appreciate a lot of the questions and, and concerns. My question is we always, you know, one of the most important pros and cons is the fiscal impact. And I look at the fiscal impact and it says that it will result in a reduction
of cost, total reduction of cost is, and now based on the questions, I question whether or not you took into consideration both sides of the equation when you stated these cost savings so are these cost savings stated in the financial impact solely based on the elimination of the of the contract or or does it take into consideration both of you mentioned training the PCPs is is that money considered in the financial impact
Speaker 26
39:37
the money we're going to spend training no it's not in here because we already have a contract with afmc who does training for our pcps
Speaker 49
39:44
where we were developing a training curriculum that falls under a current cost in a current contract they already have to do that work for us
Senator John Payton
Unverified
39:51
okay and do we have any data on the financial impact to the pcps like senator ervin's talking about the pcp is going to send their own personnel spend their own time trying to do the vetting here do we have any sense of what that financial impact is going to be that is not included in here no sir okay
would it be reasonable to think that it's going to cost them as much as it does the state to to
Speaker 36
40:21
perform the same duty so we just to clarify we're not asking the pcp to do an assessment a independent
Speaker 18
40:27
assessment in the client's home we're asking them to um specify that they think the client needs personal care because again they can't go to the bathroom or they can't feed themselves or they can't walk um to say yes there's something wrong um and they need this
service that medicaid pays for to help them um then the assessment is outside of that office it's sent back to them for review and then we would ask them to sign a 12-month prescription okay well i thought i heard you say that somebody was going to send a registered nurse out there or primary care nurse
Senator John Payton
Unverified
40:56
out there so the personal care provider would be responsible for doing that. Are they currently responsible for doing that? They do. So that's not an added burden. No,
Speaker 49
41:03
sir. Okay, thank you. Thank you, Mr. Chair. Thank you, Senator. Representative
Representative Aaron Pilkington
Unverified
41:16
Pilkington, you're recognized for a question. Thank you. I'm a little confused. There's been so much mixing of metaphors here. I have lost track. So on the one hand, I'm hearing we're taking advantage of these poor PCPs and this is an undue burden. And then two seconds later, I hear that it's the fox guarding the hen house um so which one is it i mean i'm confused by those statements but the additional thing is why are we already i guess my real question though too is why are we already paying for training of these providers with an afmc contract if they're not doing it
right now i mean so i'm confused by that so you help
Speaker 18
41:56
me clarify absolutely so it's my understanding through the contract they um they do lunch and learns for our pcps on a monthly basis and the top and we get to share what topics we would like for afmc to do in those lunch and learns and we're going to add this to their curriculum so it's ongoing training they already do with pcps and then we get the opportunity through our contract to give suggestions and and tell them what we want people trained
Representative Aaron Pilkington
Unverified
42:19
on gotcha and okay i appreciate that and thank you for uh clarifying it thank you
sir uh representative ladyman you're recognized for a question thank you mr chairman um yeah
Representative Jack Ladyman
Unverified
42:31
there's been a lot of talk here some of it i don't understand but a lot of it comes from people that are in the business i'm not in the business so i'm outside the business a common person looking at this so the savings does that come from eliminating a step in the process that's where the savings come from yes sir
it comes from eliminating two steps or two things not two steps that's not that's
Speaker 18
43:00
so it it comes from removing it from the opt-in contract um because like i think i mentioned we use it's like 497 dollars and change um that we pay them to to determine whether or not someone's eligible for personal care right now and then second right now we pay a centra our utilization management vendor to do a prior authorization every six months which is different from how we do any other
Speaker 36
43:29
service the rest of our services that have prior authorizations are 12-month
Representative Jack Ladyman
Unverified
43:35
prior authorizations so we would be eliminating a process which would give us savings which we're always looking for but we don't want to reduce the service that's needed so we're not putting any additional requirements on anyone hard requirements is that right well the personal care providers would tell you that
Speaker 59
43:58
we are putting many additional requirements I'm not talking about the personal care I'm
Representative Jack Ladyman
Unverified
44:02
not talking about their opinion in writing we're not requiring them to
Speaker 18
44:08
do anything else or are we so we're significantly tight tightening who will we want a very clear this is the you know this is the diagnosis the individual this is their deficit on why they should get personal care and tie those two things together part of what we were seeing over the last couple of years and many of you guys had conversations with us about this was that we were seeing personal care being um provided to people that did not have
uh an adl deficit meaning they could walk feed shower right um and and it was um the service was um in many cases being kind of misused or filled in when it should have been something else and so that was mainly happening under our past program and that's when they went in and we worked with them to
Representative Jack Ladyman
Unverified
45:05
change their process um all right uh so i mean if this is not working if it's not helping the current process then what i don't understand why we'd keep we keep doing the same thing we're
doing and why not why we would not make improvements and in your opinion you think this would be an improvement to the system is that right
Senator Missy Irvin
Unverified
45:32
we do okay thank you um could you get for me how many times that you've
had conversations with optum uh in the last six years about this independent assessment process and the PA process. I want to know how many times you tried to work with your vendor to change the process when you saw utilization continue to increase. Do you know
how many times you've done that with Optum? Have you, how many conversations, negotiations have you had with them about changing the process when you've seen utilization increase? No,
Speaker 26
46:07
I will be completely honest. No, we are not having conversations.
Speaker 18
46:12
We have not had conversations about them doing something different with the tool for personal care. Our entire direction since probably the summer of 24 has been developing a process outside of them completely.
I mean, I'll be completely frank. We have never asked them to change the tool. That's the problem. you were in
Senator Missy Irvin
Unverified
46:36
a contract and for six years you saw utilization increase and you had zero conversation with the vendor about how to change the process or the independent assessment of what they were doing when you had the ability to manage that contract and that rfp and utilize the independent assessment to provide savings i know for a fact because i have talked
talked to Optum several times over the last six years about different things. I know for a fact that they would have
absolutely gone and engaged with you on that and that they had savings because they shared them with me. So that's what I don't understand. And that's where I find that this is not appropriate. I'm not willing to go forward and do a complete wholesale change when that never occurred because you're because that should have been part of the thinking that
should have been part of the process with DHS in your office you have a
contract you have an independent assessment the health care reform task force was adamant about independent assessment at that time
we were adamant about that nobody with a financial interest making the assessment that's why that was put in place if the personal care agency they have a financial interest they're doing the assessment how is that not a conflict of interest there is that's why the
health care reform task force said independent assessment should absolutely be utilized and in that process if you see we've put in an independent process assessment through this contract and but in six years you never had a conversation with them about well something seems to not be working here let's figure this out because the legislature was adamant for independent assessment this isn't working maybe the way it needs to be working what do we need to do differently here you never had that conversation with them and so that's where my frustration is is because I absolutely and people
can say whatever they want to say I live with a family practice physician I know how many patients say C. And somehow I've explained this to DHS and you don't listen to me. And that's fine. You don't have to listen to me. But I am telling you, my husband's not going to deny a patient and his family to sign off on a form when the personal care agency's telling them which diagnostic code that they need to fill in. That is happening. Because they don't have the time to go and do
their own assessment and that's their name that they're signing to this okay I put apart however much money they're not going to be able to recoup on the administrative part of all of that maybe that's not important but their name is important and when they're signing something they want to make sure that they're signing off on something that's true and that's not fraudulent okay you know how many teachers say bring your kid to the doctor because Johnny can't sit in his seat all day long needs ADHD medicine you know the amount of pressure that's put on that PCP from the parents
and the teachers and everything because this little boy just can't sit still for five you know eight hours a day and they're pushing for medication pushing for medication and guess what if Dr. So-and-so doesn't prescribe it they're just going to go to this doctor and so you there's got to be some some understanding of reality here of what is actually happening with PCPs in the state of Arkansas and how they interact with patients and y'all don't seem to understand that and you don't seem to listen to us and you don't seem to listen to the legislature when we spent so much
time in the health care reform task force I've asked you to slow down on this weeks ago I asked you to do that and get back with me you didn't do it Sandra I've asked for that I apologize and I I did not so today I am upset because I thought we were at a point where my input was like we could sit down and talk through this and figure out what the right approach is before we got to here today but we're we're not here when I apologize I I would like for y'all to pull this
down and let's work on this with the legislature so that we have a good plan and a good approach going forward where we can do all these things where we can save money for the state of Arkansas where we can provide appropriate personal care services for individuals where we can make sure people are not put in a bad position to sign something that could be fraudulent because it's being completed and filled out by the personal care agencies and it's just put in front of them and they're seeing 40 patients and three of them that came in this morning are all having cardiac
arrests and they come to the clinic instead of to the er because that shit happens right now every day and you're not thinking about the pcps you're not thinking about these nurse practitioners We had a nurse practitioner that sent me a picture and said, what do I do? A patient presented with an incredible tumor in the palate of their mouth. Are they going to spend their time trying to make sure that this person doesn't have an incredible life-threatening event because of a tumor that's in the hard palate of their mouth and that they've sent to another doctor for help?
or are they going to be a gatekeeper for personal care service so that we can hire somebody to come and clean their home for them? So I'm very frustrated, and I'm going to stop right here. My suggestion to the chair is that we not proceed. Thank you, Senator. I'm going
to give the agency an option. Do you want to pull this down, work with Senator Irvin, Senator Wallace, Representative Wardlaw and myself, off record,
and let's see if we can get a rule back that
Representative Jack Ladyman
Unverified
52:38
everyone agrees on. Of course, and thank you for the opportunity
to do so. That sounds good. Thank you very much. There's no further business. With that, we're adjourned.
Agenda
A. Call to Order
B. Consideration to Approve the December 8, 2025, Meeting Minutes [Exhibit B]
C. Consideration for Adoption of Interim Study Proposals (ISP) [Exhibit C1-C2]
D. Department of Human Services (DHS), Division of Aging, Adult, and Behavioral Health Services, Review of Rule, Updates to the Personal Care and Arkansas Independent Assessment Provider Manuals [Exhibit D]
E. Other Business
F. Adjournment
Documents
Speakers
Representative Jeff Wardlaw
Unverified
Deborah Inman
Unverified
Representative Jack Ladyman
Unverified
Speaker 17
Speaker 16
Speaker 26
Speaker 18
Speaker 19
Representative Jeremy Wooldridge Chair
Unverified
Senator Missy Irvin
Unverified
Speaker 40
Speaker 36
Representative Mindy McAlindon
Unverified
Speaker 42
Representative Mary Bentley
Unverified
Speaker 67
Speaker 71
Speaker 59
Speaker 49
Representative Aaron Pilkington
Unverified
Senator Dan Sullivan
Unverified
Speaker 68
Speaker 53
Representative Denise Jones Ennett
Unverified
Chair
Unverified
Senator John Payton
Unverified