Public Health Welfare and Labor Committee-Senate and House
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- October 2, 2026
Representative Jeff Wardlaw
Unverified
0:36
Representative Starmel, you mind open this up with prayer Thank youpresentative emb ers have a motion to approve
amendments from the December 8 meeting a motion of second all those in favor sayy 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 andvi subcommittees Do I have a motion to adopt them and accept the recommendations of the chair have a motion have a second all those in favor sayy aye
all'll post eyes have it item C will be referred to both items to labor andvi subcommittee with that we'll move on to item D be looking for Jay Hill and Melissa Weatherford. Wetherton and deborah Iyman
if you guys would introduce yourself for the committee and you are recognized to
Deborah Inman
Unverified
2:24
present your room. Hi, my name's Deborah Inmann I'm an assistant director of aging at the Arkansas Department
Representative Jack Ladyman
Unverified
2:32
of Human Services it's nice to meet y'all. Hey good afternoon Melissa Weatherton director of medicaidpecialtyulations at Department of Human Services.
Speaker 17
2:40
andJ hill division director for aggingulthavior healthalthervices at DHS. thank you Mr Chairman
we are presenting to you today revisions for two manuals at the agency the state planned personal care manual and then the state's Arkansasndependent assessment manual or the ARIA manual you may have apologies can you hear me ok now we are presenting to you to revise two manuals these Arkansas Statelanersonal Care manual and our Arkansasendent assessment manual the ARA 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 in 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 were necessary yes so I didn't do my homework
Representative Jeff Wardlaw
Unverified
3:44
and read the agenda and noticed that
this was a personal care item since I work and have worked in the personal care field I'm gonna let Representativeoolridge
Speaker 17
4:00
chair this meeting from here sir Feel free to continue thank you sir secondly this the revision of the personal care manual will implement Act853 of the the previous general session 2025 which will move licenger 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 planned 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 planned personal care it will transition from a single assessment tool which we currently use the opptum our opptum contractor to perform the Arkansasend assessment and replacing it with
a more functional assessment tool it will remove the independent assessment contractor from that process as I mentioned and reassigned 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 perspective beneficiary it will also lengthen the prior authorization process which is currently at6 months so every6
months we're issuing a new PA to a be 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 of64 hours per month of services which is what has been traditional under our state plan our revisions to the Arkansasndependent assessment
manual will remove references to state planned 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 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 RE 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 Pas programme that align with the current pass 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 Arkansas the ARhoices program
the Lihos program these are two HCbS waiver services and the pace program program for all inclusive care for the elderly which do run
Speaker 16
7:02
out of the aging division. with that happy to
Speaker 26
7:06
take any questions and if I can just addds representativewooldridge a a few items it's been pretty recognize yourself
Speaker 18
7:13
for the record if you've not already I'm sorry Melissa Weatherton 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
this is a service that we provide through Medicaid but it's also a service that's paid for by the passes the passes went to a very similar system to what we're trying to set up now which is reinserting physician and APR 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 so for school
age 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 we did work with other agencies as well as extensive stakeholder engagement since June of 24 to 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 ling utilization. so the opptimependent 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 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 and those forms we no longer have to promulgate those forms but it did 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 the 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 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 questions thank you ma'am
Speaker 19
10:21
we 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's 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 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 costs so other than saving the cost of the contract how else are we saving cost or controlling cost in a growing field so would
Speaker 18
11:22
say yes I do think that if it initially was controlling costs in the personal care field using the opptimum independence assessment that we're no longer seeing those the cost
effectiveness of that tool for this population it's required right now under opptim contract that we use a registered in ourris which is highly expensive. we're paying about497 dollars per assessment. they are receiving those annually and like I mentioned earlier, the percentage of people who go through it 95% are approved for the service. so we're looking at a an arsenal of different things. one of them is brought to you today but we're also
rewriting right now how we do our utilization management contract right now we're using a centre but a new RfP has been out on the street and it's gonna be awarded and in that we're asking for a lot more detail in 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 umpresentative Booldrier is correct. there's a there's a federal reg that requires an independent third party 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 and we don't we're no longer seeing the benefit of utilizing that cost. 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 cau 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 are needed and assessed appropriately so thank you for that and we're gonna go I wanna recognize the chair, the senate chair of public health
Senator Missy Irvin
Unverified
13:59
thank you sorry I was late. appreciate it yeah I think for me,
I need to understand again when was the decision made to decision to do this not through waiver but through state plan. it's always been that way yeah it's been
Representative Jack Ladyman
Unverified
14:16
that way since I've since I've been there. OK. but at one time we did study this
Speaker 40
14:23
through the healthcare reform task force, correct? I believe it was in the aging yeah when we looked at all the aging programs as well as
Speaker 18
14:30
behavioral health and the recommendation at that time was to tear it the recommendation at that time
for personal care was to put an independent third party in place to determine eligibility and that's when we asked Optim to step in and do a tool to determine whether or not someone should get personal care and that's
Senator Missy Irvin
Unverified
14:52
what we've been doing ever since OK and on ok and so OK. so have have how many times has that opptum contract been up for RfP?
Speaker 18
15:07
goodness. don't I don't know that we've hit our seven years on that contract. I don't think it's come back or
Speaker 36
15:16
I don't think we've put out an RfP I think the initial one was during the task force and we have not hit our
Senator Missy Irvin
Unverified
15:24
seven year mark. and so you're saying here you're saying today there's issues with that assessment I don't know that there's necessarily issues with
Representative Mindy McAlindon
Unverified
15:32
the assessment. we use the you know we do assessments for the aging
Speaker 18
15:37
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 in the dd space in 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 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 this band it is just increasing year over year and again I mentioned at the very beginning we also were seeing some significant issues and there's there's been ongoing investigation s in this space on the on for our past clients getting personal care inappropriately
and so they moved when that started happening they moved to this method of back to requiring a doctor prescription and they are seeing substantial improvements of now that we've reinserted the pcp back into the process. OK so I just want to talk with you about
Senator Missy Irvin
Unverified
16:55
that for a second and I know we've got other people in the queue wanting questions but requiring the doctor is the pcp Family doctors are not social workers. OK? they provide healthcare OK? 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 OK? 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 patience 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 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 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 patient's families that are pushing hard for it or the personal care providers you know who will who who will be that and that could be exploitative
to the pcPs and I I am a little concerned about that and so've I've voiced those concerns you know, to your agency offline 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 band-aid on a person if the band-aid 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 first have y'all thought
Speaker 18
20:28
about that? We we we did talk about that the reason that we have gone this route is because this is a state planned service and we are treating it like we have been trans 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, we're mimick they're all state planned 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 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 you have any data and this will be my last question and'll let you go to everybody
Senator Missy Irvin
Unverified
21:19
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 isn't denied by the pcps? do we do we have data that shows
that the therapy has been denied and I don't have it like I can pull that let's look at that because I wanna 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 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
Speaker 18
22:03
that we could 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 EiddT that they
Speaker 42
22:13
were gonna tighten the doctor was not going to sign them so yeah but the doctors are so
Senator Missy Irvin
Unverified
22:21
busy during the day and they're there to treat you know
heart attacks I mean yeah I'm 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 I'm just telling you like that's the you
it's an impossible situation. they're seeing40 patients a day just to cover overhead generally because they're dealing with medicaid I mean I could go down the whole rabbit hole but I'm just saying that we need to think through this a little bit. Thanks. thanks senator. right we do have several
members in the queue we'll ask that you keep your questions concise and and on topic uhpresentative Moore you're recognized thank you Mr Chair. I just have a motion at the proper time. OK,
Representative Kendra Moore
Unverified
23:17
I'll come back to you on your motion Representative Bentley
Representative Mary Bentley
Unverified
23:23
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 opptum so I guess my red light's going up I haven't had a phone call in a long time.hings are going smooth so why do we want to change it? I guess that's my 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 gonna go we're gonna use the pcp in there during an office visit or are we
Speaker 67
23:54
still gonna have someone come out to the home? I'm sorry can
Speaker 18
23:58
you go over the process for me again real quick. ma'am and and we we still get a frustrating frustration calls uhjay and I do for sure morere from providers because it they feel like it's having to schedule the oppti my A and then the timeline for when they go out and they think it's delaying treatment for when the personal care providers can get in there but I'll agree with you it has died down substantial. since we
implemented it. it's gonna work just like adult
Speaker 26
24:26
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. OK so DCO will still determine whether or not somebody meets medicaid eligibility. that's not changing at all, right?
Speaker 18
24:45
just like they do today. The beneficiary reaches out to a personal care provider as they do today, right? asking
for the service they will then need to discuss with their pcp and have the pcp complete the evaluation referral and that evaluation referral, it goes back to the provider like it does for the AdT and then that provider sends out a registered nurse to do an assessment
Speaker 42
25:15
that's routed back to the physician to determine whether or not a prescription is warranted. OK follow this OKok chairman. so
Representative Mary Bentley
Unverified
25:29
I guess I'm concerned there because I just know what it takes to get a a a physician's appointment right? so it could be three months before they even have time to be able to to get in to see the physician to get that filled out I guess that's my concern there 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 Department of Health can you
Speaker 36
25:50
answer that question for me that occurred during this session you know before this last session what they you would go to the department of healthalth and you'd get a private care agency
license and you'd bring that over to our division of provider a dip squaw and they would do a certification.
Speaker 18
26:05
it was overly burdensome and it needed to go one way or the other and it went that way. thank you for that that's all my
Speaker 71
26:13
questions for now, chairman. So I do want to
clarify something so currently Optim is sending someone out to do that assessment correct ok 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
Representative Mindy McAlindon
Unverified
26:30
to bill to send a nurse to do that assessment? so it's not the pcp sending
Speaker 18
26:38
a nurse they fill out the evalu the pcp will fill out the evaluation which basically just it's a primary diagnosis in suspected deficit right like this person cannot walk, this person cannot go to the bathroom on their own. things that would 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
Speaker 59
27:03
the same assessment tool so we're we're 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 build the service will send a nurse out to evaluate whether someone qualifies for their service. So
Speaker 18
27:22
right now Optim 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 and then right and so you're eliminating the optimum assessment that's determining eligibility and asking that the pcp be the gatekeeper for that function.
Speaker 49
27:43
I think that I would refer back to Senator Irvin's comments earlier
that that I don't know that they would have time to adequately do that but we'll move on to the key Representative Peilkington to recognize for a question
Representative Aaron Pilkington
Unverified
28:01
thank 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 iss that right? Wa I following that along correctly? sir so we're reducing some of the red tape the other thing and this is what I was was curious about just so I understand this financial impact correctly. so we say next year we'll save around6 million dollars,3 million dollars in general revenue,3 million federal funds in another and another3 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
28:44
is that wrong? The financial I'm got to find the form
Speaker 18
28:49
the financial impact we are estimating a projection that will save6.173 million. And that's just based on again eliminating this part of the optimum contract and then also right now we're paying a vendor
Ecentra to do prior authorizations multiple times in a year and we're gonna move it to 12 months Go you no I see where
Representative Aaron Pilkington
Unverified
29:11
I got confused on so it's a6 million dollars savings around that ok gotcha I see where I I doublelighted a number. OK. but if
we do nothing we're still going to pay another6 million dollars next year which will be no savings to the taxpayer if we do nothing on this rule and keeping the extra red tape on is that am I understanding this correctly
Senator Missy Irvin
Unverified
29:30
ok thank you 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 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 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 opptum 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 pro
assessment with a new RfP why didn't you do
Speaker 18
31:12
that Yes well a couple of reasons.umber one it's not federally required and the current one is not doing what we anticipated doing and again trying to align it with how we are performing our other services outside of our waivers and our pass programme so we're mimicking the same process with with this iteration that was that was just the route that that we went to try to
streamline our state plan services and how we try to operationalize them
Senator Missy Irvin
Unverified
31:46
the same way ok again 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 and 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 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 pee a nurse practitioner or a physician that has no business doing that and yes they have a business doing treating them in
healthcare 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 am not for that. And I and I think you've got to rethink your approach here. thank you senator Senatorulllivan you're recognized for a question thank
you Mr Chair and chairir Irvin I appreciate those
Senator Dan Sullivan
Unverified
33:43
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 seemed to work so how much confidence do you have if this goes forward today that this is going to work even though we've tried this before so I I totally agree with you
Speaker 26
34:15
before we went into the utilizing the opptim IA we had what was called the618 which was a physician prescription've been through it all right I'm
Senator Dan Sullivan
Unverified
34:22
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 just
Speaker 68
34:30
this rule today I think I started with that this is gonna this
Speaker 53
34:34
is gonna have to be a multifaceted approach to control the utilization of personal care. let me try one more time it '
Senator Dan Sullivan
Unverified
34:42
s a multifaceted approach we all get it it's gonna 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 gonna work? I believe it will control utilization and Mr Chair I think the same thing is I'm really concerned about this past effort this is the same thing is this part of the past are these groups part of the past this is no this is the manual
Senator Dan Sullivan
Unverified
35:20
pair I think passes 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 and we that we have an audit that says yes what we had originally intended has achieved and I'd 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 and I'll reiterate and ask for that as well and audit of that system just to see kind of that effectiveness that kind of goes back to the question that I was gonna lead with after Senator Irvin's question you know you 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
realize 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 Irvin and and 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 gonna work the second time so I think that's a fair request and I'd make that request of you and the agency as well to give us a snaps ho t or a or a look back at that
to help us better understand why this is going to be a solution Representative Bennett you're recognized
Representative Denise Jones Ennett
Unverified
36:59
for a question hang on thank you Mr Chair.
I'm have a question so I'm confused so I am a parent who has a son with an 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 how was how would this affect them representative in
Representative Mindy McAlindon
Unverified
37:24
your son would be in a pass and say these rules do not apply they're they're you know a managed care entity and they set up their own
Speaker 18
37:33
rules. they have a very similar process in place to what you have before
Speaker 42
37:38
where they've reinserted primary care practitioners into approving personal care under
Representative Denise Jones Ennett
Unverified
37:42
the past program but moving forward have the new rule change how would that affect somebody that's coming into the system.
Speaker 18
37:49
It it won't. I mean you come in you get 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. So with this new rule change will
Representative Denise Jones Ennett
Unverified
38:05
it delay services we believe it will no we do not
Speaker 18
38:09
think that this will delay services with this rule change. so because I'm familiar with
Representative Denise Jones Ennett
Unverified
38:14
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 it should not OK thank
Chair
Unverified
38:33
you Senatoreyton you're recognized for a question.
Senator John Payton
Unverified
38:41
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 costs total reduction of cost is and now based on the questions I've I questioned 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 the money we're going to spend training? No, it's not in
Speaker 26
39:43
here because we already have a contract with AFMC who does training for our pcps where we were developing a training
Speaker 49
39:49
curriculum that falls under a current cost in a current contract. they already have to do that work for us and do
Senator John Payton
Unverified
39:56
we have any data on the financial impact to
the pcps like Senator Irvin'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 would it be reasonable to think that it's gonna cost them as much as it does the state to to perform
Speaker 36
40:26
the same duty So we just to clarify we're not asking the pcp to do an assessment an independent assessment in the client's home
Speaker 18
40:35
we're asking them to 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 to say yes there's something wrong and they need this service that medicaid pays for to help them then the assessment is outside of that office the it's sent back to them for a review and then we would ask them to sign a 12 month prescription OK, well I thought I heard you
Senator John Payton
Unverified
41:01
say that somebody was going to send a registered nurse out there
Speaker 49
41:07
primary care nurse out there so the personal care provider would be responsible for
doing that they currently responsible for doing that? They do so it's not an
Representative Aaron Pilkington
Unverified
41:23
added burden thank you thank you Mr Cha. thank you senator Representative Pilkington you're recognized for a question thank you and a little confused there's been so much mixing of metaphors here. I I 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 henhouse
so which one is it? I mean I'm I'm confused about those statements but the additional thing is why were 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 our I'm confused
by that so you helped me clarify that so it's
Speaker 18
42:01
my understanding that the contract they 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
Representative Aaron Pilkington
Unverified
42:24
trained on appreciate that and thank you for clarifying it. thank you sir uhpresentative ladyman you're
recognized for a question. Thank you Mr Chairman yeah there's been a lot of talk here and some
Representative Jack Ladyman
Unverified
42:36
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 umm outside the business 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 it comes for eliminating two steps or two things not two
Speaker 18
43:03
steps that's not that's so it it comes from removing it from the opptim contract. because like
I think I mentioned we we use it's like497 dollars and change but 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 every6 months. um, which is different from how we do any other service the rest of our
Speaker 36
43:34
services that have prior authorizations are 12 month prior authorizations so we would
Representative Jack Ladyman
Unverified
43:44
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 we are
Speaker 59
44:03
putting many additional requirements on a talking about the personal care I'm not talking
Representative Jack Ladyman
Unverified
44:07
about their opinion in writing we're not requiring them to do anything else
Speaker 18
44:16
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 provided to people that did not
have an AdL deficit meaning they could walk, feed, shower, right? and and it was the service was 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
45:10
change their process. all right so I mean if if this is not working if it's not helping the the current process then what
I don't understand why we'd keep we'd 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
Senator Missy Irvin
Unverified
45:37
is that right we do thank you could you get for me how many times that you've had
conversations with Optum 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 Optim? Have you how many conversations negotiations have you had with them about changing the process when you've seen utilization increase? No I will be completely
Speaker 26
46:12
honest. no we we are not having conversations we have not had conversations
Speaker 18
46:17
about them doing something different with the 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're we have never asked them to change the tool that's the problem you are in
Senator Missy Irvin
Unverified
46:41
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 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 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 healthcare reform task force was adamant about in independent assessment at that time we were adamant about
that Nobody within 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 forcece said independent assessment should absolutely be utilized and in that process if you see we've put in an independent pro assessment through this contract and but in six years you never had a
conversation with him 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 it's because I absolutely and people can say whatever they want to say. I live with a family practice physician I know how many patients they see and somehow I've explained this to DHS and they don't you don't listen to
me and that's fine you don't have to listen to me but I am telling you I am 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 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 into this. OK? I put apart however much money they're not gonna 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 OK? 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 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 8 hours
a day and they're pushing for medication pushing for medication and guess what if doctor so and so doesn't prescribe it they're just gonna 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 healthcare reform task forcece 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 Sanderrvi've asked for that apologize and 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 apologize 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 seeing40 patients and three of them that came in this morning are all having cardiac arrest and they come to the clinic instead of to the ER cause 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 of their of their mouth are they gonna are they gonna 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 for for a help
or are they gonna 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 gonna stop right here and my suggestion to the chair is that we 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
Representative Jack Ladyman
Unverified
52:41
see if we can get a rule back that 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 Kendra Moore
Unverified
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