Public Health, Welfare and Labor- House & Senate

Ladies and gentleman of the committee if you take your seats apologize for the delay we had some other business to attend to regarding the schedule and other things of I do have a few nodes of the House and Senate public health welfare and labor committees are in the process of scheduling Jean meeting. Of but we will have more information about that later. We will be going to the Booneville Human development center and and that's a and then in Fort Smith we will be meeting at the Arkansas college of osteopathic medicine so you'll be getting more information at a later date I think some of that it's been to step rectified in the schedule looks a lot better and you'll be hearing about that scene. In a. We have the along the agenda so I would appreciate your questions being very same. And the to the point in with that The chair sees a quorum and we will be hearing from we will go to Adam peaty. This minutes all right before we go to Adam D. we have I'd like to have a motion to approve the April the fourth meeting notes and done I see a a hand to do that a do I have a second. All right all those in favor say aye all those opposed amendments have been adopted all right going down to Adam D. we have doctor marrow and doctor Delahaye to give us an update on that COVID nineteen variants if you would come forward please. Welcome you to the committee and I believe this may be your last meeting Dr Romero. Yes senator a well at at at the discretion of all of you I could come back you're up until Friday I understand five PM so wonderful what we want you back as much as you are able to come back so anyway thank you very much and if the to view would introduce yourselves for the record we will get started. I'm doctor Jennifer Delahaye chief medical officer at the Arkansas department of health. I'm a mental I'm the secretary of health and the director of the health department all right you're recognized thank you so we were asked to address Committee today thank you for having us here and to speak primarily about the variance in their state and where we are with regard to use variance so um. I will let you know that the BA one Sir is the original COVID Makran has a fallen away is no longer than the major variant in our region or in the country I'm at this time. in in the country's meat duck to Americans you up pull your microphone up to having trouble forgiving can I yes I better go that's much better thank modulate my voice that are sorry so it nationally the very into currently occupying our attention is BA to it makes a sixty eight percent of the variance across the country as as of last week I'm in our region that is region six it is eighty seven percent. there is another variant BA two point twelve point one which is slowly increasing across the country and is it increasing also in our region it currently makes up nine percent it is we are currently seeing read the increases are small but consistent increases in the number of cases are being reported to the health department these this is not putting a stress on our health care system at this time and is most likely the result of this B. eight two point twelve point one of this variant has other characteristics it's more transmissible to a twenty five percent more transmissible than or micron was and. Does have some resistance to the monocle therapies and we're watching that very closely I suspect that this will continue to increase over time. I think this also serves as a reminder to all of us that number one the pandemic is yet to be over we're gonna quiescent period at this point and that there are many more variance a circulating out there now and they're willing variance in the future that will you we will need to address at this time as I mentioned in that have been reported to the governor there is no stress on the healthcare system within our state our numbers of individuals hospitalized or a relatively low not normal but low and the use of ventilators is not is not up because of that we continue to see deaths in our state at a low level would continue to be smoldering about two to four per day we're at approximately eleven thousand four hundred deaths total since the beginning of the a pandemic. with regard to vaccine there is a sufficient vaccine for all age groups across the state it's distributed in our local health units in our pharmacies are partners and we have equitable distribution. In addition to that we have a more than sufficient supply of antiviral agents for the treatment of a COVID nineteen unfortunately that we're not using it as much as we should we're getting on a we're trying to educate physicians about the importance of rapid of the diagnosis the rapid treatment so I think we are well situated as we go forward at this time and I can address any questions you may have. All right representative Ferguson you're recognized for a question. Thank you madam chair of last time you were here you said that I should not take a fourth booster has that recommendation changed yes ma'am so thank you for the question representative so as it as I said before this is a moving target right we were learning over time so at the time I think you I just was before you all at that time there was no recommendation for a fourth fourth booster the fourth booster now is recommend is is considered to consideration for you for individuals over fifty years of age or who have me may have an immunizing compromise condition it should be discussed with your physician it is available and can be taken the decision to take that fourth booster will depend on a number of factors like I said your age of your underlying medical conditions and your risk of exposure to COVID nineteen certainly in individuals that are immuno compromised I need to consider this as a as a serious option for connecting to boost themselves we know now that that as these variants have gone forward we've had changes in their susceptibility to antibody induced a sort of vaccine induced antibodies we know that the the booster that is us the the actual not the second not the second was for the first Mr brought levels up high enough to protect you and that for now we probably for those individuals at higher risk to get a fourth those. So my daughter Fizer if anyone is fine any of the mRNA vaccines are fine for. Can I follow up. The I I've known to people lately have tested of is the against the files as it plots of it is that yes yes is that the recommended treatment instead of monoclonal now or yes so so looking at the at the national institutes of health website the the the first drug of choice is to give the likes of it has to be given within five days of diagnosis it's highly effective and should be used there's not there's only one monoclonal antibody currently available for treatment because of the as I mentioned before the resistance pattern of the of the virus has changed so you are correct. Okay thank you. All right senator Hammer you're recognized for a question. Thank you Mr do you have any indication of as to when they are anticipating ending the emergency at the federal level there's been several reports and just curious if you have any latest information when that might be I'm sorry Sir thank you senator I'm sorry Sir I don't have any information as to when they're going to move that forward I mean as much detail of the dark if you will about that decision is your shall serve to your understanding then they are continue to treated as though it's going to continue to go on is that how we're operating. That that is correct there's been no change in that status okay and then last question would be the now that you've got as much experience under your belt as you do with this and moving on to the new role that you're moving on to if you could look back and do things differently are there any things that you have identified that you would do differently or that you think we should have done differently based on where we are in the experience that you've that you've gotten here thank you senator so you know with anything there's always room for improvement may be foolish to say that we did a perfect job I'm it what could we have done a little differently let me say that that we rolled out testing rapidly in our state we could have probably moved a little bit faster in that but I think we did very well considering we started with nothing my predecessor need Smith had a public health laboratory that was on that did not have the capacity to do that we have now grown that to be able to prove performed thirty five hundred tests a day under pressure all that by the way by by a continue and still continuing our routine testing for other diseases here so I'm I think we can move forward there I think that the health department did a good job and moving out the vaccine as it became available and it even more with the help of the governor we had a home testing made available to our citizens before the feds caught up with the the test to us. I think treatment has been rolled out equitably across the state. We're a big problem has been has been in misinformation. And this information and I think that we as a state could have done much better in countering that and I think that unfortunately Some of the data so we had to have been the result of a misinformation or gross this information about these vaccines it pains me I have to look at these reports every day and it is a pain in my heart to see somebody die of code and to see them die you know if young and for a preventable disease so I think that was our biggest issue here senator is this lack of of countering disinformation you know we certainly try to do is as good as we could from our vantage from the health department spent entity and but as you know social media is pervasive and has a way of getting in where even though our message may be clear so I think that is the biggest flaw that we have here in our state but we have to be proud I mean I I I do think that we we we did a good job here overall I commit I do think the governor did it to very good job I have to it meant here as I've admitted before that the governor was right we had our kids in school I that was not my advice but he made the correct decision and he's made the correct decision a number of things so I think we've done a good. Our thank you. All right the representative Bentley you're recognized for a question. Thank you chairman thank you dont remember being here today I'm just real quickly two quick questions of the severity of this B. eight two dash twelve this is less than I'm crime so just a quick overview on that yes ma'am thank you thank you very much for that the questions that so so this is the the newest. The the B. eight two and the one that's coming after that appear to have a less severe or a milder if you will milder course of illness on an individual basis but on a societal basis and you almost all that that there were so many people being infected that we had to come to the legislature to get appropriation of funds to open up beds for our hospitals right we came very close to going over the edge because of that so on individual basis yes it is milder on a societal basis it is significantly more severe that the delta area thank you one quick follow up on the last time you were here is asking about the death rate in Arkansas for do you have that number for us at all but let me to see if the. We were not did not come prepared to answer that question but as always well I'm more than willing to get that information to you and we can probably get it at a great at a granular more granular level that that is that a county level I saw an email come across my desk this morning and I am sure our state email just doctor similar can get that information to you okay descent moving for will take a look at a nation like Honduras I had nine point nine million people have less people die than we did in Arkansas I think that's something that we need to look at their so thank you very much. All right Senator Solomon you're recognized for a question thank you madam chair of long covid I hear a lot about that do we have any idea what the prevalence is and is there recommended treatment. Yeah and thank you senator for that question that's an excellent question and I think it's something we're going to be dealing with an economic basis and help basis long into the future so we don't have an actual number of that in our state at this time I'm at reports you know as high as fifteen twenty percent have been published in different parts of the country and world so we're looking at that there are studies across the United States trying to to determine whether what what the actual symptoms are and how long they last My concern and I think I've been voicing this concern for the last years as we begin to identify this is that these individuals will become a adept at AM for lack of a better word quote burden and quote with our health care system going into the future the chronic conditions are not minor we know that individuals that suffer from covid even if it was a systematic are at risk for cardiovascular disease into the future. We know that they're at peers to be in association with COVID and diabetes I hope that association is not strong but if it is that we have a Kadri of adults and children that will be with risk for cardiovascular disease. In addition to that there is a. Well described syndrome of chronic fatigue with this these individuals can not engage in normal activity and that includes normal work so they will be out of our of our economic power house if you will or engine going into the future and they will form this group that will be requiring chronic medical care and could lead to further disparities in health division to the delivery if we don't if we don't address that issue going into the future so answer your question Sir we don't have a firm answer of what it is here in the state my concern is that after the last spike we had a number of individuals infected and we may see more and more of this going into the future before the altar children thank you notice make this comment I had long term COVID for probably two months went to my local doctor and I had a hundred percent improvement in a week. Thank you thank you at it is sure you did you did ask a second question I'm sorry I didn't answer the question if I may a US if there are any specific therapies no there there aren't any at this time and we're trying to do to it not we the medical person are trying to determine what those therapies are the others there at a as another shameless plug for vaccination there there there are there is some information now growing that vaccines do reverse of the the the chronicle COVID to the symptoms again that's very early very let's let's wait and see what they say but as to I'm to send my doctor didn't do any of that yes Sir he had early treatment and within two or three days I was a hundred percent but the so I think there are early intervention thank you thank you I'm glad to hear that Sir. All right. A. Chairman Ladyman. Thank you madam chair of. Dr Merrill and the doctor will say thank you all for being here specially you Dr Merrill you've got another better job and you could delegated this so I really appreciate you coming to talk to us my question with the variance in this this virus will continue future variants I'm sure of. Is there any indication or maybe we don't have enough time in science yet to know but that this is climate related I mean could it could be you know you like with flu you see a surge in the wintertime is there any science that says that that this virus might act that way is there any thing like that I understand your question Sir no it so I will also do differ this question after I answered it to doctor delay to I know of no data that suggests that climate change is driving this issue of the of of covid but doctor deal Haitians that have sometimes more information I do answer on this on the subject so go ahead after July. So with regard to the effect of climate change in this for this virus we don't have specific information but there is concern that with the change in climate that animal species in human species that have an interactive before will have greater opportunity for interaction and more opportunity for viruses to jump from a animal species to humans so that's something we're going to have to monitor for around the world. And the if I can make one comment representative is that was going to a better job this is probably the best job I've ever had and I have to say publicly that I believe because the same reason that I came to this job as I thought I could make a difference but I leave knowing that are many other things that I had on my plate that I wanted to accomplish before I left but it is a difficult was a difficult decision. Thank you. I have represented Ferguson you're recognized for a question. Yes thank you madam chair of yeah and I do want to committee shall I know this state just difficult to hear Senate as we face difficult challenges in a changing environment of I had a constituent call me last week and said that her a company offered life insurance and she was denied insurance because she had had covid even though she was fully recovered it that may be outside of your area but I do think it's something we may need to look at is the legislatures are insurance companies going to start to nine people that it had code. The representative that at all no thank you for bringing that to my attention representative no I I am actually shocked and and I'm worried about this that that is the individual would be denied coverage after having had a covid I even if they recovered fully they should never they should not be denied even if they did not recover. so I'm concerned that it did it again I the harkening back to the eighties this makes me worry about what was happening with the with the HIV infections that occurred back then when insurance companies would deny coverage so I thank you for bringing that to my attention I'm gonna go back and look at this I will have my staff also look look at this but I I think that's agree just. All right the last questions Senator Hammer you're recognized for a question thank you ma'am chair we've heard hardly anything early maybe I just missed it about flu and you know this past year how much of the of COVID symptoms and the effects of COVID have overshadowed or have taken the place of the flu to where now we're not gonna be as concerned about the flu because it's going to be maybe taking care with the vaccines for the covid or can you help us balance the two and just give some insight on that. Yes Sir is so I I don't think we've overlooked flu numbers we haven't we it is not that we're not looking for it I I just think it's been displaced by a number of factors with the consciousness of of the public who mastered social distancing I think that there's probably some epidemiologic change that we'll be seeing in the future I think he's here it's it's it's going to be here always and we may see a rebound that is you know this this you know this twin that make that everybody's been talking about for two years that we never saw but but I think we're at risk still for a for a surgeon Act there is no cross protection from receiving a flu vaccine against that that that protects you against COVID or vice versa that the code Maxine protection against flu so we're still going to need to get those vaccines in the future we're going to continue to advocate for those vaccines for children and for adults so there's a lot changing not not not just in that buyer is but another viruses so um some of you may have heard that there was a an alteration another virus called RSV respiratory syncytial virus that is a virus that affects children usually under the age of two I'm and usually occurs during the fall and winter last year it appeared in spring and summer causing a significant number of of of diseases there are also provisions and other viruses like enterovirus and that causes a paralytic disease called acute flaccid myelitis we had been expecting a surge of that over the last two years and we've not seen that so it is very possible that that will happen again in the future so there's a lot of changes going on I think things are going it's are going to sort themselves out over the next year to and we may see these you all may have heard about the adenovirus which is causing liver disease In the in in Europe and Great Britain and here in the United States as another virus that is sort of popped its ugly head up we're not sure how much it has to do with the fact that the epidemiology these viruses have changed but we're watching for the and I feel I have to say that I will be one of my charges at the CDC so I will be watching after that thank you thank you all right thank you saying no other questions we appreciate this report but do not believe. Of we are so grateful for your service Dr Romero into a we hate to see you go but we know that this is going to be an exciting time in your life on the national level as well so I do have an of representative Lehman has also a commendation letter that I would like to read to you then we have a few things we want to you to take with you but to. Of this letter is dear secretary Romero. Let me take this opportunity to thank you for your exceptional leadership as secretary and director of the Arkansas Department of Health you have been an invaluable source of scientific based solutions and executive stewardship for the safety protection and welfare of the public during unprecedented cove and COVID nineteen pandemic in our state your knowledge teaching wisdom and exemplary strength of character set you apart is a professional and as an individual. Not only have you devoted your talents to the various research instructional in leadership roles you have held one call in Arkansas but you have also invested your talents and several national and international public health endeavors you have been a tremendous asset to the governor into this state and national leaders and your brand of professionalism grace and resilience is difficult to fund and will be hard to replace citizens like you who choose to be of service to others speaks to the higher plane of humanity and help build strong cohesive and healthy communities I personally appreciate your outstanding example of service above self you are a highly respected man of integrity and courage I joined with the leadership and staff of the Arkansas department of health your family and your friends. Extending my sincere gratitude to you for the extraordinary contribution to our state and its citizens and our entire nation congratulations on your new role as the director of the United States center for the disease control national center for immunization and respiratory diseases and may you continue to be richly blessed and all your future endeavors respectfully sis submitted Senator Cecile Bledsoe assistant pro tem chair of Senate Public Health and with that letter we have some other things and we'd like to a bring those things to you. Okay a representative claiming. Thank you and Dr Meryl I have a similar letter very similar to that so won't read the letter but we also have I have a Arkansas house of representatives commemorative coin from ninety third General Assembly that would like to give to you and also I don't know whether you're a sports fan or not are you a sports fan I I college sports primaries or football yes football and baseball okay I have a point here the senator Hammer and I gave to all the members of the legislature when the football game between you of a issue was announced so I'll give you one of those to take them to remember here and maybe in twenty twenty five you might wanna come back at I most certainly would I most certainly would thank you want to come up with if you want to come up. We're coming down sorry. Alright ladies and gentleman we are going back to our agenda and the next item of is not empty and we will hear from the Arkansas department of Human Services. Now before we really get started a I have an announcmenet someone has birthday. And to. I don't seeing but to anyone and and on the committee wants to sing Happy Birthday it's two of our friend mark a mark points birthday is today and I didn't asking how old he is because I don't like people days many. A big. Difference in the ages but we're excited that it's your birthday and you're here to to the your here on your birthday so. Anyone who sings and let me see a representative wing that I see on Facebook but you were on a. Third you have a birthday to. Happy birthday too low. Earth Day to you. Thank you members present we can come saying that to me to not enter. Thank you representative wing that was so much better than if I had started. So anyway we appreciate you being here and we're ready to hear from you today thank you introduced both that you introduce yourselves for the record thank you manager Marc white farmer whose services very Franklin Department of Human Services division county operations. I have for you today a rule In our long term services supports categories specifically changes to our Miller income trust rules in this change will be that our clients income will no longer be required to be transferred except to the extent that is needed to be transferred to make the client income eligible. We are also making a change to allow court ordered child support in court ordered spousal support payments as deductions to the patient liability amount in the long term services and supports categories and what are as part of implementation of act five seventy or to implement ACT five seventy we are updating policy to reflect that property transferred by a beneficiary deed is no longer subject to estate recovery. And finally consistent with ACT five thirty we've deleted the rule that a failure to pay a premium for three consecutive months will result in this Act debt to the state of Arkansas this is around the our home policy with that I'll be happy to take any questions. All right does anyone on the committee have a question. All right seeing none. With that objections this objection this will stands as with the. K. going on down. The measure these next rules or from Medicaid program and missiles was with payment is going to join me for these okay. Thank you would introduce yourself for the record please. Hi Elizabeth Pittman director for Division of Medical Services and Happy Birthday mark. Well that'll close please yes thank you. The first role we have for you today we have five different rules and several of which have spas pending with CMS state plan amendments so we'll let you know which ones those are and we don't anticipate too many changes from CMS but with the if we have any on these rules if you approve them today will bring them back if if we have to change them before we file. So the first rule of today is to comply with Act for forty four. And this is at the non emergency medical transportation act it was passed about three years ago when we actually did a supplemental payment for non or for an ambulance private ambulance services but it did not include nonemergency transportation at that time the legislature this past session added non emergency transportation and we have since added into that supplemental payment so that now that can be part of that payment that the ambulances get once a quarter and in that is pending approval CMS right now but we have answered most questions at this time. Thanks any questions from the committee. Seeing none. Without objection this rule stances Review K. next. So the next rule I and implements a series of acts that the legislature passed last session regarding the pharmacy scope of practice it expands the pharmacist abilities to and work with clients particularly around and treating disease they can become prescribers for oral contraceptives as well as for flu and strep and some other under common illnesses such as that so it allows the individual to go to the pharmacy at visit with the pharmacist determine if something is needed the pharmacist as in certain cases have to make a referral back to a position where that's appropriate but they are able to prescribe some some treatments under this act and we are working with the pharmacy associations you to get these rules implemented and these are also pending approval CMS all right thank you any questions from the committee. Seeing no questions without objection this rule stances Review. Next the next rule implements ACT eight eight six of the past legislative session this is the rule that extended at the benefits for mental health services I'm sure one mental health services counseling services for clients from three visits without a physician's referral to ten visits I'm this role we did finally determine after I and a lot of internal debate that we could implements without an actual rule based on the language of the statute you gave us that authority so we have actually implemented this back to and June twenty eight of twenty twenty one I we are doing a massive judgment on all of those claims CMS approval is not needed for this so we are moving forward with that and this will and formalize that role within our actual policy and match that statute. Any any questions from the committee all right senator Hammer. Recognized thank you Mr refresh my memory is just for tier one services only it's not here to yes Sir it is only for tier one therapy services okay and then when they hit the ten they have to do what they have to and get a perk at physicians PCP referral and they also need a prior authorization from our office okay and then the second question is on this one in the previous ones that we pass when it comes to the fiscal impact of the financial impact. The portion that can be picked up by the state is that factored into goals next year budget yes Sir it has been okay so so you at our end when the budget got passes last time around or the fiscal session Yuri had these numbers bill tenders a coming out of Medicaid trust fund the numbers are built in and so I I can't remember what it is I'll say that we're back in the session when these were passed we've done fiscal impact estimates at that point so and look at our budget. Estimates request we took those estimates and accounts since then I think in those so the at the estimate that in for you now may not be exactly the same as what we worked with in the session we should be close enough that it we can accommodate within our budget could you give me the total amount of the impact to the of. General revenue for for all the legislation we passed yes my court okay thank you thank you manager all right of representative Gonzales you're recognized for a question thank you senator Starmer back want when we pass this was it was something that was brought for by DHS and was there an issue with getting the our office is business I don't believe we were the in that organization that brought it forward I believe it was a a constituent group but we we did not object to it and it's not an issue with the prior authorization itself I'm it did require a primary care provider referral after that third visit so there was a delay in continuing services because they have to go see a PCP referral. All right any other questions seeing no other questions without objection this rule stands as review next. The next role implements ACT eight ninety one which is the lab and X. ray limit rule so as you know previous to this role we had a five hundred dollar limit that for both laboratory and X. ray services this will actually implements two five hundred dollar limits one for laboratory and one for X. ray it also takes out of those limits anything that's considered an essential health benefit and we have to find that is any of the a and B. recommendations of the United States preventative services task force which is quite an awful sorry about that and that includes things like colorectal screening mammograms things like that that are preventive screenings. All right any questions from the committee. Seeing none with that objection this rule stances Review. Next in the Las will we have I have for you today is the role that implements axed six three seven which is the pants pants Act and this act authorizes ice you pay for treatment if it is approved by the centers for excellence which is out of UAMS they treat pants panda under consider the experts in this state if they develop a treatment plan then they can submit that to as for prior authorization and we will pay for off label drug treatment particularly IV IG I'm CMS to determine that we do not need their approval to implement this rule so we are not waiting on CMS anymore Sir all right any questions all right senator Hammer. Thank you measure would you just clarify what you just said because on make sure got clear understanding based on what CMS said we do not have to have a referral out of the center of excellence so no Sir what we will have to have that that's required under the act itself a what CMS is told us is that I do not need to amend my state plan to cover this drug it's already part of what we already covers drug services and and that we will be able to pull down federal match the way we're setting this up so we don't actually have to wait on CMS to approve us to move forward but the way the act is written we will have to have that referral for the centers for excellence and so it if there's a modification by the center of excellence as far as methodology approach to dealing with patients that may have been diagnosed pair pains as long as that of as long as that recognition comes out of center of excellence in that would not I mean I would that that's all you need to here's that they said we we kind of changed the way we approach deal with this and it be able to clear through is that correct yes Sir based on our interpretation of the act and I think based on discussions with you about that act yes or that's how we interpret that just wanna get on the record thank you thank you Mr all right any other questions seeing none without objection this rule stances Review thank you so very much thank you we're going to K. E.. All right man manager these next couple rules or for more efficient products services and quality assurance all right so direct Martinez Smith join me for those. If you introduce yourself for the record please ma'am. The morning Martinez Smith director for the Division of provider services and quality assurance. You're recognized thank you I to have five rules this morning the first one that we have is as a result of implementing ACT seven sixty from last session and twenty twenty one this particular rule resulted in a change in our of behavioral health agency manual rule and what that rule basically said was that behavioral health agencies could co locate with other types of facilities such as a long term care facility or school or something of that sort and so that resulted in us having to make a definition change in the manual to include those words. All right any questions from the committee. Seeing none without objection this rule stands has read the next all right the second rule to was as a result of an act ACT seven seventeen from the session in twenty twenty one this particular rule resulted in a rule change to our independent choices or it as some people know itself direction program those in home care givers already had a requirement of having background checks and now they must have a registry checks as well child an adult maltreatment the language in the world manual was updated to reflect that all right any questions. Seeing none without objection this rule stances review next. The next war was as a result of ACT seven twenty five passed during the session this particular rule change said that if individuals receive certain state benefits snap ten if we unemployment benefits like Senator if they were looking to become nursing home administrators or certified nursing assistants it said assistance they could to request a fee waiver and so we updated the manual to reflect that if they receive those benefits then they would be entitled to a fee waiver all right any questions from the committee. Seeing none with that objections this rule stances with the. Next. The next a rule changes as a result of ACT seven twenty one that was passed during the legislative session this one contains a couple of changes to not only of the nursing home manual but also the assisted living manuals there were several individual items that were in this particular act so the rule changes had to be made across both manuals in some cases so for example there were some changes made to ownership and management and what you would have to provide if you owned or managed one of those types of facilities and expanded on the reasons why we could deny an individual that perhaps came into the states seeking to own one of these types of facilities. It also explained what the requirements would be on the seller and the buyer so it change of ownership in that case and then also in the nursing home manual we I went back and took a look at the direct home staffing standards and we expanded on what those particular aspects of reporting should be all right any questions from the committee. Seeing none without objection this rule stances Review and then I believe you have one more yes ma'am this particular one is was as a result of ACT nine oh five that passed during the session we updated the definition of a long term care facility to reflect that it does not include services for clients for four hours or less no more than two days per week and so that change was made in the manual to the definition as well all right thank you any questions seeing none without objection this rule stands is reviewed and thank you both very much press two thank you just a minute please representative Clement. Thank you madam chair. UP marking one of y'all could give us an update on the rate reviews are could you do that now that you're in the process of doing just an update sure I can give you just a brief update and I think this man is already stepped out but I'll give you a brief update where things are at thank you course we started with the governor's exact we're a few years back directly as to a systematic review of all Medicaid provider rates and so we've done several rounds of that over the last three years we're in the last round now of this first phase let's call it of rate reviews and so that includes a number of very large things like hospitals for example are part of that we're working through those and we can get those finished over the next over the coming months between now and the end of this year next year will start the next round and so that means that those that we've done in these last three years we're going to start again and because the goal is to have every provider have a review at least once every four years and so we will start those in January will choose them based on our current cost survey route all the providers see who is the what's the most critical need for written for another review as of example look at you know who has had their cost go with the most the most who is most affected by you know the economic situation of the job market and try to make some decisions about what needs to be prioritized the need to be pushed to the front of the line in that next year with the reviews are continuing so far most of them have worked out well we're having a good consensus point us in the provider groups and the ones that we're gonna spend some kind some tension I think that's starting to get resolved so that's a quick overview okay so let me just clarify what you said I think I heard it right is it you're actually looking at the process that you went through and instead of going the same route that you did the first time through you will look at the most critical ones and change that price. Says based on what you've learned right and the bills we will do in the same order as we did in this round okay are there may be some that maybe that has some critical needs to come up no because a COVID or because the job market is we may move them to the front line thank you. All right Senator Hammer. He. Thank thank you measure. The the rates that have been reviewed have you submitted those to CMS and have you gotten roared back that they're going to approve the rate adjustments or can you just educate real quick on that you got a Senate CMS to get approval right for most of the the data to go through CMS and so you have to extend that's required yeah we've not encountered any problems on it so far I think the ones they're the most tension was complicated or those that are tied to a waiver because then it's not just the rate CMS is also also looking at the way for itself and so you know assisted living so things titled our choices or with the services those have the most oversight from CMS so to speak so far it everything is gone through that any problem okay and are there any that we're now waiting for CMS approval on. Offhand I don't know of any that are hitting the CMS at this moment we've got some that'll be going to CMS something very soon okay but I don't think there's anything at this moment okay thank you thank you manager all right thank you for that additional information certainly very much. All right we're going down to P. at empty and this is the Arkansas health department. Do you introduce yourself for the record please thank you madam chair Charles Thompson attorney Arkansas department of health you're recognized. Thank you madam chair members what you have before you is the Arkansas kidney disease Commission amended rules update eighty H. received and transformation during transformation twenty nineteen Arkansas kidney disease commission under our umbrella before that it was in Department of career education Arkansas rehab services we receive them we realize that the rules and not been updated in many many many many years we realized it was probably we need some clarity in the rules and that's what you have what you have before us the the main gist of it is we got rid of superfluous language made it clear when it comes eligibility including financial need and that the kidney disease commission would be the payer of last resort we also added requirement to show residency we did have a instance where we had a concern that maybe someone was in Louisiana though may have had a Arkansas address but was may have been trying to get receive funds that are geared for Arkansas residents so we want to make sure that didn't happen and so that's the individuals that want to access the the program would have to prove residency and so What you have before you is a a work over over since we receive since they came over during transformation that was a bit slow down during covid was hard to have committee meetings on how to deal by Sam though the Committee members were very the commensurate commission members were very very active stakeholders very active and listening in on those meetings we have a public hearing had no comments one major up one other major update was formulaic we updated formula area that would include also some nutritional supplements that help kidney dialysis folks that was in accordance with stakeholder medical stakeholder medical input as well as internal medical input the committees that they had meetings on on those items I'll be happy to take any questions. All right any questions from the committee. All right seeing none without objection this will stances Review. Next. We have a. Our and we will have the Mr Benard bevel in Mister Chuck Thompson. Ups. If you introduce yourselves for the record. Madam chairman number any bevel Arkansas department of health. Madam chair Charles Thompson Arkansas department of health Attorney. All right you're recognized thank you madam chair members what you have before you is an update to the rules pertain to ready out of radiological technical technology licensure these are all done pursuant specific to you specifically Arkansas act Act one thirty five that is uniformed servicemembers language that was updated recently and twenty twenty one accented twenty five which is waiver of initial fees for those that meets certain financial criteria ACT seven forty six regarding work permit for permanent residence legal permanent resident aliens and ACT eighty level which was our to learn which was for regarding a potential for path to per partnerships in various occupations we had a we had no public hearing because these were pursuant to Arkansas act we did have some public comments ominous public comments were for from individuals that were already licensed in radiological technique and in the industry we did explain to them that these were all pursuant to legislative acts and that we appreciated their comments might be happy to take any questions any questions from the committee. All right seeing none without objection this rule stances Review thank you very much for being here and thank you thank you senator Bledsoe thank you members. All right of we have our which is the review of the Arkansas tobacco settlement commission is quarterly report. Miss lane. If you when you get settled if you chose to introduce yourself for the record please. I'm Emily lane with university of central Arkansas director for the tobacco settlement commission of valuations all right you're recognized my first time in front of you good. So you each should have the July September twenty twenty one quarterly report for these programs. And we're very happy to report that because COVID numbers were on the decline during this period a lot of the programs focused on outreach especially were able to really reach out to the community and do the work that they had been doing pre COVID along with of course still continuing to do their online virtual education and other types of offerings so we're gonna look at the infographic and just hit some of the highlights and then open it up for questions. So this this quarter we had almost fifteen thousand education encounters we had twenty five thousand people serve through Medicaid expansion program. Almost a thousand enrolled in tobacco cessation to be well Arkansas call center. Looking at research we had over five hundred publications in this for the fiscal year for API so that entire fiscal year they had over five thousand publications three hundred presentations if you look down economic impacts is always a high point we see a lot of leverage to money's being reported this quarter for the fiscal year A. B. I. N. C. O. PH together reported seventy eight million dollars and leveraged funds which is about six to one. In terms of other leverage. We also see of course other programs leveraging funds centers on aging traditionally leverages several hundred thousands of dollars each quarter. If you look on the third page infographic you see some testimonials and you can read those on your own time I won't go through those but these are highlighting people who are participating in programs or their provider and they're putting on an offering these programs. All in all all of these programs really did well to meet their indicators are on track to meet meeting their indicators this quarter eighty five percent of program indicators were on track to be met. And that's concerning about two thirds of these indicator still were affected by COVID so despite that challenge programs really are persevering in this quarter. That's all I have for you saute questions at this time all right senator Hammer you're recognized for a question. The committee chair the one thing I'd like you to point out to me in this reporter if you can get it for me it's for the dollars are being invested where do we find that we're moving the needle in a positive direction to show that the investment dollars is getting a return on or how do you go about. And find that that for all the money we're putting out we're actually changing thank you. Well that's a great question and it may not be captured in this report as comprehensively as it will be in the next one we have a biennial report coming up that will be in front of you soon in a few months but we can we can see at least one for looking at rates of state smoking from the very first year that these monies were allocated to programs we see it a twenty percent decrease in smoking in that time so it's about one percent per year so we can look to other health outcomes as well and see how we're moving the needle if you look at things like food insecurity for senior population are centers on aging program have really severe head of those activities and we moved from and we can have the Director coming give a more exact number but I think we've moved from about forty of something a ranking to I think seventeenth nationally which is a really huge accomplishment there are certainly other health outcomes we can look at it as well but I would say the next upcoming by now report will have more of that where you can really see those numbers over the twenty years and really see that impact how these investments are improving health in the state and not just in terms of tobacco rate but overall quality of life in our communities as well okay you set the report be a couple months a couple of months yes we're putting it together right now okay thank you all right thank you Senate. Representative claiming you're recognized thank you madam chair. thank you for the summary and the summaries good but I want to ask you questions I mean this is a lot of money there's a lot of moving parts in this lot of different agencies involved would it be possible to have one of the agencies or maybe one of the sites that gets these funds and provides these services to come to our meeting and just kind of talk about boots on the ground how that's going in absolutely some of the questions like when Senator Hammer was yes thank you for the question and of course all of these programs for Senate travel for these meetings every quarter and I'd be happy to call a few of them up now to give you some more information if you'd like we run a little late now. But if you could and we can work on this but maybe have one group come in and talk in detail about the successes in their programs and you know how to use the funds and how how people are reacting to that absolutely and work on that yes absolutely we can certainly work on that thank you thank you all right of anything else. No other questions all right thank you so much with that objection this rule stances Review thank you so much alright ladies and gentleman is there any new business. Seeing none the meeting is adjourned.