Aging & Legislative Affairs- House Children & Youth Subcom.

This meeting in order I'm state representative Julie Mayberry we've got a great crowd out there and have to be here part of this discussion we do have some members who might be joining us online other people joining us online and some members that are coming in knowing that Easter was yesterday we probably had many who did not want to drive last night to be here in advance so hopefully they'll they'll be joining us soon the first thing on our agenda is to approve the minutes from the last meeting and I believe we have a correction in addition. Spring is here okay representatives Springer was here for the record and so we want to make sure that we can knowledge that she was here at our last meeting. Is there a motion to approve those minutes. As Charlene Fite thank you and a second from the Springer thank you all those in favor say aye hi anyone opposed. Okay all adopted okay the first thing we're gonna get down to business is following up on some of those things that we discussed at our last meeting that we had and one idea that was mentioned was the use of technology and helping those with developmental disabilities live a more independent lifestyle and also save some taxpayer dollars so we're going to have first come up to the table safeguard Evans the CEO of Arkansas support network and then also Nick Seeler rally my saying it correctly who who he has come all the way from Tennessee he is with core services of northeast Tennessee and he is the program director I watched a presentation not too long ago that he did kind of on zoom for us a lot of people and I was really impressed and I said we need it was like a 2 hour presentation you're not going to speak for 2:00 hours but you have narrowed it down to help legislators understand how maybe we can use this going forward saw that you to introduce yourselves and then do a presentation. Good morning I'm doctor seared 11 of the CEO of Arkansas support network and I appreciate madam chair the opportunity to continue this conversation I the last time we were here we were here for about 3.5 hours and I just to have that amount of time to really dig into this in the conversations we've had since then we are are grateful for an appreciative of a couple of things before and we jump right into technology in your packets there are 7 some stats and some information since the last time that we were here the Angkor which is a national provider organization publish their annual case for inclusion where they look at this state of home and community based services across the country and they have 20 states that participate Arkansas is not one of them but everything that we see in that report we see here in Arkansas and their 2 data points that are included in your packet that are particularly important to consider as we talk about these innovations in home and community based services one is that that report lets us know that we're seeing provider organizations across the country who are no longer serving new people and we are seeing provider organizations across the country in home and community based settings that are discharging people from services and and no longer able to support the folks that that they've been charged to support and that is anecdotally we can report that that's that's happening here in Arkansas and just drives even more they need to look at rate settings enabling technology and DSP recruiting and credentialing more than ever so I appreciate you all for being here today to listen my friend and colleague excel really has come a very long way it's it's are now. Abre state but it's really like for states over Tennessee's along that way but Nick we started looking at Arkansas support network we started looking at how to innovate and include enabling technology in 2016 we were introduced to that as a support service and we really started digging in and you don't talk to anyone in the country about enabling technology support without hearing the name core services of northeast Tennessee of course the small provider that has been focused not just on using enabling technology as a support but really transforming their organization and the way that they support people and they've done things that are just probably an inch less than magic in the work that they've done so Nicks going to share a little bit about their journey what they've done and how they've done it. All right well thank you all so much for having me here today I'm very excited to share a little bit about what we've done in Tennessee and I hope that it might you know inspire some folks and in Arkansas and to a try to replicate that are or build upon that. So I'm from core services of northeast Tennessee we are small providers say or mention which I really feel like gives us a unique opportunity to trying to experiment trying new things it's easier for small provider disorder turn the ship in different directions but I everything we've done I feel strongly that it could be extrapolated to larger providers there's not anything that we've done that's really unique to being a small providers it's kind of easier for us to experiment try some of these new things so we support people with intellectual developmental disabilities through Tennessee Tennessee's Medicaid waiver program just like Arkansas support network in in Tennessee in 2017 we were emerging from 25 year old lawsuits in the early nineties there was a class action lawsuit against the large institutions for a lot of abusive practices and things and what came out of those lawsuits was a culture of very heavy staffing and risk aversion we were really focused on keeping people safe because that was super important and still is but we have the effect of limiting people's freedoms and we were providing too much staffing in a sense we were over supporting people I really feel like and that was kind of the inspiration behind Tennessee's enabling technology test project they felt like technology was a way to not only save money but also kind of provide people with more independence and freedom dignity of risk and all those sorts of things. And when I say enabling technology and it's a pretty broad term we're talking about a whole variety of devices with the common goal of just supporting people to be more independent and oftentimes for people that are receiving supports independence means not having to rely on a staff person or having a staff person in your home 2004 hours a day I'm just on the off chance that you might need assistance so I heard a really interesting analogy last time I was in Arkansas it would be like a hospital system the way we currently support people with ID de would be like a hospital put a nurse and every patient's room on the off chance that somebody needed something which is very inefficient and intrusive way to provide care Board hospitals done for many years provide a person with a call button there's a quick meant in a patient's room that will indicate there's an issue and then that'll a nurse will come in a system and that's exactly what we're trying to do to people with intellectual and developmental disabilities provide support when they need it and you're able to support a lot more people with the same or fewer staff persons that way. So there's everything from devices that will administer or dispense people's medications so they're not dependent on staff to take their meds there are audio reminders for people that need that level of support assistance there are stove sensors that could let a remote staff know that a stove has been left on or doors been left open or smoke or carbon monoxide was detected you can set these things up in a huge variety of ways you could alert neighbors you can alert family members you can alert the people's receiving services by providing audio alerts there panic buttons you like somebody to wear around the rest in the press the button if they fall in any assistance like the old life alert commercials that kind of thing so it's a huge variety of stuff in all of it means that people have support when they need it and not just somebody sit around the house all the time. In usually everybody wants to know how to pay for it technology is thought of as expensive but really and truly the most expensive way of supporting people is by paying staff to do it you really you have to pay very high wages to recruit staff to do this work and when you factor in benefits administrative costs we figure it is costing us about $20 per staffing hours so every staffing our we can reduce we can save $20 of taxpayer money the very first person in Tennessee the transition from supported living into an independent living situation was Carl who you'll you'll meet a video in a few minutes Carl's annual cost plan was almost $200000 he got he receive support 247 so hundred 60 8:00 hours of staffing per week it took 6 full time employees to support Carl and often times they were just there on in case Carl needed something which you infrequently did. Today because cost plan is about $54000 he received 40 hours of paid supports per week the rest of the time he's supported by technology supported remotely and he has that independence so what formally took 6 staff now takes one full time and one part time staff so with one person that's an annual cost savings of you know almost $144000 not insignificant. These are the top 20 percent of the people we support that have transitioned from supported living into more independent living environments so in that middle column there those are the amount of if you were paid staffing hours that those people have. Per week so that's Carl's up at the top he has 128 fewer hours of staffing per week some people have is 21 fewer hours of staffing per week depending on their needs and abilities so with those 9 people that is 795 staffing hours per week that we were able to reduce with an annual cost savings of 826000 almost $827000 very significant when you're talking about 9 people. And also it's sustainable we've demonstrated that I feel Carl is lived independently for almost 4 years Brad 3 years 30 months 29 months we've been doing this for a while and we really see much more successes than failures it is it sustainable if it's done correctly. I'm I'm gonna interrupt you for just a second because I just want to clarify something we have a sheet here and I was looking at the same thing and the numbers are slightly different I. I made a few adjustments to the statistics my hobbies I think so. I apologize maybe someone else was doing what I was doing it's the color copy I was looking at the black and white copy yes some of the stuff I went through and kind of recalculated because people actually expanded and advanced a little bit anxious so look at the color copy not the black and white copy yes maybe surrounded that same critic okay thank you you're welcome another issue that we're facing angle here more about today is the S. P. turnover DSP vacancies. Average in 2018 which is about the some of the newest a to 6 I could find turnover rates were averaging about 45 percent and vacancy rates were roughly 9 percent nationally so we're in a field where one in 10 positions is empty and we're filling it with high overtime costs people really lose quality of support when they have new people in and out of their lives you end up with staff that are under trained when when you have that turn over so it's really critical that we try to maintain consistency in our staffing and obviously what we've been doing for years is not working we can't continue to just add staff because they're just simply aren't the staff to provide the support that we need so this enabling technology allows us to reallocate our good staff of people that really need that level of support and allow the people that don't need that level of support the independence and freedom in your life. So this is just for services statistics at the top of our turnover rate has gone from 60 percent to 32 our vacancy rate was 15 percent percent of our positions were vacant and now it's about 4 overtime costs have gone from 15 down to 10. In our wage would be able to increase our wages because of those cost savings essentially. The National Alliance of direct support professionals road reports to the president 2017 and of course that's been 5 years ago and it's probably more tired today but they estimated that you would need over 0.5000000 new DSPs entering the workforce every year just to sustain existing need and that need is expanding as well so the required additional 67000 DSPs coming into the workforce and we they're just not there there everyone else is hiring these people to start you know willing to work for what we're able to pay them off in time so we have to think differently so we can use our staff more efficiently maybe providers can start accepting referrals again if they get the staffing issues mitigated this is a lot of people sitting on waiting lists because providers simply don't have the staff to support them so we're talking about technology we're not eliminating jobs were eliminating vacancies. All rights in this initial short video. You'll see a very as people we support using technology and Amiri out of ways. Screen. Okay. The dragon screen. She is. Yeah. As a young man Carl lived without any sports but the results were disastrous he wasn't taking his medicine his apartment was filthy his physical and mental health suffered so the decision was made to move Carl into a supported living home with 247 paid staff he was well cared for and safe but he wasn't happy about. Our years. Now more and more. In may of 2018 Carl participated in an enabling technology pilot project with the assistance of a few relatively inexpensive and simple pieces of technology Carl is now able to live on his own with minimal staff support he received the help he needs without the constant intrusion of staff and house made in his life. Carl has lived alone successfully for 4 years yes this is since he needs when he needs it but he has privacy and independence 20 does Carl is happy healthy and safe he is living his best life. Bragg live with his parents until he was an adult in an all or nothing system Bragg was forced to move into a group home with housemates and around the clock staff this is not the life bread and vision. We have on forms. Just wanna be right. His parents were skeptical at first but they eventually agreed to let Brad participate in core services enabling technology program. Read as lived alone in his own apartment since August of 2018 the staff help Brad with household chores grocery shopping and doctor appointments but he has independence during the times of the day that staff are necessary in the evening and night hours spread is supported or not. Side of their. Leding or in their. Call. Also you know make sure no alarms are going off there's always someone there to take care of their nation. His parents have been very pleased with the progress he's made they're proud of their son Brad once require the support of 6 full time staff totaling 168 staffing hours per week the same support is now conflicts with one full time staff and one part time staff around 60 hours per week not only is there a tremendous cost savings that Brad is happier. My technology in my job at Ingalls allows me to live alone without staff and house mates the only staffing I have as a job coach. The labeling technology allows a needed to work without the presence of a job coach the mobile app on her smartphone guide her through her work day alerts are received through Bluetooth ear piece the phone performs the same task a staff would but it need it doesn't view it as a nuisance like she did when staff would tell her what to do instead she sees the phone as merely a tool to help her get a job done. She can call for assistance with the push of a button if she needs. My name is. Environmental control technology allows those with limited physical ability to open and close doors control their lights television and thermostat the possibilities are limitless. Automated meta ministration allows people to take their own medicine without relying on the staff to administer it is even been shown to be more reliable with your rates of air. Let us all by myself. I pens open up whole new worlds of communication for those who do not communicate with words. In our opinion technology sports or no brainer a more efficient use of staff and a better quality of life. All right. So in conclusion you know we're our goal is to try to use this DSPs and if they're not needed somewhere let's use them somewhere where they are needed let's fill some of those vacancies and provide these folks with consistent staffing in their life which is you know probably the most important factor in somebody having a good quality of supports so we've been able to reduce our overtime costs we've been able to more efficiently use or scare System most precious resource resource the direct support professional and you know you can support more people with your staff so you can get people off of these waiting lists and while you're doing it you're also promoting independence and freedom and and in our experience making people a lot happier with the services the receiving. So the last thing I'll tell you that we use a tool to try to quantify somebody's quality of life it's called personal outcome measures it's a nationally internationally recognized way of interviewing somebody and seeing if they have various supports in their life like a community true community involvement jobs family members friends choice in where they live all those kind of things and we use certified interviewers to conduct those interviews that we found the people that are receiving services in this way are 61 percent more likely to have outcomes present and 30 percent more likely to have the supports in place to to support those outcomes so it's quantify quantify ably better quality of life in our experience. And I will conclude their and I guess. It brings me such joy to see such independence and that video I just I. Thank you thank you for what you're doing we we do have members who have questions and I'm gonna let them start off first representative fight. Here I was wondering how to use. Actually interpreters for the deaf I'm I'm assuming with the technology that that's fairly easy to access. I personally haven't done a whole lot of that the people we support have limited communication abilities and often times were able to use apps to you know essentially replace words they can touch various screens you have a screen on your iPad that'll have restaurants if you open that up it has multiple restaurants and they can select where they want to eat and that that kind of thing we don't support a lot of people that are deaf personal representative fight just you know something as simple as an iPad access to face time allows for for folks who otherwise would not have access to a sign language interpreter present with them to be able to connect in and have have better access to that so you know when when looking at technology one of the things that court does really really well and it's a mistake I think we see a lot of of providers make not focusing on this is that they really start with the person centered plan so they say this individual needs these things this is what they're capable of of doing this is where I think we need to bridge that gap and so in that process you're able to say okay this is that an individual who signs and so we would be able to access you do a facetime Services insert those interpreter services up in a really meaningful way to connect to that individual so it's not that kind of cookie cutter approach where oftentimes direct support ends up being especially when we're short staffed and we certainly support folks we we provide supports to a gentleman who uses sign but because of DSP workforce shortages he's often assigned direct support professionals who don't sign and so he has that support they are in place but there's still a significant barrier to communication whereas with the person centered technology support plan we can make sure that we're bridging that gap all the time for him that we're really creating. That that more consistent access to being full communication for him I love that thank you. Representative Crawford thank you madam chair. What are the best practices for a time of emergency when they're home alone and then the follow up to that is if something happens who is responsible. So we write plans for folks and people that are supported traditionally with staffed 247 they have plans in place for similar reasons you would want to know what to do if that person had a seizure for instance exactly how long of a seizure does necessitate the calling of 911 that sort of thing so in the same way we need to make sure we have a good plan in writing for how to support that person for every kind of imaginable scenario so if there was smoke detected in the house you would wanna have a plan in place who receives the alert that their smoke who what do they do do they call the house and make sure that everything's okay do they arrive on site what is a reasonable time frame to get staff on site to assist that person you really you just have to have a good plan in place and you have to kind of develop the infrastructure to be able to respond when somebody needs it so you might have for homes in the area close to each other and each home there somebody who's living independently and you have a staff person who's available to go to any of those homes if there was a alert that there was smoke detected or a somebody was out the door strangers out or whatever the case may be so you have the response person they're just not in the house in the way that they were before because oftentimes you're that's not necessary. Does that answer your question yes the other part is if something catastrophic happens who's responsible people see people all the time so I'm just wondering where that would go. Well in Tennessee you will be worn if we have a plan in place and it's well structured and we're following it I mean we're no more liable for emergency happening that person's life then we would be if there was a staff on site in an emergency happened I mean if it's you got to think of it as providing support it's just being done alternatively essentially okay thank you. Can I follow up to that you know when we when we have these conversations here and then we have these conversations on a national level you that 8 we immediately kind of jumped to this idea that it's a you know you Flippo switch we go from this to this but in reality really spending time with the core folks and watching how these support folks but I I've been providing direct supports in home and community services for 22 years and there's actually a a more in depth cleaning process and there are more layers to support than what traditional direct support provides when you're building that person centered service plan you're you're mapping out those scenarios and technology often gives you the ability to put in second third fourth response options whereas when we put a direct support staff in a home that's often the be all end all and so if that goes well great if it doesn't go well it doesn't go well with with the technology options there are tools and features that allow for rolling responses there's an organization and in North Carolina called simply home and they have a system that's called the Butler system and it allows you to program the first response if an alert goes off if someone presses an alert button where does that go right to that go to an on call remote support staff if that person doesn't respond that's not sufficient it allows for a rolling response so we can go to mom as a back up it could go to the neighbor as a back up core in addition to using technology very efficiently and being innovative with that has also been innovative in the way that they've looked at building natural supports around people and so even have an individual that their support and tell your stories even have an individual that they're supporting to their neighbor has been folded in. As a part of this and so their neighbor is is received some stipend support some stipend reimbursement from core in our exchange for a commitment that if there's an alert that needs to be attended to that the neighbor is it is a resource that we can pull in so it's it's more efficient it's a better use of resources it improved people because quality of life and it's effective in building natural support systems and folding more of those natural support systems into people's lives. Thank you next on the list representative Garner. Thank you madam chair thank you guys for being here I've got a question at the probably for you first in getting this pilot program started what who who did you work with was at a public private partnership or was it a public partnership or how did how did that work how to get started partnered with the Tennessee department of intellectual and developmental disabilities and having them on board is really kind of critical I think you have to have your state agency recognized that providing support in this way is a means of support because otherwise oftentimes the powers that be will look at a reduction in somebody's needs as a reduction in somebody's funding and that's not going to incentivize people to try to to try to use this of the state is on board and they recognize that this is a form of support it can be mutually beneficial it can save the provider agency money and can also save the system money okay said so did you hello yes did you have funding just from the state or did you have some some private or federal grants and that kind of thing to. To facilitate we had state dollars set aside it was about $5000 per person. But a lot of providers there are providers in the country that have funded it themselves and they were able to spend the money on the initial investment because they're gonna save in the back and on on staffing right because you $5000 it's kind of jump change in the course of a year with when somebody cost $200000 to support exactly exactly one more. Sorry about that were there were there any obstacles legislatively that you found and maybe this is a question for doctor 11 and 4 Mr white are there are there legislative obstacles for. Trying out this program even in in a pilot study something that we need to look at. I yes I mean that the system is always going to kind of resist change I think so there was there's definitely been a lot of skeptics I mean our state was pretty on board and if they really advocated for this I think to their credit. I'll let you speak with Arkansas specific. So we we've dissected what's happened in Tennessee and and really looked at the pieces of it one of the things that was a key catalyst in Tennessee what is the settlement of those long time suits so there were there were there were dollars there it does state dollars that were given to providers that $5000 a person came from some of the settlements of those suits so that's where the money started but then there was also in addition to those that direct funding that the state of TN Tennessee set up a department of innovation and actually has. State level folks that are supporting providers in accessing vendors having vendor contracts supporting providers with the knowledge and training and education and resources and and that's really key Arkansas right now today has a waiver amendment that is out for public should be out for public comment going out for public comment it needs it has a really big an important step in that it's adding in remote supports an enabling technology as waiver services which is a nice first step it's really possible that if that's where we in this conversation that we're not going to maximize that because provide it's there for providers it's it's out there for conversations between managed care companies and providers and exploring that but the technical assistance to the consultation the the infrastructure building that's necessary in order to be able to see. Provide these types of supports officially has to come with that and we we we don't have anything in our conversation right now and to that degree. Thank you very much. Senator Hammer. Thank you ma'am sure thanks for let me ask questions of to that point to carry that are a little bit further is this not something and if you're not familiar with the structure the way we do things here in Arkansas is this not something that the passes currently could be doing if they wanted to do it in order to meet the demands of a. Drinking job market but also to improve the cost benefits because that would directly translate back to savings to the state if I'm not mistaken can you speak to that yes I can't so again we we had Arkansas support network have been digging in Senegal in technology since 2016 and when the passes came into market we were extremely excited about the opportunity to innovate within the past system that's really the whole foundation of why we moved in that direction and what we found when we really started we we invited lots of past leadership to the table we are we actually took some pass representatives to Tennessee in 2019 to their annual enabling technology summit and really looked at what's possible what can we do and came back and and the feedback that we got was that the the passes are are bound by those Medicaid services those authorized Medicaid services and so we came kind of to this wall in this impasse of because enabling technology and promotes supports we're not defined as a Medicaid service centers yes waiver that passes had restrictions on what they were able to do with that so we're currently in the process of adjusting the waiver to be able to provide that but there's still a huge gap and and one of the the fears I have personally is that we we put those billable services in place and we just don't have the utilization we don't have people that are willing to explore people that are willing to learn people that are really willing to shift their infrastructure one of the things that the work groups that worked on the Arkansas in we put in place as a part of our our best funding was to look at actually having resources for infrastructure development consultation. An accreditation around enabling technology but we're also at a place where DD providers still have not gotten dollars from the first round from the first phase of the R. profundity for workforce development so we're still waiting on that so theoretically this is a conversation that that absolutely passes have the ability to sit down at the table and look at how we develop out what you'll hear in every one of the conversations whether it's enabling technology rate setting even even DSP workforce development and credentialing is that as a provider we get caught in a conversation with passes that we're we're informed about restrictions that they have from the state and one and we get caught in conversations with the state about restrictions or abilities that the passes have that aren't coming to life and so I think when you talk about legislative opportunity for us we see some opportunity and really connecting those dots because to your point we we have resources in the system there here and we have the ability to to move for with some things we get ground up in the bureaucracy between the 2 entities quite a lot. The 2 entities being Medicaid and the passes yes okay so maybe the chair would consider getting into the table we could see if we could. I I do have the mall scheduled to speak just a little bit so to just keep things moving in the order I will have all of them up at the table and just a little bit I'm just to kind of follow up if someone. How how do you even begin to know where to begin. The technology. Like here here here's the person and we can defined they need this help where does that technology come from how do you even know what's available what what sources there so we are we're always really careful to start with the person it's really easy to get kinda lost and and technology when you go down this rabbit hole years ago when I started doing research you know that you're overwhelmed by the various gadgets and things are out there so we got a step back and start with the person and say what is this person trying to accomplish what they want their life to look like how do we get there what are they capable of what are the risks in and how do we mitigate them is technology way to mitigate them in and if so you get to that step on there a lot of experts across the country we partnered with enabling technology vendors like simply home that seared mentioned there's night owl there are safe in home there's a dozen of them across the country and they're really your experts so if you're the the provider agencies know the people and they know how to support people these vendors are experts on technology and then they're able to take your input on what that person's trying to accomplish what they are capable of and what support they might need and they're able to tell you what technology is out there in what it's capable of essentially just look look to the experts in technology it's not us where the experts in providing. Good lives the people. M. representative right. Thank you Mr chairman all up we've seen all the folks you know that had disabilities you know what you've got a show tonight what percentage of those kind of people can actually receive help and capable like if it was online or whatever it may have to be what what percentage of folks you saying that we actually can help that and this one. In our experience we've supported well I showed you 9 people specifically in that chart and that's 20 percent of our agency so if you assume that we were representative of the larger population if you're able to support 20 percent of the people in save that amount of staffing you know we're we're talking about 10 percent vacancies you can do is I mean significantly improve the amount of agencies just by supporting is 10 percent. It's hard to say exactly what I would say at least 10. 20 I think if you look at you look at that that person centered approach to technology and embracing the fact that the goal is not full independence with technology right we will are what we would want to be able to do is to provide folks with continue direct support services at a less rate fewer hours and it but still continue to have direct support professionals as a part of their lives so instead of removing those supports all together using them better and better quality you know I would be willing to bet Arkansas support network that we there are I would say 4045 percent of the folks that we support that could benefit from some level of technology within within a year span right there's a lot of training there's a lot of learning there's a lot on on our part on their part in some of those folks it might very well just be having technology to improve their quality of life initially you know the first step would not be to start taking away direct support the first step is to get people a greater level of independence in their homes even with support in place with long term goals of as people become more effective at using that technology they can look at reduced direct staffing down the line so when we think about it you know on that global picture we we start kind of jumping to all or nothing thought process but we really see technology as it as a tool in an opportunity to first and foremost improve people's lives increase the quality of their life and their independence and then look at that gradual long term decrease of paid services. Any other questions from the members before I let these 2. Okay good we we still have a lot on the agenda I hope that you will stick around because we might need you to come back up as we mentioned we do have or Department of jail developmental disabilities that will be joining us we'll we also have asked the past members to be here as well and they will help answer questions at the end and we'll follow back with up with all this but in the mean that did you have something you want to say no okay in the meantime I didn't say for the sake of moving things along we want to move to the next on the agenda and that is we're gonna have Ross white at the director of career and technical education one other idea that was brought up at the the last meeting when we were talking about the need for more direct care support personnel was how do we incentivize people to go into this professionally and there was a program in Ohio that we were asked to look into and we've had or department of education here consulting with those in Ohio on what their program is and it uses high school students involving them in a program where they can learn more so we'll wait on that presentation to get set up and looking forward to hearing what you all found out in your discovery. Sign all if you go while he set that up I'll let you introduce yourself and then we'll have Mr white also introduce themselves for the sake of moving things along. Thank. Thank you Sonya right Mick Murray Department of Education Division occur technical education. The morning Ross what I'm the director for the Division of critical education for the Arkansas department of education so we appreciate you having us this morning madam chair and we'll go sit over a little bit over the direct support professional program obviously we got to hear about it a little bit I'm from the last group and so our focus obviously is going to be on the department of education and what our role tensely could be and I'm the training of direct support professionals and so I think we have unique lands within the Division of career and technical education that obviously our goal is to prepare students K. 12 the next step beyond high school but we get this unique side with career technical education that we're supporting our students moving our students to what is that next step but at the same time we are working with our local business and industry with our local school districts to what are your needs what are your skills gaps in the many things that come about with that and so I think for most of our initial research and conversations with Ohio is we do identify that obviously direct support professionals are hard to come by in so looking at what opportunities arise themselves in our state and within our programming that we offer within the Division of career and technical education. I'm so just a little bit of information about a house program and I'm sure you all are pretty well aware but will just run through some of the basics so obviously it's to provide a training opportunity to high school students and that's going to offer them those employability and career skills I mean develop them in different areas and so alternately when we look at the Division of career and technical education that is our ultimate goal is that the students that we are serving in our K. 12 settings is that we are preparing them for that next step and so anything that we can provide that provides employability skills or I'm developing their career skills is essential to us to an important piece of this that it supports post secondary education and training for special populations students And so dressing to workforce gap that exists within and the direct support professionals is really important because this is something that we can provide our students training within high school and to build the skill set and give them a next step working opportunity that allows students to earn an industry credential I am so in our division I'm for critical education what we report federally to the United States Department of Education is this is one of our state indicators I'm looking at how we certify students with industry credentials and showing that they're ready I'm for the work force so within the direct support professional program obviously the students would have the opportunity to earn a credential and then we'll talk about those little bit more here in a second and then it does follow a nationally developed curriculum and so obviously I'm from our side looking at the department of education is how do we implement programming and how to be supported yeah we give instructors a task at hand but then how do we support that the same time with our instructors and so and there are some benefits at Ohio is using with a nationally developed curriculum. So within that we mentioned about certifications and so for that division of current technical education that becomes an important part of conversation for us but what House been using is with the national association of direct support professionals but then obviously it's it's offering different levels of direct support professional so DSP 12 and 3 as you can see on the screen and so just to give you a little bit of information about what that I'm record or certification means is for ideas P. 1 that means they have earned a total of 15 E. badges and within those it's a code of ethics commitment 50 hours of accredited education and then the focus with crisis prevention safety competency person centered and health and wellness and so that's the generic to the DSP 14 DSP 2 they aren't 30 total E. badges I'm with a focus on code of ethics commitment and then 100 hours of accredited education E. badges with focus in evaluation professional community or excuse me communication professionalism community inclusion in networking and then for the level 3 that is total of 50 the badges I'm again with the court comes the on ethics and then. Focus on empowerment community living skills education training and then cultural competence and so this certification is good for 2 years so every 2 years somebody would have to recertify and so that's an important piece to keep in mind at the end of the 2 year term and they may show that have at least 20 hours of training and the training does not have to come from the national association of direct support professionals but no more than 8 of the 20 hours can come for mandatory training requirements. So as we look at the direct support professionals in the programming that we already do within the state of Arkansas I mean specifically within our division of career and technical education and we have 5 different occupational areas and so we see the direct support professionals can fit within 2 of the 5 occupational areas that we offer our programming in and the first being what we consider trade and industry under each occupational area the 16 career clusters online I'm in there in different ways and so then with that their pathways Senator trade industry of the medical profession's area typical to what might be a CNA program I'm also some LPN programs and we see some alignment within some of the programming that's available there that we can see where this could fit within our instructors that we already have House there but also just some of the programming norms that exist and then also in our family consumer science programs I'm within it and the career clusters looking at human and social services but also education and training and so we see the ability for those to connect into these 2 areas just based off of the background what those teachers are you typically doing with our students already preparing them for next steps after high school and we can see alignment there I'm obviously there is no perfect alignment within it but we see that those 2 areas out of our programming that we offer and we can see or direct support professionals can fit into that. So the next piece we're going to focus on is our work based learning that we have within our state and some of what the doctors on your right merry speak a little bit about that. Thank you so as direct white mention we did get a chance to visit with the Ohio program to get some understanding of how they implement the program which is very helpful for us because they were able to kind of map out having modeled it and so we can hopefully you know avoid some of the people that they may have had in that first run so looking at work based learning we identified there's 3 work based learning programs that we currently offered her technical education that would align nicely for this program the first one being career practicum so this section of our work based learning offerings are available to students that are pursuing a work experience that aligns with their program of study so as just mentioned with the trade and industry macro and that also kind of consumer sciences Human Services and then also at training so if there's students that are in those programs of study and they have a work experience then we can see how this opportunity could be one of their third level offerings and have that opportunity to not only gain that work experience but also gain course credit. And then also for internship so this will be far students 2 men and a sincerely be in a program of study or have a work experience that is aligning to their program of study so they have a work experience and so also this being of the opportunity for students to be able to gain that work experience while getting the training to be a DSP I'm in some of our schools on the other opportunity we see through this process is that for a work based learning programs skews me. They're all assigned a work based learning coordinator so potentially that individual that's working with the students and the schools could also support the experiences that our students are going out to have some of the facilities that will be giving them that opportunity to have that on the job training. On the other area that we have work based learning offered and it's our job to Arkansas graduates so this program is designed to support students that I may have a better to graduating on time with their peers and so they have an opportunity to enroll in courses direction and also work based learning experience so we can see happening here for some of those individuals is that they have an opportunity to roll and the senior application course and move to the curriculum that is aligned to the training for the program so with the senior application we identified that because one of the things that Ohio shared with us is that initially they open up the program to both juniors and seniors but then after running the program for a couple years ago in a fight that is probably best suited for seniors because of the maturity and that also have an opportunity to be able to go into those work environments at a better age for a lot of Arkansas ylides. That's what we chose in your applications and then also they would have an opportunity to have the work based learning component so students that would move to the eighties types of options could earn an additional 2 credits because you could get the credit for the senior application need to also get the credit for the work based learning and then students that were just living their traditional correct work based learning opportunities could get the one credit for the for the year. So we were able to also see how this could alliances some of our existing the initiatives that we have in state right now so as much before critical education we do move a lot of our work around Perkins and so in Perkins there are 9 areas that are defined as special populations and one of those areas of students with disabilities and so it is our intent and our desire and our goal to make sure that students with disabilities also have a fair and equitable opportunity to our CTE courses and have good outcomes and so we let that this would align nicely with that work as well with Jack so the benefits of Jack is that students enrolled in these programs why they are in high school however our outcomes are measured on how will we support students host high school so we're doing a year follow up after they graduate so if we're able to work students through the curriculum to be a DSP and get the credential in those cities would have a better opportunity of being employed moving on to post secondary education and so that they further their education beyond a high school diploma which would impact our outcomes as well. We also have the responsibility this granted to us by the US department of education that office of civil rights to ensure that all of our programs are fair and equitable to all students that are covered under the Civil Rights Act 885 or 4 and also title 9 and so we thought this would also align nicely with that work to make sure that everything is in alignment there we have received grants from advanced CTE which is a national policy arm that has granted us funds to be able to look at all of our CTE programs and to determine if we have any gaps in achievement for students that will follow up in a special populations so again this would align myself with that work. And then a partnership that we have been involved in since 2016 with the Division of elementary secondary education office of special education and Arkansas transition services along with rehabilitation services is to look at how we offering CT in our state are we able to present say that we are providing their an apple opportunities to students to have a disability and in some cases we determined we had areas of growth so through that partnership we have been able to develop professional development for our CTE teachers so they're able to offer universal design for learning we've also been able to develop which was formally called al program but is now called wolf which is a program designed to provide work based learning opportunities for students with disabilities and then we've also been able to determine through this partnership that we need to provide more in which many support for students in our courses so we partner with magnolia school district to pilot a CTV cold hot model in our agriculture classes and seeing wonderful outcomes so we've let that all of these existing efforts that we currently have going on this state would be strongly supported by implementing this program in our program in our state. Speaking of partnerships after we met with Ohio we did have an opportunity to quickly turn around and visit with a couple of individuals across the state that could do similar work are currently doing similar work and could be a great partner as we develop this model so I'm Arkansas police station services Arkansas cryptograms center I'm so to speak with that director in get some thoughts together on how we could implement the program and would his location be willing to serve as a site for internships and he thought that would be a great idea to have that is be available for us Arkansas transition services I think this would be a wonderful opportunity for some students that maybe interested in going into this field and this could be a part of the transition plan and to improve their political outcomes and then also had an opportunity to have conversations with the executive director of the governor's council development development disabilities and also he saw value in the program in implementing it and could determine that there are opportunities for partnerships not only with his organization but other entities around the state that also doesn't work. So as we wrap up our presentation you know our biggest conversation becomes what it become our challenges and our barriers I'm to the implementation of a direct support professional program I'm with high school students in the State of Arkansas to train future DSPs and so the first becomes the availability of in school personnel to oversee the students I think if we turn to any form of conversation any addition an education becomes who becomes the oversight of it who becomes instructor of it and that becomes a larger conversation as we mentioned earlier are work based learning opportunities that we have that's we have work based learning coordinators but within that we already you know have limited pieces and then when we add in different bill fields NO it stretches that further and same with Jack specialist you know we have a lot of Jack programs across state and they're already stretched to the brink at certain points and so being able to see that I think the other part of that conversation to becomes were looking at a specialized field in the training that's needed and so ensuring that then our instructors are well versed in well trained in what they're doing the second piece we identify the source of funds for student stipends and that was a big conversation we have with the Ohio was with work based learning that we mentioned earlier it within our state most of those students are typically being compensated they are typically paid internships that is the most common and so as we start to look at attracting students to these programs looking at abilities to be able to provide those students opportunities for it to be funded internship work based learning opportunities important I'm the third is identifying obviously who is the governing DSP entity for the state of Arkansas you know from the education side we want to ensure that our students that we are serving in training I read provided a safe and secure learning environment and so at the same time that becomes kind of a question because I know as we've done our research talked across the state there's not a clear answer and so really what is that become and then as we certify students. I'm ensuring that certification will help them to their next step in going into the workplace we want to make sure that that is something that's a viable peace for them moving forward and is recognized by employers and then Ohio one of their biggest pieces that they continue to say is their biggest rival is the Medicaid age requirement of individual serving as DSP so we train high school students we get them that certification they're serving in that but they might not be meeting and the age requirement set aside for them such as being 18 or already having a high school diploma and so that right there I'm can create barriers in itself as if we are training high school seniors which seems to be the most common in popular but we have many high school seniors that don't turn 18 until after they are in that high school diploma and so we can see that being an additional barrier with the Medicaid I'm requirements that might exist within a DSP programmer serving as a DSP having different places so those are the biggest challenges and berries that we can see moving forward from the Division of career and technical education so with that send of our presentation will take questions that you may have. I know we have some members who do have questions but I'm just going to back up a little bit to an ad that in the phone calls in the conversation I had with Ohio one of the other benefits that they didn't necessarily know going into it is they targeted and school students who were on the verge of dropping out to be enrolled in this program and the beauty of it is that everyone who entered this program no one dropped out and many of those students said that they felt like they had purpose they felt like they were needed they were validated and these were students who just really looked at school and thought. Why am I here and they finally felt like I'm I'm here I have a purpose because they're helping someone with a developmental disability and so I wanted to make sure that that was really clear that they're it it's not just helping those with developmental disabilities but also helping people find careers and finding purpose in their life so representative Springer I believe you were our first. Good morning thank you madam chair I'm just interested in the number of students that the Department your particular division is serving and for the categories that they're being served for I noticed that your report didn't include the numbers of students across the state that you're serving and what particular area that you're serving them me and I know you talked about a number of areas but you don't identify the students nor for their being for their located it was services that you're providing so I would be interested in knowing who those students are the services that are being provided and so forth does that make you understand what I'm saying so I mean in regards to just create technical education state we serve and students grades 5 through 125 through 12 excuse me that is federally mandated by I'm Carl Perkins act and so we serve about 150000 students roughly is our enrollment obviously COVID has played with that a little bit and per semester in that we have 5 different occupational areas that mentioned and I mentioned that earlier and so that can include it I'm agriculture business and marketing family consumer science and stem education and then trade and industry and so within that we have about 64 different programs of study that are offered in all public and charter high schools across the state I mean these are more can you give us a break can you break that information down so we can see it I would just like to see what's what's being handled by your different to yeah I mean it you know and I can mentions there are the 64 different programs of study and so we get real specific what we mention here is where we thought the direct support professionals the line most appropriate with based off the instructors and so that's kind of why that information was provided there to give you a an idea of what where we think it went online okay would you don't tell us who they are with the numbers already they'll you you talk about it but within within those areas yes the specific number so we currently don't have any students enrolled in a direct support professional program. Well it the the program that used that you're supporting them in my understand that I'm just saying the ones that you are supporting I'm not thought. I'm not following you as to the actual students that you will be providing support services to. Or that you are providing support services to. I think a minute into interrupted that's okay this program has not started in the state of Arkansas so so they don't have any numbers this is just they're bringing us information this is what's been done in Ohio and we're just taking I'm starting yes I'm Senate but they are you all are providing some support to some students do not providing the support any students in your department I mean within I mean so we serve 100 roughly 150000 students enrolled in our different 64 programs of study and so I mean specific to our presentation today is over how of direct support professionals could be implemented our state and the bears and not exist so I mean there's more specific information you're wanting I'm just not following exactly what information you're not I would like to see the numbers that are currently in the program and possibly for they could be served with respect to this particular program is what I'm trying to get it so who are they who are the students and how is it that they can be served with respect to this particular particular program is what I'm well I think with any of our career and technical education programming I mean any student who is enrolled in a K. 12 school in the state of Arkansas has the opportunity to participate in any program that we offer it becomes whether that becomes is a part of their career planner there student success plan that we have established within the state and so as madam chair mentioned is you know as we look at students planning for their next step in their next future you know students who maybe or wanting to work with and. You know individuals with disabilities or people that are interested in that mind set could be an opportunity for them to enter into a direct support professional program is not particularly there I mean obviously all of ours are aligned to the 16 career clusters all our programs are that are leading to the and different work skills and workplace and beyond high school graduation. And a representative Crawford your next. Thank you madam chair on the challenges and barriers. If the students were to volunteer before they were 18 or at their high school diploma would Medicaid age requirement still be and be there or is that only paid employees. So and that's a piece of where we're still learning within our state you know what the requirements expectations are and we don't have the full grasp of the information just because it does currently not really implemented within our state that is something that how has said over and over that they haven't been able to use you know pieces of their what's under there waiver with their students under 18 so I've had to find other ways in which to be able to implement that was students other than using Medicaid and so that is a pieces we've been having conversations with Ohio and working with our own different state groups that we are mentioned earlier to determine what is appropriate and not appropriate within our state follow up. Just a suggestion like CNA classes and different things do if they did possibly the volunteer work then they would get part of their scholarship maybe pay for when they went in just a suggestion thank you. Any other members questions okay just a following up so legislatively these challenging barriers are the things that we need to help you sort through and figure out is there anything legislatively like is this just all rules communication whatever or do you see something legislatively we need to take care of and 2023. I mean. In my opinion I think the biggest part is this the start of the conversation and I think as we have more conversation there might be more pieces that become available we look at it from our programming side to what we're able to implement within schools and be able that students be engaged in a program in the the certifications I think those are very feasible pieces I think we're becomes a bigger question is then the students being able to have the opportunity to earn that DSP and be able to work in that environment and what regulations exist there that might be barriers that is often a lot of our problems is you know a bears that we have is that we'll have students who have gone through a program have been trained and earned a certification that says they are work ready and ready to enter that force but then there becomes an age bear there becomes a. Security barrier privacy barrier because they are still high school student even though they might be at the age of 18 but those still exist and so I think that as becomes more of the work of what we have to be able to determine working with different state agencies to determine if we are able to implement that program and able to have it moving forward with the students actually be able to enter the work force prior to their graduation and be able to say help support the apparently great need that exist for direct support professionals and state. That. Any other last comments. No I just thank you again for the opportunity to come before you and I think back to representative Springer's questions we do have the ability to provide enrollment numbers and where programs are located and maybe that will start to give you an opportunity to see where we are providing services especially in areas of metro in Human Services and a training give you opportunities you students potentially there but back to director white's point is that we intent that this will be open to all other program areas those are just ones that we just identified that maybe would be the best fit for students that are already going in that direction we doubt that can provide you those numbers and follow up. Okay K. and actually if you provide it to Blake hill make sure it gets distributed to the entire committee so we can all get that answer so thank you so much and we will probably have you further along in discussion as we don't in other words don't leave it today and then we'll probably see you again at another meeting just to follow up but we will move along and we have next up of Melissa whether intended she can come forward I know she's been here listening to both presentations and there's things that have come up in both of those presentations if you wouldn't mind giving us your feedback from the department of developmental disabilities. Hello I represent Mayberry am Melissa whether 10 DDS director and I brought with me. Good morning I'm Elizabeth and director for the Division of Medical Services. Meant to be here today because last time we were together we had a lot of questions regarding sit General Medicaid in some past questions and technically Elisabeth is more of its over the past program and everything goes really wrong I wanted her here. But today I did want to go over and I don't know if you have a hand on front of you but as Dr 11:00 AM mentions we are kind of right in the middle of doing some changes to the C. S. waiver for several reasons 1 is waivers last for 5 years and it's up for renewal into as you guys are member of governor Hutchinson made an announcmenet and was going to find it is finding and adding about 30 200 people and to the C. E. S. waiver so making it just under I guess right around between eight 8 8000 people will be able to serve which is exciting but when you do things like that you have to go and get CMS approval and I those lights and show them how you're going to pay for so I will die right in. This presentation was M. was developed to use in multiple forms so I'm sorry if this is and redundant of what we talked about and last meeting with loris presentation on the background so I won't belabor it but for those of you who and are not aware high level the Committee and employment support waiver and allows people to remain in their homes and communities rather than living in an institution the level of care is the same for the and for the clients that are served under the waiver program M. is the same as the clients who live at one of our human development centers or live in a private intermediate care facility that's run by say easterseals OR pathfinders and clients in this program and must have a diagnosis of autism cerebral palsy seizure disorder down syndrome spina bifida or general intellectual disability and it and you all might you also have to have Senate and and functional deficits in your daily living skills and it must be identified prior to the age of 22. I'm currently in M. as mentioned we serve approximately 5400 children and adults and the most utilized service under our waiver right now is supported living which and last time I looked was 98 percent of the cost which plays really into the enabling technology presentation that you were able to see and I'll talk about that in a second the waiver cost approximately 300000000 annually. With the federal share being about 71 in the state general revenue making up 28 percent and with the addition of the new slots that we're adding to this amendment which we are trying to fill within a 3 year time period and we will then our annual costs will rise from 300000000 annually to 442000000 annually for this program. Thank you. I do want to point out that and at the time that the government made the announcmenet that was 3204 people on the C. S. waiver weight less and when the waiver comes out you are not going to see 3204 slot added over 3 years and I wanted to be able to explain that to you all today so on average we have about 150 people due to passing away or moving out of state come off of the waiver each year so those slots were not be added so we'll have about 450 people every 3 years that will no longer be served for various reasons that will be then able to bring line 450 people on the wait last also and the date of the governor made an announcmenet we filed an emergency federal document asking for immediate approval to serve 200 additional people that we already had the budget for and that was approved so those people have already been moved on to the waiver so I just don't want to I know Laurie we'll see at save there was 3000 but I'm not seeing 3000 slots added here and and she'll know the reason behind it but I wanted everybody else to be aware that we don't do it to the exact number for various reasons. But we have no doubt that will be able to serve those individuals with the numbers that we are asking to be added. And then we're also DCFS has special slot set aside for them not only did they get priority on our waiver so they get a slight and if requested that they specifically have slot set aside that they manage with eyes and and they had 300 and all of those slots are full because once you get a slight you get it until you no longer need it which is often AM till death so those children are pulling up this lights and said miss Martin asked that we had 200 more because there is she continues to see a need to add M. slots for people and for children in foster care they really help with reunifying children with their families and they also help if that's not possible with adoption. 14 just quickly there's a couple of the services that we're adding to the waiver this round so we're adding home community based supervision and monitoring so as I mentioned earlier supported living is our number 1 utilize service and it's a training service so if you go look at the definition of supported living your training people on independence life squeals cleaning cooking money management grocery shopping acting integrating with the community at large and so it really is supposed to be a training and training service where the workers documenting what they're doing to reach the goal of that training service often times if you can imagine we do have clients that if enabling technology is not appropriate not get into that and cannot be left alone for whatever reason and we have those clients workers are not doing supported living with them either a sleep right so we've added in and supervision and monitoring which is exactly what it sounds like which is you're not you're not trying to get a goal you're not keeping and a note on it there's not an outcome other than safety and ins and they can be able to stay there if they need to and if a client is unable to stay online. And then enabling technology. So I ask Dr Evans was talking about she's been a big proponent of this and as invited me and I was about to meetings on it and we wrote this into enabling technology is 1 of the initiatives we wrote into our section 9817 American rescue at plan that's initiative number 2 so initiative 1 as your member was the work for stabilization payments so initiative number 2 is enabling technology. In tandem with that we have written this service specifically name to this way in our waiver so for years we've had a service and it's still in there called adaptive equipment adaptive equipment. Really when you think about it or devices to help people communicate that's the first thing that comes to mind but also in there or were personal and per systems like personal emergency response systems but it's kind of bearing down into the service definition itself so what we're trying to do with this is really highlight this national initiative that's moving across lake and stared and Nick talked about and highlighting the enabling technology is approved is an approved service under this waiver where is it was kind of tucked and hidden in there before so really trying to highlight it and we I hope to be able to highlight even more when we M. F. employment initiative to which should be in the fall of this year that not only helps DD clients but also crimes with behavioral health and physical disabilities and aging population because that plan covers all of the specialty populations. And then one of the hot topics I'm going to questions in other words that or for money that's for enabling technology is not available until probably the fall is that what you're saying to just be very clear because I think we had questions about is there funding available to help get that started and so that would be available in the fall for our for our for the American rescue our committee yes this is very different from what we're doing on the waiver okay so it is available right now under the waiver okay. It's just that it's not highly utilized so what we're trying to do is by adding in that the specific wording of enabling technology really draw attention to this and fleshed out more in that definition section simply yes and this is completely different from our bonding okay. So also in the waiver and that we are trying to change which will come up or why and and be contested to be quite Frank and is increasing the group home that can pass IT from 4 to 8 right now there has been a moratorium on group homes for clients with ID D. that no more than 4 individuals can live in one location and I have gone in and I ask that that be and. Extended to 8 people. Now M. you will hear opposition from advocates who are are completely against any type of congregate living situation and I've talked to many of them on the phone about this and I understand their position and not let me just say from the department's position and remind personally we are watching so many people be put at the Arkansas State Hospital we're watching them be put the bill in full human development center in the Warren human development center and and. You know that is a choice DDS in particular believes people should have choices on where they live. Right it's not really a choice if we're not giving them an appropriate option in the community it's it's M. it's a force right so if you're aware unable to appropriately handle you with the with the community options that we have then your only choice is to go to an institution and so and I don't think it's a secret to say that when they come live with bass I'm at the billable Human development center or any of argument about missing there's often times they stay there their entire lives. And it's very hard to transition even if you want to go back out it's very hard to transition into a truly needs to be a choice the choice of the client and the family that that's what they want for their life so I'm asking that the group home be raised from a 4 bed 2 and 8 we've had group homes that are in the 81011 range that work I'm able and providers across the state you are grandfathered in that have them are able to take some of these different difficult clients because they have multiple staff that have eyes on people like we do and in the I. see acts and they're able to stay there and able to more easily transition still living in the community with the community provider so I'm sure that just like them my colleagues many of you I will feel 1 way or the other about this but I do think it's important for you all to understand where we're coming from on and. We we do not we do not have the options right now. So we're building them we've been building them we're working on on building a mobile crisis continue on we're looking at adding funding under the American rescue actor that continue in which I think will greatly help people in the community we're building out that new provider tight community support system provider that launched last January we have a full time person out advocating and explaining and recruiting providers for that provider type which has the more options available for people with and significant behavioral health needs but it's not they're not there yet and so if it's not there yet we I'm trying to do an intermediate stat and to avoid institutionalization of people who don't want to be there so that is I will quit with that now but I'm sure I'll get questions later and then the biggest one that I think you all will really lie. Is allowing family members to be paid staff. So made it crystal clear in the waiver amendment this time there is boxes that you can go in under each service that says legal representative guardian relative provider and you mark the one is a state of what you think is allowable or should be allowable to be paid and we've gone in for supported living and rest that and I think supported employment in March all of the above so it will be they will still don't get me wrong they will still need to meet the criteria right just like you would if you were a paid staff member and they still have to go through criminal background checks and drug screens in training and they will go but they could go be employed with a company like Easter seals and then they could be paid staff regardless of their legal status I guess that's easiest way to put it and so that is in this amendment. Okay and this is kind of the more the less fun more boring stuff so on page 5 we've also had to go in and make you will see a whole bunch of red line on this waiver amendment and we've had to clarify responsibilities between us and the passes between internally and DHS eligibility who's in charge of this and who talks to who and how often do we meet and discuss and it's just clean up that needs to be done and to make the program stronger we've gone in and clarify the meaning of administration of medication with a lot of providers who get really scared about that and nurse practice act in terms of they do have support supported living that pop pills out of blister packs or take the limits off of pill bottles and they just needed that they continuously without needing clarification is is that administering medicine or is that not administering medicine so we have put in the waiver that helping people open their pills and hand it to them is not administration of medicine. Changing the terminology throughout the waiver to be consistent and clarifying what clinicians can do what task under consultation and then correcting some requirements under care coordination of care coordinator qualifications in a lot of these were pointed out by DD waiver providers of floated the M.. The draft out to a small group of providers during informal public comment we were still revising and a lot of them pointed out that we were able to fix and before putting out formally. I mention that I am on December 14 when the governor announced and the great news about the wait list we went in and added 200 slides through an emergency pandemic waiver in in that waiver we also and. Put in there that we eliminated or were eliminating the requirement that direct support professionals had to have one year experience that was really hindering and providers to make be able to hire and train on site with that one year experience and now it says one year experience order and has sent training options and that went into effect in December and we're permanently putting that in the waiver. And then improving language around support employment there was a lot of and because the 5 year waiver and it was written prior to pass and the the managed care model what it really prescriptive language in there because we DDS was the one really overseeing this and I'm and we tried to go in and make it more and user friendly in terms and giving the passes more flexibility to approve services where they being so prescriptive so you'll see we took out a lot of the language under support employment in or leaving that up to the to the member and the past T. and their care coordinator to determine whether or not that should be paid for supported employment right it was before it was you needed this and this and this that's the only way you could be paid we took all that prescription now same thing with the respite we had put in there specifically where you could have respite we've taken out locations if the past wants to pay for respite they can deem when it's appropriate and where to to pay for respite so we took out we're trying to to to be less and micromanage she on some of this that we I think we did back before the the past program. And that is that that's a high overview of what you will see and is not a public comment yet it's still an internal and review and then it'll be put out as soon as the internal review is signed off by that top. Okay I appreciate that I know members will have questions but I'm going to before we get too far into what you just presented because we've just had the Department of add up here talking one of the things that they specifically said in their challenges and barriers in that presentation from Ohio was identifying the governing D. S. P. entity for Arkansas. Would that be your department. And enter you have thoughts that can be shared on how we can solve that yes so that was I mean I think I mentioned in our last meeting that's been the biggest barrier so for example you there's the CNA register that the office a long term care overseas and you can pull that they can pull up any CNA and see when they were licensed and when there and see you with completed because they have seeds do M. every year and so they can see who is in good standing and has not. This would be DHS setting up. S. side by side of a C. in a registry at first we had talked about DDS doing we we will be Frank why do not have the man power to set up such a registry and and I have been open about that for years with the providers of you know we really see our role as setting policy and help administering and and not. Overseeing a registry in within DHS right now whoever sees that is our office of long term care who you know does nursing home and ICF surveys but those those facilities are run by C. N. A.'s and I think that's how that was initially set up if I had to gas but no I think that's been the biggest hurdle is who who's going to manage that who's going to make sure that that database is up to date who's going to take those calls to see if they're in good standing you're really managing a training program and a certification program and right now we're just not set up at my in my department to do that. With that be something that would be under DHS though just a slightly different. We don't. We don't have staff in place to my knowledge to be able to do that I would never dream of speaking for all of us markets here. March. Mark do you have any ideas or some solutions while we're on this topic before we get to the others. Hi. I Mark why did just try to avoid it comes up your. Our. No I as as was woman said that is in that would takes additional staff and resources because we're talking about setting up a new regime of occupational licensure for a particular type of profession it just it takes staff takes time takes some resources particularly talk about one whether I'm I'm not sure off and how many direct corporations we have the state but I imagine in the council's and so that's that is going to be a live it can be done but it's just a matter of an agency having the resources and also taught I would at least look at do we have the unheard of for to do that or is that something that you as a legislature would have to create another another number of efforts and the restrictions that you are placed around creating new occupational licensure I think we have to look to see how this would fit in with those laws we already passed and that's something I've done personally but that's and that's one take a look at and then one last point. As far as weird food I think there are a couple of agencies where that might possibly fit and that's just something we have to explore how big of a staff would we be talking about is this one person. What we looked at this last time if you're just talking about CDS waiver we were looking at 10000 DSPs because as you remember from the video some have 6 people around the clock and now with staffing shortages across the state that would probably be lower but they would not be used just for the C. S. waiver they be used for the past program probably because it's the same type of staff that's doing home and community based services for our clients with behavioral health they don't need a clinical license that are under the supervision of a clinician so we're we have 54000 members in the past program right now so if they tied. Smith then each had one staff we were looking at a very large amount of people which would be great it's just M. like Mike was saying that was and that's been the hang up of how do you manage that without without setting up in an office a whole nother office if I can that I mean that is that city and stuff Service System to take the applications to manage the criteria to managing testing this required to track all the continued education of this requirement as well as the invested investigative side because you also have a mechanism to remove people from the registry for acts they've done in a way to track who's been removed in the registry so there's there's several moving components there that meets up I think it would take multiple staff to do that. Okay okay. We'll. Representative Springer I believe had the first question. Thank you madam chair on page 3 I will make reference to that page is there a plan of when and how you were so you will serve the additional 3200 clients over the next 3 years. It's a great question yes there there is definitely a planned so we've been awarded large amount of funding for slides over the years not this large I will say that this is very exciting but we have eliminated or reduced the list by 500 with tobacco tax funds and then 700 and in December of 20 so there is a process in place with a time within my office of how we notify people that they're up on the wait list we do it in batches so it's manageable so in the waiver you'll see I'm adding 1200 additional slots you're 112 0 more year 2 and 150 350 year 3 and and that's the expectation so if you divide that you know 1200 by 12 months that was what we expect to bring on an month by month now I say all that to say Hey we do have to continue to get a handle on the work force across the state or that is going to be a huge impediment as it is right now to bring people from the wait list to the waiver. So let's see so 2400 as 24 and then what did you say that the on the third Hendren and 50. So that's not quite 3000 so for the. So I think I'd mentioned the beginning that will have about 453 a question and then I went ahead and already added 200 additional slots in December okay. Unlike place some it adds up. Thank you. Representative fight. I thank you madam chairman I think part of my question was answered but I was asked by an someone watching online to ask about not being able to use the technology and provider under owned facilities are connected with the funding for arpa. Could you speak to that. Yes so on a neighboring tech technology and I'm Dr Evans might have some. Thoughts on this as well and right now it is written that it's for people who live in their own apartments not any type of group home setting group I'm generally that are and operated by providers have multiple staff and this is really as the video showed you for independence M. in lieu of staff and did not have staff present and so that is why it's currently written representive fight it's and it hasn't gone out for official public comments of course if we get comments like that and when it's out we will be sure to meet with them and see if we're missing something or we routed incorrectly but that was the thought behind it thank you. Representative brown. Thank you madam chair I just have a couple of details someone clarify on page 4 you were talking about. We say I got in the right place you were talking about a family members being able to be employed to. Provide the care of in a couple of confuse their the in does this mean that they would have to be employed by of Easter seals or some other agency and then go out and serve that family member it does we do not have a self direction program under our waiver it's very very difficult for several reasons to do a self direction under a managed care program and right now that's not an option so if you want to be appeared at paid family member then you work for one of the waiver providers and that's happened that's happened for years and years right now if you are not the guardian and you have an adult and child on the waiver you can be paid stop that you work for a waiver provider in one of the reasons is not that waiver providers and then rolled Medicaid provider so with all of the legality and insulation that brings us to make sure that they know what they're doing and then the passes can only pay enrolled Medicaid providers you could they can't pay any company that we have not said meets all of our standards for serving Medicaid clients so in order for someone to be paid by the pass they have to be a enrolled Medicaid provider so the only way to do that is to work for an enrolled Medicaid provider or to start your own company as it Medicaid provider. And that's not nail that's but that's been the case the new the new changes that M. you can be the guardian or you can be the legal responsible or you just can't be a relative and there's no restriction in there on the age requirement of the client thank you and then one other little question what is supported employment. State supported employment so I think you saw M. the young woman that was working at talk about on the video and she said I use my technology instead of a job coach and what she's talking about is that under supported employment you can have a direct service worker go with you to your job and it'll be paid for by Medicaid to support you at your employment in for her she's using enabling technology instead of a person which seems she likes a lot better and it's probably not embarrassing to hire there was actually a it's a great idea of how to use technology I thought that was a great video but right now you can pay and the passes can pay a a person to go with you to your job. Thank you. Next up representative Hudson. Thank you madam chair just quickly because I know that you've talked in the past about some of the challenges with getting all of this new staff in is there I mean is there a game plan for how to recruit and and how to bring all the staff and because you've talked about a really ambitious ramp up I feel like that. Thank you given all these caviar but yes. So yeah so we were really excited and I have to tell DHS percent we were when the only southern states actually get the American rescue that money out the door. It was quite an endeavor we did expand $112000000 prior to March 31 which is what we had to do to generate the program to get the extra federal match to use for our second or 2 next initiatives which are enabling technology and expanding and enhancing Services so we'll be able to put about $74000000 into the next 2 initiatives which will be great Dr Evans is right and I heard or make the comment that some of the providers that have it yet and there's a reason so if you build Medicaid direct so think about and personal care is a good one A. R. choices for the elderly they they primarily under ARChoices will they do only bill us direct they're not under the pass they're not a pass provider they care for the elderly that population of providers in some of the past providers received checks for fee for service that's what we call billing us direct on March 24 which meant we got about $60000000 out the door on March 24 directly into the hands of providers however there's a managed care federal regulation that if you bill and managed care entity that only the managed care entity can pay you money through your perspective per member per month payment and we were told this I guess. Well we learned February we had been working with them since last July and we got told in February that we had to fill out the Special State directed template form which they said was going to be easy peasy and it was 13 pages and it wasn't the apple so um but basically there's a phone already that says only the passes can pay and here's the kicker it can't be based on historical spend it has to be paid. On the rate setting period of the year you're in said the rate setting period that we're in is January one twenty twenty two to March thirty first twenty twenty two first quarter second Oliver forms had this say we would go back and increase the passes per member per month payment for first quarter payment so because of that we are allowing the providers under the past 60 days to get their claims then you know we normally they have 300 65 days to get their claims then but since we're trying to get the money out the door we say guys you've got to get your claims and so on June 1 we're going to reach out to the passes and get all of the claims for first quarter take it back reconcile with their actuaries and then we will know how much each provider will be paid by each of the 4 passes is super complicated it's we've been deep into it is complicated to ask so I know it's complicated for people in the public for providers even we've been trying to do a lot of and zooms and faqs and M. explanations on it it is frustrating to them because they waited a long time for the money and then some people got paid on the 20 fourth and now they get to wait even longer and to be honest they will not get any payments the earliest will be able to do payments as July 1 because we have to reconcile these first quarter claims so 60000001 now on the 24 to providers 50 2000000 we went to the passes to hold so that we could expend the money and meet the regulation for the program and then they will then distribute that 50 2000000 to their providers this summer. And I I do believe we have the passes who are here and at the end we will ask them to come up the kind of also share from their perspective that issue if if that's okay representative Crawford. Thank you madam chair just curious in these homes that you have 4 beds how many of those do you have across the state Arkansas do you know. I do not may not but I can get that for you okay in an. This is kind of a 30000 foot overview but. Let me know if you think this would work and we could work on this under the occupational license database for the CNA people. What if. 30000 but okay what is. Those individuals. Who are licensed had to. Go themselves into a database. Uploader documents that they are where they need to be. And then if you had people who were violating. Then of course the department can go in and take care of those do you think if we pursued something like that it would work. Yes I meant of entrances yes I think if if if we determine either we have the authority or you'll give us the authority to set up a system of licensure for these DSPs I would I would hope that would be something along the lines of the describe where it's as much a business online as possible to cut down the need for no having more staff and then and also make it easier for those individuals who are coming through and getting getting that license so we yes ma'am I think that's that sounds like a direction we would want to go unless there's something I'm missing that ms weather spot. Okay we'll work on thank you. Okay representative Garner. Thank you madam chair I'm in my question is kind of on the line of representative Crawford's if we're I'm trying to figure out with the savings that we would have using this technology and the infrastructure for high school students to come into the program. What's that can you estimate a bottom line of what it would cost to get the certification to to to what I'm trying to figure out is how much we need to spend to to meet the savings and what the savings could actually pay for if we had a pilot program to begin with so that's what I'm trying to get to can you give us an estimate even if we have to start fresh with a new certification program what would what would that cost. For me unless you own this. Is just an estimate I mean are we talking about. Dollars are we talking about dollars are we talking yeah inspected by the millions and I'll say that because there's course there's the IT costs to develop the IT systems to do that register ended 7 lawn on portal and all those things that go with that the course there's the ongoing staffing cost and the other the other piece is what what portion that could be paid for Medicaid so for example I mean it new you think we could just leverage we already do rent CNA's the issue is that that work is funded by Medicaid specifically for that so we have to use some other funding for this purpose and we offhand my guess is best case scenarios that is the federal match 50 percent of that that's would have to look at that and work through how much can we get from the livers from the fence and combined with state dollars but I yeah I would think Sturch cost. I would expect to be 7 figures would be not just off top of my head and would like to see for that particular project that badging program that that Tennessee is doing we did look at the cost of that is been years but I bet he knows exactly how much it is per person and we were saying we were taking that number at times 10000 at the time in trying to come up with a class because we were going to ask we were working with the passes to get the passes to pay for it because again that's not. Really something that's I think falls under Medicaid funding in terms of our allow ability on on paying for that training and so we did and then the providers didn't want to have to incur that class and so we were looking at it back then activities some of their community investment dollars that the prices can utilize towards that endeavor. Back then it was the the badging system as you can tell them 9:00 hours you have to get to get a pads was a lie and it's still alive but for especially the CS waiver providers who and there's not that many hours that we're putting people through training and so it just kind of fell flat and probably fell flat because the pandemic hits like everything else and we just need to revive it and that that nickname is the cost of of what it is per person and you get bulk discounts the more you train and the cheaper it is so that was a benefit but I can't remember the dollar amount and and want to point that I should mentioned earlier we're typically not push lost like this can be financed by the fees on the individual's applying and that would definitely take legislative action that's awesome you'll have statutes in place that borrows from in creating fees like that without your permission you do have several members of occupational licensure on this committee. That's what make sure that the gentleman. Thank you. I think that's it for the questions please don't go too far because I'm sure we will have more that's okay the next person we want to have come up is one extreme from Easter seals regarding a rate study. And I'm I kindly ask if representative fight with mine coming up and sharing for just a moment so I could excuse myself for a moment and come right back. Thank you. 2. What have you got to do this because way back in the nineties I was education directorate Easter seals so welcome to our committee please introduce yourself. Thank you madam chair my name is Ron extreme name CEO for Easter seals Arkansas and I've got a colleague with me who also serves on the board of the DPA. Welcome I'm Melissa Douglas I'm the executive director of an independent living services which is located in Conway Arkansas. Thank you and now we're ready for your presentation great thank you for having us again and for drawing attention to this issue we appreciate the time and energy that's being a devoted to looking at this this matter. As was asked it's an ambitious plan to take 3200 people off the waitlist of particular time when we as providers the DPA as the just for your for the record as the Arkansas developmental disability provider association. We are both on the board we represent 68 nonprofit community providers who are providing services in the community and employ the bulk of the DSPs across the state we're in the middle of a crisis trying to hire enough qualified staff speaking personally for Easter seals Arkansas we have over 50 openings that means there's 50 people that are not getting services right now so our ability to serve the people that currently need services is being stretched let alone additional people that led to the DPA to start looking at what we need to pay people I would say most of our providers are paying 12 to $13 for their starting wages and easterseals did something a little different as an individual provider we were able to access some employee retention credits and we artificially are paying more than what our reimbursement rates are using those employee retention credits were paying $15 an hour and back in July when we announced that there was an increase in our hiring so we do know that it makes a difference but it's not sustainable without sufficient rates I'm 1 of the things that we provided in the handouts was a flow of funds for each CVS waiver services I'm I'd I'd moved to Arkansas in late 2019 I was name CEO 2.5 months before COVID hit I thought the picture was worth 1000 words and so trying to understand get my arms around how the flow of funds in Arkansas Works particular in a managed care environment would be useful for me and then when I shared it with my DPA colleagues they suggested that we also shared in our packet and so you can see that Arkansas taxpayer dollars are matched by federal dollars that that match the US government's federal matches 71.6 percent for waiver services and 28.4 you. You heard director whether to earlier talk about the cost of the system it's 300000000 today which is about 56000 per individual being served on the waiver I'm just doing the math and that's a significantly less expensive alternative to institutionalization which you also mentioned was one of her fears that if it's community providers do not have an adequate network of individuals are ending up going into institutions which cost more money and often they stay there for a very long period of time. So DHS takes that money and they create capitation rates that are used to reimburse the passes into set with the passes are getting per individual to then provide those services. There's also currently a risk corridor that is passing funds either forward to the passes if they are not being adequately reimbursed or if they've been over reimbursed money needs to be referred refunded and based on information I've received this is about 290 $5000000 that was returned almost as much as a cost to fund the entire program back in 2019 was how much was referred. So the passes then negotiate with individual providers provide services and and we are expected to individually contract the challenge with that is no one of us as an individual provider is large enough to to negotiate higher than market rates with the passes and passes are telling us that their reimbursement rates their capitation rates are not sufficient to increase our payment rates so there's a challenge there we then take the reimbursement that we got and go out and hire DS peas out that includes their wages the training that includes benefits and all the costs that are associated associated with up employing a it workforce to provide services and then the DS peas in turn provide services to the individuals with ID be. So the DS pizzas the DPA decided 1 of the things that we needed to do was to investigate what are the prevailing wages unlike other businesses when there is an increase in your costs businesses can often than pass those along in in price increases we we see that at the the gas pumps today unfortunately we have contracted rates we we don't get to say we're going to increase our rates and what we're going to try regardless of what our cost structure is we don't have the ability to change that on an annual basis we try to negotiate with the passes but as I said we don't have the leverage to do that and so we're kind of stuck in this mode of not having enough resources to pay our DS peas to be competitive in today's work force and so the the rate study we are doing is not designed to be that T. H. us or beat up the passes but to inform us of what we need to do to be competitive I'm ensure that openly with any and everyone who wants to help solve the problem including the passes the legislature DHS and so we have engaged and we just recently hired a but after consulting organization we sent out our invitation to PO 28 different entities 7 of them could not handle it because of the capacity the 81 did and and we on Wednesday the board authorized the expenditure of funds from our association to contract with this provider who's done these kind of rate studies in 16 other states 12 of them have been with ADD rates 2 of them have been at the request of providers engaging them as opposed to the state typically it's the state that's bring them and and at least 2 times they've done it in a managed care environment and they do a very transparent process. Starting with DSP wages and all the things that go into employing them to help us understand what rates we should be asking for in order to employ a sufficient workforce provide quality services for people on the waiver. I think I will stop there and see if there's anything of a list of wanted to add is same thing just we are. Not knowing having this said where we can what would be the best rate hopefully to bring in staff. Because the the crisis of finding staff is hitting everyone I mean we are seeing this everyone is saying this when you go to the grocery store when you go out to eat when you do anything but with us this is actually caring for people this is providing care for people this is I am a nursing position open for 2 weeks and we've had 0 applicants they haven't even called to check on the rate of pay and this is a nursing position that's Monday through Friday during the day with no weekend no on call no applicants so I mean we are at a spot where all of our positions it's a it's a crisis I am ecstatic that the state has worked so hard to open these waiver slots. But we've got to have a good staff who can be there and can be working and as Ron said that we can't negotiate as a small provider we employ. Not quite 400 people we don't have the leverage when working with the passing due in our contract to say this is what we need there just were just not big enough but with it being able to have a rate study being able to have those numbers will be so helpful for us through this process thank you. Representative fight. Thank. I'm just curious how many children residential program right now. Easter seals has 40 who live with us at our children's rehab center yes that and I say that's not as referring to at the center okay we don't have a children's residential we have 97 slots in between group homes in an ICF and supported apartments but they're all for adults thank you. Okay and I I you probably said in the beginning I had to step out but would you expect the study to be complete actually didn't say that we we expected to be done by the middle of September that was the other thing we wanted it in time for any legislative action this fall that may need to be considered for the next session and that was one of the reasons some of the consultants so that they couldn't handle that the the the the work because the deadline was too close JBG 8 we have come contracted with out of Texas. They are a small organization that can also I think respond more quickly and they have a an approach that they call the brick method that starts like I said with DSP wages and adds all of the different cost that it takes to employ a DSP I'm in a very transparent process it's all focused on the cost side not under the reimbursement side so we know what it actually costs for us to be able to provide services in that model is easily updated in the future when things like that the the competitive wages change we've also asked them to look at an issue that was discussed earlier which would be okay great we we know what wages we need to to pay starting people you know entry level but what about the wage compression that the that that occurs with people who've been there 5 years 10 years 15 years we have all this wealth of experience so we ask for some additional insight into competitive wages in like 8 a career ladder approach with the DSP to an a DSP 3 as well so we can plan ahead for that. Kate and kind of following up on the conversation that I think representative Carter might have have brought up remembering correctly M.. The argument he that has been distributed can you kindly give us a perspective from the developmental disability providers how that is going and where we are and complications that have come from that while we're waiting we are in the group that. Director whether 10 talk about that is waiting we won't get our funds until at least July one is what we're understanding one personal complication I have found and my work is I have parents who have heard about it and they know that this is out there and they're saying well why can't you why aren't you giving this out they're calling me and they're saying why is this money not going out to staff and I have to go back and explain yes the news release said this but I don't have the money if I had the money it would be an staff's hands but I don't know how much we're going to get as an agency if we had the money and we can prepay it we would if we knew what it was going to be but we don't know what we're going to get is an agency so I can't make I can't go to my board of directors and say we need to give. This much to new hires we need to give this much to long to have long staff because we won't know how much we get but the biggest problem with that is that the public knows and now I have people who are upset because they think that we're holding the money and we in no way are holding the money so that's that's. That's been very frustrating it's been as a series of frustrations and not. Getting that across to families came from what I understand it was July 1 or June first July first in. How how does that affect you I mean obviously sooner better but July 1. If it arrives by then is that satisfactory that I mean yes Is that we are very excited to get the money and don't take that I'm sorry that thank you we are very excited to get the money and I but I believe it will be a big boost to have that and to be able to stir to distribute it to our employees and I'm excited to be able distributed yeah I was just gonna say that we don't also know how much that is and July 1 as a new fiscal year so we're in the middle of starting prepare budgets for next year but we can't even factor in what that amount is 70 nice to know what that amount is going to be in and like Alyssa said we would probably go ahead and pay it knowing that it will get reimbursed but not knowing the amount we don't make commitments that we can't necessarily deliver on the other challenge we have is not only to be employed DS peas within the waiver program but there other DS peas and are adult day treatment program and are early intervention your preschools of that are equivalent and they're going to expect to also get similar kind of increases because we're talking about the same labor pool and that's not funded and so we're going to have to figure out how through other funding maybe our employee retention credits also match the same kind of retention bonuses and sign on bonuses so that we don't have a an exodus from one program that's very essential to just a waiver program okay so if you could find out by a blank date how much money you would be receiving by July 1 what with that blank date be what do you need to know by what date to make proper planning in your budget for for us it be by jewel by June 1 because we go to the board in the middle of June to get our our budgets approved and make all those kinds of decisions so if you knew by June 1 and you could properly planned for July 1 yes correct okay just making sure passes here that because they're the ones who will be coming up in a minute to continue that discussion and see if we can make that possible are there any other questions from members. Okay thank you so much for your presentation and we'll have you back in September when you get results or I guess really late September or early October we look for to that thank you okay thank you thank you. Okay and it wasn't listed on the agenda but I did ask the passes to be here to see if they can come up and just share some general thoughts we've talked about a lot of things I'm gonna have all of you I believe there's should be for 3 or 4 people here introduce yourselves give us some feedback on. Everything we've talked about today which is a whole lot and I know we will be able to cover everything what I thought maybe we would do a follow up meeting next month or the month after that to. Let you put together something a little bit more formal and share your perspective on. How difficult all this is and how we can. Serve the clients so that each one of you introduce yourselves and then just go for. It was on when we're there we go madam chair members my name's Corey **** with Kerr source. Jack Hopkins I'm with Arkansas total care. My name is Brad nonmembers let me reintroduce myself to the committee I am he government relations director for summit community care I've been on the job for about 8 weeks now. Right right as you the hardest ones. Madam chair members my name is Mitch Morrison CO within our healthcare solutions. Okay we'll a we'll just ask first because it's the most recent thing we just had on our on our mind here we were told money has to be in their hands by July 1 is it okay money money there by July 1 can you have a an estimate to them by June 1 is that possible. Yeah I don't I want to come into okay this is not that we are holding the money. And the winners and the Department housing okay. I was trying to tell Brad real quick for you came up yeah but no step to their defense and emails went out to all 355 approved providers on March 24 that gave them their fee for some service dollar amount and they're projected pass them out but as I mentioned they'll be a reconciliation so I had I wrote projected about 6 times on the email right but it'll be really close but the passes I explained I think that this kind of was and thrown at us last minute when we had to do this form and and. The money through them we have made a commitment to them that all they have to do is hold it we're gonna Tellem we're gonna reconcile it forum we're gonna send the right amount of money back to you on and we're going to tell me exactly which of their provider gets how much money and then all they're going to have to do is send out the payment so and just be really close of July one is the soonest we will start the process it could go anywhere from July one to August 31 depending on how long it takes to reconcile the first quarter claims so and that's what we have to base the payments on so they're not going to be able to in their defense really to answer any questions about this other than what I tell them each Friday at noon when I make them listen to these horrible CMS updates with me so that's why I wanted to come back at is that there's questions on this they really should be directed towards me okay so this so if you're saying July 1 mean you have to understand the provider is if there fiscal set that you know fiscal period starts July one they think they have to have an idea of how much money to Planned so there's no way to move that up a little bit at least thank. They do have a projection I sent every single provider an email with their individual allocation amount on March 24 if they didn't get the email they can reach out to me will resend it was in a mass mail merge where just the only difference was their individual dollar amounts so glad to have had a few providers they I didn't get the email and we very sent okay well they could reach out to their me or avis and get the email hundreds did get the email because I have taken all those calls. And that they have projections we have it for each applied approved provider the program retros back to October one twenty twenty one so we've already had providers pre spends the money knowing that we're good for it we sent the passes and 50 $2000000 and we will be putting out the door 50 $2000000 this summer. Okay I'm just going to reiterate that I have providers behind you saying they did not receive so could you just resend it to everybody again and now ma'am I I but I will definitely do this because I know about 200 people of personally called me they got the letter from the aging side of the house and all of those providers we messages had a glitch somewhere at the end but we've also had so many meetings guys that you all can go look at the videoed online that talk about all this and how old these providers you've got money back on a call and last week and went over a fence at this so I would prefer if you didn't get it just to reach back out and do it on a one off basis and then I know for sure that you received at. Okay. I think that might clear that up thank you okay we'll let the passes take back over let's let's just kind of start at the top go ahead and just hope I can tell you from the past perspective release for from our perspective we do we have received the additional funds those funds and liquid accounts are not investment accounts or anything like that so they are ready to go out the door as soon as we can possibly do that. Not heads yes the same yes okay all agree okay but let's let's back up to the very beginning the enabling technology that we talked about and just give us a perspective from a pass is this something that you've known about that you're starting to do or have planned to do can you kind of feel as in. Fabia presentation was very educational for me I think you know the hallmark of a brilliant idea is something that once you see it once you hear it seems so obvious you know everyone wants is made available to you so I mean it certainly seems like something holds a lot of promise definitely look for ways we can support that innovation I think that you know hearing the the feedback from from Mr Phil rally from the one provide perspective that it could potentially impact 20 percent of that that disabled population is you a minority but yet this is still a huge potential impact so it's very exciting for me I think we would all want to support that I really can't. But I'll second that we're we're excited about the waiver changes in what that what the language changes means as far as going from adaptive technology to enabling technology I will say for us when we've had those discussions in the past with providers it's not that we are covering all of or we're not covering enabling technology as it was presented today it's that our system so we're set up to cover those certain one off services that don't integrate in the same manner to their platform what they presented it that makes sense okay. Yes from someone's perspective I'll save you again a very exciting presentation we love the idea of I'd like to take it back to my folks at the plan let them look at the presentation. Hers and a little areas like to yes we we are aware of we've had conversations along those lines but to Mr Hopkins point sometimes integration of systems isn't as easy as it sounds and so that's something that we've we've looked at an inn presents opportunity force that will continue to explore. And I would say to know. I knew where the newest pass in Arkansas we've just been here since January that gives us certain in 8 abilities that maybe some of the others don't have and that we can adapt quicker because we don't have things during great and. You know I I think when I hear stuff like this it reminds me when I was DHS it in one of the cases that I had that bothered me Clark is back there he he might you might remember me griping about it we had a kid that needed to tap of technology to communicate because he's autistic and it was denied by. Some of the folks that reviewed it we were having a hearing on it in it was my job to defend and because I was the attorney for DHS but you know you just walk away thinking what can we do some of these things we just we just left Easter behind us we we offer all those that are Christians it's of a very important holiday and it reminds me collation 60 and we're the east of the Bible tells us that what we're supposed to do good to all and if if we can do good all by that technology or or whatever it is that that the is now available to us and we put that in a waiver man that's great that's awesome I mean we need to look at it I think we need to study a little bit you'll probably need to study a little bit more because there's going to be issues that come up like in rule areas if you don't have access to the internet it's it's really hard to use technology and I say that is in most of you all know what live on a form out Perry County and I don't get internet. A lot of times so you know we need to look at those things and I think that the legislature has you know if you can work together if you can get ripped a rehab services and everybody working together pulling the same direction gets in task force or whatever I think we can make that work and it will be a really big help to folks that the you know they just want to live their life. I'm I'm gonna take a little D. toward it if you could not my daughter of she hears me shizzle your beds and this is my daughter Katie and don't talk about enabling technology this is she has no idea I'm getting ready to ask her to do this but you mentioned you know that the the autism situation and the the what was it that they were asking for it was it was a little hand held device to allow them to communicate to communicate okay well initially my daughter got tonight something on her wheel chair and Katie can you can just a little demonstration of the technology on your wheel chair so as as her parents she's now 20 so she can make her own decision she's completely independent but she did not want to go into a motorized chair those are very heavy very cumbersome and in a house not be easy to get around and also moving into I mean she would then only pretty much be able to write in my band which has a right to it if she wanted to go with her Daddy there's no way her dad could lift up the wheel chair and put in the back of his truck so Katie can you demonstrate come out here to the center. Well yes right right in here come from around the go the other way. Go the other way okay so she has on the back of her chair something called smart drive and she has in her on her arm and it's a little watch and it communicates through the use of her phone there's an app on their and it wheels her without her having to push and use all the energy to we'll and if you notice on the very back of the chair is that the device it's kind of heavy but it comes off so it doesn't always have to be on there so in our house she doesn't have that on but obviously when read the capital and it has given her a great amount of independence and initially it was denied by Medicaid as well they were willing to pay for a full motorized chair which is far more expensive than this SmartDrive and I had to write several doctors notes and get lots of people involved to be able to get that device so I I understand that to me that's a cost savings it was cheaper they were willing to pay for the more expensive thing but not willing to provide would actually would provide more independence for her and more opportunity to get around there's times when you come up to a step and you can't live one of those motorized chairs up a step but you can with one of these you can do a little pop of wheeling and still get up so anyway just thank you Katie for that demonstration. Spur of the moment thank you okay any other if the thoughts on you know you have our money that will be coming out in the fall will that help incentivize some of the providers and and help the pass even more than just what is normally there. Yeah we we certainly think so we certainly hope so yes ma'am. Yes. Okay and and how will you be communicate because I think that part of it is okay you know this information but how do you communicate it to the staff members who are creating these plans to make use of this because if they've never seen it they might not even know that something like that is available do you have something to do any of you already have something in motion or will you be having something in motion that will help we we all 4 of us had teams that work with these providers every single day have multiple check runs per week so we have the information that's required of us once we have the information verified by DHS's actuary that we can begin eating money out the door as soon as that is completed. Okay and and I I do know I have one. Mom reach out to me and say the concern sometimes with an enabling technology though could go the opposite direction that then people who might actually need someone with them. Might not get that and so we need to be careful that we. Don't just look at it as a cost savings Hey it'll be cheaper if we do this but now we're risking the safety of of our individual so have you all consider those thoughts as well absolutely and we we all have teams of care coordinators that worked to develop that person centered plan with the individual with or guardian with their providers the pharmacy the physician X. cetera etcetera and safety is always paramount we want people to live as independently and as safely as they are able to and so for everyone this electronic assistive technology may not be the best thing for them but we certainly think as we explore this further that it would be a good option to offer a choice. Any questions from committee members. A representative fight. He did say okay. Any others. No. Okay. Represent Hudson. It. And you all can correct me if I'm wrong I've heard from providers that currently the passes will not find and Ebeling technology because you've taken the position that it is a non medical device and that doesn't meet the definition of medical necessity is that not true. I can't speak to speak in specifics I would be happy to look into it again from our perspective it's not necessarily that we would deny anything is that we have systems in criterion place for adaptive technology. Okay quick call an in kind of along those lines too I mean in terms of that that service delivery that we've been talking about kind of a broader topic today when was the last time that that provider rates were increased. I can't answer that. I can say it's in general is true that you know kind of go out the door and and try to manage contracts on a large scale basis we kind of base it off the base Medicaid rates structure but there are many instances when when we will engages individual negotiations individual providers and we'll we'll agree to increase there are many examples when providers ask for increase rates and no we don't typically say yes off the off the bat we will engage in a conversation well here the the case that they have to make in their times and we got to have to go she ation a conversation process and at the inter the end result this will agree to increase the rate for that contract will enter into a new contract an increase rate there also times when will work with providers on individual cases individual case is particularly difficult requires a lot of resources a lot of staff it's outside the norm in wonder wheel and I engage an individual what will typically cost single case agreement to support the account out of the norm needs that particular case requires a there's a lot of times when we will engage in a negotiation process in good faith and a lot of times outcome is a higher rate. And I mean the 8 are you all sending about $300000000 back to the state because we've talked a lot about the needs to get more care givers and and get more staff and C. N. A.'s employed for all these providers 8 in the end you know I I appreciate that you have these individualized discussion sometimes with providers but don't you think that one good way to start recruiting more staff would be to raise rates of the providers can pay them especially if you're looking $300000000 a year back absolutely absolutely not now that you know to be fair that's a retrospective look back and reconciliation process that identifies the sizing of that that pool that does flow back to the state but I mean I salute I mean are you know we're we're business generosa mission driven and I mean if we can support better outcomes and better play like remembers us we're here to do that's why we're here in a lot of times providing that money to the providers verses it flowing back through state mechanisms would definitely a preference note on looking back it looks a lot more obvious but as things when voting you know the impact from covert not knowing that you look back in retrospective NECW with dollars that makes a lot of sense when you look at it from that perspective. And then just kind of following up I I don't know if you have a whole lot of comments but I did want to make sure that we we talked about it but the program from Ohio that we asked our department of education and career department it to look at do you have any thoughts on incentivizing our high school students to get engaged and becoming direct care support personnel and starting a certification program any thoughts on any of that discussion. If you let me take off my care source that for minute and put on my school board president Pat sure. Any anything that we can do to engage students with career opportunities with the we hear this all the time up here at the capitol one it's it's true we've spent so much time and energy telling everybody to go to college go to college go to college. That's not gonna work for everybody especially if you're in a rule school district like Perryville there's a lot of those kids that are we're just trying to figure out what they're gonna do when they get out of at a high school if we can give opportunities whether it's this or anything the more opportunities they have the more that they can see that there are things they can do in their community they don't have to move off to get a job they can stay here and do this stuff it's a wonderful idea I I personally you know my school board might yell at me for saying it or my superintendent I don't think you would you know we had. One of the steel plants come I had him come down and talk to a bunch of the juniors and seniors at the high school to talk about what they needed to do to go get a job with the steel plant I want my kids to have here that have that opportunity but you know that's still leaving Perry County I would like to create jobs in Perry County I would like for folks to be able to and there's there's a need there so you know from from that perspective as a school board member that is trying to work with the disadvantaged rule kids it's awesome so. Yes Arkansas okay again we think that's a good excited and happy to look into it we. But not specific to this plan but in in in in another plan of ours we worked on economic incentive workforce training and that type thing that the that we work with the state on it and up in private organizations so with we were all all Fort. Just get from someone's perspective anything we can do for workforce development in Arkansas is is absolutely critical in the past time so if something similar to this program would we love to look at partnering with that there's a vehicle down the road for. Okay add probably the biggest issues creating a whole other. Section of government that would oversee certification do you all have any thoughts of of that and and I know I'm opening a huge can of worms with any of that discussion so and I'm not saying we're doing that I'm just you know if I would give us give us some feedback I mean we we've heard you know this is not an inexpensive thing to do and is more government so do we necessarily want to do that either so just from a from a past perspective do you have any thoughts well I'm my first thought when I was hearing that is that maybe there's something you can be back with the department of health you know some of the stuff that they do separate and apart from what DHS does I just don't know what all is there but you know you don't wanna spend more government money that. You know I I guess you could look and see what the the the trade off would be on jobs created in the Mannatech tax revenue generated by those jobs you know sometimes it's it's good to spend government money if we're encouraging job creation growth it sometimes it's not good to spend it I'm not gonna say that that's a blanket true statement but you know but it's certainly worth looking at maybe get some of the folks in from from the department of health and some of the other entities to to look and see if there's some way that you can connect on and of. Maybe you don't have to reinvent the with we or you can just take it back off of something else there are. So yeah 90 first government reorder with all those boards now so you know you need the umbrella of the Department felt I think that considered idea my only comment I'm not to I'm not elected representative to spend the money. But you have been at. Actively involved with the department of health so if any comments or whatever at probably ask you to where an old hat but it you know in as we discuss things certainly appreciate the feedback if you're whether you have a comment I would just say that I mean it is a challenge you know it's an unlicensed health professional but is a very necessary and needed resource very need to position to be able to provide the services that we're talking about the rules are very clear are pretty clear for you know licensed professional physicians nurses therapists pharmacists and the way that we approach our credentialing requirements for those licensed professionals for this unlicensed area it is a lot of gray area so it's it is a challenge and and I have been seen that there's a really clear answer right now it seems like we we collectively need to answer that question. Being just my 8 week on the job madam chair I'll further. Okay. But I told you we're gonna give you the toughest questions. Okay well I appreciate the feedback and maybe have you all come back next month we can talk about more in depth may be a an official presentation dealing with some of this matter after after you've had more time to think about it and then anything else that we feel is important to the subject so thank you for being here today thank you members are there any other comments. A misprint represent Springer. Thank you madam chair I would just like to see if if Director whether 10 has a copy of this 3 this 3 year plan that you can share with us I'm very interested in making sure that we of move those of. Those of placements alone so she has a written plan this you can share with us I would love to see that. I think there were a few things that probably she was going to follow up on it and if you could send them to Blake Gillam. Any of those additional things and we'll distributed to the committee. If anybody has any follow up anything please Senator Blake and I'll make sure that those questions got answered and shared with the the Committee. Anything else. We're good okay meeting is adjourned thank you.