Alzheimer's Disease and Dementia Advisory Council

Outright now. Now they are. You you were the magic the magic brought into the room to make them suddenly come on thank you yeah Hey okay now we can now we can talk and people can hear is not just in this room but elsewhere so. But I'm state representative Julie Mayberry glad to have everybody here today Ricky Hill is been co chairing this meeting with this this is a journey that is just in the beginning and I'm looking forward as we continue to talk about things we do have some other legislators with this all raise your hands. We appreciate them being with us today the first thing we're going to do is approve our minutes. And I think I just need one I make a motion. Thank you senator hill makes a motion. Second David cook all approved say aye yes anyone opposed there we go we're good okay so we're gonna have a lot of what we're doing today is kind of follow up from other meetings that we've had so one issue that was brought up in our very first meeting was the bold grant and we just want to follow up and see if we have some information on from the maybe the department of health on how that money is being used and utilized. And Tony Bailey is gonna Sullivan thank you. So again this money is is is basically you know for building of infrastructure of this is the second year well as a 3 year grant we got it in the in the second year of the grant. Also this is a a cooperative agreement with with CDC which means they have a lot of involvement in what we're doing so and our approach is basically. Looking to to build infrastructure for Alzheimer's care. If the if that helps out hi. Sorry I think one of the questions that we had we had we had kind of left it at the last meeting okay I have to clear cobwebs sometimes from our head because it was November and we had a lot of stuff happened since then but I think one of the questions that we had left over from the last meeting was on our initiatives here it said create the position of dementia services coordinator within the Arkansas department of health so is that I use of that fund and is that something the department of health is able to do or already is doing so it is my understanding that with these funds we would not be able to create that because for this particular grounds so we will have a coordinated a program manager for this position but it will be limited to what the grant. Request and not anything outside of the grant so anything that you know we were doing within this council within the state this particular position would not be able to be funded for. Can you give us some details on what that grants request. So what I just a request what some of the requirements for the money what what can be used cars going into more detail than that so just real quick are restrictions might be the word that I'm trying to trying to use okay and I have a list I'm glad you asked of support increased communication across across the all jurisdiction for dementia analyzing use available data including purpose of promoting education about the importance of of including a risk reduction early diagnosis of prevention and management insure the use of effective evidence based interventions integration of brain health read this reduction into existing health communication and improve the knowledge for health care professionals about the best available evidence on dementia caregiving for persons with dementia and tools with and to the support available. So and I can provide the list to you again. But basically the the position that we're hiring because they will be restricted to the grant to try to ask them to do anything outside of the grant would really not be possible. And and we've had several conversations with about this within the health department with without the ball of and we just don't see how they will be possible. And I do understand from some previous conversations that when when a state plan was created it was created with that in mind that once the grant was available there that does have would work. But apparently when the when it was awarded I guess. What a Crosson does not does not understand at this point. I guess I'm just confused because what you've just said is so much of what is described in the wording on our end so I'm having a hard time to me it is kind of apples and apples I I don't see how it's different so and so what what makes it different. Is because this is restricted within the of the grant itself when we're talking about it you know if so it is not that he could work with with the committee with the council that's not the case it's just my understanding is when we get outside of that you know if we if we're talking about doing other things and it's going to. It would be possible so that the person would not be able to spend you know their time looking at various things at the council you know may want because they focus on what the grant is asking for. Okay David cook did you have a question a system in terms of all of we've we've seen other states take this for approaching and position the the health department's hiring this is a great manager position and then eventually that position would actually fall into that dimension Services court address is defined in the state plan so other states have kind of taken a similar approach in or out for this but I do agree with Drug Director Bailey that this is a I mean this is a specific structure within the grant how the ball grants been ordered an authorized and I think as we think about that position we would probably needed another appropriation ask to create that position in the health department that's a similar route that we've seen other states take of that's helpful. Any other questions on this topic. Okay we'll move on so then the next is the respite care grant and I believe David cook has gathered some information and. I thank you brought someone else with you to. I. Well yeah I mean Karilyn could actually speak to it. And. I didn't bring a packet for that okay but I can make that available to the committee well I I I believe it got printed so everybody should have what you email to me it looks. Yes. Like this. And then we also have another sheet of paper the DHS gave to me this morning and I don't have someone specifically from DHS to talk to us about this other sheet of paper that was passed to me but we can read that in a minute I'm gonna lead David and Carolyn talk about this respite grant in a prison Tatian and children aging and and youth this past week and and possibly some good news and our budget. Is not correct Senator Hill. Yes yes. So let's talk about what this is about this grant is and and see if you 2 can share with us some information sure so currently of funding for respite care that's made available to dementia care givers you can access it and in 2 or 3 ways of the first way of course is to privately pay for it the second way is through access to the waivers which is called a air choices S. the nineteenth 15 see waiver always get that second number wrong and the third of course is available through a federal program that the state uses called the Arkansas lifespan respite care program and basically how that works is that the federal funds are used for those funds are are very limited and they're spread across populations so we've what we've asked the agency to do is allocate funds within their budget that will go specific for dementia care givers DHS has agreed to allocate $200000 within their existing appropriation to fund a a respite grant program and qualify for this these grants you would have to be a carrier some with dementia so This Is dementia specific carryover funding that we uh we've agreed upon with with DHS we don't have a timetable as to when those funds will become available we just know that they're looking for funds within their existing appropriation to make those available soon as possible I what I share with the aging committee on Monday I believe it is my days are running together like everyone else's is that the association does not have plans to be a sub grantee of this money there are other providers that are that are current sub grantees of the lifespan respite care program and also offers Arkansas certainly one of those so and they're not alone there's other providers out there but also as Arkansas could speak to how they currently let their how they dispenser grant money. Our idea is that we would continue to work with the agency to develop this program out and you know develop an application process just to make sure this money gets to the families as soon as possible who desperately needed here in the state Scality speak to how you run your program. I'm very of Alzheimer's Arkansan executive director so I'm going to use the DHS lifespan of process to because we have a number agrees and based on you know the qualifications but this would be probably the way we will use it so our goal is to get the money out is vested in quickly as possible to the people that need it so we do have a 10 day time from the 10 business days it it will be turned around however we usually get it out within 3 to 5 days we up the approval is based on a doctor's statement this is that a person has dementia and requires a care giver. Upon completing the application and getting it approved what it is approved we send approval letter out with paycheck so when you are approved you get a check with that check you will get a log and then log of. Provides you with some documentation to send back on how you spent the money so being respite care who at home every use in the person you use have to be 18 and up not. In your household so you have to provide a driver's license or ID with the care giver providers address and upon completion of the funds they send it back if they do not send the log back they will not be eligible for any other grants we have until we get that back so based on that I'm going to use its 80 we have 86 percent return rate on the phones so for the most part we get almost all of the. Logs Beck. So it's a really easy process it is not based on income it's based on a Cutie like you the disease that. And not based on it the insurance that that person has or anything sometimes there may be data for that but we don't we don't look at insurance any other of any other means that is at need basis and the care giver can decide who they want to provide that care yeah they're choosing so as long as they're comfortable with that person as long as the the patient the the love one is okay with so for the provider we just have to that they have to be 18 and they can not live in the household so I can be a grants shall we a lot of people use their grandchildren they're out of the household because they get along with their growth here is really well so they provide respite care so as long as that person is 18 and not in the household. It's their choosing okay okay well hopefully this will help in I believe it senator hill to have anything to add on to this came up and budget meetings. The not on this side. David David touched on the on the money allocation at that that took place and to look into her $0 there far for the respite care and so he he's on top of that along with doctor doctor white in so let the 2 of them stay a stay on that. I do want out of a song on the lifespan respite coalition meeting today in the numbers they reported in terms of using lifespan funds of where the money's going you can kind of see on the I think there's a in your packet there should be a. Page it looks like this and with that second column that specifically DHS approvals as you kind of work through that you can see the majority of the funds currently used or they really stay in the metro areas and because a limited funding they don't get out into the rural counties so that's certainly another objective that we hope to achieve with this additional funding is making sure that we can get these ones out to the rural folks who currently just for lack of understanding or knowledge about the program but also limited access to the funds we want to make sure we get these out again to to the to rural parts of the state as well. Serve I see that. Okay I so these numbers are from our organization and based on the ages from 2019 to 2021 we were receiving about $10000 a year last year we we see the most it 40000 so the we do cover the holes they would provide education I go across the state like to senior citizens library searches wherever people asked me to come so 1 reason like the numbers are like David Souter Candice you liked it is because you know $10000 is not a lot of money to get out because by the time you get out. The money's gone so and we will and working with David we will set aside for rural areas I would like to have that built into the. Until then guidelines okay I appreciate that and I just saw mark white walk in he probably thinks he's might have escaped it but I did notice you walk in and I I did ask for this information because it came up in the meeting earlier this week and you so graciously got it too is before this meeting so I'm just gonna tell everybody to read over it but since you're here if you just want to tell us what what it says it is the the sheet looks like this from from DHS and. Kind of a breakdown of the the fines and how they've been used so far since November I believe. S. thank you madam chair mark what department Human Services CS provided some updated information to you all regarding our I take the time lifespan respite program this is a great we've had for several years to provide funding for respite programs is outside the Medicaid so this is not tied Medicaid this is separate dollars that come from the federal government for the current grant period which just recently began the federal grant is providing additional funding of 1.3000000 over 5 years there isn't state match to that that we have to make but is the over 0 over 5 years coming from the feds what we done with that money so far. Excuse me number one we've created a a rescue workers search locator is on our website to help folks bill to find respite workers we have done a contract with the UAMS to provide some training we provided care your data collection statewide so we get a budget better understanding of the needs of caregivers or on the State and finally we're doing vouchers to individual families for respite care since November one we've distributed 42 vouchers to applicants we think that we have enough funding to ride 296 total over the course of a year and those are spread around 16 counties there's information on the second page of this on the the counties that are being served as well as the get diagnoses of those families so we we had this going out will continue to accept applications through our choices and living in office and certainly would be happy to help anyone who's interested in accessing those vouchers Mr quick overview and I will as I told president Mayberry the the individual who's the expert is that the Dennis to so she's having less fun than I am but certainly I'll be happy to at least try to answer any questions you have. Are there any questions from the committee put them on the hot seat today thank you Marc always so so grateful for all your help and everything I guess the only other questions help people can know about this so what education because what I find so often is that there are lots of services that are available but if you don't know that it's available it's of no use to use so how do we get this information out which brings us to a topic that we've talked about is just you know awareness how is there anything that DHS is doing to bring a little bit more awareness to the funding we do we work with several organizations run state in years past most of money is going directly to those organizations we're doing the vouchers 3 do you just this time but we do anticipate some some grants going back out organizations later in the year certainly we those organizations are out there they work with families and they can refer folks to us and then also we're doing applications through our choices and living center which is this is an 800 number where families can call to get assistance or all kinds of questions related to long term care of individuals and so we publicize that pretty heavily for folks to specialist we have family members that may be looking at nursing home may need some in home care and so they call that number so we have we have that available there we can help route them as they reach out to us for information. Are there any other questions at represented Garner I just have a quick question about how the funding is distributed is that a first come first services so many for county or it's about my sense first come first serve okay thank you. You can leave the hot seat now Clark thank you thank you thank you for your help okay we will move on we're I am just grateful that these things are taking place so public awareness and recommendations were we're gonna move on to that we had at the last meeting some volunteers who are willing to get together between November and now and trying to see if there if that meeting took place I'm seeing a nod so is there Jennifer you it. Who who who wants to take the lead on sharing. Okay David cook them talk so much today okay. He's willing to let someone else share something. Members you should have a packet like this that so with the help of a doctor of over to McCoy and Jennifer we we put together just some brief information based on Surrey hills request but also request of center center Chesterfield for some information for legislators to give a brief overview of the scope of the council's work and also a brief resource guide it's what you have before you is is the first draft of that guide we worked with members to get information from their individual organizations to capture in here so would like you to take time to review over that and optically that the sections that provide your organization if there's information that needs to be change added or added to just just let me know but also would like to have you know this opportunity to provide any kind of feedback if this is what we were. And this is what you intended for us to put together says close to what you were looking for or if there's some things that we need to add or take away and Jennifer you all. So what I recall is that and we had the meeting last time we were all talking about how there could be a better collaboration making sure that everybody in around the state knows where they can get resources and and get help because several of us do different things in different areas a lot of us do have some sort of and hand or fingerprint or whatever across the state so we want to make sure and get together and kind of just have something very handy that you can see what efforts we have in the populations that we serve some of us are and we're medical some of us are definitely Alzheimer's like myself and we deal with Alzheimer's ourselves at area agency so we are very prepared to get the information out at the local senior centers that are in every county sometimes multiple places for seniors to get information because just like you said earlier sometimes there's lots of information but people are not getting it and especially in the rural areas so. Anything else on that from any comments have questions about the packet anything if you want to add I know it was just given to you haven't had a chance to look at it in detail might I suggest we take it home and when we come back for next meeting we can always add to this discuss it further but we appreciate to all get together over probably over the holidays to an busy time of year and and putting this together for us. No comments okay well that was good. I'm so then the next part of. M. DHS Medicaid overview so unfortunately we do not have a slide show that you can see on a screen but you do have a packet but J. hill has brought to us I think you said merry Franklin is actually going to do the presenting and it looks like this. If you want to grab that. And this is kind of a follow up to some questions we had after during the last meeting so merry will let you take over thank you. Good afternoon I'm Mary Franklin director of the division of county operations at department of Human Services. We have put together a brief high level look at the different ways that people can access services through our division we take applications online at access.Arkansas.gov we accept them in person at each of our county offices we have at least one county office in every county across the state we accept them by mail we accept them by phone at the toll free number listed there will accept them by fax pretty much as we get it we're gonna accepted and and process an application. The next thing that we have is just wanted to call out some of the additional benefits of applying online everyone of those benefits is is is one of time and logistics if we get a paper application we've got to enter all that information into our system so we've got to scan it enter the information in our system when we get applications online they're already in our system which which saves a step and so it saves just a little bit of time but it is it does save time other benefits to the online application is our portal is available 2004 hours a day 7 days a week and less it's down for for maintenance and if that's the case it is typically. Late at night when you know not very many people would be trying to access it and it it there would be a message on the screen that would say right now it's under maintenance but generally 2004 hours a day 7 days a week. You can apply for multiple people everyone in your household in multiple programs on the same form and that is actually true on the paper form as well you don't have to fill out an individual for for every individual person in your office but you can do this online for the snap program and the transitional employment assistance program those are not healthcare programs but they do require appointments that require an interview okay a discussion with the case worker prior to them being approved those appointments can be scheduled online when you schedule when you apply online you can report changes to your information online renew your benefits one of the other benefits of using our online portal is you can actually upload documents when we're talking about health care in particular the healthcare categories where someone who might need. Additional services in the home or someone who might be looking at facility care you know that that more type of advanced care they all have. Resource requirements as part of the eligibility determination resources are assets bank accounts property vehicles life insurance policies with the cash value can be resource there all of those things that can be considered assets. Can. The things we have to look at and get actual verification of these programs do require us to verify the eligibility verify the income verify the assets and make a determination whether someone is eligible so when you apply online we're going to need that information anyway whether you apply online or by paper but if you do this online and create an account you can upload that information directly into the account that means you don't have to mail it you don't have to fax it you don't have to drop it off you know to a county offices so that those are advantages you can also when you have an online account check the status of an application or renewal you can file an appeal if you need to file an appeal over decision that we made and you can read notices that we have sent to you that they will be there in your account is history and you can set up alerts if you'd like to learn about when your renewal is coming or things like that so just wanted to give you guys a little more information about everything that can be done online and I understand that not everyone can can use our services that way or take advantages of of the online auction so that's why we're still available and all those other ways but. Sometimes it's very convenient even for an authorized representative or a family that's helping someone through this process to know about this information and gives them because you know read more ready access to information and ability to manage the process. I also want to talk with you of a little bit more about verification requirements I mentioned earlier that are categories of assistance where someone is needing that more intensive in home help or possibly needing facility care they all have both income and asset requirements in addition to. The medical requirement the the functional needs they medically need have certain level of needs in order to qualify for these categories. So and we have to verify everything there are low there are several documents that someone who needs these type of services can gather on the front end and actually provide to us with their application and that will save the step in you know of us having to go okay well they have a bank account well they have this property or that property or these life insurance policies that saves a step of us have been to write all that up sending a request for the information to to the applicant and waiting for that information to come back to us so it's another way is not a requirement but it is another way that you can speed along the process and help us get through all of the steps a little bit sooner and an idea of those type of things I mean we verify social security number and we can typically do that online but citizenship is a requirement for qualified if not US citizen then some type of qualified citizenship status we verify income some of these categories have an age requirement and then some of the categories you to be in that category you need to be 65 or above or you need to be disabled so. Resources as I mention life insurance policies of so that that page in the next page of the verification types is to give folks a better idea of things that you can that we're probably going to ask you for and that you can have ready or potentially be gathering attorney and what you have with the application now you don't have to delay turning in an application if you don't have it already because we're going to we're going to ask you for it if if you don't turn it in but it is just a way that we can help streamline the process a little bit and help move things faster. And. The last thing I wanted to touch on with you is the slide called specialty services. And this. M. in both online and in our paper application we have a section where if you're asking for healthcare coverage you'll see this section that explains what to have for is what ARChoices is what what pace is gives you you know an idea of what type of services are available through those programs because we understand and we don't X. we understand that most everybody doesn't know I mean if you've never needed the services you may not know what ARChoices is and we don't expect people to know that but we try to explain here to help get people pointed in the right direction so that if they do need home and community based services for adults aged 21 to 64 have physical disabilities or they're over age 65 they can they can mark that box for us in the application helps us get routed to the right people for processing side I wanted to point that out to you guys on our paper application form to is some information like I have put in the slide you know that just kind of calls that we may ask for these types of things he doesn't mean you have to turn it in but all of that is our effort to help people through the process because we understand it's a process that we want to make it you know as user friendly as we can and yet get what we need to establish the eligibility. A federal stop and see if anyone has any questions. Does anyone on the committee have any questions first. Melanie Thompson. Thank you so it last time we talked a little bit about eligibility also and you mentioned that in addition to kind of these financial resources you also have to evaluate for medical need and I was wondering if you could just briefly remind us about how cognitive impairment is evaluated for medical need purposes and whether that's different for different age groups. So I made it a little assistance with that with those details but there is an assessment process at an initial application there there is an independent assessment process that helps to establish that needs and final determination made at DHS I'm not with our team that action a team of medical professionals of our in to make the final determination but there is an assessment process at the beginning that assesses the different types of needs there is a tool that they use and questions that they ask I do not have all of those details committed to memory but I I do I can tell you that is the process. This is Patricia Ganz. Thanks Mary. Thank you. St Mary's correct but I do want to speak briefly about the age differentials because anyone who's 65 and older than individuals not gonna go through him R. T. correct merry so we have a medical review team so we really need to differentiate the populations first just to talk about that process a little bit if that individual 65 years of age or older than that individuals can apply for the program they're gonna be referred for that independent assessment through Optum we're going to get the results of that independent assessment they're gonna go to Mary's medical review team like she said licensed professionals as our RN's who've been trained to do these reviews and then they're going to review the information provided to them and we say and and merry has said this often individuals can provide additional information it can be uploaded into the portal and that information will be taken into consideration as well as the optimists US mint but if we only have the assessment that's what will be used and then they review that to determine whether or not they meet the criteria for eligibility which is they must meet intermediate level of care so they cannot meet skilled level of care they must meet intermediate level of care and then there's a determination made of their eligibility. If they are under the age of 65 then they first must go through medical review team because that is those individuals who have been deemed is disabled and so that's a little bit of a different process and I'm not have to have merry actually talked some about that okay sure when someone under. If you're age 65 or older than you one of the ways you qualify for this type of coverage is because you have met the age requirement you're 65 or older in addition to that there's also the financial eligibility that has to be met and the medical need that has to be met. If you're under 65 then what you don't meet the age requirement so this then we look at are you disabled because if you're under 65 you can still get the services if you meet the financial requirements and the medical needs but you have to have an established disability and if it's if it's a client that has that disability already established by the Social Security Administration then we're good we we don't have to we've got disability we verify that with social security and we're done but if they don't and sometimes things happen where there's there is there is pretty immediate or traumatic onset of a disability and that person has not already been determined disabled by social security administration and when that's the case that is where our medical review team comes in we have a team we collect medical information we find out from the client will who are all your doctors what all hospitalizations have you had and we collect all that information in it is reviewed by a medical doctor who compares it to the social security guidelines because we use the same guidelines that Social Security Administration would use and if if we determine their disabled and then we can use that medical review team determination for disability to make that part of the eligibility requirements but again that is separate from the financial and then the medical need requirement. I'm sorry to carry Jordan go ahead and did you have another question no one. Yeah. Actually had a quick follow up with that okay so for someone who has severe cognitive impairment but might not have like a physical disability if they are under that 65 year threshold with that severe cognitive impairment qualify them as being disabled under under those criteria. So how are policy states that they must have a primary or secondary diagnosis of dementia. Okay so I don't know if that helps any but they have to have that primary or secondary diagnosis of dementia. Okay carried okay so this is this is my question I've been doing a lot of cognitive screens in the last week for some people are participating in my program. And one of the people I don't force my mother and she gets a 30 on the MSE every time but I live with her. And so I know she is having cognitive impairment that is not showing up on the cognitive screen. So I'm curious is there an S. and you may or may not know this answer but do they assess the family because oftentimes the family has a greater insight into the person's cognitive abilities in the person himself does and I'm curious if that if that comes into play when the assessment is done. So for the independent assessment that benefits you can have anyone participate that cut in that in that independent assessment that they want to and as a matter of fact that often happens and we encourage that to happen so there should be especially for individuals who may or may not be able to get the full story on that Sussman so when those are being scheduled we do encourage there to be someone else there who can also there's a care giver domain and that and they can participate that independent assessment. Okay and doctor it helps. Your yes. You have the floor if your mother scored 30 out of 30 on the MMIC what would be useful to do would be to do a higher cognitive assessment dislike mocha you know you might not do so well on that and then you're a psychiatric examination right yeah I mean that's my concern is that the screen is being done is a thorough enough to catch people actually are having problems yeah that's my concern with the the yes screening part of it but if they have a medical review team division to them all because they might proof of when you're saying examination and that also service manager informing service and as of this section has it and the availability for care give us with a very detailed some of them might shock some of them may due to which we capture what you want to sit in a. Hi Carolyn berry. C. Fite just maybe to give some understanding to Kerry's concern as a care giver and I hear this a lot and I've kinda happened to me personally in 2 ways and I guess just trying to make sure that we are going the best information for the application so number one is we and it you provide that assessment the people providing the assessment is there someone there in the second part of someone being there is a lot of times loved ones are not willing to say in front of their loved ones what they're cognitive disabilities are so if I am a wife and my husband is having a lot of cognitive impairments I am not going to go against what he is saying your friend of an interviewer so that is a very difficult place to be when you have to say my husband who is the leader of my household and has always had the skills he no longer has and so that makes it very difficult and a lot of times with the pyramids the person with the peer me either does not recognize or is not going to say that that is happening so tentative Hickey back I was wondering like who. Provides additional loaded information so if we're talking about a 80 year old couple do I have the. The knowledge to upload information or is that coming from my doctor or is there a way to have a conversation or interview with a local and maybe over the telephone or off the record when of the person that has the impairment is not present. Absolutely I mean that caregiver can not be there and there can be an interview optim will call these individuals and they will do that but you're gonna have to schedule that in advance with Optum and let them know so I you know we can certainly go back and look at how this independent assessment occurs and I can get additional information from Optum on how that happens but we do have Optum calling care givers to get that information. So and and the only reason I is because India ADD care givers for my uncle who. They spoke to him he did not have a cognitive he was kind of the gist of hardheaded he would not admit that he had issues to anybody so they talked to him because he was cognitively okay however the. The no one ever told me that or him that you know maybe we should talk to someone else or have been there so I know that the optimum thing per se however if DHS can't hear regulate that if there's someone that because that helps you or some way to get information and it'll help with the appeal process in getting people on services because he was the night and then he would didn't want to appeal but he did not admit that he could not do a lot of things he and no cognitive issues other than be able hit it. David. This was some clarification on something you said you said that the current waiver we speak of they are choices waivers worded that a primary or secondary diagnosis of dementia would would make you eligible for that does that include populations are the age of 65. So I haven't had the policy or here so it's the end of it so to determine individual with a functional need an individual must meet at least one of the following 3 criteria is determined by a licensed medical professional. And that number 2 on that so the number one has to do with physical issues are not being able to toilet transfer fee but the last is the individual has a primary or secondary diagnosis of Alzheimer's disease or dementia or a related dementia and is cognitively impaired so as to require substantial supervision from another individual because he or she engages in inappropriate behaviors which pose serious health or safety hazards to themselves or others and I'd like to clarify that just a little bit further because what what miss again is referring to is related to the medical need criteria. Is there a medical need for this level of care which is different from the requirement if you're under 65 to be to make the Social Security definition of disability so that answers the question for medical need whether or not it establishes disability is going to depend on what the social security guidelines say about what makes someone disabled okay 2 different things when we're talking about in under 65 person. Yes sorry to follow. And that's contingent on 80 else is that correct. This social security guidelines thank you again I'm not an expert on what those are we have a medical review team that goes by those guidelines and and compares the medical information we have to those guidelines to determine if if yes disability is established but there are more there are several things that play in you know into that it disability determination but. I do believe yet activities of daily living. Would factor in yes. I guess I I ate kind understand why David is is asking these questions because when you look at our specifically our choices it says on the sheet home and community based services for adults aged 21 to 64 who have a physical disability or age 65 and older. And so in the description there if I'm looking at it and I have a loved one who is 50 with Alzheimer's I would say this doesn't apply and I wouldn't even look at it so in my understanding what you're telling me is that that person could possibly receive our choices and can somehow we can can we add language that would make that clear we possibly can. See if we can clarify more when you're under 65. There has to be disability first and then financial and medical criteria met when you're 65 or older. There doesn't have to be disability established first just the financial and medical criteria met so. That is hard to explain concisely. Which we were trying to do here great and so I get that but is just to a lay person reading some language I'm trying to find out if there's help for my you know 50 year old friend who's been diagnosed with Alzheimer's disease I'm looking at this and saying there's nothing here but yet there is so I I. I can already think of a way we might can reworked this okay we would be very helpful in that would really open it up to a lot of people and make it a lot clearer because it's it's just confusing and I know you do this every day but those of us who don't it's just it's it's confusing yes I make myself a note okay any other questions carry Jordan can I ask you one more question about the process so. They get evaluated by a nurse that does the optimal assessment and then they go to the medical team is that how it works does the nurse referred them to the medical team or is the nurse making the decision whether they can get the date of qualify or not and. How does that work. So. They apply so I'm going to kind of try to get through this and. They're 65 were out. They go into the portal because we're gonna send their going to use the portal because it's really great and it's a great way to keep up with the applications they're gonna go into the a portal and they're going to apply for a our choices and they're 65 years old so simultaneously 2 things are gonna happen merry's team's gonna begin the financial eligibility determination and getting all that information collected and at the same time they're gonna refer that individual for an independent assessment with optim and optimum does use registered nurses to complete those independent assessments does independent assessments do not determine eligibility they gather information and assign it to your determination that tear determination and not information from that independent assessment then goes to Mary's eligibility nurse as another foreign who reviews that information as well as any other information that was submitted often doesn't have the ability to gather information at those independent assessments so that if there's additional information that you want to present to go into that eligibility that medical eligibility determination then that's where that information can be placed into the portal for consideration but that assessments going to come over and then her team is going to look at that to make that final determination. So for those people I think it gets more complicated it it's a little bit harder to understand. And when and and I agree and berries can change language so anyway if that persons under the age of 65. Then the same application process happens. Applied to the A. R. applied through the portal but at that point financial can start correct merry. I think this funny so anyway but they have to go through this medical retain review team to determine disability. And that's that's the part where they're going through this team and if they're on social security then yes they're gonna verify that but if they've not been deemed disabled by social security that has to happen first and then they go through the process just like other individual stay. To get the ticket to be approved in one of these specialty categories. All of the requirements have to be met if we need disability because there under 65 that would have to be met along with the financial criteria and the medical criteria if they're over 65 both both the financial and medical criteria have to be met it is possible that if they qualify for some other type of assistance there that is not this level of care that they could be approved for the other category but again to get this type of care in one of these categories that's that's on this slide it has to be both we don't start one unless we have the other. Karilyn very. One question about the applying online at this point what do you what is your percentages on people using online in may be mail in application of we're still getting more. Through the mail or dropped off in person than online right now I would say it's about 30 percent online. Can I think we have one other question okay just a really quick question if there's someone on staff who is charged with getting this information out into the community maybe community engagement. So we we do have an office of communication and community engagement and they're constantly engaging through social media and we do have other avenues where information is shared with providers so okay yes there there is that going on and of course we have the county offices all over the state where information is available but yes we do we do share that information. We also have our area agency on aging representatives and there in the communities representing and so that information should also be available from them as well. And then we have nurses who are on the community that worked at the DCSO offices that are available and they can provide information if contacted but they're not going to be out doing community outreach. What is your time frame this go from start to finish let's let's just pretend like the application was fully completed correctly okay what it what is the time frame to get an answer for the qualifier not so that if if we need to determine disability then it's 90 days from the day the application is turned in if we don't need to determine disability but we need to determine the rest it's 45 days that's that's the time frame that CMS access to meet. What percentage of time the only that. I'm can tell you right now we're not doing very well we are we are behind and it I was gonna say it at this point it it's. This is not new information we are behind and we are we are working very hard to get caught up and get those timeliness those time frames back in line with where they should be but right now we're we're not on time for the majority of the increase I'm asking that question what I did is not been hearing reports that they really doing here back missed a letter in the mail. Saying denied. Well now Medicaid does not require an eligibility interview with the case worker so typically this is process is not going to be and and in person process where you're talking and speak directly with the case worker that does happen a lot of times in the specialty categories because sometimes there needs to be information clarified but in general Medicaid to make it more accessible those eligibility interviews are not required in this been toward the a little farther than 90 days thank you or send your behind winner reports come back to them. Yes that that is true right now we we are not meeting or conference very well. And and what is the main reason behind not hitting those time frames as a staffing shortage please is it illness is it just give us an idea of what it what needs to be improved well it's a combination of all those things we we. With we lost staff through the pandemic at a higher rate than we normally lose them. We are working on that in fact we have increased we've reduced our vacancies in the case worker position by about 50 since July but. Brand new case worker walking in the door is not yet ready to to to do this job there's a training and learning process that has to go on so we are working on that in addition in the pandemic has caused us to have to do temporary closures sporadically all over the state where we've had to clear the building and and and those things we've had quarantines we've had illnesses and it you know. Right now it's you know of. Flared back up I mean we're dealing with it very heavily right now. I can even say recently it's it's affected us more than in the very beginning of the pandemic it's just a lot of positives going on right now and in the midst of all that we also launched a brand new eligibility system that means our staff for making that transition to learning how to do this job different with a different tool so I would say it's all of those things. And we have brought into vendors to help us get caught up they will not be doing significant work in the specialty categories because they because they are so complex and sensitive but we are using them to help us get caught up in those regular categories that are less complicated and ship some resources to the specialty categories of our of our own staff so that we can work hard as we can to get caught up as quickly as we can. I love this group because everyone wants to participate I love it. David cook. He had to go back to the 1915 C. waiver on their choices. Because you require that disability classification I mean. Sturch currently SSA only recognizes disability through its compassion allowances Clause for early on set Alzheimer's so it for some of ask you a dementia another form of dementia they would necessarily meet that disability criteria so my question is with agency be open to look at that language inside the that waiver request and amended to to add dementia as a qualifying. Class about without that disability classification because it we possible have that does that dementia diagnosis without the disability if if that question makes it. March twenty eighty eight yes I'm outside we're certain we're certainly open to looking at that I think it I would just emphasize that doing that is going to in all likelihood or that such talk about a minor change the way over that is talking about probably a in the tiling the waiver and that is a long term significant process both in terms of the resources development as well as transfer with the budget impact is up that way for I'm not saying not say no that we can't do it I will answer it look at that but I just want to make very clear up front that that is a that would be a significant addition the program. You know of any states mark that maybe have that maybe a dementia specific activity see waiver I'm I'm not aware of just what I'm you know of any state to kind of do it that way I don't know that there any they have dementia specific I know there are some have for example waivers that are specific a lot more broadly of cognitive issues such as promoting traumatic brain injury so that is so that we do see in some other states I I want to say a majority of states do not have that but so there are some states that do and certainly if we were going to go down that road that is what they want to look at is one of other states don was their experience bill. Thank you. I want to follow up with that mark though look at me look at this well going off what David just just ask should we not try to be proactive knowing that this isn't our population is aging or going should we not be proactive instead of defensive on this. All I certainly think the sum that needs to be looked at and this is and we look generally at. We know that we need to look at our programs overall knocks Medicaid but broader than that look and see can we do a better job of serving our older population because the population is growing and that's conversation I know we've been having often on internally course pandemic preparation ever in everything enters any kind of long term strategic planning but as with X. the pandemic that is one of the issues we've talked about we know that we want to work through and see what what new approaches do we need to address the needs that are out there. Legislatively what we need to do to help you all get to that point. I don't know there's at the need for anything yet I think the the big issue will be once there is a prospect this figure out how to fund that the the tri states coming one way or the other whether. It's going to happen the matter where we're at on right. Yes Sir that's it's this we're gonna see those costs one way or the other I think you're actually right about that. Is there some way that if future meeting that you all could look into other states are I don't know if that's asking bill are to do the research for as for DHS or who who might be the best source if there's other states that are more liberal in their policy is that. Something we can ask you to do. Is it ask you to do but is it something realistic that can be done let's but that way that the I'm not sure because that's that's going to take investment time by somebody and I'm not sure offense who that would be on our on our side in this course that's when these women talking about we've talked about trying to bring us but distant resources to help on these issues and that's just that's still in the works of trying to figure that out. Yes doctor. That's going to be a lot more demand with the pool would. Because that locked up related cognitive impairment but just you know going to even covid and even Omicron we don't know but people what that's sick of coming into the clinics with cognitive impairment office 6 months up to one year and getting it again they they declining the commission so. This going to be a new wave of the dimensions which are not as Emma's of Asia infection related are best going to. But that is the actual point they for thank you for pointing that out. I was gonna say more than you were in here earlier to run late late site thank you for finding the funding far as for the program we're looking for you were in here when I did that are sent one make sure I say lawyer here certainly appreciate that and I do apologize for the late I was having to work in the personnel committee and so I'd let them finish up. What I is so I'm gonna see what bill are can maybe find force they are wonderful it at getting information income pairing what other states are doing if there's anything we can do but I do agree I think we're just starting to see this and when we had an aging population people are living longer I think it's an issue that we need to be proactive on instead of the other and so appreciate that the time are there any other questions that this committee has of. Representative bro you know maybe mark I should ask you that. If if no good friend of mine back home that his wife has dementia and that's pretty much all day no. It is determined to take care of her at home. I'm looking for advice to what the telling to do from there who to call what do you who to get in touch with with the I'm thinking about you when I say thank you because you seem to be really up on the. I don't know what's going on in in maybe call you if you. Okay yeah. Yeah. Our. The please please speak into the Mike so the here yeah he's yes yes absolutely the call Alzheimer's Arkansas and you will give me okay okay if I'm is 40 to my cell phone. Yes so that's the first step in the and I can help provide resources because I work with the area agency on aging senior center so I can usually get them to the person they need to get okay anybody I have what we have with so much stuff that we do home visits I just whatever I need to do we we basically had to do it I'm sure you've heard every kind of story that. I know this couple from church and I know she's over 65 but. He takes your everywhere he goes and does everything following our and and that's a good thing but he's got a plate full as you might know as. So I've been trying to learn as much as I can about this so I can help them and I'm gonna give you my phone number okay okay thank you so much. Okay are we done with this topic yes no more questions for our presenters on this okay the next thing I'd like to thank you very much for presenting this information great information we've got follow ups and and. We have you back here again I'm doctor wait do you mind sharing information you'll have and meeting and and December I'm sorry I was unable to attend my daughter was in the hospital at the time but I know was online and if you don't mind giving us some type of update what took place of members were able to be online watching it too yes thank you co chair may very thank you for asking and I'm so glad to get a chance to share with you this is a virtual online only 3 day okay and it was called the name of our program was called resilience and memory Colin H. the army of hope and the whole idea was for us to talk about the latest in terms of therapy in cancer diagnosis and in terms of what to look forward to in the future coming down the pike in terms of earlier diagnosis in terms of prevention and in terms of treatment was very well received we received from many many positive comments we have it recorded by the way so if you would be interested I could maybe send out a link so people could if you would and they don't have to view the whole thing in its entirety I in one sitting or ever that way you can just go through we'll give you a a agenda so you'll know if their specific presentations that you would like to hone in on or not and then this way this will make it easier for everybody and we're just so grateful to be allowed to share the information because of course the more we share I think the better it is for everybody so what we. Trying to do is give a more positive forward outlook for the future because it is going to get better we already now. Are able to say really and truly that probably 40 percent or more of the patients without timers if I really have we can delay the natural progression we can delay the decline and we can even prevent in many many people are including those who have genetic vulnerabilities except for the ones with the real appreciate knowing a jeans but for example if you're in a pole like a pro Teague D.. Absalon 4 and you know that's the one that gives you a huge risk even those people can have their natural course be delayed or prevented so it's like while. And and it's all true so I I am so grateful that you asked and we hope to share with you some more maybe next time we could bring some written material as well I'll give send you the link and we'll send you some written material as a matter of fact that's where my my question was going to go next we we have talked about our our next meeting we will begin a fiscal session February 14 Valentine's day in that suite let's hope we all stay sweet towards one another as legislators but it it will last likely a month and so our next meeting date I am proposing is March 30 it's a Wednesday it seems that Wednesday's work best for this committee 2:00 in the afternoon I hope that's okay if there's some major hick up please let me know and and and again I will say that you never know what happens with the legislative session or if the special session is call when they have to cancel that but March 30 I think is the earliest that we can get another meeting in but moving to the agenda on that do you think that you could put together if we concentrate on that because one of the next things that we really need to concentrate on is quality of care and I think early diagnosis is very important in that and if we give you more time in some more planning if you could bring some of that information with you and and treatments and go through that and if you want to bring somebody else with you I put together a slide show all that thank you so much yes please dedicated an entire day to caregiver issues and how to support the care giver what caregivers need to do for themselves because that's critically important so yes thank you will do. But I think that's what our next meeting will concentrate on is early diagnosis and treatment if there's obviously Dr way has has agreed to put together something if any of you have questions or something you think that we need to talk about as a group please bring it to our attention we can always added to the agenda and send it our way we'd like to have if you know office specific Speaker you think would be dynamic for that topic that would be great any other concluding thoughts senator hill no okay anybody else have anything they want to add. Okay for clarity I just wanna know if we can get rid any kind of changes or edits to this do you want me to make it available to the committee so we can make this available to 4 would you like for us to do with it next I guess sure said you want them to contact you if in the next within the next month or 2 of any changes is that what you're saying any committee members want to add to it yeah do we really want to just hold disseminating this until the next meeting then. Let's do that let's see if we want to add to it because there might be some things that we are not aware of that need to be added and there's no rush to it also we have she's passing around I was gonna say we need some of you to sign in and so we're taking care of that yes. David if you if you would for those who are not here could you email that out to everyone that's on the committee that way that they'll have it and just kind of put a brief explanation would you please read through this for you as a person thing ladder not for the thank you can email it to Brandon and he'll get it out to the whole committee that way it's all in one go to work okay. Well thank you so much we know that you have other things you could be doing that could could be doing during this time and we appreciate you spending the time here with us at the capitol to help address of very important need in our state and our citizens thank you they'll have a good day and it's.