Aging & Legislative Affairs- House Children & Youth Subcom.

And probably probably about 1012 years ago we first started going to all those report challenges and send them off get it back 4 months later. Hope that you didn't miss a blank for a period or not I'm not wrong and just a lot of. Inconsistencies my question inside first off thank you for what you do because it is not easy and anyway my question is so the 11 years that you'll have spent on the list has there been any communication about the process along the way or is it just kind of been very haphazard. We don't know when we may hear something comic con Christmas morning you opened a piece of mail while is evidence of any communication from anyone saying here's OR and the process here's what's next in the process here's where here's where we're going no that would have been ideal again we reached out to friends that were in this process and they would say well here's the number you need to call you can see where she's out on the list in a sense seems like every time we call she never moved on the list you know she was always there was actually one time where the number she actually got further down further back away from being approved by your number went up and then all of a sudden a letter in the mail saying she's going to become an officer see waiver service so. Then I was only a few months ago so we haven't even experience we don't even know because this is that our life so we know what we. I can have now it's. But we we have that number on speed dial. Sure it was just it was like you were just sitting there Hey what's our number now. Thank you Mr. I'm I do I do want to share with members that we have not been online but hopefully we will be any minute now there were some technical difficulties there too so we appreciate your testimony and fortunately that was it was even recorded. Thank you recording there was a CD recording so later on that testimony would be available online okay so. Okay okay so we'll make sure that eventually gets on online it just isn't part of the live feed right now so anyway do I have any other members we have we have a lot on the agenda and other people to speak any other members want to ask. A. During the Gulf right now streaming is up delegate good okay you get to be the first one a representative Crawford ask the question online there you go thank you madam chair. You guys are doing a great job taking care of your children I apologize that this state or pants are not helping you so my question is is that the state or is that the feds do you know and have you known as you go through the process why it's been 11 years. We have theories. But. Ultimately when we started. This is what we were told it would be before we even applied we were told get on it now and this is not a verbatim quote but this pretty dang close get on it now when she was 4 because by the time that she's in her twenties shall we get it. With we had that conversation before we even started filling it out. So I guess from the get go it was never a question of whose fault it was it was almost just and acceptance which we had to get to. Because we had to wait in any choice of just this is just what it's going to be. But I do know that there are interactions between the federal laws in the state you know regulations surrounding that money and all all those things that definitely create all a significant amount of confusion for a lot of people. So we don't know yeah I mean we've just always kind of assumed that that's just the way it was okay maybe that can be answered when we talk to some of the department heads thank you. I'm in representative had sent in this so hopefully be the last question because I need to get on to the other presenters. Thank you madam chair it kind of piggy backing on to representative Crawford's question I know that it did add that you all mentioned sort of having a network of families that you reached out to with questions about the program have you connected with any families another state whose experience has been significantly better or worse with regard to wait times or does this seem to be the standard experience that families are are dealing with in other states as well. We've not. I mean I I is that a lot of experience in Missouri and I get a lot of parents that ask me questions about what well we had a lot of questions like what's the best state you know for kids with disability everybody asks that question. Seems like. From what we've been able to experience just over all is there a lot of so I can speak for Missouri and Missouri doesn't have anything like this and in fact the something that we always took for granted which was the developmental disability waiver under the tougher program that's available here in Arkansas is not available in this. So that's just my only experience the. Thank you. We thank you for your testimony I hope you stick around maybe there might be something else that comes up so please don't leave but we do want to bring on our next 2 presenters and that's Laurie Boen from our bureau of legislative research and their members there are some packets if you don't have it at your desk they are there are some over the table over there some written extra packets she does have a slide show that she'll show and bring us through kind of the history of this and then we also gonna have Melissa stone the director of the division of developmental disabilities joining us as well to kind of give some input. And I just I I'm before you both introduce yourself individually just for a matter of record I just want to say what a pleasure it's been working with both of you Laurie I know started this project to 6 months ago we didn't know where where to start and gather all this information and you've done a fantastic job and and Melissa you are always always so very helpful and I know that everybody in this room we're all on the same page that we want to provide the best possible care for everybody and we all represent a different perspective and she's had a huge job in front of her of how to provide the services and luckily we've had some money that's at a gonna go towards this the governor is committed and you'll explain that to and and get into those details but combining some other issues along with that so for the record state your state your names. A yes ma'am thank you madam chair and members of the committee my name is Laurie but when and I work in the research services division of the bureau of legislative research and is represented Mayberry mention about 6 months ago she asked us to prepare a brief kind of overview of the history of the waiver with an emphasis on available slots in funding and also on the waiting list and so we've used to a variety of sources of information to compile this brief summary for you all but I would be remiss if I didn't say that almost all of it coming from the division and we sincerely appreciate their help in their systems through all of this and wanted to be sure any knowledge that so you'll find in your packet today and there are more she said if you don't have one there to exhibit so D. one which is just the sort report and then exhibit due to which is this the power point we're about to go 3 so um that further reduce. As many of you all may already know the home community based waiver program and is this a waiver that is authorized under section 1915 C. of the United States Social Security Act of these types of waivers have to be approved by the U. S. centers for Medicare and Medicaid Services and it helps those with developmental or let intellectual disabilities live in the community and avoid institutionalization. Of some of the primary goals of the waiver or to support beneficiaries and all major life activities promote community inclusion through integrated employment options and community experiences and to provide coordination of care and service delivery which is administered by another of the waiver program the 1915 be passed waiver program. The types of services that are available or care coordination respite services supported employment supportive living community transition services and supplemental support. Of those individuals that are or have an intellectual or developmental disability and require institutional level of care they are the ones that are eligible for the service. As noted earlier the past entities or the provider led Arkansas shared savings entities are responsible for the care of the CVS waiver clients for with a few exceptions accepted services such as capitated dental or nonemergency transportation is my understanding that even those services can be covered but it may have to be medically necessary and then they're covered by the traditional Medicaid program from a funding standpoint. And the services that they provide or based on a person centered service plan which is developed by an interdisciplinary team. The history of the waiver dates back to a demonstration waiver that was approved in 1988 that was due in part to it and reaction to a class action suit of Baldridge be Clinton and it involved people with mental or developmental disabilities who are receiving adequate care or treatment and we're in appropriate placements. Another significant development was the initial approval of the 1915 C. 3 waiver which was done in 1990 in this waivers was called the alternative community services waiver a it was implemented on a statewide basis but it had a finite number of slots. In 90017 that the ACS waiver was renamed to the name we currently know it as the community and employment supports waiver and another major development that you're was the passage of act 6775 which also which created the past organizations which we've already made reference to that provide care to these recipients. In terms of available slots there are 2 types of a federally available slots there's the maximum federal as I understand it Melissa can correct me of the maximum number and then there is a what they call a point in time number of available slots which is more a budgeted amount of slots that the state can be simply Fund in any given year and so in the initial of pilot phase they were able to serve 95 individuals when they transitioned into the ACS in the CDS waiver of the slots of range from between 2398 in 1999 2000 this might be a good time to say that because this program has gone on a long time there aren't really good records for some of the early years so the earliest year for which we have account on this was 1999 2000 and there were 20 300 98 slots the most recent year for which reporting year 2021 had 5000 400 83 slots. And during this time period that unduplicated count of actual people served has ranged from 95 in 8990 to a high of 4000 900 72 in as of July twenty twenty twenty one 1 of the challenges this is already been discussed already it of the program is a waiting list and as of December 1 of 2021 there were 3000 200 for individuals on the DDS waiver list waiting list of the number of injured eligible individuals on this wait list has also rain had a good a good range of people on it and its range from 799 you know 6 or 7 to 3000 507 as high as 3000 507 in 1920. The waiter L. as already been mentioned as well serves a variety of ages of people it both adults and children and you'll see on page 6 of your report that a break out of all the age categories that are both those that are being served and those that are currently on the waiting list and you'll see that 87 percent of those that are actually receiving services to fall in the adult age category of 18 to 64 and this picture is a little different for those on the waitlist 47 percent of those on the waiting list fall into the age category 5 to 17 while 49 percent or in the adult category of 18 to 64. In terms of spending input and plan of care cost the average plan of care per recipient has grown from 40 $900 in 198990 to 60 1000 804 in the most recently completed year 2021 and the total cost of waited a waiver expenditures has also grown from 470 2000 and 8990 to 300 7000000 in 2021. Funding has the there have been some changes in funding levels obviously for the program over time and so the first year I'd point out a was in 199697 where the division reallocated $1000000 that to and from an existing program an existing supported living services program to waiver services and this provided for an increase of 900 slots. In 1999 the governor requested or recommended and the General Assembly authorized a $2000000 general revenue increase for 99 2001.8 $5000000 increase in the 2000 2001 fiscal year and the number of recipients 5 2000 2001 and had increased by 900 78 individuals. During the 305 biennium DHS requested a significant increase in general revenue for that biennium and by 2000 405 601 additional slots or authorize we can't say for sure exactly what that general revenue increase was but we do know that that they did increase the requested like 5.9 the first year and 17.6 the second and I know DHS grants did receive a large increase in B. category which appears to bend funded but it's it's not possible to determine how much of that was allocated for the waiver. In 2017 a ACT 50 allowed for 8.5000000 in tobacco settlement funds to be reallocated to waiver services and that became effective on January twenty sixth two thousand seventeen and that added 500 slots to the waiver. And then in December 1 of 2020 of 15000000 was added from the past premium tax proceeds and that also add an additional 600 slots. As we discuss the history and and all of the information with the Department of vision they be made us aware of a concern that they had regarding direct care workers that even if they were to add a good number of of slots in funding tomorrow that they were very concerned that they would have difficulty having enough direct care service personnel to provide care for them and so. We wanted to make sure that the committee was aware of that concern that they mentioned in fact in 2020 there were me make sure a call to the right number thanks they cited that there was 30 8000 730 a direct care workers in the state which is a decline from 3 years prior and that there was a based on a national organization that does work force research that there is going to be about approximately 60 9000 openings over that 10 year period of 2018 to 28 so you can see the demand is great and just to give you a context of what that 60 9000 is is that 10000 of it is due to actual gross and then the remainder like 50 9000 was due to separations and these are people leaving 1 facility in going to another this is people that are either asking away encountering a disability or leaving that classification of employment altogether in doing something else professionally so there is this projected needs that exist. In response to this DHS has to put initiatives in place that they're trying to address this direct care worker shortage and one of which they announced on the same day that they of that all beginning to another announcmenet on some additional funding but they requested a waiver to allow a training component for these direct care personnel to be in lieu of the one you're requirement that the federal government requires for all direct care workers for the C. S. waiver recipients in addition they are also working with CMS to use 87000000 in American rescue at planet funds to help home and community based providers a stabilizer workforce through recruitment training and retention efforts. You might have heard the governor make his announcmenet on that same day December 14 that they they could requested 200 of those point in time slots or budgeted slots be increased so that they could use some existing revenue in the amount of 13.$8000000 to add those additional point time slots 3.8 of that is state funds and 9.7 is federal. In in addition they also the governor also announced that he'd given the division in the department approval to seek special language and budgetary adjustments in this up coming fiscal session to reallocate 37.6000000 of their 2021 fiscal year general revenue increase and dedicate that to eliminating the Waverly assistant the number on the waiver waiting list as of December 1 which was 3204 they plan to do that kind of on a incremental basis where though it they hope to begin serving with CMS approval beginning on July 1 of this year with serving the full 3204 as I understand it by June of 2025. And so I appreciate your kind attention and I would be happy to try to answer any questions but missed owns the expert so. My colleagues in all questions for you until we hear from Melissa stone as well so again if you could re introduce yourself for a matter of record and share your thoughts and in the recent announcmenet as well going into more detail. And thanks for having me today Melissa stone director of development disabilities services at DHS and and thank you for the nice words and it's been a pleasure working with Lori and it's nice to have a history of the waiver we did not have this on file at the office in an it's nice to have just here we came from to see where we need to get better so it was it was a very nice process and she did a very good job. And so yes so I just she covered a lot and I'm happy to take questions so I don't want to I'm just sit at your end and restate anything that she talked about but I think it's important. To acknowledge that yes that waiting on the wait list like we have been. For several years now is is in our minds completely unacceptable and we have been working on 2 issues one always finding the 2 is getting enough staff to out in the community to support an increase of slides so and the people who were on the waiver meet institutional level of care is the same level of care that you have when you enter Human development center or when you go into a pride that intermediate care facility is the same federal and in Arkansas statutory level of care so as you lease described and the waiver or what is put in place as an alternative so that we did not force people with intellectual disabilities to go live in a facility and it's supposed to be an equivalent level of care and for the same qualifying diagnoses our issue is is that which is been exasperated during the pandemic is that a number one and utilize service under the Committee implement support waiver is a service called supportive living supported living by definition is a training service that requires a direct support professional and to come into the community or your home to help you work on goals so it's not personal care it's not that's a totally different service that these clients can also get under Medicaid it is supposed to be coming in and teaching you how to how to budget how to grocery shop how to shower how to eat how to cook how to live denies independent life and it's specialized for the client and as you can imagine it has always been difficult to hire this level of worker and providers employee and providers on the Committee employ this level of worker it's always been difficult. For the past 2 years with the pandemic and with with unfortunately or fortunately at a you know pay increasing in other M. businesses like hobby lobby and talk about all I mean that is the same work force unfortunately it's the same workforce I hire the human development centers it's the same work force that the aging and providers hired to do personal care some home health and to provide service center there waiver it is a it has to be a GED high school diploma and then for the for this population there is a restriction that right now it says you need to have one year experience with clients with behavioral health or intellectual disabilities that we're trying right now to get lifted because we think we can safely we the providers can safely train people on site so we have outlined what we expect out of a training curriculum and and then they can hire them without any experience and so it's just that we it's bittersweet because we were so excited that there was this 37.6000000 and that will be set aside in the Medicaid trust fund and earmarked for these clients then of course we will be asking that this be an annual and 37.6000000 because this will be an annual contest during the fiscal session however now that we are to you know maybe have the funding available now we are really M. pushing our efforts on building the provider network and to where it needs to be to actually serve these clients because I think my biggest fear is that we release a slight. 2 people who have been waiting for 1011 years and then they can't find a worker to do the service and I'm already seeing some of that right on social media and we're already we're already getting it from people that have been on the waiver or were received 1 of the 700 flights last Christmas so we have M. we're doing a multi faceted approach to try to to help with the situation so as the and as we talked about we M.. Are using a very large amounts of American rescue act funding to and in fact $87000000 that we are trying to get out the door before March 31 to not only the DD providers but personal care providers an assisted living providers and everyone that is doing home and community based services for our specialty populations which are aging physically disabled and intellectually disabled or have hi behavioral health needs so those are our 3 specialty groupings that at Medicaid so number one try to get that money out that will specifically go towards retention and recruitment of direct care workers so that is exactly what we wanted to use it on if it's training and marketing with its paying them more if it's offering incentive bonuses those are all allowable expenses on how we've written the plan and and we actually met with the workgroup this mornin and we have to have the application out next week so people can start applying for it we are still working on CMS to approve M. some other vehicles 7. But hopefully we're gonna party that tomorrow with them and the other thing we are doing is in January of last year we set up a new provider tight it's called the community support system provider CSS pee. We we. We have services available under the past program that no matter what how you get into the past program whether it's for your intellectual disability or your high behavioral health needs you're eligible for every service under the program so not only services under my waiver but there's another side of behavioral health focused services and that the goal was is to not answer people based on their diagnosis but to serve people based on their functional Nate and that was why the pass was that in these populations were put into the program together however we had seen that it still was continuing to be bifurcated because of the way we had and licensed providers so only weighed only DDS waiver providers could do DDS Services and only behavioral health providers could do it behavioral health services and that we still had not helped with building the silos that if you needed something on one side of the house you weren't going to get it because your provider that you know interest is not allowed to provide it so last year when we went in and we made this super provider as well you know we kind of stay in house where if you get license to be this provider you can perform all of it you can perform the behavioral health home and community based services and the DD we also did that in an attempt to use the work force that we have right so behavioral health has direct care workers DD we thought we're going to cross train all these people right because we were hoping to be able to release more slots but we need back even back a year ago we did not have the bodies to serve them so we've been putting that's been in place for a year and about and I was they wanted to have a week to pitch this idea to providers encouraging them to become this new provider type and it's so important to us that in this American rescue act funding we will give you money for construction or renovation if you become one of these provider types. And if you do these for us because we are trying so hard to build out this network so I was a lot information I'll stop there thank them we are very excited that we are finally going to get to add 3000 200 and where waiver slots in yes it's going to take some time because we've got to continue to build out these providers and these workers and and so our goal is to you and begin on July 1 and 2 in waves over the next 3 years M. I will tell you that since December 1 we already have 46 people that have applied for a waiver that will not be in this very bright so it it's it's it's it's a constant need and and I'm like the family's we're talking about on and word of mouth a lot of families don't sign it because why bother if you have to wait 11 years right but when we in publicly every time we publicly are able to add flights then we do get an influx of people applying because then I think there's hope because they're they're giving out slides and so we think the same thing will happen in this instance that once we are able to start releasing the slides that we will have people more and more people applying so. We will never say we're going to eliminate the wait list I don't think that's ever going to be possible we continue to reduce that so and reduce people's wait times I think as our as our ultimate goal so I'll stop there and I'm happy to answer questions thank you for coming today. Okay I'm gonna open it up to to our members asking questions but I do what I thank you I we're here to help you we're all on the same page trying to solve this problem together so I hope any questions that comes up or not point any fingers why haven't we done this by having done that that we're all we all recognize there's a problem and we're all trying to work to solutions some of them may not be legislatively some of them might be you know other ways so we just we would help okay no we wanna help we're gonna start off with representative Meeks. Thank you madam chair I've got a couple questions so if you need to cut me off feel free to do so as determined so my my first question gonna go to the question that I asked the the folks over up here earlier has your department considered and and thank you for to do by the way this is a ministry as much as anything else so thank you for you and your staff that are trying to to work on this have you all consider doing any training programs to help these families to know a what's available how to fill out the forms and do some coaching so that way on the front end when they're applying it helps to eliminate confusion eliminates mistakes which will ultimately make your job easier. So thank you so much for that question because I'm intent and touch on that when I was speaking so and and I hated to hear that that they didn't have any help 10 years ago because the packet is overwhelming I mean it to be just by what we need federally to meet the medical requirements and it's confusing so several years ago we set up DDS intake office so it is and it is a whole unit at TD ask that is divided by and whether it be you call about a child recall about adults it because there's different programs and they and. Send you back to that they help you login and register in the aeries portal that Marion Franklin has set up for that eligibility and then we walk you through filling out applications for the services that you want so I have staff across the state now that will go to people's homes and help them fill out applications and we started that probably I would say 4 years ago and we've been building al ever sense the next wave that we're we're doing with that unit is is doing more data driven management so that I can see. What I don't want to happen is they send an email to parents as we need this form and then nobody circles back because they're like we send the emails which I don't think it's happening but I don't know for sure so we just trying to set some parameters around data and so that we can save you know a 100 percent sure no we reached out to miss Mayberry on this state and then she didn't answer me for 2004 hours and I reached out by email this time and really trying to encourage people to get the packets completed and go out and have handhold people and if they if they need that and also we started getting out list of an event Medicaid approved clinicians who can do the testing a lot of times that's very confusing like who who can do this for me he does I keep testing so they send out those lists and then they tell you about all the other services that we and administer like OTP T. speech autism ABA therapy all day treatment centers and so we get the the the the TV programs and and if your child we go ahead and connect you with we have to federally funded grants and we go ahead and connect you with grants and staff at that point that can I miss case manage for you if you have a child so I hope we have improved greatly M. ire and outrage and assistance since M. since these families got on the last M. and that were much more friendly helpful division and then we would that we were back then also what appropriate you're being proactive especially these families are going through challenging times and can be overwhelmed and and and that can make a real difference my second question is in order to get the the full list as it stands right now do you have any idea what the the impact to state budget would be or is that going to be covered based on what the governor says recently done you have that number by any chance and it said this state portion is 37.$6000000. And that'll cover the list as it stands now for one year okay right and then my final question is in this comes to me from the one of the testimonies earlier about what we offer in Arkansas versus what is offered in other states and if Arkansas is offering more benefits to other states and their families out there that are hurting and come to the place where a Arkansas's doing it right taken care of I've that's going to create a draw from their families and my concern is. Are we making sure our people are taking care of first you know we had to be in the situation but we're gonna make sure we're getting our Kansans taking care first before folks are moving from California or wherever and I or is there any way to even do that that's my final question we are hearing rumblings in and out have any quantitative data but I am hearing people and there have been people that have moved here and for certain programs. You have to be an Arkansas resident to apply for Arkansas Medicaid so we aren't able to serve anybody's on Arkansas resident not residency requirement is that out across Medicaid actually got a call yesterday from a mother who said she wanted moved her son to Missouri. And I try to encourage her to to not do that until she actually called Missouri to see what they have to offer because I think there's a misconception that that things are transferable between states which is completely inaccurate you know each state has their own programs their own wait list their their own issues right and and you should never just move your leveling out of state thinking it can actually hurt it could actually be great. Okay and if so and but you know that's where you get to when you've been waiting on wait lists for a long time as you start thinking like that maybe that go here then I can get better service and is just that I think this is that and a nationwide problem a lot of times and with some of these waiver programs and I do think we have a very good programs here in Arkansas and and now that we have we can give this many slacks. We just need job help me and find people to come March. Thank you thank you manager okay and next a representative McKenzie. Thank you madam chair and representative makes got my question there but I want to build on that because I was wanting the same thing about. How we. How it works between the states so now I'm curious though and Vice forget thank you for this program thank you for having this this discussion because we certainty to tend to this problem but my question is since obviously were handling things differently than Missouri and you answer questions about the potential issues there could you. So I got the states here sounds like a or at each status I guess prioritizing you know what I'd do we gonna do and what so can you tell me as our state that's perhaps and again not looking to criticize you were trying to do we can but as our state that's. Master this or maybe hi I realize we're all dealing with the labor issue across the board across the country across every spectrum but. How do they compare and why is is Missouri doing something else or they just are not made this a priority I find that fascinating really that that we're investing a good deal general revenue what looking to do more for such a good cause but what's going on what my missing. So so no no one is doing it perfect there there are problems in a damages to different programs across the nation I will tell our own one for just a second and because I've over the past and 5 years since the governor has. Really. With this life he had already given us and the ability to and you guys I mean to approve the funding for 1200 flights and now 3200 more mean we've doubled we're doubling and the people we serve when he came into office and I came into this job and it's phenomenal and it's raised a lot of national attention and so did the past program is an innovative program that continues to need you know tweaking and improvement nothing is perfect but we can ask the lights to come on a national level and present programs. It's perfect I'm so. Okay. Sorry number got you remember that. It is what it is and and you know it's hard to celebrate at the scene of a managed care company on the one year anniversary year at a pandemic right so we are. Can take a little longer but and we're making efforts every day but we cannot so why to come speak at conferences and to share ideas which is very flattering they think we're very doing very creative things in fact one of the problems we're having with this American rescue at funding is the amounts as well no one else is doing it this way you know this is very innovative and we don't really know exactly how to approve it and so you know in which inspiring but also come on we needed to praise them but I think we're doing some really cool things here because we get asked all the time by other states to explain our programs and. And I would also like to plug the national chain is also to M. to close and any kind of congregate care settings and I think miss Evans is here and she talks you will completely disagree with me which is fine but. We say that but I am that we here in Arkansas are very unique that we have taken the approach and people to be on the side where they want to live whether it's in a facility or whether it's in the community and we've invested in our facilities right alongside our communities of people have a trade choice and and that is kind of against the national trend there's a lot of states that have gone in and close down the facilities but now they're having a very hard time not knowing where to put some people because some people cannot live simple or simple can be very dangerous you can have a mental disability in some very intensive behavioral health problems and and need something more structured than living in apartments so I think we're doing something unique here we're constantly trying to stay in tune with what what's working other places and they were all nationwide struggling with this worker shortage it's not it's not just here. Vaught so it sounds like them with maybe just comparing Missouri their neighbor and then they mention them is perhaps Arkansas is taking more of an emphasis and a priority on trying to have as many folks stay at home or be able to be in the environment that they choose where as maybe other states you're staying with maybe the institutional model is that perhaps the difference the funding is still taking place it's just a matter where you're choosing I mean you know we can beat. With every other state agency in state funding I think that that what's been unique care is our governor and our our DHS secretary and I legislature has consistently in the last 5 years made this a priority to find this and when you find this it takes away from something else it does work it's taxpayer dollars and you know this is state general revenue that we pay and for this program so I think that what's different here is that it's been it's been made a priority across the board for the last 5 years and and and maybe in Missouri there's other priorities that and this just hasn't been funded. Thank you thank you and I'm gonna ask the future members if you could try to narrow it down to one question we do have several other people who want to present and I know when I started to the 2 hour mark I'm gonna lose some of you and I wanna make sure everybody gets an opportunity because we have some other great speakers coming up in just a second so next is a representative Garner. Thank you madam chair thank you Miss down for being here and I can tell you as a supporter of disability rights for 40 years DHS has changed DDS has changed drastically so thank you for for everything that's happened we've got a long way to go I will say that but but thank you very much my question is and I'm concerned across the board with care givers from infant to toddler to to hospice and and DDS probably those folks with disabilities are probably taking the brunt of that of that issue so my question is how that affects funding so. How are you guys ensuring that the PMP in payments are. That are made for individuals currently receiving a waiver benefits how are you making sure that those are being spent on services. That's okay yes so. This gets down in the weights okay but I will say that so for example there are several different rate cells within the past model and FOR D. D. in particular we have and if you are on my own DDS weight less and you're already receiving Medicaid state plan services you are assigned a passcode you receive a much lower per member apartment payment so the process we have worked out is one thank you aweber slight you're not made to a higher payments here until day one that your home community based services it started so I we insure that that person's or service plans that dated I know who your provider is your tell me what you're going to get in terms of pass they tell me what the client's going to get in on the date that the service begins that is the date they are made into the higher rate tier and then that's reconciled because I can see how it's billed and what day the first services built on through an encounter. It's a that is the short version of how you move from wait list a waiver the program in general how we ensure services are being produced in a medical services are being provided Senate there through encounters so every time and I passes build it comes through our billing system in a form called encounter it's a shadow basically of what was billed to the passes system our systems are connected and update nightly and so we have a live feed essentially of how the passes what they're paying for and and then at the end of the year if they've not spent 92 percent of what we have the funding we've given them on medical services for past members there is a and process is called the risk corridor where we go back in and do M. an adjustment and if they've not expended 92 percent I. Medical Services then we're able to recoup the funding and so every year since the past program and started the risk corridors been in place and this is how we ensure that we're not overpaying for a product and and 92 percent is they don't know of that in my water is extremely high and it's higher than and other managed care programs and across the nation so we're proud of it and that's how we ensure that people are getting what they need as well as other things we do that are required by the feds in bypass which is randomly pulling thousands of people's persons their service plans and thing with their services are and reconciling it with claims to see if it was built and and and and served Senate committee and give you all the ways that we monitor that metrics on that we have all of that and there is a multitude of efforts we do to ensure and you know that that that the product is being used correctly yeah I would love to have more more information about how the passes are getting paid and what where that where those how we're insuring that the services are being. I senator mark Johnson please. Thank you madam chair is a non committee member create the opportunity to participate. Melissa thank you for all you do is implore thank you for this report it's. Walling down a pretty complex thing a lot of on page 13 of your power point. Are you talk about the growth in in program spending and I kind of all I didn't fight but I got a little weak when I saw the numbers and I realized more participants and all that but. Without getting and I know it all depends on the needs of the individual a recipient and what's available there could have been something come available that didn't exist 30 years ago started but a how much of this is just ordinary old inflation and cost of things going up and how much of it is expensive within the either populations served or the programmatic side and I'll let either one of you dress that. Yes when I worked really hard on these and on this financial. Because it once you move into the past program it's a it's a per member per month payment it also has everything else in there so we had to get with actuaries to extract this payment but yes I mean Medicaid in general has been the cost of medicated of course is resin your every year which is one of the reasons the past program was developed through the health care task force was to try to bend that that inflation curve that was occurring across all the Medicaid program so you are seeing some of that I have to go back to look to see if we need more expansive service I will say that we probably are doing more and. A 24 hour type service of the play billing where and because they're there isn't that what we're talking not to keep people in the committee if you want your love want to be in the community we think your love wants to be in the community even if they need 24 hour care a worker can provide 24 hour care if we have a worker Senate would there is probably an we don't put restrictions on the amount of hours you can be staffed and I know that is a change from how it was initially started so you can receive as much services you need in your home to stay out of an institution we are going in and having some services that and we are trying to go in and add a technology service and we have technology as part of our our budget funding and we really think that a lot of people can benefit and have more independence in last worker sitting with them if we had more technology in the home and the people and we could train clients and families and how to use that that we do think may and. Down on some of the cost of a what it is to have a a person with you 2004 hours a day. I like we've done with telemedicine correct thank you so much for answer thank you manager. Senator back. Thank you manager the the the question I have is. So we have 4 pass in the state correct and they're paid their their own by providers primarily and they're paid to provide a service and then they they backed the bill back to DHS essentially with the 92 percent you said that you want to provide them with $87000000 of our money. In the in this document this is DHS hopes that this some fusion of funds will result in an increase in the number of workers available. You have no performance ties to the thank you you have to train 1000 employees to get this money or in are you going in the second part of this question is are you going to evenly distribute this money or is it all going to one pass if they want to. That's a great question so it's not actually going to the passes so OR but planned for this spending it's on our website but I can and get it to you so you can read it is not sick for 5 pages so it's it's easy to see but there's on their list all the programs that are covered under that so it is and home health providers assisted living providers all the providers who do our aging waivers and the DDS waiver we have an autism waiver that's that's listed so it's everybody in and Medicaid who is taking care of our special populations out in the community are eligible for this funding the way we did it we had this and we have an art that stakeholder work group for all these providers are represented and miss Evans is on the workgroup she can talk about it she likes it or not but and we try to make a big effort of having more engagement on developing this plan and how this funding would be used and in short we're taking 87000000 all the providers that are eligible can apply for it we've asked all the providers and for data to tell us what they were paid in fiscal year 21 for home and community based services and how many unduplicated beneficiaries that they serve it's entered into an algorithm and it's it's going to shoot out a number based on their what that data shows on what they're eligible for so that was that a unanimous decision on how to set that up through the stakeholder or but group we think it's gonna work we're very close to getting at like I said we have this survey it went out on Friday we had a provider call within this mornin the survey is due tomorrow by close of business and we have to put the applications out for this money next week but I'm not gonna be able to send them checks until CMS approves said that's what we're really focused on right now and we're ready to go and these workers need the money. Have any providers receive the application Jett applications are available yet of any providers then provided the application is not finished being designed to attract. I do that when I leave here we have an overflow room leads that there's. In the past there's been preferential treatment with that email correspondence is about that and I I just wanna make sure that. We had a program earlier in the year or maybe as last year where. Applications were completed and filed before the program of one online that was with DHS is with another program so make sure it's very transparent and every provider has the opportunity of applying and not go well we're out of money 2:00 hours before the rope and that's why we did it this way you're exactly right because I don't like the way they do that either like here's the money who replies first gets it and that's why we said we're going to do an algorithm and we're gonna set your committee aside this is your money you need to apply for it now if we don't have a provider apply for their portion we're gonna have to figure out how to redistribute it but you're right it's not first come first serve it's here's applications and do you want your allotment your incentive payment or content. Thank you. Representative Watson. There we go thank you madam chair US senator Johnson while ago mentioned the briefly about inflation the question is is there a long term plan for the problem. But with our workforce to meet the inflation in the minimum wage increases. Branching out further is there. Anything under the hat they could. The secretary to address this is instead of the year by year that the of state legislature will do which is the 36.7000000 putting is there anything else possible to be done. As a great question so what I'm talking are defending a lot but it's a lot of money so we're able to a lot of stuff with it and in the plan we have asked for a long term strategic plan around and home and community based providers people are getting older people are are getting sicker more people are wanting to stay in their homes not just on the duties abit on aging and elderly side and so we are at with part of the spending asking we putting out a contract for someone to come in and do a very strategic plan about how do we maintain staff what is a need to look like what kind of training did they need so that we don't get we are better positioned when things like this happen M. for the D. D. population the clients on this waiver all under the past program we are going in and changing some of the terms and of the agreement we have with them and setting expectations about when we expect service to take place which in turn will. Probably drive rate discussions with providers that we think will help this problem as well thank you one more question please real quickly. It reference to a competition on the direct support professionals as far as the inflation that hourly rate hourly rate that we're really trying to achieve has there been talk or could it potentially be talk about some of the really dedicated DSP employees are I mean day in and day out there hanging in there about potential bonuses. Some question so that's when I reply back to the past contract so we don't actually set rates D. D. D. H. S. does not set tax rates now the first year in our contract we said you have to pay passes what Medicaid pays that language was never in any future contracts because you know part of it if it well it was never in any future contracts so they passes negotiate their own rates for their own provider networks that they determine how much they want to pay for an hour of supported living I will say this we have had a lot of internal discussions about. What we usually do is that a Medicaid base rate. And really getting out of the business of doing not for a pass only service because we feel like it might actually hinder and negotiations on rates so we have internally been discussing do we want to stop doing that and and truly get or where we intended this to be which was providers negotiate rates with the passes passes pay the rates based on need we have a need right now. Thank you I also want to remind any member who didn't know there's packets over here and it goes into much greater detail on expenses and numbers and everything so make sure you get one of those packets Senator Hammer. Thank you ma'am chair for having a meeting and very informative sold like to thank the House Committee for having this meeting of my question is this with the difficulty of getting employees which I really don't see that letting up any time soon what are the limitations and what could we do to open it up whether persons in the past or they're in the program through another means to allow family members to be able to be reimbursed and provide that help knowing yes some people gonna take advantage of that but yet given the situation that we're in what could we do to open it up to where family members could be reimbursed to stay at home and take care of their loved ones. So family members are allowed to be paid staff for adult ID declines on the date on the DDS waiver it's just that children 8. I could not be paid to take care of my 12 year old son who lives with me said the restriction is on children and because there's the parents are still legally responsible for them we had we have gone 18 and above is our stance on paid caregiver. Follow permit barbecue whichever. But we are where we are dealing with what we're dealing with is that a CMS federal rule or have you petition CMS to ask for that latitude to be able to let the family be the ones that would stay home and take care because 99 percent time I don't think anybody can take better care of their of the patient client then their family member agreement what's the best caretaker I agree with you I don't Senator hammer I'm I have to look it's one of those things that's always been in there and I don't know if it's us or the feds and let me look at that would you look at that and maybe the chair would want to share that information with all the committee in the senators are here but I I really think we need to find the the firewalls and reckoned out thank you. Excellent question I had that one too so I'm glad you asked it I have 2 more members to have a question and then we'll do what we will move on because we still have a lot of ground to cover representative Hudson. Thank you and and and thank you directors John for coming to answer questions I know you were in her earlier when the families were coming up and testifying in one of the things that they talked a lot about was that the cost of their families for having to work part time or stop working entirely or to recruit family members and and then we also talked about kind of juxtaposed that with the cost per individual for participation the program has there been any studies or economic impact research done to see what the cost is to families who are not able to access waiver services versus what the cost of the services because my thought is that likely the economic impact on the state is probably higher for people who have to ballot of the work force either a full or part time basis or the cost of institutionalizing in the alternative and so I wonder if there's any information on that representative having I think that's a great question I don't think anyone's looked at them. But it. I see missing I'm happy with our performance given thank you good good question see we get those answers a representative Brooks last question. Thank you madam chair I don't want to run a fellow of your your 1 question the rule of but I 2 quick questions and thank you Director stone and and Lori for spending time with us here I may have missed this Laurie's you're going to your presentation so we're Garcia in relation to the the 3204 that should be coming off of what is the the need it worked with Russia the short direct care workers what's the need to service those here do we know that. No I couldn't qualified because the the number of direct care workers really depends on what's in the person's plan of what they want and what they need in terms of support and because they've been on a wait list will develop the passes will ever care corners will develop persons their plans when I give them a waiver supplier. Okay follow manager into this little bit off of that topic thinking about the 3204 and especially hearing stories like the the Sturch family and the rocker family earlier on parents and and family members and loved ones who've advocated for a long time 11 years is a long time to advocate for anything I get worn out calling 18 team of my cell phone bill for you know 1 day so you advocated for that can can be extremely taxing and challenging heard from a constituent recently who has has been doing that in advocating for their child for a pretty extended amount of time and he actually received a phone call from someone within DHS on the side not in the office who called and apologized because they were he was told that his family been put on a blacklist and that he was told they were told to not be helpful to them when they called and advocate for their child that's frustrating obviously my question is what can we do within the DHS team thinking about 3000 plus people who will be working off of this list and a lot of frustrated people what can we do within the DHS team to to better have an attitude of of partnership between DHS and the families who labored and worked and toiled so long to get services what what we do what can we do maybe just within 88 from a personnel training development standpoint to do a better job of of creating a date a team approach that we're not we're not opposed to each other but we're working with the families well I at I'm just I'm I'm disgusted if that's 1 of my staff I'd like you to send me that if if we have blacklisted someone and told someone that and what I'm hoping is that this a bad apple because. I don't get a lot of complaints on my intake staff which the staff they're supposed to be helping and people complete applications and hand holding people through the process so I'm hoping. That we're talking about of a rogue staff member that needs to be. Retrained or discipline. I will say that by the time parents get to this point I do think and families in general that have children and loved ones with intellectual disabilities are are extremely worn out and extremely tired. And by the time we get my waivers like they're extremely frustrated right and they need help and we had talked about did we want to add a service in I talked to family about it that the family kind of support service we have an other programs across DHS where it's not something behavioral health counseling but it's it would be something that would focus on and family and family dynamic and how to rebuild emotionally supported late because and it I talked to a lot of mothers in particular and that are just they're at their breaking point so I'm with you and and that's what we're looking at adding a service on to the waiver but I hear what you're saying it's before you get to the waiver it's why you're waiting so yeah and that was the comments and that the parents that were appears that right that we're not doing a very good job of keeping people up to date on where they stand on the wait list and what they could be doing and I will commit to looking at that to see can we do more outreach why people wait so they're not out there in the wilderness by themselves not knowing what's going on. Thank you director in place in me then and of that person thank you. Okay we'll let you to off the hook for a moment. Thank you so much again we're just we're we're we're a think tank today is what I'm hoping I just getting information out there and appreciate all the research and we will probably have follow up questions for later on but I did what I move on to some others that I've asked to present here today and and I please ask the members to hang out with us as long as we can people have taken time off to to share information with us so we're gonna have Larry staying in Lima Henderson developmental disabilities providers to share their perspective on this waiver what it does and we are lucky enough and I'll let him explain more but Larry staying was actually here when this whole program began so we dealt a little bit into the history and and our previous Speaker but. and with DDS and with with all of the players but we've just got some we've got some leg work we've got some do it bridges to build and we want to do that and so we're we're ready to do that and we're we're rights ready to get to work thank you for having us thank you senator Hammer you have a question. Thank you madam chair a got a couple but all he wanted to put me wherever you want to thank you of the letter you heard me mention while ago or ask. Melissa about being able to compensate family members who are willing to fill that role as care givers about the 18 and under do you have any inside as the original creator of what it is that prohibits us from being able to do that well when it was originally created it it prohibited the use of the allowance of having parents even for adults and we got that changed. But I. I thought it was a CMS role but Melissa will check on that okay and and see but I think even if it is a rule there's a possibility because of COVID that we could at least get a temporary kind of thing but if it's not a rule I think we need to look at it because the bottom line like you said that there's a lot of parents who warned of losing their jobs because they have to go to a doctor medical appointments and they have to go you know the child has to come home from school and all these things and. I can remember one parent telling me well can't wait the be 18 and I can stay home and take care. And that just defies all logic but mention of a girl bank you know you got House members thank you. Representative Crawford. Chair. I have tons of questions I'm asking everyone and make one statement. Do you think with your experience that it would be possible you mention the CNA classes do you think it would be possible to begin a high school track a college track my granddaughters part of the health science program through the osteopathic college imports meant and she's in junior high. So do you think that would be possible to be able to get your work force. I think it's an excellent idea and I think seared 11 is going to speak to that there is a program that's already doing that you not in high school in another state. And I think it's a you know right now one of the great things is everybody's all on the same page it's like was said earlier we all want to figure out ways now that we have the financial part which was always the stumbling block we didn't have the money to fund the slots now we have the money to fund the slides but we don't have the the staff so I think it's a great idea because I don't know how I'm how many people I talk to you know they're getting ready to graduate high school they have no idea and and that's not a surprise I mean I want up going through college not knowing what I wanted to do and you know working in a liquor store using my psychology degree and I got to analyze everybody based on what they bought but I heard a radio advertisement for the teacher corps program and for whatever reason that's stuck in they want up telling me you have to go to Conway Arkansas and that was 50 years ago. And I came to Arkansas through the teacher corps program so I think any Avenue where you can start getting young people involved in things like that would be awesome okay and my only statement is. Who made pass god or the final say I would like to know that. I will say that we will talk a little bit more about the as you mentioned and and miss Evans is going to share a little bit about of a possible program that it we could match out of Ohio civil if you have questions along that line if you can kind of hold off. Yes. Can you answer questions. Of. Okay I'm as I mentioned we've already reached out to our sling sling county career technical center to begin working with them this is only their second semester and we totally legal on their first semester let me get their feet on the ground but now we're in the process of kind of reaching back out and doing that and that program is that school is designed for high school juniors and seniors so yes that's that is where our focus is kind of going. Representative brown. Thank you I'm not on this committee but the. I'm glad to be here today. I was listening to someone talking about the the the veterans administration nursing homes and in incentivizing the CNA's in giving them additional training and career opportunities and different things because we were kind having this same discussion. And. You mentioned one thing that might be helpful is more technology could you please give an example of how technology could help you with the staffing issues and hello and then elevate people up from the low wage category to give them I mean how how does that help them go up the ladder so I'm probably not the best person to speak to that I'm not technological master if I may. Senator you cannot Senate is actually going to speak to that to a larger degree here in just a few minutes if if that's okay that would be fun okay thank you sorry. Representative garner. Thank you madam chair 10 years ago my daughter in law was the first EDT for Arkansas waiver association 1 of the things that we talked a lot about what's professional licensing of the direct care services of the Director professionals is there and and maybe doctor 11 you're gonna talk more about this but but is there a way where we can do we need to certify what are the pros and cons of certification where the need what are the what are the ways that we can provider career ladder so that so that those folks that want to stay in direct services can can go up that clinical ladder as opposed we had the same issue a nursing you know we finally have a clinical nurse practitioner certification because folks want to state in the clinic in the clinical setting but there's no way to go with the latter so I did ways to do that and I'm I'm going to actually seek because we're we're getting into the next section so you will stay if you don't mind but if you can move over a seat I'm going to have and and I know we have some others that have questions I'll get to those questions but we keep coming back to the same topics so it to save time if we can get miss Evans up and also we have Dr Jill Fussell tuning into us from Arkansas children's hospital or UAMS I don't know exactly what her location is right now but I know both of you have some thoughts on this and I'm gonna let both of you share that and and then the other thing that I I really want a perspective of is this list continues to grow and why is that you know what what what insight can you give us as legislators to understand that okay we're gonna remove everybody's name that's on this list by 2025 but that list is going to get longer again why why is that what are what are the things that are taking place so miss 7 so let you go first introduce yourself and and share. They don't have Dr Faisal share and then we'll come back and ask questions sure at my name is Dr seared 11 I'm the CEO of Arkansas support network and the president of the Arkansas waiver association a representative Mayberry thank you so much for facilitating this conversation and thank everyone in this room for being here and continuing to be here at 2:00 hours and brevity is not my strong suit but I'm gonna try to to to be focused on this and jumping in just where we are there been several folks that have talked about what I call the opportunities and the solutions of our field we do a lot of work at a S. and we are statewide disability service provider we support people all across the state in home and community based services it's it's what we specialize in at as unlike other providers we don't have a lot of traditional service programs we do home and community based services and DSPs are the backbone of what we do we currently employee about 850 DSPs and I'd today need 200 additional ones to meet the needs of today so there was a question earlier about how many what are we talking about as one of the larger statewide providers that gives you a little bit of a perspective about what our needs are we spent a lot of time talking about solutions and talking about innovation I say innovation probably 16000 times a week because it is the only way that we're able to grow with the needs of our expanding service community and really meet the moment and so there are a number of different things that we look at we look at the DSU work force we look at the mistakes that we have made historically in the DSP workforce there has been this misconception in this assumption that direct support professionals are kinda glorified babysitters that they show up in their jobs are just to kind of keep people functioning. At a minimal level when it the reality is I started my career with a as and when I was 19 years old as a direct support professional it's the most dynamic and rewarding and engaging work that I've ever done and I'm a CEO today so I think that speaks to to something direct support professionals are required to come in and have the skills that to assess what's happening with the individual that they support to respond to that an appropriate way to provide support around medical needs around emotional support needs around activities of daily living and then we ask those folks to be dynamic diligent communicators and liaisons with the community around them and so we ask them to engage with landlords to engage with court systems to engage with medical mental health services education services family disagreements and in navigating relationships every aspect of life DSPs have to be able to have a skills that to support navigate people through those those instances in order to provide quality services it is a dynamic professional level job skills in duties and there are national that works specifically the National Alliance of direct support professionals that have done diligent research and and exploration about the the field the work and the skills that are necessary in a DSP has established 15 core competencies that are necessary for a direct support professional to provide quality services they've also established a code of ethics for the field and offer a DSP credentialing program that allows for people to build the skills build the knowledge and build the ethical applications necessary to provide good services for folks with developmental disabilities and their communities there are. Our opportunities to really look at that career ladder perspective that representative garner mentioned date the NE DS P. focuses a lot on the trajectory of nursing and and the history of nursing you know in the 19 forties and fifties nurses were often viewed as as instrument passers folks that just provided that physical assistance for practice and today nurses really operate our medical system and provider medical care because of career ladder ring with CNA's and LPNs and our ends in a P. and there's an opportunity in the the direct support career focus to do those things as well and it's a huge opportunity for us as we look at where we are today really a crumbling Service System underneath our feet right now in this moment and thousands of folks that will continue to come on technology comes up a lot and there is lots of exciting stuff that it's happening across the country when it comes to technology and for many of us we think technology we think about things like iPads computers smartwatches what we're seeing in the in the disability services field really started in the early 2 thousands with some of those one of the the best things about direct support professionals is we get people that enter our career field as college students they have no intentions of sticking out their career with us I 22 years ago I was one of those people and I I a I tripped and fell in here I am still but they come in and they're interested in computer science they're interested in all these other things and then they go out into their career fields after college the graduate I just had a conversation this week with one of my previous employees whose an SSA and the FBI looking at cyber crimes but they have this passion in this connection and so what how. And in the early 2 thousands in our field in other places across the country or some of those tech folks we're direct support professionals for a time and then really carried the passion of the work with them and have started looking at smart home technology looking at monitoring things the simple things that are are very affordable looking at a stove sensors that will turn the stove off that's been left on and an unattended for 10 minutes bed sensors that will weigh the weight of a person in that bed and provide an alert to remote monitor when that individual gets out of that bed in the middle of the night or even is out of that bed for more than a 15 minute time period time to go to the bathroom and come back that gives us the ability to do something that nothing else I've ever seen in our industry allows us to do and that is to provide a triple win enabling technology when it is implemented appropriately across the country and in these pockets of kind of shining examples gives us a triple win in that it reduces cost for the payer for the entire system it reduces the strain and the burden on providers that are are right now we're strangled by workforce issues but it does a third thing that often times are best initiatives don't always achieve and that is that it respects the individual receiving services it provides dignity to that individual and it provides the greatest opportunity for independence to the greatest degree possible there are extremely positive pockets of things going on across the country. One of the things that's been after a couple of times here today and I think it's really important to put into perspective is that it it is essentially impossible to directly compare state waiver services from state to state because waivers are written by states and so there's not often times not even in direct language that you can compare in Arkansas's waiver to someone else's and so there was several kind of high level speculation stabs at Missouri the reality is more Missouri as the state has no more institutional services director stone made a comment about our disagreement on that the the the institutional supports and services in many states have gone away completely largely due to concerns about human rights violations of folks that live in those settings and I've continued to say she and I will continue to disagree that there's really significance our concerns in Arkansas around some of those same things but that's a whole nother topic but to the yes ma'am that to the Missouri issue there their services are primarily up entirely home and community based and they approach them in their funding mechanisms in different ways so where's Arkansas is PM PM 2 passes that the and get that build out on a unit based service to providers Missouri has these these collections in homes and and budgets of money go certain places and get W. doubt in certain ways apples and oranges it is it is really hard to have those direct computers and conversations but there's a huge opportunity in in being able as a state to say we want to explore innovation right we want to invest in the process of establishing our. Our neighbors in Tennessee actually have a state department of innovation that was born out of a lawsuit based on institutional concerns and money was put into this establish that department and what they've done for the last 6 or 8 years is really explore what's happening across the country and how can we bring those pieces back and put those into place to allow us to provide quality services to everyone who's eligible for them and also do that in a way that we can manage the growth of this budget and and the financial resources. Jumping back up to the list and the need we in at Arkansas support network we operate a family support program and we work with families who get that diagnosis show up early on and help navigate that process in that setting in that situation I will tell you that we operate that program largely off of admin overhead and fundraising so there is a huge need in our state to have some dedicated resources to look at serving people and that way we make a significant impact in people's lives as a part of that program we help them to apply for Medicaid waiver services we help hold their hand through that process we direct them to the states resources we say all the time the Medicaid waiver waiting list would be longer if it weren't so long. We have conversations with families day in and day out we tell them about that service we tell them what's involved in applying and they say I do not have time for that and so they don't apply and what we experience is that for the majority of people that wind up learning about waiver services they learn about waiver services at the point of crisis they have Bob along in this sea of of day lead challenges that their family faces doing the absolute best that they can and it's not until those families escalate to a point of crisis and having real strain on their family structure and their child well being that they're even introduced a waiver services and then 1 more point I want to make and I I'll I'll stop and and and welcome any questions is and and I think representative Hudson alluded to this earlier there is a significant economic impact that we as DD providers that waiver services make in Arkansas and you know when we talk about needs we often talk from kind of this charity lens and perspective and we talk about the needs of individuals with disabilities and you know there's often this kind of pull that you know it if if it were my family or the people that I love I would want this but the reality is in in fiscal year 2021 waiver spend was 300 and $7000000 right which is a huge amount of money. But this state its contribution to that was $70000000 I certainly don't suggest that $70000000 is this means but that's more than $250000000 of federal money that's coming to the state of Arkansas been paid out in wages goes to landlords in Arkansas buys groceries in Arkansas and pays taxes in Arkansas that is significant contribution and so the opportunities to look at how we innovate afford us the opportunity to not only stay how do we innovate a quality service meet this moment and provided to not only everyone who needs it today but to that growing list of people that will continue to need in the future the reality about disability is that you are either our person with a disability or you will die before you are. That is the disabilities part of life it's part of all of our lives this is a growing population in the committee continue to be so the opportunity to also invest in the economy of Arkansas in July of last year the governor commission a report looking at pandemic recovery and there were 6 recommendations of that report that looked at what Arkansas needs to be investing in and focused on in order to make sure that we're we are recovering from the pandemic not that we're actually leaving it but that were recovering from the pandemic well and the number 1.on that list was workforce development and one of the interesting data points that was cited in that report what is that Arkansas is 40 fourth in the country and women returning to work after having left the work force at the beginning of the pandemic the DSP workforce traditionally and historically and currently is primarily a women's workforce there is an opportunity for us to put resources in place explore the innovations that are going on across the country and even across the world in things like workforce development and in technology and really benefit our Kansans as a whole. Thank you and I know a doctor fiscal has been waiting very patiently online so we're going to let her share her thoughts you listen to everything going on and I'm but I'm sure we will have questions afterwards so ready to hear your thoughts. It. Yeah we're gonna see if we can make it a little bit louder in here we can't hear you but we all have to be super duper quiet so I'll let you go ahead and talk and see if they can play with the sound a little bit go head. Institutional issue institutionalization potentially. This state or medical care. Right so this person centered service plan referred to several times and just a point that that's a plan that's developed around the person maximizing that individuals functioning so that certainly requires investment and appointments from support but the point that that's what invested more people that are spoken before have made straight so I does. Wanted to say very excited on behalf of. Russian colleagues and the feminism serve about transaction to get close to that but it also just making the point about insuring rebel to retain. Transtar developing individualized plans and specific to that person's strengths. It supports some I just appreciate a chance to be here and. About. There's been some great suggestions discussed so I think I can to stop 0 percent sure. Yeah we can hear you now it we could hear you before it's just we can hear better now I would like to ask a question of you when we look at this list it started off in 1989 with 90 people can you hear me. Yes hopefully can you hear me I'll. Hello NO. Okay well I can you hear us now can you hear me Dr Faisal hello. Of. Okay we'll we'll work on that and and I'll I'll I'll ask you if the panel that we still have here because this is a of a question that. Well maybe we'll come. We we might be able to get her back is this is really a question for her. Okay I'm. What okay Lee I think I had. I. This is just kind of an off the top of my head thought from someone who's been doing this for a really long time it seems like a very basic answer but for one thing. We still have children being born every day with various medical diagnosis several palsy down syndrome you know whatever we also have a group of children. Developmental disability part of the definition the true definition is that. The whatever that calls. The the disability or the delay has to happen before the age of 22 so for example a child may be 34 years old and have a severe medical crisis and have a stroke resulting in. Okay whatever I'm more than maybe in a car accident or whatever those children so you have those type things going on that may potentially add to the numbers 1 I think we're still getting out I mean I think there are a lot of people I know you probably didn't hear about waiver until to your own child was was a little over an I fact I think I may have been 1 of the ones that had the conversation with you but then 1 of the things I know I've heard in my past is well we don't we don't need that because of we have 1 family talk about the grandmother has been taking care because my mother is going to take care of the child and that's great until the family member has a medical crisis and something happens with their support system and all of a sudden they're they're in need and then then they go on the wait list so those are just a few reasons why you see the number continue to grow in another single basic but that's that's just come out thoughts okay yeah that that is kind of what I was trying to get a perspective from a a medical doctor from children's hospital is I've just had this thought and I feel like it's part of the discussion because you know we we took over 1000 people off of this list in 2017 and the list is still the same number and it's continuing to grow and I just can't help but think and reflect that you know we have babies that are being born much earlier and it's a beautiful thing that these babies are living our doctors at children's hospital in all the Nick use around the state are doing lifesaving procedures and their surviving but they come into the world sometimes with more complications than they would have had that had this been 2034 years ago and they just would have died and so we're also having more and more children who are at not just even at birth but just later in life it's surviving a very complex medical situations that yours ago they would not have survived and we are very happy that they are surviving but they need more. Systems and then on top of that we have more more children being diagnosed with autism for example I mean I think that's the you know growing number we see or is before that's how wasn't diagnosed now they are diagnosed they get this diagnosis and now they need help so just your perspective if you don't mind and my just making this up or is this also what you're seeing do you mind just kind of giving a perspective on that I was hoping our medical doctor good how to share that but. I. Okay I'm at I can speak from the family support perspective operating a program that that meets families at that point of diagnosis and really supports and that works for them that all of those things are accurate that we you know our medical technology continues to improve and we have babies that are surviving complicated complex burst that previously wouldn't I will also stayed on on the the support delivery side you know we have people that are living longer with really complex and needs and and continuing to need that support they're also you know able to live better quality of life because of our technology advancements there is absolutely no reason to believe in in my opinion that if we can make this investment and we cleared this waiting list in 2025 that it won't regenerate itself it within a minimum of 5 years we will be right back in the same spot and so the challenge before us is not you know 30 $7000000 to find a year of of the waiver wait list but how to look at the of strategy to of different initiatives that we can bring together to ensure that we can continue to provide support for our kids is with disabilities and their families well into the future. Make sure that our representatives get to ask questions to representative McKenzie. Thank you madam chair I appreciate the the the long view the take that were we going to do both but with regard to the fire is burning right here in front of our faces now that we see that there's potential for there's funding and open up the slots but we all know we have a staff problem we've all talked about that and it's across the board teat the schools can't get to subs in fact I can't go in there and sub it's a shame what it so we need to fix that problem do we need to make some variances there but with regard so we know we're gonna have a problem here and the the professional the all these things are and take time so I think a constituent issue that I think I'm gonna hear from folks is on the short term because these people aren't paying we need to get some relief 2 things we've we've discussed a number of times a year can we can we get an answer if parents if if parents love with family members can we pay them up I know good was a foolish thing for me to do but it looks like that there's some programs out there were Medicaid is in certain states are allowing that so can we do that number one and number 2. What about these family members as they look I can find a family friend a loved one that I trust that I know that they don't necessary want to go to work and be this full time but if they'll come in and fill the gap for my love which make me feel better it'll it'll free up the staff we can get for other folks is that a possibility that we can explore. I think that goes on every day we we talk with families and ask them if they have anybody that they know of you know sometimes we have issues with passing certain tests but other than that I there's no prohibition and it takes everybody to try and find folks and I was gonna say of you when you talk about strategies like seared was saying about reducing. That wait list if will if we can by different means that's why the autism waiver was developed one of the reasons of the autism waiver is much different than this waiver because it serves very young. Children that are diagnosed in it's based off a program that saw that up to 50 percent of these children that one through this 3 year waiver didn't need this level of supports that the photo of the children that did not go through the program did so there are some efforts you know that we have in place trying to ameliorate you know the level of need for some of the folks and that's one example I would just add to that the I think there's absolutely an opportunity to really take of an approach of saying in this moment you know based on the the pandemic and where we are to to look at multiple avenues to look at at 8 directors and mentioned that they experience requirement but I think that there are some other components that we you know could take a deep dive into looking at what are the barriers that are limiting our workforce and and and make that request even a temporary request to CMS to be able to alleviate some of the restrictions that are built in that day the family care giver topic that's come up a couple of times just for some clarification at a if family members can provide services to adults and non parent family members can provide services to children but legal guardians are still restricted so if if mom is the legal guardian of a of an adult child then she even though that child as an adult she still ruled out and it that question has just come up at representative Mayberry raised it about a week ago and everybody's responses been it's it's just been our Norman nobody really knows the origin of it but just in some some very limited research there seems to be some suggestion that there some room there and that that's something that even if it weren't a permanent change that it might be a temporary change that we can put in place. With the request to CMS that the challenges that those you know it requires the the federal approval on all of those waivers the benefit of waivers that you have the ability to really write specifically what your state needs as long as you can justify that the moment and then you're at the mercy of the federal system for the timeline of approval and we're still waiting on those things I would also add that the R. publicly and and that Director stone mentioned we're hopeful are going to make a pretty significant impact in the burning building that we're in right now an $87000000 is nothing to sneeze at and we've designed those plans ideas and and DHS at a great job of working with provider work groups and so we've been working across aging DD services in B. H. as providers to really show up to the table and say what's going to make an impact because to your point we we don't have time to to you know planned for tomorrow it's crumbling out from under us today And so we've built a model to really be able to shift that money providers will have the ability to shift that money as they need it into things like recruitment bonuses retention bonuses getting that to hopefully have some competitiveness in this this wilds hiring market that we're all in right now I'd also like to to point out and make sure that members know at the lifespan respite grant that is available I didn't know about it I know about it now it's up to $300 a quarter that can go to the family and they can choose who they want to help give them that respite it can either be a provider or it can be you know another family member or a neighbor or something like that it was a very easy application and got the money very quickly so you know that might be something that we can look at and see if we need to. How many people are using that grant how you know how many people know about it and if we can put some more towards that we have talked and will be on the agenda at the next children aging children and youth meeting the Alzheimer's association is trying to get more of a respite grant just for Alzheimer's and dementia but if we receive that if we have legislators who can help move that along intent then maybe some of this other money could be used more towards developmental disabilities as well so I think that is something that is quick turn around I can get someone help right now I mean if you apply today I think it took maybe a week or 2 for the money to actually go to the house and once a quarter you can apply for it okay we had other the senator Hammer. MedMen chair my question is going to be for Leah and either mark or Melissa at the appropriate time so if you want to finish this up I'd I would ask this maybe they can shed some light the. The number how do you pin down the real number of who's on waiver because I've sat through several these meetings where comes up we've got this number that was put out the public reality issue call and they got tired moved on the the frustrated because they've been offered so many options before it gets pulled out from underneath him or they die how do we how do we can down the real number known there's people coming in but people that are on is what I'd like to know and you can't control it think about it and get him to come up it'll take another question water thinking how to answer that and this is from representative brown. Thank you madam chair back circling back to technology. I'm just wondering. Really we're talking about people today but technology that will lift assist with baiting moved people transfer people do you have that in your budget where does what a family get that someplace else because it seems like that kind of equipment could take some of the physical stress off family members and or your employees yes so currently in within waiver services there there is a service option 4 in its active equipment and environmental modification that can be used to look at things like lists and at being able to modify a physical space that allows for for some of that physical support there is not currently a waiver service option for enabling technology or for remote supports and so we've had these conversations with passes and with the state about you know that the need for that and the they need to innovate around those areas and so that DDS has actually made a commitment 2 we're we're currently renewing our waiver as a standard part of the process but to add enabling technology and specifically what with that being that might be a ring doorbell and a stove sensor array of a bad sensor that might be some alarm systems that would go off if a person were in the wrong part of the house I have a voice activated emergency access to a direct support lots of different kind of ways to adopt a physical environment and then remote supports would allow for a provider to have someone on call currently a provider cannot bill for supported living services unless there is a direct support professional on site building that service and so remote support would provide some funding for providers to have someone that's monitoring iPads and smart speakers and so if someone does call for support and assistance we we talk about not having 247 direct support but instead having access to 24 support as needed and that's really the idea of enabling technology so our hope is that in the spring the that the Arkansas waiver will be amended to add those billable services and then at that point it would be a billable service that goes through on that individual support plan. They do they do provide if you needed a personal emergency response system that's about IT or technology right now. Thank you. And that if we can get Melissa stone or mark what everyone of you to come back up here and and speak on that also one thing that you mentioned technology but money being applied federal money being applied to help with. Staffing shortages training people we've talked a little bit about technology as well but Melissa can you also share construction making things more accessible in a home might also be available and March if you don't mind answering that and then we'll get back to senator hammers questions as well yes I need to get you the iPad standing plans so if anybody wants to review it that there's 3 major back it and am I think about this tables helped me write it. Mmhm no I look down there so and workforce recruitment and retention stabilize the workforce enabling technology which includes and what's what we're trying to do is that technology assessment that we've kind of modeled after assessment tool right now and based on Oklahoma to see that that client and the provider with a lot together are they capable of doing it what kind of training do they need because if we want to give out technology want to be successful and then the last back it is and it's called enhancing and expanding services and it's really focused on building out our service options and it could be for construction renovation on single family homes that can be duplexes and make it be facilities and it could be aimed at a at a and using it for for household goods we try to make it very expensive and could also be for and bathroom remodels say that you know we can have handicapped accessible bathrooms and doorways and so it will be a program that will be open to the providers under the plan that we hope will work with their and beneficiaries to make the request access. In the time frame we still don't know exactly when someone could apply where where are we just kind of Phyllis and as legislators if someone asks so there's 2 ways to each 1 of these packets the first wave of money has to be out the door March 31 and whatever we get out the door and if we whatever we accrue and dispense and before March 31 I get we can generate a 10 percent additional federal match on it back and then utilized in 2223 and 24 for this program this is the program I've been talking about we're CMS has not yet approved the vehicles for us to spend the money and we are hopeful we work through some of that tomorrow 1:00. Okay because we're getting close to March 31 yes we are okay but you can't I mean you can't apply yet for any of this now we have the application not next week we're not stopping the application process due to this lack of CMS approval that's permitted or not but since we are so close to that time line we have to keep moving both routes at the session next week people can start applying they need to reach out to their provider yes then we will have an application online and we've been doing a lot of messaging around this to the providers of and we like I said we had a very large call this morning we do a lot of emails with each other okay senator Hammer you can follow up. Got to fill out one is your bill question in about up to floating number how do we how do we get a real point in time number I know that's one but when you are we are we just gonna wait for the 3000 plus or whatever the number is to start responding and do you did you send out email or how do we get that real number. Because like to test my wife got a call in the person's past way I know from previous meetings we've had where people just got frustrated and they're they've been promised stuff before they don't want to hear from us so how do we have a real number so we have a tracking system for the wait list so once you've I applied for the waiver you go through and and all your testing center and then it's mark to completed packet and goes to our clinical psychology team to make sure you meet the federal institutional level of care and once you've got the there's 2 steps you are put on a wait list that is tracked on IT systems so I do I can pull point in time numbers and they were in her and the red lorries report I can. Well then every single year and see exactly on or waiting on July one of. 2020 on July one twenty twenty one okay so there's a year about a year laptime NO okay and real issue is that people don't understand is that that number changes every single day I guess if someone goes into a human development center someone's brought into DCFS custody or adult protective services gone out there immediately and everywhere they have to immediately receive a slice okay there are priority designation and there's good reason for that right I mean there's a lot of federal law and logic behind that concept but you call 1 day and I've brought they brought in 3 clients and APS that you know they qualify for the program you're gonna be force for positions down then when you called yesterday and when I get that slot the way you're going to move back up and so I know it's frustrating to people you should never call 1 day B. 200 lower than what you are right if that ever happens I always they call me an but there is fluctuation because of the way our waiver is written with priorities and but it is I will tell you it is trapped in in in in in in I. T. system okay and the second question is in Italy I will put you in awkward spot. Who is the pastor told you that. We have a recession now I want to I want it now I'm sorry I want it now. Some. Okay I'm really we need to verify that I want to here's what I want. If I'm a manager. Here's what I want to providers an awkward way because if you push back against the passes too much. It can be uncomfortable and things can happen. And that pass which paid money to do their job. And if you had to do their job for them and you're not the only one that has said this okay but if you have to do their job for them then Melissa what I would like is. I think that we need to set up a system that if she has to do the passes job for them she got to be able to charge back to pass an hourly rate or some system to where they can be reimbursed by the past because I understand I understand the problem but the in the day if you signed up to do the job you do the job and she should have to be or no provider should have to be doing the job of the past because that's what we're paying for far as I'm concerned you had to do your job and they didn't do their job and they got paid a day rate in my book that's fraud in my book they need to be audited to determine how much that has happened and. I would finish by saying would you agree but that that is that is my state if I can clarify for just a second I don't know the ins and outs of lightly at was talking about I did here there is there it continues to be discrepancy over and the definition of a care coordinator under the pass verses the primary provider and it always ends up being waiver because our way providers treat these clients like family so what you know so that continues to be an ongoing issue we're aware of that I think needs to be fleshed out in the contract itself to there's a lot of like what is facilitate mean because that's what the death you have the definition says these words that are a little fuzzy like the care coordinator will facilitate and now coordinate you know talking about Leah and so I think it's just a matter of going in there and maybe cleaning that up a little bit to. Here's what you do here's what 70 and as you know and I think that's part of the issue right now I don't think that's something that is providers we've been asking for for a really long. But okay there you go but it was that just one particular case was just strictly that no sorry were on Christmas vacation plan when we get back. I know I know nobody wants walking a meeting here these kind of stories but the reality is they happen every day and if that's your job and that's what we're paying you to do I don't care which title is and if it's matter clearing up the definitions they need to be cleaned up so when a when because we're talking about people. We talk about people and those people need to have their needs met and I think you've got the message so I appreciate it thank you thank you manager. Thank you we we don't have any more questions from members unless someone wants to chime in with anything I just would like kind of like to end because we didn't speak too much I mean we did but can you reiterate the Ohio program I will tell you I have reached out to Arkansas state university they said it's okay to mention their name I hope that's okay that they are interested in working on this idea they already are involved in high school curriculum I have sent messages to the department of education no comment or anything but we need to get the wheels turning on this but you know I don't know if all of it needs to be done legislatively or it can be done just through rules or what we need to do but can you explain what you shared with me that Ohio started in 2015 yeah so Ohio as a state actually had done what what I mentioned we have have begun the process of doing that is kind of partnering with the National Alliance of direct support professionals and and really made the commitment to establish a state chapter of the alliance of direct support professionals so they have an organization an entity there the Ohio alliance of direct support professionals who led an initiative to really look at the work force needs the workforce barriers what was what everything that we're we're we're experiencing in talking about we're not unique in this and they they put together kind of a multi faceted platform that looked at primarily 2 things first and foremost looked at a wage initiative that that gave additional funding an additional rate compensation for certified DSPs then provided some some incentives for that skill development which is beneficial for the quality of services is also beneficial from the the investment in a career path and then they were able to take that model and partner with. Secondary education provider so high schools and looking at students who were not on the college track and providing multiple semesters of of learning of education specifically tailored to the 15 core competencies in the code of ethics and then partnered those school districts when they entered into this program that was really facilitated and supported continues to be by the Ohio alliance that those school systems are matched with local waiver providers and students not only get the education the classroom education and learning the knowledge and the skills necessary they then participate in an internship program with providers and they get that experience or learning and at one of the things that happens in our field a lot is that people come in they have an idea of the work they have an expectation of the work we we are providing one on one services in people's homes and so direct support professional show up every day without a lot of reinforcement without a lot of back up no supervisor on site at the site to troubleshoot and we have a lot of high turnover because of that people aren't necessarily prepared for what the expectations of the work are and that internship has proved really invaluable in in the long jeopardy of that program having folks that are committing to the work as a career option because they have a good solid understanding of the work and the expectations of the work before they're formally hired on and get started right out of the gate so it's a great model there there are other good models across the state but it it really is a model that kind of speaks to where we are today and providing some some stones to step on and out in front of us to navigate through okay one thing sure so I think there would agree we've been talking about kicking around this idea for years at the rate that we talk about the badging system we have that passes come in. I think some of our biggest hang ups is not that we don't think this adds value and not that it won't I think retain staff be and give them a career ladder and we completely I completely agree with everything. We have an issue of how are we going to pay because of the time it was 10000 maybe direct support workers the the the cost of putting them off the training so that we can do this through us they would hire at our school program that's already got that structure that would. And then the second issue we had was who's going to keep the registry. Is it you want to make sure that that that it's like and like to see in a record straight you go there see in a school and you pass the NA Office long term care at a you know keeps up with and certified nursing assistants if they met their training when they're an on going training they need every year to stay license and that was something that I think for me a DDS we do not have the capacity to to run a DSP certification database it right and then that and then there wasn't a watchable a really logical location for that to set this up here. It is but I will also reiterate what I said earlier that you know we we to meet this moment we're going to have to look at doing things differently and and one of the failures I think of the state system failure strongly one of the errors of the state system in the way that we approach funding waiver and and and this continuing wait list build up is that we you know we've come to it saying this is what we do today we just need to do more of that I disagree with that approach we need to really look at what we're doing and strategize ways to be innovative about how we do it moving forward and so just saying we're going to add a new certification program a pilot on top of the DDS office as it's structured to implement is not going to provide us the relief and the solutions that we need so. Did we agree on. Any other final comments we do have a representative Crawford last question so give us one thank you madam chair just in listening and you have a problem with the database for the certifications could that not come out of the American rescue funds it cannot no it's so that plan for the American rescue finds that we worked on was submitted back in July and and approved in September so it's pretty and it's it's locked again on what we can and cannot spend the money on we did have the option in this 87000000 and using it for training but it is not going to work the way we're allocating it because every training to be bifurcated by provider we had a lot of discussions about this and and thought what's our biggest hurdle right now and it's actually getting staff we're not even at the point of training staff and and building this system and to we work with we do we get the staff is so and we tried to just prioritize what's the most urgent need with that funding and it was recruitment bonuses and retention bonuses to get people in the door. But then the next step would be to focus on this we've got a bill back so there's no follow up please so there's no room in the training to be able to set aside or be a sub category to where you could go ahead and hit both come from both the in state it so when you have your staff then you know they're trying so that you already have that in place and don't you well it's not it's not outlined in this plan I don't think there's enough funding to set aside that's not already there's not any lives funding everything's been accounted for in the plan we had to go into great detail on every bucket of how much we would spend them when. But don't please don't take my word that these staff are not trained at the the staff are trained as a doctor 11 and you know she's training the staff before they go into a home it's not this structured and credentialed career ladder type training that's much more robust and right now it's just a basic and training course this would be a more professional lives training course that we're talking about. Okay. First one last one so to be able to accommodate this and not be behind the 8 ball in can you give us how much that would cost so that maybe during legislation we can find some money to go in so that were hitting us from both both ends and we don't get part of it done and were. You know when a hole on the other just to make it come together so can we can we look at that thank you at some cost estimates together only looked at this probably 2 years ago before that the endemic yet we can look at this particular program and this was not the program I don't think that we were and pricing but you have India okay thank you. And I guess that would be the fourth fiscal session with it. If you don't give it to me yes I'll get it. I would also add in in their in in kind of discussion about you know where things could fit in I think there was a mentioned earlier about looking at pass and and some of you know most of the Director stone at talked about is some of the shoring up rate and some of the pieces of the past there's there's a really great a portion of the past contract that requires community investments and we we've seen some some exciting things about that and then we've also seen some kind of it you know it's glorified marketing dollars for the past and and not a whole lot of direct benefit for providers I think there's a huge opportunity there to really look at that contract in those requirements and and potentially opportunity to be more specific about community investment dollars as we face a burning room and and you know being able to try to of maximize dollars that are already out there already mandated to be spent on certain things and really pull together that the the mandates that those are are specifically looking at workforce development credentialing legitimizing the profession all of those things. Well I thank you all for joining us we do have 2 people who signed up to speak I don't know if they still want to or if there even I know one is definitely still here. Sure sure real quick Senator Beckham sorry and I apologize I had another meeting and to get to it just came back in and I guess timing was perfect you're talking about the Q. community investment dollars and I'm not sure this would be you would answer this responded to those. There was a program. That I've heard rumblings of of a crisis hotline. There was funded back it in the committee investment dollars isn't a contract requirement it isn't there a able to bill to that to get to that 92 percent threshold correct. Can you speak on that crisis hotline the number of calls have been taken by that. So I can I can start preserve mark one to get up here and by I would say this came up in budget hearings yesterday and they've asked us to come over to public health and specifically talk about okay and this but in general yes there was a pass that there was a an allegation of fraud that was investigated and found by the attorney general's office and and and okay so and they have entered into as my understanding and agreement but yes it was surrounding some can mean the investment dollars my understanding and because of that and I wasn't going to go down this rabbit but since you asked because of that they are tightening and that did vision of Medical Services is tightening the parameters around community investment dollars and and how it's how it's approved in what the metrics will look like this is not a requirement is just a way that they contain more of the funding as an option that is kind that comes to us and we approve it or disapprove it and but yes it is that it can count towards the passes medical loss ratio and. Like what we're talking this basically did it's a way for them not to pay the state back the money that they have no healthcare if they have that community thank. Okay last last last question senator Hammer make it quick do you know how much community investment dollars between the 3 or 4 passes. It was last year. Now I'm I can get that to the center if you would get that and then the second thing is DHS y'all actually wrote the guidelines for the community investment dollars if I'm correct and if I am correct that means you could go back and re write the rules as far as how the passage could use that money to address the representatives us suggestion combining this conversation 1 that those dollars could be re directed in my right or wrong in that I don't think we can get down 72 of spelling out exactly what they can use it for it because that was not our purpose but I think that we are trying to tighten it and and ensure that it's helping the community at large and it fits our mission but ultimately you stamp the approval of it so you can stop it if you don't like it right for what they were saying that there's a lot of things you know we like to go back and tweak so we are planning on doing that thank you. Okay you all are dismissed hurry get out of the way before there's another question out of the hot seat so that we do have some folks who have signed up to speak and and share a few words I'll have both of you come up I know that you're not connected at all but that what you're already at the microphone and and all that one is Jennifer Dixon and the other is Ron extreme. So I will. But both of you get settled and I don't care which one speaks first Ron if. With and you do have to hit the little button there and the red will come on go ahead introduce yourself and share what you want to share. Yes Sir thank you very much my name's Ron extremism CEO for Easter seals Arkansas I've been the CEO for about 2 years and also a board member of both the Arkansas waiver association and the DPA I want to applaud our my colleagues for their testimony a number of things that. I wanted to share the burden covered. Prior to coming to Missouri though I did live in Arkansas I did live in Missouri and was CEO of an organization called the juniper and center. For autism the provided waiver services as well as from the Committee based services for individuals with autism. And Missouri's experience I just wanted to make sure we got on the record the intentionally froze additional admissions into their institutions to redirect those funds to help with home and community based services so the people that were in the institutions were allowed to stay but they were not adding any additional people to those institutions because the cost of care in an institution is 10 to 20 times more expensive what they did do was help fund supported living homes and we would provide services to individuals who are living with 2 or 3 other individuals who have support needs to one staffer 2 staff could support for 5 people in those homes which is a a model that does not seem to exist here in Arkansas. And I can give an example of an individual we took out of a state institution who was put in there by his parents told he would never work never have friends never have a life and when he came out he was in his mid forties he ended up getting a job living in one of these homes for a scrap company of recycler he had this behavior issue where he'd like to break things and smash things and love the sound of that we got him a job that allowed him to work part time in an environment where he was making a contribution it was great for morale for the company the company needed a worker to do that they were having trouble finding someone it was a perfect fit so I think there's also an aspect that we haven't talked about today about work force in the need for employees there are a lot of jobs individuals who we serve could work in the community if we were giving them the right supports and assistance so I wanted to make that point that was not discussed previously I do think that this is a complex issue that has a complex solution to Senator hammers point like what is the number that's like a bath tub how how much is in the bathtub 2 ends on what the rate is of people coming out who are getting served but it's also the rate of new people coming in in order to do that we've got to think differently I think about the about the situation and that involves things like the community living housing options yeah one of the things that parents of of children with disabilities will tell me my greatest fear is what happens to my my kids after I'm gone and they want to live at least one more day than their their loved one and what a what a horrible thing to go through life and and I think if we could create a system that that provides that assurance that their loved one will be cared for that we have for. To the house and we have technology we have a work force that's capable and able to provide those services that would give incredible piece of mine 1 of the ways that we are able to save money and think about this from a systemic perspective is from a social determinants of health not only for the people we serve but also for their families if if people are not fully engaged they're not contributing but they're just being warehoused it's hard to keep them also healthy social determinants of health talk about access to health care employment community integration I'm having a happy life people who have that tend to stay healthier and stay out of emergency situations urgent care inpatient hospitalization so if you look at the whole health system even though we're not providing health directly health care it is reducing those costs that are also part of the Medicaid program in terms of the solution we've talked about affordable housing technology but the employment first is also an option that ought to be considered and explored turning loose an untapped workforce that would help the state I'm I can also say that the situation with staffing is also being felt here at Easter seals Arkansas when I joined at the end of 2019 or starting wages for $10.25 just a little bit above minimum wage when the pandemic hit we raised it to $12 because we were struggling to find people today were paying $15 and we're still having a challenge we're we're barely keeping their heads above water with our existing staff we've got about 50 percent turnover the way we fund and that was through employee retention credits from the federal government it but for that we would have a multi $0 loss. So over the next 2 years but we instead use that money to fund employee wages and and I can tell you just you know if you use us as an example $15 an hour does not seem to be enough to be able to attract the staff that is needed so one of the things that that the or both a planned that bliss a stone talked about was the study money to be set aside for a study to say what are the barriers to having a stable workforce how do we attract people retain people keep them in the work force and and I think a part of that is starting not with the assumption that that we've got minimum wage workers but what is the prevailing wage that we need how much does that cost so that we can be competitive with entry level positions and then as has been discussed on a career whether that keeps them once they get in right now it's hard to even be on that short list of options or even considering because of starting wages and people who would love to work in a field they're wired to be helpers they're wired to be caregivers are not even considering us because of wages one last thought I had was one question that could be asked regarding the passes if they are in fact returning money because they're not spending the 92 percent of the medical loss ratio that means that at the same time we have a wait list and people are getting served money's coming back to the state because it's not being spent on which is a bit of a challenge and so when we look at how the passes are funded they could be very important to understand how that money it gets that and then what are the rates depend get passed through to provider so that we can provide livable wages and careers for people to provide services and those were my comments and and observations and thank you very much for the opportunity. All right thank you very much for that and we do have a questions Senator Hammer thank you venture this Melissa that just your what you could you get the amount of money that was returned that he just referenced. Okay and then. I just wanna know where it goes when it comes back to go on Medicaid trust fund manager hire you on and let. Senator yes I'm assuming because it would go into the Medicaid trust fund but I can and I can verify that but it would have to pay the just the the Medicaid bill for all the programs we would just use that money 7 I'm find out the amount we reconciled last year and where it went okay if you don't mind I'd like to know how much came back. Because it seems to me like why did you come back when we had a purpose for to be spent number one number 2 where did it end up if it ended up Medicaid trust fund how much was thank you senator. Thank you representative Eubanks you're recognized for a question. Thank you madam chair I didn't catch the name Sir but that have you ever been to the Human development center and billable Arkansas I was scheduled to go to the centers before COVID hit and wound up having to cancel my ability to tour okay the reason I ask that that's in my district and. I've been there many many times in there the these clients or patients are not just warehouse in an institution they they have work that they do their and the the location of it is absolutely beautiful it's real it really is I I would think most family members would be glad to have you know a family member at that location just just because of the the location of it is in a very rural part of the county they have a lot of activities form but they also have work for them and every time I've gone out there. I'm pleased with what I see so but I'm not a I do not object to alternatives that some people may be able to fit into an a and a community based situation but I highly recommend it you go out and take a look at that that's the only one I'm familiar with I don't know how the others operate but I do know that one. Thank you madam chair appreciate that thank you you that. Thank you have no further questions I'd like to recognize our next Speaker if you like to introduce yourself. My name is Jennifer Dixon and I am the mother of a 13 year old young man that tests ripple policy of an intellectual disability he's on the autism spectrum he's non verbal and he can become very self injurious. Nicholas. Has been home and I'm very blessed that he is being home with my husband and I for over 5 years he was on the waiting list for about 20 years. He was also in a facility. For about 7 years and. He never consider that to be home. Always upset always current and always trying to hurt himself. I would like to say that. If you go to these facilities and they're expecting you to come you're gonna see a lot of good things and I'm not here to bed now any facility or anybody but when you go in and you're not expected to be there it's a totally different story. My son is the happiest he's been in the 30 years that he has been alive and we are so thankful that we have the waiver because if we did not have it. I don't know where we would be today because he would not be back in an HTC. Home is home and it's where he is happiest we're he is loved and feel safe and is important to the people that live in that home which is my husband and myself and we have had some great people that work for us. 3 years at a time. But it's very very hard to find anyone that wants to work in this field it's specially if they go through a drive through somewhere and see that they're hiring at $15 an hour to work at McDonald's are anywhere and this is no dig on Easter seals or anybody but. This system has got to be fixed my son is not the only one that goes through this I'm imagine each and everyone of you all know someone that has a family member that is special needs it is a totally different lifestyle. We arrange everything around my son my husband and I have been married 23 years we arranged our honeymoon around our son because he is a part of our life he is our life and I can't imagine. Him being left out. When we're gone. You know I I often say you know I hope when god takes me he takes Nicholas because. I can imagine someone else taking care of him and loving him so what I do and knowing him the way that I do. And I know him better than anybody. And it is a privilege and a blessing to be his mother I thank god every day for him. I do want to hit on the fact that if that money is not spent what happens to it I've been told many times that if you don't use it you could lose it well we're not using all of ours because we don't have the staff that we need to we're we're approved for 24 hour staff he's got to have somebody with him 2004 hours a day he cannot make decisions he cannot give himself medication him cannot cook he has to be based he has to be have follow up care after the bathroom all of it every bit of it and. We're not using it all because there's not staffing available there's not anybody that wants to work in do this type of work there's not anybody that is dedicated. And part of it is because the pay is not high enough the benefit is not high enough and you know you really have to have a special. Heart to work in this field because it's not easy. Nicolas can injure himself very badly. He's injured many many many many times I've got many scars to prove it but you know what I wouldn't change a thing because if it's going to keep him safe its fists going to keep him happy I'm gonna do whatever it takes and I just want to say that I appreciate all the help that we received easterseals is who we get our waiver services from an I have been very pleased but again there is not enough staff. There's really not and I just urge you to please please can continue and fund every year because these are people that deserved to have happiness in a life regardless of their disability and I thank you for your time. Thank you very much I don't see any members with any questions is that correct okay we've kept I I I am so thankful we still have so many legislators still sitting here it's been over 3:00 hours and that you all are still sitting here I know many are watching I've gotten text people have been you know watching online or they can go back and watch so many of them had meetings to attend as well we hear you we're glad that you're you're here sharing your stories I would like to just kind of say that my goal and I I'd be willing to listen any other legislators is maybe come back in 2 months after the fiscal session and kind of pick up where we left off at about the training you know look into what Ohio is done look into some of these other issues let this kind of settle in some lines here let us kind of discuss will all be around each other during fiscal session we can have conversation then but maybe have another formal meeting going digging a little deeper as you know after the fiscal sessions so thank you all of you am I I know we're we're all going to work together everybody here is committed to to helping with this because and lots of different aspects to look at so thank you thank you legislators and with that. I mean you have a lot. We will not condone the party has.