Joint Budget Committee - Pre-Fiscal Session Budget Hearings

So we're gonna go through a report by DHS will go to the audit findings then we'll get to the budget request and with that. I'm assuming. Diskless sear you are you presenting sworn. And if you could just recognize yourself for the committee and you're welcome to see. Syndicalists be I'm the secretary of the department of Human Services. He's a Smith deputy director children family services good morning dawn Staley deputy director for health and Medicaid director. I Mark quite a chief of staff legal legislative affairs for DHS. Thank you Mister chair I will just go through this very quickly just wanted had a few highlights to set the stage around our budget before the rest of the team starts coming up to answer specific questions and walk you through there's the. As you can see from what you've got in front of you there were not a lot of changes from 22 to 23. However there's a few things we would like to talk about that or some changes that will be coming this year as part of it in some way through session so that you're aware of them we can talk with us about him today the first thing is on the personnel side we are going to be seeking an increase at DCFS. And that is tied to primarily the shift in piloting a teaming approach which we will talk about a few minutes where we start to. At where we are trying to have our work force both for safety reasons reasons and improve performance have more than 1 case worker working as a team with the program assistant for more efficiency that will be another hundred 9 positions which we will be seeking and SO 423 budget and we will talk with you about details on that on the general revenue side the R. S. F. Y. 23 of budget included an increase in Medicaid G. R. and what we are ask going to ask to do with that is to restricted part of it you heard this in the governor's office. Discussion with the legislature his proposal we want to at restrict part of it to be used now and in the future for DD waiver slots in order to basically eliminate the DD waiver as it existed in December so that's a restriction that we would will seek to do with you if it's allowed through session the other part of the funding we would ask that you allow us to reallocated over to some of the other divisions that really have a great need that have not seen G. R. increases in quite some time and we need to handle some very particular problems will walk through those. And then finally on appropriations overall we will be asking for an increase an appropriation even though we are asking for STR in Medicaid and what you will see we will explain that it's due to the public health emergency and we'll talk through that and the appropriations needed to cover the reallocated G. R. of for those new agent for those agent divisions excuse me and then in general there are a number of areas where the agency is drawing down more federal money and we will need the appropriation to cover that federal money even if there is no G. R. Mede tied to it so to move into this quickly. I want to ask you City explained the DCFS pilot. So as the secretary Gless be stated the only request that we are having this year for new positions is tied to children and family services so one of the things that we are trying to roll out this year is what we are calling the teaming approach and you have a slide where you can look at a little later on so you can see exactly how we're breaking things apart but the purpose of us doing a teeming is that you all are used to seeing a family service worker that is responsible for multiple things we have learned in talking to our staff doing studies working with outside groups that it is this too much on one person to do all of the things that we expect of a of a case worker so what you'll see here is that we will have individuals in the foster care side in home services and differential response who will head 18 and they will have a support group around them that will help them surround and surround both them and the child but also the parent that is in need of those services in order for reunification since that is our primary goal are teaming pilot will be rolled out in phases and if successful will rollout throughout the state and so. Perhaps one of the most. To me one of the most important elements this teeming pilot is we hear from our DCFS workers all the time that safety is their primary concern is one of the reasons that we do lose case workers family service workers so investigations would be conducted by a team of at least 2 individuals we would no longer be sending someone by themselves into a home to do an investigation so that should assist in some of the concerns around safety as well. The Medicaid G. R. restriction and reallocation just to walk through that as you remember we us several if you worked with us over the last several years Telamon 8 the DD wait list we're extremely excited about this and so what we will propose is taking 37.6000000 of the Medicaid G. R. increase in restricting at so that it can only be used for the DD wait list and Director stone has put together a plan for how to once we have the funding approved and the waiver from CMS how to begin in July if this is done working our way through that over the course of the next 3 years so that's really exciting exciting one for us. We would propose moving $11000000 over into DCFS roughly 4000000 of that will pay for the increased personnel costs are tied to this teeming pilot the reason it's 4000000 is remember that we do get a 50 percent federal draw down over in child welfare so even though the cost is 8 we will only need for in G. R. the rest of the 7000000 is tied to changes we made earlier this year to begin paying family service workers when they were on call and also to pay for overtime both of those personnel changes in the last year we think have really helped us to begin to slow the loss of family service workers and are part of our effort to really pay them for all the time that they are working so those were very well received then the other piece of that is for intensive family intensive in home family services. We have this already are rolled out in about half of the state and in the counties where we have this program going this is where when a child could safely be left in the home rather than taking the child we provide intensive services in the home in those counties where we have been able to do this we have seen a massive difference in the percentage of children that we then have to take into foster care those counties that have that have actually seen a reduction in the number of children in foster care while the number of children in foster care in the counties without it continues to increase so are increase is all tied to counties without it so what we are proposing to do is to take 16 more counties with this $4000000 and we are looking to see if we can figure out how to go ahead and do the whole state but if not then in SF why 24 we would that be back to try to finish this up and have the entire state done so we think this is a very very critical use and we're excited about this one over it deseo the Division of County operations we would propose moving $5000000 over there. Deseo has not had an increase in awhile and deseo as all of you know with the county offices is a place where the work load has continued to grow there are some very specific uses that director Franklin has asked for the first one is she would like to put in place an address verification and validation service to increase the integrity of our Medicaid eligibility process she piloted this had some good results and now she like to go out with the north P. and see if we could actually bring on the service permanently there have just been over the years an increase and county office operational costs as we've had to renew janitorial contracts rent other things they have gone up And so while she's absorbed many many costs over the years through efficiency at the end of the day after a while inflation just means that some of your contracted services cost more so she's seeking $2000000 for that we were looking at some one time wind down costs that she'd like to have $1000000 towards is will be matched with federal money of course this is the public health emergency wind down as the emergency as the feds and their emergency which is right now scheduled to end at the end of this of June. We will have to go through redetermination of everyone who is on Medicaid there are quite a few costs associated with that it is you know it will be several $0 and mailing costs alone so she seeking some G. R. for that and then lastly. We have to relocate offices in redesign offices every year we are constantly going through movement of those offices this last year we had an act or this year we've had an unexpected lease ended Washington County and are having to make that move so she is also seeking some funding to be able to use for office relocations and renovations. Then over at the division of aging adult behavioral health services were asking if we can move $6000000 over there very similar to the county offices ash the Arkansas State Hospital has had over the years quite a few increases in their day to day operational cost Director hill can talk through these but what he is hoping to do is to be able to use some money towards some of his. Base of operations cost contract utility costs. We contract for physicians there with UAMS and over several years you do end up with an increase in the cost their salaries to go up and so he is seeking 2.7000000 for that contract increase that has been coming over the years and then finally. Direct care staffing is up as you all know we have struggled with hiring and retaining as well as with the personal just being out and having to use increased contract staffing so he would use part of the money for that and then lastly D. C. C. E. C. E. child care and early childhood education they are doing more oversight of residential. Adolescent facilities and so there are some of their seeking about 400000 in costs associated with that that are largely tied to. Of personnel I believe it's for additional individuals and their travel and other costs associated with that. So those would be the re allocations that we will be asking and as I said they can discuss those in more detail. Moving over to Medicaid there are. At the end of the day our Medicaid numbers are always driven by. Enrollment size and utilization. How many people are in the program and how many medical services they use I know many many of you just work through the state employee health plan with EVD and so you're you're very familiar with how a lot of this works in the case of Medicaid we do draw federal match and a big driver therefore in or the driver and how much federal money we will have coming to offset these costs is always tied to the F. map so these are the current F. map assumptions that we're looking at this is the baseline F. map. What you see is that we usually get around 30 we usually get about $0.30 on the dollar and. What's interesting about it for us is going to be. That with the beginning of the public health emergency back in March of 2020 now the federal government gave us all enhanced F. map so they gave us this extras you can see the secretary of basically 7 percent and that has allowed us to use less as G. R. over this period of time as I said right now that is scheduled to end at the end of. June. I think most of us had thought that until this most recent surge it was planned and at the end of March and we had thought it actually would and at the end of March but the recent coverage search the federal government just came out last week and told us it will now be the end of June so the big difference between S. FY 20 twos budget and S. FY 23's budget on the Medicaid side is 2 fold one is that. As long as the public health emergency is in place. We have restrictions from the federal government around eligibility they require us to keep on the Medicaid rolls anyone who is on those roles unless very specific circumstances exist they die they go to jail. President or they ask us to take them off the rolls so the roles have grown over this period of time as I said in Roman is always a very large driver of the overall Medicaid cost this is what the federal government requires in return for the enhanced F. map. So. 4 S. FY 23. What we are looking at is seeking both for this year for 22 you will see this coming separately to you. $400000000 in additional appropriation no S. G. R. but additional appropriation because of the extension of the public health emergency and the increase we now have in hospital medical and that we would like to ask that you carry that increase of 400000000 over into S. FY 23 for us the. Impact of that as you will see is per S. FY 22. What we're currently computing is that and this is for casting essentially with ourselves halfway through the year is that our Medicaid overall cost will be around 9.3 9000000000 as you can see. This state cost of that right now is 1.8. As you'll see the enhanced F. map is where the federal government has come man to put up more federal money it would have been 2.one this year but it'll be 1.8 for next year that enhancement goes away. And when it goes away. We're right now forecasting 9.4 a as R. 9.4000000000 as our Medicaid costs next year which would require 2.269 in overall state share the general revenue cost as you see goes from 1.365 to 1.372 and remember that we are restricting for the DD wait list within within that as well OR will be asking to restrict the DD wait list for S. FY 23 as you can see that will mean that we will begin eating more into the reserves and trust fund now that the federal enhanced match will be ending. We do have a state law that requires us to do the re determinations in Medicaid not within a year as met as CMS will require but within 6 months so as we the reason why you see the. Increase for FY 23 not being as much as it might have been is because there's we have computed at with the idea that within the first 6 months the people who are on Medicaid we go through a redetermination that a significant number of them would roll off so. That's the primary look at how our Medicaid funding looks couple of quick things that I'm going to just ask dawn to point out. If you would just for a moment about provider rate reviewed included in the increased cost for 23 are provider rate reviews as well as implementation of some of the new state laws that will impact utilization in coverage so if you would run through those for a quick second certainly and so with regard to the provider rate reviews you know that is something that was both based on the interest in the legislature and the governor's executive order that we go ahead and complete rate reviews on all of the rates within the Medicaid program we are very close to having that done in that we will complete the remaining rates that have not been reviewed by the end of this calendar year we unfortunately had to push back to schedule little bit in light of COVID in the pandemic but with that we will then continue to resume the rate review process on a 4 year schedule so whenever a provider was done within the last 4 years then they will be up again in the next 4 years we are in the process of completing that completing those rate reviews and then working with providers on how we design the next cycle which will begin then in January of next year and then with regard to the state laws we've had several state laws that were passed in the last session that impacted both Medicaid utilization coverage just a reference a few of those several spoke to the coverage of new specialty drugs so you see that built within the budget as well as increases in utilization so things such as where additional benefits such is visits to physicians or visits to other types of providers we're also put forth as part of a new state laws and so that's also represented within this budget. And then finally you'll see a list of some of the budget rest there's always risk but the. Only one I will point out here obviously foster check number chart poster children juveniles but only when I will point out is I have been in correctly predicting the end of the public health emergency now for about a year so this budget does assume that it does and so that would be a a major change if it were extended again so with that thank you Mr chairman. Thank you. One thing on the just ask about quick you don't mind. We get back to page 9 and that's the Medicaid funding flow. In the state portion we do this rate review I'm assuming obviously because we don't know that's going to turn out to be but that's going to be an increase in state G. R. I'm assuming. That's undetermined at this point or did you all do some. We have how do you see that playing out with with Soviet project for 2023 start sure so typically what we have done and we saw some of this built within the last session is that as we have completed those rate reviews you know in some cases the reviews say that the the rate the current rate is sufficient in some cases it says you know it actually could be lowered but then in many cases it actually says it does need to be increased typically when that happens we look and see kind of what the impact looks like on the budget and then we have brought that forth in the past to then DF in a in the governor and then built that in as part of our budget projections and so we would anticipate that as we complete the ones that are under this current cycle to the extent that there increases that we would need to built into the budget then we would bring those fourth as part of the next final request this does include the rate reviews that have been conducted and the new increased rates that are coming in this SFI 20 years of 4 yes so there are rate review there are rate increases already built in yeah but we should anticipate probably something higher than this then racks the setting the budget. Going forward we will likely come back I mean we're still in the process of finalizing several of those so I don't want to get too far ahead but I know even with some of the recent ones like there's one that were finalizing now with with one of the provider groups where likely we're looking at trying to do that over the peer over a course of 3 years because there is such a significant difference when we look at what we pay today in relation to where the other the other pairs are both within the state but also how we compare within our region and across the market do we anticipate some of this is going to settle itself out I mean it Francis the the price of yes you know nursing is yeah I'm in extraordinary right now it's certainly our hope as well yeah but even as it does the increases that have gone on in the last 2 years are going to have a permanent impact in the system I mean we we end up paying not only will impact rates in the future but it also will impact the supplementals that we pay out because we do pay out supplementals basically a year late a year after services were performed for the shortfalls so there are they're going to be impacts coming down the road still from all of this. We. We have a Medicaid forecasting we. What we've shown you here is what we believe is a conservative forecast but not done most conservative so to your point things can happen that would drive it up and we would eat more into the trust fund right so that's kind of how this this works as that trust fund goes down it gets more scary for future years because frankly it is the trust fund that allows us this year to say could we restrict the money for the DD wait list and please let us reallocate to some other needs. Yeah that's kind of my concern is at some point this is going to pull in pretty well at senator Hammer you're recognized for a question thank you Mr regarding the rate reviews could I get a list of where we are as far as which groups have had their rate reviews done and where we are in the process of the ones that are currently under review and which ones are yet to be done if the end of this year is the goal could I get that list please yes will provide that and then once the rates are reviewed they going to affect at what point so if you review of you know what segment of providers are we are we implementing those rate reviews at the time that the review is completed are we waiting. Typically we're doing at the time the review is completed now many of those require in some cases getting federal Medicaid or CMS approval as well as coming to the legislature so just depending upon how long it takes for those 2 things to occur you know will then dictate when the new rate would actually going to affect any of those cases sometimes it is done retroactively you might wanna give the example of the 1 you were just talking with me about outside sure so I think many of you may recall that we had previously based on the minimum wage increase did a rate review of the personal care services within the state and put in place increases for that program as a result of that we also then went back and looked at where there were similar services within the program most notably what's called the attendant care service within the the Arkansas the the ARChoices waiver which is our waiver for elderly and physically in 80 H. R. Kansans and within that while we're still working with CMS to get final approval of the waiver they are allowing us to go ahead and implement the rate increase on attending care back to January of 2021 and so we're working with the providers and with our team now to go ahead and process that adjustment so that rate increase will be retroactive to January for those providers and that's all covered in your budget for the portion that will be responsible for the what you're presented to us day has that that's corrected into art I'd like to get that is could couple follows Mr. Okay. Ask for drop down all right thank you. Regarding on your hand out. 50. Second third page long there it's it's the of. The new pilot program. You've used the phrase if successful. What are you gonna use to define success and we at what point are we going to say this wasn't successful because there's a lot of money hinging on what we've committed in a way of positions and also what are the tangible measurable results that we as legislators will be able to look at and say it's successful or it was a good try but we need to quit. I can start and then I think a key server if director Martin wants to say but from my perspective Senator there's several things one is that. We will look to see if we have had an appropriate safe reduction in the number of children coming into foster care and being able to instead remain in the home and the family become more secure and the child being be able to stay there in a more successful family setting so that will be data we will we will see and be able to keep up with secondly we are turnover rate among family service workers and our ability to retain family service workers for a longer period of time will also be something that would be a factor we will be able to look at thirdly director Martin has a very comprehensive set of. Data. Component she looks that looks at literally day around the performance of the child welfare team in terms of timeliness of investigations timeliness of handling of working with the parents timeliness of instituting treatment you know all relative placement all kinds of components and she has targets in all those areas and so successful will mean that we will see ourselves getting more and more of those targets and being able to get that system working more more effectively okay I just about his set of those standards that you're gonna be using so that I can follow along as we go thank you Mr. Thank you I think. Senator Gilmore thank you thank you Mr and and I too would like to get so the rate review information that Senator Hammer requested shifting gears a little bit. In the news recently there's been some some things come out about a pass in Arkansas and and the fact that the fraud control unit found I think it's about $10000000 can you explain how that happened what was the oversight process for you guys and then what is the process going forward to remedy this so this doesn't happen to future. Certainly I'll speak to that and then if there other questions or details directors Pitman can speak to that when she comes up as well but in in general what happened was with the passes there's a portion of their expenditures that have to be tied back to direct care in terms of actually providing services for the client and then there's a portion that's considered administrative expenses that they can use to pay bills salaries those types of things part of what we saw in this case and and ultimately what was found within the attorney generals Medicaid fraud control units investigation as well as the office of Medicaid secretary general with that there were concerns about how the administrative funds were being used and reported and whether or not that was done appropriately ultimately after completing the investigation the Attorney General's office found that the funds that had not been reported correctly and in some cases had not been used appropriately and so based on that they are they have agreed to a settlement that includes changing the way some of those funds have been reported and used as well as paying back the the question cost to the state there's a lot more technicalities that go into it but that's that's kind of the general explanation of what happened in the situation. The so it's safe to say that some of the. The reporting was maybe miscategorized or something along those lines and how was that was was that. Information given to the past and know how to do that correctly what was the communication process from DHS to the pass because I'm just my my concern I don't want this to happen again certainly so then what are you all doing to mitigate that thank you I forgot to answer the second part your question yes so the the information with regard to how they report that is is provided both by us in terms of through our past you as well as through our actuaries with regard to how to report the different types of information as well as to the the insurance department because since these entities are regulated by the insurance department they also receive some of their guidance and instructions through that mechanism what we have done to support that is to make sure that we have greater oversight and approval process sees for what they are categorizing with regard to those expenses as well as being clear with regard to what is and isn't approved when they come forward with their plans for how they want to use a portion of those funds that could be reinvested in the community so that's part of what we're doing with regard to making sure that's more clearly spelled out within the agreements that we have the to the passes as well as working with the trails Office an omega on increased oversight monitoring we've also put a number of other. Assesses in place currently with regard to like like while they were in the suspension while they were under suspension we actually were monitoring their bills on a daily basis and approving the payments for the non direct care costs so we learned a lot through that process and plan on continuing to build that into the safeguards and integrity of the program thank you in 11 final if I could get I'd like to see because oversight can be an ambiguous term I just like to see some of those processes certainly and and what that oversight actually means thank you Mr Sir thank you representative love. He's actually represent thank you chairman I appreciate. I'm Director Glasper secretary Gillespie just look at F. 23 numbers I just wanna get some clarification of and we can you said that when we will get done with the emergency going to re. You expect to see a large decrease in those that are eligible can you give us just a little more specifics I know it's projections and what you're looking applicant gives this a couple of more specifics on where you think that's that and and we came up with that assumption I guess. I can give you some I can give you some numbers but let me you said it yourself let me qualify these all over the place because we have not gone back and look at these individuals and it does mean when we do it will be less than what I'm about to say right many of them will qualify for Medicaid still in some way but at this point we have about 180000 that we have extended due to the public health emergency now for many people who get extended. They would you know that numbers constantly changing because there are constantly coming back and coming into another category all right it might be that they got disabled it might you know all kinds of things happen and in people's lives so that. That's the only number we have right now that we can work with but we are not trying to say that it will be that if that's helpful just a quick follow up chamber that so you did you guys assume the 0 we're going to lose 180000 and your numbers we're looking at our F. 23 members are all of that are partial of that just trying to get this a little idea on that no. You what I'm gonna let her censure going deep into the numbers. So it is it is hard to say what percentage of those individuals likely will remain on the program we have continued throughout the public health emergency to do the re determinations you know which I think puts us in a better position compared to a number of other states who simply stopped you know for those that we were not able to complete the re determinations those of the individual and it could be for reasons where they might still be eligible but they failed to return information to us or we had the wrong address or you know any number of reasons so we're really focused on trying to figure out what we can do between now and the official wind down of the public health emergency to really focus on getting updated information on clients and being able to you know try to update that information as much as possible in advance of doing the the the remaining redetermination so unfortunately I don't really you know have a good number to give you because there is so much variation that we see you know based on the different populations whether it's adults or children but like they were doing as much as we can to try to prepare in the hopes that we'll be able to get a better sense of what that looks like once we can get some updated information so so just to clarify we don't know how much the numbers that you're presenting here today decrease by 180000 you where the numbers come to so those are so honest trying to clarify where were. Sorry in terms of the 9.4 yes so we have a card to the policies with regard to the the bulk of that increase is with regard to our hospital medical program and really that is tied to when we look at as secretary Glaspie said the 2 biggest drivers or enrollment and utilization in this case in a hospital medical bucket what's paid out of that is like for example our payments to the past program payments to like our dental managed care program basically any of the programs as well as for general care for hospitals physicians and others and so since part of that is based on the enrollment aspect you know we have to continue to make those payments you know until we are able to start seeing some changes within the enrollment you know as we move towards the end of the public health emergency so your numbers here still include all the 80000 being enrolled and not removed from no no they do not we actually we plan on having a phase down approach much as as was put forth in the last session we have to complete the redetermination process by state law within 6 months CMS's working with states on a 12 month timeline but for Arkansas we're planning to do that within 6 months so that were compliant with the state law and so the the the budget was built on a basis that once the public health emergency and the Secretary Glaspie said planning for the beginning of state fiscal year 2023 that over the course of those 6 months we would complete the redetermination process and then whoever is not eligible after those 6 months would roll off the program thank you. Thank you. I think this is represented right yeah. Ladies I had a few phone calls in the past 23 weeks and basically what's going on here they say that they have received you know an increase in their social security but that is not the amount of the Medicaid program. So no with regard to at individuals who receive like a payment through so security there other federal government put in place the cost of living adjustment I believe this is actually the highest on record that they actually increase the amount of funding that individuals to receive so security actually receive and that that effect just wait in place earlier this month. Follows please. Well they received a letter though they said that they were gonna be removed from Medicaid. And we I know we had a few individuals who as a result of that we had some letters that Roni Astley went out because we are not able to in people's coverage right now and less in very small situations such as when someone dies without a state or tells us that they no longer want Medicaid coverage so we did discover we had a few notices that unfortunately went out to individuals when they're so security increased because normally that would be an income change that we would then process and then re determine eligibility but in this case those individuals will not lose coverage through the end of the public health emergency and you notice was sent that's correct so that they would so that they would have in writing that they are not losing their Medicaid coverage right now a reserve Robbins save for you and for any other member anytime at a constituent who receives a letter like that whether some questions are urged not sure about certainly feel free to give me a call and give me a call that letter and we'll track it down for you and make sure they get the answer that a. All right thank you. Senator garner I think. The. Thank you Mr Reso. I'd barely entered on this so you can help me out with this. The federal government jumped up there and said basically rural pay you an expanded rate during the public health crisis and I don't know the numbers I'm trying to look through it but that's probably tens of $900000000 that came to is that correct yes it's at 66.2 percent increase that they give us to our match rates that you saw within this like what what's the amount of what we would have to pay as a state versus what the government cut with the federal government covered I think you can see a lot it's about 999 would give you the best summary yes thank you Page 9 thank you thank you chairman yes it it's for the state with the enhanced match rate it's worth about 80 $5000000 per quarter okay and you anticipate that that's going to end in June. What will happen what confidence do you have that would actually happen I mean you all sales will be March you'll sit before going to this other time we know that we're depended because now turn into endemic will have future variants. Is it just the bottom ministration who decides to continue to continue this is not like a CMS or any kind of legislative approval so you're you're betting that the body ministrations going to actually in this pandemic of emergency power this summer and not extended as far as possible so. If I could. We're preparing a budget based on what they've said as of today which is that they extend the they extend the federal public health emergency on a quarter by quarter basis and so last week they extended it through the end of the next quarter and so at this point we are working off of that other than that we might we primarily as I said I've guessed wrong on this and I'll let you know that but what we had started to see from them prior to this most recent search. In a covered cases was they were actually starting to work with the states on detailed plans for the public health emergency wind down so they were starting to actually have meetings with everyone beginning to give us detail beginning to work their way through components of it and they were basically with a lot of the programs that they were putting out they were starting to have this March 31 date on them so they had said that it would end data extended only through that.. period Then they started to work with us and then it changed so you know I I guess that's my I have a budget based on if I'm correct about here I've asked this question for correct about it once we entered this deal with the devil they're gonna own us for the the rest the time until we get out of mercy we cannot kick people off Medicaid expect the we cannot get out of the program without risking funds were in it till the end of time and it sounds like there is 80 plus $0 that the taxpayer of Arkansas didn't have to pay last year to the state government course the federal taxpayer dollars but that's a completely different argument we get that free federal money that are people pay for my question is when does that money go back to the people when is this 80 plus 0 and is likely emergency going forward or go see reduction so that we actually give that money back to the people since their get double taxed now it seems like the state revenue didn't hit the federal government is getting hit I'm just trying to figure out the point whenever the people of Arkansas get some of this money back that they've been getting hit over and over again about. I think the rate one of the reasons that the legislature and the last session. Decided to have us ended 6 months instead of a year is a desire that as soon as this is released they want us moving as fast as we can to to do this and it's partly why as a director Staley said we are doing a lot of work right now to go ahead and set up to be able the minute it ends to start moving Arkansas out of this it's not just the redetermination but just you know just so you are aware of some of the kinds of efforts that are going on to make sure we can meet that deadline that y'all have given us which we agree with we we had we are very very much in agreement with that one of the elements that goes on is that it's not just a computer redetermination a number of the people that are on the program actually are on because of medical eligibility they may require an independent assessment during the period of the public health emergency a lot of individuals have not wanted people in their homes so they haven't been assessed so we're working very closely now with providers to try to make sure we are able to go ahead and as many people as well let us go ahead and get the process so we can go ahead and officially extend them for a year and not have to come back so it's as director Staley said we're doing read determinations as we can on people and that's for most people so that we're poised to move as fast as possible. I have a under a separate question agreement just like that you. Your term is up to you would go ahead and wrap it up okay I don't on the similar subjects so. We have people now that our Medicaid that can't be kicked off so in theory our Medicaid rolls should be flush with people which means hospital should be receiving Medicaid funds for people to go there that maybe what are eligible or would traditionally be on there. Do you also do the the additional payment that hospitals get for cover related to constructing the federal government what what all programs or hospitals getting either extended pay extra pay more revenue more resources from DHS due to pandemic that they would not have received otherwise you got kind of a general ballpark at. I can certainly we can get that information some of that information some of those payments to come directly through us with regard to billing and payments some of that money has come through the state with regard to some of the cares and cash funding that the state has gone and then funded hospitals and other providers through those funds and then hospitals like other providers have also received separate funding through the federal government to help support them through the pandemic but certainly we can get you information with regard to how much we have provided through can you give me a ballpark is it tens of millions or hundreds of millions tens of it's tens of billions probably actually probably closer to hundreds of millions when you put in our money so that's interesting because I think that's exactly the point I think we do we find ourselves at a point where now we have to give an additional bail out of $50000000 or hospital so they can have dad gum ice you bet when you're in a pandemic we give them hundreds of millions of dollars specifically to keep up with the need of there was a rush of patients. And now we find ourselves at a point or once again the taxpayers have to come through because of staffing shortages even though this free market approach now we have to pay for their staff and sources and I just always interesting that DHS the federal government state government probably in flux hundreds of millions of dollars your words not mine the last year point 5 but we found herself another $50000000 we have to give out through a rule in A. L. C. thank you. All right seat 19 please. Okay president will. Thank you Mr chairman madam secretary I will I'm. Totally in support of what you're trying to do and Family Services and out reach their very familiar with that and and I appreciate your effort of course you know I'm a stickler on personnel and it comes to funding and money and the B. D. and all that I guess my question is of how are you going to or the use of 109 additional positions are they going to be used with and when I look at the report that I have us the of. 111 of Division has 700 48 Blake held positions on the other 1 has 200 63 and then the to the Department in total has 1620 vacant positions as of 1122. So are we talking about ending just for a not used a celery of $50000 I don't know whether that's correct with the used to multiply that out and then a duty we do the same way as 6 that that's about 6 points of almost 6.1000000 additional dollars is this no budgeting that you're asking for for those positions. The short answer would be yes and if I could then explain a couple of things the. The. Which began the pilot or were beginning to pilot now with some of the other divisions loaning over some positions so we could go ahead and get get some people hired and get the team going because our normal our turnover rate in DCFS has always been bad but as you know during the last 2 years it has really been extremely bad so to begin movement we've done that those positions that were loaned over need to go back to the other divisions because the reason we have so many openings is because of our hiring shortages that we've got particularly the human development centers and at the state hospital and at the help center we normally need to set to be comfortably staffed around our facilities and what we have to do and not be using expensive contract labor and running so much over time we need to sit closer to about 7000 between 6900 and 7100 please build employees to be able to staff what we need to do we have been under that sitting more at around 64 hi 6400 right at 6500 and it's one of the reasons you see us asking to move that G. R. increase over is because we have to figure out how to pay for all that contract staff were having to use. We don't have L. or overtime we obviously we're looking at facilities we don't have a choice we have to staff and staff 247 in order to be able to keep people safe so the reason we're asking to add positions to DCFS is so that we can permanently raise the size of that work force and have it more aligned with this teaming concept so if you're follow up if I may you're you're you're saying that when you when you take the salaries of a fun for for you multiply that by 100 28 of 4 matching those that that comes up to about 7000000 Bucks including the the the the the. But. Or are you saying that what when you're this team approach will be for the safety of the children going into those homes that's what you're talking about safety of the children safety of the workers our workers leave partly because they fear for their safety when they have to go into a home unfortunately we do have occasions where they are attacked and so a teaming approach where there's always at least 2 of them I agree is a smart thing to do we think of him but will you look will you to look at your budgeted amount for personnel and see if we can utilize some funding in the budgeted or if you talk about reallocating your general revenue to cover some of those salaries so so we don't take of a $7000000. He is like I said I understand I fully agree with what you're trying to the yeah of. Well I would appreciate that if you look at that we will take it that will take your response to access and the 6 with the positions that you did turn in thank you Mr chairman thank you madam secretary Sir thank you. Representative Hodges. Thank representative back with. Well here. I certainly understand the challenges with the budget and I want to I have 2 questions one is just to give me a little bit of a glimpse inside the actual process of. And I understand that you've got people that are gonna be moving off of programs you don't necessarily know how many people be moving out thousands and that creates a problem. But in my never ending search for numbers do you start of the base number like for instance we think that 85 percent these people are going to stay in this program that will introduce this number of people now for every additional percentage or maybe forever project visual 0 people stay in this it's this much of an incremental does that level of detail exist. We don't I will let Director Staley talk this through we don't look at it like that as we are budging we're looking at we're at the end of the day what we're paying for for these individuals are services right so it service lines and we are looking at the different types of service lines and it's tied back to utilization utilization obviously is tied back to enrollment right so we're always looking at historical trends and and but part of what you look at is your pre COVID historical trend where were you obviously with inflation on top of it medical inflation etcetera but you're looking across trans to see. What what does your program looks like in terms of that type of population I don't know if I'm saying this very clearly but it's not you don't build it up on a person by person basis you're looking at and across trans simple example. Is a a person who is on the DD waiver is far more expensive for us then I child children are cheap they do not cost a lot on a per per kid basis will be paid for their services but on the other hand a child on the date of the waiver is a very expensive Medicaid client because the services that they use are far more and they often have other illnesses along with it so that's what we have to look at it across service lines. And population tied to those service lines if you would like to clear up the model I've made of that. Just it just just to add a few more details as an example so with that like when you look at a child versus an adult like take a take a category or a line of service such as like physician services we know that when we look at pre pandemic we we can look and see how often were people going to the doctor right you know with regard to how many visits that they had per year we know that as we look at what happened during the pandemic you know during the first phase we saw that that was significantly suppressed in the sense that you know a lot of people were not going to the doctor even for those preventive kind of wellness and checks it was usually if they were really really sick or you know needed hospitalization you know as we started to come out of the last phase of the pandemic part of what we saw was that and we saw utilization starting to come back up a little bit people are feeling more comfortable they're going to the doctor you know and then we saw a little bit of a drop off will now we're seeing we're you know folks are definitely going back to the doctor you know in terms of their feeling more comfortable going out there getting that you know health care that perhaps they put off for the past year point 5 in addition to than normal hospitalizations that may be occurring but the other factor we have taken a consideration in this is something that's new with the pandemic has been the increase in the use of telemedicine you know I think some of the services that we have seen during the pandemic have been services that have been in lieu of you know people actually going you know into a physical location such as a doctor's office telemedicine is just the opposite we actually see where as people are going back to the doctor they're also continuing to use telemedicine and so we expect that in that case telemedicine will continue to be utilized at that same rate if not even higher in the future and so that's part of what we have to take into consideration the Secretary Glaspie said as we look at the historical trends pre COVID or pre pandemic in this case we look at what happens what is happened during the pandemic and then we also have to make. You know look at look at how that factors into how we project going forward and so part of that does happen based on the line of service as well as the the population group in this case children you know as we used in this example. Thank you Mr I have one quick question. Of the intense in home services that we talked about that in thanks for $0 increase their net increase number of counties how many counties would that represent. 63 I'm I just missed that one said 16 so would be 16 the additional County so how will that be total. Director Martin. Okay I know 18 will be left correct. 6. You Sir brown number. 37 plus 165353 so that will cover 53 counties so that after the 16 or added skews me that they'll be how many of you said 5353 thank. All right thank you. Senator Rice recognized for a question. Thank you Mr US secretary Glaspie since the Supreme Court ruling recently which I think was more political ruling that it was a constitutional ruling just partially. It is going to put the. Certain entities in the past I have to make decisions. Calculated in your budget or have you heard I've I've not heard I ask mother. Members have not heard. How far down this is going to reach I understand the the healthcare entities but does it retail down into DC as safe with and and anything like that are are the religious and health exemptions going to be recognized we've heard we've heard nothing from that and yet this is going to come to council next week and the. Man man that's and so I am asking during the budget a if you calculated in the sand on the people it's going to be affected in your organization by this in House so. The. Well a couple of things at this stage it it only hits our workers at the Arkansas State Hospital and at the Arkansas Health Center. We do not have clarity at. On the surveyors right and he would officers and him it does affect the human development centers so are 353 types of facilities we run the 5 human development centers the state hospital and health center oral impacted by it the workers at that we do not have final clarity from CMS around the surveyors to survey the nursing homes that work for us so for the moment we are assuming they are not but we do not have. Final word from CMS on that so those are the workers that are impacted we sent a letter this morning to request to come in front of council next week as you just said to address this at if we a. Are approved to put it to put in place the requirement then immediately the exemption process will start and I'm going to let. Chief white talk a little bit about that because he is putting that in place. Sure so we we do have a drug policy we've drafted around providing those religious and medical exemptions and process we will perform we've not put those out because number one we the man expending question and number 2 what we don't know have authority to do it yet and so that's what rendering that question to you all in council next week as far as when I will be in that mandate of a we do have those policies ready to go SO there will be opportunities for employees to request exemptions for if they have a medical reason to not have that vaccination or if they have a sincerely held religious belief and that should not work to make that process as simple for the employee as we can because we don't put it off schools and in the place of employees who have those convictions and want to claim that exemption with the tat. Employment pool that currently. In there have you all put anything in your budget or do you have anything you need to share that concern the that you're going to have to do if you have the loss of the number of employers are but they presumes that unfortunately the same type of turnover issues that we've had throughout this last 2 years which is an extremely high turnover rate at our facilities and continuing to have to contract because that is our reality as we face it today even before that comes into place. Chief white when he sent in our letter did also include the remarks that we sent our comments that we did send on this to the court so I hope you will see that we we did speak out ourselves and supported the case. I look forward to some clarity thank you. Thank you for that I'm him you wanna just real quick because of a few like this were fixing to go but. I mean we keep saying religious beliefs strongly held religious beliefs but when you go back and actually look at what constitutes a religious belief actually just says it's a strongly held belief and that's one thing that I think these get communicated to the members think it needs get communicated to your staff that knows I've heard from some that you know what I'm not you know it's not against my religion and they would be wrong for me to sign this even though no one take vaccine we still very strongly held beliefs and I'm and I'm assuming that's my understanding in a lot of health care you know that's discussions happening amongst their legal teams and I'm sure yours too and one that we really need to make sure we comprehend as a legislative body with your intent on how to roll out you know a mandate that you didn't seek but with that just a little clarity for the members we get in next week and I think hopefully they will be looking for. And if I'm wrong on that say a raw. No Sir Oct I think what you said is accurate it's it is I mean that there's a religious basis with that be as of the end of the day the question is is this a strongly held belief right to tie back to this person's religious beliefs and the law and from what we saying law does not give a lot of leeway to second guess that for that a great way and so that's where we're gonna implemented and follow the policy that the feds sent and make sure we allow those exemptions for employees thank you aren't senator Hammer. Thank you Mr in the event you should miss the June cut off date and the federal government extends the emergency well that a creek will that create additional revenues coming into the state that you don't have built into your budget. It will create additional revenues but also additional costs and that we will have to continue caring folks that maybe an eligible. Do you know if the cost will offset the income or the income would offset the cost to where would be a net positive to your budget. I mean at this point we are we are I looking at it from that perspective I would say that we are net positive but it's a question of how long it remains and then what impact that will continue to have on the budget and if it goes to net positive. Where will that additional where were those additional funds end up with the end up in the reserve trust fund or where would they go in the budget. It would increase what it would increase the size of the reserve right trust fund in that we would spend less as G. R. so what would happen is it would look. See the enhanced F. map race on this what would happen is something like that would flow over into this year we still spend the same amount of money but that enhance component would now come from the feds that's meeting we would spend less STR than we had planned because we have to keep more people on it could be that we have to come back and ask for more appropriation. Not more STR in order to be able to continue okay so we'll watch that see what happens on that date because that could result in increasing the reserve fund if it goes past that's kind of the summary of it right yes okay and then the second thing is historically you guys have always come to us and said that you need more money need more money you don't have enough money in your various agencies and on page for your hand out I wanna make sure I'm interpreting something right it seems like you found 22.4000000 by reallocating money away from other areas did you am I correct in my interpretation that you are shifting 22.4000000 out of the budget in order to take care of the needs that you've identified. Mark yes center so in other words the governor's original recommendations balanced budget recommendation that he made to begin the biennium we're not asking for any additional dollars over that we're just reallocating within those dollars okay because I've got some emails instant messages from various people around the various agencies that are expressing that they have some real needs that are getting taken care of so my concern is if we're re allocating 22.4 way from these other entities what have you done to make sure that all the needs of those entities are being taken care of and that could be facility enhancement that could be other various things to make sure that that were not shorting somebody in order to take care of somebody else right and that 22.4 as being reallocated out of the Medicaid budget so it's not coming from any of our divisions or from any agency staff this is from what we're going to Medicaid okay and then the final question maybe this. Empower on the subject of an power how much did they actually over bill what was the total amount identified as far as what they over build. It's the I don't know the exact figure was approximately $10000000 that was misreported or mis characterized in some way and others are split among multiple years and so that made a difference in terms of how the winners for kut but the total was I once 6000000 a member okay and that money has been totally recoup so they're back to point 0 the the money that impacts the past fiscal years has been addressed and recruit to the extent that it can be there are there was some characterizations that affect this current year and that will that will be recouped as we go that makes sense okay and then so this is reason ask these questions and this is just put it out there the other passes feel like you're given on favoritism and that you should of issued in the death blow because of past history and also what appears to be on going issues why did you not issued the death blow on empower and just go ahead and terminate contract with them given that you got 3 other passes that are in the state and especially if it was costing money that I guess through auditing procedures were determined is favoritism this being show to empower by the fact that you did not issue a death blow and how does that how does that resonate among the other 3 passes had it been them especially if it's a new one coming up on the ground that that there seems to be of an appearance at least of a much put it out here so you respond publicly that there you've been very lenient given the severity of what has been substantiated. It and also having a few things I think that that are important to make sure that everyone is aware of it in in that when the initial action was the recommendation from the attorney general's office with regard to that they found a credible allegation of fraud and then with the office to make inspector general recommending suspension typically in those situations yes we like with the physician for example or someone else that means that they are no longer able to provide services what we looked at and this was after you know looking at and then also looking at the the clients which is really our focus here is to look and see how many clients are that where they serving at that point in time and whether or not those clients could be adequately served by other passes that were in the program at that point in time we had 2 other passes now As you referenced we have a third pass we have 4 passes they're in the program at that point in time we didn't feel like it was in the client's best interest in that there would be an access issue for those clients if there was a determination to go ahead and completely suspend in power as a pass at that point in time however we did put in place several sanctions as part of that suspension first and foremost we said that they could no longer receive any new clients and that meant either new clients to the Medicaid program or that minute client who might say they were with you know another pass and then wanted to change you know to empower neither of those situations were allowed as I mentioned Center Gilmore's question earlier we put in place extensive monitoring and reporting actually making sure you know making that the day to day decisions with them about what bills that they would pay since that was part of the findings you know from the attorney general's office the other factor that we had to put a consideration was thanks to the impact on on the clients and the program overall we ball this past in terms of. Our in the new past cure source were undergoing reading this review as part of some of the changes in ownership and coming into the program and I can assure you that from the beginning of that process all the way through the end which is still on going in the case at least one of the passes all passes were treated very fairly with regard to timelines with regard to expectations and so I mean that the way that we have handled this with regard to the passes and and with regard to how they have been treated has been based on first and foremost the best interests of our clients but then also making sure that it was fair for for all of the passes whether that was for existing passes as well as for you passes to come into the program how many how many members did empower lose. 20 thousands what they had how many are they down to now through the sanctions you issued. I have to check on the current enrollment number of that something we have at the at the tip of our fingers otherwise we can get that for you I would say we have heard from several clients as well as others of the intention to to move away from in power but like that so we can get you those numbers I just don't have that enrollment number as of today right in front of me but we can get that for you one thing I think may be helpful because there's I mean obviously you Senator Hammer is wanting a lot of detail on this I think we've had some you know at least had one other question when there is a Medicaid subcommittee avail C. that could take this up there's a lot health and have a kind of a more thorough discussion especially since they were prepared for today but there is interest in maybe if you all could reach out to the chairs of one of those 2 committees to have a further discussion that could be helpful thank you Mr thanks thanks and then seat 15. another program where we will come back with an M. F. G. if we need to carry over. Additionally issue covered funding are thank you thank Mr. All right thank you any other questions all right seeing none I've got a motion to adopt executive record going to second all those in favor signify by saying aye those opposed motion carries. Remove on to. The DD at. Yep yep. You're recognized thank you Mr chair the division of developmental disabilities services request begins on page 204 it's funded from a mixture of general revenue federal revenue special revenues in various programs support and the recommendation first is for about 100 93.$3000000 in fiscal year 23 on pages 273 to 19 as their operations appropriation which the only on the changes it's fun for make sure general revenue federal revenue and very strong support in the recommendation is for 100 73.5 $8000000 in fiscal year 23 which is an increase of nearly 80 1000 for salary matching adjustment includes my presentation all the happy answering questions. Thank you members we have any questions representative Cavenaugh. If it's for the agency okay. You're recognized for a question thank you Mr and this is just really dealing with page 2262233 to 35 it's basically the same questions I'm on the long term care facilities can you tell me how many of those that we've had to take over in the last 2 years. And. Do we know because of the backlog of paying these long care facilities how many of these are in danger now of having to have assistance. Arkansas but that's a different division we can problem up there cheers okay I'm sorry I thought we were on that division we are on of the felony disability or developmental disabilities. Okay well when ya come back if you can answer that that would have to look it up I appreciate all right to any do you have any questions on this and. All right now Senator Hammer you're recognized for a question thank you I'm on the page to or for the manual about the division of developmental disability services. Actual was. Hendren 28000000 and it's going up to 168 is that just Committee explanation for the increase is that were the additional. People that were picking up off of the waiver Lester Garner educate me on what that is please. Melissa stone division director for development disabilities services it the H. as Senator Hammer now actually the DDS waiver is paid for out of the Medicaid budget so what you see within the DDS budget is and a small amount of programs in federal grants and mostly the majority of my funding goes to the human development centers. What what are those position increase request if I read that right it's going from. We're going up to 2586 from 2472 by right on that are could you help me understand that. No I'm not seeing it that way I'm not asking for any kind of increase the positions or budget. It just clear 25 a 6 that was the road authorized this current fiscal year and we're requesting the same for next fiscal year okay and that that is money that goes to the human development centers is that correct and partially easy in the majority my staff work at the facilities there's a small fee you of about a hundred a hundred 15 people that work on the other programs okay all right thank you Mr you. Members any other questions. All right see number got a motion to adopt executive record got a second all those in favor signify by saying aye those opposed motion carries. All right and that brings us to a medical services. Thank you Mr chair The Division of Medical Services request begins on page 200 23 it's benefit a mixture general revenues federal revenue tobacco settlement that's provider fees in various programs support and recommendations for nearly 9.$3000000000 at the appropriation changes the operations appropriation which is on pages 2306243 and the preparation summary is on page 243 Is Fanta from extra general revenue federal revenue various programs support in the legislative recommendation is for an appropriation of approximately 12.$5000000 in fiscal year 23 which is a little an increase of a woman 7000 $500 for salaries to match in this concludes my presentation for this division and I'll be happy to answer any questions thank you. Representative Devin you're recognized for a question questions for the agency. You're recognized representive thank you Mr chair secretary les B. I'd is we look at the long term care trust fund specially under the section of nursing home closure cost. I see the Executive recreation requests for 4.$5000000 in that an understanding with the purpose of the fund is but when you look back over the last 10 years of this fund only one time in 10 years it was actually 10 years ago to the agency Hey out of that it was like $23000 so curious is this just an arbitrary number that's carried forward and if. For that larger request. Am I just to assume because I think everyone here with me we all have have known a facilities that have been forced into closure over the last 10 years so am I to assume that other owners to step forward and and for those cost to take over those facilities rather than the agency actually paying out of this fund. The correct version wrecker service. Yes it actually operates this fun for her right Martinez I do have a follow up mission chair okay. If you could just recognize yourself for the committee and then you're recognized to probably restate the question in the fall of certain Martinez Smith director for the division of provided services and quality assurance Martine you meet you need me to restate that yes so looking at the at the long term care trust fund in the category of nursing home closure cost of agency requests executive reg 4.$5000000 when you look back over 10 year history that number stayed fairly consistent only once in 10 years back 10 years ago was or pay out out of this fund and it was $23000 roughly so my question is is this just an arbitrary number this carried for this 4.5 and the second part of that would be am I to assume that because we all know that they're being closures over the last 10 years have there just been other owners of these facilities that is stepped up and for these cost. And in an acquisition rather than the agency actually paying out of this fund. Right so the first part of your question yes part of that has been carryover and yes usually when we have situations where of facility has financial issues some facilities have come and taking the over the burden with that facility but to 1 of the earlier questions we have also had to take over and take into receivership some of those facilities and we took over 5 of those in 2020 okay hello Mister thank you so any in looking at that number 4.5000000 that's in this trust fund may I I think we could go around the room here and and everyone of us knows facility somewhere within our districts that is is operating on a very fine line. Our that due to COVID but also part of that due to the fact that I know that Secretary Gillespie and and and chief what would would agree me we we've had multiple conversations for months. A bit of getting the in a long term conversations on updates to the culture for manual and we're concerned consistently having owners telling us that they're getting father and father father behind and so. Taking a little bit deeper dive into question it back sometime Senator Hammer ask. Would you agree that if if we're if we're looking at the fact that we need to allocate 4.$5000000 for potential bailouts of homes to make sure that we have would it not be a priority of the agency to get these cost manuals up to date and and and get these owners back on the right path. Yes it is a property that I have Elizabeth Pittman the director come out because she is working very closely because if I recall the question that was asked by Senator Hammer and I believe the Staley answers she said. Yes we are dressing some of these costs in these manuals and we're trying to get people up to a 4 year cycle. It seems to me that if a 4 year cycle and cost adjustments and health care in what it calls today to take care of a long term care patient would be extremely higher than what it would be 4 years ago and so is this a priority and we can we expect that these these cost report manuals are updated and accurate. Yes I can answer that I'm Elizabeth Pitman the director for the Division of Medical Services it is a priority for agency we have ongoing meetings with the Arkansas health care association and that represents the nursing homes in the state to discuss nursing home costs manual updates the manual itself has not been updated in quite some time and we are aware of that can you quantify that nonce not updated sometime I can't tell you the exact year but it's been since the early 2 thousands I okay is that right so it's been it's been a long time so it's it's needed I'm so we're working with them to come up with some new methodologies that we feel are more appropriate in the meantime we do actually signed a 3 year we re based nursing home right every year based on inflation and and direct costs that we look at an administrative cost in a direct cost and then re adjust the rate on a yearly basis that should be coming up in 2022 I haven't had a chance to talk to the H. C. A. about those exact numbers yet but we are anticipating that will be quite large this year in light of that because it costs. And then we also just recently did some are preventing for nursing homes and I can get you the exact amount that we paid out to help support staff well thank you very much I believe those funds are paid kind of been exhausted. I guess my last question that would be. If we don't have a real record. Of expenditures that is. Noted within the budget. Over a 10 year history looking at the volatility of some of these homes are where we are across the state. How do we know that 4.5000000 is enough I mean I realize that every home can be different number of clients that they have the level of care that's given in those homes but. Is 4.$5000000 enough if we have closures that we are hearing we are close to having all that and because of the vision document discreetly but special praise conversations I think she would agree that this is sufficient a couple points just keep in mind on this this is not our only tool we have to deal with nursing home closures or nursing homes again trouble we have several tools we can use and fortunately we've not had to tap this particular fund know much at all in the last 10 years the thing that's always a little scary is those unknown situations because they come up in a course skyline a few years ago is a perfect example no that was an unprecedented event where you had multiple nursing homes in trouble that had been dealt with and so the key thing for us is we've got to have the tools necessary to step in and take those immediate actions and get them through those first few weeks yes certainly if we have a situation where it's a real crisis and there's more funding needed there are tools when we come back to you as a legislature and seek that additional funding or preparation but as long as we have that those stop gaps for those few weeks it may take to get that authority from you that's what we need that's what one person the service here certainly thank you very much and and and I appreciate that the fact that you stated that this is a priority of getting these costs manuals updated and especially with the anticipated increase it is going to have a very large effect on our homes in our districts and I would appreciate your attention to that thank you Mr. All right thank you representative right you're recognized for a question thank you thank you Mr chairman posted on December 10 we had a tornado that went through Truman and Monet it wiped out basically both of those nursing homes can you give us a call an update of what we can expect because each one of those homes had about 100 people we only lost one today yes but can you kindly give us something to look at for what's happening there sure individuals with only one article appeared if presidential detail I will say that Mercedes all the residents were located to other facilities or other placements and so everyone's take care of a course that was a tremendous effort by notice of ourself staff helping but also also by the industry they just really stepped up and it a tremendous job to fill that need very quickly that fact that evening on other folks up there working to help get those folks placed L. aussi Burch Smith was that anything else no I believe that's it all of the residence where transpired to other facilities we did checking in with all of those residents to determine if there was anything that we could do to assist those residents with me entrance fire. Yes. All right. Representative Cavenaugh. Thank you Mr so now go back to the question I asked earlier so you're saying I think I heard you say there were 5 that closed that you had to take over and 2020 that is correct do you know how many you have to take over and 2021192021 okay do we know the cost of taking those 5 over in 2021 what the cost was. And where did that money paid to take those over where was that find out if sure so approximately 3.$7000000. And that paid out of that particular fund was paid I'll just say out of the CMP Fund was with the civil money penalty fine. Okay of follow up missed share. So with the backlog of payments to these long term facilities that we're experiencing it is put committee on the brink of having to close down and I'm sure you all monitor that situation to try to stay that how many facilities to your knowledge do we have because of our lack of ability to fight them in a timely manner. Are on the brink of having to have the state take them over. If I could we are as she said working with the healthcare association and have asked them to identify for us any facilities that are in that type of trouble and we will put them to the front of the line and get their backlog work first so there is a constant communication going on between the healthcare association and director Mary Franklin and her staff that are working through the backlog around that at this point I don't believe as of my briefing. I get freaked out once a week yesterday that there was anyone that they were saying make this one priority today but that doesn't mean that something didn't come in last night we take the priorities as we get them and work them very much and how far. Backlog are we now. The. I think the numbers I saw this morning mark will pull them up is that around the nursing homes there's about 646 is that correct merry that are that we're still working our way through. And what is coming up. Do we know that dollar amount. No we would know what dollar amount because these are applications for people to be eligible so it's not $1 amount until their eligible and then there it's retro paid back. We have 600 this these numbers were as of the seventeenth 614 overdue nursing facility applications. An overdue there over the 90 days or either over 45 or over 90 whichever standard applies to that particular application and do you know that how many days pass do that how much over they are. I do have some. About 60 of the nursing facility applications are between 45 and 60 days. hundred 6 are between 60 and 90 days. And 428 are over 90 days. Thank you I just want to say again. If you were not getting your money 445 or 60 would be 1 thing but if you're not getting your money for over 90 days you can pay your bills either. I'm going to urge you all to find a way to get these paid because whether or not we're willing to go on the record and made it there are a lot of long term facilities that if we do not get them paid are not going to be there and I would appreciate anything you can do to prioritize all of them because none of us really want to see these facilities close. And is it status because you don't it's not that you don't have the money to do not process. And I would appreciate anything you can do thank you. Thank you a representative Hammer you're recognized for a question. Thank you Mr the of the rate reviews that were mentioned by represent 11 while ago I forgot do you guys do those in house for you contracted out with the company to those. We have in house staff to work on them we also have our contracted actuary the does the actuarial work around those reviews are the. The the contract that you have with the outside actuary firm are they timely in their contract obligations to meet the deadlines that have been given to them as far as when they need to have those reviews turned in yes Sir they happen. Okay the second question laws discussions around nursing home what about assisted living in that conversation about the number of Medicaid that that are pending what is it on the assisted living side. You are at this point during 50 cases that are backlog. Okay and anticipate and sorry when you expect to get those done. Over all their plan is around the backlog the contractors have we do appreciate the legislature giving us the approval to bring on contractors to help support this the contractors of the first wave has started work and the second wave is in training to start work and our increased staffing their hiring is working and we are getting more bodies on it so all of that is good their plan is to aim at getting everything done in the backlog not just LTSS but everything hopefully by the end of March so it is a very rapid burn down okay land on again same thing we within the LTSS area we try to prioritize and we are we were talking this morning about having the same discussion with the assisted livings around identifying priorities that are close to closure to make sure that those are bumped to the front of of work or thank you because I know there's some mails out there that are on the verge as well so and then I thank I'm sorry is this a and and if I could. It was a Christmas that we were able to release the additional 6.4000000 for them so much appreciated very much appreciated on your budget numbers the prescription drugs I am looking at 223 in our manual Medicaid. Of prescription drugs you got a number in there under 6. 648 down under 8897 you've got a costs for prescription drugs and then you skip on down to the funding source you've got drug rebates. Do the drug rebates get credited against the appropriation number on the top or how do those all coincide and help offset the cost of the prescription drug side. On the preparation no we we expend we pay for that prescription that comes out of that 897 appropriation and there's not a way to undo that since it's just preparation in terms of funding the that rebate it does come back to Medicaid funding and what I'm saying with the Medicare trust fund is not spent elsewhere. So so ultimately the rebate ends up in the trust fund yes Sir why would we not credit it against what the actual cost is instead of your market to the trust fund so as to know what the real number is based on the rebates it's a woman if the funding is half the fun is not split into those categories is simply one set of funding we have divest your comes in and so there's not a specific funding category we can credit that back to it's my money's fungible so when I was there or the trust fund is going to be spent on Medicaid Services either way. Is that. But not an indirect way to re direct money to the trust fund that really is associated with an assigned item that is tied in directly to the budget. You. Yes. M. as well for that that we do have in the funding one of those funny not of is those drug rebates so they do flow back into the spending for the program all right and then last question hospital assessment the is that the bed tax I don't know that you I'm just asking is that the bed tax. Yes. Yes that's that's the hospital tax that the news uses used to fund their supplemental or access payment okay well the actual amount was 140 3000000 but the budgeted amount is 966 at 75 if I read the numbers right why would why would those numbers not aligned with each other can you help me understand the difference in the 2 numbers if the actual for 2021 was 140 3000000 but the recommendation is 966. Why would does not be more in line with each other. We waited tables what else up for that he was just a moment to thank you for and that's my last question is sure thank you. It's. Right. Don's daily deputy director for DHS yes the the difference of what we're showing is with regard to in the past how much money has been collected versus how much is actually necessary to make up that gap and so what you see reported as you'll see like what is actually collected verses the difference of what is actually paid out because under under the law we're only allowed to use the amount of money that's necessary to make up the gap even if we end up collecting more money than was necessary that is very is from year to year where's where's the difference go for what you collect verses what you have to actually pay out word does it end up the trust funder where does it end up. It goes into the various programs support line that you see at the bottom there but then it's adjusted it's basically adjusted based on the gap so like when we look back at historical amount will say for example we needed to percent of funding to be able to make up that gap so that's what we'll send out in the upcoming year and then when we do the reconciliations if it looks like we need more or less then we'll adjust that with regard to how much we have to collect from the hospitals right where's the money part I guess is what I'm asking why you go through the adjustment if you project more than you pay out where's the surplus part right so then that part that that part in terms of if we don't need them the if we don't need much additional money to make up the gap and that money is returned back to the providers are thank you. All right thank you representative Beatty. Just a quick question dealing with TCM and the TCM services I'm hearing from some of the service providers in my area that DH nurse DHS nursing staff are polling clients regarding the TCM services and I was trying to see with this budget what are your plans regarding those services this is an increase in reimbursement or is it to eliminate those from the contract that would eliminate jobs. We're not planning on eliminating TCM services in fact were actually looking at places where we would potentially expand having that service available that is one of the areas that we're looking at with regard to some of the the home care services initiatives that were that were working on so yes by no means are we planning to eliminate that program okay does not it was just a perfect opportunity to ask that I've had of Ascot's since those polling and those questions are taking place thank you. Thank you members but I believe we have any additional questions with that an emotion Dauphin's second record got a motion I've got a second all those in favor signify by saying aye All opposed motion carries that's gonna bring us to the Division of provider services and quality assurance you're recognized C.. Thank you Mr chair the Division of provider services and quality assurance request begins manual to have to pay 258 it's been from a mixture of general revenue federal revenue tobacco settlement funds in various programs support the recommendation is for total appropriation of nearly 20.$5000000 in the coming fiscal year with an increase of about $11000 $500 in salary matching dispensing need to appropriations that have positions and this concludes my presentation for this division and I'll be happy to answer any questions thank you senator Johnson you're recognized for a question. My question is for the agency Mr. You're good to go send Johnson. Thank you Mr chairman a. Put my glasses on site so you Mr. Madam secretary my question has to do with the the respite services specially in the rural areas. How much of the current dedicated funding is going to reach those folks especially yeah I'm I'm concerned about Alzheimer's and dementia patients and their caregivers. Sure so last year Martinez Smith I'm sorry director for provided services and quality assurance last year we applied for a grant from ACL the administration for community living that grant that was provided to us as a mixture or will be up 270 5000 federal and then we have to putting in 25 percent so the 7525 percent match that money that we ask for in the grant is supposed to be used for all disabilities all ages it is also supposed to be used for a respite locator program is supposed to be used to train individuals in respite so that they can provide those services to other people as well. Senator staff of the of the Alzheimer's association has made a request for additional to $1000 and rested Fund we think we've identified a source for that we're just double checks and sent things but it's S. as B. G. social services block grant we think there's some money there that we can pull the use for that purpose okay so we're working to finalize mark could you just keep me in the loop on that let me know what's going on yes okay thank you very much thank you Mr thank you. Senator Hammer I think your last on the list here are thank you Mr if you don't mind a share common concern with senator Johnson's fires all time my mom had it and social personal to me and I know there's a meeting next week on that maybe by then you could have those sources identified and maybe reporter that committee it meets next week if possible but all right thank you thank Mr. All right thank you. Members we have any other questions sing none got a motion to adopt that sex rex got a second almost favor signify by saying aye those opposed motion carries that register last you Services Division. Thank you Mr chair the final recommendations for DHS for the Division of Youth Services and they start on page 266 and they're appropriations offended for make sure general revenue federal revenue and various for the support and the recommendation is for approximately 67.$6000000 in fiscal year 23 which is an increase of approximately 5000 $200 for salary and that's adjustment in their operations appropriation and this concludes my presentation for this division and for the department as a whole and I'll be happy to answer any questions. Thank you. Senator Hammer what you bring some last question is that the agency Mr. You're gonna ask your questions Senator Hammer. Thank you I did DO you want amenities for the record I don't know if our president would if they if they get to him and he needs introduce himself for the record because he's going to answer the question that will have to do that but it article which is we don't know the question will thank you my question is going to be around facility management of the various facilities around the state with our youth or that are responsible for housing or you can you tell me in the budget what you have allocated to meet those needs and what those needs that you intend to meet with the budget. Microprobe rector Division you services. Basically the last. The I. residential as far as for the facilities are numbers dropped considerably with the reform efforts and things during covid when the court said down they bottomed out really low we went from a high of probably 350 close to 400 we start of these reform efforts a few years ago to as low as 150 some odd kids I'm in the facilities since the courts of open back up in schools of open back up were up a little over 200 again so are our number are spending for facilities is still much lower than it was in previous years right now we're trying to budget for anticipating that number to stay in the low to hundreds you know for those for secure facilities and that's that's unless we see you know you can never. Yes exactly how many kids are gonna have committed I mean we will send you but for right now we expect the number to stay relatively flat going forward a memoir first came on down here we had a meeting out at the el agenda you Senator and the key issue back then was the locking system which the provider at the time was responsible for member right that was the agency that was responsible for that and are we regard I mean because what we had 200 we got 20 we still got obligation to make sure the facilities are safe and up to standard fencing were supposed to be locked for the supposed to be you know there was a case where line of sight was not available not long ago and it resulted in a real bad situation because adequate cameras were not in place what I want to know is. In the budget where is the money to make sure that those issues are addressed and when will they be addressed so that we don't have them. In the near future or just give me that comfort level to know. Yes Sir so we have money that we set aside for our I. T. needs every year and so we're constantly either upgrading or replacing cameras we don't really have a the budget to a cure no blind spot type of set up is really expensive plus there certain places rooms things like that will never be able to put cameras but we feel like we have adequate coverage as far as the cameras go right now it's just a matter of replacing the ones that are damaged or maybe the technologies old we spent some money the last few years upgrading those cameras all the facilities to make sure that you know they're not the older analog cameras as much as we could we don't have the specifics of the size that far as a project to. Upgrade those even more or add more cameras more maintained as we go as far as the fencing we added fencing at the Alexander facility and the manse of the facility in the last 2 years menu you may recall senator when we had we had quite a few kids Alexander that were going AWOL escaping from the facility and knock on wood we've not had anyone that Alexander. Very big not a would probably a I'd say year point 5 it's been since we've had anyone because we added we added more no climb fencing and we put in a second fence around the back I would raise why we do the same thing And Mansfield because we had a lot of kids that were boys just a chain link fence so we did the same thing we could have no climb fencing and a second fence around in the woods so in that facility we've also not had anyone in that same period of time and and let me wrap it up and thanks for tolerance Mr but what out what I'd like to do is approach to chairs of the appropriate committee to do an assessment because you've made the statement that implied you need more money I would I would like to see us at least address that are make sure that the facilities line of sight cameras adequate fencing of locks on the on the doors all those things are where they need to be and if not we can't do anything but if you don't bring a price tag back to us to factor that in before we get in the fiscal session so would would like to work to get that that result thank you Mr. Thank you represented 11 you're recognized for a question thank you Mr chairman crop I have a couple facilities in my district that. Continually having a problem with what I recall serious and violent offenders. The facilities are quite concerned. Continually taking in use that are destructive to their facilities. Dangers to other. Residents of those homes do we currently have a facility within the state for. What I call serious violent offenders and if we do not then why and what would your plan B. to correct that. Sure we have our Alexander facility is probably where it's a large facility and that's where our our most serious offenders are House it's one of the most secure it's easier staff in central Arkansas than it is other places so that's what we house the serious offenders we also have a Dermott facility that is designated for males ages 18 to 21 so we do have some serious offenders will be and are not we only have 2 other facilities one in Mansfield one in Harrisburg and those are both for more moderate ones for girls and ones for boys so I'm. The we we housing primarily Alexander and what would be the answer to that question. In those 2 facilities you are. Staff to an adequate facilities for these repeat violent offenders yes we are as I said earlier Alexander's is the easiest the staff because of just the population here in central Arkansas and Dermott has not generally had at large staffing problem because you have you have prisons in that part of the state so you have a lot of people who are looking to pick up extra hours to have the type of experience and it's just you know it's just something people look forward as far as a work alternative down there so yes it both those facilities staffing is not really a big problem. Thank you Mr. Thank you representative representative would. Thank you Mr chairman. Several months ago maybe a year or so ago there'd been a problem with the contractor refresh my memory or we are these facilities operated by the state or do you have a great but without outsourcing the they are operated by a contractor I believe this contract you're referring to is why oh why youth opportunity investments I believe his name there are no longer self with this in south what south Arkansas youth services before that so as the Division before my time took over the facilities the south Arkansas youth services operated and we also had a a contractor youth opportunities investments but they they pulled out of the contract about a year point 5 or 2 ago so awful facilities are operated by a right of passage. It's just a different contractor. Thank you thank you Mr thank you members I believe that the end of our questions. With that in motion. We are a motion for executive record going to second all those in favor signify by saying aye All opposed motion carries members that concludes our business we've got a pretty full mornings of you to have done quite a bit a nesting Page SO if you can be sure to pick up the trash at the curb papers and again staff staff little bit help this morning with that again thank you for your time and we are adjourned.