Public Health, Welfare and Labor- House & Senate

That your November meeting minutes and when you're through looking at them if I could have a motion. For all right have a motion to approve second. All those in favor say aye all those opposed thank you meeting minutes are adopted. And going down to a tee. A. Mr Hudson. I'm sorry I skipped I'm sorry I skipped the part of me. Dot to green field if you would come for. Dr greenfield if you would introduce yourself for the record and we want to tell you how excited we are to have you this morning and we're looking forward to What you would like for us to the. And you're recognized after you introduce yourself. Good morning yes good morning my name is a doctor we will if you pull the microphone a little closer please Sir good morning I'm doctor William greenfield I'm the medical director for family health at the Arkansas department of health. thank you for the opportunity to present work all right to work with two committees that came out of legislation that was started in two thousand nineteen one was for the formation of the. Paternal mortality review committee for Arkansas and the other was for the maternal and perinatal outcomes quality review committee we submitted two reports that you had an opportunity to read or will have an opportunity to read and I just want to give too broad overviews of what these reports represent. The maternal and perinatal outcomes quality review committee grew out of and it originally what was prenatal resolves ation are committee has met with the intent of efforts to improve maternal outcomes for moms and babies across the state of our key activities for twenty twenty one we increased the frequency with which our committee Matt I do to the pandemic and twenty twenty we did have some decrease in activity some transition in terms of activity in terms of people who participated and part of our relationship was to work with individuals at the CDC in terms of implementing some tools that they have that would actually be helpful as well after a brief period of sort of re orientation and development of getting some team members up to speed the key activities that we did for twenty twenty one where as a to develop and implement a charter no would actually help governance activities ever with which would require a vote going forward we had subcommittees that were developed with a specific targets of identifying quality improvement projects for which we can apply. Specific efforts to improve health outcomes across the state and then education subcommittees as well some of the key activities that we did war efforts to with the pandemic obviously being at the forefront of many of the things that we that we were able to prevent present information to hospitals and the different stakeholders across the state and within your report you can see some of the numbers that we've discovered with our pregnant women who were impacted by covid the vaccination rates in the tunnel a death rate so on and so forth we've identified some projects going forward that will address issues such as I'm a preterm birth of syphilis in the state and other activities that will actually improve education not just for the healthcare providers but we have some activities that will hopefully be coordinated between different stakeholders across the state that allow the public the general public to be informed about efforts that they can do to improve health care. For the maternal mortality review committee that committee I've was formed and put together in two thousand twenty we begin with a review of maternal deaths of for the year two thousand eighteen we poured there were roughly about thirty six thousand births in two thousand eighteen we identified by the maternal deaths of that year and then we went to a process of identifying and reviewing each staff to see if it was specifically a pregnancy associated a pregnancy related death the details of what that difference as is in the report of the key findings from that point we're that in two thousand eighteen our we had thirty three thousand thirty three deaths per one hundred thousand live births that was just sort of a broad overarching Standardization process but the summary of the key findings in two thousand eighteen we have thirty six thousand eight hundred ninety six live births thirty pregnancy associated deaths twelve pregnancy related deaths thirteen pregnancy associated but not related and five pregnancy associated but I'm unable to determine relatedness the key point that I would like you to appreciate for the those definitions is that pregnancy related deaths are those deaths that but for the woman being pregnant well some event within that pregnancy set off a cascade of events that resulted in the death if she had not been pregnant she likely would not have died so that was those are the summary of the findings the key recommendations that we identified or broken down into different targets one of things that you can do from a system perspective from a patient perspective from a patient and family perspective from a provider perspective from a system perspective a key recommendations were efforts to promote clinical Act excellence representation of safety bundles of which the details would be in the report efforts to expand maternity coverage I'm from sixty days to up to one year postpartum because we did see that about forty percent forty seven percent of our pregnancy associated deaths occurred forty three days to one year after delivering our efforts expand diagnosis care and treatment for mental health and substance disorders because mental health substance disorders though they were not the preponderance of those deaths they did occur in certain cases and then our efforts to increase access to contraception for those individuals who to ensure that every pregnancy that occurs is that this act pregnancy. So stop there taking questions all right we have some questions A representative Bentley your your first. Thank you chairman Dr greenfield and are extremely busy so thank you for taking the time to be here today we really appreciate what you're doing and you just give us a little more specifics from our colleagues here in the committee on exactly what some things that are being done I know that code has delayed some things we can give some specifics that you think will make a difference here in our state and even up to an awesome I was really interested in is what we are our grow your own program that you that you a mess has to make sure we get. Of. Your providers get really can speak to a constituents but she down the dealt in those things can you give me an update on those somewhere some key specific things that you think we can do to make a difference here so next year so we have a one of the one of the biggest things that we can do is increase our coordination of care we have a number of groups enacted a working on specific activities you can take the nursery alliance at Arkansas children's hospital which is working at level one and two hospitals which or the lower acuity hospital freon icy use level for the children's hospital with a comprehensive care of the U. S. as a power group which has the education outreach group and what we're trying to do is to bring all of these groups into the full side one that we don't have you know redundancy and duplication of activity where people are not communicated that's one of the biggest things that were actually trying to do and then and we have actually brought all of these groups we're starting to bring all of these groups and to the same to the same piece where we are we know what each other's doing and we can work collaborative everybody wants the same outcome but you find that sometimes this group is working over here they're they're little I have over used term silo but they and their silo and and we're in hours so what we have done is to bring individuals together now specifically what will what I'll give you an example of one of the things that we're able to do when with COVID for example we have a health alert network come out to say pregnant women were woefully under vaccinated and we had sort of the dubious distinction of getting a lot of media attention when we had maternal maternal deaths when we got the information we were able to blast that information out to all of our stakeholders to say look whatever you can do with in your community and to specifically increase education regarding vaccinations for these pregnant women that was that was one specific activity another effort would be what we have done with a surplus for example in pregnancy is a is not a incredibly common occurrence but we have seen an increase in our state and so this is not necessarily something that is at the forefront of everyone but none the less it does have a long term impact on moms and. Sept certainly has a long term impact on babies and members activity and there was legislation that came out several years ago about how effectively we should be testing and it was required what we did find is that not everyone was aware of it it came out people it was planted what you should do what you find is that people you know they don't go back and read the legislation we should be doing so we've been able to sort of put that information back to the forefront and then begin to target efforts to make sure that people are testing a properly and then that they recognize it as a problem and then it's surprising so we had a number of infectious disease doctor children's coming present to our group so what we've been able to do is to provide education specifically to the community to the doctors and to the hot city docks but release hospital stakeholders as well another example would be group prenatal care centering pregnancy is a program that you any masses put in the place that has been shown to have an impact in terms of decreasing preterm birth and the reality is if we could decrease preterm birth with that that would solve a lot of problems if you look at most of the the neonatal deaths in the infant deaths it will be from congenital malformations which would likely that's a little bit tougher to address and then the next issues preterm birth well Senator Ingram pregnancy program at UAMS was one program that and she can show nationally to help decrease preterm birth rates when we have that group give a presentation to the other hospitals across the state you found that most people were not even aware that that was a mission so now as we go back to quality projects I can tell you a conversation I had about an hour and a half ago with one of my colleagues was let's go back and look if we can figure out as to why that's the case if it were you know if we could this is just be editorializing here but if we cannot get identified that there was a non pharmacologic interventions that can actually decrease preterm birth that would be amazing and that those are some of the conversations that we're having some of the specific things that we're looking at going forward in terms of maternal mortality the findings Or what they are we found that there were disparities that existed in terms of age and we find that they were disparities that existed in terms of race where African American women were two times the you had two times the rate of death and if you look if the report to me get the number correctly black non Hispanic women comprise nineteen percent of all person we look at the two thousand eighteen rates black and Hispanic women can comprise nineteen percent of all births but they were thirty seven percent of all pregnancy associated deaths. All right thank you a representative Ferguson you're recognized for a question I have several questions if you need to come back to you we just ask when you get just as one and then we'll come back well I mean is certainly a big part of maternal mortality is implementing the safety bundles and hospitals so that you have a of a and the recipe sort of our cookbook method to deal with that with bleeding or hemorrhage or any events how I mean the reports interesting as it doesn't tell me anything I didn't already know I'm more interested in what we're doing to address these problems so tell me about the safety bundle implementation in hospitals and how is that is that working well as set up and running I know Kobe disorder delayed seven that make sure it is going pretty well on the safety bundle implementation activity was already going on through the former angels now power programs in that park continues what we also do what we do with our committee with a lot of it is making the the hospital's aware and then we don't know the Committee itself doesn't necessarily provide support but this to a court dated partnerships with is how we seek to get the bundles in place. So all the hospitals are participating in safety bundles not all of them and I don't and I can get back to you on that information I can come back with specifically which numbers are which hospitals or participating in safety funds unfortunately I don't have that information right in front okay you can come back to me all right thank you all right of Senator Solomon you're recognized for a question. Thank you madam chair I'm back here to your other set. I'm looking at your on the covid and I I see talk about education it seems that if you. The biggest fear that I've heard about him among pregnant women is the fear of taking a shot in the impact. So do you track the incidence of of adverse reactions to the shot yes adverse reactions couple different systems that are used to track athlete you have that information I don't have that information but cannot get that to yes we can certainly get that information to you okay all right thank you madam chair all right thank you of representative Bentley were back to you. Thank you chairman Dr bring for this real quickly can you tell us if you think the breast bank that we were putting into place here with the helpful with infant mortality here in the state and how do you think that plays a part as well. I think you have to give them a little bit more detail and all the nuances of the grass bank itself but any difference that increase breast feeding the use of the term breast milk that would be an effort that would actually I believe increase and email and infant outcomes but I'm not that familiar specifically with that programs I don't really wanna speak too much detail I do not breast feeding rates can be improved and we do know that those after can transmit the I antibodies from a troublemaker gonna be beneficial. Just one fast follow up chairman that's okay and just so our our of another thing that I want one our C. section right to they decrease that you've seen in the past few years and that might be at an affect as well that's going to be one of the quality projects or we look at going forward because one of the targets is not what we call no appearance meaning that if the first pregnancy term okay singleton vertex Act will call an NTSB that's one of the numbers that we're actually going to be looking at and we like to create a couple pieces of information regarding our rates have held pretty steady and but we don't have This Is Your the detail in terms of that NTSB and why that's important is because the the the caesarean section for the person who's had a previous a certain section it's not fair to compare that person to the first pregnancy who comes in full term with a single baby that's in the proper position so if I wanted to say what is our blankets a certain section rates which which typically in the thirty thirty five percent range that's that's a high number we certainly would like to get that down but when you put that number with all pregnant women including women who has a certain sections for women who are having a caesarean section because it's a premature baby that has to be delivered due to an urgent matter that's not an apples to apples comparison so that's actually part of quality work that will be doing going forward and additionally we like to have that information one of the things will consider is like having that information generally available to the public so that individuals know like what is this what is that in TSB rate for a specific hospital that would that would be information that I think will be beneficial for patients not just for hospitals and health care providers to know that rate healthcare consumers should be able to have access to that as well. All right thank you representative Ferguson. S. thank you madam chair I was looking at the policy recommendations because I mean I think going forward that's probably what I'm more interested in what we can do to help in terms of legislative action I didn't see that it says extend Medicaid to three under sixty days has that argument it is is is is that you know it isn't okay that's why I didn't think we had done that I and I've asked for this information from DHS and haven't been able to get it I guess my question is how many of these women how many people are actually losing coverage for up to a year after birth have you track those numbers because I think some of them continue Medicaid some of them would be made to Medicaid expansion I've not been able to get a handle on how many incoming do it through all claims database are Medicaid information to see how many women actually still have some type of coverage three hundred sixty days later because twenty five percent the deaths are after patients would have lost Medicaid if they lose Medicaid after sixty days are not being made to Medicaid expansion of eminent is there a way you can get those numbers are we say that is not something we can look at I think it just to make sure that I'm clear question that you're asking of those women who are pregnant what is percent actually lose coverage after the six week after after the unfortunate and the masking of quit the other thing you had suggested that is Garrett's law that was put in place in two thousand and five in I've you might can you address why they would be important to not test are you saying not test women for drugs or just change the law where they don't lose it what is the recommendation if we no longer I mean I do think it's important test women for narcotics or you know so we don't have opioid babies that why this recommendation in which which one would make a written specifically with African you know I copied it from my computer so it's. Back in the policy recommendations of. And I'm sorry their number recommendations and sometimes have to look at specific right yeah we every day test newborns for drugs and if they have if they in other words if they're born with drugs the and DHS can remove the child from the home. But you're recommending that we no longer do that because it keeps your bill from accessing prenatal care that was one of the things that we send our policy I'm sorry after twenty eight of twenty sorry yeah I I printed it from my computer at home so I don't have the page numbers. So one of the things that we notice you know substance abuse was present and in a substance use disorder was present in a number of the cases that we reviewed and it just to give context of who are committee make up is our committee make up is is is positions that are includes our country our women's health community stakeholders as well and one of the things that we noticed was that frequently with substance use disorder there was also a lack of engagement from times in prenatal care and the concern was is the removal of the unintentional consequence may be that removal of infants from the homes may result in bombs not seeking or engaging in prenatal care throughout the course of the practice or even in the post partum period so I think you with if the effort is to identify In the end we in that with some of the substance use disorder cases that we saw some of the deaths were suicides Is is there any unintentional consequence there is exacerbating underlying mental health disorder when you end up removing a child from the home and the bombers had a substance use disorder when the the true issue just like how do we get our appropriate treatment how do we get that family keep that family intact how do we improve mom's health can prove they have the baby without this necessary feeling that it was adopted that connection between we've identified this substance use disorder we've and and resulted in removing the baby and destructive family and then we see a pregnancy associated with death or unable to determine relatedness staff from the box of simply having worsening substance use disorder or or suicide yeah no I agree on that I think a lot of times women if they know their drug dependent want seek prenatal care because they're concerned about the child being taken or what will happen but the other problem is we just don't have enough treatment for for pregnant women at I know some states they have allowed pregnant women sorted to be moved to the top of the wait list is have you looked at the options for how we can more of quickly get pregnant women are are women who deliver of opioid addicted baby into treatment you know we have a look specifically at that what we did notice was that there was and there was a need for more access and more providers specifically for mental health disorders as well as substance use disorders once you got out of the metropolitan areas of and we have a number of committee members who are from a committee is made up of folks across the state and we were very purposeful to make sure that we had representative some all by public health regions and it was not an infrequent comment from our providers in more rural parts of the state to say that works in Little Rock that does not work here. So what can we do to increase that and that was sort of a question no we haven't figured out exactly how we can say what we like to have more access more providers that's the way how that's to be determined by the conversation from the folks who are in more rural parts of the state where work was frequently. That's nice but we don't have that access and so we would talk about issues like telehealth and telemedicine to expand crease access and that was good but even then they're still a a lack. Okay I will get with I guess I was glad to see the policy recommendations and maybe representative Bentley nine eighteen. Look at you know things that can help going forward but thank you. All right co chair Ladyman. Thank you madam chair doctor Greenwood I think I'm up here. Thank you for this report it's very educational for me and a lot of good things that you've done You know we're a what forty eight or nine. In this category AS in states and I I reviewed a few things there's been committees formed before to try to address this problem we're still forty eight forty nine. You know we we've got to make progress. The only way we can make progress in my mind is if we measure if we measure our progress the things that you've talked about a great they're good programs that how do we know it's working how do we know we're improving the numbers are you are you all gonna have some kind of tracking mechanism for you can say Hey we've we've gone from forty eight to forty seven I mean that's the first step but Hey that's not good enough we want to get to the top ten right right but but it takes measurements to do that is that something you're planning on absolutely what you're looking at right now particularly with the maternal mortality we we have been around forty six right in terms of maternal mortality in the country and we simply just have to put a stake in the in the grounds and we're going to start here twenty eighteen we're going to start looking this is a bit of a background what was implied for years for the past several years of the maternal mortality rates were increasing which would true a lot of attention was particularly concerning on further review it appears that it wasn't so much that the rates were increasing its that's how we were measuring it to your point we had a gradual implementation of a pregnancy check box on the desk on person on death certificates back in two thousand three it was gradually adopted across the country that implied that maternal mortality rates were increasing it turns out that really was not so much the case but none the less it drew attention to a to a real problem but I rates were higher despite your dance medical care and despite spending a lot of money on healthcare so where we are right now we know what our numbers are and we know as we go forward hopefully with the implementation of the recommendations and the efforts of these two committees we will actually see these numbers trend down and as we get to probably a three year five year mark will be able to see really what are trained as the numbers I know when you look at the true pregnancy related deaths these are small numbers out of thirty seven thousand deliveries up but each each and but. One thing you will notice is that when we look at our maternal deaths one of the six questions we ask is was that death preventable. And that's the key question and out of looking at those deaths the committee determined that at some point between the time that that mother died and that pregnancy was conceived there were things that could have been done that would prevent the deaths ninety two percent of those pregnancy related death so that tells us that that there's something that can be done and then yes to your point yes we will measure. One follow up yes also you talked about groups African American the number being much higher so have you looked at groups that you can focus on or I had a question about regions I mean of the Delta where I'm from is it is the are the numbers higher there than they are in Northwest in the Ozarks and are you looking at that so that you can focus in on a group or region or a city we haven't gotten to the point of looking at the groups of the regions right now within the state because the numbers are still very very small and it will be difficult to pull anything particularly meaningful of that right now but as we go forward that will certainly be something that will and be something we we track and monitor because it you know one of the questions we want everyone to ask is is there a problem is there at like a system problem is there you know is there something that is going on in a particular reason a particular system or something like that that's current we don't have the numbers right now to totally dressed up it'll be something that will last just one more thank you one more question from looking at this it seems like it's kind of heavy the committee on providers or professionals I mean is there anyway I to me it seems like education out in the community all of the books on grand we're the people that the women are that need the help and maybe they don't access the web page or they don't have they don't know where to go I mean are you looking into that area I know you got education subcommittee but are they looking at how they can go to to the people I have people in the community that are maybe not professionals but someone who can get those people to the professionals that's going to be in here I think you're exactly right right now the if you look at what they're turning quality committee look a lot of the work of education was geared toward systems and health care providers. But you're exactly right and I and and my concern is that reports like this will be submitted and they will collected nice they will feel web pages and that'll be information that's there but you're right what we're we're going to break in specific efforts to get into the communities and I think that's why community health providers I local community workers will be engaged we haven't developed a strategy as to how to do that just yet but I I totally agree if you look at the recommendations that came even out of the maternal mortality Review Committee their recommendations entity or to systems system recommendations for policy the recommended basins for patients and families and we'll have to figure out the best you know tactics to get that information to those families but we have some departments you within the department of health and I think about Dr Michelle Smith's group which is and some of our other community engagement rings we have some tools that I think will be a factor in getting this information to them thank you thank you for your work on this all right of. To greenfield did I hear you correctly that did did you say that ninety two percent of the maternal deaths could have been avoided when we look at the pregnancy related deaths in there so the umbrella of the universe is pregnancy associated mom was pregnant with any year she died pregnancy related will be does he that sets that set off as a result in yes and we're seeing preventable we're not necessarily saying there was a specific event in the delivery that occurred we're saying you know if mom had engaged prenatal care and attended regularly perhaps something would have picked up your family would have been the supported something would happen you know if mom had many of the deaths one of the number one causes was underlying cardiovascular some type of heart related condition we think about some of the the disease processes a pregnancy but if that mother had a heart condition and she did not want to be pregnant should not have been tried in the first place that would have been something that. Okay directly would have been a preventable death by not becoming pregnant so that it goes across the continuum from the on Senate conception through those three hundred sixty five days into yes and when we looked at it we said this was a factor this was a factor these types of things and I think about that so the classic Swiss cheese model of me talk about medical or will briefly talk about the Swiss cheese model where it's all the holes lined up in the Swiss cheese so if we could create some barriers that would prevent it all right thank you all right senator of Gilmore you have the next question. Thank you madam chair Dr I don't know if you remember back in the session we passed what is now act I believe five thirty the our home bill which was the Medicaid expansion bill in that were specific A well I guess I should say more broad maternal health goals I don't know if you looked at any of that or were consulted on any of those but I just wanna know what your thoughts were going forward in the sense of how we're looking at that will move the needle and and some of the promulgation of rules coming out with that if you if you think that some of the insurance companies to meet some of these goals are are taking the steps needed I'm not really prepared to discuss the or home component about it is I I do remember being part of the discussions about it but I have to look back at it specifically okay I don't feel quite what would would you please take a look at it because I do think it's very important considering you know what we're trying to do here and I thought I'd like to I'd like to hear your thoughts on that so if you know we can come back another time you discuss it thank you. All right thank you a I don't see any other questions from the committee I want to all right representative clout you're recognized. Thank you madam chairman thank you doctor for being here just to kind of circle back around what representative Ladyman was asking in your report we've had can break down on aging insurance ray six cetera I think it would be extremely important information to have a break down on geography okay so if I understood your answer that's forthcoming could could you give us an idea of when we may receive that well what we can do we can do we can give you geographical breakdowns I believe even of what we have now and it would just take us probably I I have to speak to my happy melody folks exactly how long would taken put that together I don't think I'll be very low we can get that information the problem through we have two things one is that the numbers are very small okay and so when we get to and what all of the information that you're looking at is the identified and so we try to keep when we would have liked thirteen that an applicant again pregnancy associated a pregnancy related deaths and I get to this depending on how quickly how how local we get I may begin to I'm asking identify that that patient so that's just simply one consideration we can certainly get information to you as we get a little bit more information over maybe a year to use with the data that'll be very helpful thank you one concern that I have to double the very last talked about is if I have a maternal death that occurred to see in your district and I tell you that that death was part of that ninety two percent of purple preventable there are a lot of things that are sort of implied in that and the way the you guys are. The members authorizes committee is that the it is sort of protected information so I just would like to just be mindful of that as we get to breaking down how local we get with the information okay I think that would be very beneficial thank you thank you any other questions. Seeing no other questions we thank you so much for being here we hope you'll come back real soon I thank you it was a very interesting discussion thank you very much all right the ladies and gentleman we are going on to he. In a Mr jim Hudson if you would come forward please. We're talking about unemployment updates. If you a. I would introduce yourself both of you for a for the record you are recognized. Thank you chairman but so jim Henson department commerce. Cordy trailer deputy director department of commerce division of workforce services all right. But I'm sure just wanna say that to adopt children want to be here today but she actually had a travel engagement so prevent her from being here but as you know she and I've worked on this issue together a lot so she asked me to substitute for now I was happy to do that so what you have in front of you it's being handed out now is a copy of the presentation really want to start by just making some general comments about the strength of Arkansas's labor economy for talk about unemployment rule implements really kind of a function of how well the labor economies doing in Arkansas and the good news is we're doing quite well right now three point seven unemployment rate that's the sixteenth in the nation in terms of strength of the labor economy we've grown a lot in terms of our employment of course the past year and recovering from the pandemic all the metro areas in all counties are showing job growth at this point to areas such jobs were available actually have more people working today than before the pandemic which is great news indeed and in terms of just the sectors of the economy durable goods manufacturing employment is actually at a higher point now than what it was prior to the pandemic there's any softness would be kind of in our leisure and hospitality area we all know very well it suffered a lot that secretary did during the pandemic they have rebounded quite a bit over the course of the past year but they are still down compared to prior to the pandemic so restaurants hotels still struggling a little bit. I would say the greatest headwind that probably are labor economy is facing at this point is just supply and we don't have a demand issue we have a supply issue right now and so we need to increase the labor force in Arkansas Parlin balls of people who are currently outside the labor force coming back into the labor force. It also includes making Arkansas an attractive place for people to relocate to and so some of the work that you will be doing later this week in the special session addressing tax cuts makes Arkansas a more favorable destination for people are currently residing in other states so that will hopefully help over time with our supply problems well and go the next page one to give just a little bit of a kind of status on how we are relative to covid four the department of workforce services COVID was just a huge event unprecedented event terms the level work that they had to do giving you just kind of free to these lines here are before and after sort of snapshot so our peak week where we had unemployment claims initial unemployment claims first time somebody filing house back in April twenty twenty sixty two thousand. Sixty thousand and then last week's initial you unemployment claims fourteen hundred which is about what normal is that number also it's a little bit but I can say that in terms of initial claims were back to normal times now in terms of continued claims after someone's claim has been filed subsequent weeks of how water mark was in may of twenty twenty eight hundred twenty two thousand now we're down to about eight thousand again consistent with what normal times looks like and if you look at the web page visits so these are people who are going online likely to file claims or to get information about employment three point seven million hits to the website in April twenty twenty and that's down to about a hundred and seventy thousand in October of twenty twenty one. And then finally just as a staggering number to me the the dollar amount that was paid in unemployment benefits all sources taking into account so the federal supplemental benefits P. UA all that three point four billion dollars in unemployment benefits paid since the beginning of the pandemic. If your foot to the next page that gives you a little bit of information about our claims adjudication let me define adjudication for you most claims come into the office to review their assessed for eligibility this is an eligible person has enough wages in the system the separation reason is a valid reason they guess flow and get paid benefits there is a subset of individuals because of likely separation issues where that claim needs to be scrutinized a little bit more closely that is referred to what we call a judicata where you have more senior staff more experience staff they look at all the different factors that go into that claim and make a determination as well not in the is a compensable Klein about a year ago we have the high water mark in terms of the number of unemployment claims that were in adjudication a little over twenty six thousand and that's just a staggering number to think of that when you think of the hundreds of thousands of people who are actually applied for employment at that time it's it's a relative number to that but it's still a big number check if you're one of those twenty six thousand wedding to have your benefits paid I'm happy to report that over the course of the year the claims injury cation have dropped significantly now it's about eight thousand three hundred seventy four in in most of those have been education for less than ninety days so they're moving the claims through the system. To get that dramatic a drop because again this is just a snapshot so you have claims coming in and claims flowing out on a continuous basis in order to get that drop they had to clear a hundred two thousand claims in the system. The issues that go those hundred two thousand claims about a hundred and seventy thousand issues some claims have multiple issues that attached to them. And so I'm here to say that I think the team if you have yes as done a tremendous job resolving a lot of the education issues over the past year we're not to the end yet there's still more work to be done but we are quite satisfied level of progress that's occurring there in terms of the appeals are pending there is actually a mistake I think in that number we're gonna need to verify but that number the three thousand eight hundred eighty eight may not include P. U. A. claims their appeals circuit on double check that maybe update the spreadsheet and get it back to you it doesn't change the fundamental conclusion of the of the chart here that they have significantly by more than half white down the the number of claims education an appeal and if I get to say real quickly as well of a group that I want to thank and Brownjohn is your staff the House staff in the Senate staff do a tremendous job vertically Martha Gerald the House staff constantly reaching out to us bringing to your attention some things that we need to look at maybe something we messed maybe a claim that's been languishing a little too long and I see them as a really effective and important part of the overall team that has really worked on this issue so I do wanna say thank you to them. Finally want to bring your attention to the the last page there if your call Act of one fifty three chairman Ladyman you and Senator Irvin co sponsored the bill provided Director shoulders along with executive order from governor Hutchinson the authority to waive our charges so that a charge for unemployment benefits that would otherwise go to an employer's account which could affect the rate for pandemic related unemployment claims you gave her the authority to waive its we've already waved the claims for the second quarter of twenty twenty and that protected employers for twenty twenty one the twenty twenty two rates will be based on claims through June thirtieth of twenty twenty one okay three follow calendar here a little bit Q. three and Q. four of twenty twenty still had a significant number pandemic claims and. So from you know October excuse me from July first through the end of twenty twenty still a lot of of those claims are in the system. If we don't waive that then about a hundred fifteen million dollars in charges will affect Arkansas employers and so Dr Childress is done in house as she and her team have they've made the decision to go ahead proceed with waving that will be sending out notifications to employers in the coming weeks letting them know what their rates are for twenty twenty two and letting them know that they won't be penalized because of something was happening in a pandemic I do also want to end with just saying that our trust fund even with of this non charge is incredibly healthy very very healthy at eight hundred twenty five million dollars that's not quite where it was pre pandemic but it within a stone's throw of it. And so that my insurance of my report happy take any questions all right thank you a representative Lehman you're recognized for a question. No no later Ladyman. Thank you committee chair well Hey I I appreciate that on the waiver I really DO because employers would be hurt severely and really appreciate that and what you've done and I don't want to sound negative I mean what's all done it's been great these numbers look really good I don't get near as many calls as I used to about unemployment request not being process I do hear that from some other representatives and and I think this this may be a regional thing as well you talk about Jones world Fayetteville until you in Jonesborough if we could fill the jobs I mean there's a sign on every street corner our unemployment rate would be half what it is I don't understand how three and a half percent of people in Jonesborough can't find a job when every other business has a help wanted sign on it. Yeah can you all give us some insight into why that is I mean I I really don't understand that when our unemployment rate is below four percent I'm O. three percent is full employment and used to be back when I took a non expert so you're never gonna get to zero but I don't understand how we can have people on the unemployment and have all of these open jobs and it's not just McDonald's and Burger King I mean there's factories in Jonesborough who have really good jobs that they cannot fill right and yet our unemployment rate is low. What is the problem it is the people are they not participating in the work force is that the issue maybe all can't measure that but somehow we need to try to resolve this issue because employers are suffering yeah I get tired of waiting an hour at I hop for breakfast because they don't have workers there needs to be something done I don't know how to solve it have you got any input on that well just to your quick response and terms like Jonesborough and and say something from northwest Arkansas as well the unemployment rate if there's actually much less than three point seven three point seven the State breaks of the you're factoring in some higher unemployment counties Chico Phillips to get that number I think John's for less than two percent is probably about one point five one point six something like that but to your your point though I think particularly for our leisure or hospitality industries that's probably the reason why their employment levels or lacking is not because that they're just you know not wanting to do the business the business is not there's not demand issue they can't get people take those jobs some of that may be that folks have made a decision to upskill and move to a different job maybe they're working part time before now they have an opportunity to work full time maybe have gotten some training. And so now there there's no telling different sector I think it's really hard for some of those restaurants that already operate on very thin margins to increase their wages set to a sufficient level to be able to track that employment so there's just a little bit of a reset a chairman I think it's happening now I do think there's a new issue as well still with continued federal transfer payments I'll see the supplemental unemployment benefits have ended at a federal level but there are other benefits I have commenced right when those federal benefits for ending the federal income tax credit changed and so now rather than it being something you take on your ten forty when you file your ten forty you're getting that as a three hundred per child per month supplement and so that probably is creating a little bit of the resistance for some folks to maybe come back to work that income tax credit used to be the earned income tax credit as well in order claimed yet have a job that is no longer the case that's federal policy is not state policy drops and so I do think there's things like that that create a little bit of a headwind for people who are currently not in the work force to come back and then just general we see with the with the economy right now on the market assets have appreciated there some folks who decided to have the ability to retire and have decided to go ahead and do that maybe they're also concerned about COVID and things like that I think that just the labor Connie like every other market will adjust and at some point some of those folks you're currently outside the market was set to come back into it but it's it's tough for employers right now no no doubt about that thank you. All right I have a question. But on the same subject of we were celebrating a birthday we went to an upscale restaurant. And I know that this particular Owner of the restaurant really does well and treats his employees well but he said he could not get people to work and the so he then thought about hiring people from other countries he said some are doing that now we're ending in a others that want to work from other countries what do you think of that and has that been something that's been popular to bring in more workers and some of these places. You know I've not really heard that being a being a trend I think there might be some difficulties from immigration law standpoint with the categories of workers that particular you can you can bring in they would not have necessarily the technical sort of skills to qualify for certain categories I really do think that there are people in Arkansas who can benefit from having a job and I think we need to continue to encourage them to buy the property centers to get them back in the work place if they're not in the workplace right now some of the tough choice that folks would make about whether not they stay in their current town and what what they need to consider potentially making a move to another part of Arkansas that's a that's a real tough thing to say to somebody I wouldn't you know rush to encourage that but you know for individuals that might be the best option for them this was in Little Rock so let you know but I just hated to hear that and I'm like to a representative Lehman in that we have these good numbers but when we go to a restaurant whether it's a hop or something else and we see that you have a lot of people in the restaurant but very few workers very few servers and so I I think that might be an interesting thing to look into to see what we can do about it may be something to have a conversation hospitality associate that would be a great idea thank reach out to them just kind of see what we can do all right thank you so much appreciate that all right represented Ferguson you're recognized for a question thank you madam chair let me tell you what I'm hearing from employers and you tell me if this is true that if it is I'm appalled. They say are like just recently at an employer said Anna put out that we needed applications I had thirty applications for employment I called in fifteen of them said oh I don't really want a job I just had that check the box to keep unemployment. And I'm hearing that from numerous employers that they're just they're just applying for the job to check the box and keep an employment they aren't aren't even really interested in the job is is that true and I mean is there a solution can employer say I offered them a job and they refused and they lose unemployment I mean. Yes ma'am what's what did what did my employers need today when that happens you know I guess been around nothing nothing surprises me anymore it's sad I agree with you it's sad those employers can contact DWS of vice as to the circumstances that offer and if a someone whose current receiving unemployment benefits to clients suitable employment that's the definition then we can terminate their employment benefits I don't have that number we can get it to you and we do contact and have communications with the chamber on a regular basis they communicate that information or news letters well but we're happy to share that with you to I am in there saying they put in the application I called to come in for an interview that warning coming and I said oh I just needed to check the box can I do that I mean what what qualifies to check the box I applied for a job it's it really isn't about just applying for a job it's if you're offered a job or are being considered for jobs that is quote suitable employment in your fuse despite you can lose your unemployment benefits and we want to hear about that I'm an employee I'm not hiring somebody that tells me that. Sure. That has to be a wise choice I agree with that but we still want to know about yeah maybe less maybe emailed me what the employer should be doing if they offer these people a job and they say oh I'm I'm really not interested by that staff and looking at all member states thank you. All right of center Sullivan you're recognized for a question. Someone in thank you madam chair that so that we're all hitting around the same thing so the what I'm hearing is the unemployment number. is not really equal to the people who are available to take jobs that's correct so what would that number be. Could you talk you talk about you said People who are outside and we're trying to get back inside so evidently is hearing other comments there people who are outside our. Outside of the employment but they have opportunity because they just choose not to do that so what is so that makes the unemployment number really not an accurate number yeah what is that number yes Sir I can tell you what this that number is four Arkansas that's given to us by the by the US department of labor generally the labor force consists of those who are working plus those individuals who were on unemployment or otherwise seeking work so if you're somebody who is not working and not seeking work you're not a part yes that's what I want to know yeah so what is what is that number and if we don't know what that number is how do we know it's bad. Well I think that we we know people for example who are retired we we know they're out there okay you know what I'm where I'm going I know we okay so help me out help me get a handle on just trying to figure out what that true number is of not only unemployed people but people who are unemployed but could be employed if they so chose I'm not sure to know number Sir okay so how do we know it's bad. Well again we're Strossmayer princes here in the inference is that we know there are people who are out there not collecting unemployment benefits it's anecdotal but we know they're out there we know there are people out there who are retired there are not included in the labor force present okay so also how long does one stay on unemployment before they exhaust their benefits. Currently is sixteen thirteen weeks yeah. Thirteen weeks thirteen weeks okay then are there opportunities for them to do file for extensions and selling it that's all that's all over okay we're back to this state statutory unemployment benefits at this point the federal extraordinary unemployment benefits ended last summer right. Okay we don't again we just don't so that it be accurate to say that our unemployment non number is not really reflective of what Of the entire population of people who are unemployed an eligible if that's an accurate statement it's a highly studied and discussed the issue that's not just true four Arkansas street I understand yeah okay thank you thank you manager is thank you senator Wallace you're recognized for a question. But good morning senator. I haven't done this since. The COVID area but in years past as an employer if we denied. Unemployment requests that would that would be a appeals process that we would go through. And I did I would just and I'm I'm hoping that we're doing that again now. I would just urge you to listen carefully to what the employers. Or or saying aye it's just not in the. restaurant history it's it's all over yes I could you six more people right now today and in a better than average wage it's just it's just not there. it's really hard when you. Your passion of work and you see somebody that's gonna implements. Yes. Yes Sir and that's. S. eight maybe in some the conversations you hear from claimants as they reach out to your offices complaining about not being approved for benefits you know we have to be a neutral arbiter in terms awarding benefits we have to play it down the middle blow for the sake of the claimant and the second employer because keep in mind in Arkansas we talk about the trust fund that trust fund is funded hundred percent by the employers in Arkansas and so any decision to pay benefits means an employer is also gonna have to make up the loss that's in that trust fund to pay those benefits and so we want to make sure that we're not just kind of leaning one way the other again just following the rules for everybody if you look at our education statistics the vast majority of claims that are kicked over for adjudication mean further scrutiny they don't or resultant award of benefits to the claimant. Ninety percent of them mean no benefits are getting paid at all so I think the team is doing a fairly good job of identifying problem claims before they actually get paid benefits to scrutinize those little bit further did you say eight or eight zero eight zero eighty. Roughly eighty seven ninety percent. Thank you thank you. All right to a representative Gonzales you're recognized for a question. The manager of the following up or representative Ferguson's questions or in response to that I think you said if they were offered suitable employment that y'all could terminate the unemployment they didn't accept the job what what is the definition of that consistent with what their experience is and what their skills are you know for example if if our become unemployed I've got a you know thirty year work history of the sort of jobs I'm able to do if I turn down a job you know at a fast food restaurant that would be held against. Okay so if that's not held against them them the water they get why would they get credit for applying for that job what is that. A constant them keeping their their unemployment of the rule so you have to apply for employment then how are they getting by with applying for that job of this not a single job. Well again I think it's too folks will when they see a system they're gonna try to figure out ways to maybe gain the system that are we're dependent on employers to bring to our attention something that troubles them if they feel like someone is gaming the system implying it let us know and then we'll look into it and see if that person actually applying for suitable employment and if they were you know in the running for a job do they turn it down for you know without good reason so in the rules doesn't say that they have to apply for suitable employment or does it just say that that they have to apply for for employment. Luplow personable planet but. I'm not so it. I'm not sure I know that they are required to apply after certain weeks of being on unemployment but I'm not sure if there's a suitable requirement added there but I can look into and get back to you okay that just maybe something we just drove me nuts application verses turning down a job so I believe you have to apply for suitable employment but will will clarify that for you get back to you okay thank you but if they turn down a job that is suitable employment then we will withdraw them unemployment you see where I'm going with them because you know what I'm thinking that's if they're applying for jobs that you all go your going to terminate their employment because it's not suitable employment for them them what's what's the point of order or we really get that so yes maybe that's something we ought to change of is not there. So we'll look into will clarify that for you. All right Senator Rapert you're recognized for a question a thank you measure just quickly DM from what I'm hearing from my colleagues what I see in business. There's a disconnect I mean there's a lot of programs out there people can get no grudge that. But I don't feel your agency is. Maybe don't have time either we've been under fire for longer somebody's gotta check this stuff because as an employer if I call somebody to put an application and I saw a lot of them want to job like representative referred to say it's happening. I'm through with. I don't have time to call up or sent out into the computer program and tell you all what Cornell there's gotta be some follow up on this is not all the the eleven or twelve or whatever we unemployment it is it's much much broader than that because there are federal programs or state programs that are being male and I'm talking about young people able bodied young people that need to be at work and we've made it too easy for them to get around I'm not I'm not. Grading anybody that needs the assistance that should be getting but I'm taking system being played big time and I thank if you all slow down on that for now somebody needs to get back in this and check it out follow up on some of this and I think you'll find lot more people than you realize is doing it. Senator Rice aye I don't disagree with your point there I think we've we've been a little bit in survival mode for the past year and I think if there's there was a disposition to let's make sure that people are in time of need or getting the benefits as possible but as the numbers show we're pivoted back to mark what normal times look like and what normal times look like is we make sure people are eligible for benefits and then we're tracking without the comply with the rules and so we'll make sure that we're redoubling our efforts on the you know if we if if you do show up for a job in can pass a drug test you have a job in your just about anywhere you will there's no reason the but I mean there's just some Turrell happens naturally in in jobs or jobs job but long term unemployment should not be the case in this state with this rate of unemployment thank you Grady are being ever get your breath thank you Sir thank you for your support. All right the are there any other questions from the committee. Seeing none without objection this rule stands its review thank you very much I appreciate you being here. Also I'm not sure a said of FOR D. without objection this rule stands is reviewed so also for the. A. Rule will be a switch will stand as read the now we're going to skip if. We're going to G.. So those who are presenting G. if if you would come to the table please. That be a Mr armor. Breaking. In Jamie cook. If you would identify yourselves for the record. Amanda Yarborough attorney for the department of public safety the division of law enforcement standards and training. Bragg gang deputy director on here for direct the she's out with a medical issue all right thank you a you're recognized to begin your presentation okay we'll make this really short this is a comprehensive role packet for class this encompasses rule changes of legislative changes from the twenty one session and also several recommendations from the governor's task force so this is just a comprehensive package trying to. Get all of those rules updated to comply with the the various rules that have changed laws have changed and will be happy to answer any questions all right any questions from the committee. Seeing none without objection this rule stands is reviewed thank you so much for being here. Going on to H. and we would have a miss you and Terry Paul. Thank you introduce yourself for the record please thank you madam chair members of the committee on large you I'm general counsel for the department of health. I'm Terry Paul the environment health branch chief all right thank you you're recognized thank you we're here to present our rule today pertaining to drip dispersal systems this was approved by the board of health on July twenty second of this year we are currently under a public comment period this updates at UPS specifications and it's a technical design rule we have the authority to implement this rule under our general authority under title twenty and also under title fourteen dashed at two three six dash one oh seven and we are happy to take any questions right any questions from the committee all right to a representative Ladyman you're recognized thank you madam chair so what were these specification changes based on experience that you've seen what why are you making these changes yes this rule was first incorporated in twenty ten and a lot of the things in there have basically changed with the technology and we're just updating them to make a clean a rule primarily. And you had no comments in the comment period not so far that are in writing but I there may be a order to we need to to work on but nothing substandard I don't believe this point thank you. Any other questions from the committee. Seeing none without objection this rule stances Review thank you so much. All right ladies and gentleman. We will be going on to a. The next one this is the review the Arkansas tobacco settlement commission met Gilmore. Introduce yourself for the record you are recognized. Yes ma'am Matt Gilmore per health thank you pull the microphone up a little bit closer all right now. Thank you Committee you have in front of you the January through March twenty twenty one. Really report for the tobacco settlement commission of using the site report before you also got a graphic that I think Mr price's handing out because it's some of the highlights from the report. I won't take much time to go on the agenda for today several things I'll point out COVID has impacted a lot of these programs and their activities and has That had to cut back a little bit on some of their outrage that's more of in person type nature of of of educational programming but they're moving for as much as they can a lot of it's being done now through virtual presentations using virtual platforms would also still doing some in person as they can but it's been limited somewhat low the programs also engage in providing educational opportunities for healthcare professionals across the state and those are still being a done deal with different format smaller groups and providing that virtually as well with nursing students things like that. Couple things I'll point out this is in the numbers are down also director educational out out region some other service opportunities but some of the clinics are still moving forward as much as they can they're utilizing telehealth and in a in a good way now they're also providing some home visiting programs as well which has been helpful. The screens or been helpful as well those of continued somewhat limited but that also kind of such a shift gears a little bit to help with COVID screening and testing but also vaccination efforts. And then also some of the number so that would make expansion program of the programs fund those numbers are down just a little bit I think that's just it has a Tatian people seeking treatment care they typically would do their health care and due to some the hesitation with COVID. The minority health commission's been helpful as well with some of the key responding to distributed in a good partner to work with and some of those funds again as partners across state help covid response efforts there. Cultural health it's been helpful working with higher ed institutions and helping with some of the efforts there The case investigations and the COVID response. The next page you got there the talks with some of the different research opportunities of the program's been engaged in and you can see some of that I want real this little lengthy but doing the some research in Arkansas with Arkansas investigator's Arkansas students it'll be helpful moving forward so we got some good stuff coming out in the future with COVID related information it'll be helpful specifically Arkansas. And then again you have some of the numbers down the bottom how about some of the economic impact the state's having with these dollars and how to use that leverage bring outside dollars in and support their operations of meant that work so and then you have one more page there in that graphic Mr price handed out with some testimonials that provide some one on one personal. The impact the programs are having across the state and just given some more detail there so happy to take any more questions if you've got a more if there's any thing I can provide more information on all right thank you any questions okay here we go up represented Ferguson you're recognized for a question. Thank you madam chair I'm sorry have so many questions going. Know what it you know ever since the direct settlement started we we look at smoking cessation numbers and they they look impressive of committee but when you look compare that in low income populations we've almost had no results in smoking cessation in low income populations which directly affects medicated state dollars. What what specifically do you I don't ever say that you bring its numbers based on economic of status the do you have those numbers and what are we doing specifically to reduce smoking cessation in low income populations so the number has gone down in Arkansas so but there is a segment though that I think that is you know little bit more like a better word as hardcore on smoking I think it's probably some may be low income just you know lower education type and you know situations We continued our efforts there you know I think the money was given towards that so we want to keep moving forward in that area I think that we're trying to I think one thing we're seeing is helpful is moving forward with younger population provided some education early on especially the schools and with some of the younger of folks in the in the colleges as well and then also some of the different legislation all passed few years back well we're making it easier to for the pharmacies let that to provide some smoking educate must look excuse me for a drawn blank here providing the Smoking cessation medication in the pharmacy something like that that think that helps as well and also we have the bill will program which focuses on providing a number they can call to seek help we were close with Medicaid on that reaching out to those individuals so I think there's efforts but I think what we're seeing it is probably the best way is probably working with that with the younger generation coming in to keep that number from getting higher and they continued to have decreased over we've got now so I mean do you actually run statistical data we based on economic reasons I think we can provide that for you that okay thank you yes ma'am all right the representative Ladyman you're recognized for a question thank you madam chair of met my question similar to representative Ferguson except we we just got this report about maternal and prenatal. The issues problems trying to improve those numbers one of the things in this report talked about smoking in pregnant women smoking is being an issue. A is that a Target under the issue an area that this group would work in or could it be added so with our tobacco prevention program here at the department of health we have what's called the well baby it reaches out to pregnant mothers a new born families to have new borns and kind of run some education and provide some incentives to engage them in to suck smoking cessation and then also you know I think it's so that's that's an important part and then also or other programs that reach out was very populations that's part of the education may provide whether to minority populations are than Medicaid expansion as well but also in our programs in the delta with UAMS east they try to encourage that as well but we do have a specific program the focused on pregnant women and newborns that's worth saying focused on try to get them to quit smoking. Thank you. All right to Senator Sullivan you're recognized for a question. Thank you madam chair yes the a number of issues on here like sign that education to have any direct outcomes so we have this program we educate people are there any direct numbers it says because we did this we improved in this area as a direct result of this program it will be specific to each category you're looking at I think you could look at you are different rankings across the and we're let other states on different things like smoking cessation are we improve your I think the way I think we are I think like in smoking cessation as we talked a little bit you know we've seen a dramatic dramatic we seen two or three points of a of a of a of the movement in the better of that we were look around okay yeah and I'm looking on the second page of and that it's talks about C. O. PH projects focused in Arkansas what is that ninety four percent means. So that's ninety four percent of their programs that they that the and their research projects are of Arkansas based Arkansas focused okay we have data it sounds like a Ford and the best thing that high and that we have data that says that's actually improving their to. As a result of that focus so the ninety four percent is more of a. We track it is not so much doing. Not sure what your question is thank you for if you read the if you read the whole paragraph before that are underneath that it talks about researchers are investing this and talk about what they're doing so as a result of those projects can we also show significant Arkansas gains in those areas I think so if you if in the report there's more detail but the okay I'll take your word for the form approving us sure that's a question but okay yeah limited that'll bit more here I think when when the when the money was given to the focus towards research the indicators in the outcomes were to be that we would keep a certain amount focused on Arkansas focused research Arkansas based research and I think we continue to see a high percentage of the work that these programs do ninety four percent of it is pretty high okay that answers and hope. All right thank you manager right representative Bentley you're recognized for a question. Thank you chairman of Mr Gilmore can you tell us what we're doing right now with our students and vaping as I know it's still a huge problem in the schools in my district as I miss with my superintendents what we're doing specific educational us with that shares so cove it is impacted that a little bit we're providing work with the schools we've got partners and we have what's called the project prevent which is a program across the state we have local chapters in in the schools their student led working with Our local partners but they're still a student led programs that provide education in the classes in the in the schools and then they also do community efforts to provide education to all their peers and that's that's been heavily focused on vaping just because of the rise in the increase of that that's when that's when the bin the one of the major things we've done with that also we have our normal so grants we went out to the communities to provide education to you know employers and the community leaders but vaping has been a has has been a huge issue and so we try to shift a lot of what we used to do towards tobacco specifically towards vaping is but the project management of the a big effort those chapters around the forget the exact number we've got right now across the state but there's a there's a I want to say it's. Read a hundred around the state in the schools in the in built in the counties so that's been a huge of benefit I think it works well the students being involved in providing those of the one on one peer to peer type interactions with their fellow students one quick follow up chairman yes so are we doing some data tracking so we can see there were what we're gonna do across the state as far as decreasing the rate of vaping original schools we we track that and I can get that done for you but we do have we do have the The state rankings I think it's every. I think it's every two years we can get that for you. Thank you this all right. A representative Payton you're recognized for a question. Thank you madam chair saws look at this handout and the back page has the testimonials the first one is about research study and baths in Kenya and or want to know about COVID does that mean that tobacco settlement funds are being used for that reserve. We've got folks here in Arkansas I think trying to look at the virus and and looking at where it came from but I don't think we're. I will double check but I don't think we're going to I'm not saying we shouldn't be studying those things but I think the tobacco settlement funds were intended to be for smoking cessation Elysion things like that I'm not sure it was the end of the research program there well it was it was to have a focus on Arkansas research there was there seven programs and and two of those are heavily research focused and it wasn't there was agricultural research focus in there as well and then also just of biomedical type research was part of that so I think it I think it does fit with what the intent of the banks on the dollars were okay thank you thank you madam chair all right thank you any other questions. Seeing none without objection this rule stances Review thank you so much for being here thank you thank you all all right next is the Department of Human Services and more quiet in the list but if you come for please. When you identify yourself for the record you're recognized. Thank you madam chair more quiet for review services and Elizabeth Pittman Division of Medical Services all right. All right members we have a series of rules for you today this first rule you may know that a few years back you all change the mystery procedures act to say that Medicaid procedure codes no longer have to be promulgated in a rule and those important because procedure codes change frequently every year for example Medicare Petan update that we have to incorporate into our in our rules and to our process sees and windows had to be promulgated that put a significant delay on implementing those procedure codes so you'll change the rules a few years back to say those don't have to be promulgated we we don't take the next step what this rule does is worst removing procedure codes from our provider manual so they'll no longer be in that promulgated rules are rather will maintain list on our website that providers can access where they can access those procedure codes they'll help us speed up our implementation of procedure codes there's no substantive change in this rule today is just removing those items from promulgated manuals and our expectation would intended for January one effective date we may have to push that back to Feb where everyone just getting everything on the website ready but other than that the should be as it is for you will that be happy to answer any questions. Any questions on this seven two. All right there are no questions here but of. A representative for a Wardlaw has some questions for you and has another meeting so we had like to kind of let him go and ask you some questions that would probably be more appropriate later on but was going to take his questions now all right a representative Wardlaw thank you madam chair and I appreciate you allowing me to go in question because I do have a Levin o'clock call. Clark you and I met in Senator Rice in a group of people back in first of August indigent July J. July get my head straight here and we talked about a few the nursing homes long term care facilities that were on the French we talked about you know working through some help through one time funding A. R. P. money which I think stage one has went out and we're really close to stage to inform to being ready for that we talked about red claims we talked about eligibility we talked about a few other things so in the last week I've met with quite a few of these groups and talk to him about rape claims and eligibility for that seems to be where the biggest heartburn is at the moment and we're still not seeing much improvement in that area so we get a weekly email from you guys is full disclosure committee knows of and we can update on these subjects and we get something staffing bill is in there too and as chairman said I was going to wait to that but we were not going to get to it in time. So can you give me an update and give the committee an outlook of what we see happening over in long term care and how you see yourself improving the rate claims and eligibility and get it to the forty five days that we're supposed to be at. Sure on the eligibility front which would work with facilities so they can help us identify cases whether seen issues or single ladies we've got a pretty good process going we're facilities will send the spreadsheets that show the cases they've got they're showing that ought to be acted on at course we've got your reports for your going back on those numbers each month so that is we're seeing some progress there but ultimately the at the end of the day we've got to make progress actually clear that backlog and get fully caught up and courses as we discussed the it's primarily an issue of staffing you know we've lost a lot of staff course like private employers in this economy we're having trouble getting folks in the door and get them to stay and that has that has affected us one thing that we're getting ready to do is we'll soon I expect will soon be on boarding an outside vendor to help us with eligibility work and although they will not be directly working on the long term care cases that should with their work should free up some of our workers we can then put on the long term care cases and provide some additional resources to help get those numbers down so things are moving there is certainly not as fast as we like to use the real problem and this is the problem that I brought up and just so everyone knows I guess I forgot to say that again but I do work in long term care at under full disclosure I'd like to say that every time but I'll of four major groups in Arkansas we're looking about five point two million dollars in outstanding claims when it ties to eligibility so we're not talking about pennies and through the pandemic we've had a number of nursing homes that are already closed there's one I know that's going to be mired soon so there is closures and when these homes closing rule Arkansas just so everybody has an idea they don't open back they're gonna. And those people in those small communities that have to drive to another community see a love one which puts another strain on the family because in today's busy life no one has time to to drive an hour down the road to see a loved one so we want him as close as possible. So I guess the point is still the same we need this stuff cleared up these people need to get the money that's owed to them so they can continue to show this care needs rule areas so. You say you're doing it what is the actual plan is their plan I know one time we talk about you need more staff is there plan coming in a fiscal session where you're going to ask for more staff in this section to make sure we fix rate claims what is the actual written out planet before next week before next Friday's council meeting I'd like to have a copy of that plan submitted to public health and council. Of what your plans are to actually fix this stuff I mean your sentences weekly emails and you're saying you're doing this stuff but there's not actual planned there. So do you have one are you gonna put it together or where we at with that. We have we have plans we don't have anything this written down in one central place to certainly will will pull together document and get all that listed for you in that in that place I know we have a very frankly here's our vision County operations if you'd like some more details around what she's doing on eligibility side she brought some additional details there I'm on the red claims we are adding some additional staff to handle those reclaims one difficulty there is it takes an experienced person to build process that and that's that's been par or issue there we've added another staff member to handle that we've got another staff member that we're going to get trained up so they can start working on that as well and that that's that was is purely just a staffing issue okay we'll look forward to next Friday see in that will put you at into the agenda so you can give us a heads up on what that plan exist of but we need to see that before the fiscal session so we can budget for that and make sure that it's taking care of because these these are real problems and rule Arkansas suffered and I represent rule Arkansas and my people don't want to drive to little rock to see their loved ones they want bill to go to Warner wanted me to go to Monticello and they want to keep them local as possible and this this is getting. May we saw Maggie nursing home close last year and we don't we can't afford any more closures we need to fix this problem yes Sir three green what we'll get to that plan have the forty Friday. All right Any other questions on J.. Seeing none with that it up without objection this will stances repeat all right I'm going to leave Q. on the agenda and we're gonna go to it after the others so if you have any questions about those you can ask them at that time all right of going to K. E.. March you're ready thank you madam chair of back in the session you all past ACT seven fifty eight which expands the number of prescription medications which a Medicaid beneficiary in fee for service Medicaid can you access to other was one of three this expense at the six medications and also provides that certain maintenance medications are not subject to those limits and so this rule just implements that act we've defines maintenance medications that address things like high blood pressure high cholesterol things like that they're not subject those limits we have an answering questions on any questions from the committee. All right seeing none without objection this rule stances with the. Going to a hill. Thank you madam chair and measure should mention on the previous one that is in this winter's several these rules today we're waiting for CMS approval of the Medicaid state plan members to implement those in social to be clear the offer those awaiting CMS approval will hold off on filing was secretary state and so we got that approval back just in case CMS demands the change so that we need to come back to you to make a change in that role. All right I know and we missed records going to join me for items Hey. I'm sorry the you're you're speaking on K. C. okay. All right your. If you if you defy yourself for the record please. I'm sorry I'm sorry. I misspoke measurement and I'll mail is with Mr Frank was here for so. All right just a minute are you have seen the stand with K. E. yes ma'am all right to no other questions so with that objection this rule stands are going to L.. Good morning this is merry Franklin with the Division of County operations with the Department of Human Services. Right and measure up I'm L. this is our home fipple met on the eligibility side of things The New our home program which you'll approve that in ACT five thirty back in the session and so we've revised our eligibility manuals reflects the new or home program most this very link the rule most of it is stylistic changes and name changes to reflect the new program we do have a few substantive items in there that flow from the act so for example there is a reduction of retroactive coverage for our home from ninety days to thirty days and that is something that was in the act that you all past beyond that as I said most of this is stylistic but this is one step of implementing the our home program starting January one you know that we have to answer questions all right any questions from the committee. Seeing none without objection this rule stances Review going to M.. Thank you madam chair item in this is the implement ACT six forty three this is an act that directs Medicaid to cover continuous glucose monitors I would your devices that beneficiaries can use to regulating continually monitor their glucose levels we put this rule together if with this we are awaiting CMS approval on this one but as soon we receive that approval they will be ready to to put this into practice have to answer questions all right any questions. Seeing none without objection this rule stances Review. In. There's item in this is another change from an act this is acts seven sixty four what that act did was it directed Medicaid to provide coverage for services for FQHCs. Excuse me federal federally qualified health centers to cover services abroad by certain providers options particular rep behavioral health rider tops a licensed certified social worker licensed professional counselor licensed mental health counselor and licensed marriage and family therapist. This rule doesn't necessarily change what types of services are are offered but it does allow if you agencies to bill for the services of these providers which puts them on par as with other Medicaid provider tops you know that we have to answer questions any questions. Right seeing none without objection is hosting says we need going on to in. M. M.. Where are we one. I see women hello okay. Yes ma'am and this is the role that implements ACT seven sixty seven ACT twenty eight twenty nine ACT seven six sixty seven allowed for services to be provided to the client in their home through the use of telemedicine and ACT eight twenty nine allowed for provider reimbursement for telephone only services these were both measures we put in place add you to the pandemic that we made I'm part of our extension of of the pandemic efforts COVID manual this just leaves puts in place permanently I'm in response to those acts so it makes it a permanent role happy to take any questions. when you say Hey telemedicine by phone. Are you are you talking about using like facetime and a County face time it can be audio only it just means using a telephone cases having a video component. Do you have any way of of. Documenting that that has happened by phone space especially audio. So I don't know that we have a separate modifier for audio we can look into that we do document that it was provided by a tele medicine verses and in face to face encounter I'm so we require certain billing codes and modifiers but not for the audience no we don't have it special audio only code we can look into whether or not that would be appropriate or if there is one that exists in measure out its mission well it bill are raised a related issue of the act talks about the broader may create a health record documenting this we say that they will provide a health record documented it because that's for Medicaid is baton committed and so that would that should also include that as well all right thank you any other questions. Seeing none without objection this rule stances Review thank you P.. And for this item or one as miss Emma stone to join me. You would to introduce yourself for the record please. Hi good morning Melissa stone Department of Human Services director of developmental disabilities you're recognized. Yes. Okay sorry I had to and I don't know what from Swiss so we revise the occupational physical and speech language pathology manual all of those therapies are contained within one manual. We an it looks like a complete rated because we did change for everything was laid out so we re organize the entire manual M. as they mentioned earlier we've pulled all the billable codes out of that manual so it's easier for us to change codes when Medicare sends updates and so we've added all the hyperlinks into the manual for those billing codes as well as hyperlinks for the approved evaluations people can use because for example in lots of cases we said you can use this type of valuation and then a new version comes out and so you know it cause problems we don't have to constantly be going in and to update the evaluation versions we also updated their retrospective review section there was some time lines on it that did not job with what we do across the rest the Medicaid programs and then we and make permanent the option of telemedicine as a setting for O. T. PT and speech happy to take questions or any questions from the committee. Seeing none without objection this rule stances Review thank you thank you Q.. The manager and for this item Martinez Smith is going to to join at the table. You'll introduce yourself for the record you are recognized. Good morning Martinez Smith DHS director for the Division of provider services and quality of. You're recognized thank you madam chair so this rules implementing ACT seven fifteen this rule that relates to staffing requirements for nursing facilities you may recall we brought an emergency rule through a few months back to get that rule going to that nursing facilities could have the benefit of that rule more promptly this permit rule takes those same provisions makes a permit and continues the emergency rule essentially for the most part as it is now we are working with the facilities around some other changes to make and so I special having another promulgation coming to you with some other changes to continue modernize it we wanted to see how things work initially with this new program look and see if there any difficulties or problems that crop up as facilities to submit their first reports so we'll be watching that here the next couple months with the association looking C. for any issues that we need to address and then pull that together in a rule and bring that back to you with that we'll be happy to answer any questions all right senator Wallace you're recognized for a question. Thank you Mr. Mark specifically we are we going to address the nursing hours from column B. in this in this meeting and after the first of the year. Yes Sir yes Sir will have some language I think we've I think we've pretty much reached agreement on the language roll call M. B. so I think that's good to go in the new version which that that Colby is active now they can use that in the four so it's it's active and ready now for the facilities we were I think in that next first the rule we will last language around that does assembly we association or restrict remote on it we're just as I said to keep an eye on these initial submissions consider any in there is a confusion any issues we need to clarify the rule for the thank you I have a second question manager yes. Mark I appreciate what you just told me a separate issue we have numerous nursing homes that are having real issues getting paid some of the rich cases that we've we've talked about additional follow up on what some of our. Orders you have talked about we've got nursing homes and will go out of business. I'm a business person or somebody told me. Money from a year ago. I don't think I can carry it and we can expect them as a state to carry a we're using their money and we get we get put on that what what do you need from us to help you with that. At this point I don't know. I don't know that was there anything we need from you is less like specifically We have some contract items working on I think those will probably reported back to you all through the review committee and that would come out specter next couple months we may have some items from personnel we're still looking at those working through those that's a possibility but I don't have a specific on that yet certainly as anything comes up where we need to also help will certainly bring to we recognize this is a very significant issue needs to be addressed as quickly as possible thank you Sir Mr all right thank you. any other questions seeing none without objection this will stands as we'd be going to our. Thank you madam chair and this will be we've got some others that are similar to this you may recall we did a COVID response rule early in the year we did an emergency rule initially then came back to change to a problem of permanent rule that had a end date of December thirty one and what these were these were all the regulatory flexibilities for providers to recognize the difficulties and unique circumstances created by the pandemic. First we did this back in the spring we thought that we would be out of the public health emergency by the end of the year but now the federal government has extended the public health emergency into next year at least for the first quarter so what we've done is we come back to revise the that code response manual just to say that it continues so long as that public health emergency is in force from the federal government and the reason is that's what gives us the authority under federal law to extend those flexibilities and so this is the one for that plus nursing facilities and that you have to answer questions all right Senator Solomon you're recognized for a question thank you Matt thank you madam chair so why do we make these this is a. Change in perpetuity if it's so easy to make this change are coming not coming back to us every year I'm just very hesitant to say this is good from now for ever. Well at this point I mean it is possible the the feds may leave the public health emergency ongoing for even longer I we strongly we strongly suspect that they will and the public health emergency in twenty twenty two because part of that is as part of that they're paying that enhanced F. map on Medicaid that additional sixty seven percent match to states and they're not going with that to continue forever well yes I guess we disagree on that I think it's going to go until twenty fifty my question is different the question is why if it's so easy to extend this why wouldn't we just take the ten minutes that it takes to to review this yearly so that we are bringing this before the US regularly rather than having us extend something forever we had come back and and I just don't understand why we do it in perpetuity well I think from the standpoint providers this gives them a little more certainty enters they know they will have these flexibilities as long as that public health emergencies in place if it was an annual thing or if it had to come back every so often and I think that will create some some doubts in their minds of you know in terms of trying to plan going forward of their actions no because these things these are all flexibilities that are designed to make things easier for providers and give them some of the four I'm I get where you're going I understand that I madam chair I'm just when I'm not favorable to supporting this as written if they would do it for the year extended till twenty until December thirty first of twenty twenty two I like what they're doing I just don't like and improving things for multiple years thank you all right. Sure if I may we'll I'll talk with our folks and see if if that's if they'll create any collateral problems if we were to say if we were to say that in the public health or city or December thirty one twenty twenty two whichever is earlier it with the committee's permission let me check and see if that can create collateral issues and if not we may will bring revised version back when this comes before the ministry rules subcommittee so you would like to pull this. We want to continue I think I would like to continue with understand that what we may submit that changed to the Mr rule subcommittee before they meet next week all right to representative Ferguson you have a question yeah at at yes I need a little reminder I I believe they enhanced F. map is right really like a huge advantage for the state did you tell us in one meeting that we were actually making about seventy five million a quarter by the enhanced the aftermath I forget the exact figure but yes it is it is a financial advantage it's it's the there's a net financial advantage to it does have cost no and that's one reason our Medicaid role right now so high because we cannot remove people from the rolls but overall it is still in that benefit the state yeah I thought you said about seventy five million a quarter what what are we doing are we putting any of that in trust to save for later what are we doing with the with the enhanced match money goes is the Medicare trust fund recognizing that when a public health emergency ends it's gonna take time for us to roll those folks off the rolls which means they would have a higher cost because read more people are having to be the state match on and so but that's we we are saving that make a trust fund for that eventuality okay thank you. Senator Solomon are you back for a all right sure so have we ever done a rule like this where we with the rule in effect forever. I mean I know legislation is. No forever but ever ever done a rule like this we said just it's effective forever I am most rules do not have an Endate in them but you'll have put legislation in place that requires that all rules have to be reviewed I will I believe every ten riders if I remember correctly re not violating that no so this would still be subject to that. Okay thank you manager. All right to the Committee to remember that to this is just a review we're not saying we approve or disapprove we're just reviewing it and I believe that to a Mr white has said that he will work with this and come back if there are some issues is that correct yes but all right. All right any okay a representative Ferguson you're recognized. Well as out of us Senator Solomon is concerned we could as a legislature always come back and put an end date on if we decided that we were unhappy with the federal indictments that right yes ma'am thank you. All right do I have an objection a. To put it to sending this out it's just reviewed. All right seeing none of this rule stands as read the next. Thank you madam chair. The annexed rule of this is in a Medicaid rule relating to outpatient acute crisis units you may remember I'm sorry miss business going to join me for this rules only introduced herself. Hi Elizabeth with Division of Medical Services all right. So as I say manager what the you may recall a few months back we had a rule change to allow hospitals to operate a Q. crisis units and these are facilities where individuals can come for a temporary period of time because there have a behavior health issue there crisis of the some assistance and our thought was we want to work in the hospitals to expand this around the state to make these available we've seen the success of the crisis stabilization units which are a form of AC you that this would also provide more capacity in other areas of state that don't have C. issues at this time with this rule does is this is the CMS side of what you also a few months back we're suppresses CMS for approval to provide these three hospitals and this also includes the rate increase which we provided which goes the issues and that also benefits the C. issues as well and with that penitentiary questions all right to have a question. We will the out patient acute crisis units be combined with the stabilization units are they too so I think we talked about this before are they to separate entities they are they're two separate entities but for the the crisis stabilization units they can function as an acute crisis unit and so they can bill Medicaid as an AC year that's what enables them to bill Medicaid for services and the stabilization units cannot. As a stable issue on its own cannot but but that same unit they just thank register with us as an acute crisis unit and then they can. So do you anticipate that there will be less stabilization units across the state and more outpatient acute crisis units not expect the before stabilization used to continue as they are but this will allow for other parts of the state to see the same benefits as the all right thank you senator Hammer you're recognized for a question. Thank you madam chair can you tell me on the four units across the state how much they're being utilized now or they have to pass the or. Do you know right off I don't know off the top of my head we can we can get some information for you on that if you will my just Commission historical data because they've only been up and running what if two years I can remember how long far back to go it's two three years yes Sir will she get some historical data so we could see what the usage is by each one of them please yes Sir will do that and if maybe the chair wants us and out to all the communities that think it's a good idea thank you Mr if you would send it to Mr price he'll send it out to the committee. We'll do that. All right any other questions. Seeing none without objection this will stances Review. Next. Next item this is the Code response manual for the Division medical services the same explanation as the one I gave earlier and as with that one as I said I'll talk about folks and see if we can win at that additional language to make clear that is the the earlier of either in the federal public health emergency or December thirty one twenty two. Thank you senator Hammer you're recognized for a question thank you measure the current or the the recently passed emergency powers bill here in the state if we chose to exercise that to terminate the emergency would it supersede what you're trying to do where this is used through the multiple times in these roles or how what those two conflict or complement each other those that they would affect one another because the the legislation addresses a state declaration public health emergency this is tied strictly to the federal government's declaration a public health emergency and that's declarations made by the secretary of the US department of health and Human Services so as far as our authority as a state in dealing with with the termination date basically all we can do is just a line with with what's being done is rules is that right yes our thank you all right any other questions sing none without objection this rule stands as review next. The item you again this is the same explanation third third verse for the code response manual for our division available disability services we are making one substitute change in this one we provided we're paints providers for to do well checks on beneficiaries this when the beneficiaries could come into the clinics that's no longer needed and so we're going to move that out but the remaining pieces will just continue through the end of the public health emergency all right any questions. Seeing none without objection this will stand says review Adam the. And then same song I think last verse this is the covered response manual for the Division of agent told me here all services and it against continues those things as they are now. All right any questions. Seeing none without objection this will stances Review W.. Then R. one W. your potassium legislation acts one thirty five and some forty six are these relate to occupational licensure one ACT relates to licensure of military families the other one relates to the loss occupational licensure individuals have green cards and what we're doing is we're just changing our rules around licensure for CNA's to comply with us to acts and I don't think there's anything substantive beyond what's in the acts themselves without would be happy to answer questions. So you are you will be doing the long term care facility nursing assistant training program what exactly how long does it take usually in. But for any program let me see if we bring this method okay to answer that for me. Martina Smith DHS division for provider services and quality assurance so most programs are usually for a couple of months three to four months as they move through the modules that are set in that in ATP manual and then once they're finished they're able to take the test but in this case based on the law that was passed during the session if you are a military spouse or member what have you thank you have an opportunity if you were a CNA in another state to apply for reciprocity with this and so that would mean in that case those individuals with fill out the form providers for example with their DD two fourteen approved military eligibility social security card driver's license six cetera. All right thank you any other questions. Seeing none without objection this will stances Review. All right of X. we are skipping Committee that's not ready. All right we're we're skipping X. we're going to other business and the representative Ladyman has the motion. A mark of. I miss my number people just to if we could get an update on the empower situation are you prepared to maybe give us an update on that. Yes Sir if I could bring this Bittman up for any questions but I can give you a brief overview of where things stand okay and appreciate that. Elizabeth Pittman Division of Medical Services. So as Mister in the running power there's really two issues that were working with with them right now one is around to reading this review back in session you all pass legislation which provided that an insurance company could not have ownership in more than one pass as a result that led to the split of beacon from in power and so they have been working through that I thinks it's common knowledge there been some thanks and difficulties and some some some hard feelings there between beacon and power there is litigation that's going on between them our role in that has simply been to ensure that when that split happens that empower has all the pieces in place to continue serving beneficiaries as they have been an issue the beneficiaries will be hard that's the ratings reviews required by CMS rules we're in the midst of that I believe is not completed yet but we are working through that now and power and so that's that's process is working and should be brought to resolution I think fairly quickly. The other issue which is a completely separate issue as you may have seen in the in the news the Medicaid fraud control unit of the Office of Attorney General made a finding that there are credible allegations of fraud related to empower under federal law when there is a credible allegation of fraud against provider Medicaid is required to suspend that provider unless there is good cause not to suspend and so fuku made the termination date provided that to the office Medicaid inspector general and Medicaid inspector general determined that empower would be given a partial suspension so continue to pay claims continues our beneficiaries however there were system conditions set on the moving forward one is that any expenditure for administrative expenses or other things that are not claim payments would be subject to DHS approval that there be a chance to monitoring oversight by both DHS and by the office but again inspector general and that assignment of new beneficiaries to empower will be suspended and so that and that is in place pending the resolution of the investigation by the attorney general's office or resolution of legal proceedings that may result from that no that's said the Stephan taken should not have any direct impact on providers or beneficiaries they should continue but receive their services riders can continue to build and power they can continue to pay those claims we have given been fisheries notice of this because federal law says we have to have been Fisher does have the right to choose to move to the pass if they choose but beyond that we're taking no action around beneficiaries or providers that should be continuing as is and also to make sure of if you have left out now that covers the. All right thank you of senator Hammer you're recognized for a question. Thank you and share that point you said on that as part of the of the pause button I'll call it that you would have to review any payments made that part of it R. is that's going to fall on the staff a DHS to do that review process and and how labor intensive is that going to be on the DHS staff to do that during the period which that'll have to be done. It will fall on us it will be labor intensive but we have worked on a process to get that done. Is there. Any of. Distribution. Or any payment that would be made back to DHS for the cost of what that's going to occur. So that it's not fallen I mean that's gonna fall back on the taxpayer's and it's supposed to be their job to be doing that and now y'all gonna have to be picking up the cost to do it so I'm just wondering about how you gonna track what that cost is and is there any repayment option in that back to the state. So we have not discussed a repayment back to the state for any of those functions right now the time being used by the state is state staff only and there's a committee that's reviewing those payments it's about three people that are already on full time state staffing right now it's not taking any extract out side of work our time it's just a lighting specific time to that we will continue to monitor and and and look at you know what the resources we need to right now we feel like it can be absorbed by the existing staff and you know we have not discussed whether or not that should be a cost back on and power that would be something we'd have to discuss I believe with at the Attorney General and with make before we could take any of those actions okay and the last thing is how long do you expect the investigation so that will notice legislative branch when when it's been concluded what the findings were the investigation on the on the fraud department we we can given really giving you an estimate on that the investigation there is the investment investigation ongoing by the attorney general's office we don't know the extent to which there may be other investigations ongoing and so I think that would be a question for the attorney general's office. Okay all right thank you Mr all right Senator Solomon you're recognized for a question. Manager mark you may not know this but does the fraud investigation go back past the dividing the split between the two companies. Well they they have not split yet there I think leaders set to split how as of January one okay they're still together so then and then the fraud investigation does include both the both of those agencies B. can empower. I don't want to say that only because that as I understand it there is a split responsibility you can hand a handle some functions in power staff handle other functions I don't know which side of the house the US centers for and so what. Why was the what caused the investigation to to initiate what is a self report was that a investigation generally if there's an investigation there there had to be an impetus for that a report do you know what the what cost investigation I know that there was at least one or two items that were referred from DHS for an initial look but I don't know what other referrals for mankind the turns office are thank you madam chair all right of representative Ferguson you're recognized for a question. Thank you madam chair I really just have a general question about assignment to the passes of are we now assigning tier one assist people to passes you know me we are not yet I'm just my personal doctor said they had a patient come and that was there was nothing medically wrong with them but they needed counseling so with those people going to pass. You know me and they would not it's all they need if on the only service they need was counseling services they would not qualify for a past they would have to be independently assessed and determined to have a functional needs related to their behavior health condition them and that they needed some home and community based services or perhaps an in patient facility and then they would they would go into it so that their tier one I can stay in Medicaid yes okay thank you. All right senator Hammer thank you after just one quick question the because the fraud allegation and that's what it is allegation It because a fraud allegation came up after what appeared to be you are about to turn loose because they met the requirements of the reading this review does that in any way now affect their readiness review because there's a as I understand there's a financial entity that's trying to bridge the gap between the separation of beacon from empower did did any of this now affect your you're reading this opinion about reading this review it does not directly affected and just be clear our readiness reviews focus more on their systems and their operations there is also a look at the financial side but that is more through the insurance department and I just I can't speak for the insurance department terms what they've seen or what they may anticipate. Okay all right thank you. All right the that concludes our questions about this and I'm sure we're gonna be hearing more about it up so we unless there's other business of before I say that we returned wanted to remind you of that Christmas at the capital and to obey smart state few minutes and if you've got a check or you've got cash he's he's available and of course this goes for the teenagers they're in foster care and also of their their held that the department of you services so it's a very important thing for these teenagers anyway thank you so much for your attendance and we are turned.