Arkansas Legislative Council (ALC)

Jerseys quorum call a meeting of the Arkansas Legislative Council to order and we are here today is we. I had some information at Joint Budget on Friday We have a. Hopefully more information you have questions you be able as those this is our. First call a border is the the American rescue plan ACT for appropriation increased acid to DHS representatives come forward and we also have I believe. Rachel bunch mmhm. Line. You. The man with. Welcome and if you will introduce yourself and then we'll go to the. online and let her. Good morning Cindy Gillespie secretary of the department of Human Services if you will pull you might as close to you they've they've got a lot of court there or by taking here with the warning dawn Staley deputy director for DHS and state Medicaid director. M. mark white chief of staff chief legislative affairs for DHS. Okay in which but you're you with us. Give us just a second we'll see if we. Yes Sir this is Rachel much funding. Okay. R. I'm at liberty program did you recognize who you're with. This is Rachel bunch of the healthcare association okay now got that one. Thank you and The secretary Glaspie again welcome we would ask you got opening comments we will be brief in our comments so that we can spend time on questions the proposal in front of you today was developed by DHS working closely with the Arkansas health care association or to try to address some of the short term issues. That the nursing homes in the state are facing this is a proposal that is structured in a way to wear assistance would be would reach to all the nursing homes in the state not just in any particular area but it would go throughout the state. The last. Well guess now we're running about sixteen months the last sixteen months have been very difficult as you all know on the skilled nursing industry in this state and not only do you to a lot of the shifts in business operations that they have had to deal with but a lot of additional costs that have come from their shift in operations as well as its changes in the way they operate. Where it used to be okay to have two people in a room there now in most cases having to move to having only one person in a room occupancy rates are way down at the facilities and yet cost of doing business operations are up. And so as we look ahead they are right now really struggling with staffing and the rug of struggling with a lot of the operational costs that they have we are working with them at DHS and have been for some time on some changes that will be brought to the legislature later this year that will revamp a number of the ways that we are sort of the formulas that are in place around the way nursing homes in the state are paid and those will go into effect if finalized approved by by the legislature and by the federal government by CMS those would go into effect next year but right now many of the nursing homes are in critical shape obviously I would defer to miss bunch to talk about that because she is closest to them but we have been seeing the evidence of this and our regular reports that we get from them so this is a discussion that began between our organization sometime back the proposal you have in front of you today is to try to alleviate the short term problem and be able to help them stabilize to get through to the future. And With that if you like we can extract explain the three buckets that are here Mark we're done with but if you just take a moment subject to very high level. Certainly all a walk through these buckets and then certainly a mistake we can fill in any holes that I missed the first book it relates to funding for the exceptional cost that nursing homes have encountered for disposal of medical waste and also for COVID nineteen testing this on the because the pandemic both of these expenses have increased far beyond what the homes that with the the facilities have encountered in years past particular until the testing even though they can get reimbursed from Medicaid or Medicare for some of the testing of residence CMS is required extensive testing of employees as well and that's not something that's covered by Medicaid or Medicare ordinarily and so the cut the budget sets aside I believe forty million dollars available for those costs on to cover those types of expenses the second book it relates to assistance with increased need for staff of course again because of the does this because of the pandemic as well as the increase requirements that imposed by CMS this is certainly place a strain on staffing within nursing facilities not to mention just the general problems that as you know all health care facilities all health operations are having around maintain staffing during this pandemic and so we thought a second bucket of funding to system around that staffing piece that's total of thirty million eight or twelve thousand. In the final bucket relates to unreimbursed property cost and and and we beat brick be very clear on this the funding that is bucket can be used for operations and staffing and so will help them in that but the basis for it ties back property cost specifically under our funding formula that we used to fund nursing facilities there's a piece of it the ties back to the property itself and that piece is adjustable based on the occupancy rate of the facility so facilities occupancy rate drops their funding drops as we've seen the pandemic nursing facilities that before the pandemic may been running eighty ninety percent occupancy are now running fifty or sixty percent occupancy and that has a direct impact on their Medicaid funding and so this change would help fill that gap and provide this additional funds for their staff and operations overall this would benefit two hundred twenty six nursing homes in the state some so certainly facilities throughout the state in every region the state and I think that covers the basic fault for this day for any additional details. I think that covered in this day could you please give just an explanation on how this will be how we would ensure that we know duplication in terms of Medicaid or federal funding or any other source paying for some of the same costs. Certainly so to speak a little bit about within the first bucket that Mr white mention there will be information that each the facilities will have to submit that actually speaks to those unreimbursed expenses and so that's something that we can then compare against whether it's been expenses that we have paid for or others will be able to see that through that documentation we also have within the reimbursement for nursing facilities part of the payment is based off of occupancy as you heard within part of it is based on those other costs that go into it caring for residents and that information will be submitted to us on a yearly basis as part of their annual cost reports and so what we will do is in this is actually in the qualification section for anyone as a proposal in front of them homes it of facilities that choose to participate in this particular opportunity will need to go ahead and submit their cost reports in advance a lot of times due to the nature of the timing of those they can end up being submitted later as opposed to sooner so the only to go ahead and submit their initial cost report for state fiscal year twenty twenty one as part of the application process and then a year from now the only to submit their state fiscal year twenty twenty two cost report that we we can compare and see a how that compared to what they submitted upon application but also how they utilized any of the funds that they may have received through this proposal so we can make sure that they have been reconciled appropriately. Thank you Mr chairman will be happy to take questions. Okay members I will remind you it's sometimes it gets a little hard to hear and wonders conversation so if you can keep those down or taken to the back of first one is Senator call will that is online with this the center call well can you hear. We've got a little bit of July. Okay hearing center I yes you're recognized center calling with. Yes we can hear you go ahead. I'm sorry to have. The first state to the requesting this money. The process is been flawed in fact this is the I certainly do. The sure you may receive this for this group here in Australia. She. Senator call where you're cutting in and out of it the only thing that kept the. Senator goal are you gonna have to have better service let me skip over if you can find a better signal and we'll come back to you. Thank you thank you. Okay next call representative Charlene Fite. You're recognized. Thank you Mr chair my question is that assisted living facilities have the same difficulties and yet they're not mentioned here can you help me with that. Certainly so this proposal is specific to our skilled nursing facilities we have been working with this is living providers as well as other home QB services providers to submit a proposal that would allow for funding to be able to be utilized in those types of facilities that that is actually a special provision that was in arpa that allowed state Medicaid agencies to be able to make an application for that purpose and so that application has been submitted it does include the assisted living facilities and we're waiting on CMS approval thank you. Senator English you're recognized. Thank you very much. So. Of a what we're we're of all these people gone. That were in the center saying homes where they all gone. So it certainly there there are some individuals who may have either gone home or who may be living with family members what I can tell you you know what we can't speak for every single person who may have been in a facility or chose not to transition to a facility we do see the other side of it as well and that we administer our home committee services waivers and in this case the programs that allow individuals to stay in their homes and communities and we have seen a significant increase in the number of those individuals who are applying to stay at home and that maybe because they're able to stay at home longer not transition to the nursing home or maybe because of some of the concerns right now that they've decided that they want to stay home a little bit longer before making that transition so I certainly can't speak for every single reason but I can definitely tell you we are seeing a significant rise and individuals who are trying to continue staying in the community a little bit longer before they make that transition. Okay this is serve it and and I know there's not quite the same but but in reality if you were thinking if you're in the. hotel industry all of their or their occupancy rates are down to so it's kind of like asking the question are we just taking care of one segment of our industry group or are we taking care of everybody the other question is that's probably almost rhetorical because I know with the injury but one of the things that it the steering committee the other day the Secretary beset brought up this forty million dollars for the medical waste and and what he was trying to say is that that is required so can you give us some more explanation about that that's a lot of money. You want any medical mental to the. Certainly and I think part of what was being discussed at the steering committee is that you know and and an unfortunate we know from our experience of past sixteen months there has been a lot of there's there's been a lot of changes and evolutions around what's required what's not required what's happening from infectious disease control perspective but when things that had been raised was the centers for disease control and prevention's guidance and what that looks like and certainly while the CDC has put out information with regard to testing and laundry facility waste the other thing that we have to remember is that physically for nursing facilities they are also regulated by the centers for Medicare and Medicaid services or CMS who largely pays the majority of of of their costs and you know well most of the time those regulations and rules fit together sometimes there are situations where CMS as the regulator and funder may actually have more stricter guidelines and regulations and in this case that is one of things that we see is that since CMS is the entity that licenses and then pays for the services they have had more stricter infection control standards then what might typically occurred during other types of infectious disease outbreaks whether that's like you know the flu or TV or whatnot so I mean that's really I think where we see the biggest difference is that is that with with CMS being the main paired regulator they have had increased regulations over these facilities throughout the pandemic. And so are these things gonna be reimbursable as so people have to do the work and then then they'll be reimbursed for so we're not just going to send them some money right so for all these things that that's correct support this is a short term and then a long term issue so short term we know that there are number of expenses that facilities that had to incur as a result of the pandemic and that's part of what this proposal is trying to address we also no longer term that with with with where we are with the pandemic and what things may look like for the future with regard to with regard to infectious diseases our standards are going to have to change along with our payment and so that's one of things that we are working with the healthcare association as well as the the end of the individual facilities on to say what does that need to look like in the future right like today we may say we're only going to allow you to claim up to X. amount right for like laundry or for getting rid of biomedical waste in the future we know that that number's going to have to increase and so that's part of what we're trying to work on now is saying we know we have a short term issue but the longer term what does that need to look like as we certainly find our way through this pandemic but also be able to plan for the next one. Senate just one more question okay if you will we got a lot of people I'm sorry so got going back to the to the number of fewer residents in and so are we looking at six months from now that that the the residency rate occupancy rate would go back up or we think and that this might be a long term kind of thing so that's part of what we're working with the healthcare association as well as others on is you know will certainly none of us knows how long this current wave of the pandemic will last you know trying to figure out what should our occupancy rates look like longer term and then building in several step stones to build so okay after six months or after year it's going to increase to accidents can increase to why so that's that's one of the things that we're working on now is to figure out what that needs to look like as part of that longer term payment policy changes thank you Sir I know your first questions rhetorical but I don't think it may be realized in my opening remarks I was I didn't explain the staffing issues that are the nursing homes are having and of staffing issues are very very real and that's that is the short term impetus behind a lot of this just as we talk about the hospitals in little bit just as the hospitals are struggling to hire and retain people nursing homes are as well and it's like today we saw some statistics I will get the numbers wrong but there were like two hundred fifty six positive of I was a staff in the nursing homes around the state recognize that when you have positive staff the staff going to quarantine but everyone else that also works with the staff goes into quarantine so retaining and having adequate capacity to staff even read with reduced occupancy is extraordinarily difficult and just as. The hospitals are seeing issues around the work force nursing homes are having the same thing it I heard the other day about someone brought me a report of twelve twelve workers that all walk out simultaneously in the middle of this year I mean people are tired they are worn out and so most of this money will be spent on staffing that that comes through loud and clear as you talk with the health care association. Senator Hammer you're recognized. Thank you Mr a don't you come go how when when have you worked with the assisted living facilities that they're given equal treatment to what's being asked for this proposal. Certainly and I don't have the exact dates in front of me but we can we can provide that if if that's of interest to the committee or others but as part of the planning that we did for the homing here based services plan that we had to submit to CMS we held a number of meetings largely that were over zero I'm just kind of given the current situation but we held a number of meetings to initially introduce the the idea once we got guidance from the federal government about what that could look like then from there we've actually brought that into a series of work groups that we had we had individuals not just from assisted living but we also had individuals from the behavior health community subsidies community as well as the intellectual and disabilities community edition of personal care and several others the participated in those meetings and actually help come back together with the recommendations and ultimately became part of that plan okay thank you on a shorter answering this question you mentioned about the number of vacancies in the facilities I'm looking on page three of our hand out. D. can you get us could you expand that to include like in the fifty to sixty nine range and the number facilities can you get us the total number of beds and then the current occupancy so we can see. Those numbers broken out by the range please. Certainly I mean if we can get a specific to each all that would be even better I don't know that's proprietary information not but if we can get that specific to each home would like to see that as far as my counties concerned or my area the requirements to CMS CDC on the medical waste would you define bio hazard as to what it is it's specifically driving up are we talking about trucks are we talking about needles we talking about what for bio hazard driving up the cost certainly and and I I will speak to some of that and then if those funds would like to speak that she can as well but so it's everything from like when you think about with our like PPE with the personal protective equipment for example there is so much of that that we are now having to where additional PP and having to change that so much more frequently and once that has become contaminated that has to be stored and then and then disposed of properly we also know that as residents become positive with COVID there is more supplies it's whether it's needles whether it's guys whether it's you know linens linens a lot of Libyans are part of what has to go through the go through the laundering process if possible otherwise having to dispose of that waste okay so there's a lot that goes into that try to be respectful time limits this because one thing shall we say it is what's being classified as bio hazards is actually could actually be treated as common trash are you saying that once a patient has come in been diagnosed as COVID regardless like the chucks or the the PP equipment that the staff has to wear and does that all have to be handled differently than just the general trash so per person mass and again these guidelines to change but Percy a mess the regulations that have come out of indicated that the trash has to be treated separately when you have concerns about contamination or you have no. Own contamination that like the trash laundry other types of the waste has to be treated separately our thank you Mr broke you thank you. Senator Stubblefield you're recognized. Thank you Mr. You know one of the one of the differences in the what we're talking about here in and hotels is we're dealing with one most vulnerable groups of people in the state of Arkansas and I know one of the biggest expenses was was testing. That was required by CMA and also I know the nursing homes in my district we're having a lot of problems getting in ninety five mask in those N. ninety five masks it normally we're three dollars before the pandemic hit we're ten and twelve dollars. So they had a lot of calls that most people don't recognize and I know I'm just I've talked to some of the nursing homes my district in several more struggling they're struggling because we had people take their loved ones out of nursing homes after they watched on television the Bakul that happened in some of these other states including New York. When I had the fear that if I had of losing their love ones because they were putting people who were tested positive for covid back in these nursing homes so Do you agree with that. Yes Sir. Yes okay that's all thank you Mr chairman. Regained her turn the phones off. Representative Bentley you're recognized. Thank you chairman Mark one quick question on these nursing homes that are under capacity are there fines associated with that as well just under funding you need to be a lot more specific and how we're going to correct that in the future. Sure it is not a fine or rather it's an element of the formulas used to calculate the payment rate that if if if there occam's razor falls below a certain level it reduces that rate their pain that and that is something that we're looking at modifying going forward but that's I for looking long term solution that still leaves that short term cash flow issue so what time line would look at that with that sorry June. We are working with association on rules changes that will bring you all shortly I'm hoping we'll have some some final recommendations here within a matter of weeks. Thank you can I have another question chairman roof with. Okay if we have a miss bunch and how in the world are going to increase their staffing their December second a serious problem one that one here is how did you lose maybe to requiring vaccines for everyone did you lose a number of staff and on how how we can compete with the with a hospital and everyone else to get some stature facilities with these funds and just curious censure which might be able to do. That was for me yes you yes. So we have that they represent that late we have lost at quite a few staff members I think every healthcare provider struggling staffing right now we've lost a lot of people through the pandemic we do have some facilities that have mandated vaccines for employees but as of right now the vast majority of long term care facilities have not made any vaccines and as I told at one senator last week we were talking about this if there are people healthcare workers that want a job that leave their job because of that we can definitely find another one in Arkansas there are lots of places looking at opening ADD as secretary glass we mentioned a few minutes ago we believe that we've lost people due to co that from the from our IT facilities but also when we we have to staff extra right now and look for extra staff because as people are exposed to covid and have to go home from work or you will have to go home that are sick and not able to be at work like I am right now we have to constantly look for extra people to be there income to that is a lease so it's just constantly turning over one thing that we're doing is trying to work with some of our colleges and higher and about how we can increase the capacity for nurse training to offer more of that but it's just like a problem that continues a work force is definitely one of our greatest issues right now and we're we're constantly fighting with a monster cells with other health care providers for staff members but we're hoping to stabilize the workforce that we have right now. Thank you. Representative wouldn't you're recognized. Thank you Mr chairman. First of all I want to commend you all for your efforts annoys me and try and challenging time. Can you do you have the assault on a under eighty percent occupancy do do you have a of the exact percentage and number of how many of patients that they have lost their their from their Population census began. We're just pulling up our notes we have some notes about each of the. Facility those trying to conceive that had the occupancy rates otherwise Rachel is that something you want to. Sure sure I would say are are lost in occupancy is a it's a combination of things Walden we have people that are choosing to move and family members to a facility later than what they would have in the past just as Senator Stubblefield stated concerns and things at her on the news about about facilities another big thing that I think the biggest factor in the biggest change an impact to our occupancy is when a lot of our hospitals work had stopped doing elective procedures and people in the community that are elderly have also put off having elective procedures things that they normally in the past would have done and come to the nursing facility for short term rehab and able to go back out into the community a lot of that has slowed down for various reasons related to the pandemic it's a lot of people who would have come to the facility before in either state long term or just in their short term for re having on home that has not happened. Well what are number or do you have a I'm sorry percent I'm L. alone I'm asking about is the representative reduction from what the population in these facilities was before we got into the pandemic and person would I don't have the total numbers maybe some examples. I'm sorry. Cozart twenty per from where we were pre pandemic. So so that when it says occupancy below eighty percent we've got some that are below eighty percent we have a dollar amount of money that these facilities have lost because of the pandemic. I don't have a dollar amount by intelligence the stock in the spreadsheet just this one page of more than there's one thirty facilities on here and only see maybe three that are eight percent and so all the rest of them are. How to hello eighty yes Sir okay yes we have one more follow up if I may Mister chairman. Okay the president of staffing this bill laws do you have that. Hello this is any given day it's going to be different but. Are they having a problem hiring people or they have a problem because they're having a quarantine or is it just a shortage of CNA's people to work in their. So I'll say it's all three but I think let miss one speak to some of the specifics. It would be all of the above it it's we've lost people every facilities a little bit different and that's part of I think the the you'll see that in this proposal at some facilities have a really high number of testing costs for a PVC cost and other facilities will have a lower amount so disabilities that had a widespread outbreak might have lost staff that went to go work somewhere else it's just it really varies everywhere we have some facilities that have been able to retain staff we have a lot of incredible nurses that stayed at the facilities and been in long term care throughout and get other people who is left to go do other things so it really varies by facility but I would say an easy answer to be all of the above our staffing issues are real and they're very complex and it's something that we deal with every day. Thank you realize we've got a real problem here and it's not going to be short term. If this continues but even if it doesn't continue long we're still going to be faced with being sure that we can provide adequate facilities for our elderly and I appreciated thank you Mr chairman. Senator Ingram you're recognized. Thank you Mr of. This state would you get us the of. The though the language that requires of that required by CMS verses of CDC that that back to the battle has or that that the trash has to be handled differently would you get a set language certainly will provide that to the committee of one quick question I am trying to remember in our peer groups of states that surround us of our percentage of folks in nursing home versus at home care. What you what what are we in Arkansas verses are we about sixty five thirty five four of how does that break out own own home on payment of treat treating in nursing homes versus trading at home. Unfortunates not something I can speak to you at the moment and I think that's just because with the impact of the pandemic so much that has changed so unfortunately I don't have a number I don't know if that will thing miss bunch would have if you could if you could get it provided with us with our peer group of surrounding states because I know that when we did the health task force it was of it was a the other states were significant difference in the ballots funds and how they were spent of and then up missed last week you mentioned that there were two hundred and fifty six nurses that have have been removed because of because of it staff or staff for two or fifty six Stafford I used to work nurses but state and local I was trying to remember the number from the meeting this morning so if I remember correctly it was around two fifty something of that they were reporting and had We're out to you to covid of the two fifty do we have any idea of how many were vaccinated versus unvaccinated no Sir that's just the report that I got this morning okay thank you Mr. We have had trouble we all about broadband. Getting a call we'll look back and let me discover some stuff. As he was saying aye call part of it is that the steering committee only receive the request. OR were made aware an hour and a half before the committee meeting. This menu these the second continue to be as we know their their fluid. And but something of this magnitude that continues to be a problem with the legislature everything is last minute emergency. And while we. Want to help B. as responsible as we can that is one of the concerns let me go ahead I'll let you address that too but Is asking when will the new funding. A formula be available and are we using our funds in place of DHS for dresser all right sure I will start that then let the others take it so the first point about the steering committee getting it very very shortly before the meeting he is correct and that is I hope that is something we sincerely and I sincerely apologize for it is a it's not how we like to do it's not how we like to deal with the legislature I would prefer to brief people in advance and this was highly unusual for us to have to move this quickly we I had been working with the healthcare association and with the hospital association because that one also came in late and we had been working with both of them and trying to find our way through the bottom line is that the situation just began to move much more rapidly out of the public the staffing issues became much more problematic much more quickly and we had thought we would have more time and suddenly it was no things are really reaching a crisis stage and we need to do something and we need to go ahead move so we finished our work back and forth very rapidly worked with the FNA who also was. Brought in very you know to do their reviews very quickly and they all jumped in again in the same way and did their reviews so it's it's not perfect and I do apologize for it very very much it is it is just simply how quickly things started to move outside and how bad the staffing issues became so good could you address that is the funding formula out of date and in one yes when the work will the funding formula eight formula is out of date and there are pieces to that like around the property that are over valuation that are over twenty years old I think some of the there had been discussions over the last few years about the formulas on the other hand I think it was with the pandemic and the unusual situations that we all saw that made us realize you it's just got to be addressed so that work had started around that with the idea to have something done aw through the legislature and approved by CMS so that it could go into effect hopefully in January so that work is still underway. Even as we and the healthcare association come to an agreement we will then need to make sure that CMS is going to agree with it and then that the legislature is also going to agree with it so our hope would be to get through that process and the next before the end of this year to be able to have something and the legislature for your review so that the there could be a new role in effect new rules in effect by January in the art for funds in place DHS five. Some of the areas in here Are not. And I will let deputy rector Staley speak to this better than ice and she's the Medicaid director but I have also asked those same questions quite extensively and a lot of what we're looking at doing here doesn't quite perfectly fit within the way CMS works and the way they will allow us to use monies and she can explain that more detail I I do want to make sure that something we have been saying is clear we have been talking about the nursing homes separately from. assisted living in home and community based services. There was an arpa a very specific provision that allows us to use Medicaid money with an enhanced match that they give us around hummocky based services including assisted livings we are developing that plan is she said with with those industry groups. And we are going working through with CMS to see what they will approve that one will also come through you all for approval but that will be all Medicaid money therefore when that one comes we will be not be going back to the Arkansas during committee for that steering committee bucket of monies around that industry the nursing homes however were not included by CMS in that provision it's only home and community based so. And just to add a little bit to some of the specifics within the proposal so there are certainly things in here that from a longer term perspective CMS can and would likely pay for I think part of it is the immediacy issue given the situation within the nursing homes and the facilities that we're facing today I think the other aspect is that you know as you can see within this proposal it is asking to be able to go back to the date of which the funding first became available which is March third of twenty twenty one while we anticipate CMS will be able to work with us to get things approved going forward CMS is typically typically not wanting to go back on some of these types of payments arrangements because of the way that the the way the funding flows to some of the formulas that are associated with it so I think that's one of the biggest challenges that we have been trying to use Medicaid funds for the proposal is that it is retroactive as opposed to being solely forward facing. Thank you I have represented Vaught you're recognized and has Senator Hammer in central Chesterfield. Thank you thank you Mr chair So I was in on a meeting what I'm I have actually two nursing homes that are about to have to close their doors it's the two best nursing homes and in my area period paragraph one of them actually is the only one in my area that houses people with Alzheimer's and I know that they are on second mortgage third mortgage trying to pay bills trying to pay the staff trying to pay their vendors so I know that I'm an I'm happy I don't usually like for many to be pushed through like this but I know that these people absolutely have no where else that they can go and that's one thing that I think that we as legislators maybe don't look past two is where I want to say maybe that was fifty one mark in my getting close to rat facilities that are in trouble the number of I remember if I remember right from that meeting and and so it breaks my heart to think that someone's mom someone's dad would not have a place. To go in my area if my to nursing home shut down so I'm that's kind of where I stand on this is I don't think about anything but those people that need the care and but would you find it fair to say that we need DHS or us to prioritize this money so we don't have to come back again for more one time money to help these facilities would that be a fair assessment. Yes we certainly think that this is a very important meeting that's why we brought it to you today thank you thank you Mr chair. Senator Hammer. Thank you I'd like to ask that you had one more piece of information to the expanded chart on page three based on representative Williams comments would you go back and establish what the average census was by each population prior to the start of covid so we could have a benchmark to show what was back when life was normal the other thing is this the. CMS. See see all these entities are mentioned on the handout they are like almost imposing unfunded mandates on the nursing home ask them to do the same why are they not providing reimbursement out of their normal funding streams instead of us having to use this money and what discussions have you had with them regarding that if any at all. Or my misunderstanding. I think with the with the CDC and that's I can't really speak to to OSHA specifically but our city with CMS we can't speak to the CDC specifically but with with CMS refining perspective you know it's much like kind of the discussion we're just having of you know CMS is definitely right now from that perspective focused on the infection control aspect I mean they do recognize their increased costs associated with this and I think they they are definitely happy to entertain proposals and say yes looking forward how can we help fix this issue I think it's just being able to deal with the immediacy and also kind of a look back issue of where we know that we've had facilities that are dealing with staffing dealing with costs above and beyond the normal but definitely going forward that is something where they've said yes we will work with you I mean we've we've talked them about some of the policy and payment changes that we're wanting to make so they they know that this is coming and they they definitely are supportive of the broader changes okay so you have it are you I know you guys are swapped but are you starting to develop that conversation what that's going to look like so we can get that in the hoppers quick as possible yes we actually we we yes yes okay then the other question is this I mean just on a normal day to day the reimbursement rate to the nursing homes non covered related seem to be extended out pretty far and for those fifty nursing homes that are struggling and others why why can't we get the regular reimbursement rate time shortened so we get that infusion into them Sir later because if I forgot my information correct were or maybe pushing a hundred twenty days and beyond to get reimbursed on Medicaid Some claims that had been rejected and so we're working on some one on one issues I know we've also worked with some facilities that with the changeover in some of the eligibility systems were working through you know some of the the changes in the process of the timelines pulled my understanding is that those are those are isolated incidents but certainly if you've got others we love to talk with you and and figure out how best we can help she just give me the reimbursement time certain embarrassment time for the facilities as far as what the average reimbursement time is and will Arkansas health service center the beneficiary of all this I think I saw we're should state run facilities yes they also be taken care of in this yes yes okay could you thank you. Thank you senator just feel you're recognized thank you Mister chair I move that we approve the item before us. It is a proper motion if you will hold it just a second the. Mister one Senator Dismang okay he's waving all have a motion to approve the the second. All. Just one minute. I co chair representative Wardlaw thank you Mr I will just make an announcmenet sixteen from voting because this the industry that I am employed by. Thank you for that okay we have a motion and a second all in favor aye aye. Posed. Motion carries approval. Thank you and we will now have a. Arkansas hospital co would surge staff funding proposal. The same ones the. And and new ones so. Come up. And we're let you recognize yourself the representative. All right with the Arkansas hospital association thank you for doing this Mr I'll. And we're ready for you to present on this subject. Thank you Mr chairman of. Again I'll I'll just be brief sense everyone has the proposal this at joint budget committee on Friday this one was referenced a number of times because this is the proposal that we've been working with the hospitalization on to help stabilize the existing workforce hospitals throughout the state this is a proposal that would cover all of all of the hospitals at a throughout the state it's very broad reaching proposal this one is largely aimed at the staffing problems that they're having you've all heard about that this will help them both to retain staff as well as attract staff Staffing issues there are I think everyone is aware of how serious they are it's not just the exhaustion of the staff at every level from the nurses to the technicians to the CNA's and then having to a. Quarantine short on staff very similar to what I talked about with the nursing homes the staff is working multiple overtime shifts and they're worn out. so we appreciate greatly the approvals last week for assistance in terms of new beds but this will allow the hospitals in the state to be able to both retain current capacity where they do have empty beds that they're not able to operate their license to be able to hire so that they can in fact expand capacity in those areas and We feel like it's incredibly important as you can tell the number that was come up the number most the money here is for the staffing part of the proposal the The way that number was calculated is Working with the hospital association talking with some of the different hospitals we also we realize that the situation at each hospital is different and they each need the flexibility to deal with whatever their current staffing issue is whether it's retention a tract attracting additional workers or just a additional capacity and So we ended up working out a you'll see there a nine thousand dollars Purred up per bed day number that was used this is essentially working off of Back in twenty nineteen what it cost for a bed a bed at that point was roughly of the staffing costs only around about at that point as I remember and Bill may be able to be more accurate look accurate this was around seven hundred seventy dollars and so that bed J. what they did was they took that bad day and the nine thousand dollars that we're asking for what essentially using twenty nineteen numbers allow each of the hospitals in the state over this period that will run through the end of twenty two to have that amount of money to be able to use to help with staffing costs which would basically be about twelve point six days worth of their total staffing with COVID rates where they are right now everybody's in this price closer to ten days of additional money that they would have to be able to use toward staffing in this period of over a year so that's how that number was formulated the other two pieces are in here are additional allotments that a hospital can receive if the hospital is receiving COVID Payson patients as part of COVID com not sending but receiving covered patients they would be eligible for an additional allotment and then the last one is if the hospital will set up to administer monoclonal antibodies there is a cost in doing that they have to set up a a section in there outpatient area to be able to work with those patients so this gives them an additional component if they're willing to do that so that's that's essentially what this probe proposal is but it's to address the existing staff in the state. Anything I missed that those versions thank you okay can you address or or. Funding for current nurse is going to be increased. that will be a decision of each hospital as to how they are going to spend this money on staffing but both would you like to address that. Sure I think that's right and certainly we said to retain staffing so we know we're being targeted by hospitals in other states travel agencies coming and trying to recruit our nurses away to go to other states so I think having that flexibility so that hospitals can make that decision whether to spend some of this money on retaining nurses I think it's good good for this application good for hospitals. Thank you Senator Ballinger recognized. Thank you Mr. My question would be obviously my district we're dealing with the hospital is now you know getting really close to to firing a bunch of people because they won't give acts need to individuals who on this was worked through the pandemic rescue their own health separated from their family all that stuff and another on the hospital's phone to the questions will some of this money be used to help prop up those hospitals in order to find people hire people from out of state to replace these people they fire. I think those hospitals would be certainly want to retain what they have instead of going out of state so I think that's a. A decision that they will have to make but they still need staffing we still have patients that are coming and we still have patients lined up in the ET so they're they're looking for staff to just like every other hospitals of the they'll be plenty of opportunities for those of the staff people find jobs just wanna follow up so if they fire as much as ten percent of their their staff medical workers they could use these funds will provide to help prop up to try to replace those people whether it's from travel nurses or whether it's from you know just hire another other place other agencies. That's the flexibility of to use it to retain and recruit nurses so yes. Senator Hammer you're recognized. Thank you Mr some hospitals operate more efficiently than other hospitals what's the safeguards to make sure that a hospital maybe that is managed better than another one. Is not going to get the same treatment or same opportunities so that we can keep the competitive edge for how hospitals are actually manage. With regards how this money is dispensed. All the money is to is The way this is going to be set forward is every hospital is getting the same amount of money if they choose to to take the allotment the hospitals are each getting the exact same amount of money per bed so it's really working they're all getting treated exactly the same in that way. when they use this money they will have to report back to us on how they expended the money and so it will go through an audit review by us and that's how will make sure that this money is being expended properly and in accordance with what's allowed. Like a copy of that audit begins because I had a board member hospital contact you over the weekend after he found out what we did in here on Friday and said at the rate that they were being given that that was a heck of a deal and so you know that's a hospital its manage pretty effectively so I'm just going to say that is those audits coming up like to see that because we we we don't want just give money without accountability the other thing is and I'm not sure if it's you or the Department help to answer this question since Friday when we'll allocated money to Baptist in the other hospital I've been several conversations with hospitals that said we would have been willing to do that too so I guess my question is the that you were Boer Department health how many other hospitals have submitted any of applications like we approved Friday morning or. Can you say. I cannot say this time but I do know that hospitals are considering submitting applications I think we appreciate that they wanted to see the Arkansas hospital association application for all hospitals be considered first so you may see other applications yes okay Sir if I could just add you know we we have facilities that have had to. They may have been operating at you know let's just say for the sake of argument a hundred percent of their license capacity but as they've developed staffing problems they've had to pull themselves down to you know ninety percent eighty five percent of capacity right and have the staff focus on a certain number of beds one of the hopes is that with this funding what they will be able to do is to now hire additional staff and be able to take themselves back up two hundred percent of capacity so they should hopefully help in addition to what you're talking about with new proposals coming in they should also hopefully help get us back up towards our normal capacity in the state J. last question vote on religious objection for those that don't want to take the vaccine to all hospitals have policies in place for of folks that want to object to taking the vaccine either religious or otherwise do they all have standing policies. I think there are exemptions that that can be had yes like you don't know about all hospitals but I think there are most I'd like to get those especially hospitals don't have them in place I'd like to get those please thank you. Representative speaks you're recognized thank you Mr chair I'd like to ask who someone I don't know at the table how much money has a hospital's received so far from the cures act fun. I believe in total it was a hundred and fifty million dollars there was a hundred and twenty is that right mark in August and then supplemented with thirty million in December. May I ask another question. Is that for every hospital or. Because you're dividing the money up among the hospitals is this ever hospital has received that much. Yes they have it was saying it was based on the same allocation that similar to this proposal where it's a permit of allocation and then there was an add on to go with that. So it was split up among all the yes yes it was but among all the hospitals thank you. Thank you representative Dotson you're recognized. Thank you Mr chair so if I understood what you your answer was a moment ago Senator Ballenger this these funds would basically be a blank check to be used at their discretion on how they need to use them for their entire hospital off operation regardless of there there are no restrictions on these funds is that kind of what my understanding of it is it's it's restricted the staffing. Staffing in hospitals to recruit or or retain staffing and there's audit requirements on that they'll have to submit of bills or invoices that they've used for staffing so they'll have to have our documentation to back it up and it will be audited at the end so so it's requires reimbursement requests. Not so they have to expend the funds first and then. Request the funds or they get the funds of funds on the front end that the funds would the funds would be available on the front end and I think part of just to clarify from some of the previous discussion so when we did the proposals last fall or last year rather we were very specific in terms of saying that it's this amount of money that's going to this worker based on if they're full time or part time and there were a lot of specifications around how those funds had to be used as we start talking with hospitalization and certainly hearing from some of the hospitals individually they said you know it would we would certainly welcome the opportunity to have additional funding but to have a little bit more flexibility so that we don't have to say I'm going to give mark this much money I'm going to give dawn this week so I mean that's that's really what we're trying to respond to us to be able to give them the flexibility to design those incentives to design those recruitment strategies as opposed to us saying aye government you have to pay this nurse this much money in order for the forty hours you work this week but if we're going to be putting hard earned taxpayer dollars. Two as a supplement to hospitals being able to hire staffing in the state of Arkansas and these hospitals are are letting our Kansans go. That are working for them and hiring out of state workers to come into the state of Arkansas a with these flexible funds do you have any type of restrictions in place on these that if if a hospital facility decides that they're going to let nursing staff go because they're mandating vaccinations that. There's a restriction on those funds they can't use them to hire new staff to replace to back fill those without a state workers. No Sir that's not in this proposal this proposal gives the flexibility to each of the hospitals to figure out how to handle their staffing needs you need to that hospital. Hopefully you can consider that the future thank you. Representative bill you're recognized. Thank you chairman of I'm really excited to hear that you guys are doing something to do Michael antibodies I hope that you'll encouraged to do more early treatment because you're saying more more research come out that early treatment is done decreasing hospitalizations by eighty five percent so I just cannot tell you how much I want you guys to contingent courage doing that certain see more Kansans healthy and not die from code the other question that I had on that road with senator with represented by a Dotson put for their my heart is sick and to think that we're going to fire Kansas harpy from our state I just saw this morning eight twenty five thousand dollar sign on bonus for not getting employees of the twenty five thousand dollar sign on bonus I don't care how much money put out that we've got to change things that are going on our hospitals and I strongly encourage you to get with your of members but one tell them that we're not approving the deal with this man and vaccines for folks that have worked there for twenty thirty years of experience you're not been replaced with somebody else thank you. Representative Payton you're recognized. Thank you Mr so what I'm hearing is we have a supply and demand issue with the labor force the staffing and it's because and the price to go through the roof because there's a short supply a supply and heavy demand and so we're asking the taxpayer to step in and assist with the inflated prices that are being created in this environment. It seems to me that the hospitals that are. Requiring their staff to be vaccinated that doesn't want to be. Is counterproductive to the supply and demand problem and for us to. Incentivize that bad behavior would would just complimented you know make it even worse so do we as as a state I'm if we're going have the taxpayer's. Pony up the money then I believe they have a they should have a seat on the board. So as a state do we have a way of income of telling hospitals. You can't use this money if you're willing to let staff go I worked on vaccinated for over a year. And I encourage him to get vaccinated I've started encouraging my constituents to get vaccinated. But the bottom line is if they're not willing to the then I don't think in this environment we should be willing to firearm and replace them without a state help which is driving the overall cost up we're seeing inflation and labor market there. And everything we're doing is counterproductive so what can the department of health of the state this body do. To get the message through those hospitals. The that they that they don't need to be let in our Kansans ago. An expected our Kansans the bail him out. What can we do. Ferguson thank you I think I would say that the the difficult sourcing the staffing I mean these predate the issue of required vaccinations so if there been staffing issue since the beginning the pandemic they've gotten worse as time of gone on to clear out hospitals we're seen just severe strains of trying to keep staff and yes there are those no from my understanding for smaller hospitals that have decided even in spite of that we're going to require vaccination and they've they've made that decision but that's I believe small number in it and that that's not the source of the problem the the problem is the pandemic and all the staffing challenges this round of the pandemic and so all the hospitals throughout the state are seeing the same issues as are the other discussed earlier nursing facilities and other healthcare facilities so I think this is this a problem is much broader than just that vaccination question and certainly stand the concerns around that but whether or not no no the handful of hospitals in north northwest part of state compelled vaccination for their employees the fact remains that the hospitals and the rest of the state even though they may not be doing that they are still encountering severe challenges in getting staffing in to take care of patients And that's that's the purpose for the surviving follow up Mr. I'm a. I agree I mean I think that's been well communicated to us but Wall it is a small percentage in a handful of hospitals that are trying to make that and we've heard testimony right here in the last hour that we had money that went out to the hospitals they had a lot of strings attached it's not unprecedented for the state to demand that the money be used a certain way. So while it is a small number what can we do. I mean should we include them out of the program. That's a sophisticated ways and exclude. But. I will wall a wall it's a small number. What can we do. I'm I'm my concern would be that if if we if we took if we target that worse were potentially sacrificing patient care just to address that issue in the small number of facilities I know that are looking at that. It may become a bigger problem if we don't address it no I understand how many but ultimately I think that's that's an issue that have to be addressed legislatively and I know there's no there's that's initially all looked at during the session another you did pass a bill out that if you know related to that in some ways but I think ultimately if if that's the restricted that's that's restriction that needs to be done to me in statute rather than in funding where potentially threatens the the funding for all hospitals increase issues for try to make sure the patients are being taken care of. Thank you thank you Mr chair sounds like we need the legislative session so we can put that in statute. Representative back you're recognized. Thank you Mr chair. What I'm a bit confused by. We have out of state hospitals are coming in and pulling staff out of our in state hospitals. And I'm assuming they must be using dollars and sense as a care to give them to go out there. And then we're gonna put more money into the State dot hospitals here in state. so that we can get more. staff it into our hospitals the question I have is that it seems like you know just. Resented Payton was was referred to as a supply demand thing right so we're trying to say you know more dollars is not going to create. More staff as a whole The the number of staff that's out there right now are are are certainly out there and they'll be divided up accordingly I guess whoever gets the most money for so I guess my question is why do we think this would help and and I'm going to suggest an answer. In this might be the the shorter is it the fact that Arkansas is paying a lot less for their staffed in our supporting states because you have given more money in the states I heard someone say that we're gonna go out of state and get people back in you know well that doesn't make sense either because they're going from out of state to coming to get our stats of their lobster shortage there to. Did you can't dress at issue so how you came up with this figure and and how much how increasing this fund is going to actually either bring our Kansas back into the state or are get some other from on the other state. I'll start okay eighths And there is no one single answer each hospital has its own unique issues that it's dealing with from to you know day to day. And the staffing issues that are going on in it it's interesting there's always been a supply demand issue in Arkansas we've we've talked about that many times well before the pandemic the need to create more medical staff at at every level. At the same time. Honestly the job that they're doing at the hospitals has changed. It It is. Bluntly it's worth more now what they do that was before I mean being a medical professional has always been a very difficult job but being a medical professional now where they are having to do a full time shift then do an overtime shift then maybe sleep a little into another overtime shift and at the same time have the support staff is supposed to be around them not necessarily there It it is a much harder job. And like any thing else that goes on in terms of labor supply when the job gets harder the pay goes up and so this we we I think everyone believes one of the reasons to deal with a lot of this short term with this funding is because this is a short term crisis period being in the pandemic where the job is harder we watch it even with our hospital that we run which is not an acute care hospital but even in that hospital setting. When you have every day and you are dealing shift by shift with who is going to be not able to come in because they've been quarantine or they've been told they have to stay home you know until they don't test positive and you are constantly there for moving around your staff. and people are tired. It it creates a real issue. I'm. The ability to in some places will look to hire more more people and pay them more some will choose probably to do bonuses for certain staff those will be their choices right some will choose to fill other types of positions in order maybe relieve some of the pressure on some of the folks there but each of them will make their decisions based on what is going on at their facility when we did this before with cares money we came in and said. Let's do bonuses and let's do bonuses for workers and let's pay them this amount and for the following positions which meant that we didn't give the the hospital any flexibility around. They might have a position that for them really as a frontline position but we had not recognized it they might have a certain type of worker that really is not compensated for the level of work they're now asking being asked to do so. This time we said let's be much more flexible. I know that that started to address your question but. Thought I'd. Sorry about that a good vote but do do you think that maybe what we did earlier with this with the cares money creating bonuses or whatever has sort of created you know served raised everything up and now we're saying okay we gotta raise it up again to stay competitive is that possible. No I don't think any of us that are running facility see it that way right as that was going on and right as those bonuses ended you had some staff that was upset but that's been a long time ago now it's just that this has been a long haul and forced some of the work force quite bluntly as we have entered another wave they're tired and it's. You know it like I said each hospital will know its workforce bass and know what it needs to do to try to encourage them to stay with them through this next wave and keep going. Thank you Mr. Members I've got six more in the queue Senator A. you're next. Thank you Mr chair Mr unload unless you just want to go on to the other six folks here I I was prepared for motion. Your prerogative okay I Mister chair I okay then understanding we've got to help people get through this none of us are all that happy about maybe where we are but code that does not respect anything that we think so with that in mind I move acceptance of this request. I have a motion to approve I have a second. Senate. All in favor aye aye opposed no. Motion passes approved. I have one request while you're there US secretary Glaspie of. Represent Lowery you're recognized. Thank you thank you Mr chair Secretary Glaspie of it's been brought to my attention with I mean we've been hearing a lot of testimony about just the domino effect of COVID and how it creates just ripple effective of negative repercussions on down line and one of the things that's been brought to my attention is that uh some of those who are most vulnerable for instance involved in either drug rehab or domestic abuse centers of those different entities have been told that they're going to lose anywhere from forty to fifty percent of their funding have there been any recommendations brought to you to help. Sure that up because obviously during covid they're probably I don't have the numbers but I'm sure you could probably attest to the fact that there are larger and larger incidences of domestic abuse probably drug addiction so the most vulnerable or actually being left out in the cold and we're not really doing anything I don't hear any proposals I don't see any proposals coming forward to take care of our domestic abuse shelters are drug rehab centers that are losing federal money which my understanding is a lot of it is tied to fines at the federal level in S. courts are beating less and less and less handing out less fines again that ripple effect there's less money to the centers so is there any has there been any kind of proposal anyone talk to your department your agency about bringing a request to help make up for the loss of funds thank you can probably tell from our expressions that if somebody's talk to someone somewhere else in the agency we have not heard it this is the first time I've heard that there's a shortfall so if you have what will go back and look into it if you have any information to give us after this hearing would be happy okay I'd like to do that and hopefully maybe of a Mister Walter can also sit in on that so we can actually put together a proposal to help shore up the shortfalls. So thank you very much thank you Mr chair Senator Hammer you have a last question. Thank you Mr I'd like to make a request to vote please. Why is at the table but would you provide me a list of the hospitals that are requiring their employees to be vaccinated please. Thank you. The business the committee is adjourned. What.