Health Services Subcommittee of House and Senate Public Health Committee

Four members of the committee and also members of the audience the chair she's a quorum going to go against started try to respect your time make it as efficient as possible. Welcome to the first meeting and it would just say this the this will be a working meeting hope that you got on it because you want to work but we do have a budget we got to stay within so we'll try to make her time efficient and manage it well we'll be looking the scope of practice Bills coming down the line part of what our duty will be and so we would like to work together as a team to try to make sure the process is efficient effective and we go into the next general session for those of us are coming back to bill to make sure it's well that it before we get there proud to serve with representative Pilkington hope that we is your of chair and co chairs will you don't do you right and with that I yield to him to Sherri comments he wants to share. Thank you senator perfectly senator Hammer let's just begin. And with that being said need to the consideration of the adoption of the November thirtieth twenty twenty media minister gonna get a motion motion second any discussion. All favor say aye. A post very good wind item D. and that is a discussion of ACT eight oh two twenty twenty one creates a legislative study a mental and behavioral health and that is actually gonna be presented by representative thought is that correct yes ma'am which police and anybody wanna bring to the table with you two of president please bring them and we'll get everybody introduced for the record. Good morning Mr chairman thank you for allowing me to be here to present this morning this is something I've tried to work on for every since I've been here I think mental health is a huge problem in our state for a county jails it's a real big problem in our county jails and then trying to figure out how to help people who have mental health issues it's also a big problem in our schools and trying to figure out supers and and counselors trying to figure out how to help these children with mental health issues and it's not something that they really focus on when they're getting their education as far as counseling for schools and so they really need some help and guidance in this area so with that it's I mean mental health is something that's very dear to my heart anyway but the purpose of this study is to assess the strengths and weaknesses of the mental health behavior resources and care currently available in the state of Arkansas and recommend legislation to the General Assembly regarding best practices and improvements within the area of mental and behavioral health care for consideration during the twenty twenty three regular session we want to look at the access to and availability of mental health behavioral care within existing mental behavioral health care facilities in the state how Medicaid programs regarding mental health and behavioral health and other public and private medical reimbursements for mental and behavioral health providers and facilities within and without this state of best practices and provisions of mental and behavioral health services even in other states and how other states are addressing it and Mr feel has actually Put on the back a study for us which will help them look at the inpatient psychiatric facilities in the state of Arkansas I'm told that we don't have enough beds in the state of Arkansas for the mental health That's in our state and so that something else I'd like us to look at is the number of beds it's actually available and I think that he has some of that even in the in this report I know that my county sheriff's say that they're often told whatever they have someone that they arrest that needs this type of of medical attention that there are no beds available and so we need to figure out why there's no if it adds available and how we can free up some bands first thing such as this and that's kind of really an overall I know Mr feel is Mr prices given me some good ideas of people that we could come have help with this put up with this project also and I'm open to any kind of advice on how to help. These. constituents in our area. All right open it up to any of members that have any questions or want to counter some free advice. I just ask of maybe a couple things you might throw in the mix of things if you don't mind yes Sir and ask if you have intent to do this are you going to look at the judicial system as far as in rolling of judges that are having people transported directly say to the state hospital that. Create some of the back up by by passing some of those people there in the county jail that may be in line for sure are you going to do a deep dive into the judicial branches Robert love to do that with you Sir yes Sir okay yes we can I have that okay. Representative person. Again I notice maybe what's missing on this list I think in our area some of the people actually go to ten the city that okay inpatient teenagers particularly are they use today I don't know maybe they could complete the list with how many people were paying for at a state out of state yes ma'am I'm that and give that to you. Any other member see anything you like to have considered into it. Okay and you're going to be the point person work representative great yes I know people can funnel their ideas to you that yes that time frame when you think you might be back before the committee with any suggestions or we're going to try to manage the agenda make sure we give everybody time so we can just have an idea to build a schedule any idea I doubt that I can get with you offline and we can figure that out if you want to that's fine or just communicate with Phil and okay it feels happy we're happy and and then that way we can just make sure to keep the the plate balanced yes that okay anybody else. Sure represent person yeah and I apologize I don't know a lot about mental health facilities are are all of these Phillies they have the certificate of need is there a limit there any as the limitation that we're not allowing them to do more bids because this ticket and any problems or that what I know and I don't. If there's anybody behind me that can even answer that but I can try to find out for you. Thank you all right yeah but else. Consulted with Phil we don't have take action on this but every sixty days we need to talk about this that's just sit for the committee and say here's a brief update and again we're trying to build up to schedule because we do what scope of practice in here to to make sure that we don't get a bottle of bottlenecked toward the end. Yeah. Thank you okay no comments or anything thank you for the presentations won't look for to hear back thank you thank you for. Next on the agenda is I to me which is an overview and update on DHS implementation of the committee sports system provider Medicaid provider type. Exhibit eight Mr Wyden your team or whoever's president which shall come. Senator Hammer Melissa stone division director for developmental disabilities services okay. Temperatures again deputy director division of aging adult and behavioral health services okay you're going to go ahead president. Such thing so I'm you should have in front of you a pretty brief power point so we figured we'd answer questions and fill in some of the gaps he didn't want to make this too wordy. So as you know The past program is a Medicaid program that once you can come to the door of Medicaid there's several different eligibility categories but if you have hired behavioral health needs or higher and intellectual developmental disability needs you receive an independent assessment and you get a tribute to a pass so what we're talking today about today is a provider type primarily housed within the past program to provide services for people with those higher behavioral health and higher intellectual disability needs. And it is called the community support system provider. CSS pee is what we refer to it as. Chechen I have been working for several years this time on this concept and this idea so I think the easiest way to describe it was once the past program set up as you guys know it launched full Rask in March of twenty nineteen so unfortunately they celebrated their one year anniversary during and the start of the pandemic here so they have been actively trying to improve upon their program while while making concessions and changes to some of their services because of COVID nineteen. We stood up this new provider type this past January. So it is by no it's been very hard and we continue to work because it's very scary to kind of change your business model while you're struggling and to just maintain the model that you currently have so we're doing several things but the reason that we and finally you know promulgated this provider type is because we saw a continued problem with how we had set up the program in terms of which providers could bill so when people go into the past and you know whether they have ID D. or behavioral health they have a primary provider and that's either a behavioral health provider or it's an intellectual and disability provider and never the two shall cross so all that we set up a service package that and stated once you get in the past all services are available if you need them said you can cross over and behavioral health clients can receive ID D. services if they are and helpful to them and could help them improve their functional disability vice versa but the problem lies is that because we only covid and certified certain provider types to provide certain services we started to notice that and if you had behavioral health for instance and that provider only was providing or approved to build behavioral health and the other side of the house was not being represented because sometimes they don't even know who provides those services and if you only have a DD provider then it's the same thing they only bill and provide aid IDT's services and if a person could benefit from behavioral health and they didn't provide it there was no behavioral health provider at the table when they're developing the person's plan would add to that. And also remember that we have forty years of behavioral health services and we train our providers extremely well so for over the forty years we really created a very distinct divide between ID ADD and behavioral health so we were trying also to change a culture that we had created over forty years. One that's a good point because we continue to hear and still do here and session I do we can't provide access service because their primary diagnosis is why right so this belief and and what and she's right we set it up that based on your primary diagnosis is what you could bill and be paid for this is a totally different concept for providers so it we were trying to get the providers to go over and get the other certification meaning trying to get historic DD provider to go get a behavioral health license to provide those services and vice versa. It just wasn't working we had been trying for about a year and so we said you know what we're going to develop and stand at the new provider type that is cross walked and said that that workers are specially trained in both types of populations and that provider can perform an array of services that are both historically behavioral health and IDT so that was the reason for the change and that we discussed on and on page two and I will stay at the bottom bullet when it's it's gotten harder and harder to find placements and that is just quite an understatement and some of these clients and and a lot of times they are duly diagnose meaning they have been deems institutional level of care that they have and cerebral palsy autism down syndrome intellectual disability. And have a pretty significant behavioral health diagnosis of bipolar disorder schizophrenia and those particularly I would say adolescence once you have that kind of age range we have a very hard time placing them and truly are duly diagnose and can and should benefit from both sets of services in order to help improve and their functioning ability. So on page three. What this is intended to do as a new certification that would certify them to serve both Habel health and intellectual development disabled and that is that are we call duly diagnosed which is a significant behavioral health need with a significant intellectual disability name. And the benefits of this provider type would be to eliminate you know multiple certifications for providers and trying to extent because we all know what a and struggle is right now to find staff for the for the healthcare workforce so on trying to you and take the work force that we have and that versifi them in means of training them for both so that we can expand their business opportunities so they can get into that field and then what I mentioned earlier break down those barriers between. M. you know that the mindset of you have and you have down syndrome therefore you can't benefit from behavioral health counseling or services and which that that mindset still exists in many areas and Page four. So this you will see on the left is where we are to we're trying to describing it is complicated so that's what we're here to answer any questions and on the left you'll see. I am a box that says CVS waiver and that stands for community and employment support you guys probably hear DD waiver that's what that is so that is the waiver that provides for the home and community based services with clients with intellectual disability that's the one that we talk about the wait list alive. Then on the right eight is outpatient behavioral health and these are provider certified to provide behavioral health services and as you can see we are that new provider type community support system takes many of those services that these providers can provide input some under this new category of provider so if a provider comes a CSS pee they can do all of them. Can you pause for a minute I can't meet. Had a couple questions real quick can. Make sure I'm tracking right you first of all go back but eight minutes ago you said you were having trouble getting providers to switch over is this all part of that conversation we had and this is personal birch tree in the manuals and all that business that we had that discussion about a year and a half ago or so is that what all this is around yes senator Hammer that's part of we had two very distinct providers in two different certification requirements for those two distinct providers the ID DD providers and then our behavioral health providers and so like a Melissa said they really couldn't cross over so in order to provide those services they had to have the best certifications and then we also had our therapeutic communities certification which is under your behavioral health agencies and we knew we needed to make some changes to that program and you you came to us and asked us to make the changes so this is part of that which is we knew that when we created that program that we need to go back and look at how that therapeutic communities program was okay was was situated what what refresh my memory why you're having trouble getting providers to cross over I think about eight minutes to go in your presentation you said you had trouble getting providers crossover and I'm just wondering the problem at the end this conversation like a year and a half going doing good remember what I ate for breakfast little here have to go but. But there were problems back then as to why they work crossing over what makes us think now that this is going to help that cross over effect take place if I'm thinking right. And the reason they wouldn't cross over is because they had to get by the certification so it was a barrier to them to have to meet the certification requirements for both the behavioral health therapeutic communities federal health agencies are vacation as well as the the requirements under Melissa as C. S. waiver or the DDS waiver so that's why we were having issues with them crossing over which is part of the reason why we created this new provider type now you only have to meet one certification requirement to to provide services under both programs okay in our the manuals because there's I'm I'm remembers about manuals that the manuals all had to get passed by us by rules I think we they were pushing to get one done are all the manuals in place now we got all that business taken care of by which these the rules are in place for the this new model to move forward with yes for this the model I feel like we're always revising a manual but for this particular program yes we brought it to the legislature that was reviewed and approved okay. And I would just after what was setting out from the DD provider side of the house and. You know we. We do you person centered I mean that is the model for DD clients it is it is not very it's not as stringent as you would see in other programs because it doesn't make sense for people with intellectual disability to say you need this many hours of this type of therapy you need this many hours this in a program. And so really you'll see language and all of our means that says person centered the amount of staff you need depends on the person's needs the amount of service you need and what type depends on the person's needs and you identified that front in a planning meeting and then you act accordingly with that plan very different from how behavioral health has been historically run which is I'm particularly with therapeutic communities the old manual had very strict requirements that clients need this many hours of individual counseling and this many hours of group and it doesn't translate to every individual it's good in theory but it just everybody doesn't need that or they might need more they might need something else so I think the way we had written the program manual so differently just because of the history of how these operated when we went into this and manual it is very person centred and those requirements as stringent requirements have been removed and and we do believe that that will allow providers to more easily come into this space and and provide the service representative version. Yeah I guess it has there been collaboration with the providers are they is anyone objecting to this scene either provider group or they on board with this they're not objecting because we are not forcing it so we are not in setting the provider type on the left or the right said this is truly a choice this is that overwhelming need that we are out actively discussing and talking to our batters about but it is truly and for them you know their choice on whether or not they want to enroll as this new provider type and we don't have any plans to go in and enforce anyone or get rid of another provider type. Yeah I guess my question though if we're sort of expanding the scope of this group where they can now provide the services of the other his is there any objection to be heard any objection from the provider side neither side to sort of expanding who can participate yes may I would want to yes we had some from providers from that behavioral health side of the house I think it was a concern the purpose services that you're that are listed here are really those home and community based services that many of these services are done to a high school grad maybe college degree with their parent professional services for the most part and we get to that on the next two slides and there was concern you know that they needed the clinical component attached to it this does not mean you can't do a clinical component you can't have a counselor but these really how they were written into the past manual on how we promulgated that program they are para professional services and meant to go in and help people in their homes these are not suppose take the place of any kind of inpatient subacute psychiatric hospital that is that those are not allowed to be billed under this provider type and these are really people going into your home in doing work with you to stabilize you and teaches life skills. I'm sorry I guess I wanna yes Sir when we run this bill as anybody can come to committee and testify against thanks well this is already in place and they did we didn't work through all of that with them. We think that there was confusion on what this program was supposed to do and once we talk three with the providers they understood but I let me just be honest I mean anytime you expand a provider type to include and the providers there is a competitive consent competition concern so I don't want to act like it's everything's great and everybody's cool with that because I think that and there is still concern that people are coming into their area today's service but I think we work through with the behavioral health provides explaining to them these are really services that are done in people's homes this is not trying to take away from your hospitals. So we're not talking about running any legislation passed what we did this last session to create this card right this is already there okay thank you and represent first and then they can correct me if I'm wrong because again I'm going back to the conversation about a year and a half ago a lot of the providers that had issues with this works pressing their opinion back then when this was all being worked up in those manuals were being worked out the biggest issue I think back then was that one of the provider groups wanted you all to go ahead and push that manual through your shown resistance because you wanted the other two manuals and do it as a package and we went ahead push that one through because there was the issue of what they have to get dual certification or could at all so a lot of that stuff got discussed year and a half ago not say somebody may not still be happy with this but I don't think it's going to be because it's gonna be more the spirit of competition and and who's grabbing the lion's share of the market based on where they want to adopt to this new model or not or move away from the old one and I in my in my mission care to raising anything in what I just said or is that of a decent summary yes I believe so okay all right of center Beckham. Thanks chair I was what's the difference between the door certification this new and it is what are we sacrificing. What is a provider of not required to do. To get this certification versatile certification. So I'll so I would say on the on the DVD side this is a hot and for those providers that are currently C. S. waiver this is a this is a harder certification for them this requires accreditation you'll probably heard them people talk about cars and it's an outside company that comes in and make sure you're meeting all the requirements that there is an accreditation requirement associated with this provider tight there's also additional training on this provider tight that that DD. waiver providers were not required or not required to do under their old because we want people trained on on duty and behavioral health we want people to serve both under this type so I would say for DD this is am I harder maybe a harder more things to jump through to become this provider type because of the clientele we're asking them to serve. And we did not Sunset the provider types that already existed so we continue to have the hero Health agents and therapeutic communities that is certifications accessed but the therapeutic community certification was extremely prescriptive I think Director stands already talked about that in the providers actually came to us and asked us to revise that main all because it was so prescriptive. It didn't allow for the freedom to move back and forth like director Stan said with services based on beneficiary need it required X. number of hours no matter what and so for the barrel health providers this new certification allows them to actually provide services based on the acuity how how difficult the clients are that are within their programs and the client specific need and for providers who don't wish to get this new certification they still remain certified under the old sorry cation regulations because we did not sentence at them. Go ahead on the behavioral health side of it what's. Really not required to do for this than what they were before to do the same the same functions they had before. Training so that was part of that concern from behavioral health clients when we were running this back in the winter. Under outpatient behavioral health which is the one on the right side there there is an enormous amount of training component that goes along with that by with that provider type you have to also remember that provider type also houses all of the very intensive services that you will be discussed probably in this committee which is that the in patient the seven key that psychiatric residential facilities and all of the behavior health programs were put underneath one manual so what we did with this is we pulled out the ones that did not have a clinical component in the services groups and that are done by pair professionals so we felt that because we're not talking about this higher level of services they're not allowed under this provider type and that the training component did not need to be as stringent as it would if you were going to Methodist into one of their you know bads in their hospital which you know we do think that means a higher level of training I'm sorry thank you to. Are any other questions at this time. So. The it if. A firm wanted to bring their two respective columns together into one new classification one new provider group are they going to be reimbursed any at a higher rate because you're providing both services or What's the incentive for them to do that because getting work force. Getting work force is gonna be just as hard as it ever was but this new provider group. It's going to have that challenge any higher reimbursement or incentives yes so that is something that we have been talking with the passes since we before we even promulgated this that there is a real benefit to these provider types that can be both sides of services and therefore yes we do agree that the rate that is page should reflect that in effect we are currently if you look on page five there are programs on the right called therapeutic communities and community re integration. These are. In many cases secure. Facilities that operate very similar in our opinion to do what we can provided the Arkansas State Hospital and human development centers. Currently what's happening is if someone is very hard to place and I am full at the human development centers and duration J. Heller full at the state hospital which is almost always. And because on a that they are they stayed busy over that then. There seems to be like there's there's nowhere else for them to go. So what we're dealing with these two programs on page five therapy communities and can mean community reintegration. These are two programs that you can provide under this enhanced level of CSS pee. And these are being looked at right now for complete rate re basing. We are asking them to take the hardest clients that Medicaid has and we think we should pay accordingly so we are looking M. and the comparisons that we're looking at are the rates at the state hospital and human development centers because there really isn't anything else compatible and there's not a lot of states doing this and so you will see very soon we met on Friday and to look at the proposal and these rates we M. we think will go up and once M. we start talking about that I think we will see some more movement in this space that people wanting to become this provider type lots of people are on hold waiting to see if they can financially make this work with an increase in the rate because we have heard that this is a lot of work a lot of staff a lot of and you know a lot of physical plant requirements keep people safe and they would like to know what the new rate is going to be safe and that should be coming out in the next several weeks and then you'll see us probably really start pushing this new provider type particularly these two programs and across the state to our providers and we have a. I would say four to five members in the past each week where we really struggle and and spend an enormous amount of time trying to find the appropriate service and we think that there's that there's a series of things we're working on but we think these two programs and will really help fill a gap in the continuum we have right now and everyone not funneling to the state hospital and human development centers and especially for the population that is our our primary need is for those who are dually diagnosed which means that they have both the behavioral health is significant the herbal health disorder as well as if it can't DD ID disorder as well so that's where we're focusing these programs and these two programs are and twenty four hours a day programs like Melissa said there secure where they provide twenty four hour monitoring for these individuals to ensure their safety within the community center Gilmore. Yeah just a quick question so how many providers have applied or do you anticipate applying for this do you have any numbers on that I would say six. Yes asset for Friday we had twenty providers have gone through the certification process and are currently certified as CSS okay providers that's more than I thought. Thank you well let me rephrase that twenty sites that may be the before the six providers but we have twenty specific sites I just wanna make sure vote in in asking you anticipate more getting into this. Geographically are they getting spread out across the state or they all clustered up. We wanted that on Friday at this point Senator Hammer we would really just need them to open and it's it's you know we can be completely Frank but yes ideally they would be position across the state and because the bill H. C. C. is where we send a lot of these members and said we have a lot of people going to Booneville we also have units at the Warren Human development center so people are going to war and and so right now we're doing quite a bit of traveling and with some of our clients but we are looking at how can we position our our in house provider said think about the holes that we're seeing in the mapping across the state. Okay I want drift back to representative Baltz I S. P. and representative gray because you mentioned common denominator that is get him out of state hospital a and the mental health services is there a is there and not make any sense to to be a connection between what this is doing and what they're proposed ISP is doing and maybe the two need to get together and talk. And yes absolutely yes okay the other thing is. If are we going to be seated climbing population out of the human development centers as this model takes hold more providers embrace it because you've mentioned the human development centers on a couple comments already so what do you anticipate the future being that if a birch tree or some other private provider that's getting in this business now begins to capture that market how's that going to affect the human development centers that are out there because we've had heated debates about human development centers over the years so yes we know that I feel like I'm going against national trend and we're building. So no there is no doubt that we won't stay full human development centers we are seeing a change in our population I mean when I first started it was a lot of them clients would just ID D. who parent whose parents were getting older and they were bringing them to the human development center out of fear that they were going to pass away and not have anybody to take care of their son or daughter. Now we're getting a lot of referrals for this type of member who has pretty significant behavioral health needs and so we are actually on the Google campus I think Mostaganem we're building some really pretty state of the art buildings at that campus and we are only from this point going to bill behavioral units clients do really well there there's thousands of acres of land it separated out and the staff there been trained to take clients with both types of disabilities so when we talk to the passes and providers we say we don't believe this is going to and take our clients we think this is just going to help us find places for people to go and we have no intentions of not keeping our centers open and full but I bet my behavioral beds are always full time I do have openings for other types of clients but will eat that are you know just need extensive medical care we're not getting those referrals. So we're trying to ship accordingly to the need right now to represent Bentley. Thank you chairman a couple quick questions first what are the numbers we're looking at in the state for this population do we have an estimate so what what our numbers are looking like. So I know that we have done some estimates on the state hospital we were John Maddox to to head so for the complex we're calling complex placements which is a really difficult non restore opal beneficiaries and we have about a hundred of those a year who come to the state hospital that would benefit from this program the therapeutic communities and increased beds for that so just that population is about a hundred a year quick follow up chairman yes ma'am so he said it's not many other states in doing what you guys or entity which applaud so what what are the other states to just increase in advance or and. We only we only have one state hospitals some other State some other states do have additional state hospital beds I'm an old clinician so I I have to be completely transparent and clinician and you know we want individuals to be in the least restrictive environment possible so certainly we want them in home and community based services and that's one of the reasons that we created this and created the past system is that under the old system the system was medical and it was a treatment system in so there is that point at which individuals needed home and community based services to support and keep them safe and a home environment so ultimately that's where we wanna get with those individuals who can and for those individuals who cannot then we want the appropriate placements for them great one last question sure take chairman so. This is to talk about representive awesome there bill what is a crisis stabilization units fit in with all this with you guys is that. And the crisis stabilization units are part of our continuum of care we added a cute crisis units when we did behavioral health transformation and then also there the crisis stabilization units and they're part of that continuum of care that we've tried to build out over the last several years and the therapeutic communities and community or integration our state you know a step down or step up from residential services and we added adult residential so the crisis stabilization units hopefully will help us increase our continuum of care to ensure if someone needs to go into an acute crisis unit across the stabilization unit then that leaves open beds for acute process for those individuals who are more stack and you know cute with crisis is just what it sounds like it's a keep crisis or talking about a very limited number of days that you know he stabilized make sure not to harm yourself or others. These that we're talking about these programs like therapy committees for adults and community reintegration for Children long term treatment. Okay. A couple quick questions we're gonna raise paid to these provider groups I kind of anticipate that there's going to be a he said I didn't pay anything to hang on to. Senator Beckham S. the question. He per day you. Your your cell but go ahead. The C. S. waiver groups when they get this new certification those things that they're doing now they get higher reimbursement rate correct. So what we're looking at so on the on time we are looking at that rates that Senate what we're looking at on page five on right now that we anticipate will go up are those two programs on the right therapeutic communities and community reintegration which are physical facility locations buildings twenty four hour staff all the ones on the left so I will say because and that now with the governor's executive directive we are reviewing providers rates on a regular four year schedule all the service on the left are in queue to undergo a rate review so M. it should be starting in the next episode months two months because they're in the schedule so they will be looked at and I don't know at this point because I don't have any information on whether or not they'll go up or stay the same but we're actively right now DO in the rates on therapy communities and community reintegration. You mentioned earlier that I think it's all of a sudden it's being billed out of top tier rate. We're trying to get the passes to pay. Where to you know I gotta be careful I don't put them on the spot because they're not here working with the passes to and. To see the value in having one provider type provide both sets of services and when they know that we actively are working on these provider types and we have insinuated that I'm paying for this provider to hate because it would benefit them would help us build this out. Thank you good. Members just give your comfort level I'm I'm shooting for eleven we may not get there but that's my target eleven o'clock Senator Bledsoe. Thank you Mr chair under your plan Leding of the C. issues to community re integration. With the C. issues still be voluntary or will they become involuntary. So I want to separate that the crisis stabilization units or those units that are funded through our division the division of aging adult barrel Health Services and they're written in statute I mean look at Clark is gonna make sure I'm I'm using the appropriate terms so crosses stabilization units are part of that statute part of the working with mark law enforcement training of law enforcement and being able mark you want me to hash okay. And so does our crisis stabilization units Medicaid has a provider type a cute process and that all of our crisis stabilization units are also certified as a Medicaid provider which is an acute crisis unit and so our hope is that we will have individuals who can who build out that continuum of care by becoming a cute cross issuance and mark your. Mr Clark why did just if if I can add to that. The C. is used when they're acting as CSU's their jurisdiction and their thorny is isn't statute and so for them to transition to a non voluntary system op I believe that would require a change in the statute and so that would be up to you all to a do a change now with that said. In other programs that we have talked to see issues about some other opportunities for some programs they could offer to help generate additional revenue no the use the best they may not be using other days and so some of those may play into that but that would not be at if when they're functioning as a CSU if that makes sense. I agree that it would probably Would have to change the law but would we not have wouldn't. You know he didn't name them something else if there involuntary. If if they became involuntary the. Yes I speak you probably wanted to change the name change number of things that that was the the choice the legislation may when I was thinking on so with expensive too because you'd have to have a. You know say you're a secure environment yes because the the the secure environment that as six two significant expense to it was that part of the reason why we're talking about what we're looking at adjusting the rate for no therapy committees Committee reintegration because those are often have to have that secure element as well and so yes that that does add to the cost we need that secure environment for thank you. We have how many you think you've got for providers that have already. For providers are very up and certified ready to go with that equates to twenty locations across the state. how many of those providers are fully certified ready to go. I do think it's sex with various sites I'll tell you this on for CSS pee as you can tell on that. Page five there's two levels so you come in and you can do this base level which is all the services in the home but if you want to do the service on the right the enhanced you need to enhance license so we have we have some DD providers that have come over and receive their CSS pee right now all they have is base and what what the barrier were up against is. Finding land building facilities right now right or if they have the property renovating them and getting them ready to go when committee or or struggling with their business because of what's been going on so we are meeting in offering ways where we can assist with that part of it and will be coming before go again with them some some of the archipelago cels one of the things that we're looking at is at back at defending that providers could request to actually build or renovate to make therapy communities or community reintegration because we are in such need for these placements so but right now I would say people that have the enhanced that actually can provide therapeutic community or community re integration as stress said I would say it's between five and six providers and they have multiple sites okay if a provider has already gone through the process of getting certified they did that at their own expense with no compensation from the passes anybody else that was on their nickel right well I would say. Necessarily so and so Senate community care was offering to their community investment dollars they were offering to pay for providers to become accredited because that is a pretty significant cost and as I said C. as waiver does not require accreditation but this provider type does says summit was paying for providers to be accredited and empower healthcare solutions what is paying for the training component of the and training for the workers for behavioral health and DD that were requiring so they were both chipping in on programs to provide those two services that providers would not have to and feel that expense that's when they became the state provider type representative first. I guess I was just wondering how we're doing on placement now is there a wait list for placement and has the pandemic affected placement other people that we actually have not been able to place. Yes we have a yes I mean. Yes yes all that time this is a huge name. And you will see us really discussing at the next couple of weeks we are that we are spending a lot of time. Trying to make sure people have the services that they need. Do you have a widely I mean is there do you have a number of people on the wait list just so we have some idea we can get that for you we don't keep a wait list because we make it we're making it work right you cannot leave people in certain situations we are making it work probably not in the best place but we're and we're getting them the services that we can and to stabilize and help them so I wouldn't say there's a silly a wait list all the time but we are working forty five cases a week I'm trying to get in the best place. It if I may add this is not a new problem I know as long as I've been at DHS it is a once a month if not more often situation of we got a frantic call of an individual who is there any are there in a bad situation they need to be placed somewhere in there someone has really significant needs and there's not an appropriate placement for them and so it is always this long been a struggle there but I think we finally got the structure in place now we can start addressing that and really start to get these people in environments that are appropriate for they need to be and no particular on the past model no I was talking to one of the other week and we've we've got paspalum running we've got a lot of low hanging fruit in our start to jump to address some of these real significant challenges that been challenges for decades and course we're happy to be working to pass as a partner with them and to get some solutions going. Senator Gilmore but we don't represent first. Yep Sir go more. Yes so just wanna make sure I understood this correctly if I'm wrong. So it passes helps some these other providers get the higher certification which will do away with lower certification right. To the extent right hand if they want to get rid of it yes yeah. Okay it's so. Okay I'm I have a follow up on one thing about the. The When you talk about acquiring property. I just put in this request that you think about that somehow no these are geographically spread across the street state and maybe even look I know the human development centers several of them have large tracts of land which would put a private business competing against state paid employees which might be you know might be a little bit of a stealing of employees environment but. Public private partnerships with some of land we've got if that just so that the main thing about well I would say we would give that property away at this point if we could but there are federal wills called the settings requirements which means that a private provider cannot come builder provide service on my property because I ate ran an institution so it is barred and everything we talk about the past that I have some step downs at the Jonesborough center that work really well because you just walk across the campus and you go to a private provider that they have and they have stopped to that that is not allowable now under federal law so we can't balance and grandfathered in but I actually can't have a private provider on my property. And maybe this will work on long term because that ridiculous but anyway okay anybody else on any this matter represent Bentley. One last quick question thank you chairman would how many people been and is there pretty committees and what is the average length of stay. We actually just saw that and we had right around four hundred people and that have been served by therapeutic communities and there are various levels at their peak committee so they can that they can step down and back up depending on the need and we'll have to find you the average length of stay what are concern lies is that it we said you know it's not we're not seeing the number of denials right we're seeing a number people they serve that we're trying to figure out how many like you are talking about how many beds do we actually need how many people are being turned down that could benefit from that service so we've gone back to regroup and that's what we're looking at that will go into play only separate. The representative so maybe you can answer my question I asked the and earlier is there a certificate in Nader limit I mean can I just add the number bits they wanted these facilities are they have to or is there some approval process for thirty communities committee reintegration there's not a limit that's if if provider get certified for us and and you know jump through those hoops they can they can open beds the staff in the process of applause the only as rolling here would be applies to assisted living facilities and also psychiatric residential treatment facilities and for P. RTS in particular there is a moratorium on approval new P. RTS at this point and that's those are within the health service permit agency over the part of health yeah I guess the reason I ask that you not have the facility in West Memphis than I thought at one time they wanted to add more beds and we were actually sending people to Tennessee to get traded instead but they couldn't get more benefits is that still I mean that was several years ago and there is there is still a moratorium on adding additional best other arson had been several club member businessman added to serve out of state residents because the more for only applies to bids for in state residents but with that said and I'll certainly keep instead open correction I'm not aware that there is a shortage of those bids least I'll think we've had any issues with placing folks in those bits when when is needed I would certainly go back double check on that. Represent Bentley were you done I'm done thank you Sir okay part of any other questions. Yes Les Paul knows make you're going to you're going to set the rate. That's going to go to the passes who will negotiate with providers to take care of this population am I right. Marcus adequate can't so I would say being about rates Yes so you know the rates for the pastor said based on their membership in their global payments that went rate increases if a rate increase. That is taken in consideration what we pay them and their their payment also reflects that increase okay then I'm gonna ask this question Catherine's in the back room maybe a couple the other ones but. I just wanna make sure that when that rate is established that the providers they're gonna be actually provide the services are not gonna be operating on a shoestring to where they can afford that if they're gonna go through the certification process to offer this new Avenue that we're not going to be here at this far as not being sufficiently compensated maybe you can't get into that don't want to get into that but it's been said anyway so Catherine you want to say thing you're. In a record for the same tile for record please Catherine's of a summit community care government relations okay want to address. Comment so just I I think structurally it's important to understand that the way that that passes pay is generally based on services so there are several services within this provider tape so what we're talking about is like to rates within one fifteen twenty so that are currently being increased on the fee for service side so if that's helpful to understand I think we do generally you know aligned with their pay more than the fee for service rate for each service but there's not like because they're as CSS pee I daily rate no matter what that client is getting they would see a range of clients so they may see a client who only needs DD services or only needs behavioral health services and so we would pay based on the services that client is receiving they may also see these dual members who arguably have higher you know higher needs and then higher costs to serve so I think from the past perspective we're often having conversations with our at summit provider investors about you know how can we work together to meet the needs of these may be harder to serve members who may be more expensive and that's a conversation less is getting to that we're trying to collaborate on that all these rate changes would be factored into that on the past I've certainly we're not looking to you know not reimbursed for the harder to serve clients it's just that we found it skews me on some of these even going to. When we're trying to go to providers and find someone to serve a hard to serve clients the reimbursement doesn't always make the difference even when we're willing to make some flexibility is there so we are looking at multiple solutions. Including great flexibility to an account number represent Vaught. Thank you Mr chair for indulging me even though I don't sit on this committee miss Catherine is there a is there a fine to the passes if we can't find a spot available for these individuals or is that left up to DHS to do. Mark's gonna answer. Yes there is potential of living sanctions on the pass when they are unable to find an adequate placement for an individual because that's that's part of the contractual responsibility okay can I have a follow up sure if there's a problem with places to go with them why are we finding someone if we're having a hard enough time as it is finding a place for them to be well because of one reason we created the house was the the bringing a private organizations to help develop those environments and develop those placements because that is something that he can be done it has been on rotation and just need to be done here and so that's that's part expectation the passes is that they it's not they're they're not just there to pay the bills they're there to help create the structure provide appropriate placements and appropriate care for beneficiaries can I have one last follow up sorry Mr yes ma'am so I mean I got a text message from someone who got a twenty five thousand dollar fine but they were doing everything passed was doing everything they could to find a spot for them to go. And I understand miss Melissa actually help them out and found them a spot within her facility. But the pass was doing everything possible so that's kind of a no win situation I mean I'm not taking up for the pass or condemn and for a fine so don't misunderstand me I just don't know how you overcome that hurdle if they're doing everything they can we don't have a spot to put on are they say magically supposed to find a place to put on I mean I'm kind of confused they're they're supposed to do the investments in the work necessary to build a structure we have those placements and so I mean it comes down to I mean this is their contractual obligations no just we any other vendor for the state we pay that vendor to do a service to provide a product if they can't do it then there there any consequences. Senate go more. And I know you're all you're gonna love this question marks there anyone down there I guess maybe if Martin want to answer it but I'm just gonna throw it out there how how does this proposed change has this save taxpayers money. Well for a for this proposed laws say it saves taxpayer money is by providing appropriate placements for people who need these services because we don't have appropriate places they become drains elsewhere out that sounds bad but it was it's not it's much it's more efficient and better for taxpayers for an individual who has significant DD and B. H. issues to be in a community setting rather than sitting in emergency room or sitting in a hospital I mean there were situations where. I've heard of non Medicaid clients sitting in hospitals for months at a time and that's just building up tens hundreds of thousand dollars a cost that when this appropriate placement is available that's cheaper the taxpayers in the long run. Okay so to wrap it up. This state this model is in place now. Manuals are in place now. Providers are moving toward this model if that's what they want to be and the if what would you say as far as the effects of the success of it by the reduction of the numbers in the state hospital in other locations if we had to come back what two three months and you could say Hey here's where we are today and this is here's a measurable concrete evidence. What what do you need a couple months or. I would say that with this look that problem or by like a six month doing one year run away because we've got some providers that are interested in setting up more a particular out there be communities I think most of the writing place that's going to be the trigger they need to actually start those plans in motion it will take some time for them to get facilities pull together up in operating and course as you all know hiring staff is greater and greater struggle in this economy right now but I think six months to a year the gross one good indication of success okay so let's do this subject to the co chair being agreeable to it let's have it back in three months let's have the providers later on in the loop on the discussion let's just do a spot check in three months and by then maybe representative Vaught in her eyes P. and represented Great we can we can merge those two things together just to have that conversation is that okay with you yeah okay certainly that is our thought of this this is a topic that would play right into what the study is looking at our represent first. At the end of this is not exactly the subject but related how is the assessment process going a man is that become more seamless I mean how are. And getting people on the waiver listen just of getting them into you know a category of type one two or three I mean has all that assessment going. So it's it's going while signal often does thousands of assessments for us and then and back in March we and we put some waivers in place that would allow some of that independence estimates should be put on hold and then some to be done and virtually and what we're doing right now as part of I think and what mark talks about a presentation on P. H. E. wine down independent assessments are a big component of that we're going in in ensuring that the assessment that they're not resend that were re assessing people before we get to the point where we're looking at their Medicaid eligibility so we have a couple of different less going where we're doing the ones recess due on time and even the ones that are put on hold and you can do in one's on certain days there's a lot going on with independence estimates but there is a schedule and that method to the madness on how we're going through I'm I'm twenty now and December. Good. Okay anybody else. Thank you for the thorough presentation in the answers questions and I think we got through all your material that we or was there anything else thank you for having us okay we'll see in about three months and fill work it out with you. All right less items if and Michigan I think that you. Mr will not be amendments can be the primary presenter on this and also she's bring Mr maybe ill as well in the committee some self that's when you would just twenty second air lection on this we're seeing the use of piers Morgan more or and treatment for substance abuse and mental health and seems really exciting things is not so it's got a lot of tension the past didn't know if you all were very familiar with the use of peers and not so was going to come for you and give you a little explanation of what's happening some exciting things are happening do me a favor for the record mark witnessed name and title please yes I'm sorry mark quite the edges all right if you all would please introduce yourself for the record and then proceed at your leisure centres again deputy director division of aging adult may have a health services. Jimmy McGill recovery manager division of aging adult and behavioral services okay we'll go ahead. I apologize I printed off the wrong presentation this morning so and. So I'm gonna give a brief introduction and then I'm gonna turn this over to Jamie to talk about peers in two thousand eighteen DHS hired peer recovery coordinator Jimmy McGill and sent him across the country to receive peer programs before two thousand seventeen peer recovery was really virtually nonexistent in the State of Arkansas peers only worked at treatment centers in a substance abuse treatment centers where a lack of understanding of the unique role appears lead to an appropriate job descriptions and under utilization of peers and as a again I said that I've been a clinician for twenty six years so really there has been a very clinical focus and that kind of bled over into the use of peers and Jimmy and I have had some really amazing discussions as we've gone through this transformation of how we look at peers in this state based on the review of these programs the Georgia model was deemed to be the most appropriate model to use in Arkansas it was developed by the appellation consulting group and was considered the gold standard I was being used by up to forty states the Georgia model was modified by Arkansas to include by substance use and mental health and graduated levels of training and certification in it became known as the Arkansas model. Since two thousand nineteen the Arkansas model has gained national attention is considered to be the diamond standard of peer support recovery the Arkansas model is the only one in the nation offering a career ladder with workforce development. The initial phase of development Arkansas concentrated on substance use recovery efforts but in two thousand twenty one substance use and behavioral health mental health is all under the division of aging adult behavioral health services so we really began to have these meetings around integrating fully and completely by the substance use and mental health peer recovery into a model and moving forward to develop this integrated and expanded peer support system in the state and Jimmy I'm an attorney and I read a. Thank you cherish and thanks for the opportunity to be here what makes the Arkansas model so unique is not just a workforce development and career ladder but the supervision peace so one of the things we quickly learned as we were traveling around the nation where the peer support according to the federal government was a key component to reducing recidivism helping citizens sustain long term recovery in mental health and or substance use but that would quickly burn out there was no there's no room for them to grow their we get hired on at a minimum wage a year to later they would decide to go to school so this most effective tool that we discovered was suddenly there was this gap in employment because there was no room for growth in the work field so we quickly modified that we that got leadership to buy in and we created the first ever national career ladder for peer support so begins as appear in training then you become a certified peer and then an advanced peer recovery specialist and then you can go on to become a peer recovery care supervisor in clinical language that would be a clinical supervisor for us C. I. T. a counselor in training and so that created the need and you can only get to the next phase by completing testing and recertified each level and so the the basic criteria to even be considered to be appearing training is you have got to have a minimum of two years of substance use recovery and mental health recovery that means you have lived through your diagnosis or you're if you're addiction and you have not been defined by and in fact you have overcame it and you're now using that experience to help others. Once you've got that two years if you have a GED and you have not according to ACT nine fifty one that the governor signed into law in twenty nineteen if you haven't got any sexual offenses or any violent offenses you would qualify to be a peer recovery support specialist which is also key and why we are so good at reducing recidivism rates because we can go back into the jails and into the prison systems and we become a beacon of hope to a population of people that identifies as authentic. Now once you've completed your training you receive what's called a peer recovery peer supervisor they are the only ones who can sign off on the five hundred hours of internship that is required for you to take your state exam. And so that that's the basic peer in training now once you're certified. And you can pleads all of those those criterias you have to have forty six hours of class time you've got to have an additional sixteen hours of on going education the five hundred hours of work experience and one hundred of those hours are domain specific and by that I mean twenty five an advocacy ethical responsibility mentor in an education and personal recovery and well Bridie and twenty five hours of those are direct peer supervision where if I am a basic peer I am meeting with the certified peer recovery specialist one hour a week for direct supervision this person is monitoring my on going professional development my ethical stuff my my scope of practice my standards of work all that. Now once I've completed that level this is where the Arkansas model became nationally known I have the option to advance and by Vance and I also increased my pay incentives and I I increase the level of care that I'm providing with experience and and more in depth training so I've got the option to become an advance peer recovery specialist that's basically the same exact scenario that's an additional twenty four hours of class time training sixteen hours of have continued education another five hundred hours of internship same process and again. you can also do that with the peer recovery supervision now there is a state exam at the end of each process you cannot get to the next into you take in a seventy five questions peer recovery exam which is certified to a national accreditation agency called Nate Act association of addiction professionals and so they're nationally known they bring air of legitimacy to what we've done in Arkansas that the peer recovery peers supervisors what everybody wants to become a P. R. P. S. at that point same process now The difference is during that five hundred hour internship you're also providing supervision under supervised care so you're learning the process off the bat and again the same Criterion test now. Once you get that you start getting into the program development Lonoke county jail was our first peer recovery project in twenty eighteen so this is where we get to saving the money in the data that backs it up we chose sixteen truly knuckle headed individuals that wouldn't qualify for drug court these are not people who could be released they had substantial criminal histories they were in and out of the jail on a it was just I hate to use a stigmatic term but they were what they would call a frequent flyer. And so out of those sixteen man. Ninety days of a jail program. Nine months of after care working with the peer recovery specialist twelve of those men are still insisting for recovery today these were people who had burglary charges staff charges they were a burden on their community and now they're called to be a beacon of hope to the same communities they wants trouble they sixty percent of those Manhattan had never been offered drug treatment. They were unaware that recovery was even a possibility. forty percent of them had been in a traditional treatment center sixty percent of these men chose to leave jail and go to sober living instead of back home where where they could have went and did whatever they wanted to. Eighty five percent of them had been incarcerated at this same jail. For more than three times over thirty days if they had stuck to that recidivism rate they would have got out based on their own their their own. The this is their records we're looking at every time we release some they would be back in jail within three to six weeks about fifty six dollars a day to house an inmate in the state of Arkansas those twelve inmates one year save loan County taxpayers two hundred and seventy four thousand dollars based on the one thirty five thousand dollar salary that DHS provided them with that open the door for funding everywhere for peer support so now we have got five different to the jail program six different law enforcement programs we've just we've got programs everywhere we launched what's called the recovery clinic that's a social media the substance use and mental health tool that during covid the most important thing that that me being a person in long term recovery myself has is the community of other people in recovery now COVID strip that away all of a sudden the recovery community we can go to our church groups we can go to our cross speed we couldn't go to the GM we can go to AA meetings we could go to self help groups everything that has to help us become a contribution to society was ripped away so the peers came together presented to our leadership and they funded what's called the recovery clinic we have helped hundreds of people over the last year to this social media get into treatment for mental health and substance use we formed overdose awareness events where we turn the Bridgeport purple on October thirty first everybody comes out we celebrate some of the jail programs that we're in currently are Lonoke County Lawrence county garland county and Sebastian County. in addition to that we also have a program in the Division of Youth Services so we've got to peer support specialist providing peer support to the juveniles who are incarcerated in our state. We've recently formed what's called overdose response team again Arkansas is unique in this this is where you peer are you pair appear with a police officer so I imagine the story cops and robbers with a happy ending you've literally got a recovering drug addict and a law enforcement officers in most cases these enforcement officers were the ones to arrest a person in recovery and so they're going out I just wanna use the Izard County project for example there peer recovery specialist in the last three months has gotten twenty five people that overdose into treatment instead of jail now the the the the accountability is still there we don't remove that you're charged if you commit a crime but you get the help you need to that process so instead of putting them in jail we were able to get them and drug treatment and I did that that twenty five eighteen of them are still working with their peer support specialist so we've got a total of six of those we've also place peer recovery specialist in emergency departments at Bradley County Medical Center Jefferson County unity health river valley and we're currently in process of placing one and Salim county to be used in a try try fictive basically between both hospitals and selling county and the sheriff's office we currently got three hundred and seventy three peer recovery specialists trained in the state of Arkansas. That number is important but it's important for this that's three hundred and seventy three our Kansans who were once a burden to us because of their addiction or mental health and now that's three hundred and seventy three people who might save your sons daughters and grandchildren. That's an important number. we've got ongoing classes to increase peer recovery support specialist we have a training every month out of the seventy five counties the Division of aging and adult behavior health services has a goal to place peer recovery support in all seventy five counties we've got twenty four counties to go twenty four and that's amazing we're using multiple funding streams to support the peer recovery initiative in the State of we're currently in outreach to courts law enforcement hospitals providers criminal justice system and any others that we can identify and create opportunities to place peer recovery support specialist. And that is it for me Senator Hammer all right of going to start with members and I've got questions if they don't get him represent Bentley. Thank you chairman this is a great report now tell me what we can do as legislators to get this in our district as I don't see any of my counties listed here but there's a huge huge need I can say that for sure so what can we do as legislators to help support this in our districts. I'm we are currently is is Jamie said we're using multiple funding streams to try to impose tight turning crease the number of individuals who are being trained we also are really bringing this program together so when Jimmy talks about the peer support peer recovery support program he really initially focused on individuals who have a primary substance abuse substance use diagnosis but in the conversations that Jamie and I've had over the last year what we realize is that you rarely is there a one sided diagnosis we have individuals who also you know we earlier talked about the C. S. S. P. programs and we talked about people with persistent and chronic mental illness. And to give you an example the we we have some awesome stories so I'm sorry only is your question ma'am I'm to throw out this awesome story we had a lady who is dually diagnosed meaning that she had about the substance abuse issue but she also was chronically in persistently mentally all should a diagnosis of schizophrenia. She had been in contact with law enforcement multiple times she would she would be picked up she would be screened by the local community mental health center she would go into an acute treatment program and then she would come back out and we would have the same thing again and again and again so what happened is. I am we got the brilliant idea because we are clinicians I understand that as a clinician I have a license I have an ethical standard and I think about making sure people are safe in an acute care setting I just have to admit to my own what is it Jamie. So here peers has been really we we have done a lot of talking so we said why not we con Jamie and we set it appear to go and see her she's in jail again and this is not working so we did add instead of approaching it from the mental health side which is screener and get her into an acute care placement we went about it from the pier side peers have a whole different way of dealing with people than we do they packed her up in the car put their her in their car drove her to a facility went in with her helped her son into that facility but then they continue to call and talk to her they went and picked her up they took her back home they helped her find housing they gave her their phone numbers so that she could call them twenty four hours a day seven days a week it is a different model than what we really have experienced under so because of that as we took someone who had been in constant contact with law enforcement who had both a substance use in a chronic mental illness and got them stable in the community with that peer support so what we're we have seen the value of that so moving forward we have multiple funding streams we're working with Jamie we're combining our contracts we are going to continue to train peers we need people to help us identify those peers in communities so I think one of the things that can happen is that if you know someone in your community has been in recovery someone who might meet these criteria let us know we can reach out to them they may not know about the peer support recovery program so certainly helping us define these individuals within your communities Making sure that there's some place for them to go to work when they're through with training so we we want to make sure that when we get through training them they have a place to go and a place to work hospitals courts legal jails places to go where they're going to be employed and they can become peer support specialist peer support supervisors and expand this program so I don't know if that answers your question. One quick follow up real fast sure so you said that there. So the civic jails and hospitals hiring these people so explain the funding stream just real briefly to me on that. Yeah absolutely. It began with what was called the state targeted response grant which was also the grant that hired my position I was able to basically talk are Drug Director into letting me try this program in the criminal justice setting so that funding source with the data that we collected from S. T. R. the late into this state opioid response grant now the the programs that we're seeing now. They have been continued on when the grant funding when I went away and that was always the goal the goal was to gather enough data that showed the effectiveness and the necessity for this program that that basically an agency would look foolish to not hire the peer and and we've been very we've been very successful in that so but but it's always been so started by the state opioid response or the state targeted grants and now miscanthus got. Our own funding sources forced. So we have block grant funding which we can utilize state them what grant funding we also have some sense of funding and technical assistance money that we're using to expand this program and will continue to look at funding streams to expand at. Okay. Good all right the representative Ladyman. Thank you Mr yeah I had a question about liability with the peers are you familiar with we are the twenty two it's a bit from this organization and they have bedrooms to go in and and because it's a suicide prevention program there's twenty two veterans every day in the United States to commit suicide and that's a very good program I've been the three other meetings and spoke at the meeting but they had the question of the liability because these are individuals that have experienced this they're not really first responders so what about the liability a question in your. So absolutely and that's a great question thank you the difference between peer support is I never give advice sound like that unlike the clinical person who is going to give me a well you know thought out suggestion or piece of advice my role my scope of practice my ethics require me never to suggest anything to you I'm just a person in recovery like you that's it I'm a sounding board to walk beside I'm not above I'm not beneath I don't reach my hand down I reached across and so there's really no no liability piece for me. Because I am not responsible for any decisions I don't encourage any decisions all I am is a role model and a person to inspire hope okay follow please yes. as follows to that Do you have a suggestion on legislation you know we have the good Samaritan law that might come into play here but when I talk to the where the twenty two leadership they felt like that was a little bit we can what they do because even though that somebody might bring a lawsuit that's not going to they're not going to win and it's still there's a lot of problems with that so can we do something legislatively to protect your program there program we have another group there and create County John three sixteen it does similar work you may be familiar with them and be someone good for you to talk to if you're looking for folks to get into your program but do you have any suggestions on the legislation strengthening This American law or whatever. Personally I would say I think there probably are some tools in statute now that may we could be expanded to include and cover the situations good luck with the good Samaritan law there are some others I know that relate to volunteer efforts and similar things would be glad to work with them and see what kind of solutions we can find and have some filtering forward. Thank you thank you Mr represent person. Thank you Mr chair what what kind of requirement to your peer support people have for on going random drug testing I mean I know even after years of recovery relapse is not uncommon so is there some system in place for some random drug testing of the peer support people absolutely if there was some in place for the other employees as well. So to treat the peer different because of that would be basically setting us up for a disability acts unfair treatment center okay thank you. All right here's fifty questions I've got of this three hundred seventy three are all of those actively employed in working or are they just out there waiting for employment. So we're hoping that you will help us with that about two hundred of that one hundred and seven three hundred and seventy three that that the thing to that Senator Hammer is a lot of people have went through this training with the desire to be better in their own job right that requirement for training is that you're a person of recovery but there are a whole lot of clinical people who are people in recovery a whole lot of CEOs better people in recovery and just want to be better at understanding recovery as a role in their agencies how do you go about identifying who is a peer specialist without be trained defective maybe they've had a problem in the past the. That are just how do you handle that situation. So the biggest requirement for peer support is that I'm publicly loud and proud with my recovery and so that is part of the nature of the job when you when you sign up for it then you fully where else there there's no anonymity that we're not trying to break our job is to come to the legislative committee and testify to the power and hope of recovery okay so. Have you done a cost study a fiscal analysis that if you had those other hundred plus or minus people out there gainfully employed how that would reduce the cost that we pay out to the county jails and other state services because that was one of the things you were holding out is this is a real cost saving so have you done a fiscal analysis that for every one peer you have a positive impact of ten over here that might equate two dollars better spent over here. That's way above my pay grade let's work together on that because I think one of the justifications is if you've got historical data that showed that you could employer peer specialists at this price and it reduces the cost of incarceration over here that's a worthy investment that could net in savings and tax dollars and Justin approved as society should like to work with you on that may will turn that into a nice Pete that this committee could could work over in everybody chipped in and let's let's she would do to make it work the other thing is. You've got to have two years of personal experience as that as someone that is addicted before you can even get into this program because that's such a key component or not or is recovering from a behavioral health disorder so most often it's both you got have personal experience with your problem with zero two years success from being out research what is the problem yes Sir okay and then are you in the Alexander unit. You mentioned sling county are you in the Alexander unit yes Sir that is far too peer recovery specialist that's that's the captain unit for the Division of Youth Services okay all right and then As far as finding candidates for the peer program how do you interact like with John three sixteen John three seventeen some other organizations that maybe have their own concept about what peer recovery is and do you try to recruit out of those programs or how do you how do you recruit who goes into the peer program well I at this point you've got people left and right since submitting applications so what that looks like is is word of mouth is spread we've also partnered with fox sixteen and caring A. R. K. E. we've got mid south that sends out an email blast you've got this large social media push I myself have been a large component NO social media wise I've got over a hundred thousand followers and so that really helped us put the fire. To spreading across our state okay. Don't get away I want to talk afterwards the four year wait because I'm I know your personal work can be made with you and you you do an outstanding job and then senator Hammer before we stop I would really want to make sure that we are also working with our behavioral health providers to identify individuals who have been in recovery on the behavioral health side of this so that we can expand this network of providers so we hope to see a lot of individuals who are applying for in completing this program okay if I have any other questions for this. Okay thank you for being here we pray gets back to maybe get a pulse check in about three six months Tricia FOR you get away I got one question for you then we're going to adjourn yes this goes back to the previous topic yes Sir. Do we need to look at expanding the population at the over here to state hospital. Or maybe Clark is gonna answer that question for you if I can answer that I think right now the the the key need right now is for placements that are less restrictive in the state hospital and so that's that's what the one main reason for working through that right around community reintegration and therapeutic communities this creep those additional places because for every person who is in the State Hospital and really could be in a less restrictive environment once we move them out that freeze of a bad for someone who truly needs it now we're and we're looking at it and so it may be we could pull that we do have to ask the best state hospital right now we think the primary need is in those less restrictive bets okay and I want to Jimmy do you guys partner with private industry like say of I don't wanna call one part but say a large company to see about them hiring on your peer specialist to work within their population to have that working relationship with private industry yes Sir and anyone who it spear and his serves a population of people with a diagnosis of mental health or behavioral health or substance use we would encourage them to hire their own peers most of them do that with they don't have to go through us to higher up here all we do is guarantee that training and the development and the certification okay maybe we ought to match up to work you get with par or for services that could connect you with big companies that it be cheaper higher peer specialists inclusion ploys but anyway just a thought. All right any other questions. Thanks to the okay nothing else for the committee your journey