Public Health, Welfare and Labor- House & Senate

Ladies and gentlemen if you'll take your seats we're going to start our meeting. The chair sees a quorum. And the. Chairman Lehman you have any comments that you'd like to make a. Yeah I would like to make. Thank you all for being here I just wanted this a manager that I think next month I think a meeting is on August the second I believe it is his first Monday. At one o'clock. Sir I. Well I know it's is ten o'clock on the web page or something we need to correct because in these B. one. And I thank our subcommittees might need to meet at ten that morning at least the environmental committee because I I know there's a requirement that they meet. Every other month and we've got a lot of uh intern studies that probably need to be discussed. So members of the committee you need to watch there might be some subcommittee meetings so thank you manager. All right ladies and gentlemen I know that you some of you already know the subcommittees and of the code the chairs in. All of the members but I'm going to call that out. All right on the health services Committee subcommittee Senator Kim Hammer is the chair senator Dave Wallace and senator Ben Gilmore our members Human Services subcommittee Senator Scott Flippo is the chair Senator Breanne Davis and Senator bart Hester remembers. The labor and environmental subcommittee Senator David Wallace is the chair senator Dan Sullivan and Senator Scott Flippo our members and the you can also give you that on the website. All right moving along. Do I have a motion to adopt the minutes. I have a motion to have a second all those in favor say aye. All those. Motion passes. Right going to the. If. To add an update. A this would be mark point mark would you come to the table with with this is a discussion of the end of the federal public health emergency and its impact on Medicaid including Arkansas Works in Arkansas health an opportunity for me our Arkansas home and you're recognized. Thank you madam chair mark what department Human Services asked what apologized committee dawn Staley who is our district for health and state Medicaid director originally she was going to come to make this presentation I'm sure the family situation under her away so she sends her regrets and you got me instead to kind of walk through this but certainly I've got some other folks in the back who can help with answer any questions or if you have any. So what's what's author briefly about at what happens with Medicaid as we approach the end of the health emergency preclude the the public health emergency as declared by the federal government and I believe that you've got a copy of the slides in front of you. So as you know we are still in a federally declared a public health emergency the secretary of health and Human Services I renewed that public health emergency back in April as of right now it is scheduled to extend through July nineteenth and then if your call part of what that means for Medicaid is that we're receiving an enhanced match rate on our on the the federal funds we receive from Medicaid which means would put up less state dollars to pay for Medicaid expenditures of the catch is that as part of that the feds have placed limitations on us on removing individuals from it from Medicaid essentially if they are on the Medicaid program as long as this public health emergency extends they have to be left on the program skews me even if we think they may have come and help an eligible unless us unless they doubt or move out of state that's essentially the two conditions which we can remove someone from eligibility so we do have individuals who are on Medicaid rolls and we have to leave them on the rolls even though once we get to the point a bill to make a decision about their eligibility they likely will be found ineligible and we have removed from Medicaid. Now that that enhanced match rate this being paid it expires at the end of the quarter in which the public health emergency ants and so if it expired July nineteenth and that would put the expiration at the end of September for the end of that match rate but our expectation is that the that HHS is going to extended again based on what they have said to us as well as with a message to the governors around the state we believe that they intend to keep the federal public health emergency in place through the end of this calendar year and they've also indicated they will give us at least sixty days notice before they allow that federal public health emergency to expire. And I should also note that this is just the federal declared public health emergency we're talking about course we did have a state declared public health emergency as declared by the governor that is no longer in effect but that does not have any impact on the continuation of the federal public health emergency. As I said this does affect of all of our Medicaid programs and so includes that eligibility for our populations both on we'll call the man I got mad Johnson out of the house which includes our works will include our home our kids was of the categories include our Medicaid waivers for home and community based services as well as our other populations it also does have an impact on our Medicaid providers as well because we do have a number of flexibility as we have in place to give providers a little more flexibility and accommodation so they have some sort bars they don't necessarily have to meet wall that public health emergency continues are just as an example would give some flexibility on providing fingerprint verification for background checks we also delays some site visits for providers and as those things catch up Sir will will work for all those with that is exempt the flexibilities that will go away once that public health emergency goes away it's clear by the federal government. So what we're doing right now is we're continuing to do eligibility were determinations so that we see where folks stand which kept act on them if we find them an eligible but we do have folks to are indicate is eligible partly some because their income is has gone up some because they've not returned to a certain documentation are supposed to send us some because they have not done an independent assessment that may be required for their eligible to continue their number of reasons why someone might fall into that bucket of that we're finding them ineligible in this interim Tom and so what we're gonna do is as we reach the end of the public health emergency will be reaching out to those beneficiaries to help them understand that they that it or something they need to do something they need to send us make sure they understand what they need to do in order to keep their eligibility billing and so we'll have letters other communication and outreach efforts throughout the community and will be working to develop a plan to really get that message out there for beneficiaries will be doing the same for providers who may have some things that they owe us some things they need to guess in terms of documentation or other actions so they can get that in and remain enrolled even after the public health emergency ends. A student. And so finally we are working on developing a one down plan to reflect how will work through this process will be putting this on our website along with all the other code related material that we've for that guidance and other information for providers and will identify what we can do we can't do the steps the need to take and and then also how we're going to reach out to both providers and beneficiaries let them though this plan and so that's that's where we're at now I DO want to caution this this can modify somewhat as we receive guidance from CMS in the coming months because we expect there to provide some more specific guidance about how this process should work and as we receive that will adapt and revise our procedures also the ring is usually somewhere compliance with that. And with that madam chair I think that covers my presentation and I'll be happy to answer any questions from committee. Thank you so much senator garner you're recognized for a question. Thank you madam chair so right now we have people who are on these programs that we know without a shadow of doubt or either out of compliance for violating the laws for the you know eligible for the program you're saying the state of Arkansas is being held hostage by the federal government we can't remove those people at the expense of taxpayers that correct. Louis an accurate statement I would say is that he said something we have a opportunity to opt out of can we reject the match rate go back to the traditional rate then disqualify those who are violating the eligibility to program. I don't know that for certain I would need to go back with our lawyers just to verify that answer for it but I can I can talk with them and they get a response back on that secuestro may madam chair so you anticipate that the. By administration will declare a public health emergency until the end of twenty twenty one is that correct that's our expectation at this point so they could continue to kick that can down the road in anticipation till twenty twenty one. Yes Sir thank you. Senator hammer what cheer you sitting in okay number eighty ma'am all right. Thank you ma'am chair. With regards to the of the match rate if if the feds are forcing us to keep people on the roll. Are they reimbursing a hundred percent for those that are being kept on the role that we are determined to be on eligible or what is the state price tag for the for that decision. They're not reimbursements for that that is coming out of that enhance Max Richter providing this abased always saying the state is still to the good on those dollars hours we've not seen a loss on it we we still are eight incur accruing a net financial benefit from that we look at what we pay out on those those those individual still on the plan no compared to the federal match but is it all comes out of that same injury. How much to the good are we because what you articulated that it sounds like DHS is making money by staying in the current situation we're in is the total amount is about seventy million dollars per quarter that we're receiving and as I said from what we saying we don't think the cost of the those additional individuals is exceeding them. And that surplus money that is being created is it going into the trust fund or where where is it ending up goes the Medicare trust fund and bouncing Trust Fund is how much now. Apologize centers want to bring that and I did not but I can I can get that for you okay so. Do you know what we're projected to have at the if the crisis is going to go to the end of the year. What's going to be do you have a projection what the net of. Benefit revenue is going to be to the state by saying in the situation were interviewed projected out we have a projected out because just in there too many variables there to really get an accurate projection at the end of the year I can say as of right as of the end of this fiscal this past fiscal year our carry forward I was blues the neighborhood of five hundred million and so we do have some funds in there. We expect that to decrease as we start paying obligations in the in years going forward so okay so last question would be we're we're creating a surplus now through the policy of the current administration that is creating a surplus into the Medicaid trust fund what's going to be the expectation that they would want to come later and take that back or what are the limitations for how we can spend that in the future if it's being put into the Medicaid trust fund there any strings attached under state law those funds can only be spent on Medicaid but that will will help lessen the reliance on state general revenue in future years I thank you. Thank you a. Representative Ferguson. When you go we have a new system set up thank you there we go okay thank you madam chair of at I have some questions about the transition of patients because I know when we tried to when we had the work requirement and we were moving people off of Medicaid if they didn't make the work requirement that was sort of a rolling Issue with eligibility that what I think five or six thousand a month it wasn't all at once will these additional people be all at once after sixty days or will it also be on a rolling removal process it will be on a gradual process there there's part As population where we can do an eligibility check our system and we can determine no right now without their eligible very quick manner others though there are multiple steps to the B. taken directly those on the waivers where it's not only financial we'll start with their medical condition as well in order to gauge your eligibility so I'll cross population it is going to be a gradual process to work through those. So. Are you will it take a full twelve months like we did before and if so what we're going to get a reduced reimbursement for those people while we're processing them I'm I'm just trying to understand the process it's I don't believe it would take a year although actually I can if I can bring very Franklin up your vision County operation she can email more detail on come timeline for that. Please come forward and identify yourself for the record. Good afternoon America including Director of the Division of County operations for DHS and at this point the CMS guidance they want us to be through our wind down within six months of the into the federal public health emergency so. In handling these cases over that six month period so do you were say they enhance reimbursement for the whole six months or to city and when the emergency and. I believe it It is when the emergency and that's why we're staying the course as I said CMS is going to give sixty days advance notice of when that's going to happen is still be using those sixty days to start the process to identify folks suing to start removing folks know expeditiously to keep the financial burden as small as possible is this just Medicaid expansion or is it also Medicaid or Medicare it's everything and so are the is the reimbursement different for Medicaid expansion enhancement than for Medicaid what. For making expansion I believe it remains it ninety percent. Former ECR but for everything else that is enhanced batch now maybe. I'm not one hundred percent certain about that we'll have to verify that and get back to me if I'm maybe if you could just explain a little bit better ten made the process for how you're going to reach people because that's been the biggest problem that people get you know they come into the office and I've lost her medical coverage and I didn't even realize they didn't have it or said they were contacted explain to me how this is going to be different than when we did the work force the work requirement and so many people lost coverage and didn't even know they have a requirement. We're we're going to be we know our experiences is important and we are already reminding people check with the I just make sure we have your current address is correct contact information but that is going to be part of our wind down plan is to start messaging that and you know engage with our community partners to help us message that engage with you all to help us message that so that we we do get current contact information from these clients before we start this public health emergency. I'm sorry I missed what exactly is the enhance reimbursement for each Medicaid Medicaid expansion. If you would introduce yourself for the record you will be recognized. Yes good afternoon I'm Elizabeth Pittman director for the Division of Medical Services. Our traditional F. map or match rate is around seventy percent with the enhanced after not the traditional one goes to about seventy six a little over I think president Arkansas Works I received a ninety percent not trade so we pay ten percent it did not get an enhancements because it was so high already. All right the representative Ladyman you're recognized. I thank thank you up well part of my question was answered by representative Ferguson but was If I understand right the sixty day notice is that for individuals that individually those are the sixty days that is seen Mrs told us they will give the states at least sixty days notice before they allow that public health emergency to expire and so that will give us at least sixty days in which we can start the process of working through getting notice out folks telling them when this is going to speak again and and start identifying those folksy so mark you you said that Right now currently is through July the nineteenth. So we know it's not going to end on that date if you need sixty day notice is that correct correct okay all right thank you. All right to. Represented them. Thank you madam chair of my question is what percentage of the individuals are we talking about that I am eligible. At this point we don't have a good estimate of that because even though we may go through and do a determination and they come back as an eligible thank you for a number of reasons and we see it when other old good number folks out there who are in that bucket only because they with some documentation they have sent it in and they could still do that and so that's that's where we just don't know how many of those folks we actually get to a decision point will there be an eligible or not in a course even for those who have had an increase in income that may change between now and then as well following members here what I would have a demographics can you tell me where most of the people are located. It's I mean throughout the state we can certainly expect some specific information about Medicaid beneficiaries NO a specific counties no Medicaid enrollment is higher in or more rule parts of the state in the southern half of the state but beyond that again just trying project who's going to be removed and not just nothing we can accurately predict at this point. One one one one more question all the ones that I am eligible is there a possibility that something can be put in place so those people can become eligible are they just miss and some information that you all need or or is this a problem with that the big problem a problem that can be resolved yes we think that for a good number of these folks there will be something they can do to to become eligible and this recommend one added to. We we continue to process changes in applications as they come to us we are continuing to do our work some of those individuals may actually regain eligibility through the normal course of business because they've had a change that they reported in when we REDETERMINED them their their eligible they're not just being extended so it is possible and outrage is gonna be part of our one down planned so that people get an opportunity to let us know what their current situation is. Thank you. You are on this Senator had a Garner. Yes ma'am okay thank you. How many people have been added to the rolls of all the programs from today versus pre pandemic whenever we started getting more we couldn't change the eligibility or people what's the number of people who've been on that date verses that number before pre pandemic. Are you just example if we look back to the end of June twenty twenty and that was when we just got in the pandemic we're just starting to see the impact at the club at the end at the end of June twenty twenty we had another sixty thousand two hundred forty four enrolled in Medicaid. At the beginning of this year and we had one million thirty eight thousand five hundred eighty nine. Roughly a hundred thousand more people. That's cross old Medicaid programs crecer about Medicaid expansion Arkansas Works everyone called now there's just all categories of Medicaid okay do you have a distinction that number as well. I can see here. I don't have a going back that far but I can tell you see here. As of the end of may in Arkansas Works we had two hundred seventy thousand four hundred ninety one but if Fisher is enrolled thank you HB thank you Sir. Senator Hammer you're recognized for a question thank you ma'am chair I'm trying to get my mind around the ineligible the eligible that conversation so if somebody. If somebody could become an eligible for Medicaid. They would not be allowed to become an eligible for Medicaid because of the administration policy in my in my right on that tell the public health emergency is declared over there just kind of frozen in the system yes and I think our described as even though we may determine that there is eligible we can't take action on that to remove them from rolls. Have you asked what what what is the Department done agency done to ask. The administration we don't think this is right we think these people need to be discharged from the system because they become an eligible what have you done the the requirement as set out in the rules that HHS and CMS put out for that enhanced match rate was so this so they they made very clear to states at the beginning that this is what the rule would be. I don't know off hand of what our contacts have been S. with C. masters of asking them to change that I wish I'd have to go back Mr folks about that I'd like to know what communications you had as an agency to ask for that for that to be waived so that people have become an eligible. That they would be discharge otherwise there's no motivation for them to up to do anything different because they're getting the benefit and not so I'd like to see a communication please okay thank you thank you Mr. Representative Ferguson you're recognized for a question. Okay sorry I didn't hear much. Of. What. How will are you all working with the insurance the carriers the for Arkansas Works to weigh what is their responsibility in this for contacting people that they have insured under Arkansas works have you been working through the process with them and have that'll be handled and how much will be expected of them versus DHS. So I can they do report to us when they become aware of address changes and things like that and then. That is something that we ask of them anything you'd like to add I'm I know I mean we have communicated with them since the beginning of the pandemic regarding the maintenance of effort requirement to keep individuals on the rolls we're not dissing rolling individuals from Q. H. P. so they're aware of of all of that and will work with us we will reach out to them we haven't really and talk about exactly how those communications are going to occurred in turn we started discussing outreach efforts and we know there's going to have to include Q. each piece I think within the week next week or two we plan to reach out to them and actually start working with them on some of those communication efforts. That might just make a suggestion or ask a question you know when you run eligibility in a provider's office would be it would be very helpful if you sort of had a flashing red you know missing information or you know something that when you rather eligibility you can at least inform the patient that they need to contact DHS I think a lot of times you know they get a letter I mean I do the same thing I get io base make sure it's up from in the trash you. So I get a statement. Thanks thank you. Senate just if you you're recognized for a question thank you so much madam chair for recognizing me could you tell me what is making them an eligible. What is the major reason for the ineligibility. So it it could be a number of things it could be that they reported something or become employed and the income is over the limit it and so they make a dollar more than they're supposed to then enter an eligible if they are over the income limit for the category that when you and what is the income limit it It is different limits in different categories it depends if the two of them. for the Arkansas Works program is a hundred and thirty eight percent of the federal poverty level. for that a hundred and thirty seven percent of the poverty level hundred thirty nine percent the poverty level in there an eligible. That's right if they're over a hundred thirty eight there an eligible but they should be eligible and what is the coverage on the actual family of four give me an example of what that would look like how much money we talking about. I don't have that with me here we're not talking about a huge sum of money then our. Not not a huge sum of money for a household of one it's around sixteen hundred a month so it would be incrementally increased by the numbers of a person may sixteen hundred one dollars a month that would make him or her an eligible is that right. If if they're over the hundred and thirty eight percent of the federal poverty level so it can be fifty cents a dollar whatever they're over the eligibility right that's career in the middle of a dell to very and is that correct so we're still in in any emergency health situation because they seem to be the COVID nineteen very and seems to be surging here in the state of Arkansas is that right we we are seeing more cases you. So as we look at our fellow citizens is scofflaws it is important to remember that they are fellow citizens and some of them are making ends meet as They're in a very very difficult environment and so whatever we do to the least of these. Is one of those things that I guess we're keeping in mind at this point thank you very much and center just a response your question this is an example for a household of three under the thirty percent poverty level that would be thirty thousand three hundred five dollars per year. All right. If any senator. All right of representative Ladyman recognized for a question thank you. how does this affect the passes I mean this extension I mean is that a positive economic impact for them or negative or does it matter it shouldn't affect passes the the matrix focus back to us with passes they simply receive their capitated payment which is combination of state and federal funds. So they don't get any additional benefit or loss based on this. No Sir okay thank you. All right the next is representative for a. Yes ma'am thank you very much Mr chairman of mark even though you're you're talking about that sixteen hundred and one dollars the manager children it's within a family has a big impact on that too and I have it does okay thank you Sir. Right next senator Record. Who is sitting in a chair ninety two. Your. Well he he might. So we'll just we'll take you off then all right of anyone else does anyone else have a question a real question. Seeing none. Ladies and gentleman we are. Yes we just thanking you for the report and we would just filed the report thank you we're going on down to item D. and to mark flight in merry Franklin already at the table but would you introduce yourself please. Thank you madam chair I will want to bring you an update on our Aries integrate areas eligibility system implementation days important day in that process I'm I'm on run slideshow and turn this over to miss Franklin for her right we would introduce yourself I'm sorry manager mark quite DHS. Mary Franklin director of the division of county operations for the exercise you are recognized thank you I'm glad to be here this afternoon to give you a brief overview of the The New Arkansas integrated eligibility system we call it Aries of. And just to update you from when I was here last to talk to you about the impending healthcare release late last year we have fully implemented health care or all Medicaid in the new area system the final counties were implemented in that system back in April and today are we started our pilot for release to which one which brings in the supplemental nutrition assistance program and a transitional employment assistance program into the area system. and. Aries is an integrated eligibility system and If for the first time in years many many years it is going to have all of our programs and county operations in one system of for years we've had staff that have had to work in separate systems often entering the same information for clients across multiple eligibility systems to do all of the work needed for those clients so. This is this is a big change and it's going to make a huge difference in our operations and convenience for clients. So we have been working on the system cents twenty nineteen to design and develop it our goals in designing and developing this new system were to be more family focused to be more user friendly so that clients don't have to put in separate applications for separate programs we have in the past had up to eight different applications for different applications for Medicaid different application for snap anti and in the system now there is one application for all programs hi you can apply for everyone in your household on the same document and you can select the services you want to apply for on the same document as well as in our new eligibility system The New eligibility system it will adapt to any smart device so our clients who don't have desktops and for may find other devices or technologies more available or easy for them to use they'll be able to use those devices when they're applying online and are the worker portal in our new system is going to make it easier for employees to to do their work for many reasons I mentioned there can they can enter the information once for all the programs and there are some there is automation also involved in the system where some things that had to be manually done now the system is doing that for them. Our next slide just as an overview what our goals were at the outset for this very system we want to a person or family centered system are we want robust self service for clients to use our citizen portal we want to increase the access we have to data for clients and for staff lower our technology risk and cost and improve our operational efficiency and effectiveness and overall decrease the total cost of ownership With this new platform. Aires's replacing two eligibility systems at this time with the two eligibility systems or answer and Kurram are the answer system's been in use since the early two thousands and is the current system where we process snapping Teague and we're going to continue to use answer until we get all of the counties are fully implemented with snapping Teague into areas and up until April we used it for traditional Medicaid it was the system that handled all of our traditional and waiver Medicaid applications. We have retired the current system now Kurram was where we process my job Medicaid my job Medicaid are Arkansas works the our kids the pregnant women coverage those types of categories and since we have now implemented the new system statewide Kurram has been retired. A brief update about the cost of berries in twenty twenty state fiscal year twenty twenty we spent a hundred eleven point one million to support the areas project in state fiscal twenty twenty one we spend eighty eight point three million are we are projecting to spend sixty eight point three million this fiscal year and all of those figures we are still on budget and within the total projected costs for our prime contract for this system that you all reviewed and approved. A little bit more detail about what's going to be better in Aries as I had mentioned the mobile friendly across phone tablet laptop or desktop. It will be available in English Spanish and Marshallese for our citizens who use the portal is available twenty four hours a day seven days a week in our previous system we had to take it down between seven and nine PM to do not only batches and maintenance but in in areas were able to have it up and available twenty four hours a day seven days a week unless we do some maintenance or implementation at which time people are notified if the extent to law again. In addition to being able to apply online clients or clients will be able to manage their personal information check the status of their cases set up an email or text alerts to get updates about their cases they'll have the ability to opt into. Our email or electronic rather than paper notices they'll be able to view their previous notices in the system reporter changes renew their coverage and upload documents and I think these these are things are going to help our clients particularly the ability to upload a document not necessarily have to mail something to us or make a trip to the county office in the same thing with the alerts they're gonna be able to opt into those words to help them keep their benefits coverage up to date as well as their contact information. The next line is is is a graphic that just shows some of the differences in the improvements I went I went over the citizen portal improvements but on the on the worker side where the workers are working there is even scheduling out to help them with scheduling of appointments for snapping to clients that do require interviews As well as in taking data collection and master client index across the programs all of that is in the new system and again they have to enter information once instead of multiple times across. We implemented this system carefully in a phased approach starting with a pilot before expanding statewide that's how we handle the healthcare implementation and as of today we have started our pilot for the snap into program in five counties where. Residence of five counties Carroll County Hot Spring County. Independence County Lafayette County and Polk County they together represent around six percent of our caseload so um. And people who live in those counties that had existing cases in our systems had their cases converted to the area system over the weekend and now any new applicants that apply in those counties all of their cases will be handled in the new eligibility system including health care and now snapping team and we will implement the remaining can't we're gonna pilot through October with these five counties and in November will implement half of the remaining counties and in December will implement the final counties at which point we will have healthcare snap anti all residing in one eligibility system the next what is a picture of graphic to help you see where the pilot counties are there in the darker purple color those five counties the blue counties are going to be our waiver one that will go in November for snapping Teague and then the green counties will go into. I'd also like to give you our information about what we have done to to help make sure this implementation goes well of the several things including ongoing testing that we have been doing since January of twenty twenty to make sure the system is ready. we've done broad and robust training and communication internally to make sure staff are aware of the changes in our are trained to handle the changes in the new system. We analyze that process in the healthcare implementation and made some corrections and changes for the training that our staff went through for snapping Teague. And of course using the pilot rollout strategy is part of our precaution the reason that we pilot and we don't have a huge percentage of the case load impacted at one time and so that if we have any problems or we need to learn anything or fix anything we can do that before were affecting a large majority of the state. We have simplified language on this portal and in our notices are to fifty seventh grade level we have done focus groups with clients to look at our notices look at the new application I'll just tell you as an aside that the new applications is longer than I thought it would be it's it's over twenty pages and I saw people are not gonna like that but in the focus group. You know they said it's okay that is longer because I know I'm filling out the right one and I'm not filling out the same thing over and over again like I might have had to before so that you know reassured me that this is okay it's longer and of course in the when they apply online if they don't apply for all the programs the online portal is going to show them what they need to fill out based on what they've applied for on the paper application it has everything and so we've we've identified what you need to fill out which questions you can avoid if you are not applying for everything so we have it's longer but we have tried to make it user friendly so that they know what to fill out we have also with our communications team they have helped produce several videos how to videos about how to use the new citizen portal and all the new features and these videos are short bite sized pieces of information about what are the new features and there's a video about how to apply there's a video about how to create an account there's a video about how to how to use an authorized representative or report a change this is a series of videos and we will plan to have all of those videos available in all three languages that one as well right now they're all available in English but it is part of our plan to make those videos in Spanish and Marshallese well. And of course I don't want to leave out that we know everybody is not going to use the online portal that's not going to be something that everyone can use or will use so we are still going to be available and are available in all the ways we have been before people can visit our county offices they can apply with the paper application if they don't want to apply online they can ply by phone and so they can still mail list things all of those things that we had in place are still there we just now have this enhanced citizen portal that we think will help clients and be convenient you can can help also reduce the number of phone calls were handling in the number of visits people have to make to our county offices. And with that I will pause and see if anyone has any questions all right of. Representative Ferguson you're recognized for a question thank you madam chair this is great I mean I don't want to think I don't think this is great I do think it's great but one of the things from back when we did the task force in twenty thirteen is the lack of integration across systems is there anything in this system that integrates it with work for services or other education or a those other departments I mean is there some place on the educated on the application that says you want to apply for work at the end of the application you click a button and it takes you to work for services to help people access education work. Opportunities so we we do also have a resource page that people can access through our access Arkansas that has our our compilation of not just workforce information but all types of information about housing health care child care it we have a resource guide that's out there and one thing to in addition to Medicaid snap anti with release to we are also implementing a referral Avenue with the Arkansas department of veteran affairs Abdullah I clients can indicate their if they would like a referral to add are more information about veterans benefits and the same is true for child care thank someone wishes to apply for childcare they can indicate that when they're applying for snap to your Medicaid in that division will get that referral and areas does have the capability of being a backbone in other entities can at some point decided to join and become part of that series integrated system. What add to that as misprint so with this system was designed from the beginning to provide that kind of technological backbone that other agencies could utilize and help leverage this a number one states not paying for the same thing all times but also to create those connections like or talk about it so we do or have connections are planned part of that earns affairs worked with other agencies to look at those other connections and also there is also being used partly to help enable the governor's ready for life initiative so those connections they are starter they'll be continuing over the coming years I guess I just need to get on and look at the application I was trying to do that on my phone is or an app on your phone or is it all just through the website there's not an app but that the website is mobile friendly so even if you pull up access Arkansas on your phone you'll be able to navigate can see through the screens so it is possible or it will happen that it say the end of the application you check you need you want to be connected education or work is there a button to push to immediately take you to those services this is. The the. But in the push to get information about childcare and adva is at the beginning we're when when a client of selecting a programs they want to apply for they can tell their the for other agencies there is a link to our resource guide on our ACT axis Arkansas website it's not a button inside the actual application that they would click on okay I guess I just need to get out and watch the video thank you. All right the representative Ladyman you're recognized for a question. Thank you madam chair of first off the thank you for being on budget that doesn't always happen especially with IT programs so good job. The rollout process is this a new way of doing that or have you done it before I mean it looks good what you're doing is this a new way of rolling out programs. Well I will say this starting in ninety rollout with the pilot is is a best practice really in the IT world and it's actually required by the USDA food and nutrition service which of funds the snap program but regardless we had decided to pilot just you know for the reasons I mentioned this so we could identify problems early before we affected majority of the state and that's how we did the pop and the Health Care implementation with the pilot in the rolling waves and that is what we are doing with now. I think it's a good process one more question of when they're filling out the application is there a way I mean if they get halfway through does it save that they have to start over if they get interrupted or whatever is it thank and save it and come back to it they don't have to finish it all at one time online and of course for the snap program there's minimal information required to actually submit the application name social security number signature there's there's even though it will help us process and determine their benefits much more quickly the more information they provide there's minimum information that has to be provided to submit an application. Thank you. All right ladies and gentleman any other questions. Seeing none thank you so much and we will filed this report. All right Uh we're going on to item itself and the of March you will still be there. In joining you will be Elizabeth Pittman and Mitch Marcus John run Jason Miller and Jason Bearden and we may need to bring some seats up from. That this other signs. Or. Going to eat six. And as you know ladies and gentleman this is about the passes. All right of we have someone new of Jason Bearden from Kerr source has just been approved and he will not have a report until the fall but we wanted him to sit down at the table with you raise your hand please okay there you are so you'll notice face so of Markham turning this over to you let's read if you don't mind all of you state your name for the record and then you're recognized the manager mark what with or you services Elizabeth and also with the Department of Human Services. Jon Ryan Arkansas total care. Chase American CareSource pass. It's Morrison power healthcare solutions. Jason Miller summit community care. All right all right you're ready thank you madam chair I thought I might do is misdemeanor I will just give just a brief overview for the committee around the past model I know some of your NUS Committee seminar has as much background with passes some of the other members of the logical walk through that then answering questions that there maybe relate to that in the course with the CEOs who I'm sure they should ask me for which they can provide and are available for questions well. So the password over the past those referring to the provider led Arkansas shared savings entity B. A. S. S. C. passed that is a model of organized care created by legislature back in twenty seventeen and the intent of it is to serve individuals with significant behavioral health needs or intellectual or developmental disabilities each pass organization is a partnership between Arkansas Medicaid providers providers have to own at least fifty one percent of each pass and they can also include a partnership with insurance carriers who performing ministry of managed care functions things like claims processing and membership member enrollment. The way that we pay the passes is also unique in Medicaid and that we pay the past a monthly flat fee for each beneficiary they have assigned to them as well also known as a capitated payment and so we make that payment to the past to provide care coordination and all the covered services for that beneficiary has been assigned to that pass those services includes all the healthcare services they ordinarily would receive for Medicaid things like their doctor visits hospital therapies but also includes past Pacific homing Committee by services things like support of living cross intervention in day treatment. As of today there's just under fifty thousand Medicaid beneficiaries who are assigned to the past as I said each of these are individuals who either have a significant behavioral health issue or they have an intellectual or developmental disability. Each pass is regulated by the state insurance department as a risk based provider organization and then they're also accountable to DHS under the federal managed care rules. Right now we have three passed organizations that have Medicaid beneficiaries assigned to them of course there is some cells Arkansas total care empower healthcare solutions and summit community care and for care source just last week the insurance department approved them as a risk based provider organization and so we're gonna be working with them on next steps and also they will have to go through what's known as a reading this review which is where we go in and we verify that they have all the systems and protections in place to serve in a fisheries and make sure that beneficiaries health and safety is protected. that's just a brief overview of pass and Mr chairman of serving stop of the sport or we'd like the CEOs to go ahead and make some statements we can do that. I think we could just start marked with the CEOs and go through all three presentations okay we might have have questions after each presentation if that doesn't get too low so certainly what I think what we start on this in here with us for what now the. Please tell us again introduced yourself so we make sure we know which one we're talking. Members of the committee my name is Mitch Morris I without empower healthcare solutions a recent job transplant from Jackson Mississippi area happy to be here in Arkansas happy to be without power healthcare solutions and please to appear before you today so I've been CEO within power healthcare solutions for about two months now our membership currently numbers about nineteen thousand six hundred that membership leans towards the behavioral health children categories a little over sixty five percent of our members are children that are identified in the behavioral category about twenty three percent are the ultimate hero Health six percent in the intellectual developmental disability adult category about three percent IDT children category. so I'm her I'll give a quick overview of some of the questions we are provided in advance that you guys would like for us to address. Let me can I read you just a second I've got a couple of questions and they may be for mark on his presentation so I want to check with them US senator Hammer your question for DHS. My question is regarding the financial sheet and the Medicaid dollars paid to the passes. You want it now gives I can wait. Yep go ahead if you haven't okay I guess my question is we were. Let down this path thinking that it was going to be a cost savings but yet a notice on the handout under F. one that it seems like the costs continue to go up. Each year and when you do comparison of quarters it seems to be you know a little bit of fluctuation but I don't see the trend going down to see the trend going up and I was wondering what the explanation of DHS for the passes are as far as the increased grand total pay out. Sure just a couple points in this early at in they can force this is on the pass is a new concepts start in twenty nineteen as far as actually having been a fishers and providing those services so it's been a learning process as we go through and get those services up and running for those beneficiaries I think we have seen savings and I expect out of talk with Senator Bledsoe injection instructions talking related about it would like to bring you all the latest iteration of the Medicaid transformation scorecard which outlines the savings and walk that walk through that with you and they'll have us significant more detail about the savings they've been achieved not only went and passed across Medicaid that the scorecard would just put out this morning and so we'll bring that to your next meeting follow up Mr yeah you're recognized so on that score card that be you know off the chairs allowed I'm sure they will but the what what's the magic line that we say okay this we hit the pause button and review whether this is actually gonna be cost savings approach to deal with these populations or not and and who who produced a score card who's the Outside source DHS the passes or who who generated scorecard the adjuster is the scorecard and that goes back to the recommendations of the health care for task force several years ago if your call what they does they set a baseline of lease five percent annual increase per year based on healthcare inflation the other things the normal expect around healthcare costs and so are our savings are plotted against that baseline that was outlined by the task force back then and so is its numbers from DHS I don't know I would say there's a there's a magic line I mean service under that we monitor but we've been we've been happy with the progress made in terms of the trend of the spend but also keep in mind that no originally when the pass because it was was envisioned it was a way I think we expect the the population because launches has been and so it has been a higher population than was originally projected and certainly that would reflect for the cost as well and I should I should add misdemeanor reminded me. What we discussed earlier about the inability to remove folks from eligibility that does apply to the passes as well now I think in their case the number of individuals are going to be ineligible to win much smaller than the rest Medicaid just because the nature of the population we're talking about but there may will be submitted on there that wants to public to mercy as they get pulled off are Mr chairman gonna go the bottom the queue but thank you. A representative Miller you're recognized. thank you Mr owl. These individuals Spanish if they can be so timely dollars per question. Thank you. You. Thank you. Thank you all right of Mr Morrison public gesture interrupting you so you can go ahead and you want to start of beginning the and that would be fine thank you Mr chair I'll be very brief so we can pass along my colleagues we can get to the questions that members happen again my name is miss Morris with our healthcare solutions CEO joined the company first of may be happy to take your questions. So I'm I'm. Read. Yes okay so I'll just add this I I know you have our information in front of you and we have the data I am glad to speak about it hello I'm Jason Miller some community care I would I would add this maybe to Senator hammers question and we talked many times I I think value is more than just the dollars and I think the past program in just the two little over two years and we've been here we've we've so a lot of things alone decreasing hospitalizations are increasing access to outpatient services but our premium tax for example is help to move folks up wait list a waiver we're continuing to address health disparities in health caps just in my past alone we've allocated seven million dollars to a committee investment project that would have existed without the pass so putting those dollars into the community or during a crisis transition we're actually helping folks find employment we're giving a free training platform just to provider so they can train their staff and we were able to respond to code in ways we probably would have never been able to do without passes I mean I there's the list could go on and on and I'm not saying we do everything right everything perfect but the other big part that's important is we are provider led will provide around in my past alone I have for task force going on right now and then I have seven committee investment committee that all together have forty six different providers involved in decision making of what we're doing with our members so I think there's a lot to be said we can certainly talk about numbers I know mark as more of the global numbers we can talk about ours as well but what we're bringing to I hope the market will bring you to the members in the behavior health and IT D. community such as these communities which is the most complex of all members and Medicaid I think brings a lot of value here I'm in a I'm was born and raised in Arkansas and around my life of provider before I was here in this role and so I certainly understand that I think many of my colleagues do as well so I I I think there's a lot there you can see in our records and things we've given you. Just a snippet of the things we're able to do and we're again we're just two and a half years old not even two and a half years old so I think there's a lot and I didn't get into care coordination of those components of what R. three hundred fifteen my past or in fifty members I know images in John's pass a probably a quick point so you have almost a thousand individuals out there touching personally directly involved in the lives of these members day to help them find resources accessing those things so I just I just wanna make sure we say that think that's probably the best or detailed more so than just the numbers which we can do any time is that we really are trying hard to really make a difference in these behavior health and intellectual but my disabled individuals so they can get better access to services one. British terms. Thank you John Ryan represent Arkansas total care today Arkansas total care I represents about thirteen thousand five hundred members in the past program on a statewide basis I would echo a lot of things adjacent said about value in terms of responding to the pandemic and being out in the best of our ability to be in the communities to help these most horrible said It citizens I'm happy to respond to any of the questions about the information the data that we did some that around demographics for claims or customer service and happy to answer your questions. All right Mister building you want to making comments or not sure I'll be happy to okay just tell again who you are in. A little bit about your company. Thank you madam chair vice chair members of the committee really appreciate you allowing us to have an audience here comes the full of excitement anticipation and a committee of the long weekend like many of us did so bring the fourth and I think moved most pertinent to us being here your source pass and I'm sorry all the. Want to try to talk as much as I can but I want to hear me as well but that being here today is I. R. C. U. eight licensure approval that was received via the Arkansas insurance department on the on July first so we're excited to be here partner with you all were you are passionate about people are passionate about service service serving you all so most importantly serving the end of the Arkansas is across the state of Arkansas would IT be and a rural health challenges and so but we we commend you for the vision you all had a bringing the passes on board it is a very innovative model that's a big part of what your sources interested in partnering with you with DHS with the governor's office and the providers across Arkansas to transform the system the work to move to improve quality create value through additional access and deliver care more efficient way so again thank you for allowing us to be here I'm happy to answer any questions as we looked into the market and passed by readies for you with with mark and in this button as we move forward so thank you again and I can answer any questions all right thank you Marc you have anything further that you want to say before I open it up for questions. I'm sorry just one thing option a couple things I should have one course you do have or are responses in front of you both responses from the individual passes as well as the DHS responses to information Senator Hammer I would just point out that no up through since March ninth twenty nineteen for the second quarter of twenty twenty one know what we're reporting is eighty one million in savings from the past model as I said we're going to go of what went into more detail two little deeper dive on the scorecard we bring that back to you next month and then also on the I think I mentioned this before make sure I did course the the fact that we do have to keep individuals on the Medicaid we as I said that does affect passed or an IDT IDT clients you know that's probably not going to be an issue at all they're likely be eligible regardless of the payroll side that's that is where we may see some decreases folks come off but again as I said we'll set actually get to that process and work with folks and see see what the outcome is there and Elizabeth do you have anything you want in. I believe mark just covered it I would just add that we do also within DHS run an office called the passam but it's men and so we work with each of the passes to address any issues that might arise all right committee we're open for questions and Senator Hammer you are recognized. Trying. There is thank you manager all right. Okay go ahead get the score cards out to us there is you can't release it sure yeah we can get off so we'll get that staff nest industry to the committee okay and then as far as the new the number of members of each past that have been vaccinated of can you all just quickly not if you're above eighty percent of your of your individuals are. That are vaccinated. Yes it centers John Ryan I don't care I I we get you specific numbers I don't believe we have a population that's about eighty percent. There's other two German one way in I know because I just looked the other day our first one does twenty two percent of our members have had one does but only six percent of the second. Third Gen one please I would agree in general does not have specific numbers with me but I would say our experiences and very self. What what's the reason for why the low percentages among the populations are serving that seems like a pretty vulnerable population is it just resistant on the part of the of the client or is it or what is it. Yeah I think the two things I would say Senator are one is the population a vast majority of it is under the age of eighteen so vaccines of just become available to them in in recent period I think the other is general community has to the state and I can't speak any more than that but I those are two driving factors. Okay a thing it said by the other two. Okay and then the last thing is of what about committee I don't see it on the survey maybe I missed it maybe it would be something we get at it next time or word word we find how you'll spend your community investment dollars or can we get that sent to us so we can see how the community investment dollars have been been spent. We continue summary you berries that we we do a newsletter once a month on it lots of committees and that's exactly I can provide a summary to to you all and the other one on the committee okay I'd like to get that you know how the community dollars how much been. spent how much is left to be spent and where it's been spent please thank you manager. A representative Ladyman you're recognized for a question. Thank you measure up I'm looking at your exhibits that you presented all three of you I'm up here sorry. In the what I'm looking at is question number two words as your pass have a customer satisfaction survey and when I look at all three of those the the satisfaction number is very good eighty six percent. Eighty one percent. And ninety percent. but on the the summit community care exhibit it shows a number of surveys that were attempted and the number completed. So we have a twenty six two thousand six hundred three attempted three hundred and twelve completed the other two does not show. At least I can find the amount of. Completions. That seems like a low percentage of respondents and I know surveys are that way but on the other two reports the you all know what you're percent response was in do you think that's low and is there any way to increase that sure what what if Arkansas total care as we had about three hundred fifty six enrollees that did respond out of about thirteen thousand probably really around thirteen twelve thousand five hundred thirteen thousand the time the survey was conducted so was at about three and a half four percent or so something in that range in general I would have expected a significantly larger response rate but it that it is slightly low I think some of that is timing the survey image the general nature of people being you know disinclined to respond to surveys okay. so our response rates going to look very similar I would also add to agree with with those comments I would also add that this particular service pretty lengthy survey instrument it gets pretty involved and so we're kind of asking a lot of our members to complete this information although it is very valuable information we definitely encourage it and it helps us it helps to inform the services the quality of services they're receiving party services that we're providing health system than five areas we can improve so it is I am very valuable information but it is sometimes very difficult but I would also say that response rate is pretty simple in my. Yeah we have actually tried to change different formats we used to mail them out which didn't work very well so that we do telephonic surveys we've tried that and it's getting a little bit better response but it is very tough it's tough to find folks in general because it is not helped but in general it these this this particular population of individuals and not well response but we do we do a lot of engaging a lot of anecdotal information but in terms of social surveys we turn in our metrics yes the numbers we love. Do you think that's a representative I mean does it really represent what's going on in your business at less than five percent response and I know that may not be thank you can do about that but My it's been my experience that the ones that like the system of the ones that respond that may not be the case here. But is there any way to increase that number to give us a real good indication of the service level what people think about service they're receiving the audit any ideas at all about that. Hi I mean again I think we're trying to commit different ways we've tried we we would have explored using care coordinators the care coordinators to do part of that but we ask about the care coordinator so we we want to be non biased and that we want to be careful that they're giving us to information obviously the higher sample size you know the more statistically significant the numbers are also there are some similarities and some of our responses is trying to get early we have a much larger portion of children to adults you know ins and different things so you can sometimes you can weigh in a little bit of statistical significance to smaller numbers when you have a similar population versus the population as a whole yes I'm we certainly would like to do that so we're we're looking at work by a variety of ways Telefonica's work better for us than the male because addresses are rarely correct a lot of these folks don't stay where they are many of them you know homelessness issues and and a variety of different things so this challenging sometimes to get that or they're also cognitive levels for some variety folks so we have to sometimes rely on families to help with right so we're coming out in lots of different ways yes I was we are working to the number of so from the surveys have any of you all identified. You don't normally the purpose of the survey is to know how you're doing but also to identify problem areas so whether any problem areas that stood out in these survey responses areas where you needed to work in is there anything that you could offer their. I like to do a little bit deeper dive and give you some more specific results but also in general because already kind of come up with some of our response that. Communication and information sharing is kind of or what we do but it's also a barrier and a lot of ways I would just be able to as as as referenced earlier even just being able to contact members a lot of times can be challenging but. Sharing information repeatedly they're different methodologies trying to make sure that our members have what they need to access care I was a need to engage our care coordinators are very regular basis to help them access back here I think that's one thing that you'll see in the survey results but like to do a deeper dive to give you a little bit more. I would agree with that I think the other opportunities to continue explore the different channels methodologies in which we can't communicate and on a a a more frequent basis what what what channels and avenues drop the best response to the best timeliness. Thank you. All right representative Miller you are recognized for a question. Thank you madam chair of ended with. Your permission I'm a little leeway with this I have about a three part question but I'm going to give the two or three of us in the committee room that's paying attention a little background I know that last year at least one and you all one of the past organizations sent out an email to your providers the DME providers specifically announcing that maybe at the first of the year or sometime you would be cutting your reimbursement rates nearly in half. To the providers who are obviously Medicaid riders whatever that's all purchased from. You know just be real with that the reason you do that you're trying to make more money I get it your business your business to make money it's not a nonprofit it may be called that but is not Question number one are you aware that when these emails go out that providers then have to turn around to their customers their clientele who are the recipients your past members and tell them that they are not sure. That they can. Actually service them sell them parts for anything from wheelchairs to whatever else are getting because they don't know that they can sell. For the rates that you're gonna be reimbursing the. Which is obviously a problem and these people either you know Hey go find somewhere else. Which you know causes a problem for that provider business are they you know they they decide to wait and do without or whatever and I'm not sure I can't remember exactly which one or two of you all it was it did that but I do know what happened can do research and find out but Is that going to be a is that going to be happening. Again like I don't mean on a regular basis I'm talking ever. As long as this protest. That's my question for right now I have a follow up for may is represented Miller Jon Ryan Arkansas total care I'll I'll take accountability for our organization had having said that an email like you're talking about durable medical equipment suppliers et cetera we did a proposed if the schedule change and we did very quickly retract that and did not move for with that so that I'll I'll be countable for that brochure in a and and I'm I'm glad that you retract it I'm glad you know all that happened but I also know of. Literally probably two dozen. Individuals that shall serve. That that had to change providers which you know are to providers business because they're concerned that well I mean this provider can't sell me. Whatever I'm meeting together are or whatever because you're not going to reimburse them all because of one email and I understand it happens but I'm I mean what is the thought process behind other than just the fact that you want your bottom line to look better why that happened yeah I think in that specific instance we did have providers that we did reimburse at the lower level and trying to gain consistency and in the market for that reimbursement level was the I think that the answer to your question love one last follow up if I may venture. I just wanna be very clear and I don't know if I will be back here or not or what I will be doing of and in two years. But I wanna make it abundantly crystal clear I have something like that happens again. I can guarantee you there will be legislation filed in this past program. Because there are some others out here who are in touching providers and in touch with the people that shall serve and note in here about some of the crap that's going on. If that happens again. Real file legislation to be done. We have an understanding Sir thank you. Thank you finished up day. Pardon me I'm done okay all right to. Senator Hammer you're recognized for a question. Thank you. Thank you for your patience with this new system. Try again or let me. Thank you thank you Mr chairman. And and I'm not trying to project Doumer gloom on the situation I would like to be familiar with what the processes are and procedures are there's now a fourth player in the field which means the pool is going to get them down a little bit and what what are the procedures in the event one of the passes. Goes out of business and that population has to be picked up by the remaining proper passes not to reject anything on all that just kind of wanna be prepared in the event that happens. Yes Sir and I'm there's a lot of detail in our our passing with each one of the passes so I'm just and kind of give you a broad overview but we do have transition provisions in each one of those agreements were DHS consented immediately says we have to start transitioning beneficiaries we would then work with a at past that they are currently in and to make sure that the files got transferred to the past that they were going to if a passion you try to do that in advance so we continually monitor what's going on with the passes we work with each one of them if we think there's some question or concern we ask them immediately to address it Page they generally respond very quickly and and we've had our issues addressed to dates we have not had to invoke any of these provisions because we're continually monitoring and we have those provisions built into our contract we would immediately start the process of transitioning beneficiaries over the course of a certain amount of time to reassign them and make sure files that transferred care coordination the most important thing for DHS that there's not a destruction services so we would make sure to transition seized insure continuity of services for those individuals because they are such a cute service means in this pass population okay and what is the editor could could put Michael closer please sorry I'm trying to share that's right and what is the required time frame that they have to give you notification that they're going to not be doing business anymore I don't know that off the top of my head that is in the agreement we can get that for you if you don't Hillman like to know yes and then the other thing is I I I cannot remember which one it happened but I've I've got constituents should work for passes everyone else sent out a message saying you all need to find jobs by the end of the year and then that seem to get you know retracted of whichever one you all that applies to. Are any of are any of your employees lose their job between now and the end of the year or has that issue been rectified. Senator I can just that in a little closer Mike if you could please thank you we have to address that so empowered healthcare solutions is going through Small change in our ownership structure and organization structure and so one of our primary service contractors did. Make that communication to a number of employees I can tell you that that is not the case that all of those employees that received a notice have received offers and confirmation that their employment will continue. And so that should not be in question at this time but we have committed to those employees that they still have a job within our healthcare solutions it was primarily care coordination so they have a job provide care coordination services for our members okay I will continue thank you thank you ma'am chair and senator if I may add Jenna Coleman who's in the back and runs are passed program just texted me it's a hundred and twenty days in the contractor supposed to give us one hundred and twenty days notice before we have of anything that would and because the contract and. All right represented board you. Nothing for questions. Thank you senator of Mr why I've just got a question here and and I don't want to like dig up dirt or anything like that I it is this is a legitimate question so other states have reported allegations of overpayment through PBM issues and I want to and I just want to know what the state of Arkansas with DHS's doing that you can tell us to make sure that is not happening in the state of Arkansas. If I can find it made the first payment I think she given more detail that I can try I don't have that report right in front of me today but we we can get you some more information as well so you know that the for service Medicaid does not use the PBMs so we don't have those issues within view for service Medicaid and Magellan access administrator for us but they're not a fiscal agent so they don't deal with any of the money pieces I'm for the houses who duties PBMs we've actually incorporated the law that was passed in twenty nineteen into their contracts and we monitor anything that they might be doing regarding service spread pricing and sorts of practices and and and to date since that that legislation has been enacted we have not seen any suspicious activity but we monitor that every I believe order but I'm not sure a hundred percent not but I believe it's quarterly. In order to that for those for your non legislative audit list of all the do a look at this they did approve the job or not only us but also EBT and others around the use of the PM's I saw there was some discussion about that but we've we've used those findings to help feed back to our practices of what we monitor as well as needed to we made some changes last couple years to ensure that we are the the PBMs are falling Arkansas law is insofar as a related passes. one follow Mr minister thank you I'm glad that you're you're looking at and I'm glad that you acknowledge Arkansas law and that there are things in place need to be done so I I appreciate that I just wanna ask specifically there are some concerns about when there are two PBMs being used by a plan and just are you doing anything specifically want to be PBMs OR an emplacement not a I'm not aware that being an issue I'll look into that and see okay well I mean I'm happy to discuss with you further but and I do appreciate that you all are paying attention legislation and and following through on that thank you. All right Committee are there any other questions. Right seeing none we thank you so much for being here and we will find this report. Going on to G.. The mark this but again. So if you don't mind a define yourself for the record one more time. Thank you senator Clark what DHS Elizabeth admin with the M. S. all right you're recognized. So I am exhibit G. is the rule that technical corrections rule for Arkansas Medicaid and we have gone through our committee will provider manuals and review committee under names I'm previously we had actually listed vendors who were performing functions for us such as prior authorization requests and reviews or quality at reviews you know we I under state procurement law have to refer care every seven years every seven years we at least we have to go in and update those manuals so in an effort to keep our manuals consistent because a lot of times those references would get messed with taking out specific vendor names instead just referencing vendor being used and in providing a link where you can actually go and find that vendor's name contact information and how that how to get in touch with them and so that's what this is right here. And I'm happy to take any questions any questions from the committee. Seeing none. and without objection. We will these rules will stand. So going on to age. And this rule is another correction rule so for our pharmacy claims we have historically used what's called place of service ninety nine which is a national place of service codes it means other there is a specific pharmacy place of service codes zero one and so we had heard from some pharmacies that they would like us to change it and in the interest of being in line with national coding week we are changing its R. one and not that is this rule and happy to take any questions any questions from the committee. Right seeing none without objection this rules for staying. And ladies and gentleman I believe that gets this to other business and we've already discussed the next of public health committee meeting August the second with the subcommittee's meeting in the morning at ten and then the regular meeting didn't want and so with no other business we are adjourned.