ALC-Administrative Rules

Tablets where. Right down here in the middle of a few here to sign up to speak for against something in one of the rules please go ahead we'll take those up here in a few minutes so this your opportunity get signed up. A first of all right Sir all the agenda with item B. which is a presentation regarding status of the code of Arkansas rules and if you would please to the table there and introduce yourself Isaac for the record. Thank you Mr chair members of the committee Isaac line I'm I'm an attorney with the bureau of legislative research I'm here to give a brief presentation on the status of the creation of the code of Arkansas rules to give you a little background the project stems from ACT six sixty two of two thousand nineteen which directed the bureau to compile format and index codification of Arkansas's existing administrative rules. The act up requires bill are to format the rules in the same style as the Arkansas code so if it's the same style that you see regularly and bills and acts that come out of the General Assembly and so what that entails really is you know if we have if there's a block of text in a rule then we'll go through subdivided to make it easier to read will make us spelling corrections if there misspellings grammatical corrections that kind of thing if there are outdated names of entities or funds will go ahead and make those corrections if this sounds familiar to you it's because it's basically the same function that the Arkansas code revision commission performs for us statutes and acts of the General Assembly we're just going to do that with the administrative rules. Just about every state in the nation is already doing this we're one of the last ones which is beneficial because we could look across the country and see the way different states approach this but it's also coming last means we have a lot more rules to put into a code in so yeah it's a little bit of an advantage but then a little bit of a disadvantage at the same time the result whenever we're finished with this is that you will have a searchable code of rules just like you have the Arkansas Code. it's going to look very similar so you'll be able to just open the code of Arkansas rules and find all of the administrative rules in the state in the same way that you can find the statutes in the red books in Arkansas Code. When you're assembling a code one of the basic principles is consistency you want the you want the rules in one title to look basically the same as rules in another title it makes it easier to understand whenever you're looking at different rules you just have one basically one format that you need to understand and if you want you understand that format you'll be able to understand the organization of all of the administrative rules in the state that are in the code. It makes the rules easier to read and it makes it easier to site if if you are at the unit judges in their opinions can cite exactly two The subdivision and you'll be able to go exactly to that sentence in the ministry of rule or if you're in the you know in the committee and you're having a discussion about the an administrative rule and you want to cite a particular provision you can just. The lead out that you can just say the citation and everyone will know exactly where to look rather than having to navigate through big blocks of text of the rules will look different than how they look now but the substance the meaning of the rules are going to stay exactly the same these are pretty much cosmetic changes if you will Again you know grammatical corrections and names of entity corrections nothing that is that is substantive but just will clean up some of the errors that are in there and then the formatting will look different the one of our goals is for the code of Arkansas rules to exist in harmony with the Arkansas Code and so we are organizing it very similar to the Arkansas Code so for example the Arkansas Code is organized entitles one through twenty eight that no all of you are familiar with that you know title to his agriculture title six education it's that are a. We are going to retain those titles in the code of Arkansas rules so an example is you may be looking at a statute in the Arkansas code so you're looking at a statute entitle six education and you read some language that says the department of education must promulgate rules on this certain the subject matter all you have to do then is you'll just open up the code of Arkansas rules you'll go to the same title title six and you'll be able to find your the the rules that are related to that statue right there so it should it should it should make everything easier to find an easier to follow. Once the co goes live agencies will be drafting to the style of the code so that means it's a whenever you see rules in this committee once we the code of Arkansas rules is live the rules will look a lot like a bill. because the formatting is gonna be the same of the Arkansas Code and whenever they amend the rules in the future they'll be amending the code and so hopefully that'll make things a lot easier for you guys and a lot easier for everyone else to follow along. this is a massive project as you can imagine there are about a thousand rules in Arkansas the the they're composed of anywhere between forty to fifty thousand pages there's a whole lot the rules we we have a bunch of them in Arkansas and so we're having to go rule by rule and make these conversions and park them into the Code of Arkansas rules where we of where we have place them. Of right now the current deadline is January one twenty twenty four we hope to be done by then we expect to be done by then that again this is a really big project and so you do we're we're optimistic that we get that we will make that goal but a lot can happen between now and then and and every rule has its own issues that we have to resolve and so but we feel confident that will make that go. It's not a a mention each rule has special issues that arise you know we're working on one rule right now we're it's about fifteen hundred pages and but about fourteen hundred fifty of those pages are basically the code of federal a federal regulations that were inserted into that rule right and so that's going to be a challenge to figure out how to exactly represent that in the code but you know we're we're confident we're gonna find a way to do that but that's it that's an example some of the special issues right now they're in every agency is kind of they're they're doing their own thing you you know that because you see the you see the rules all the time and and the format every agency has their own formatting in their own way of approaching them and so we're just into part of the part of the the really the the biggest part of what we're doing is corralling all of those and putting them into a uniform format so they're much easier for you guys to be able to follow them. to implement the project we formed we we came into this with the knowledge that. We have a Yeah we have a certain viewpoint from the RC of what the rules look like but we don't necessarily have a three hundred sixty degree view of what's called the goes into each administrative rule and the process is that uh we are undertaking to implement that act into into for the project so we formed a really early we formed a work group of a double act sort of as an advisory body to help us along whenever we have some questions about an approach that mean what we may want to take that on the advisory body we have a member of the governor's office we have a representative from the Attorney General's office we have a member of the bar association that sits on it and then we have about four five representatives from state agencies across Arkansas. We've had several meetings we had a few but the or we had some before the session started session start in that kind of eight of everybody's time and so we expect to have another one to give them an update and to seek their advice on some issues here in the next few weeks hopefully. Another another thing that we did is we ask each rulemaking entity out there to appoint a rules coordinator to act as a single point of contact for us whenever we're reaching out to that it that entity to work with them on their rules and so we have about fifty of those right now And that the in so the fifty individuals that we will be in contact with whenever we're working with the their particular entity you know what we'll have that single person that we can contact but to give you an example of sort of the the scope of this week the the cabinet level agencies you know they took on a whole lot of some of the smaller boards and commissions and and departments and so we're working with that so for example the department of commerce you know they they're composed of the insurance department AT T. C. and several of other entities but we have a single rules coordinator that works under the that works with us for on behalf of the department of commerce that the is a that's important to us that we maintain that a small of a number of possible so we can keep up with who were in contact with over these agencies and it's more efficient for us to to work that way. we put a we put a premium on outreach at the beginning before we even started work on the rules so starting last fall and going all through the spring and even up till now we're still doing it we've provided a whole lot of trainings to agencies to sort of educate them on ACT six sixty two and what it does what it means what it directs the bureau to do how we plan to implement at six sixty two our our plans going forward what they can expect and we feel like that you know we've held a series of trainings and repeated you know the same training sort of the several several times and I believe we've reached just about everybody the in state government who has the and interest in crafting in administrative rules and sort of shepherding them through the process and that would be involved in the project so we did a whole lot of the a whole lot of education at the beginning so no one is taken by surprise I will say that The executive branch has really been helpful the governor's office it's been a wonderful in reaching out to their agencies and preparing them for the project keep it going so we really appreciate the work that they have done and so far the agencies that we've been in contact with them we've been in contact with very very very many of them they've all been very responsive cooperative up really helpful they've given us a lot of insights on things that we may not have been aware of and so again I I would like to just express that the the executive branch has really been has bought into this and I believe they they see the big picture and the benefits that will exist at the at the end whenever we're finished with it the project really can't go forward successfully without that collaboration and so we really appreciate it and we you know we we approach this from the very beginning as a partnership between the Bill art and then the various agencies out there who have administrative rules and so far it's going as we planned there than we hoped and it's a so you know so far so far so good Once we finish doing our codification of a draft we send it over to the agency whose rule it belongs to they do a review they give us feedback and then we incorporate any of their suggestions that a fit within the the the mission of the project which is most of them you know we recognized that these agencies have subject matter expertise on the rules that we may lack in so if they've been really really helpful and and we I appreciate their their help in doing that we've already so we've begun the work that we've been doing it the set the substantive work of this we've been doing it for a few months already we've completed several drafts of of rules that are in there completed stage and so far the the the agency's whose rules we've completed have been happy with the results as far as I know it's it's certainly no complaints or anything and we just can will continue to move forward that way so you can expect to hear from us periodically will will continue to come give you status updates and let you know what's going on and So this is the first of the status updates that you will be seeing from us all right with that Mister chairman of take any questions all right thank you Isaac the completion date again was twenty four twelve twenty four the deadline date yes at the January one twenty twenty four okay very good anybody any members have any questions. Or should prove to be a helpful tool for us moving forward and and appreciate your work and the work of the agency any questions right of a. Our thank you guys you thanks for. All right the next on the item there other reports use active subcommittee which we have no reports from education executive subcommittee this month so we move on to the next sign which is the so if we get the presenters rules under item D. one department that culture Arkansas natural resource commissioners if we can get shall come forward please. And if you will please state your name title for the record. Good morning Mr chairman Wade Hodge chief counsel department of agriculture okay recognized you had percent please yes we have the a natural resources commission title fourteen rules here this is just an amendment to comply with a change in the law that allowed of these tax credits for certain water projects to be transferable and to be happy to answer any questions thanks any questions from members. A question. There with the objections rule is reviewed approved thank you. And you get to. What do Mr chairman thank you this is the die camber rule of this is the same role that was over here in early may and presented to you as an emergency rule and so the light excuse me the languages exactly the change it was very thoroughly discussed at that time I'm not sure there's a whole lot more I can say about it but if you have any questions I'll be happy to try to answer those. I think the one thing what to a mobile to Senator sample first senate sent. How many. comments did you receive on the public comment as seated there was. If it was over five hundred center I'm not sure I have the exact number but it was in excess of five hundred. Can you tell me how many were for and how many or more against. Senator there were there were slightly more for the rule then there were against there were over three hundred that would for the rule okay your. Thank you Mr welcome. Let me ask you because there's litigation going on with this spring courts of all would you just give us the layman's of. Perspective of where it is and the outcome of what this committee decides today how it will have any bearing at all given the fact this is in litigation before Supreme Court yes thank you there were there were two lawsuits filed challenging the rule in Pulaski County circuit court those lawsuits were consolidated they were. Two separate judges were handling those so they were consolidated and just one judges handling those of that judge issued a temporary restraining order to restrain the implementation of the new rule and of the attorney general's office on behalf of the plant board took an intermediate an immediate interlocutory appeal of that in the Supreme Court did issue a stay of the Pulaski County circuit court's ruling so the rule is back in effect and so the issue is now before the Arkansas Supreme Court and the rule is back in effect is which rule because we don't the emergency rule the the new rule the emergency rule and the date for that an emergency rule was what the day the judge the June thirty cut off date right and that's the rule that's before us today that's correct okay and so if we you know without objection approve this out of here then how does that play into whatever the Supreme Court decides once this thing is all played out well then at that point the the Supreme Court because I would anticipate that we may not get a ruling until. Next year on this so this is spring court would then be determining of the sufficiency or the effectiveness of the rule that your examining here today. K.. how many complaints have you had this year regarding. the campus free. And senator I I do not have that number only have the twenty twenty case five members. Have complaints started coming in this year yes. Okay we can get you that number may not I just like to have it for personal reference for future because we'll see how this thing plays out the long run but they would be good if we could be kept informed about the number of complaints and how many investigated and you know found found to be true Senator English. Thank you I guess I'm kind of confused because I we've been hearing about die Campbell for years. So the emergency rule says what. The emergency rule allows a deed allows the camera to be used up through June thirtieth of this year yes. And so what this what would so then it's going to the Supreme Court and and. So does it all and then on the thirtieth of June and then this is not it not an issue anymore the rule is not in place anymore welcome the Emergency rule of course will only be effective for a hundred and twenty days so that'll actually be affected through September four and so we're asking you to promulgate promulgate this as a permanent rule so that will also be the rule that would be in place for next year in any coming years until quite board would choose to amended again and so what have what what happens when the Supreme Court rules. Well it depends on how the rule if if they rule that the proper procedures for or follow them then the if you approve the real today then okay this permanent rule would be in effect if the Supreme Court overturns this rule then it would go back to whatever the previous rule is. Maybe because that Hey you know whether the previous rule is effective and I want to go into this far because it's an issue in the litigation but that's now an issue before the court as to whether the even the previous role would be effective I thank you. They're saying yes one more question how many states have banned the use of the campus. I don't know of any states that have banned the use of di Kampus senator there the EPA has only approved it and I believe thirty something states but among those states where it is approved I don't know of any of them that have banned would you go back and research it and about the information to the committee yes Sir because I do believe that there is couple states have banned. Thank you thank you Mr welcome if you will just send that information to Jessica and she'll push it out to all committee one last question there where the questions will go ahead and move on this the it's spring core comes in and says what we're what we may pass here in a minute they decide no it goes back to the original what was the date of the original that they could spray up to may twenty fifth so I could go back to that and what the Supreme Court determines to do second record wrecked okay all right Sir so feel. Sure Stubblefield you have sorry Mr thank you Mister one last question let's say that let's say that we approve this rule in the Supreme Court goes along with it in the and then what if we have an unprecedented number of damage report unlike anything we've ever seen what we do then. the plant board can always re examine the issue and redo that rule yes Sir. Okay all right thank you. My final question is we got a totally new make up of the plant board now as opposed to the plant board that started this discussion one die Campbell first came on the scene is that a correct statement. That's correct that the blast the county circuit court did enter the order removing nine of the members from the board how may the current board members are actual farmers. Four hi okay if I'm not mistaken all right of center hill. Thank you Mr Hodges up with everything that's going on with the plant board do they even have a quorum to capacity rules or anything. Well at at this point in and senator I I've I would hate to get too deep in that because that's a it's also an issue in the litigation so I would I would hate to say anything but let me just assure you of this the day to day work of the plant board is and how always has been done by the department of agriculture staff so you think about what does the board do a board promulgate rules and then they preside over administrative disciplinary licensing hearings but the day to day work of the enforcing the plant board rules continues to go on on a daily basis and enforced by the department of agriculture staff the plant board by its bylaws meets quarterly they've already had their first two quarterly meetings. They won't be scheduled again to to meet until the third quarter which would be July August or September third quarter meeting has traditionally been in September I am by that point the new law will be in effect and we should have a new Plant Board and no issues about whether or not there is a quorum at that time but but as of right now they would not have a quorum correct at what once again senator that being in a day this is a yes or no questions are okay. Senator I'm yes Sir it can be yes or no answer. Okay I'll say yes they do they do okay thank you. All right there's no other questions on board So summation of it is we passes rule out of here today this is the one that's before the Supreme Court that they'll be looking at if the Supreme Court upholds it and it aligns with this rule today we move forward if there's problems in the future then the plant board will have to take that up and possibly come back and amend the rule if the Supreme Court strikes down says no there is a possibility you could but go back to the March twenty fifth may twenty fifth date and and then we'll be back to square one and the discussions will start from there depending on who wants to push the issue is that a fair Lehman that's first second third okay all right. Members don't have any other questions on the board nobody signed up to speak for against it. With no substantive Stubblefield last question concerning appreciate thank you what we don't pass rules I. Well it won't be in effect as a permanent rule lived with the emergency rule would still be effective through the remainder of this growing season through September fourth and like I said before there were an unprecedented number of damage claims the plate ward would put into place an emergency stop for next year it would not take place this year. at I suppose the point board could put emergency stop in any time could could act at any time. Okay thank you Mr okay. I have no other questions. Without objection this rule is reviewed and approved. Thank you Mr thank you. Next up on the agenda then department health. The morning of March you I'm general counsel for the department of health and I have with me Rick may hand the Director of protective codes and Terry Paul the branch chief over the environmental division of the department we're here to present to rules for the first being the plumbing code our board of health approved this rule in July of twenty twenty we had a public comment period in October to November of twenty twenty we had a hearing on in November of twenty twenty we receive no public comments of this was reviewed by the public health committee in June of this year and we're here to answer any questions. Members have any questions. With the objections will be approved. Reviewed and approved thank you Mr chair next one we did also have the fuel gas code which had a similar app procedural history this was presented to the board of health in July twenty twenty it had a public comment period between October November of twenty twenty and a hearing in November we receive no public comments this was reviewed by the public health committee in June of twenty twenty one and we are here to present the rule if you all have any questions. Any questions from members. That objection the rules reviewed and approved thank you. Thank you all. Right next up on the agenda. The Human Services. Sure what name and title for the record please Sir. Thank Mr more quiet chief staff and chief legislative affairs for DHS. And this is on the. COVID nineteen response manual right yes Mr okay go ahead. Or if I could was chairman I'd like gives little bit of background and explanation it applies to this autumn but also applies to several other items on today's agenda. Last year as a result the pandemic DHS had to make a number of adjustments to our operations both to accommodate changes that were needed to reduce the spread of the virus a reflective safety restrictions I would also reflect temporary changes made by the federal government in their requirements and their systems as result endemic and so making those changes meant the DHS had to suspend a number of rule provisions I use the authority that was in the governor's emergency declaration. So earlier this year after conversations with the governor's office with legislators we moved to incorporate those temporary measures into a promulgated rule and the reason for that was of those measures could continue and would not be dependent on the continuation of the states declared public health emergency our back in March we took this package to the exact subcommittee as emergency rule I contained these regulatory flexibilities and suspensions and at the time we told the committee that we would promulgated as a permanent rule and I use the word permanent cautiously because what was a permit for this rule we're talking about things that we thought would need to be in effect through the end of this calendar year emergency rule can only go in effect for a hundred twenty days and so that's what is for you as a permanent rule died these items do have expiration dates in them so they will all expire by December thirty first of this year. the subcommittee did approve the mercy rule but they did ask we'd carried that to them as one manual subcommittee asked that we brought forward the permit rule that we split it up into individual manuals for each division and says well done that's why you have several items on your agenda today as opposed to just one and so the pieces that time back to the federal changes in federal requirements those will expire with the end of the federal public health emergency we don't know for certain when the feds will release that a merger declaration at this point they're committed through the summer we expect it will continue through December thirty first but ultimately that's a decision be made by the federal secretary of health and Human Services and so but these items in this rule are marked continue through December thirty first of this year. And so that background of for this first one is before you this is the cover costs manual for our division of aging adult and Health Services I have had just a couple of items in this one number one we have allowances to extend the service plans for our long term care waivers this it allowed us to continue providing services for two individuals beneficiaries even when we weren't going out to their house to add to check on them to do assessments because the pandemic because they're trying to reduce that personal contact we're all very often doing phone checks and phone assessments is that would Senate top of it with this allows for the service plans to continue even during that. I will also keep a continued the reimbursement rate for assisted living facilities and kept that from dropping were scheduled to drop into the original waiver and then finally we also allows for some additional flexibilities for acute crisis units to keep people in their facilities a little longer because sometimes they need a longer stay because of the safety requirements around pandemic we received a few public on this respond to those in in those really related to something else that's not contained in this rule would that be happy to answer any questions. The questions remembers. Senator Stubblefield thank you Mr chairman mark the fiscal impact on this rule can you explain that a little more detail and work where exactly does that. Originate from sure the fiscal impact it's part of it was maintaining that slightly higher assisted living payment rate it's what's the cost of doing that for the ninety six hours. It will be another cabin no component that I six hours is for the acute crisis unit and that would include across stabilization units of which we have been Sebastian County correct head Washington and Pulaski because of those extended stays there was there was going to be summoned increase spent because those extended stays. With two hundred twenty thousand you can be passed on that this year but next year to the locals. no that cost be passed on to the the local local any units administering the CSU's must be pure mathematics because. Our thank you Mr. So you kind of set the tone for some of the ones are coming after this that are all related to that so we won't have to have that explanation on the rest right yes Sir and all this is built around the end of the what happens at the end of the year if the feds continue the public health emergency the way this is worded everything in here will and by December thirty first the latest now for some reason the fest decide to spend the federal public health emergency into next year will three by way that that this fall if we think this of these need to continue we may bring another rule back to you but as it as it stands now none of these will extend past December thirty one okay would you bring those back as emergency rules. Possibly just depend on the circumstances but I would I would expect that because unless something significantly changes I wouldn't expect the feds to continue that federal public health emergency more than a hundred twenty days into the new year okay and which one because of all the things that we did during the general session to make things permanent in law why are we doing these or these were the were these the things that we didn't create legislation take care these are things that were not addressed in legislation and things that we thought should be temporary they should not be a permanent change even after the pandemic okay so you would look to create legislation on any of these things were doing because they'll go away the end of the year and if the feds extended we'll just take it up at the time right okay all right any other questions. The objection this rule that is reviewed and approved and if you just wanna going down your list. All right thank Mr in a item of five a this is for our vision county operations amendment to our medical services policy which is our eligibility for Medicaid you may remember back earlier this year actually we go back before than that in December Congress passed solid appropriation act president trump signed it among other things that Act extended Medicaid eligibility to the adult Marshallese population and for those of you around you know that we've had an issue with that they don't Marshallese because of a glitch and some a bill passed by Congress years ago they've been excluded from Medicaid coverage so Congress they fix this December and mandated that states cover these populations are so we brought for emergency rule or this year to get that implemented that was approved this is a permanent rule that continues Medicaid coverage for that Marshallese population no that'll be happy to answer questions. Any questions members. Not with the objections rules reviewed and approved. On next item this is the code response manual for the Division of county operations you can go back to the explanation provided earlier this provides some flexibilities around how we do interviews and process sees for eligibility for snap Medicaid reflects the the changes that the feds made at their level as because the pandemic and again these things will end by December thirty one. All right any questions from members. The objection the rule is reviewed approved. Next item is the co response manual for Division built little disability services and this has again changes in flexibilities related the pandemic for our developmental disability providers includes some changes to allow for some of the clinic based services to be provided in the home so that individuals do not have to come into the clinic and not coming to the in person situation also allows for extensions of a prior authorizations for certain treatments and then also provided for pain I providers to do well checks we're this gave to cause more click based providers gave them of a revenue source to keep their doors open during the pandemic where they were providing telephone checks to check on beneficiaries insure the beneficiaries had what they needed they were not like anything. That have had to answer questions I guess the question I've got is we've declared that public health emergencies over in the state of Arkansas. Why would we need to continue doing this. If we've recognized in state that it's not is it strictly to get federal funding what's the rationale. Part is that these things are more tapering down no this doesn't age can be stopped right away and also order sure they'll you know take some time for things to get back to normal for these click bait Services is organised provider some time to reconfigure their operations get back to normal operations and not just cut them off from these opportunities one time. I guess I'm wondering why. What happens at the in the year when this goes away then. Why we would want to. Continued to make it permanent because it'll go away at the end of the year I'm trying to get my mind around why you would want to make it permanent. If I could let me let miss stone Gillam more detailed explanation of that okay and why you're coming I'm just wrestling was were in may it's gone away. What we need to keep doing it at all. And if I keep doing it to the end of March why would just turn into a permanent thank. Thank you Senator Hammer Hey. So N. name and title for the record yes unless it's down and division director for developmental disabilities services at DHS said these two services in particular so we're talking about we have about twenty one thousand our Kansans adults and children who attend a day treatment clinic so either and early intervention day treatment clinic or an adult person and when the pandemic cat I'm you know there was a there was real concern because a lot of those members are not in our past program they don't meet institutional level of care to be and that higher level of service that in those members impasse have a care coordinator so there was a lot of concern that these members who have L. elderly parents they aren't in the past they don't have care according to check on and we needed a mechanism to allow their and day treatment providers to go by and see them they got food for check on them adds things of that nature what we did we still have. Plants that are still remaining at home right we have I mean if you have a disability it's very common that you have a medical needs that a company that so we still have clients at home what it did do was go into this role and tighten it so you can't bill and Medicaid for a while Jack unless you haven't been able to attend the clinic for five consecutive days because what we didn't want to do always have providers and not saying they would do this make out of it and. That raises Love nights that I'm not trying to be a skeptic here but what I didn't want it was a someone didn't show up on a Tuesday and I didn't want to provider to then go I'm going to bill you for a while Jack when that's very normal that someone maybe miss one day during the week if they don't feel well so what we did it was and more open until we pass this and manual all the first time you're an emergency and it says you can't be both either your medically fragile and you can't attend a day treatment center therefore you can bill to well tax a week or you come on site one of the other and I'm we're watching the utilization of people attending the program continue to rise we are not at the percent we were before the pandemic is we still have some clients that remaining in their homes but I think the reasoning behind leaving in place till the end of the year was making it consistent with the rest of our rules so we didn't have a lot of different time frames that we can fees the providers or the public and I think the safeguards are in place well we're not being double billed for the service okay thank you for the explanation the questions remember. Without objection this rules reviewed improve then thank you. Chinext one mark Mr next item will be the division medical services first one of our state plan amendment for medication assisted treatment and we missed payments going to join me for this one. Morning name and title for the record please yes my name is Elizabeth and I'm the director for the Division of Medical Services at DHS to pull it Michael closer to you please I will thank you have better or a Joe go ahead with your explanation please yes this is a new state plan amendment for medication assisted treatment last year we brought you a state plan amendment for this that allows for physicians at their therapists behavioral health therapists and other providers to provide medication assisted treatment services it's a package of services that includes the medication itself that treats opioid use disorder it also includes counseling and laboratory services and things of that nature so that they can monitor the client as they're using that if you eat use and disorder drug. We at this into place like I said last year to create this physician service and it turns out that CMS needed in a different place in our state plan so we have gone back with CMS and put it in the correct location which is what you have here I CMS approve this last week on June eleventh so this is now accrue from CMS it's Richard back to the October first start date which we had for the previous I'm plan and it does not change the packages of services at all and I'm I'm happy to answer any questions about that. Okay so it's just part of the. To the end of the year that you were talking about as well mark. No no no Sir this is is a permanent rule on this apartment one case or and the cost employment which what's the why the high dollar amounts with what it costs to implement this rule. While looking at the wrong one. And. I think that's on the next one there's no cost to implement this right there is there should not be any additional costs to what we had put in place before because like I said it does not include any changes to the previous package okay there was a cost to what we did last year that should not have changed okay a question. Without objection the rules reviewed and approved thank you. All right Mister in the next item this is the Division of Medical Services code response manual again has several items related to the pandemic and the changes necessary for that the biggest both of these are things that allow for number one allowing for COVID testing to be done in regardless of the order limitations on X. ray and testing and other lab expenses there are in place for Medicaid and secondly to provide for payment for COVID treatment so if Europe was the motto nuclear antibodies that's one of the most victories than this has been developed we had to do an emergency rule to allow for payment that treatment and that continues in this role. A questions members. The objection rules reviewed and approved. Thanks chairman and then the next item this is Medicaid waiver renewal for the living choices assisted living Medicaid waiver this is our waiver that pays for assisted living services for adults with physical disabilities and also for the frail elderly we've gone made an emergency care up you yes let's let's back up I think we skip see there okay let's see here. DHL's telemedicine COVID nineteen so I apologize Mister chairman let me. Looks like I have that out of order in my packet let me pull that up. And for that out of work so this is the on our telemedicine allowances around COVID and pandemic this wasn't everywhere there was quite ability solution that came through to make permanent changes because we recognize the value tenements telemedicine that's an experienced pandemic hill to see the way the telemedicine in individual benefit for providers and for beneficiaries we have a number of items here just provide that additional allowance the providers can conduct different services through telemedicine. Although this reflects an indicted the sum of thirty one we are working on rules to make all of these changes permit and so you'll see additional rules coming through later this year building on the legislation to make these telemedicine allowances permanent. K. A. questions from members. Surjection rules reviewed and approved okay now the the living choices okay. R. S. this is our Medicaid waiver forces living services for adults with physical disabilities and the frail elderly the main changes in this are some changes we actually push through an amendment to the proper waiver or carrying them over into this one your real it's makes it things easier for me to fisheries and that once they are on the program we will not necessarily require them to do an independent assessment every year if our nurses are visiting the beneficiary and our nurses term that beneficiary's condition has not substantially changed we would not require them to undergo another independence us for that year so that should simplify things for us never processing makes things easier on the beneficiaries and providers we think that's a good change on the beyond that the covers the key changes within that way for renewal. Okay specifically this population is to. This would be adults with physical disabilities you're twenty one or over have some form of physical disability as opposed to develop disability or behavioral health issue and also the frail elderly and the requirement for them as they have for either side they have to be at a point they need at least an intermediate level of care which stands they need some assistance with mac two is a daily living things like toileting bathing and things like that what about the assessments what's the. You get a lot of complaints about the assessment process if you're going up this that I interpret what you're saying to mean that this is going to reduce the number of annual assessments is gonna be left up to your staff to make that determination whether they need that third party assessment is that that correct that is correct because for this population particular I mean if you have an adult who is a quadriplegic. That's not assistance going to improve and they may very well state parole police no at the same point for several years and or their condition and so yeah it for the comp type of individual we recognize is just is not helpful to do another assessment every year for that individual right so are we gonna be dropping or we gonna be lower in the contract amount we have with the firm that's currently doing the assessments. We I believe so I believe we have adjusted that amount I have to double check that bubbly we did adjust that amount of what we're paying a fortune for that contract we pay by assessment so even if even if the contracts not adjusted they're told compensation still going to go down because if there's not assessment or not pay okay all right could you just can't get summary on that if you don't mind leisure all right members any questions. Third junction this rules reviewed and approved. All right eight. All right and this is a believe our last Code response manual this is for a division of provider services and quality assurance this two out of this one relates to some flexibilities on the pre mission screening for nursing facility residents recognizing just there's been we've had some movement for nursing homes because the code and has about breaks and we just Rep would relax things in terms of those pre admission screenings that orderly required and then also we provide to some flexibilities for therapeutic community providers so they had a reduced number of hours of in person services to provide for their clients and with that be happy to answer any questions the questions members. With the objections rules reviewed approved before you go on the next one I want back up to the living situation ask you this yes do you anticipate that will ever go back to what we worst first of nursing staff that you have been able to just do the assessments by themselves and not have to contract out to a third party. I mean this this service and we can explore think there were some some good reasons for delegate that to an independent entity and I'd also add that does allow for our nursing staff to focus on doing more and they're it care coordination and checking on beneficiaries ensuring that our beneficiaries have what they need and they're in the services they need but with that said on I don't lose anything that would bar us from doing that the future the service on we could revisit okay we'll have it is within all right nine. And I just you're done actually to your thank you members. Thank you all right nine department of labor licensing. Good morning name and title for the record please. Thank you Mr chairman members of the committee I'm Denise Oxley I'm general counsel for the department of labor licensing and I'm here today on behalf of the board of what barber examiners on it's a small rule change that basically would allow the board currently has a rules establishing credentials for the director's position that they hire in this would allow them to consider an employee who's been employed by the board for murder more than two years you is actually not a licensed barber. He's been employed as an investigator so it's a small change there were no comp public comments during the public comment period but I'll be happy to answer any questions I'm just curious what motivated or you'll have a hard time finding somebody that you had to make the judgment or what is that well the commission has been vacant for about a year now and I think the board is interested in of the current lady who is been in effect the office manager or the acting director has been employed for a period for number of years by the board with strong administrative credentials but she is not a licensed barber Senate. And I would like to consider her for that position okay a questions from members. Without objections rules reviewed and approved as thanks for staying here Sir. All right Right there okay. A final item on the agenda is letter for the are read culture Arkansas bureau standards regarding a status update courts ACT five seventeen two thousand nineteen you have leverage your packet and there is no obligation and will review and filed a letter as a status update any questions regarding that. All right that it. Well business for the jerk before the committee were adjourn thanks for being here.