Alzheimer's Disease and Dementia Advisory Council
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- October 2, 2026
Speaker 3
0:00
We're going to give it just a couple more minutes and then we'll get going, folks.
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0:30
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Speaker 3
4:30
Good morning. Welcome to the Alzheimer's Disease and Dementia Advisory Council. I think I hit the gavel
Representative Les Warren
Unverified
4:55
a little bit too hard for a couple of ladies next to me, But if they were not awake, they are now.
So good to have everyone here this morning. And we don't have a long agenda, but we will start with seeing a quorum. And then we will consider approval of our minutes. So have you all looked at the minutes? Okay, do we have any corrections or changes to those minutes?
Okay, I'll entertain a motion to approve the minutes. Okay, motion in a second. Any discussion? All those in favor, say aye. Any opposed, same sign. The minutes
stand approved. So next we will move into a discussion of the Arkansas State Plan. So, David, do you want to come to
the table, please? and just an fyi senator penzo is uh on his way uh he called me just a few minutes ago he went
to get in his truck and someone had bashed a window in so the police are with him filling out the form, and he said, I will be there, but it'll be a few minutes late, so I'll shift over and let him finish chairing the meeting, but he is on his way. He did not forget the meeting, so David apparently does
not want to come to the table.
I tried to stall as long as I could but I ran out of material I guess I should have called on Senator Flippo because he's always got material so well it we'll just call it a gift and end with that okay all right will you uh identify yourself
Speaker 14
7:32
david cook a director of government affairs for the alzheimer's association
Representative Les Warren
Unverified
7:37
all right you are recognized to present your plan
Speaker 15
7:41
the uh laptop is uh password protected Brandon oh okay just one
Representative Les Warren
Unverified
8:08
presentation is locked if you'd like to sing for us or entertain us while
David Cook
Unverified
8:21
up with a little ditty pretty quick, I think. Okay. While we are waiting for assistance, I do want to draw your attention to priority number three under the objective sections because there will be an amendment.
I was working on the state plan. There were some formatting issues I was trying to clean up yesterday, Naomi just pointed out that I did leave an objective off inadvertently, and it is specific to a mapping where Arkansas currently has pet imaging, MRI monitoring, infusion services, and dementia specialist or care services. And so one of the objectives that I presented to you last month was to map our available services, also identify the gaps.
And then the objective was to utilize some of the existing infrastructure to close some of those gaps in terms of access to infusion centers. And that is a project that we will work jointly with the UAMS Centers on Aging on the Alzheimer's Association and DHS with the Dementia Services Coordinator. and I think the Arkansas Department of Health is also named in that. It is just an objective that got left off inadvertently, but I will ask the council to, when the time comes,
approve the amendment or the state plan with that pending amendment. Okay. All right, looks like we've got an IT guy coming for you. Sorry about that. It's the same as this, Web User 1. Oh, okay.
Representative Les Warren
Unverified
9:52
Just in case it looks out again. There you go. All right. There we go. Okay. All right.
Speaker 5
10:20
Is the PowerPoint on here? Is the PowerPoint on here? All right. We
David Cook
Unverified
10:43
will just go through the state plan as a PDF. I did have a PowerPoint, but I guess it didn't get loaded in, so I apologize for that.
The added areas that we didn't have last time, of course, the cover has been updated, and then the table of contents has been added in there as well. One other thing to note, there is a brief letter from the Arkansas Department of Health that discusses the partnership between the Department of Health and the Dimension Services Coordinator that will be added in as an appendix item as well. This version of the state plan, this update, it was very important for us to make sure
that when we did make updates to the objectives and the priority areas, we took into consideration the advancements that have happened in Alzheimer's research since the previous version of the state plan. And so we talked briefly about some of those advancements that have really changed the landscape. One of those, of course, is access to early detection diagnosis. And we'll talk a little bit more about that in just a few moments. I do want to hit the highlights of just the impact of
Alzheimer's disease across the state of Arkansas. You know, based on our population study with the census in 2020, we recognize there are over 60,000 Arkansans over the age of 65 currently living with Alzheimer's disease. That number does not include those individuals who may be living with a younger onset diagnosis or those living with another form of dementia. We've spoke at length about the impact on family caregivers we know there's over 175 family caregivers here in Arkansas
who in 2025 provided over 268 million hours of care so caregivers play a significant role in delivery of of care across our state so we've talked at length about the importance of supporting family caregivers as well based on those statistics one of the other things I'll draw your attention to is just the workforce shortages you know we we have currently 60 geriatricians by 2050 the demand is to increase that by 61 percent so certainly more efforts in this plan
are highlighted about the importance of not only the recruitment but the retention of the direct care workforce and extending beyond that making sure that we are recruiting and retaining geriatricians and attracting geriatricians to the state. Given the fact that the state has also made a lot of headway in ensuring that we are attracting people to retire to this state, we want to make sure that we have the infrastructure to care for that influx of aging populations across the state
of Arkansas. Again, this plan builds on some of the progress we've had earlier in the previous version of the state plan. Just the council, we've talked about this at length, but just the support of the council and being able to move through legislation that helped us deliver on some of the priorities we identified in the previous state plan. But to ensure that this state plan reflects some of the advancements in research, we did update the priority areas and we've already
approved this as a council but just to remind you of that our four priorities are again advancing risk reduction brain health early detection and diagnosis and we wanted to make sure in this priority area we identified objectives that of course reflect some of the latest developments in research we know that since the previous state plan we now have treatments to slow progression of the disease. We also know quite a bit more about risk reduction in terms of some of the
things that we can change, some modifiable risk factors, and so we leaned heavily on trying to make sure that when we developed objectives, again, reflect some of the advancements we've seen in research in this space. The council, since we began our work in 2018, has always sought to prioritize family caregivers and of course we continue to do that in this version of the state plan by identifying a single priority that just enhances support for family caregivers
across the state and then our following our last two priority areas again ensuring access to diagnostics and treatment again making sure that the plan reflects the advancements in research in this space as well you know we we now have blood-based biomarkers and so the ability to identify and diagnose the disease earlier is certainly accelerating as the research moves we now of course also have treatments so we talk specifically about looking at insurance coverage
and when we determine whether or not an insurance coverage is adequate we want to make sure those policies cover the wraparound services in terms of diagnostics but also access to treatment and so part of that priority amendment that we I just mentioned deals with not just you know it's great to have treatment but we want to make sure people can access that reasonably and so one of the things that we wanted to work on is mapping some of those gaps and then how do we close those gaps with some of the existing infrastructure and that's something that we want to to work on
during the next four years. And then we want to make sure access to care is available for people regardless of their zip code, but also make sure that care is quality care as well. One of those other access points we need to continue to monitor is diagnostics. As I've talked with Naomi, the coordinator, We both agreed that these objectives are highly ambitious over the next four years.
It does require the council to work together and collaborate on some of these efforts, but nothing outside of the realm of possibility. Again, we left the objectives broad enough, so it gave us some flexibility to not only change and adjust priorities when needed, but also the flexibility to move where the research takes us. So, again, research is changing every day in this space, so we need to have the flexibility to adjust the plan to some of the new research developments that no doubt we will see in the next four years.
Any questions on the priority areas? Clear as mud. Thank you, Mr. Cook. Are
Senator Clint Penzo
Unverified
17:41
there no questions for anything? I've got quite a bit more to go. I'll just pause it for a
Speaker 15
17:46
second. I do have a question. It's not a question, it's a comment. It's a small matter, but supporting access...
Speaker 44
18:00
As number four and the insuring access, it's kind of a little bit confusing as to what's the difference. I know on the third priority it says ensuring access to diagnostics and treatment, and then it says supporting access in the fourth one. It may be a minor thing, but it was something that I just had that question about the difference. The wording seems similar for priority three and four. That was just a comment.
David Cook
Unverified
18:30
I don't really have anything else to say beyond that. No, I appreciate that comment. And, Dr. Jordan, you know, on priority three, we're really focusing on the diagnostic and treatment space, on the access and quality of care. We're looking at more of care across the continuum in terms of long-term care, HCBS services, and things like that. But thank you for that.
Okay. Each one of the sections, you guys have seen this before, we did approve most of the content that's there. There has been nothing changed in terms of the content areas that lead up to the objectives. I would like to spend the rest of the time just looking at the objective areas in each priority area, the objectives in each priority area, excuse me. Under risk reduction, brain health, I will not read all of these in their entirety, but I'll hit the highlights and just talk about the why behind this.
But on risk reduction, brain health, early detection, diagnosis, and care planning, we have made some headway. there's deeper collaboration between the health department and DHS. We're trying to figure out how do we integrate brain health messaging and some to our, some of our existing chronic disease strategies. And so lots of conversations will be had about how do we, you know, use our existing, the existing public service announcements or public health campaigns, and how do we integrate
brain health to normalize the conversation around brain health and again speaking about brain health doesn't carry the stigma that Alzheimer's and dementia does and so if we can be proactive around risk we can change and influence the conversation and get our candidates to be more proactive around the brain health and seek out detection and diagnosis when they do recognize memory concerns the Arkansas Department of Health is currently running both of
our specific modules inside the behavior risk factor surveillance system the cognitive decline module and the caregiver modules are being ran on an alternated cycle and so it's when we collect that data we wanted to add a priority here making sure that we're utilizing that data to inform policy decisions but also that the council is aware of what we're seeing some of the trends we're seeing across the state both in the cdl and the caregiver space um uams uh and i have discussed this dr
overton mccoy and i had a conversation about this earlier but um they have already done some of this trying to incentivize and increase the use of the medicare annual wellness visit we want to continue to track that status and identify strategies that help us, again, increase the use of that code, whether it's patient awareness, clinician awareness, UAMS, and the Chronic Disease Council and the Health Department already partnered on a project. And so just building on some of the existing work there to help us continue to make sure
that people are aware of the code and also providers are being proactive in offering this to their patients. We are seeing some clinicians across the state be very effective. This is part of the patient file. When they turn a certain age, they're automatically going to do this. And so we'd like to see that to be a standard practice across the state. Again, we talked a lot about the direct care workforce in Arkansas and how we've
done a lot to expand scope for APRNs and PAs, and I also identified my concern that the clinicians that are not attached to major health systems don't have access to the same information as their colleagues who are. So making sure that we are proactive in educating providers on the importance of early detection diagnosis when they need to make a referral, but also incorporating risk reduction into their clinical practice. And so provider education is key.
And then finally, in that section, just making sure that people who do receive a diagnosis of dementia have also been offered care planning services and are connected to community support services. Again, there's a variety of strategies that we're working on to incorporate this into everyday practice. One of those, I think, is, you know, the dementia resource centers as well, expanding that footprint. So, and also some things that DHS is doing in terms of
developing, basically, a care navigation system using some of their infrastructure. So there's some things that are moving in this priority area, but certainly more that we can do as well in this space. And I will pause there for any questions on those objectives. All right. I don't mean to be full of questions today.
Speaker 44
24:02
No, please do. I'm just wondering about some of this data that's being collected, if included in the outcome, if we could say something about report to the advisory committee, because it would be kind of nice to know some of the information that's collected from some of this data.
David Cook
Unverified
24:23
In addition to the BRFSS or the other data that I identified, the wellness, annual wellness visits would be interesting.
I will go back in
and make that note to include data reporting to the council. I guess we need to ask for,
approval or amendment to the plan on that
Senator Clint Penzo
Unverified
25:27
section let's wait till the end and if there's any additional
David Cook
Unverified
25:41
time all right um caregiver support again the heading uh and the material there is the same, uh, looking at the specific, uh, objectives. Um, uh, one of those, uh, is to just
ensure, uh, of course, currently we are using, um, a pilot program that, um, uses SSGB funding, um, to provide this, this respite service across the state. Uh, we've been operating in that capacity for the last four years. And as we've mentioned before, our disease space really has not gotten any SGR support. We've really tried to do more with less.
We would like to see the state invest, like some of our neighboring states have, in a permanent dementia respite grant program, just to ensure our caregivers have access to respite something that the state could be proud of to build upon in the coming years you know kansas funds their program at eight hundred and fifty thousand dollars annually and that's probably one that's most like ours and we've we've been capped at two hundred thousand based on the ssgb draw to operate this program mississippi is at 350 000 now and then our
neighbors in Tennessee across the river are at a million dollars annually now. Granted, Tennessee has more of a prevalence than we, but just kind of a ballpark of how other states are investing in services like this. Also, one of the things that the legislature continues to ask us for is a one-stop shop for caregivers, and so that's something that DHS is working on as well, Just establishing a single caregiver navigation system so families know where to access treatment, when to access treatment, and that families aren't waiting until a crisis comes to access care and support services.
There's availability across the continuum from mild cognitive impairment to advance Alzheimer's disease. People have nowhere to go at every stage of the disease. Expanding evidence-based caregiver education and support groups into more underserved and rural counties. And so that's something that can be moved programmatically between the work that we're doing with the Centers on Aging and some of the other nonprofit work being done by the Association on Alzheimer's Arkansas as well.
Again, one of those priorities that's essential to family caregiver support is expanding a pilot that we've began in Northwest Arkansas, establishing a dementia resource center. That's something that we'd like to expand across the state. And so we are working with the Schmieding Center right now on the pilot. We are also working on collecting data, and we'll have some more presentations on that as we get some more data in place just to kind of talk about the reach of the resource center, how valuable they are, and how important it is to expand that footprint across the state.
And that is something we can do with a very limited fiscal impact as well. And then what increasingly these get a little bit more ambitious, and I think really having a discussion around establishing a pilot dementia care specialist program, very different than dementia services coordinator. That coordinator is housed inside a state agency. What the care specialists are, according to the model that I personally dream of,
we would have a care specialist in each one of the Centers on Aging, excuse me, each one of the Dementia Resource Centers, just to help families navigate the health care system, refer them to community services, but also it's very essential to have someone in place to help close the referral loop, so making sure people, when they do receive a referral, they do follow up. You could use kind of a community health worker to fill that space as well, But I would like to see us pilot that in year two or three of the state plan, which may be an ambitious goal, but one that we're up for.
Any other questions on community support for caregivers, family
David Cook
Unverified
30:36
All right. sorry about that the priority number three just ensuring access diagnostics and treatments
one of the the tasks is is make sure we continue to monitor the different payers and how they are covering diagnostics how they're covering treatments but also all the wraparound services that are needed in terms of, you know, ongoing monitoring with MRIs. And so one of the things we looked at is checking that through mapping. That was an amendment I mentioned to you previously.
But, you know, we looked at some of these coverage gaps that, of course, always lead to policy, things that we need to do policy-wise to make sure those gaps are closed. But that's something we need to continue to monitor, and Dr. Jordan, to your point, report back to the council on what our findings are and how do we close those gaps. Number two kind of builds on that, just to address any inconsistent coverage of FDA-approved amyloid therapies across Arkansas payers.
So once we identify the gaps, how do we close those? Again, expanding access to cognitive evaluation to telehealth provider supports and referral networks was number three. You know, under that broad category was one of those strategies like developing a hub and spoke model similar to the mitigation we do in stroke. So building a system where some of these role providers have someone they can lean on for consultation when they are evaluating cases.
We also highlighted that blood-based biomarkers have made their way to the primary care space. What does concern us is that clinicians aren't always educated on how to use those blood-based biomarker tests. And in several cases in Northwest Arkansas, you know, the PCP refers once they get a positive biomarker test, they refer it to a specialist when the specialist has to review all those cases um and in one one
instance again this is this is an outlier this is one case um of 100 cases he received uh only about 30 could go on to more evaluation um and so it's important again to educate those rural providers who aren't connected to major health systems on the appropriate use of blood-based biomarkers, um, and, uh, you know, when, when to refer that, that patient on to a specialist. That'll be an ongoing, um, issue, uh, especially as the, the research space in blood-based
biomarkers continues to evolve. Um, you know, before we were just testing for amyloid, but now we can test for tau as well. Um, and so that, that space is going to accelerate. Um, if I was Just reading tea leaves, even a year from now, we'll be in a much different space than we are right now. It's just moving that quick. And then even a clinician that's attached to a major health system, you can't expect them to keep up with everything. So ongoing clinician education is key.
And then making sure families, consumers, they have clear information on available treatments and all the risk and benefits that are associated with available treatments
Speaker 66
34:52
second the same verbiage from the measurable outcomes so on page 15 expand access to dementia resource centers across the state you said funding secured for a pilot center and on page 17 that same verbiage was carried forward
for educate primary care providers it's just a typo it is a typo um that
David Cook
Unverified
35:19
deliverable should read guidance issued and providers um trained with
Speaker 40
35:24
referral referrals tracked where the data exists yes yes yeah it's just a typo i will i will
Speaker 47
35:35
get that cleaned up as Well, that's again me trying to format these boxes
David Cook
Unverified
35:44
and I copied and pasted stuff and that was a mistake on my part. Okay.
Under the access and quality of care priority, the majority of our objectives live here,
and so I'll kind of go through those as well. Over the previous state plan, we were able to advance legislation that established dementia training for assisted living communities, law enforcement, home care providers, and even enhancing some of the requirements for facilities who choose to have an Alzheimer's special care unit. And so one of the questions we have is whether or not that dementia training is improving care outcomes,
and so continue to evaluate some of the impact of our dementia training standards, and that's something that the coordinator is working on. Sorry to keep calling you the coordinator, Naomi, but I know she's working on something there as well. Strength in recruitment, training, and retention of the direct care workforce, serving people with dementia. Again, making sure there's growth across the board and how do we come up with strategies,
develop strategies to incentivize retention. And, again, I think some of our partners in the room are doing some great job to recruit to that workforce. I think AHA's, you know, their nursing training program is amazing in filling some of these gaps. How do we continue to build on things like that? Also improving care coordination when patients are transferred between care settings. So someone is discharged from one facility to the other, how do we make sure there's good care coordination along the way?
This would also include hospital-to-home as well, just making sure people have access to the services that they need as well. I think monitoring access and expanding access to HCBS services is a priority that we had in the first state plan, and I brought it back for this one as well. Just making sure that there's another carryover deliverable there. I apologize, that's a typo, but just monitoring access points to HEBS services and closing those gaps where services aren't available.
This is something we've continued to work on with various partners, but making sure we strengthen protection of Arkansans with dementia from abuse, neglect, and financial exploitation. We have done some legislation around that, but just continuing to identifying gaps and monitoring to make sure that, you know, the dementia population is protected. We have done a lot in this space in terms of training first responders in our law enforcement community.
Certainly, there's a need to expand that to other first responders and emergency personnel. But just we want to make sure that emergency departments are dementia capable as well. And so I know that the UMS Centers on Aging is doing some of that training. And so how do we build upon some of those training mandates and get them into some of the other areas that are needed? Strengthen community confidence in home care, memory care choices by closing any gaps that we see in existing licensure standards
or any kind of disclosure requirements that need to be added. That will just be identifying some of the gaps that we see and coming up with strategies to close those gaps. And then establish consistent dementia-capable training standards for clinical and paraprofessionals who are caring for persons with dementia. So that is where most of our dementia training legislation would live under, identifying some of the dementia training standards across care settings, identifying those gaps, and
closing them with policy solutions any questions on that section our final section is is really the 2027 policy recommendations I did get I know Brandon noticed this but they are a little more broad than I've put in the past but expanding access to cognitive assessments more specifically one of the
things that the gaps that we are immediately looking to close is the one that exists in Medicaid Medicaid has yet to establish a reimbursement code a reimbursement for CPT code 99483 which is the cognitive assessment code it's available to our Medicare population but for those individuals under the age of 65 who may have memory issues there is no coverage on the Medicaid side of that but Medicaid does you know they do because of the CMS rule they do provide
coverage for FDA approved treatments but again the cognitive assessment benefit is not included under that and so the the when we look at usage of this code across the states especially in Kentucky I think Kentucky has paid 400 claims in the past five or six years so the fiscal impact is really minimal for this but it's something that we have been asking the Medicaid department to close for the last five years so we're still working on that
as well expanding access to the caregiver respite support this is where again establishing a Permanent Dementia Respite Grant Program would live. I would expect to file legislation specific to the respite program this session. Strengthening dementia training for healthcare providers, the two clinical areas that we are proposing
that we look at this session is PAs and APRNs. Just adding a continuing education requirement to those clinicians who are serving individuals with dementia without adding to their current existing continuing education requirements. We'd like these incorporated into their existing ones and also not doing anything to impact their scope of practice, but just making sure that that is mandated in the continuing ed because things are moving so quickly in this space.
you know, making sure there's consumer protections in home care. One of the things that I have mentioned is that we do require licensure for Medicaid providers, but not for those individuals or those companies who may be just private pay. We don't have a licensure standard for that, so that is really concerning. And then also just expanding access to FDA approved treatments. More specifically, we're looking at the state employee benefits, even though Blue Cross has changed their coverage determination, we're still not confident that that has any impact on the state employee benefits division, and so we are waiting for some verification on that, but I would expect us to move on that issue as well this session.
Senator Clint Penzo
Unverified
44:00
Thank you, Mr. Cookin. Does anybody have any questions about anything in
Speaker 79
44:18
there? Hey, David, thanks for your work on this. There are a number of, it's probably just me being the way I am, but there are a number of period issues, ellipse issues, commas, those kinds of things. So I've marked mine up to help you when you're going through
to kind of fix your objectives and make sure they're correct, just to make sure all of that's correct before you hand it
Speaker 51
44:49
to council for their approval. Okay. Anyone else? Next question. None of those are, like, content-changing,
Senator Clint Penzo
Unverified
44:56
just grammatical things. Okay. Okay. Well, what I'd like to do is, with that objection, do the three amendments that we had and vote on those.
The third one was just a typo. The first two, I don't know if we
want to restate what they were, and then
David Cook
Unverified
45:22
we'll vote on it. So amendment number one under
priority area number one was just to include data reporting to the council where we have shown in the report that we were going to collect data. So that was one of the amendments.
Amendment two came in page. Naomi, yours was 17, right?
Yeah, the typo was a carryover on page 17, and this one, 20, yes. And then under enhancing access, yeah, enhancing access to diagnostics and treatment, there was a priority that was inadvertently left off. And that that objective should say mapping where Arkansas currently has pet imaging, MRI monitoring, infusion therapies and dementia specialist.
And then also the deliverable was identifying those gaps and utilizing existing infrastructure to close some of those access point gaps that we we
Senator Clint Penzo
Unverified
47:15
recognize. so all in favor say aye opposed
motion passes uh next we'll vote on uh approving the arkansas
alzheimer's and dementia state plan as amended uh all in favor say aye opposed motion carries the state plan has been adopted. Next item on the agenda is a discussion of potential legislation. I don't know if Representative Warren would like to take over
on this. I think as far as basically we've
Representative Les Warren
Unverified
47:53
got our legislation in place,
what I'd like to do is look at it from a perspective of if we have positions which Brandon and I are going to meet that have not been fulfilling the appointment, then I would like to see us get a couple of people. I know Baptist Hospital has a dementia, Alzheimer's, caregiver-type department, so we need to try and include someone from there.
if you guys have any other suggestions i would ask you to get those to me but we need people who are truly wanting to be engaged in this process i think david's done a great job on our plan but the more people that we can get that understand this disease that are passionate about this disease the better we're going to be about getting the message out into the entire state
and seeing some results from what's available so i would just ask you if you've got names of anybody get those to me and uh i know i'm i'm looking at dr davis from baptist that's the only name i have right now but any other names i'd be welcome if you if you want to get with me after the meeting and share that with me
but i would i would ask that you would just allow senator penzo
and myself to work on just amending the existing legislation to delete
some that aren't active and add any appointments that we think would be beneficial to
Senator Clint Penzo
Unverified
49:52
the council. Thank you, Representative Warren. Is there any other business we need to discuss today? Do
you have any additional comments about anything else?
No, sir. Okay. Nobody's got anything? We'll go ahead and adjourn the meeting. Thank you.
Speaker 76
50:13
I just want some clarity on our process that we've updated the
David Cook
Unverified
50:18
state plan. I'll make the changes today, and then we mail that back out over to the council.
Senator Clint Penzo
Unverified
50:26
Yeah. If we could have everything into Mr. Smith here by the 28th, that would be great. That way
he can do his thing and get it submitted by the 1st.
David Cook
Unverified
50:39
I would feel more comfortable if the council got to look at the state plan with the amendment. it's at
Senator Clint Penzo
Unverified
50:47
least via email. Um, okay. Okay. Yeah. And then if anybody's got any, uh, objections or anything, let me know and then we'll reevaluate at that time.
Speaker 56
50:57
Okay. Okay. All right. We're good. All right. We're adjourned. Thank you.
Agenda
A. Call to Order
B. Consideration to Approve Minutes from August 25, 2026, Meeting [Exhibit B]
C. Discussion of Arkansas State Plan [Exhibit C] - David Cook, Director of Government Affairs, Alzheimer’s Association, Arkansas Chapter
D. Discussion of Potential Legislation
E. Other Business
F. Adjournment
Documents
Speakers
Speaker 3
Representative Les Warren
Unverified
Speaker 14
Speaker 15
Speaker 17
David Cook
Unverified
Speaker 5
Senator Clint Penzo
Unverified
Speaker 44
Speaker 40
Speaker 61
Speaker 38
Speaker 66
Speaker 47
Speaker 79
Speaker 51
Speaker 76
Speaker 56