Insurance & Commerce - Senate

Calendar do we have anything else for the good of the calls all right let's go and jump right in we've got a full docket Senator Irvin you I believe have an amendment to present to the committee first so you want to go and begin their. Yes thank you Mister chair members of the committee and I want to go through the amendment first and The Amendment the first part of the amendment deals with our border hospitals in Texas and Tennessee that language in the second part of the amendment that deals with an increased accountability and oversight to be included the third part of the amendment includes language that was requested to be more inclusive of those outreach organizations the M. X. B. and the last part of the amendment is technical clean up and clean up to you include the minority party As representatives on the accountability and oversight panel and with that I would move adoption of the amendment okay we have a motion to adopt the amendment as presented do we have a second. The second Senator Teague any discussion of questions on the amendment. Anybody in the audience to speak for against the amendment seeing none all in favor of accepting the amendment as presented police say aye hi same sign opposed. You have been amended pass your amendment now it's time to move on to the bill okay so members of the committee at first I just wanna thank you for your time and consideration I want to recognize the people that we have here to support this in the audience they will be available for questions if you have those for them the Department of Human Services we have Cindy Gillespie secretary of health we have Dennis Smith senior advisor for Medicaid and health care reform we have done stale who is the deputy director of health and state Medicaid director in the insurance department we have commissioner Alan McLean it we have a generator he was the general counsel with the Arkansas hospital association we have rile president and CEO Jody interest executive vice president also in support we have Arkansas hospital CEOs in attendance Dr cam Patterson from UAMS he would like to say some words and Chris barber with St Bernard's an Arkansas hospital board chairman and Allen Finley from Dardanelle regional Medical Center we also have with this Arkansas health and wellness and team corporation John Ryan who is the president and Arkansas Blue Cross blue shield Chris Barnett president and CEO we also have Mister shall not starter shall not here as well at to answer those questions members of the committee today it's really an honor to present to you Arkansas home Arkansas health and opportunities for me as a new five year waiver designed to replace Arkansas Works. This legislation that you have before you is really the framework and the guidance that we are going to be able to provide to DHS and creating Arkansas health and opportunities for me another what's known as our home. Our home uses the same financial structures that have been in place since the inception and the passage of the private option and then those remains as well through the Arkansas Works program so it uses the same financial basis and partnering ship partnership with qualified health plans as a premium assistance and programs there are so many benefits to that and we actually have data now seven years of data to prove that that negotiation and the partnership with the qualified health plans has literally been able to bring in billions of dollars into the economy of the state of Arkansas which is help stabilize our health care economy and infrastructure so that is the financial policy in the basis of this plan that I know all of you are all very familiar with and this new our home waiver would bring in an estimated nine point seven six six billion dollars from the federal government into the State economy over the next five years in comparison and expansion of a different kind and would bring in a lot less of that with the reduction of three billion over the next five years so this is honestly the best policy to present and moving forward funds but financially and with healthcare policy another reason why we use this financial model is because it does increase the rates that are paid to our providers and our hospitals by twenty five to sixty five percent what that does is that really opens the door for increased access for our Medicaid patients from all types of services that specially particularly specialist specialist at a services and it I want to talk now you you understand the financial policy of that and how that waiver is going to be designed and how it will be negotiated the federal government but I will also want to talk primarily about the health policy around Arkansas home. The health policy is very intentionally driven when I say intentional it really goes back to the name of Arkansas home health and opportunities for me it is intentionally designed to meet the needs of of the citizens that are the beneficiaries of on this program and now we know from claims data and we also know from enrollment to these individuals are where they are in their lives what types of issues that they have going on with them and what our home does is really the the first time that we have a real rule health initiative as well as an Arkansas based Arkansas citizen based initiative so it is intentionally designed to really target that individual and meet that individual where they are in their life and and bringing and yield all of the resources available to them that we already offered in many areas or resources that we need to offer to them to make a difference in their lives and so the best public policy that I know of is one one that it's intentional that it's smart fiscally and then also that it's accountable and so I'll get to that portion of the bill as well but our home uses what we call CaringBridge organizations and we have name those life three sixty homes and we have three live three sixty hands the first being and maternal life three sixty homes we know that over sixty percent of the enrollees and the current Arkansas Works program are women and we also know that about twenty one thousand burst are covered under Medicaid every year we also at an unfortunately Arkansas ranks forty ninth and intent and mentor and maternal health outcomes that is something that we absolutely have to address so the maternal life three sixty home is intentionally designed to target those individuals that are expecting mothers so that we can ensure that they get good health care. Starting at the minute that they are no that they're pregnant you all know how incredibly important it is for a woman to receive health care in the first trimester of the pregnancy and that is what we are targeting to do is make sure that these women receive good health care within the first trimester and then to follow them through their pregnancy and then also to work with them two years after the birth of that child this will ensure that that baby gets into the world without serious health problems it is intentionally designed to help that mother and that newborn baby dirt while it's growing in the womb and then when it gets delivered out to the real world you and I know that a Nick you stay cost a fortune and about approximately twenty one hundred babies were born that required to stay in the neonatal intensive care unit that in combination with a low birth rate and high risk pregnancies that's costing the state of Arkansas over a hundred million dollars annually so we've got to do better and the maternal life three sixty home is intentionally targeted towards helping those young expecting mothers the second home is the rule rule five three six PM this is particularly important to me living amount the Arkansas we have a small rural hospitals a critical access hospital there it got wiped away in a tornado in twenty two thousand and eight so I know first hand how important it is to have your hospital in your town and so the life three sixty home for rule Arkansas is intentionally designed to address the needs and the concerns surrounding rule healthcare and our citizens that live in rural Arkansas over forty percent of our Kansans live in rural Arkansas and unfortunately study after study shows that our mortality rates in rural Arkansas are higher are co morbidity rates in Arkansas are higher among star rule our Kansans. So rules throughout life three sixty homes is intentionally designed to target and and helping to improve the health outcomes for those citizens the third life three sixty home is a access live three sixty Currently there are approximately seventeen thousand formerly incarcerated and individuals that are on Arkansas Works. We want to wrap around those individuals and ensure that they have the care that they need to have a successful and stay and hopefully provide for preventive recidivism rates also in this life three sixty six as time our veterans we know that veterans have their own at issues and problems and this gives us an opportunity to really intentionally target and help our veterans in the state of Arkansas with all of their health concerns as well as their mental health issues that that we know that there is a problem. That needs to be addressed I'm also in the success three sixty homes we are intentionally trying to also work with the youth that were informally in the DYS system and help them transition it back into a successful life and then also those with that have been in the foster care system we know that those populations of of our citizens need extra intentional support in order to help them and have a more successful life and and and contribute greatly to our state so I'm thrilled about this healthcare policy it's it is a phenomenal rule health initiative to be honest with you but it also combines with our urban issues as well with some of the success homes and at and I'm I'm thrilled at the work that has that has happened over the last year on this piece of legislation I also just want to say I'm very thankful to the legislators that really dug in deep and brought all of their ideas to the table Senator Bledsoe represent of Ladyman Representative Ken Ferguson Representative Deborah Ferguson there are so many others that really participated in work groups with DHS pre code of it and then it became a little more challenging after cove it but those legislators really came to the table in a work group setting working with the team at DHS to really figure out how we can be intentional about our health care policy and that is the result you see here before you today in our home this is a collaborative effort and I can be more proud of this effort I know it's going to be difficult and I know it's gonna be hard but but it's worse absolutely worth doing and that the last piece I just want to say is thank you to the stake holders the insurance companies that worked with us to develop and continue develop the accountability piece of this I think it's really important. our hospitals and their ideas that were thrown on the table as well we know that can be a challenge to implement this but it's a worthy challenge that were I know that we're willing to take and and I can talk more about this life three sixty homes and how they're anchored with are utilizing our hospitals and to that point it is so smart to utilize our current infrastructure and to provide them with additional financial resources to stabilize our health care infrastructure to pay for beds that are sitting there empty in a small rural hospital to meet our crisis our crisis stabilization issues we don't have to build new brick and mortar at crisis stabilization units when we have critical access hospitals out there in the state of Arkansas and beds available in the case of a mental illness crisis I Justin Justin time bed is critical to have instead of having to take somebody to a jail or to an emergency room when they have a mental health crisis this plan allows for us to utilize our current infrastructure that we have in place to meet that need all across the state of Arkansas I love that part about this bill and the accountability and oversight committees that are are in the bill those are and at three I I won't go into detail but again that is really to provide an effort of making sure that this is an on going collaboration for accountability and oversight for our legislature as well as the stakeholders and that is very important with quarterly reports and setting made metrics that are going to be met and and making sure that we meet as health outcomes and those measurable goals that is a huge part of the accountability piece of our home and and we've added more oversight to go before the Legislative Council as well if if certain metrics that we set are not met and. I can go into more detail but I just wanted to give you an overview and then let you will ask questions about the legislation and the more specifics of how this policy has been put together thank you Mr chair okay thank you senator of an I want to congratulate first of all the audience if you have conversations this is a pretty critical piece of legislation if you have conversations where I ask that you please thank them out into the hallway one keep the room in the decorum correct if you can find a chair that's probably best I know they were trying but we have a limit in that in the room were allowed I have with code restrictions so if there's chairs available please take them are we good. yeah we got some up here if you need them all right so with that service presented bill questions will start right off center hammer you're recognized for a question thank you Mr Senator would you drill down on the accountability factor or is it simply the fact that in the amendment you've in the bill you put in a committee that's going to be kind of keeping their eyes on this years or more to it than that. Thank you for the question Senator hammer so with the amendment we actually added an additional accountability piece and you'll see in the amendment on page nine it will be inserting this that if the Department of Human Services determines that those plans are not meeting the quality and health performance targets I'm for two years then they shall and we direct Department of Human Services shall develop additional reforms to achieve those targets a performance targets and they will come before and Legislative Council or the executive subcommittee of Legislative Council for immediate action to basically right the ship and that's one level of accountability that we've added but the main part of accountability is going to be found on page twenty of the bill and if you look under page twenty we create the health and economic outcomes accountability oversight advisory panel that is a combination of legislators as well as executive branch officials we also have community members that will be appointed to appointed to that oversight panel and and and I would just want to say to you I want to thank Senator Elliott and some of the others that helps me on this language because it is important that we represent all of the citizens of the State of Arkansas M. and at I want to appreciate the language in the amendment that she suggested for that on page twenty one but you will also look on page twenty one and going three twenty two twenty two at the top of twenty two is where you have the quarterly reports that'll be prepared and then refute but this advisory and over count accountability and oversight committee will help set and advise on the metrics in the performance measures and the targets and the goals and that need to be sat and that under the qualified health plans. Both Mr follow up granted thank you. You know all that stuff should of the my opinion been being done the last five years while we're waiting to get into the renewal process now how is this going to be any different than what we've been doing the last five years that's going to change anything with this going through. So thank you for the question senator hammer I agree with you I think this is been something that we've missing I will say that I think we learned a lot from the health reform task force that you served on and that was an opportunity to really drill down and study our Medicaid program looking at other Medicaid programs as well as you're aware I Medicaid program is just they're not you can't hardly compare them there and they're not an apple to apple comparison every single state looks differently they're all in different stages of where they cover up to the federal poverty level they all utilize at different infrastructure when it comes to the financial and implementation of their Medicaid programs and so this is an encrypted this is a very important oversight and accountability committee because it it tracks along with the implementation of it and it helps that those metrics in this performance and to hold accountable to those performance measures that are going to be set and meeting with the quarterly reports and having that be a very intentional effort I think it's going to allow us to continue to. At make adjustments as we see fit as the process unfolds over the next five years ago one more you mingle bunk you're. Well as I have not been requested for another question so do one follow up and then we'll go okay you're ready okay so I'm looking at have you I'm looking at the flyer that was given in the last few months about this in its talks about the role hospitals in America the media at risk of closing rural hospitals that immediate or high risk of closing and for the last five years we've been operating under the pretense that with the passage of of private option and now you know Arkansas Works now we're going to this that these hospitals it would prevent the hospitals from closing how is the passage of this legislation going to change anything with regards to the rule hospitals have been identified as an immediate risk of closing given the fact the last five years it was supposed to stabilize them is it management of the hospital or is there anything in this new approach that's going to infused them with the operating cash they need in order to stay afloat. So thank you for the question great question I will I think it's so important to see this map and if you look at this map Arkansas is an island here and this is a great thing in this map you will see that fifty seven rural hospital closures and the surrounding states around Arkansas have closed this is from January twenty twelve to January twenty twenty one in Arkansas and neighboring states we have had one rule hospital closure in the northeast part of the state but other than that Arkansas the big islands we have been able to maintain our rural hospitals because of this program and I want to thank senator Dismang dismaying Senate is Mang you know he and former Representative John Burris they did it and outstanding job and I know I know a lot of us were nervous about it and because we don't know if it's gonna work or not it has worked and this map right here shows that it has worked I mean the financial components of this are incredibly smart why because it allowed us to negotiate with the federal government I one hundred percent match that goes down to a ninety ten match when you look at our current mix of the Medicaid matched which is a seventy thirty split we were able to shift folks from that seventy thirty over to the ninety ten that created a savings but then also being able to utilize and partnered the qualified health plans allowed for us to bring in more federal dollars because of that ninety ten match it also allowed for us to pay our providers and our rural hospitals a lot higher than traditional Medicaid pays under traditional Medicaid it is a it's a very limited of benefits and you have a restriction on your monthly prescriptions you have limits on your on your diagnostics that you that you can utilize and and. So you really that premium assistance and being able to qualify you as a qualified health plans has been a tremendous influx of federal dollars that have really our role healthcare infrastructure in place and why is that important. When called it heads we we had a pandemic in the health care emergency and my eyes really opened up a lot because it was amazing to me that we had hospitals that were having to lay off nurses there hashing to lay off janitorial staff receptionist Administration happen to lay off a lab technicians even doctors had to get laid off when the pandemic kit and there's so many reasons as to why you know our hospitals had to go into almost lockdown mode right that that when you are starting to lay off the actual the individuals that are going to help us bring bring us through an emergency crisis a public health care emergency crisis and we're letting them off that reveals how then the margins really are in our rule health care infrastructure and a lot of there's a lot of reasons about that there are one of the main reasons is sequestration that occurred at the federal level under the Medicare cuts and so you know what they're shifting and moving money from one pocket to another the federal level it's our responsibility to make sure that we get those federal dollars to come into our state and so we've had to financially shift from you know relying on those Medicare patients payments over into an expanded Medicaid program because we have to follow where the federal money back it is and that's not all Mike where we do in other parts of the government to be quite Frank we do that in commerce we do in an education for sure we utilize state general revenues which we know are hard to come by to leverage federal dollars to get more of our money that we send to the federal government back into our state we do an education we do and commerce and really what we're doing here and health care is not unlike where we do and other plates of of government so yeah I think the last point. I would say about the the cobra crisis was also the hospitals were able to increase their bed capacity for icy you bets for cobit patients by nineteen percent that's phenomenal you know why we were able to do that because we had a rule health care infrastructure intact if we had not had those critical access hospitals in Mountain View Arkansas on in Clinton calico rock in Salem and and magnolia and all over the state of Arkansas we would not have been able to increase our I see you back capacity by nineteen percent to provide those covered patients with the bed they needed in order to survive this crisis y'all that is a tremendous success that we should all jump up and down and and I applaud it for our state. Senator Elliot you're recognized for a question. I thank you Mr chair of the Senate Irving we've talked about this a lot and of course I as I said yesterday I read it and have all the questions and people have submitted questions to me I want to do them all at one time well I'm just out of my purse one here I got notes so I can stay on track so for the cost sharing that that's in the bill if if there is if somebody is unable to pay a copayment and cost sharing arrangement how are you how would that work if somebody cannot do that. Thank you for the question so and at I and I'm going to attempt to answer this but I do have a folks at DHS might be able to specifically answer question but under the federal government currently cost sharing is allowable we've just never actually incorporated that so the cost sharing is I've available and it is a five percent of their income so that is let's we're gonna be following under the current federal guidelines is going to be a five percent of what their and their income is if they cannot meet at there will be M. that is going to be in partnership with a qualified health plans to ensure that they are able to meet it and the way that I believe that they're going to work with them to engine to hopefully they can meet that is to create incentives and different availabilities to waive that cost sharing if they if they need to but I think it's important for folks to understand that I think there's needs to be personal responsibility to if you're on this program and you can't pay and the cost sharing is allowed under federal government we want somebody to have a by an and a personal accountability so that they understand what product they have and they can better utilize it and so the cost sharing is is the ability for us to help them steer them to seek care at the right place and at the right time and and to work with those individuals if they do not meet those cost sharing it is written in the bill that then they would be transitioned into the traditional Medicaid plan. M. but there are also other things that we can work with them as well well that's what I'm really interested in is those other things once you said something about that something could be worked out they may be waived from the cost sharing and I am in no way we don't even need to get crosswise at all about for personal responsibility here and I don't and I think we're not but it really can be the case it is five percent of my income I can't pay the light bill that's the kind of thing I'm talking about right do we have a way of dealing with that without the person having to be there and just shifted to try to Kate I'll invite Senate Gillespie up to the table to answer that question thank you thank you. Or or Dennis. In the back of the head and he's the one that's all the details okay Dennis please identify yourself for the record and then we'll go on. Dennis Smith senior advisor for Medicaid and healthcare reform the Department of Human Services FOR cost sharing there is the five percent overall cap of of household income but then there are individual cap so the most that you could pay off for a doctor's visit is four dollars and seventy cents. For a prescription drug there are differences between preferred drugs and non preferred drugs and then it subject to overall if you do not pay your co pay. Do you do not go back into regular Medicaid so that is not. The that's okay so that that does that is not a reason to be unenrolled from your Q. H. P. you go back so I wanted to make certain we clarified that because that's important so I'm sorry. Your hand. We are. It's so of at the point of care and in which of the. Of the pharmacies for example they've been collecting copays at point of sale for quite sometime it's automatic you get you you pay at the point of sale in terms of of physicians for in terms of how all of this gets tracked the Q. H. P.'s will track this of for their members to make certain that the five percent will not be exceeded if you do hit that five percent then the flag goes into the system that says no more cost sharing for Dennis for the rest of this quarter for example. All right. Go ahead. I believe this is also what we do currently under Arkansas is that correct Mr. There is cost sharing in other parts of the Medicaid program there's cost sharing for people above a hundred percent in the current program the there's no cost sharing below a hundred percent again these will all be within the federal parameters that would be approved by the new administration now keep in mind I'm not question the parameters on just question question process how do you make it all work if somebody has a as an issue I know we can do it this second question is I just want somebody else to make us out the rest of my mom some of the others I'm I can get done later on I'll ask for the mobile of granite okay so for this for folks from I think I know that these places where they are that that's called the compact free association compact of free association thanks to allow. Micronesia and the Marshall Islands these are folks that are part of our compact to you know that for whatever reason but you should allow them to have health insurance are they covered under in this. In this bill anything I can tell somebody about that. The whole. Yeah please identify yourself for the record and then you may proceed with answer afternoon dawn Staley Medicaid director and deputy director for Arkansas. Proceed with the answer I think you get the whole question yes I did make a repeat does on the bottom right not at all yes so this was it this was a new regulation that came as a part of the cache Act federal cash act and so in Arkansas those individuals we actually just presented that to the legislature we appreciate you all passing that is part of a margin to promulgation and so yes if those individuals meet the criteria for the Medicaid expansion program then they would be covered through the our home program likewise if they're if they're eligible for other party to the Medicaid program and meet those eligibility correct criteria than they would be eligible for those parts of the program that is an excellent answer thank you thank you. All right very good. Anybody else with questions of the committee I see senator hammer waving his hand thank thank sure somewhere talking with other members you have a you reference well go about the four dollar copay and that I thought I remember in the discussion somewhere that were looking to the carriers to collect what was unpaid in my mistaken on that ended that include the copay or what part was that about. And what what responsibilities on the carrier's. The responsibility on the carriers will be to track it to make certain that their members do not to go over the limit. But the obligation is the beneficiaries to pay that copayment. The television hello granite and then I also want someone hits the could the the upper limit then the as it is today then the that portion of the cost sharing would be covered up by the carrier and reimbursed by DHS that's how it works today we set an advance cost sharing reductions amount but in advance and then we reconcile those amounts so if an individual hits their cap then they are no longer liable there's no longer an individual obligation then that would get paid again and that the carriers would not be out of pocket once those limits are hit then they would look it would work just as it does today for the population okay thank you. Senator Ingram you're recognized for a question. Thank you as chair of. Gosh Senator you did such a great job in extolling the virtues of of of the private option and in Arkansas Works first thing I thought of that why do we want to change something that's working but anyway let let I ask this question of a couple times and I'm not sure I really understand I wanna make sure because I think this is important regarding budget neutrality of it we were able to bland that budget neutrality over I think three years in the previous aeration of the program Arkansas Works and if I understood dentist right yesterday if the budget neutrality was going to go on a annual basis is that if I got that right I don't have that right well that's not unusual if you talk why. Flooding or a. It. Hi syndicalists be secretary of DHS thank you right click so budget neutrality is a growth trend that said in this case will be over the five years of the waiver. And on the federal level it sets it up over that five years but they will tell you in each year what that would be but it is technically over five years the shift we're making legislatively in Arkansas not in the way for but in Arkansas is that we will every year cap the maximum amount that we will pay Q. H. P.'s at the annual budget neutrality limit it is a budget control measure we will have in place in Arkansas. Okay so that difference I mean in in in the past me what is happened in the last seven years of with when we give on April thirtieth the information and the the insurance carriers re write it what happened typically has been there's been a bomb because there's some things that are maybe new to the program or that their new and it's only for a you know and then the next couple years it balances out that it doesn't happen what they were rating for but with with this we we won't have that correct correct and if I could just historically when the program started yes it started out and it had that period where it went up but the program's been very stable and in fact a few two or three years ago my mind can or what what it was there was a federal change that occurred where the fed stop paying cost sharing for those that are in the individual market but not the ones that we cover at that point we met with the carriers because it was a great deal of concern as to whether or not the costs from that side of the market place could pass over to the Arkansas. Medicaid side and that's the Arkansas taxpayer and all agreed that that would not happen and the way we would make sure of that is that each year we would be capped ourselves we would be doing it on an annual basis at budget neutrality for the Q. H. P.'s so we've actually been operating this way it puts it into statute okay. Of the next question that I've got is of. One of the real concerns or the trigger mechanisms that are that are going to be instituted or better yet I guess the incentives so with that we're going to call. You know I have a real concern that the average individual just looks it insurance coverage is insurance coverage and does not differentiate between private coverage and of Medicaid. And if they don't and they fall in Medicaid I'm I'm afraid that when they want to go to see a physician that that position might not be accepting Medicaid and then that individual is going to turn around and go back to the emergency rooms and undo seven years of what we've tried to do in in getting getting people healthcare coverage of from from providers so. How. For our citizens going to know. The difference or the incentives of that that in order to take advantage of private healthcare. Serving you want someone to come to the table yes they can and I I mean I want to just I'm gonna follow up after he talks about it but just in reference to one of your earlier questions I want to respond to you senator including treatment. So one of the things that has been going on on the insurance side and including already in other carriers here which is on the health initiatives in particular and a number of these of quality performance measures the carriers will want to incentivize people to meet those of for example one of the thirty some performance measures is the adults getting their flu shot. So a carrier can offer someone a to say we will give you a whatever amount of the gift card to get your flu shot to get your annual health check up to get the there are number of the performance measures related to screenings screenings for women in particular so if someone is not getting the screening today the carriers could give an incentive to that woman to get those screenings so the performance measures in the incentives on the health initiatives go hand in hand really to make certain people are incentivized to do that and carriers are doing it because they do know that it works people are responding not everybody not everybody but there's a great deal of the population that if we engage them in a way then they will respond well Dennis you know we've we've talked about this communications is the key to this thing absolutely and and and. Forgive us if we were a little can be a little skeptical about it because of what happened with the shore the Bakul own the work the a work requirement many many people did not know they didn't have insurance until they went to their provider there was no communications to them they didn't know what they had to do to meet it and so I I know that something that is important it has to be addressed this time around right SO just to address that I I agree with you and if you look on page fourteen and then also in the definitions portion of the of the legislation it talks about the economic independence initiative is what Mr Smith just described and how those a state incentives will be established and Kerr and partnership with the Department of Human Services and the Q. H. P.'s and and then also to your point on the communication portion that is found on page seventeen of the bill and we have actually put that in the statute because we want to make sure that there is no word and let me just respond to it this way and you said you know if we should why change if it's working you know if it's working why should we change right I understand what you're saying and where you're coming from but let me look at it this way the private option really was the first financial peace right it was a risk we didn't know if it was gonna work or not right we did something that was completely different from the rest of the country by and so and it was it was a gamble we didn't know but did the gamble pay off or is it working yes we know that being able to purchase qualified health plans both financially were able to pay our providers more we were able to draw down more federal revenue and we were able to create a premium stabilizer effect in the private health insurance marketplace so I see that as step one right a foundation of financial policy foundation then let's go to Arkansas Works. Arkansas works is a one size fits all approach. You know I I think that we all believe or I believe maybe not all this I mean I believe that work is a good thing that it provides you with the ability to be you know something to tip to make something to be innovative and creative in and productive life produk produk full and so you know I but it's not a one size fits all approach right and we know that and so now that's that was the second part of it but we also know that we want there to be engagement that we want there to be a health policy that can engage with these individuals to help them finds better work it's what we do in career and technical ADD why we put all the money into a career and technical at or why do we put money into all these other educational programs why do we put money into areas of the state of Arkansas and all these programs if we don't have a way to connect people to them. Why do we do it so this program. Breaks down all the silos and it targets and is intentionally designed around that person and where they are in life to be able to connect them with the department of workforce services to be able to connect them with a birthing hospital to help them with their social determinants of of health to be able to and actually improve somebody's life and so I see our home is really kind of the last piece of the puzzle to really incentivized. For better health outcomes but also better life circumstances for that individual and it's intentionally designed to do it and to utilize and bring the full force of government programs both at the federal level and the state level in a way that we can better communicate what's out there for them if it's a young mother and maternal life three sixty homes and she's working and she's going to school and she needs help with childcare well guess what where there's a federal program over here that we can connect her with that she can get a voucher from to help her with their childcare that's great but this our home is a vehicle to be able to do that. And so I'd love your question Senator Ingram and and I just I I think you're I think you're on target but I think it's going to be open and intentional partnership with our qualified health plans on May helping to incentivize seeking the right care at the right time and as you know preventive healthcare is incredibly important to preventing those long term health care costs down the road will soon resume let's take one more follow up there someone else in Q. but I'll do this one more follow up if you need to conduct rules of. Well if you look like can I make just one comment no yeah that one I have one last question I don't of we know. From reading this is ambitious the key to it is going to be communications and of the of the homes of our homes are going to be dependent on what ever that community bridge organization is whether it's the hospitals are not. One last question can can somebody give us an idea of. Of the reimbursement difference between private of the insured versus Medicaid is it is private insurance double what Medicaid is or or you know what obviously doctors it closer panel and the in KC patients there's a pretty big significant difference so actually Irvin D. of someone you'd like to bring I would actually like for one of the folks from the hospital association to it because they they're the ones that run those books and those hospitals and can better answer your question I can tell you from my experience but I'm not. Hospitals going to be a different ball game please identify yourself and you may proceed with the answer. Chris barber seminars healthcare also chair of the Arkansas hospital association centering room thank you for the question is a significant difference about thirty seven percent difference from Medicaid fee for service to the Q. H. P. that's on the impatience day so as about five or six thousand dollars difference for a standard impatience day router barber I might have you leaned into the microphone. You hear my response on that are thirty seven percent thirty seven percent on the physician services about forty eight forty nine percent is what the differential is significant yes Sir. Okay we have another person thank you senator Ingram Senator Teague U. it ask do you need to bring someone to the end of the table less specific we surely got away from the end of the table before he got his question and so do you want to ask for the person so maybe I'm serving senator made okay we'll has claimed yet either Senator. I'm Linda. Mr Gillespie and Dennis spoke to the caucus the other day I would call a question being asked about work and we all know the to work. Got thrown out on the last few I have the impression that there was some work in here but I don't find it can you or somebody explain that to me and explain to me how we work in an. Yes. What you'll find in the language of the bill it can be found on page. And maybe while you're at it explain why for the last time why it would work this time right some page twelve of the bill there have been some requests from the legislature is if there is a lot grants under the federal law and regulations that we can apply for that that would remain in that legislation if that opportunity became available and then the that next section is our front door is right in reference to any future potential waiver if that became available that that we would pursue that as well but that that language is in relation to what may be in the future and our ability within the next five years to apply for it or not. So I didn't hear you say exactly. That L. word got in their house it's gone now and we're going to do work maybe. Maybe I caress Mr Gillespie about it can. You're recognized thank you okay so as she was saying there's an address two things she was saying in the look of a proposed law there is a provision that says if somewhere in the course of the next five years while we're. Operating under this law there comes the opportunity to request from the federal government either a block grant or a work requirement which is what we had last time that DHS should begin that process minutes essentially what's in there and it does not say DHS will go ask for a work requirement now all right we did not include in this a proposal at all to go last for a work requirement now. I think part of what you are asking about is. A one of the real goals of what we're working on here is to try to help a lot of the people on the program as Senator Irvin said very eloquently connect to opportunities that can help them move towards economic independence and some of those opportunities are around education some of those opportunities are around health and some of those opportunities are around developing skills and getting jobs and in some cases it's even supports father in those jobs so that's where work comes in for some portions of those populations. But that's how that is done it's it's still a goal for us to help the individuals move towards work it's probably At this stage one of the reasons the other just to point this out I think I said this to you all then. The population that's in the program right now is also up from about two hundred fifty thousand two little over three hundred eleven thousand today and that's because of the pandemic so there's a lot of people that are on the rolls this year that were not in the rules a year ago and those are individuals who by and large would have been working a year ago had their own business or been in the job and they are now so we'll be using this program to really try to help them connect to some of the resources that could be there to help them either retrain get a business going again do what do what they need to do it's very much a collaborative effort between us workforce services career add chamber of commerce cetera around helping people connect to opportunity okay follow up granted. I think I remember somebody saying we wouldn't notice September but when we got disapproved or not help me understand what that statement was about sure we actually won't know till after September what the actual waiver looks like the schedule for the next few months is once once this is passed we will presuming it is passed I don't wanna presume anything we we have to then develop the details of this framework and put them into a waiver which would go to the federal government before we do that we have to put out for public comment in the state once we have state public comment and we've made any changes based on that we submitted to the feds it goes out for national public comment and we begin negotiating with the federal government those negotiations usually take quite a few months so as that is going on we would also be preparing rules so that when we know what the details look like we could bring those rules back through here. So it's a lot to be done before January one when the current program ends okay. one more follow up we have two people in the queue so let's so you're not going to start about in March. And then take a more often September seventy I'm I'm just trying to understand. Is there gonna be works when this goes into effect or not. Works meeting are people going to have to go to will work to get this benefit NO no this is this this will operate if you don't mind this will operate just like the current program does when someone applies for Medicaid and they are determined to be eligible for what we refer to as the expansion population today that is Arkansas Works January one that would be called our home they will come come into the program they spend about forty two to sixty days in fee for service while they select a plan and if they don't select their audit was signed into a qualified health plan so roughly two months after they come in they go into a qualified health plan and they will be there so that that part is not going to change for anyone coming into the program. When I appreciate it yes and Senate are written you gave about the thirty minute talking about ten minutes I was afraid she was going. sixty eight during that time to get thank you Senator Elliott you are recognized for he told me to keep it really short as I have the late not take a breath. Thank you Mr so I need to ask about the random selection than that in the queue H. P.'s it is an infant not infinite number of people who can be a part of the Q. Q. X. P. or is there a finite number. And when they're assigned or randomly is there any is there any opportunity to control for risk so that one company doesn't end up getting risk appeared another man gets missed them here. Sir I'm gonna tend to answer that question yes and so that it is a very complicated process because you're exactly right since when you have your insurance you have a risk pool and you have the ability to censure folks in and out of that and in order to control that that risk pull mechanism so I actually have a chart I'm not sure if you saw the chart that we held up at the meeting the other day but but really when you talk about that that ability there are some caps and some thresholds that have to be met because of all of those intricate details and there's formal is that that they have created in order to determine fault of the injuries at the age of. You want to come up this quickly not formulas but but but this is this is a complicated issue but we. I'll let him answer quickly all right. So so the key to a stable market is to have sufficient number of people in the pool yeah and we have seen what the historical numbers are the lowest that we have ever had in the Q. H. P.'s in the last four years is a hundred ninety one thousand people okay so we know that that the the poll was still stable at that. Volume we are now around two hundred and sixty thousand people so the what we are trying to do is to use a mechanism as a budget mechanism on the state spending side because every time every with someone gets added and we pay the premium for those individuals and this state share is about eight percent beginning for somebody in a Q. H. P. kids like you H. P. is paying a premium tax. However there's a point in time in which if if and this is only and if we need to slow down the number of people going into the queue H. P. as long as we do that on a random basis. And what I mean by that is the first one the the the person who signed up three months ago yes the next one in or every seventeenth person as long that that's what we mean by randomness as long as then that keeps the pool a healthy enough what we we don't do it is to say well let's look at all of our sick people and put them into the queue H. P.'s that will that would be the. That would be a major file all right we don't want to do that so as long as we keep it random then the poor will stay healthy okay and but there is no there's no use that is already grown to two hundred and whatever six six south sixty thousand whatever there's no books correct number for the Q. age please not it's not not currently yeah okay okay correct okay it's important also to note in advance because the carriers have to set the rates we have to we will tell them in advance. So we do what upon the call purchasing guidelines the for which they set their rates on and then the rate's going to affect the next January as long as again we do that far enough in advance then they know how large their pool is so that they can set their rates okay all right okay. Sorry I believe that date is April thirtieth correct it's in the legislation okay all right thank you Mr Senator Ingram did you have a question that I've got Senator hammer yes since Dennis is still at the table and that is I just wanna make sure that the there is nothing in this language that we're passing that if and I'm not really worried about the current administration but if a block grant program comes along that could switch us out of where we are with our waiver and put us into a block grant the situation. There. The law are on their the language a is what is in current law and that did get expanded I'm sorry extended rather the but the any change would have to so we will submit the waiver based on the legislation that it is based on the current administration we will negotiate that if there is any other Amendment it for the and that's good for five years so those are the terms and conditions that we're negotiating for for five years of it and so the current administration would have to agree to any change within that five year period of time. And so the the the I I know that we do that this block grant language it's in here we are we referring to the block grant ledge the language it's in here S. specific to say a work requirement or we talking about the overall program could go to the the overall program is generally what you are referring to that looks in open globally at the way the program is run. Okay. But again that would have to be approved by a judge by the federal government. Senator hammer recognized for a question. Thank you Mr do you do we have the capability in here for you to offer more than one metal plants such as being able to go down to the bronze plan. This one moment they're gonna come to the table. I the rest a really dumb question really good one. Five. Or both. We're confirming the way that finally wound up being written. What. I think it's. Just a level of plan. Okay. Maybe State the question one more time Center amicus sure I just want to know if the language has the flexibility for you to offer a bunch. Branche a bronze plan or we locked into one day of flexibility. So a center where the the the the terms of the statute says the level of the plan of what we would say in advance of the. However a bronze level generally means the premium is lower and you've got more built in on the cost sharing side the way this will work out it is really about the actuarial value of the plan and the actuarial value of the second lowest silver plan is what we purchased today and again this would be set out in the purchasing guidelines we say this in the purchasing guidelines of what level of plan would and what level of the actuarial value that plan. So right now the actuarial value is around ninety four percent. So you have to. You you. Set that value to the member right so that the beneficiary is the ninety four percent of the value the plan in their benefits. Does that help. I would just like. To make sure that that flexibility would be in here that we get locked in at one rate but you could do something that by the way you right away for precludes us from being able to do something that's gonna be advantageous long run I'll just be watching to see. How they get right and and again this is in the purchasing guidelines we set out in advance so that carriers know what to how to set the rates so everyone would know that in advance of what the value of the plane would be if I get one quick question I got a motion property Mr. All except your motion at the proper time but go ahead with the follow up on page fourteen of fifteen the way I read it. You're going to set the terms of. What potentially could lead to somebody being removed from the plan. And. Dismiss somebody from the plan but they're not going to lose our Medicaid health care coverage based solely on distant Roman can you explain the bottom page fourteen fourth top of page fifteen and how that works out because it seems to me like there's no incentive on anybody to. DO anything if they're going to be able to get coverage is sometime all the time so could you hit that point please thank you. Second lasting. Quickly. Thank you. yes it is exactly issue said if an individual We'll both two things. After this framework is passed as we develop the waiver we will be working to flesh out exactly what this would look like and when it would occur and how it could occur and to the point that Senator Ingram was making how the communications with the beneficiaries Whitaker chin up so that they would know what was going on and be able to engage an opportunity however if after considerable period of time that beneficiary had not engage in any of the economic or health improvements that beneficiary could be put into fee for service Medicaid instead of into a queue HP and so that's how it's a vision to work they would not lose Medicaid coverage. Okay. US okay Senator Elliot do you have another question. You're recognized thank you. I am I reading from. Page two. Our where we talk about the house of the hospital based community bridge organizations that's all you need to know about where I'm reading from so I wanted to be clear about I understand hospitals are not going to be required to be not gonna be required to be a bridge organization so what is it what are the implications for Areas of the state for we may or may not have that a hospital acting as a. Bridge organization. What we thought about what we know from the hospital association who never Who's prepared to participate do we have any ideas about that I'd like to know the possibilities so just yes that they this is voluntary I mean it is based on a participating hospital so for your rule success five three sixty homes as a B. participating critical access hospitals located in and a rule Arkansas and I do have a map of where those would be located potentially at which is right here and then you have for maternal life three sixty homes that would be barred hospitals right hospitals that that have that capability but also included in that definition as you know the hospitals and Texarkana or the hospital is in Texas and then we also have that same situation over in the west Memphis area at with a hospital some of this being utilized in that capacity and then with the success like to sixty homes you do have this map as well as potential anchor hospitals but again it is it is voluntary it is participating I know that you know with the with the DHS and the legislature those are also gonna be part of the quarterly annual reports and the accountability and oversight committee because if there are areas in the State of Arkansas that are not participating in that are not covered you know it is the intention of DHS and mine and I think you know I should be for all of us as a legislative body to really make sure that we need to target those areas and help find ways to get them covered and to work with those those entities in those areas of the state to make sure those citizens have the ability to participate in a live three sixty but two quick things because I I Who have stepped up and raise our hands said I will. And if nobody does an area of the state then what happens. Last of my questions that I will do thank you okay Senator Teague. Okay you get you get you ask a question and answer okay I'm I have somebody come up okay they and they are saying yes rolled all bills from around the state. Thank. You're my cards not working with hospitals over the last year on this a number of hospitals are interested what will happen now if this is passed into law is we would be working as we're working on the waiver we will be working with hospitals to get into the nitty gritty then of what does it look like and what would it mean that they have to do no no business is going to say I'm all and before the details are there so but with that we have been trying to have constructive ongoing conversations to understand both what would be for example the rural areas what is both mutually of the greatest benefit for the state's needs as well as what's the greatest benefit for them on the financial stability side and so we feel good about it but those details will come our goal is to get a few of them started in the first year. If those few get going others will go okay this section was beneficial for them it's not that scary and they'll come in. One of the I think advantages of the new provision that you approved today in the amendment that says if after two years health improvement targets are being met we are to come back to the legislature with proposed reforms you could have some of those health improvement targets not being met around some of these target populations for example because we aren't getting a check up in some areas so it could be that we come back and say we'd like to make the following types of changes. It's a five year plan and that's why we also think it's very important we all move through that five year plan together figuring it out as we go to make sure it works but we want to start with the hospitals because it's an infrastructure in the state but in some places is very under utilized and we need to shore up okay Senator Teague. Thank you Mr what one just for a quick question on page sixteen somewhere in the middle of the page roughly it says the army resources may approve up to one percent of revenues as community investments how much money is one percent. About twelve million dollars. So. We're gonna spend one point two billion total has a. A hundred times twelve million one point two billion. Is that is that accurate twenty one. That's a twenty twenty. Thank you all right. Share isn't saying any questions anymore so we're going to move on down the list of what we do is there anyone in the audience would like to speak for against this bill. Mister chair we do have several that are here and support so they can just raise their hands instead of because of time and I think that just raise your hand or it would that be okay and I know that doctor Patterson was here but had to leave for a four o'clock. We do have for the record I suppose we could use the who signed up to speak for we've got a lot. Five people here for. All right members do we have any other final questions. Seeing nuns. Senator been. Would you like to close for your bill I I think I've spoken enough. What are the wishes the committee Senator been you are on the committee yes I would make a hold on a sec okay I do have a motion at the proper time you're you're willing to settle down from now I'll I will defer to senator hammer okay ocean at the proper time to be recognized. Sure make motion do pass as amended as amended you're good with that. Motion do pass as amended yes Sir that's what I meant thank you guys that go out and I have a second from Senator Irvin. Okay we have a motion as amended and a second from Senator Irvin all in favor of Senate bill four ten police say aye. Same sign opposed. Your bill has passed graduations thank you so much members of the committee I really appreciate the level of questions and then also everybody in the room that's here supporting this effort this is transformational for the state of Arkansas thank you Senator Irvin you don't get a break as you're up next with House Bill twelve twenty six unless you'd like to pass over that yes please okay I thought you might want to will get back to that Senator hammer you had mentioned house bill thirteen sixty two you might wanna extend the time frame on that Mister chair may also just say that my dad is here yes. Jerry Thomas my dad so thank you all and thanks for letting him be here for me today thank. Okay Senator hammer are you going to present thirteen sixty two today can make a comment Mr you sure can I've gotten information on that from we're a DVD and I think it's critical for the committee to do a more deeper look forget the estate will someone send that out to everybody and we mentioned that earlier so I'm good with that thank you and I think that takes us to House Bill twelve fifty five Senator Dismang. Senator Teague. Let him get out here. I don't understand why they they don't want to be here to listen to the presentation on crest choir with cross collateral is ation I don't understand. Number two they were sticking around for that yes. Thank you start when you're ready. Third is when you're recognized for house bill twelve fifty five thank you Mr chairman members so this is going to provide some clarification of something that that's been done for decades be my understanding in and banking and the relationships with their customers it's going to allow cross squatters they should continue on as it has done in the past there was some confusion created from a court ruling and this goes back and says essentially that the cross collateral is ation Clause has merit in will us to sustain itself and with that I expect I think I've had a chance to visit with everyone I'd be happy to take any questions. Senator Elliot you're recognized for a question. Please once I got to a point I can say this without crossing myself up and I realize I I do have a bit of a question because I wanted to know I guess if. If they're it. Blake the lobbyist for the thank you the lobbyist for this. I know but if you want this bill to pass I need to testify I have a question. Okay. All right then and that's just fine I want the bankers were you will come testify that's my question to them. No was was a lobbyist I guess I'll let go I think I got it I got it I got my answer but will testify that's all I need to know. During the interview done lasting sell done. Thank you. I just make up my own mind. Okay I'm not cause was anymore is fine are there any other questions yeah Blake's Blake stop being a good sport when left the Razorbacks. I'm not sure that they're mine all right. So many questions is anybody on to speak for against. The ones that we have several signed up to speak for I have a motion yet. I have a motion to pass in the second from Senator Ingram. you if you're for you may not want to speak for it because it looks like it's in pretty good shape but just up to you. Anybody will speak against. So we have a motion and a second. All those in favor I opposed yeah seven serviceman you've passed house bill eleven fifty six out no no no twelve fifty five thank you. Is the any by here for eleven fifty six. Mr I think there's an amendment that has been signed if that'll get signed before the next meeting I'll take care of I'll take care of it if it's back up again but. So you leave it on the counter.