ALC-Administrative Rules

Members we're gonna try to get started here in just a couple minutes so if everyone. We will call this meeting to order we have no reports from the executive subcommittee for this month so we'll proceed with the next item on the agenda so items see on the agenda of the department of agriculture if you would please come up and introduce yourselves for the record and presents a rule. Thank you Mr chairman Wade Hodge general counsel for the department. And Patrick fiscal director lost art and culture. This is the or the rules percent to the national poultry improve improvement plan this is a federal a USDA program that we just administer in the state so like many other programs we have a for going to administer the federal program we have to play by their rules and so we're just going to the adopt the rules in a little bit different manner than we have for the past thirty years this method will have keep us from having to come and re promulgate same rule read year after year thank you. Members are there any questions. And without objection this rule is reviewed and approved thank you. And y'all have a. Adam to the department of commerce. If you would introduce yourselves and you may presenter role. My name is Steven porch chief legal counsel for the department of commerce as well as the object of property manager for ADC. Clint more department of commerce. You may present euro go a. What we are five is the supplemental Arkansas rule connect a corona virus rule is the permanent rules we filed a emergency rule. About two months ago this rule essentially allows electric coops to participate in the art program and since following that rule they have participated as well as other entities smaller in number. Have applied as well so far this rule give gave us the flexibility to reach that high hanging fruit and we've done extremely well in the program we have a sixty. Projects and we have disseminated eighty six million. Because the state. And there was no opposition to this rule. Members any questions Senator Irvin you have a question. There you are thank you Mister chair I just wanted to thank Mr force Mr Moore and everybody at department of commerce I know this is supplemental to the emergency rule that was passed is working great wonderful work just so proud to see this come to fruition and just want to thank you for your work thank you we appreciate your assistance to Centerville we've worked in tandem with the legislator cleaning Representative love to get the message out and to get people signed up to so we at the department of commerce thanks each of you for your support and help. Members any other questions. And saying no further questions from without objection this rule is reviewed and approved approved thank you. We have. Adam three. Department of commerce State Insurance Department. Well for. Okay I'm sorry we didn't we skipped over one we get the department of commerce backup. We had that was item a we did not cover item be self Department of Commerce that shall yes Sir Apapa are there no problem at all Mister chairman thank you have you may introduce yourselves yes Jim Hudson general counsel for a DC Trinity will also with ATC. Mr chairman the proposed rule we have fun today is the changes to the rules for consolidated incentives act the proposed rule this conforms the rule to changes that were made by Act three twenty seven of twenty nineteen with one exception Mr chairman one note on page eight in the definition of new full time permanent employee the rule was modified to reflect an interpretive position that the commission has already taken we want to clarify that and get that in front of people who follow the rules to make sure we understand if you work in a non standard work week you still would be included as an eligible employee for purposes of the incentives. With that have you take any questions Mister chairman. Members to have any questions. And saying no questions without objection this rule is reviewed and approved thank you Sir. Okay now will move the item. Three on the agenda of the department of commerce and state insurance department. We're gonna go through item a first so if you would introduce yourselves and then you may present euro thank you Mr chairman bill three Arkansas insurance department managing attorney. Yes Amanda rose associate counsel Arkansas insurance department. Rule forty nine. Is. Simply an amendment to. This rule that guides our life and health guarantee fund in the two thousand nineteen session the legislature passed a bill that allowed agent knows to be covered by the guarantee fund which had not been done before so we just had to amend the form. That was really the only purpose of the amendment to rule forty nine. Okay members to any questions. And saying no questions are there without objection this rule is reviewed and approved thank you. Are you all doing be also. Yes we're doing all three. Okay so role eighty two is just of modernization an update of our current annuity suitability rule the NERC has developed a new model that has a higher standard for consumer protection so all we did is adopt the national model. Members we have any questions. And single questions without objection this rule is reviewed and approved. All items see our seas of Arkansas insurance department rule one twenty one declaratory orders for Education Committee state agencies are required by the Arkansas administrative procedures act to have a rule in place to allow the agencies or boards to issue declaratory orders they are censoring it orders that interpret the insurance code or whatever what whatever that is under the jurisdiction of particular agency or board the insurance department through medications time that we did not have an adequate rule that permitted declaratory orders to be issued and so this started off as an emergency rule that there was also an active as a permanent rules so we're here today asking your approval for this rule will be glad to answer any questions. Have you ever experienced any problem having emergency rules go through the process absolutely not correct okay member saying no questions of them without objection this rule is reviewed and approved thank you thank you. I move on the item for the agenda department of education. Good morning cortisol as Ford chief legal counsel department of education. we are requesting review of the rules governing special education and related services section eighteen governing residential placements changes were made as a result of ACT five twenty three of two thousand and nineteen to allow reimbursement of cost for educational services provided to students without disabilities placed in residential treatment facilities in states that border Arkansas this reimbursement is limited to a per day cap of sixty dollars and only for a maximum of twenty students and I'll be happy to answer any questions. This may be a little bit off to how many out of state placements to we have to you know I don't know an exact number but there were approximately five out of state facilities that are approved but I don't know the exact number of students okay this just puts a cap on what we're going to pay when those students move out of state am I correct correct correct members you have any questions. And saying no questions without objection this rule is reviewed and approved thank you thank you. Item five. Department of Health. Cavenaugh do I represent the Arkansas State Medical arts give me dental board and we're with Meredith Rogers. this rule Was present act nine ninety with removed the terms more a good moral character it also removed a requirement that a dentist or dental hygienist would have to appear in person before the board in order to get a license with the language was changed to may be required. Just in an effort to make it easier for someone to get a license. Members any questions. Say no questions without objection this rule is reviewed and approved thank you thank you. Ron Adams six department of health again. This item may. You are here for the state board of optometry with Dr Brian actually is the chairman of the state board of optometry this rule was developed pursuant to act five seventy nine It expand the definition of the practice of optometry to include certain procedures surgical and laser procedures of this rule was developed by traveling to other states talking to schools and and in an effort to to prevent prevent us from reinventing the wheel we basically took a lot of language from rules from other states around the country that do this procedure and worked with other optometrists educators an ophthalmologist to come up with this rule. Members to have any questions. Yes does the board. We have a lot of discussion about this during the legislative session. Does the medical board ever act in conjunction with our. Independent groups that are for or against legislation is pending. The optometry board or the medical board medical board aren't comfortable or do they do they have a stake in saying legislation passed legislation failing and did they ever work on on behalf of No longer right none of the boards take a position on pending legislation because I believe that it would create an inherent conflict of interest for instance if the board came out against over a particular bill and it passed then the questions would immediately arise whether the board was actually acting on them so yes so we had a if we had a lobbying group contacting a board asking them to do research and asking them to to find out in order to to pass or kill a bill that would be an appropriate. Well they could send it FOR request right so long as they were in Arkansas citizen but beyond that no okay we wouldn't do it okay members any further questions without objection this rule is reviewed and approved thank you thank you. Item seven. Department of Human Services. If you would please introduce yourselves you may present euro thanks German mark what are you services. Mr chairman Kirk lane state drug director. Thank you. You may PM by Mr men and all further Mr lane to give an overview of this rule. As chairman this rules for uniform program operations for the state funded multi jurisdictional drug task forces in our state it outlines a fiscal responsibilities as well as training responsibilities and reporting responsibilities that are required by some of our federal grants. C. forty nine is that Senator Rice you're recognized thank you a rigid job entered on the. May not be directly to this program but we had something. I believe last week in committee that a process that I'm getting more familiar with I thank all those who want to be supportive of our. Drug crime task force. Which one you are the one that the three reports go to correct myself in the effect okay. Are you familiar with. Some of the I mean I know it's been isolated problems in the past with. I believe I'm correct in that but one more racially. with the dispute owned property taken from. A someone who was charged that the property was in the name. Chrysler thank was in the name of. The mother. Are you familiar anything with that I'm familiar with that state and also federal seizures yes and a lot of discredited in and that this what I read in your background this is sitting with this help in anything like that advertisement about actually this bill outlines uniform structure for what the state will pay for what requirements are for training which comes from our federal grant requirements and and those things it really doesn't speak to asset forfeiture asset forfeitures of sept separate issue altogether that comes through legislative bills and and and laws that come for what can be seized and is also covered by the prosecuting attorney who would oversee those operations and the courts with the the key things that I saw as a I read through our. Outlined here is funding for the DC TF. Which any time funding is tied to sometimes. Four years keys me increased accountability. We're for clearly and but when it talks about clearly defined statutes understanding me this area but it also talked about increased training and established strict reporting even if it's not in. This area hope you focus on training. The lead statewide no. And I'm not I don't I don't know the details of this but we we've had that in past years and judiciary and I hope from your office you can stipulate that out to the state that we we want to do everything above board and when they just get the after well you should have filed sept the known to the regular public does not understand the process they're never going to understand it I don't understand. So. I just hope that that will have. A task force law enforcement the fire in in. Remembering that if there is a. Unintentional victim in this that they they get credible information again this may be of course with this but anytime you have training and all I think it's good the to be able to Read as much knowledge as you can that thank you senator point taken thank you. Members any further questions and saying no questions is rules reviewed and approved thank you thank you Sir. The item eight department Human Services. Thanks chairman I believe miss Harper's want to join me to broaden explanation of this rule. Good morning my name is Kristen Harper an assistant director with the Division of Children and Family Services. We have one roll up for review this morning to allow the division to at date this section of our policy regarding adoptions and other considerations following termination of parental rights. The substantive change is collapsing formally separate rules into one regarding adoption selection preparation and finalization processes prior to this proposed rule there were separate policies for relative non relative in current foster parent adoptions with the requirements are virtually the same so we've streamlined those into one role. This new will also emphasizes preferential consideration of relative placement as well as the importance of maintaining sibling groups and adoptive placements. We've also included additional requirements related to adoption recruitment activities in which is how may participate depending on the status of termination of parental rights. In providing more detail regarding and elements to be included in the adoption disclosure packet. Finally formalized existing practice regarding adoption placement activities and rule as well as how to proceed in the legal custodian wishes to adopt the child in their custody at a later date. Specific to adoption subsidies we've removed obsolete references to the fostering connections phase in schedule we've also clarified that any subsidy agreement and associated payments extending past the age of X. eighteen due to mental or physical disability takes that that the date the new subsidy agreement reflecting the extension is signed. We've also updated the rules to remove duplicative information or it appear elsewhere in rules make technical corrections and ins and prefer organization formatting and finally better align requirements for instance relinquished for adoption with statute per the safe haven Act. These revisions were made through a work group compile comprised of field in central office staff and have been shared with stakeholders such as Arkansas advocates for children and families the item program costs the according to that program we received one public comment from the therapeutic foster care community in for the request we added in specific language regarding the involvement of therapeutic foster care parents and TSC staff in these processes. And this was also reviewed on Monday by children eat Committee I'll be happy to answer any questions you may have. Thank you a Representative Love thank. represented your there you go okay thank you Mr chairman in full disclosure I I've been actually going through through an adoptive process so that's what really piques my interest so what is what actually is going to change between the process now and what you're proposing. What we tried to do is give more guidance to our adopted staff we work closely with them and so and a lot of this is just updates to policy because this section had not been updated for some time and system of it really is that organizational and streamlining process so for example it looks like a really big packet and but if they used to be about two separate rules that have been condensed into one and we've also again try to give some specific guidance in terms of pre placement activities and the schedule that should follow in terms of you know the first visits to be extended to a full day visit overnight visit we can visit at cetera overprescribe period of time and so those are just a few examples okay soon. Eight all right so you're talking about schedule visits and that that's I think that that's great any other subjects it substantive changes in which the policies that you're proposing today will will make a major change we've tried to be give more guidance for our staff particularly in terms of duties and prescribe to the foster care case manager in the adoption specialist and to try to improve those processes and be more clear and chart in terms of what the foster care management foster care case worker is responsible for an adoption workers responsible for to help improve that process and speed things up so we don't have to wait as long for these adoptions to finalize that would be another example it's just it's more detail overall in terms of what that the full process from recruitment to selection to finalization should look like okay thank you our home. With you all for have any further questions yes Sir. Senator hammer you're recognized for a question thank you Mr I wonder why there was no public hearing held for this rule or was the public given opportunity to comment on these rule changes and we did have a public comment period of course and in which the rule was and in the Arkansas Democrat Gazette for three days the public comment period ran from October fourth two November seconds and again a lot of this is formalizing existing practice into a formalized pool and and a lot of organization formatting changes and we did share this with several stakeholders in that process and so for that reason we do not have the an actual public hearing and center if I can that we we have to try to have some public hearings but course pandemic has really affected that I'll just tell you this and once we done trick or done by teleconference we have not had much participation from the public so which one is nester when there is no certainly not. No we we hear there are publicized populations out there that want to have the opportunity to voice their opinion in that manner we have tried to schedule public hearings by large will be seen most folks they want to submit written comments okay who are the stakeholders that were involved in. Yes Sir we share with Arkansas advocates for children and family the Arkansas attorney ad litem program the statewide casa program and also the court improvement program with the administrative office of the courts okay and they were all involved in the process no objection yes all reviewed and yes and we had discussions and made an changes as necessary in the therapeutic foster care community also commented we made and changes per their request you may come and go about practices put into rule should rules defined the practice why did you make your stay with what you did about practices put into rules or could you qualify your statements sure and so over time particularly as we meet regularly with our adoption staff the last four particular policy interpretations and it cetera and we have found over the years that sometimes when area does it this way and and does it that way and so you know we want to immediately respond to our staff and give guidance and so we would do that following these meetings and so now we have prescribed this specifically in rule I think that does happen over time when staff ask for interpretations and so now we have prescribed those in rural that it's written and everybody can access it from the same place so should that clear up some of the issues people have about depend which part of state you're in one one one situation may have an application based on interpretation and are the disciplinary practices in place that if staff violates these rules that they'll be dealt with accordingly then yes okay one last question do you get much response whenever you run the ad in the democratic there's that as far as the public responding based on that and it depends M. and oftentimes particularly if we know some things may be controversial we do you let people repeating more than just that and we will directly email folks that are involved in the be affected by the rule and then so that will often an interest in the way listed more comments thank you thank Mr. Senator garner you're recognized for a question thank measurement set the constituents sent me. A screenshot of the Senate questionnaire I believe you'll ask when it comes to people who are doing this on section eighteen now this is green shot so I don't know the broader context of it is check the boxes describe your parents when you were a child and has per mother primary care givers ask questions such as I believe sex with simple never discussed sex condemns homosexuality sexually repressed. What is the reasoning behind this line of questioning for people who want to adopt or take a cure kick is foster care to seems to be pretty intrusive questions that don't really have to do much with the safety and welfare of a child can you explain that to me yes Sir and so first and just want to mention that that that is existing and nothing in this rule and it pertains to any changes in the home study process we have these the safe home study questionnaire for goodness and coming up on ten years now and it is the only evidence based home study process with a suite of tools that's used to evaluate potential foster adoptive homes particular to your inquiry and there are some very and looked as you describe intrusive questions and we believe those are important you have to remember that many of the children who come into care and have experienced sexual abuse and so some of those issues will come up well placed in those homes and it's important to know and this applicants and history in that regard and to help the know how to respond to those children who have been victims of sexual abuse and and and and also and how to respond generally when you're raising to make sure that they're comfortable with talking about sex and the talking about different issues that may arise because oftentimes they take teenagers and those are you know as any parent would and some real conversations having a safe and appropriate way that have to happen. Okay so that is in any way or form could this disqualifies somebody from be able to. Partake in either program a single question on the questionnaire should never and based on the responses qualified person and the point of the questionnaire is to gather more information and the person completing the home study process and that they're just it's the the responses allow them away to follow up on certain things and gather more information. It's it's basically giving guidance and in the past with prior to implementing this a home study process and relief once again and it was done differently depending on where you are in this state you might get a two page home study make a twenty page home study sometimes the two patients that he was a lot more informative than the twenty page home study and with the safe process it gives us a structure and a former and and again a simple response to one question the questionnaire should never disqualify anybody it just allows us more ways to follow up and gather additional information okay mark would you send me a copy of sample what that would look like please thank you Mister Mister if if you to send that to the chair then we'll get that out there for about a thank you. Stubblefield you're recognized. Thank you Mr. I'm sure and is there anything of this rule change it deals with the Pasu changing of requesting child support from an adult the parent. And so there were clarifications to that effect just give me a moment to get to that section. And this is what this is speaking to you is when adoption is finalized M. and at child is later taken into care and re enters foster care due to an allegation of abuse or neglect and often times when adoption finalizes that is accompanied by an adoption subsidy and so in the event that a child re enters foster care as a result of an allegation of abuse or neglect and we may work and to request child support which is essentially the subsidy that they're receiving and the adoption subsidy is a legal contract and we cannot they're on the specific circumstances in which we can terminate that subsidy and so while the child readers foster here we will sometimes work with the court to request child support in the amount of the if not the adoption subsidy they're already receiving a successful have you been in acquiring the subsidies. And the child support. And I do not have that information on hand but it's certainly something that I can follow up on for you I would appreciate it I'd like to see that thank you ma'am thank you Mr. Again if you'll send that information the chair will make sure about against yes Sir. Senator when you're recognized for a question thank you Mister chair and just a quick question on the at could you just elaborate a little bit more on this section Under intense relinquished for adoption under the safe haven Act yes ma'am again the in this section it was largely formatting of the previous rules that address two different instances instances in which and that maybe relinquished for adoption Warren and when there is what we call Garrett smaller substance exposed infants and which is actually already dealt somewhere else and policies so we took that out so it doesn't appear in two places in policy and specific to the safe haven intense and did some work to align it and better with what appears and statute and also decent updates per the last legislative session that also allows fire departments you and except as intense right and so when you're listing off the people of stakeholders that you send this to I would I would ask that you broaden your perspective and include Arkansas right to life because they were instrumental in creating the safe haven Act was Senator Bledsoe Senator great work on that and those are stakeholders that need to be at the table when we're talking about adoption of children that is an incredible important organization to many of us in the Arkansas legislature and this rule you know is aligned with statute that they helped create and so and the Catholic diocese of little rock is another one that is a stakeholder that needs to be included in these types of discussions along with the other list of stakeholders that you fit for the second question I have deals with medical coverage and psychiatric conditions and I would also like you to add primary care physicians and of pediatricians to that list because there are lots of issues that are dealt with with foster children and their medical history their medical care especially when they are transferred across the state into you know available homes it causes problems and issues. and for your primary care physicians in your pediatricians that are trying their best to take care of these children but it becomes inconsistent and incoherent sometimes because of the travel on the move and the placement of children and that becomes a problem so those are other to stakeholder groups that I would really like for you all to reach out on when we're talking about foster children and adoptive children thank you the. Members are there any further questions. Saying no questions within our without objection this rule is reviewed and approved thank you thank you. Adam nine department Human Services. Thanks German Mr we miss sprinkles water join me on this rule. And the next one as well. Good morning my name is Mary Franklin director of county operations for DHS. You may proceed thank you. So the first. The court. The first rule that we are presenting today is about the elderly simplified application project. We are currently of the agency is currently participating in a thirty six month certification. Demonstration project waiver allowing certain elderly and disabled households to be certified for longer than the regulatory twenty four months. But that current waiver is no longer supported by a finesse and they have asked us to move to the elder simplified application project. Also want to point out that this. This is a vulnerable and low risk. A group that we serve. And there are these cases are low error prone. And What we are hoping to do is reduce the churn in that population and simplify and streamline the process for them they will continue under this new waiver. To be able to be certified for thirty six months rather than the regulatory one year. And this This project will also. Waive the re certification interview requirement for this group and it will Reduce the burden of providing verifications because we will be able to use data matches up for most of the information we need and a case workers will assist these households to get the information they need To help them preserve continuity of coverage with that I'll be able to I'll be glad to answer any questions. Members to have any questions. And saying no questions and without objection is removed reviewed and approved thank you make or the item be. All right this other role is To add a homeless living allowance and a basic utility allowance to the snap program. the homeless living allowance is required by the twenty eighteen farm bill. And it applies to households that have experienced some type of expense they are qualified as homeless households but during the month of their application or their re certification they have had expenses such as paying for hotel or motel rooms or having to pay for laundry or any charges they may have experienced it they are staying in a homeless shelter other other examples of expenses these households could have also include if they are living in their vehicle and they are having to pay towards ownership of that vehicle or insurance for that vehicle those are the types of expenses that would qualify household for this. standardize homeless living allowance that we are adding to the policy. The other change in this policy is related to is called a basic utility allowance and this would be for households that do not have an ongoing charge for heating or cooling their home but they do have expenses such as water trash sewage phones other things that don't involve their utilities but they don't involve heating and cooling and so. This role adds that basic utility allowance and removes the actual utility allowance that is currently impala C.. And with that I'll be glad to answer any thank you so we're basically trying to be very clear and breaking down where there is some confusion try to be very direct and very clear on what people are services are receiving so that we can better track what's going on is that kind of an accurate description. Up well. Yes and and it it it will also help make this whole process less error prone because we are not rendering individual exact utility bills its it's easier on households for not having to provide all those individual utility bills and possibly not getting the full credit for what they are produce a good a good description thank you Senator hammer you're recognized for a question thank you Mr the could you just help me understand on the utility part of it. The. How that is going to help clarify. Can can you speak a little bit more and is this is all in compliance with federal regulation and really you've just written the rule to comply with what the feds are sent down correct. Yes this is all allowed by by F. and S. by USDA that administers the snap program the homeless living allowance is requirement in the twenty eighteen farm bill the little bit of elaboration on the utility allowances this might be a bit weighty but there there's more than one type of utility allowance in the snap program there is a standard utility allowance which is for and it's the highest dollar amount allowed Currently at two hundred and eighty three a month but. It is for households that have to have a heating or cooling charge in addition to the other things that we all have to pay for for maintaining our household such as trash and sewage Phone those those types of things and then for households who do not but they have to have a heating or cooling to get that standard utility allowance the basic utility allowance is smaller it's eighty percent of the House of the standard utility allowance but it it It allows for households who have expenses that are not heating and cooling they so they don't qualify for the standard the basic utility allowance still gives them Give them credit for the expenses they do have and Utilities factor into the. How many benefits the household can be approved for snap is a very specific program where we are calculating benefit amounts down to the dollar and utility expenses can have an impact on the actual dollars that the household receipts Does that help answer your question but it it did Lowery I've got a question but I'll do it offline which but that helps thank you thank Mr. And member of any other questions and saying no questions without objection this rule that is reviewed and approved thank you. Regarding the item ten. The Department of Human Services. You may begin with the item a. Thank was chairman and Mrs does want to join me for these next few items. Good morning Melissa stone division director for developmental disabilities services. May begin. Eighty first K.. I have several rules before you today so starting with adult developmental day treatment and so. Okay the companion early intervention day treatment they're both on your list for today so for those of you that we're not a public health on Monday just a brief background so we used to have an. Multiple programs that provided day treatment one was for children and adults another was just for children they were cents added back and twenty eight eighteen and two new programs where the successor program that we set up in those are early intervention day treatment that serves children primarily birth to five or six depending on if they get a kindergarten waiver or not and then I don't developmental day treatment which serves adults eighteen and over and these programs did not have their very own set of certification standards at the time we just put in a line and at the top of the standards that we had in place we've had a lot of problems with that the nineties are unique different programs from what we had before so we've been working for several years internally and with the stakeholders to develop standards for early intervention day treatment programs that they could be judged against went licensure comes out to evaluate them that's what's before you today I'm very happy to announce that maybe for the first time ever stakeholders had no problems with the standards unless you've heard otherwise and and they were very engaged and we're very happy with how they turned out we also went in and made just a few changes to the Medicaid manual and that goes with the standards and there were no problems or concerns with that is from our stakeholders as well I'm happy to answer any questions. A man the everybody's on board. Get Center hammer you're recognized for a question this chair are there any stakeholders in the room. With. Our representatives of a stakeholders in the room. It doesn't appear so. Okay we'll let right thank you. Your question so one of the problems I know they we've been looking at is the moratorium of sorts that we have so does the implementation of the new manual impact that other words a new provider could move into a restricted area based on certain conditions so now that we have new conditions how's that going to affect the more the restricted area where people come of. That's a good question so what we did in the standards is we just cited this statute said this that she is you know I was still in place that places that restrictions on how and when you can move into a new and there were there were exceptions to that and now we have a new manual Dalby new exceptions correct we're going to continue to work under the exceptions that it been in place that you and I discuss is particularly since we're doing an interim study on this program okay. Represent the other questions. And without objection this rule is reviewed and approved. An item be. Mr this next item this is a the same song second verse for adult develop developmental day treatment as Mr explained us similar issues we are adopting new certification mail for the AT T. T. providers and I believe that covers it. I would be happy to answer questions. Members are there any questions. Without objection this rule is reviewed and approved item she. I didn't see pertains to are on Medicaid state plan and therapy services so I'm. You know we are sent and federal codes down by sea in mass there was an a code update to and both men grabbed that. Two and physical therapy evaluations in occupational therapy evaluations so prior to the kind of change and these evaluations where am conducted and reimburse based on the time a therapist spent conducting the evaluation CMS's moved to what they call complexity codes so it's based on the complexity of the evaluation the therapist is undertaking so they changed it to a low moderate high complexity so what we did was we tried to make the providers hole we weren't trying to change the rate that they were receiving so we work closely with the therapy associations to make sure that when we converted from a time sensitive time limited code to a complexity code that they were going to be reimbursed the same amount or something extremely similar so I'm happy to say to you on this rule that think we ended in a very good place the therapy associations that we worked with are supportive and the rate structure that we have agree to implement January first and I will say that in accordance with the governor's executive order of going through our provider networks and doing great reviews on a more frequent basis it is time for L. T. P. T. speech to be formally reviewed not just these two evaluations but all of their services the starting January one all of TPG and speech services will undergo a rate review so if something is not right with these rates it'll be corrected at that time. Members any further questions. And with no further questions this rule is reviewed and approved thank you. And members have had a request by one of our members to move item and the up and I'm going to do that without objection does take a minute. If you look at that Without objection the subcommittee will suspend its rule to consider the next item on the agenda will someone from this agency please come up introduce yourself for the record. This item D.. To have someone. Mister eleven the eighty one I'm sorry D. one. The department of commerce economic development. Ron page for the agendas are. We have a member that needs to be another meeting just briefly and I don't think this contact for a long. Am I right there Representative. Okay. Born again Mister chairman Jim Hudson general counsel for ADC. I'm G. noble in the director the grants division at ATC. Remediating director of legislative affairs for ADC. Okay a correct me present the bill Mr take the question first present world yes correct what we have before you please tell me is a proposed rule that really makes permanent a mercy rule the term currently in effect that implements and operationalize is the fresh start housing stabilization program this is a rental assistance program that is funded in part through the cares Act funds and through part was CDBG funds as well and so this is a special events continue to minister the program beyond the expiration of the emergency rule and with that I'll take questions adjournment. Members questions. Representative Lundstrum yes thank you I commend you for this program I know there a lot of renters that appreciate this and a lot of landlords that due to it's come at the Nick of time for some people and I've looked through the program and and heard back from different folks there there's been only one concern and that was the the the concern was that the two and a half months once that was over the program ask you to waive all late fees from the past and to not evict in the future and that's been a contractual concern for some landlords can you tell me that this is been changed in that there's been some confusion on that. Represent I think that's the correct understanding what the program provisions are it is not a perpetual giving up the right to a Victor perpetual giving up the right to impose late fees presently E. the action is suspended pursuant to the CDC moratorium and that runs through the end of the month all we do is incorporate what is that existing moratorium into the rules but once the moratorium expires the the benefits have expired we're not involved in that anymore in a landlord is free to pursue his or her rights under a lease agreement to affected patients so chose to use or they want to impose late fees okay because there's been a lot of concern that we're interfering with contractual law and I'm like the state of Arkansas doesn't do that yes ma'am I I agree with that I think that's that's that's a fair statement there have a lot of concerns about the late fees and whether or not you were forcing people to give up all late fees I think what we're trying to do is is broker conversation between the tenant and the landlord and if the landlord doesn't want agree to that the war we're stepping at well there shouldn't be any late fees if we're paying the two and a half months the landlord should charge late fees at all for that part and disingenuous yeah I mean or that's a bad actor it could be that there is a community million history that's unrelated to the recession and that's not our problem not our monkeys yes ma'am we're innocent bystanders is that well I just wanna make sure that we're not interfering in any of their past or their future we're only concerned for that two and a half months. Yeah that's it exactly during nineteen a month will make sure we get the benefit of the money that the state is putting into the landlord's hands and into the tent more please landlord's hands to be able to give them a little bit of respite right and that's and that's clear is clearly stated in that contract yes ma'am okay I commend you for working on that program thank you. I'm not saying no more questions without objection this rule for reviewed and approved and hello I apologize but I'm going to allow you to go back to your seats and come back up in another moment because we're going to move back to our agenda on item eleven okay do you guys come back and talk more about this particular rule no with this rule you don't approved I'm sorry so we're done okay all right was read thank you thank you Sir. Hi we're gonna move back to the agenda item eleven department Human Services. Reshaped the committee's indulgence in letting Representative Lundstrum maker comments. Okay and If you would again introduce yourselves and you may begin. Thank you Mr chairman mark white with for him services. Thank you Patricia gamma Department of Human Services. we also have a miss stone who have been shipped to us I'm still be available to answer questions on this rule as well. You may begin thank you so this rule is a community support system provider standards the purpose this rule is to create a new provider top for Medicaid provide services for our clients who have behavioral health needs are also developmental disability means we have tremendous needs for more provider capacity in both those areas and so this is a proposal we've come up with to help expand that capacity around the state and I just to be clear that the services we're talking about for this provider these are not clinical services for the basic level provider in this these are home community based services they're not be H. services they're not DD services these are services that work for both of those populations because they have very similar functional needs and that's per the services to address those needs and with that alternative is again the anything else and then we'll be happy to answer any questions. We just wanted. Sorry. Senate this rule is we're itching this new role to establish a pathway for certification for providers to address our current and future needs for behavioral health developmental disabilities and duly diagnose clients it creates a new provider type and certification for community support system providers that allows providers to become certified to serve all these populations and diagnosis within these populations so we just we want to present this as a way to move forward with serving all of these beneficiaries who have some severe functional needs. Senate members we have any questions. Senator Rice you're recognized for a question thank you. This is a. Pretty big undertaking and and and needed to After the first visit on this Read Inquirer. Of. Some outside. Information to who who has been involved in the. Leding at this because we see a lot of down the road good intentions though repeated known to ask more questions of is there anybody. You're the. Can go a little bit broader in the standard. I mean this is a man you will be put out to everybody one thing that came to my mind are we going to we will be taking money. Out of our behavior health and and the the Critical needs to do this. Are the people. trained in. They don't have licensure or. The the necessary over so that that that they need to do this with the different levels. The. It's but please don't think I'm question you because you know your job I don't I don't know enough of it and it's a great question but the different levels of behavioral health. In the different levels of illnesses invulnerability. That we have in our population are you gonna be able to get. The right level. A of. Hello there with that can you understand what I'm asking them yes Sir and if I make a few points in that and then Christmas gamos Mr me what apps and things are. This provider top is per intended provide specifically home committee based services and so it's not intended to be a comprehensive set of services so if we have all these clients he or they wish for throat you're still going to see their PCP and that'll be treated under different provider will know if they need counseling they sterling a counseling there's several different provider times they can use for counseling this provider top focuses on those home to based services that are common across these populations and so any mention what so what price for certification of these providers so that they can use this thing and certified and provide these services to both of those populations as well as those individuals who can make me cross over because we have at the very top in with individuals who are dually diagnosed who are have very severe issues on both sides of that equation but behavioral health NDD we have other issues that they're they may be developing disabled but they may still have other your payroll health needs it was like everyone may struggle with depression and anxiety things are needy clients have those issues as well and they may need some some support in their homes to help them stay at home and that's what this product is intended for an international training and oversight a couple of points on that out there are training requirements in their interests are and we have some some discrepancies discrepancies between training on the B. eight side of the house and on the TV side of the house and so this takes more middle ground approach between those two for the training for these workers who will be helping these individuals and there is that provide for oversight others not necessarily political oversight that's because these are not clinical services these are services that can be overseen by someone doesn't have to be overseen by a doctor specifically because these are not medical services and you often correct me five misstating that. I'm sorry I was a few minutes late to the table Melissa staff division director for development disabilities services. An electricity civil talk about behavioral health because that's her area of expertise but out I would say just to expand on what we're trying to do. You know we put these the service package under the pass for those tier two and tier three DD and B. H. clients and the way we read that the umbrella of that program was no matter if you come in and you have a behavioral health diagnosis or whether your primary as an IDT diagnosis all the services under the pass are available to you if you need them but what has happened in actuality is that all the all the services are there where we can send staff into people's homes and help them stay out of institutions of higher levels of care if that's appropriate in necessarily is not happening because of the way we have the provider certified so they they still continue to stay in their lanes so what happens is that my clients public could benefit from supported housing right someone helping them with that that right now can only be performed by an outpatient behavioral health agency. On Tricia sat on the B. H. B. H. clients could benefit from supported living it's a training program or someone comes into your house and helps you learn how to do skills but right now the only people certified to do supported living of the IDT waiver providers and although we were hoping because the way we build the service package was they would all build on each other and the clients get the benefit of all of them because of the way we started by these providers and we've not changed it they're not getting the full package my clients are getting the historical DD side of the services and her clients are getting the historical B. eight and never the two shall mix so what we're trying to do with this new provider type is take those services that are similar in nature that we developed to build on each other they're done in your home that are non clinical and we want one provider to be certified to do all of them so that the services at least offered to the past members because right now what's happening is is not even being offered so that's in and the most simple terms I can think of what we're trying to do with this and all that trash talk about more on the the B. H. levels and we try real hard and we remind the passes often. The service package is not based on whether you were a tier two or tier three people's needs change all the time your service packages based on what you need right then so we've made and stop the wind will then not a tier three so they don't get this or they're not they're it here too that they only get that that's not how it's set up and that's not how we monitor them so it's based on the functional needed the member what the tear does is it sets that payment we made to the pass so for the network of members but it is not drive your services so we're wanting to do a provider type that can serve all past members right now we got forty five thousand that you not have a mix of all of these needs and could benefit from all of these humming Committee based services and we hope that we can keep them in their home and stabilize them better in the community then what we're doing currently. And then just to talk a little bit about the changes that happened over the last couple years around the behavioral health services we originally had a program called R. F. P. M. R. rehabilitative services for persons with mental illness and that's that program was a medical model and what I mean by medical model is that those services had a physician or clinician him over sought treatment and the treatment with medical in nature it was treatment it was not home and community based services so when you came into a agency to receive services you were seen by a doctor and a clinician and then you had a single service called intervention which was provided by mental health para professionals and that's service was an extender of the clinical service as what we know with the B. H. population the herbal health population is that we need home and community based services in order to help this population remain in their homes thank Melissa said ultimately the goal of this is to keep people in their homes and I believe that people recover from mental illness they can have supported housing and live in their own homes they can do support of employment and enter the work force we didn't have the services available under the old program under the **** PMR program those services were all based on medical necessity and when someone began to get better you lose some of that medical necessity criteria so what we did is we converted over to a new program and understand that we've done this in steps so over the last two years we have begun this transformation of this program so that we could create services that helped people remain in their homes behavioral health beneficiaries and their families need support in order to stay in their homes they need education around how to go to the grocery store and buy groceries how to make sure that they're paying their rent and keeping their apartments clean so that. They don't get evicted and end up homeless they need adult life skills how to look in the newspaper to see an ad to possibly get a job and then to have someone followed them and assisted them while they're trying to be employed talk to their employers if needed to help them gain that skill and for families to be able to have someone who's there for them and that they can call them in the middle of the night or in the afternoon to stay I'm having issues and you know can someone support me so these are supportive services they're not clinical services thanks for home and community based services and I think that that and I don't want to be too wordy but I really want to point out again what mark and Melissa have does that is that the services that are under this provider type are not clinical services we are not trying in any way two can you serve and and by the way I'm a clinician so we're not trying to usurp the authority of or the the relationship between beneficiaries and their clinical staff for their physicians were merely adding these home and community based services which are based on functional impairment not medical necessity these are functional impairment and so they get that there's a whole different criteria for that for the services to allow to be provided. What I've heard and all the discussions no one disagrees with either of the presentations everyone agrees that there aren't is a need on this side there is a need on that side so I don't think there's any disagreement with the disagreement is is clarity on on how these are defined. In my experience and I've had my foot never one of these is that we make rules DHS and legislature makes rules providers provide service the pay their employees the in patient gets a service and then DHS comes back our Medicaid comes back member and says what you didn't do it right because it wasn't clear and you know that we just heard of testimony from DHS employees earlier talking about we're trying to do this to clarify you're making these changes to clarify the word was used what we're error prone a little while ago and and that's exactly correct and since we are error prone there is a need to be very clear and very explicit in what we're doing because the history of DHS and Medicaid has been do not be clear into the to the point of people misspelling words in their treatment plan and having money recouped for services that already given tens of thousands of dollars in many cases so you know again no one's disagreeing with what you're saying it's just how we navigate this your call how come you've waited so long here we are at the last minute there won't be any more meetings and now we are coming here that very last of our meetings and you're asking us to approve a very controversial rule regardless of which side you're on so why have you waited. I was a represents love and so like I said when we launched the pass and if you remember it went full rest on March first of twenty nineteen. So that's when we started seeing really the mechanics of exactly where women I would take exception to that we've known this problem for for years yes knowing that people that we're building our expand my couldn't do those things so to to write testify here that we're just learning this is just not accurate in my opinion let me clarify what I'm trying to say thank Paulette stone NO. When I even thinking that and we've said that many times openly that the past when we put all the services under the path umbrella that there was going to be an instant fix to the problem we have had for many years because that way we had made or the services available and it wasn't basing your diagnosis anymore. So but it's not fixed at because of the way that the provider structure continues to operate so I would say that we started watching this start happening once we got through the alliance in trying to help everybody make sure they could be billing correctly and doing all the things that we did it with many of you guys and I am hoping once we started really watching we realized we yeah this is the problem before the past this is a problem under the pass there really is just no where for some of these people to go or they're not getting the services that they should be getting and I don't want to speak for the passes but we do a lot for client meetings with the passes talking about specific clients just struggling to figure out what what happened I would agree with your assumption that when we did this the assumption was that this would fix the problem that everybody knew is there so what is it that the passes have failed to do to fix the problem well I don't think it's necessarily a failure on that on the passes I think until we change the structure of of making certain providers stay in certain lands and only giving them a certain service array we're going to continue to see this problem I mean we have these gaps were I think you know specifically for DD clients the man they could really use some services like therapy communities nobody's yeah I'm not hearing anyone disagree there are gaps amend I think that's everybody agrees yes there are and and we by making our rules created those gaps so by the question this by creating a whole new manual are we creating other gas and but by not clearly defining what that service includes that's what I hear from providers as we're not we're creating a new a new manual with that lacks clarity to disagree I would disagree and I and I will and I will say this team just to be completely Frank so we heard some. Those comments on Monday of the lack of clarity and confusion of what services is covered so we offered an amendment yesterday outlining exactly what services we've coated that would be on the fee schedule and might I add they have been the same services on every power point we have done since August the fourth and multiple multiple stakeholder meetings and individual meetings with the exact same power point and service array the services are defined in the nineteen fifteen on in the city that the past operates under that the providers are doing right now so the services aren't they're not changing their the same descriptions they've been out there since we started the program okay so thank understand where you're going and no you have lots of meetings you spend lots of time and ours are genuinely concerned about having a quality program and I commend you for that I know you all have worked really hard and I guess we'll need to do is here we have some testimony later we'll hear from that side if you have a question from. Mr Rangel I'm sorry Senator Rice go were you finished can you you're done. With the senator You finished. Can you get your **** and. Okay got you senator rice I was almost finished. Let me say I appreciate your explanations I had some pre discussion With Mr Wyden and and others on this again we I think we all know the needs we have concerns about something this big rolling it out to make sure the right input was in it I I think what I'm hearing from you is there's communication and collaboration what I was trying to get across is when we see because I do believe to because of same someone can come out of mental illness and and there's different levels at different times and if we have somebody in there helping that doesn't have expertise I want them I will DHS to let them know absolutely they have the right to communicate the navy didn't and and let's get help because things do change in that from just a light man that doesn't have any MPM put knowledge about it but what I'm trying to get across the hope that's built in thank you senator I apologize for jumping in on your question interrupting I'm sorry. A. Senator Breanne you're recognized for a question. Thank you Mr chair and I just you know I I would I just wanna for the for the value of the members of rules and regulations subcommittee we did have this in public health we spent probably an hour and a half to two hours on this rule in particular we held we heard testimony from different stakeholders that came to the table M. and at that time you know we we did review it I did note that there were objections from the members of public health asking for clarification in the language of the services provided and so you said that amendment you had put that forward to do that to clarify clarify that so I applaud you for that efforts with that amendment rejected or accepted he was rejected okay so you know I go back to I think that this is absolutely unnecessary rule I think this is a good thing I think it's a place to start is the perfect narrow that the rules that we started under the other things that we have not been perfect and we've worked on this and we've asked to continue to collaborate with folks and you have done that and you've tried but I can just tell you let's talk about I'm tired of talking about providers I'm tired of talking about DHS I want to talk about the people that are struggling I want to talk about people I know that have family members who need these people to come into these homes and help these individuals and that have reached out to me in support of this rule in support of creating a new person that can be there to support their loved one and can be in their home when they can't be there these people are testate bless their hearts I mean we have families who struggle with loved ones they want their loved ones to be independent living they want their loved ones to be functional and healthy and happy but they're worn out I mean these parents have to have helped these loved ones these family members. Have to have help and so I think this is absolutely the right thing to do I think we have to have some flexibility because you're absolutely correct the the structures of of how we do things and I completely and sympathetic and empathetic with the providers I understand this completly we get to rigid right and if it's if it's not defined under medical necessity you can't get it when you and I so that's Rose common sense out the window and in my opinion and so what I think you're bringing forward is how can we use our common sense to go okay we've identified the space we've identified a problem you know we want to try to be as flexible as possible creating a new person to come in here to provide these services so we're not overpaying or underpaying or you know utilizing somebody who has the skill for this they're just not gonna be interested in doing that if they're over skilled or over trained they're not gonna be interested in going and doing this and it's probably not appropriate because we need them somewhere else so you know I I applaud the I'm supportive of this I think it needs you know I think we continue to work on it but I've heard from provider groups that are very supportive of this but more in particularly I've heard from families that are supportive of this and for their loved ones and so I applaud those I have a you know what I have a very close family member at very close associates and friends who had a family member who was in an older gentleman who had severe schizophrenia and you know they would come in to try to help him be independent living and help him you know cook and clean and you know he it was unfortunate sometimes because he couldn't control but you know we do have to have training for those individuals and I think you have clarified that would take that in consideration but these. Families desperately need that assistance and help so Mister chair thank you for the latitude I want to speak for the and I believe it's a rule that is appropriate and that we should pass thank you sure thank you. Yes I would agree I don't think there's anyone that disagrees with the services are needed there is a gap in there trump need us tremendous sent a Representative Kofi Cozart you're recognized for a question. Thank you Mr chair agree totally I think this will need thing I don't have anything of the concept right the only the only concern I have is I think that the certification is not quite the certification as a would be in a clinical setting is that correct that's that's the only concern I have is long as the people know that those certifications are not and that these people cannot turn around and move into a clinical setting with that same certification but I think that's a very needed thing that they need to know that these people are not certified the same ways clinical. And if I may respond consent arise had as a similar question and and I mean this is down disparaging on our providers but they are very quick to tell us when they can't handle somebody. So today so we get calls and then they can move into those higher levels that we're trying to avoid that the services but that's levels are still available right so partial hospitalization acute residential enter intermediate care facilities may HTC's that higher tier I mean that higher level of service we're not touching it in this this is for those people who at the current moment don't need that higher level but they need some help to stay where they are found and and like so just stay in their scope of training and certification is the main thing I would have a concern about thank you thank Mr. Senator hammer you're recognized for a question. Thank you Mr chair and and we have been having discussions since August July on this and we're operating under a set of emergency rules as you know dictated by the governor right now there are some groups that are concerned that when those emergency rules go away if this manual's not in places can be very disruptive in my correct on that yes Sir and yes so tell me about the disruption that'll happen if the emergency stops these rules are not in place what happens to the apple cart sure so we have put some temporary changes in place around take around therapeutic communities which is on those higher levels that that missed owner for two there are some changes in this rule with this product can access this and use this and build products therapeutic communities under a higher level that's under this rule and they will give them the same benefits that they're receiving under the temporary emergency right now at this point them in the mercies been extended by the governor through the end of the year op I don't expect that to change of course they'll be questioned the new year's legislature will deal with them to get the session so we're we're taking that as it comes and if we need to make changes to adapt to help those providers continue in operation we're certainly certainly up to that well that's does come a point we're headed toward a perfect storm that the emergency goes way we don't have these manuals in place we're gonna be right back where we were and actually some services have been provided under the relaxation created by the emergency rule is that a fair statement. Yes Sir yes that they are taking advantage of this mercy rules and that's and that is certainly a service that is that is needed and that and we think this will address it and I would like to clear up one thing because I've been told privately that the passes do not necessarily have to operate according to the reimbursement as dictated in the Medicaid manuals that correct. Yes that is correct so that was a requirement your one they had to do exact same rates however with my conversations with the passes I think all of us are in agreement that this this particular program therapy communities and community reintegration which take really hard clients that rate probably isn't sufficient and and Janet man is here from DMS but that she has added both of those programs to the rate review study that will also begin at the first of the year. This is going to help assure that that will help six a couple problems one in that the reimbursement will be there that they can staff up to take care of a difficult population whose needs are not being met now that fair characterization yes ma'am for those who are not familiar with their P. communities they take many of our clients that would otherwise go to the Arkansas State Hospital both behavioral health clients and clients with developmental disabilities and they are very much needed we don't have enough of them we need we need as many as we can get okay and and then the last thing I would say is why. If the passes are receiving reimbursement why have they not been helping meet the needs of this population up till now for those members that are members of the passes why are we having to and I'm I'm giving my perception you straight me out why are we having to do the passes job for them by creating this because it seems to me like they should been responsible for taking care of this need without us having to get this involved so help me understand why were this involved when they're getting paid to take care of this population and all needs I don't care which column there in there charged with responsibility meeting all the needs so why we have to go to all this work to do that. I am happy to answer that I think sometimes they get a bad rap sometimes desire but sometimes a bad rap and on this one it's a bad rap so you know they are balanced by Medicaid rolls in terms that we turn on certain codes for certain provider types they can't pay pathfinders right now to go in and do your support again I mean under the I. D. D. provider type so there's still balance by how we set up the structure in Medicaid enrollment of what we allow providers to do or not do and I think it's represent of solvents that this's been an ongoing problem and they we have watched a provider just a few weeks ago offer you know at provider a much larger sum of money then what Medicaid would pay just to take a fourteen year old girl with autism that also has behavioral health needs and finally the provider was like it's not about the money and you know we don't have the staff here to to treat this little girl because she's got both issues at the same time going on and we don't feel like we can do it so I think that they tried I think that it's not their number one to put them places the placements aren't there and you know what money you can't just throw money at it to fix it so because I will not responsive we're giving you money pay them what they pay them right pay and what they need to take and and we watch them do it they wouldn't take her so am I think that this is a this is a bigger problem than what the passes can fix on their own and and I think we're gonna make this you know this wait interstate ramp for them and then we are going to expect them to cultivate this provider type into trying to get more across the state and the places we need and that will be on them those are on that they're network we need them to get more these providers in network. And we we hope to see placements happening and if they don't then we know right immediately that there's an issue with that provider type and we need to go in and fix that because we're given the tools but this provider type and we expect a lot of this to be corrected. Okay and without this you don't feel can be corrected Nassar Marcus you for Lucy of the day did you have to get that I know you're on shore up I don't have it will give that to years as quickly as we can I understand what's working under thank you thank you Mr. You're talking about a new provider type preserve real clear definition in the rule that says this is what this is that the clients in the service must be have that dual diagnosis is that clearly defined. Seven the. I would say that the amendment that we offered yesterday clearly defined. That exact service in the exact population and I am happy we are happy to insert that back into the role we did that at the request the B. H. provider and that spend you know concerned and when that was rejected late yesterday and then offered a substitution that we just do not feel like we can move forward with we didn't bring that forward today but it outlines exactly the services where the definitions are and who the member who the beneficiaries are that can get it okay Sir clearly defined to the clients are another qualified okay a member saying no further questions how we do have a couple of people who would like to speak Joel under now Joe would you come forward please. And introduce yourself and you may make your comments. Yes yes yeah Carrowmore it's going to a company. If you would just introduce ourselves and maybe who you represent also. Certainly thank you Mr chairman. My name is Joel inferno I am the executive director of the behavioral health prep providers section. And I'm Carol Moore. Per your green button. Yes thank you Mr chair I'm Carol Moore I am the president of the Arkansas behavior health providers association and also a licensed clinician okay you may make a comment okay thank you Mister chair I've been asked to appear before you today to speak on behalf of the association who sees some positive benefits to many of the things that are attempted to be achieved in this rule and you go pretty much cover both of those things that we see as the most positive in the direct testimony from the Department of Human Services we agree with the concept of tearing down the barriers between behavioral health and the different TV services there's no reason why there should be a separation where one services available but I know the service is not in the same agency and we also agree that it's urgent actually that what this does achieve in the in the regard of reducing the over regulation and therapeutic communities and it's it's that aspect of it that makes it as time sensitive as it is and although the intent is good we believe we still feel compelled to ask that you not approve them or that you approval with some sort of changes to its limitations to its scope or at least at the very least limitations on a time line so that the remainder of the problems with it can be worked out in in the coming year the reason why we think that it is is that it it's even subject to be rejected is because we don't believe that it meets the legislature's intent that was behind the passage of act seven seventy five that created the past program in the first place past program was established in order to. create an organized system of care to improve the experience of health care including without limitation quality of care access to care and rely and reliability of care and our concern is that it doesn't meet the quality of care intent set forth in the a pass ACT we believe that the outpatient behavioral health services manual does because it's consistent with the purpose of providing efficiently economically and only when medically necessary quality of service that meets professionally recognized standards of care. And this is particularly true with respect to the supervision of the para professionals the date that those folks who are not licensed to practice mental health services. At the moment the services that are articulated in the amendment that was described by DHS or the services offered by the pass and those services include things like behavioral assistance child and youth support and mobile crisis intervention. Under the current licensing scheme for behavioral health agencies those services can be delivered by an non licensed personnel these are college degreed or not but they're trained and they work under the supervision of a licensed therapist under the behavioral health services manual that supervision must be face to face at least every fourteen days and there or have to be weekly supervision on a paper review and at least once per month personal observation of that para professional delivering the service. Under the proposed CSS P. manual you would have non degreed nonlicensed people rendering the same services such as behavioral assistance and Mogae and child in your support. But there proposed manual only mentions supervision with respect to those clinicians who were not licensed for independent practice. It's completely silent on whether or not the pair professionals themselves would have any supervision. So under the CSS P. manual what with these para professionals be doing with no clinical supervision. They would be executing some of the services that were articulated and that are offered in the past mental behavioral assistance for example is a specific outcome oriented intervention provided individually in that interview or in a group setting that will provide support to attain the goals of the treatment plan. Treatment plan. They say this is not a medical service but it's under medical supervision. In the behavioral health world the treatment plan is prepared by licensed therapists it's signed off on by a doctor and it is the prescription for services. That was that's the case still that this aspect of our city my has survived and this is still in the past manual it is still the criteria that is used to determine whether or not a service is reimbursable. And in a retrospective review it's the criteria that's used to determine whether or not the documentation of that service is adequate it has to relate to something in the treatment plant. So if they're gonna be rendering services that are implementing a treatment plan but doing it without the supervision of a licensed therapist that's a quality issue in our view. And it's not just behavioral health a behavioral assistance also child and you support John your support services or clinical time limited services for principal caregivers designed to increase child's positive behaviors. Clinical time limited services I'm reading from the current manual in the past services these are services that would be rendered by the individuals who are licensed by the CSS pee. If there is going to be a shift away from medical orientation then that shift needs to include the behavioral services manual as well and I think that clinicians might have a view on that. Which I'm not expressing I'm just saying that you have the BHS manual survives and is subject to these prescriptions and the C. S. S. P. does the same services without those restrictions and we think that's a disparity that needs to be addressed. The mobile crisis intervention short term on site face to face therapeutic response to remember experiencing behavior health crisis. In the manual that was something only done by a mental health professional or psychologist psychiatrist. This these are quality issues and our concern is that. It does create a pathway it's it's a pathway to. A lesser quality of service with less clinical supervision. And. We don't believe that that is that's a good way to go forward. Because the services are tied to the treatment plan and because recruitment centers around medical necessity it does open the question of how would make review whether or not something is subject to reimbursement under services rendered here if they're not done with clinical supervision if they're not tied to a medical treatment plan what are they tied to so we don't believe that all home and community based services are equally intense summer more intense than others which is why you have the disparity in the training requirements for the Q. BHP's which under the existing Q. B. H. P. manual I have to be supervised they have to be tested have to undergo a skills test and a written examination all of these things have to be done by a para professional in the behavioral health agency in order to be able to provide the services none of those things appear in the CSS be manual so we. Asked that the limitation be put up be put I'm sorry on the application of this so that would apply to therapeutic communities it would apply to DD only apply to deviate paper health call more but but that is not applied behavioral health purely at least with respect to to the services that I've just mentioned and that's that's not something that been willing to accept let me say this we don't oppose the slightly. I appeared before public health on November seventeenth twenty sixteen that's when the transformation went for for public health and how we expressed qualified support for a higher qualification was that we were concerned that care coordination wasn't properly defined we're still not sure that it's it's what it ought to be but even then we didn't oppose that we don't take the position of opposing this lightly and we don't think it's a a pathway to quality we're concerned it might be a pathway to by pass quality. we do have recognize the time sensitive nature of the therapeutic communities portion of this which is why we would ask at the very least that its application be limited in the behavioral health side and that a sunset clause be put in it so that there's a hard deadline say December thirty first twenty twenty one so that they would be a motivation to revisit some of the issues that were raising right now and so with that I think I will thank you for your attention and often like to miss more. Yes thank you Mister chair for allowing us to come and speak for this committee we have and were part of the presentation on September third a in regards to this new licensure there were. We have we are. We feel that there are many many questions that have not yet been answered adequately. In the on the mental health providers side we have the ability to serve ID clients as long as we can cognitively show that they can benefit from services there been a lot of questions raised about services in the community services and office services in a hospital. Outpatient providers. Are in the community they work in the homes they work in the schools yes we work some from the offices but we meet the needs of the clients that we serve where it best suits them as long as it's allowable as a place of service under Medicaid. There are. Services that are equivalent to we have Individual life skills and group life skills which addresses many of the things that were in someone of contentious point earlier in the week working with clients to provide them teach them the skills that they need to maintain in their homes. One of our main questions remains that if these are services that are needed and necessary for the particular clients that we serve in everything we do is for the to ensure the best. Eight months and to meet the needs of the clients that we serve if these items if the services are necessary then they should be written into the. Person centered care plan completed by the care coordinators in conjunction with all of the. Persons that meet those needs of that client and if it's in that person centered care plan then we should be able to provide those services. Some of the services we do have a concern and jail touched on it These services are for duly diagnosed clientele that have ID and we definitely need more services for that particular population I work nine years in a in a an HTC so I understand that population but so many of these services that Joe mentioned. Are by definition from DHS clinical services as they require medical necessity in a clearly states Sir clinical services including the master including the treatment plan. One of our biggest concerns and I will stop with this unless you have any questions for me. The duly diagnose population is not a matter of somebody with Developmental disabilities and anxiety Senator Irvin you mentioned yourself a schizophrenia compounded with the ID and the concern is the lack of a level of training in regards to mental health services the statement and this CSS P. manual is employees assigned to a specific beneficiary or group of specific specific beneficiaries must receive training specific to such beneficiaries as required to meet the individualized needs of those beneficiaries. All pair professionals that provide services under the scope of a B. H.. Our. Trained in all aspects of mental health approaches of interventions and there under the close supervision of a mental health therapist a licensed clinician. State and and these trainings that are listed in CSS beer excellent and please don't don't think for one minute we do not see the need and recognize that made but there the lack of mental health training in these listed items is very scary it would be almost impossible to take one pair professional under CSS pee and trying them specifically to that client's needs we would request that additional oversight and training and supervision. Be incorporated into this we are not standing firm against this we are standing firm against the needs that there are some changes that are required okay we've got a few questions if you all take some questions Senator Irvin you're recognized for a question thank you and an opportunity to respond M. as well so do you believe that clinical supervision as needed to in order to add clean someone's coffee table. Yes or no do you think clinical supervision is needed to clean somebody's kitchen or coffee table yes or no because there are there are folks that you have represented you have put out videos showing that so which I thought were really hope horrendous but do you believe that you need that as a medical necessity and that you it requires clinical supervision in order to clean somebody's coffee table yes or no I would like to respond to that is not a yes or no answer is a yes or no answer that's services available under B. H.. Thank you believe that requires clinical supervision all I got is yelling do you think that limiting services to individuals and to people is appropriate because that's what you're advocating for you rejected language to clarify the services which is what you requested on Monday during public health you rejected that language. To clarify the services you are advocating to limit services to people that's what you're clearly at the table advocating and I'm tired of sitting here and listening to spin master's. I'm tired of it because this is something that is necessary and needed. And we're trying to find availability and people to go help these people and DHS has done a tremendous amount of work in crafting something and I do not believe there's medical necessity for somebody to go in and help somebody perform functional. Functional items functional types of problems that they have I don't believe that the medical necessity issue I don't believe there needs to be clinical supervision because see if you do clinical supervision you get paid more I understand that I understand the business aspect of this I think we need to be real clear about this because. You know there is an application and there is a way that you need to apply things and we as lawmakers need to pay for things appropriately we don't need to overpay for something. That's not appropriate we need to pay appropriately for services rendered and what is needed and we need to have flexibility and I think that's what they're trying to bring to the table but I mean for you to say that you're not opposed this rule actively trying to kill this rule. You're actively trying to stop this rule today and kill it. And so I I take issue with the fact that you're saying that you're not opposed to this rule you think it's a great thing but then you're trying to you know you're you're you're killing it actively and so I I take exception to that and I don't believe that that's correct. And so you know I I'm just I'm concerned that. You're saying that the issue of quality of care but what you're really asking for the only change that you're really asking for is to exclude one class of clients from the services. I do not support that I do not want to exclude anybody from services and I I find it remarkable that you're actually asking to exclude people from services. I find that to be remarkable. I'm fine with clarity I understand clarity in need for clarity of services and how they're defined so that you can get paid that's pretty simple we represents all of and I would agree one hundred percent on that point you know I believe we understand how difficult it is with different payers and how if you don't cross the teeny don't dot and I you don't get paid I understand that if that's the kind of clarity that we need absolutely supportive of that if that language is needed I will support adding that to this rule but I will not support limiting services to pop to clients I will not support that and I will not support us trying to. You know deny people the ability to have somebody come in their home and help them. Now it is clear and it was made clear on Monday that the training is going to be up to. The provider in office and with guidelines and if there is going to be a clients that they have come into the house they absolutely will ensure that they are trained correctly appropriately that's going to be a working relationship and I think that's an appropriate thing to do and I appreciate the flexibility given and that latitude with the behavioral health providers so that they can have some flexibility about how they see this new group of a provider and what needs they need to give them to handle that situation they're going to go into again that's me is common sense and I I appreciate that but I do not support clinical pharmacy provision for functional services I don't think that's appropriate I do not support limiting services to patients and to people and to clients I don't support that and so I will support if you want clarification on services and how those are defines that you can get paid for them absolutely I will support that. But I think you know we have to be real careful about what we're asking here today because this is necessary and needed and if it doesn't get reviewed then it's the people of the State of Arkansas that's going to get hurt the most thank you. Mr thank you respond Your printer bring another question up if you're okay with that I meant there was an item here question here heard a comment that. Senator hammer you're recognized for a question. Thank thank you Mr you may you made a comment amended three hitter yellow button again senator are you not I think I'm on Sir okay or thank you you made a comment I just wanna clarify make sure don't misunderstand something can you currently provide the services to the population under question now. Which services or those Senator hammer well. I got I thought I heard you say something about being able to provide the services to the population under question now and I was just wondering with so many in the population on served as referenced earlier in the. Meeting why you are providing services to that population now what which prohibiting you from taking care of those thousand that were mentioned while ago I think you might be talking about the thousand that have the dual diagnosis with Intel and you can only provide to one portion of that which this addresses that's the positive portion of this of this document the concern is is that there are some of the services that we think required clinical supervision and maybe wiping tables isn't one of them but the April assistance and child you support our which document when you say this dock me talk about this this plan you're the one that you're reviewing. Okay so it would take care meet the needs of those thousand because it It allows for singles service provider to do behavioral health and D. D. on the Committee services in with a single certification right now they required double certification and I don't think anybody does that and you don't think that your position as an association to do what's required to get that deal certification you just want to stay in your lane we we we we could do that the concern is that this creates two different standards for what kind of supervision is offered to things like paperless systems and child and you support for behavioral health agencies they'll still have to be behavioral health agencies in order to see tier one client. And in order to do that they'll be governed by those rules which requires all supervision for professionals that they now have to meet that aren't in this new manual okay all right thank Mr. For for we are running up on a time crunch eleven o'clock we got two more folks up so if you would be let's try to move quickly through this Senator Rice you're recognized. Mr I'm not against this but I I've I've been concerned in and wanna hear the need that the Arkansas the possibly for a review of this apartment leased part of an after year and thank is. I would be open to make a motion to the delight approval of this until Friday if we can get some people together and move this thing forward. Your term what he thinks he's here that's what I'm here. I have a motion. On the floor to have a second. This first second to the motion. I have a second to the motion to move this to Friday to allow the two groups to. To a. Discuss this further. comments on the motion. Discussion serving you have a comment on the motion yes just discussion on the motion I a. I I think You know I just wanna remind the committee that. Our purpose in our function here is we can reject a rule if it's inconsistent with state or federal law or legislative intent and so you know as we that's a diss question point on this on this motion and I'm not opposed to to position us to Friday and having a full hearing of it I'll see if if that's the clarity I'm asking for clarity of the motion and then also if if the amendment that was offered that was rejected but I mean I review that and I'm okay with that language if we want to add that to it I guess question to the chair or maybe perhaps a question is EHS is I'm and they may not be able to answer questions discussion of motion but. What how would that affect what would if if languages added between now and Friday how would that affect us in reviewing the rule. I don't know if you can answer that. Or. Provocando have a motion to move this to Friday and allow for further discussion. A all in favor of that say aye. Your post no we have some service one US one to speak. Okay represented what city and. Okay Representative Ladyman you're recognized thank you Mr chairman I wasn't in on this fall meeting and I apologize if I'm repeating something or missing something here but but I just wanna state you know we we discussed this for two hours Monday in the public health and I know there was an alternative offered I wasn't in on the discussion of that but but I just like to say that you know I've listened intently for many hours to this discussion and talked individually the folks on on both sides of this issue and and and I understand it's a big issue but also understand that there's a group of a thousand people that need help and we've identified a way to help those thousand people. And I think it is our duty if there's a solution to helping one thousand people. Who really need help and we need to do that and any time we make a change this big there's going to be you know bugs to work out there's going to be individual issues I think those could be worked out later but you know what I for one want to help those thousand people get the help that they need and I support moving this rule on. Thank you. US senator Johnson. With the I would ask you for your this rule is it acceptable to you to go back to the to a different to the L. Y. to the old manual to you. If you're a question as to to to not do this rule is that is that acceptable to you. I'm asking for change to it to limit its application and to put a sunset on it so that we can continue to work out the issue we realize the hours late. And especially with the time sensitive urgency of the therapeutic communities changes up does have to happen one way or another either through this manual or through an emergency change to that of the manual. So what we're hoping for for at this point is is a limitation on its application to some of the services that need it clinical group supervision and argue the child support shall and you support and behavioral assistance in particular and maybe crisis intervention and then have a deadline in it so that we're working on revisions to the manual and in calendar twenty twenty one. Well I just wanna tell the the committee how much I appreciate DHS and their ability to to work with. many of these the. Therapeutic providers and and senator hammer and I I worked on this at a late at a later date trying to get this thing the acceptable and get it before this committee before the year change so this this manual could be possible and I appreciate this committee to advance this now and Work on your concerns following the this is this is the late date then I see no purpose in and push it back till Friday thank you chair. Thank you senator represented Wardlaw you're recognized thank you Mr Committee my main concern is is what can we do Friday that we're not going to do today and delaying it to Friday could potentially delay it for six months because its committee probably won't meet again after Friday. For another six months because we have session coming up so I just think it's very important we take care of our business and I agree with represented Ladyman this does feel that need for those patients so with that I'd appreciate a no vote on that motion thank you. Senator Reid Shepherd commenter questioned and I appreciate the input from my colleagues and the again you said the the late hour I'm going to pull down my motion I do of the eight yes to hear this there are concerns. One thing I see over and over again is the unintended consequence you're always going to have a program this be. I don't think it's too much to ask for a review after year no I don't know what your work out I would like to see that before final Report on Friday but I am not going to pull this up so I withdraw my motion thank. Emotional withdrawn and the witnesses you're excused thank you very much. You're gonna have DHS come back up this very quickly please we're gonna try to move pretty quickly but I just want to share something with you at the table. You're my experience is that are when things are not clear that. People don't get services is not a matter paying the provider is not a matter of people getting paid as if you have no one to provide the service that doesn't happen we've heard that over and over not I do when I hear the conflict in the manuals that were there's a definition here that is enforced that is enforced over there than that the end result of that is clients don't get services so I really hope you will take that seriously and that the manuals will be consistent across the board and if that doesn't happen then we're gonna be back down here having a really big battle because we've been there before so the objection has been withdrawn so are there with any other objections they without objection this rule is reviewed and approved thank you. Thank you are we will move on to item. Senator common. The two forty two. Fifty one char. That a I hitch officer. One more time. All right now your thank you I I quickly I do thank you represent that Mister Mister chair for your comments I would also say that if that amendment is necessary I would ask you to put it in even if it was rejected I do think that it does provide clarity I looked at it and I think it might be a good thing so I just wanted to that based on what this chair did say and I think that would help matters thank you okay we can bring that up on Friday I guess okay moving on we are remit all the way to be. Go ahead I'll be brief approach Mr occur this rule what this does repeals part of the Medicaid provider manual if you if you see in our provider means at all they we have thirty or forty or so there's one for each provider top for the five sections are the same across all the manuals one of the sections section five is just a list of forms and web links is nothing substantive just has those those that information in it so we're doing is we're taking that out of publication because nonsense substantive and we think it's a waste of your time to bring you an amendment every time there's a name of a form changes and so that's all this rules doing just taking that nonsense that piece out of the promulgated rules. Thank members any questions sing no question this rule for pewter approved Adam city. were passing over and say I'm sorry. Okay on the item D.. The report this rule does is this allows hospitals to operate acute crisis units I know many of you familiar with the crisis stabilization units or C. issues that we have for around state and Jonesborough Fort Smith fable in Little Rock those providing great service to by providing a place for people are having an acute behavioral health needs that they can go to and get stabilized we have that need across the state and we need to expand that capacity so what this rule does was ill allow hospitals to provide a see you so we can get this and more it's the state and there is some other things related to this the whole both see issues as well as these new AC use around rates and run the regular regulations but this is just one piece of that and evidence request Ms. Are you are you finished yes our members I see no comments or questions so a single question this is rules reviewed and approved item E.. Two sides the change some changes to our our choices waiver and living choices Medicaid waiver our sources is the waiver that serves adults with physical disabilities as well as the frail elderly living choices the way the process resisted living services for those same populations order is two things one we is we're simplifying three eligibility process so that individuals do not necessarily have to have an assessment of our vendor in order to become found eligible continuing on this will help make things simpler for beneficiaries and also for our for our staff were also clear funds from the appeal rules to make it clear that an individual if they appeal their services will continue Paul that appeal is pending I just wish you would have any inadvertent cut off of services for someone who has a real need no that have answering questions. A single question to Saddam is reviewed and approved Adam F.. In these last two items are rate changes for providers the first one this is for the personal care rate us of you know this this came up earlier in the year we proposed an increase in the rate for personal care which is that's that hands on assistance with individuals to help them with activities of daily living for proposing to increase that by thirteen point seven two percent I wish with that rate up to twenty dollars forty seven cents an hour all that happened requested members any questions sing no question too is room for viewing approved Adamjee. And this is rate increase for positions we brought a rule for earlier in the year to provide a five percent increase for positions in Medicaid we also we're we recognize we're going to increase the rate overall eight percent for the other three percent we thought we might look at some other options for how to implement that maybe some ways tied to qualities from other things but in talking with the doctors we finally decided the best thing to do is go ahead and add that additional three percent on to the five percent so that would after that does. Member saying no questions this rule is reviewed and approved thank really thank you very much. Three of the Department of Parks and heritage and tourism. And if you would introduce yourselves and you may present your rules and I'm I'd look through these I don't think they were controversial so if we could reform pretty quick I would appreciate a circuit morning I'm Leslie Fisk and I'm chief of legislative affairs for Arkansas department of parks heritage and tourism and I'm here with my colleagues Grady Spann and Joe Jacobs increased director of state parks is going to present these rules okay you may proceed. Thank you. The first rule is to allow E. bikes are pedal assist bikes in our parks this is already a law in Arkansas we're just extending that to have the ability to do that in our parks as well. Members any questions and saying no question just rules reviewed and approved item be next item is establishing our fees and rates for the next year and every year we of survey like the facilities around the state to make sure we are not undercutting any other private businesses and keeping in a competitive rate and so these the these are our fees for the next year and just just that accordingly for members any questions. Yeah no question his rule for reviewed and approved items city last item basically defines the hours of operations for state parks and museums across the state as well as our central office staff is standardizing that to where we're not having to identify every single facility across the state with the hours that they have to operate three members in the quest coast Senator Irvin you have a question you're recognized just a comment I wanted to congratulate Mr span on his position if you'll let us know what you're serving now all currently serving as the president of the national association of state park directors which represents all fifty states state park directors have that position for two years thank you for yes thank you so I just want to recognize that because that's really exciting and that Arkansas is leading in that you're in that position so thank you for doing that and stepping up and I'm excited to see how that's going to help improve our state parks congratulations thank you senator thank you and I see no further questions in this rule will stand reviewed and approved thank you very much. Yada NO go that quickly did you already came in today. number thirteen Arkansas treasury. And we're gonna have a lot of questions for you Sir. Please introduce yourself and you may present euro grant Wallace to step the treasure for treasure million. You represent a real and this really is the update and technical corrections to the able program rules we had the first round when we first rolled out the programs that we've been in operation for two years these are just some technical changes just to clarify the rules for the program. Straightforward. Thank members. A any questions and saying no questions this rule for review and approve thank thank you much. Adam D. as without objection the subcommittee will suspend its rules to consider the next item on the agenda will someone from the agency please come up and introduce yourself for the record and present you will. This is the racing. commission I guess work. If you would introduce yourself and I think you've communicated with a lot of our members and we have a lot of them here but if you could kind of summarize what you're doing there won't be a need to present each one of them individually can someone to act first introduce yourselves please share not buying for a return to racing commission with me John Campbell who is executive director racing commission and Walter evil who is the attorney for Oaklawn park. If you would can you summarize these far so let us know what you're doing I can't it ended the year it each year the racing commission that Oaklawn park in the worst near the trainers owners meet income of proposed rule changes they did that this year those are all the Interstate parties and we had a public hearing there are no objections and the horsemen stated they have no objections these rule changes. Of the first rule changes can I go through this quickly as I can rule twelve seventeen C. that prohibits the use of a. Shockwave therapy which was approved several years ago this and then make this rule makes it illegal there's number that's a. Regis to a mall or group well Yeah well Bachem if if any does anybody have any questions about them centre manager but not. On. Thank you actually I would just like to make a motion to review these I understand there's a time sensitive issue and there's a public comment period time that making sure that we review these rules that that the same rules can be in place or out the racing season rather than changing part way through the season I think is a little bit the issue so I'm just happy to make a motion to review these of at this time. Okay. We have a motion to review that these rules be reviewed and accepted per that. Yeah without objection to make that motion there reviewed and approved thank you thank you. Okay members where it hi Adam II the agency updates on delinquent rulemaking. Hi the our final item on the agenda is a letter from the department of ag regarding its status update in accordance with ACT five seventeen of twenty nineteen you have a letter in front of you and there's no objection we will review and filed a letter as a status update. And saying no objection this rules are reviewed and approved. And folks that concludes that I appreciate their by sticking with this and we are adjourned.