Public Health House and Senate

Thank members will take your seats will get started. I would love one. your sweet thing here. Like I said on my I'm on my. Okay members of he'll get to your state we're going to go and get started. And I call the meeting to order. And. I am not trying to start a new fashion trends at. I've had an allergic reaction and so. Here you have me. I made it M. after steroid shot and to Benadryl than three cokes here I am. This one I wish everybody merry Christmas I know Mr prices off the the sweet but sure we're glad to have you here and I just again want to re re emphasize how much we appreciate our staff in the bureau of legislative research and the south for all the work they do to help our committees and again just thank all the members of the committee that work so hard it's just been an incredible honor and pleasure to be the chair of this committee and and so there's a lot that we're going to go through today important things but most importantly I just want to say also thanks to the state agencies that have worked with us so closely we appreciate you and the work that you've done and we're excited to know that there is a vaccine that is out and being delivered and being administered to our health care professionals right now so our prayers are with them and members I would also ask a special prayer for a very dear friend of mine and Dr slash injures brother. And he has at I would just ask for prayers for and his brother and he was struggling with very serious complications from coke at nineteen. his name is mark. M. and with that also prayers just for everybody that has suffered through this disease and continues to suffer. again it's just been a great pleasure to be able to bring the information and work as hard as we have with you represent of Ladyman and all the members of the committee you've been just such an honorable man to chat with and I'm so grateful to you. Recognize you for comments. Thank you madam chair. Well I'm just like to repeat me Christmas to everybody and I've also enjoyed sharing this joint committee and I think we've done a lot of good work and I appreciate cooperation from everybody but I want to say specifically to the the House members of the committee I really appreciate what you all have done during the session you know we stayed late at meetings and the work the hard work that you all did during the two years that I've been chair you know you did a really good job for the people of Arkansas and made my job a lot easier so I appreciate you all for that thank you manager thank you. All rights and we will go and get started so we have a consideration to adopt the minutes from the last meeting there a motion and a second those in favor say aye. And oppose ayes have it is the imminent minutes will be adopted I'm item the Arkansas department of health. If the Arkansas department of health will come up we will get started. With all of these different rules that we have before us today. If you're just state your name for the record you're recognized and you may begin. Senate Tedford director of the board of nursing. Hi David Dobson general counsel for the board thank you. Okay we have multiple rule changes in chapters Out go kinda chapter by chapter and stop if you all have questions most of my related to act that was passed in two thousand nineteen chapter one is result of act five ninety three of two thousand nineteen change in the definition. Chapter two is part of its related to ACT nine ninety of two thousand nineteen. M. and the other let's see we have changes in the compact law and again nine ninety. We did have one thing in chapter two that was not a result of an act it was changing continuing education requirements for reinstatement of a license and it was filed as an emergency rule back in may as a result of carpet. Chapter for the changes are all related to ACT nine nine either basically clean up of language. Chapter six is result of ACT nine ninety cleanup language. Chapter seven is a result of ACT nine ninety and clean up language. Chapter eight this is our section on met medication assistance certified and right now they only practice in long term care facilities and the department of corrections is ask for them to be added to the correctional system which allows people that are trying to medication administration to administer the medications to the detainees instead of the guards administering those medications. Chapter nine is our Result of changes from the department of education they added a sentence about. Employee volunteers and we just change the name of the agency in the rules. And that is all of a rule changes. Okay members are there any questions. No questions okay St nine the pharmacy and reviewed thank you thank you Committee. Next we have item eighty Arkansas department of health division of pharmacy services. Good afternoon thank you madam chair and large you and general counsel of the department of health and I have with me and Shane David to help present the rules dealing with the controlled substances list and you should all have a summary and exhibit E. providing the proposed amendments to the rules and Mr David is here in case you have any specific questions are public comment period is still pending it will expire tomorrow and as far as we know we have not received any public comments on these rules were happy to take any questions. Okay are there any questions on this rule. Again this is just an update based on the federal update correct. Represent avoid. Thank you madam chair I just wanted to clarify and I apologize I'm not find it in my packet does this take care of Apodaca lex and changing. Yes that's item twenty one its cannabidiol Gates listed as a cannabidiol product thank. Are there any other questions. All right fee and then the Saddam stands review thank you next item. M. F.. For item F.. Again this is large to general counsel with the department of health we're here to present the amendments on the rules for abortion facilities this is to come into compliance with axe three fifteen five twenty two six twenty eight a one an axe nine fifty three of twenty nineteen there were only a few of the act that were passed in twenty nineteen that we were able to move forward on acts for ninety three six nineteen and seven hundred have been enjoined they're also as pending acts from twenty seventeen that have been enjoined so we're trying to update the public health committee to let you all know that we are moving forward with the the portion that acts that we are able to enforce at this time our public comment response is pending and it should be filed either today or tomorrow once we have a consensus and then we will would have asked for review and approval before A. L. C. rules as soon as they can meet to address are amendments act five twenty to the men's the women's right to know act and it provides for a consent form and we also change the right to know publications to include the notice pursuant to ACT five twenty two. Also amended the rules pursuant to ACT six twenty to post an annual report on the website related to abortion complications under act eight a one we amended the law exceeding amended the rules to comply with the law concerning licensing abortion facilities with patient access providing that they would be at within thirty miles instead of minutes and it also mirrors the CMS facility requirements and under act nine fifty three we created of the amendments to comply with the parent etal palliative care act and it requires informed consent to include palliative care seventy two hours before the abortion is to be performed these are the acts of twenty nineteen that we can enforce at this point and we also have draft rules and at any time if the Hopkins verses Jackley I litigation is resolved at some point if there's some finality of judgment then we would move forward on the enforcement of those rules but as of this date this is the portion that we can proceed happy to take any questions thank you members do you have any questions again members I would just look Direct you to look through the packet and understand where things are being held and what they can move forward with or what they are asked to basically put on hold because of the court's actions so that's all listed job done a very good job of tracking that and providing not for us. A lot to keep up with so. thank you for that. See no other questions this item stands reviewed thank you merry Christmas. Nextwave item G.. At DHS and the glass David this is going to be a an update on the activities that would happen in twenty twenty. We're glad to have you here with us today. Bill this state your name for the record and then we. Mr chairman. and I appreciate troll. Today to. It's been just a minute looking back at this last. This is definitely been one for the history books I think we all know that and in looking at what all has gone on this year I I really want to just to take a moment to come over here to say thank you to all of you in spite of what we've all been through this year and maybe partly because of it the work that has gone on has been and. Not only has normal business gotten done but y'all have helped us respond to the pandemic and you've helped us take actions really really quickly and I felt like it was important to come over and say thank you thank you for the way you have worked with us and helped us get done what needs to be done for our Kansans this year so if you don't mind this is probably a quarter of what all has been done this year with the Department of Human Services but I just wanted to go through a few highlights so that should be aware of of how much evil manage to do with us over the last year in spite of it. People often don't you all do but many people outside don't recognize how many rule changes go through this committee for the Department of Human Services this year we've done twenty six rules with the committee can you bring your mind down just a little bit so we can hear a little bit better thank you that better yeah that's grainy six rule twenty six rules have been reviewed by this committee thus far this year and there's ten more today I mean many agencies don't even do one a year you verbally have received huge changes. These are not small included things like thirty more slots for on the autism waiver seven hundred more slots for the CS waiver which the developmental disabilities waiver we started an ambulance assessment program which came out of legislation new standards for E. ID T. N. eighty tea that's been years in the making and finally got done this year prior authorization for opioid treatment disorder again that came out of legislation that was passed. You know that's one area where being able to read that treatment will save so many lives and I do also have to mention another program that's going on with the number if you the narc hand saves program I look today before I came over here we are now at seven hundred thirty five lives saved from nor can that is really amazing. It some. Electronic visit verification something that CMS requires us to do but that is a very big change for the way we operate in the state in terms of paying claims after they are verified electronically that the visit did occur that is starting with its soft launch this Munch month big change for both DHS and for the providers and that kind of leads into the fact that this year there are a number of initiatives have been going on for many years to come to culmination this year and still have moved forward and in each of these cases these are areas we've been working closely with the committee for several years. Perhaps the biggest one is building are of infrastructure for the future for benefit management and eligibility the integrated Aries the Arkansas integrated eligibility and benefit management system that launched today. And it's pilot and five counties so they spent the weekend doing the conversions getting it moving and it started today that is years in the making and I hope you never hear anything else about it as it continues to roll out over the next year but I I thank you for all the support getting to this point that one automated backer of sorry I was just going to comment on that you know whenever I was elected in twenty ten I attended a public health committee meeting and not November of twenty ten and that this software was a huge problem eligibility system was a huge problem. They were going down a path that was not going to work and did not make sense they actually can scrapped it and when a different direction but this is been an ongoing problem since twenty eight before twenty ten but we've been working on it since and so for that for that program to launch today and tremendous work lots of hard work lots of after lots of push and that that's just a tremendous tremendous accomplishment I do have to add that appreciate that instances on it the workforces the art our team has worked so hard during the pandemic to try to stay on track with getting that one launched and we really appreciate the work and support that we've been getting on that automated background checks again this was something that came to us not through legislation but through a through legislative let's just say. Focus and attention saying you guys finally need to make this move to electronic background checks so we have started that with the DCCC child care and the rest of our back trump checks will be automated within this within the year. A waiver tracking says tracking system for aging waivers got set up this year and APS case management again both of those were areas where we needed and receive support and then online maltreatment check this is something that has been since I came here five years ago something members of the legislature have brought up to us and said can you please get that process online where it moves faster so that has actually finally begun in the last month. again another area that has been under way for several years and made significant movements this year partly through number the rules that thank you all In place has been building our state's behavioral health system I think this is an area that is near to dear to all of us an area we know is a multi year effort in order to build the system out as it needs to be in the state. It started with the work of the health care task force back in twenty sixteen where the moratorium on behavioral health providers with ended and then after that the past the provider led insurance company for insurance for intensive care coordination for those with the highest level of needs and behavioral health and DD new services new provider types crisis services initially began with crisis stabilization units across of for now across the state for law enforcement and this is been an area where we have seen a tremendous promise and also tremendous assistance mental health treatment recommendations and treatment changes to the forensics process and more to come in that area to our next set of reforms are going to focus on filling gaps and the VA's in over the next two years some of this will come before you today including a new provider type to survive those in the past both developmentally disabled as well as have significant behavioral health issues and then also to expand acute crisis units statewide through hospitals and hospital wishes to join the system talking with the hospitals and working around the state particularly in the rural areas there's an infrastructure there that can be tapped into and provide those services with if hospitals are wanting to do that we really want to see crisis services developed around the state next face will is getting under way and that's going to be working on co occurring substance use disorder we do not again have treatment and residential placement services in the state level we need again something you all talk to us about an area will keep working closely. With you on. As we look again this year I think some of the things I'm also most proud of and working with you has been the work around our state's programs for the developmentally disabled. We've made investments in the HTC workforce for the first time in forty years. That is something you should all be extremely proud of that is that is a critical infrastructure for us and we had not made the investments in it so both changing the credentials that are required for someone to work they're moving to having CNA's as our base of employment there adding nurses and then any supervisory structure all of these things are transformative for those human development centers and infrastructure improvements coming there for the first time again in decades Booneville broke ground on actually adding residential centers and infirmary plan now and starting under way at Conway New recreational facility at Warren these investments are just as important as the investments in home and community based services so working with you all we have been able to put investment at both sides both in the home and in the institutions and the passes are continuing to do well and to grow and they have started making community investments as well particularly in the crisis area which is again as we said an area that's quite needed and building the telemedicine infrastructure for services for those with high levels of need and a final note around the passes is just that you know I mentioned the seven hundred new slots for individuals to go on the DD waiver those slots are actually paid for through the premium tax on the passes and so now that we've got our first year of those premium taxes in we've been able to move to actually put this law into place so that's great. And then you know that's just normal business and that's enough in any any year but I have to mention that this last year of course we all had to deal with the pandemic. And I must repeat again how much I appreciate the way you've worked hand in hand with us. You've helped us identify problems and helped us move really quickly to take action when it was needed I think you have I know you have seen that we in the amended dozens of temporary changes to rules disaster waivers disaster response to help clients during this time in Medicaid snap T. child care The services through telemedicine was probably one of the fastest ships in this state we've learned a lot from that and one of things we have learned and I think we've heard this from a lot of you is that we like it and we see where it has been of a great help I'm a switch it to a different my excessive and put that on the feed. Now you can get real close to it because we have people online just pull it up to you okay that can you hear me better now okay just pull it pull the whole thing up to you from the base of from the base okay great so telemedicine has been a a real learning experience I think for us and for the providers in this state but it has gone well and one of the things that we will do this coming year is we will be bringing rules to make permanent of the use of telemedicine in many of our areas we we know it has been effective and we want to keep using that. We've had quite a few operational system changes we've had to make very quickly I have to also commend for just a second a few of the contractors FMCG D. I. T. Magellan Optum and chichi delight I hate to mention because there are so many others but everyone had to stop and make system changes to make things work. And then finally I'll note that we have we continue to make adjustments so as you see problems emerging during the remainder of the pandemic and areas we need to address please continue to bring them to us we made some changes just last week and I've already seen some differences one was to suspend there is a rule for that you can only have someone admitted into an acute crisis unit for ninety six hours is brought to our attention that in this period placements are hard it is hard to find some place for someone to go after ninety six hours and during this pandemic so we suspended that rule and already on Friday we we did that I think on Wednesday and Thursday and on Friday we had a crisis situation where someone was in a see you they were a purpose it was a C. issue that was the acute crisis unit this case and pay. Have been independently assessed and found to be at the highest here but it was going to take seven more days to find for them to transition into the past and into a placement because the rule was suspended they are allowed to stay and we don't have to take someone who has been in a mental health crisis and put them back on the streets in the middle of a pandemic so that is another rule we will be bringing forward to change permanently to allow us to be able to extend someone when it's medically necessary in an acute crisis unit I'm sorry I just want to highlight that because it is incredibly important and the the work around trying to utilize our rule act rule critical care access hospitals for the infrastructure and for those that for an acute crisis unit is going to be game changing for the state of Arkansas expressly for those that are dealing with mental health and your county jails in your county sheriff's in your county judges are gonna thank you so much for being able to find a place for so many of those people that should not be in jail but really that need help because there's just no place for them to go your emergency rooms are also going to be thankful to you because that's another place where they tend to to come and build up so again that's just incredibly important and then again waving or suspending not rule and then changing that time threshold I think it's just critical just wanted to point that out because it's going to be appreciated again huge game changing for the state of Arkansas our hope is to get crisis services around the state and then to be able to also let people stay in those services until they can go into the right placement so as long as it's medically necessary services I really appreciate that then finally with cover there has also been a flow of a great deal of Kerr's money families first money all the. Different programs so again same thing we had we worked with you around moving those funds out in many cases we needed additional appropriation also there were the special initiatives that came to the cares steering committee for those programs and those have been thank you same thing And number if you worked very closely with us to design some of those and to move on several of those. And one of the big ones have been the ones around the hospitals and nursing homes and other providers I will say it has been some of the work particularly around the veterans and around the community outreach grants that has which is where we really see individual lives being touch and so I do wanna thank you so much for all the support and encouragement and working hours and number if you've put in with us on those programs. That line it has but I promised I wouldn't go on and on it it's hard when you look back at twenty twenty not to go on and on because so much got done in twelve months. But I do appreciate the opportunity to come here today just to say thank you There are a lot of places in the country where People do not work together like they do in Arkansas and I think this year in this in this time of an emergency it has been so interesting to me and so rewarding to be part of a. The government here where everyone comes together and does what's needed for Kansans so I thank you very much. And our team will be here to present the rules for today and look forward to your they let forty year. Questions and reviews but if I don't see any of you before the end of the year I wish you the very fairy Marius Christmas and look forward to a. Much happier twenty twenty one for all of us. Well surgery left the I just wanna thank you for personally coming and being here and providing us that update and kind of look back on twenty twenty and all the work that's been done and DHS you know the other thing that I would also like to express my appreciation to you know when the when the pandemic started we were on conference calls weekly bi weekly and a lot of people did a lot of work and and I want to just name the Arkansas hospital association the nursing home Arkansas health care association Arkansas pharmacy association the nursing association the nursing board the medical society in the medical board and the ambulance association I'm asking Kelly all that and that's probably just a few but there were so many of those associations that came together that I met with conference calls weekly and we means just a magazine all of the work that's been going on you know you my math and hung call all the time children's and there's just so many people out there that really jumped in to help make sure that our Kansans were taken care of number one and so just so many people that are you know that we need to thank that works so cohesively with DHS and and I just really want to thank your team you ought to tremendous tremendous work and and I just can't be more grateful to you and spend often working with you other any questions for Secretary fluffy. We did a great job thank you thank you. And with that we will move to the rules for DHS item H. mark white and Janet man. Thank you bill state your name for the record and then you may proceed. Thank measure more quite to a chief legislative affairs at DHS. A Janet manned director of Medical Services DHS. So this rule well before you today this is a repeal of part of our Medicaid provider manual if you're familiar with all the proper Medicaid provider manuals we have a a unique manual for each provider stop that we operate so there's several dozen of them but within those manuals there are five sections for the sections are the same inconsistent for mangled to mangle one of those is this section five and also action five is is is a list of Medicaid forms and web links to resources and because of that because it's not substantive it's just form names and links we were proposing to basically on promulgate that so that you all don't have to take the time to approve a promulgation every time the check the name of a form changes or a web address changes ASA is that's what proposals to repeal this Census non substantive and we thanks release not Nesser helpful for to be part of the promulgated rules I will that will be happy to answer any questions. Thank you are there any questions or anything and nine that item centrifuge next item. And for the next item I have a motion stone is director the Division of the whole disability services join me. Okay I feel that I am for the record you may proceed thank you Melissa sound division director for developmental disability services. Harpley deputy director for DDS. It out so just quickly direction on the stone to give more detailed introduction I want this is we're proposing a special replacement of the manual for our early intervention day treatment Medicaid providers I love that on the stone to walk through the details. Thank you just give some background them in case people have forgotten so there used to be two programs and child health management services which was CH in mass and then a day treatment program and couple years ago we sense that is both of those programs and stood up to successor programs one for children and one for adults so early intervention day treatment is for children that have developmental disabilities and delays and they take ages birth to five or six depending on if you get a kindergarten waiver and then they also allowed to serve older children and during the summertime when school is out when and people want to continue to receive services at the centers you receive an occupational therapy speech therapy physical therapy and nursing service if needed and may also receive a core service call day habilitation which is a service that works on the goals that you learn during therapy services so it runs the and the date is similar to a day care setting and we arm the part number we have some transportation that we set up special for them that goes back and forth we've been working for quite some time now to put a new certification manual in place for these particular programs so what we did accept these new programs two years ago or maybe three years ago at this point we put a place holder in some standards that we already had and it just it just hasn't been working so it and certain things weren't and jiving so we went in and complete we're St setting the standards we had in place that were both for kids and adults and we set new standards one for children and run for adults and then you'll see a lot of references. In this particular standards because all of these clinics are also licensed by day care licensing because they serve children so a lot of the references and refer back to daycare and then I'm not sure if this is on them review for right now but we also went in and made some changes to the companion early intervention day treatment Medicaid manual as well but those were extremely minor cleanup changes and I am also very happy to know that the providers worked with us for years on this and has far as anonymous you guys tell me differently differently today people are very happy with this thing as we put in place and and with that I can take any questions. Are there any questions from members of the committee. All right within ninety. The Addams interviewed next item. Thank measure the next item is very similar and has missed on referenced we have the rule book on the children's side but also the adult side and so this is essentially the same approach on for adult developmental day treatment which is that adults are the shoes referencing represented happy to answer any questions. Madam chair if I may say one statement on this so we have had some concerns from providers in particular for adult developmental day treatment on the transfer tax for transportation section of the standards this is a new this is a new updated section like I said these are brand new standards the only concern is the requiring an alarm system be put in that transportation vans for safety purposes and the providers are okay with the lan system but they're requesting a ninety day implementation window for that system which we are we are and think is appropriate since we're at the end of the year when we're coming towards out for you before you guys and it would start January one so we are going to be sending out a memo waiting that requirement until April the first and that's been voice to the providers and they're happy with the ninety day window. Okay. Senator hammer you're recognized for a question ma'am sure of down the listener month thank you okay. Right are there any questions on item J.. All right CNN that item stands review. For skipping K. you for that one okay. L.. This rule was some therapy changes we've made right occupational physical and speech language therapy services and again all deferred business down to provide the details on this one. Thank you mark so I'm for the therapy changes it's M. it looks like an enormous amount of pages but a lot of it is just places we had to go in because therapy is referenced all throughout the Medicaid state plan so this is put these particular changes pertain to occupational therapy evaluations and physical therapy evaluations and the feds have sent down a different type of coding and system for us to utilize I've been to this point your evaluations were and paid based on the time that it took you to complete the evaluation they're switching over to what they're calling complexity codes so it's not a time wanted code it's based on the complexity of the evaluation that you're conducting survey and they're doing a low moderate and high complexity initially we had put out some proposed rates for the change in these complexity codes in metes board cross BlueShield rates as our as our guide we spent a lot of time with the therapy association representatives and we spent about five weeks every Friday with them and I'm happy to announce we have come up with the rate but we are and happy with that we feel like and reimburse them in the same manner as what and they were reimbursed for the time that it up and that was always and then we went trying to and to take money away from them on this transition we were just trying to transition from a unit rate to the complexity rate and actually talk to them again on Friday and and committed to them that I would let you guys know that this really is a place holder in terms of the rates and as you know the governor's executive order we are meticulously going through and doing right reviews on all the Medicaid provider. S. and L. T. P. T. speech the evaluations and that they'll be services themselves our first and last to be reviewed at the first of the year so would be working diligently with them to ensure that the rate that we're putting right now are still appropriate. All right thank you are there any questions. Right stand nine that item stands review next item. Service department chairs making sure correct on the agenda The next item is a new certification may know for a new provider top of that we recommended create ads provider top is known as the community. A support systems provider or CSS pee hi this is a new provider top that we're developing to help provide services both in for developing disabled population but also among a behavioral health needs populations and with that I will. It without alternate over two I missed on to walk through some details on this new product. Thank you if I may madam chair. The analysis done DDS so and so I'm not alone on this rule them of one of the table because people that said this was a joint effort between and developmental disability services Division of Medical Services and then aging and services and behavioral health care. On the other line and then in addition. The church again deputy director division of aging adult barrel Health Services thank you. The reason that there's so many different divisions across the H. as involved with this new provider type and and I'm gonna try to try to say this is simple as I can because I get down in the weeds and then resented Ladyman similar day I needed to and I need to be more plain with this explanation. He's familiar with this world and if he if I got too deep with and then I got Waititi said. And this provider type will be able to serve tier two and tier three behavioral health and IDT clients so these are people that have been assessed and popped him on the independence Asman and they tear that higher level and have been attributed to a higher level of care like the pass. So. When we first launched the pass the goal was to not serve people based on a diagnosis which is a huge shaft for both behavioral health and ID D. you could only get certain services in Medicaid if that was your primary diagnosis so back then if someone had ADD and I needed to mental health therapy it was very difficult for them because mental health professionals were not able to bill because the primary diagnosis was intellectual disability and vice versa so if your primary diagnoses of schizophrenia but you also have intellectual disability they were in the same situation where that ID de providers were not able to provide service because it was not the primary diagnosis that was one of the major things we changed when we launched the pass an independent assessment said independence is not actually look at your diagnosis it's it's a functional assessment and once you get into the pass regardless of what door you enter the pass and services in the past available to you and it doesn't mean you get all services but if it's on a person centered service plan and you need that service then the services under the past umbrella are supposed to be available. It's not working quite that well all right so what we've learned over the past probably year and a half is we put all the services in but that doesn't necessarily mean that they're available for all and so we came up with a solution of trying to make a change but expanding the services that a particular provider if they became this Britney provider type could perform so what this does is it takes all of the services that are done in people's homes by high school grad G. E. D. para professional level when applicable commissions here we're talking about people that you hire and train without any clinical experience we're taking this group of people that provide services like supported living and there's a service on the other side club your support and we're putting it under this the provider type so we're since we were mixing some of the services that were historically for the behavioral health population and those historically for the GDP population and we're putting them under one provider type and that's what we call that the system support it's like the Super support system if you meet the if you meet the requirements of accreditation training and you know how your made up and you can provide the services and show that to us is certification then we'll expand your service package then one is strictly been able to do it was a few reasons we did this one was like I said we saw huge gaps in certain populations I have a really hard time getting IDT clients mental health therapy still it's just hard and then on the other side of the house at the same thing if you in no need any kind of had to have a house service if you have any type of autism anything like that it's very very difficult you want to expand on that. Reference such a long time there is such a division and we really trying to referral health providers very very well to kinda look at diagnosis and they had to really determine that there is a behavioral health diagnoses in order to treat beneficiaries who were dually diagnosed or if if you had someone with ID or DD you had a barrel health disorder they were hesitant to to treat them so what we've really done is try to take down those barriers to say we really want all beneficiaries to get the treatment that they need. And before I take questions just a few things I think that are really important that this the new provider type in my not taking down or cents adding any other type so is that what the provider type that IDT class historically is is that the E. S. waiver provider they're the ones that they hire like Easter seals our pathfinders of friendship that go into their home and provide workers to come in people's houses and take care of them for ADD on the house side they want the provider type historically used is outpatient behavioral health will not send setting C. S. waiver or outpatient behavioral health what we're trying to do with this is give people a real choice if you want to expand a book of business and take on the same provider type and you meet the certification standards we want to allow you to do it and we won't allow you to do array of services that are have on both sides of the house to all past members when appropriate and we do feel like this will fill some gaps we also feel like I think I've talked about this before when we gave those tobacco slacks and added CS waiver it took us three years to fill the house lights and we just got an approval from you guys infancy in mass on them to starting on December first we started you know what a filling apps M. six hundred more which was that thankful for but we do not want to take three years and we know workforce this section barrier here I mean I'm I see that the human development centers every day so we don't think we're going to get more people in the workforce so it's also a way we've been talking to providers about expanding the workforce that we have meaning if historical behavioral health providers would like to get in this space then they can help people ADD side of the house and serve them with ADD historic services so that I don't know if that was. The symbol is amended to be or but I'm happy to answer any questions. Okay thank you so total how many slots have we created we've added how many people you said we started December one six hundred Morris the total for the year for twenty twenty because we've added the others from the. I'll be honest on Senator I'll go back and look at it between forty seven hundred and forty seven fifty I believe. That we've added this year no ma'am that we serve that we prior to the slides and December first. Right the earlier in the year I think it was seven hundred or something plus the this now six hundred nine oh I'm sorry it's seven hundred four hundred days or DCFS lights so and it's the same it's the same lines we just brought this to you earlier in the year and it got it the senators to five hundred we added a couple years ago using tobacco tobacco settlement funds and those were the two additions right okay and so okay. I understand this from the standpoint of we've added more people that need services we don't have the workforce to provide the services so we're trying to create a secondary. At work force that can really fill the gap and be more tailored to what the needs are. Because we don't want somebody who's highly skills going in and doing something that somebody else maybe that needs to be skilled but not to that degree of skill level so and this is optional people can choose to. And become this provider or not correct yes not replacing anything. Now replacing outpatient services now but I would like to be very transparent about a lot of conversations with the therapeutic community providers and although you know we we do believe this is optional because we're not send setting any other provider type I would I would like to fully inform everyone that there is a therapeutic communities provider type out there besides this however we made a lot of suspension steering code that and so that that will really good things today I'm we were kind of over regulating them before in some respects and so I would like to say that they do not feel that this is a choice for them and so I would hate to get up here and and say that they feel like they they they must do this in a provider tight because it is the only provider type right now that we're running that has V. and some of the code suspensions incorporated into it and so I wouldn't want to S. to say you know everybody can make a choice they can there is an old man on place but if they would like to do and this type that has some of the suspensions and that and this would be the route to go. It is and we worked very very closely with them in the development of this manual and got a lot of feedback from our community and our therapeutic communities providers that are currently providing that service. Thank you enough I've heard from both that on both sides the members I have a lot of people in the queue for questions I do have two individuals that are here to speak on the on this rule and which I will allow and so you just need to tell me what your question is for and we'll go down the line for percent of brown. Yes just pressure yellow button then don't touch anything else. Not the green button. All right can you hear me yes okay. I believe this question is for The. Purpose of stone. A there's been a lot of concerns raised about this. A raised about this new rule one of them has to do with the behavioral health and it's my understanding that the requirements or certifications for this new CSS P. are not as stringent as the requirements for behavioral health and so one of the concerns was who has requested this and the other is what is to prevent someone who has this new certification from just serving behavioral health patients. Thank you and yes I am and those questions are name I've I've talked to the providers about both of those issues so who is behind this so I would say Tristan and nine policy center behind them in terms of once the past lines like I mentioned I think we were naive in thinking if we put the services there then people would magically get them and and it just wasn't the case so trying to bridge that gap so they are having to go to people I have to go between two different worlds to get their service and trying to merge that world is what we were trying to do on the past because a lot of clients have both names and a lot of them have significant needs and both so and as far as why can't people what they signed up for this just go do B. H. R. D. behavioral health survey different service so like I said these are home and community based services by a non clinicians that appear professionals and actually pulled some of the services just I know I talk about the TV services all the time the are really probably familiar with me talking about supported living and respite and things of that nature but we have very similar services on the behavioral health side of the house under the past model and so they are when you read them like this one peer support. So it's when an adult is trained in camps and to provide hope education healing advocacy in a meeting federal meaningful role model in the life of someone else. So these are these are home and community based services they are done in people's apartments people's condos people's living rooms and they are done in a non political way and they are not replacing counseling and they're not replacing a key or subacute care no not at they're not replacing they're not even in here right that this is completely not appropriate for that so this is very clear exactly what services you can provide and it doesn't hinder you from getting other behavioral health services that you could today just like it doesn't hinder ID D. clients to go into an intermediate care facility that's a totally different provider type so and these past clients are seeing a wide array of different types of providers and this does not stop you from that continue on that we have in place the only thing it does in my opinion is it set if you need your support anyone supported living you can have one provider if you choose and maybe certified to the both of those things to you because it's so similar in nature and the people that do it are the same level of credentialing and it's the same type of training. And I want to thank you for your efforts to try to resolve a problem I mean not just ask my question but I do appreciate you're trying to resolve it so so you're saying that the that there's no conflict there there's no you get this dual certification but you one just necessarily serve just the behavioral health community. The purpose of it is really we want you to be certified. To serve both ADD and behavioral health they're functional needs and a lot of ways can be extremely similar extremely similar in with the right amount of training and the type of services that we're talking about that are done in someone's home the non clinical look very much alike and we think we can expand the work force but by training these people in both ID ADD and behavioral health and making sure that it's safe to do so and and and we do think that this could work so that if it didn't we wouldn't be up here fighting so hard for that so and that is one reason why we didn't make it mandatory. Because if a provider chooses not to do it they don't have to do one more thing thanks stay right where they are. Thank you I'll let somebody else ask a question thank you. Thank you represented brown senator hammer you're recognized. Thank members you're to the point you just made us not only about expanding the workforce but it's about usually work for she have more efficiently because one individual could get multiple services from one provider groups if they decide to go through the certification process is that fair. Yes Sir okay so one issue that's been pointed out to me that there was some question about I'd like some clarification is that there's a transportation component maybe that the providers were totally happy with on this could you speak to that and give us your position please a second so it is similar so there's two things I want to start with the first time by may so similar to what I what I stated when we were talking about adult developmental day treatment what we're trying to do on transportation and all of these manuals is and make the standards consistent so we want all the vans that transport Medicaid clients to have alarms right it doesn't make sense to ask the only net they have would have alarms we would like vans that the providers and operate to have alarms and at the same concept of what we want the net brokers we're trying to prevent death and injury serious injury so but I do understand just like with the double developmental day treatment the providers need more time to put those alarms and so we're going to put out the same suspension of ninety days for those and for the C. S. S. P. providers as well. Second fellow there was another issue brought up with transportation and but I spoke to one of the providers about and then followed up with an email and never never received M. a response to it or if I did I miss that I checked before I walked in because there was some concern from from her that it was more stringent or didn't jive with what she was already doing as a subcontractor for nat but I'll tell you we pulled and we pull does not contracts and it's the exact same language now being inserted in every single Medicaid manual and we made very sure that it didn't go above or below the requirements that we put on the net brokers so I I will say at there might still be something out there out standing with her but I couldn't get what exactly it was. Okay and in the simplest terms before this option is available or before came available at which all work done so you had populations that either would serve over here populations that we serve over here in your creative pathway for that if there's a provider group out there entity that wants to expand they're gonna be able to do both under one certification process but that doesn't preclude those that want to remain in their lane sort of say from doing it but they're gonna operate under the they're operate under the old rules will the new rules in the manual apply to them any differently or the you've actually got three. Oversight manuals one for this population more for this population and now this one for the new provider group is that a fair assessment yes Sir so in the certification process for the new population or the new provider group that's being created what are the assurances that the certification is stringent enough but also liberal enough because you just admitted that we're over regulating the industry so what to start with. The so in the certification process what it would talk about it a second. So there is there has been some concerns boys from outpatient behavioral health because right now I'm. For their for their staff that are non clinical they're called Q. B. H. P.'s qualified behave. About a qualified behavioral health practitioner thank you and they they're not clinicians either and they are and it's a mix of high school G. E. D. in some have college degrees and that they are para professionals nonclinical workers that are they're trained. Their training is twenty hours a year. All right on the on the ID decide under the CS waiver those workers the same type of para professional although they were trained they're trained by the later providers we never win and and dictated M. and hourly training regime right so this is a middle ground and this is twelve hours this is and you look at it we put down the modules that we thought it best match those at the house so you'll see mandatory modules are mandatory topics in there for both behavioral health and I. D. D. And again these these are on the C. as a result we've been doing this a long time and this is a new concept for the behavioral health side of the house but at the same level of person and now we are Commend you because I have been a little bit involved with this going forward and it's you know it's like any other product new it's not gonna be perfect certainly a step in the right direction I do want to commend you all because I know you've worked with providers spend a lot of hours with them and the I did want to commend you for the effort that you put in and also all the providers have been pouring time into this thank you thank you major campaign second that's comments thank you represented Gonzalez. Thank merger so how many people are we talking about serving in this population. Servite now the price has an M. little over forty five thousand and so I mean technically if they became a provider type and and it was appropriate and in that person because plans of how many people do you see falling through the gap that you're talking about that you're trying to that you created this for. What a I mean we have some that are truly dually diagnosed right that if you got an independent assessment for B. H. anti D. they tear three on both and we estimate we have about a thousand of those people who we have we're we're working on a little girl today that she wouldn't tear at three on either one and she's got autism and he's got some pretty significant problems from reactive attachment disorder and we have had a heck of a time. I'm trying to get someone to serve her because you know it's still that same thing where if you're a historic behavioral health they say we don't have the training and the date and then on the TV side it's like we have a qualified because we don't you know we don't have enough history and behavioral health so I mean what we're really trying to do with this is can I start the overpass right and like Senator was and this is gonna take this is gonna take flushing out all right I mean we're just trying to get in place so that we. We are just sitting here watching it happen over and over like we've been doing and and then we'll work on it will keep working on it so you said you don't expect new new providers to come in and fill this gap you expect the ones are out there to get recertified in this is there anything to to prevent that from to prevent someone from being duly certified in the two organizations that are out there now and I appreciate you rolling back regulations you know for code or whatever in trying to do that that here but would not be simpler instead of creating a new provider time so. Let's eliminate those regulations on both of those things and then let them become duly certified instead of creating a new provider type. I'll tell you not to get too deep in this but the way the passes are set up with utilization management so similar to insurance. It is so driven service approval is so driven by the provider in terms of the other ones turning in the treatment plans they're the ones getting their request approved or denied. What we keep saying over and over is if you have a primary D. eighty eight you don't have a behavioral health provider advocating for you turning and treatment plans that even know you're alive. And the same thing on the other side so give a primary B. H. but you have some DD needs their primaries B. H. they're not turning any requests for DD services and meet so it is just that's what we're trying to fix it having one brought provider type that has a clear understanding of both populations they can't do all of it but they could do some of it and then then we think that once we get B. H. providers in this arena anti D. that they'll start to learn more who does what and we'll start sending those people to the right location because right now we're all just staying in our boxes that's what we're doing we're not so is that a good way of thinking on a Lambert I'm not I think it's a good way of saying it and you know Melissa is talking about the beneficiary that she has that really they need those B. H. services but people are kind of staying in their boxes on the barrel outside we have exactly the same thing I spent probably over an hour last week we have a B. H. beneficiary that very much need supported living we were looking through the definitions that we have access to under our nineteen fifteen I waiver which is on which is on the B. H. side we don't have a comparable service that was really going to fit so once we move forward with this certification then we can have a provider that could provide the the adult life skills or the peer support on the on the sea on the nineteen fifteen I waiver side but then also we could pull in supported living which is the C. E. S. waiver service for this beneficiary to keep them in the community and out of that more restrictive setting the Representative I add one additional point again going the question of. Amending the current rules as per screen this new certification Arafat was that Bakri Mister certification this country is less destructive for riders because if you have a provider that they're comfortable with what they're doing now thank you keep doing that and we're not we're not messing with their operations and not forcing them into change the amount may not be comfortable with and so we with other top creators options for providers that would be better for everyone overall. Yeah I agree but it just seems like an option would be to be duly certified and both the roll back regulations and then encourage them to become duly certified not not necessarily require it Senate what about the reimbursement rates and this is our difference and overall reimbursement rates so there's nothing change in there again I just don't understand to me it just doesn't make sense to create another provider type one when you have the ones out there who who you're you're telling me you're expecting the same people to serve these people the same providers to serve the same people right I would like to a circuit breakers back to those those those difference between those two provider Tosh because yes but you could have and I understand the difference and to provider times but you're telling me that you want those to provider types to come together and and apply for this new certification that you're not expecting new providers to come into the state that are already doing this. I want my being at but that's not what it was designed for but at the end of pro abortion on that and I'm right yes yeah I mean the problem lies Representative that for for this whole time that we've had both of these provider type in the past and all the services available I mean CS where providers could have gone out and gotten an OB H. certification and vice versa and sounded like some of the providers have both but it's just not enough and we keep hearing this And this feedback over and over and I think it's because of what transfer thing which was they B. H. with subclinical in nature and that we're trying to get to this new wave of home and community based non clinical that means you would be surprised how many times we call and try to get past member into a behavioral health clinic and they say we can't we can't bill for them they've got a diagnosis of DD so we got rid of that. Going to move on represent Gonzales if you want to get back in the queue that fine M. Representative Womack. I'm sorry Watson and this can I just wanted to kind of follow up before I go to him if you don't mind just kind of in layman's term if you don't mind just explaining what's the problem we currently have and then the solution and if you if you don't mind explaining that just very layman's terms. I'll I'll give it a good time the we have this is Mike right up to you because we can't hear you and I ride on it okay there you go with a system that was very very solid the system with behavioral health Melissa said we may have all health providers we had B. H. providers and the two didn't meet and the metal so often times beneficiaries given that to one side or the other there is no crossing over the line so. What we did and when we went out and talked about the us and we went out and said Hey we're so excited about the herbal health transformation we're so excited because we know that what are beneficiaries really need our home and community based services B. eight had a very treatment medical model focus almost all of the services were clinical services for medical model services provided by professionals there was a single service called intervention that was provided by behavioral health care professionals that service had to be it had to be at the direction of a clinician and it was connected to that treatment plan and with that clinician the issue with that is that many of our beneficiaries who are the most vulnerable who are the most chronically mentally ill really needed home and community based services and so when we did this transformation the nineteen fifteen our waiver allows for home and community based services they're not based on medical necessity they're based on functional deficits so what we're trying to do is help those beneficiaries to remain in their homes by getting assistance with staying in their house someone who's helping them learn how to take care of their housing and clean our house to so that they stay there because we know our B. H. clients get evicted a lot from their houses because they don't do that so that I let me just say that I'm just want to repeat what you said the nineteen fifteen waiver from CMS allows for this type of provider to come in based on functional deficits versus medical necessity those are two very different terms and distinctions and so we don't we don't necessarily need somebody who's highly skilled or highly qualified doing. Home and community based services like teaching them how to clean their house because they were videos actually that were put online showing you know people might end on coffee tables are helping those and get them food or go from the kitchen to the living room because I had difficult walking things like that and so you're trying to fill the gap of people that need to be of people that need to go into people's homes to help with those types of functions which are not considered medical necessity and that's really important when you look at the distinction between the two and how you bill out for the services and what we should be paying for right I don't want to pay a doctor to go in and clean the kitchen I don't want to pay a nurse to go in and clean the kitchen rights correct okay so I think what we're talking about two is have to be specific because. We've got to make sure that we're billing appropriately but that we have the right people going in and helping individuals and meeting them where they're at particularly with they have functional deficits correct correct we want to keep them in home and community based settings who want to keep them out of the residential type settings we want people need to be where they are at home with family members are in their own homes versus in a residential or hired the higher level of care and so we knew under the old system that though that was what was really needed everything. Moved around and under medical necessity and under that clinical program so that's the nineteen fifteen I waiver which is kind of the sister waiver to Melissa's the E. S. waiver and I'm not even going to begin to say that I can talk about the C. S. waiver so we had the silos and we will what we wanted today are intended to do is break down the silos so that all these beneficiaries had access to the services and certainly any of these providers could have crossed over and gotten dual certifications but being duly certified as difficult you have to meet all the requirements of the federal health agencies and all the requirements of the C. E. S. waiver provider so this is an opportunity to kind of bring the two together so that agencies can have a single certification and provide all the services under the C. E. S. waiver home and community based services as well as all the services under the nineteen fifteen I waiver Hammond Committee by services to keep beneficiaries in their homes and that probably wasn't simplistic enough but but ultimately that's the goal no I I I understand that we're talking about providers mean organizations are providers so they can hire these different buckets of people whether they choose to or not used to this up to them that's just a business decision that they make clearly residential folks are going to go now because they want to be more residential but I mean we also want people to stay in their homes and be able to be functioning in their homes so okay thank you Representative Watson you're recognized for a question I've got three more on the queue so thank you Sir thank you for the leverage to the ask a question since I am not on this committee just real quickly what I'm concerned about so is as far as all entities being able to stay in their own lines they will be guidance in the in the rules of spelling this out am I correct on that. No I'm happy meaning that the rules just like someone today when there's all these and provide tax like early intervention day treatment personal care they're all different provider taxes your choice to become an before you today I'm not send setting will not bring anything to sense that we're leaving everything in place alone that would be that would be the I guess the the the way you would tell that we were trying to but there's nothing actually in the rule itself in front of you that says. Nothing else is being taxed. Okay that's so. Okay that pretty much. Is what I'm what I'm the direction that I'm going to it a lot of the questions have been answered I appreciate it and this is pretty deep because it is a I guess the word for it is fairly new Appreciate thank you much thank measure thank you. Senator Wallace. After twelve o'clock. Ask for this was a particular provider group that asks for this. No Sir this is a cause of that are stacked developed based on looking at the needs both on the one hand recognize the need to that we need more capacity to help serve especially the developing disabled population we also need to pass in favor whole son so I recognize in that would also be recognizing that overlap that we talked about between the services is functional top services that are needed by both populations where there's a lot of similarities we were trying to leverage that influence providers who can build that capacity and serve both populations. One follow up manager please. Who's going to provide oversight over this new provider group. Seven four seven how you know we have a division and that specifically does that and Depp's glass and Division I've providers services and quality assurance and then all of these provider types must be accredited so in the accreditation agencies are rested there's only certain once built will accept and accreditation is a huge and oversight for these providers and and then of course I'm sure Chechen I will get all complaints and so we'll be monitoring them as well. The and and we'll course will occur from the safety side and sure that those products are qualified as numbers does it also the accreditation the following off Medicaid inspector general looks all these provider tops from a fraud and abuse language thank you thank you madam chair yes and to follow up on Senator Wallace's line of questioning they all will have to it'll be required to do background checks consistent with what we have because they're gonna be going into people's homes that's going to be crucial and very very important yes yes represent of gray you're recognized thank you madam chair. Some trying I'm trying to follow this best I can I'm on page forty seven I was looking through the comments One of the comments was related to medical staffing no medical directors required to oversee ham is currently the case with companies license as B. H. agencies and the response was this is not a medical model it's a home and community based model which I know you've been saying that repeatedly are the current B. H. NDD medical models or community based. Senate TV is separately at home and community based model and then when we put when we set up at nineteen fifteen I that answers was discussing under the pass it also is a home can be based model and it's just that for so many years it would it was a medical model and so we're still seeing that transition Representative that we're trying to get to the point where I think everybody comes to their comfortability around it's a we've implemented different model and so the DD is home is community based the behavioral health is a medical model. Well I think it's cemex just like the duties and Max so like you know the if you go if you have a license to go residential or to go to a partial partial hospitalization that's not this I'm not we're not doing things like that this still medical we have these triangles we can share with you so it's like highest and you know restriction so it hospitalization you know you're in a queue you're in a residential and then you got down to a lower intensity and these are the the bottom intensity these are ones where everybody's rocking along in their houses and we're bringing in these services and for the past program to keep you there from going up the triangle if that makes sense so is there a difference in tears as what the behavioral health model could C. as in tier one two three versus what this new waiver we ought to see if there's no medical P. Senate at all I guess I'm just trying to figure out why we have a medical piece in the behavioral health model but there's no medical piece and you say that it's not a medical model when you can't say you're taking these two and put them into one if you're not taking all of the elements for each and putting them into it and and that we are taking all of the elements from both and putting them into one we're taking all of the home and community based services and putting it into one of this is so technically a third provider tap it's not that you've got T. one umbrella there is a third completely different so what I really want to see if I'm just looking at this is I want to see about Hey you're all health with a medical model also get this and have to licenses one making the the medical model and one that can do the overall community based services model what makes the best case scenario right because what we want is for people to be able to move people up and down there continuum. As needed right I mean that would be ideal for by thank you that makes a little more sense now thank you. Thank you yes if you'll read page forty seven of I think that is Mr Mr. Lanter now it's going to be here to speak and we can ask more questions about that represent of gray when he gets up to speak. Senator hammer and then I have one more with representing brown and then we'll go to the two individuals that are here to speak. Thank members thank members here and used so submitted go maybe wondered about this so in this new provider manual if there's a component within that new provider manual where the rules and rags were either relaxed or changed in order to cope accommodate the creation of this new medical model was that equally applied to the to existing provider models so that if we made accommodations in the new one he carried over to the other provider manuals. So. No this is a brand new provider tax so nothing has been necessary relaxed strength and write this is completely new from the ground up I think some of the things that you are hearing is that it's less than others that we have now and that this like churches thing is very different this is a provider type that will be able to serve to do a very good distinct group of how many based services so everything we wrote was to make sure the safety of that service package for this provider type. Senator if I can get example Mr mentioned earlier the training requirements around some of the workers and so in the existing manuals one has a higher number of hours that specifically required the other has a much lower more vague requirement so this new one what we're came to was more middle ground so this is not this is being relaxed across the board if we were to go back and make changes in those other two manuals there would be something that the river at least there's other things that the more restrictive and that goes back to that point of not want to disrupt the operations of the existing providers but provide a third path that if if I want to just keep doing what they're doing thanks stay as they are now but for others they can take advantage of this new pass. Quick follow and share. Yes here's what I wanna make sure we see is that if there's a component that moves from either one of the existing private provider groups into the new manual okay that that standard is is not any higher than what is already there so that what we're basically doing is discouraging providers on either side of the new manual of make it harder for them why you've made it easier for the ones that might come to the new model and if there if there is a I'd like to see a comparison list I guess is what I'd like to ask for that if there's a service this provided in either one of the existing models and it has made it harder for them to remain in the current model but it would be easier for them to come over to the new model and provide that particular service I'd like to see a list what those are please. Hi thank you last question a person of brown. Thank you madam chair of. I know you're getting tired. Of any answered a lot of questions is there any reason why in the rule you can not explicitly state that this new provider tie. Is specifically designed to treat both the DD and the behavioral health groups that that is that combined. qualification the rule if the rule does state that there are lot priced services to both those populations I think for the issues that we have heard from a couple providers of wanting to restrict this the only those who are duly diagnose Tourette you might set the Toppin's of both our dual disability N. B. H. I think our difficulty is we have many individuals that they may not be at the top of both of those they still have needs on both sides so you have individuals who are they prepared at the highest level for developmental disability but like like everyone else know there are instances of mental illness among those who had filled with disabilities so we have these clients who they maybe their house need is on the TV side but they also have those behavioral health needs they need assistance with I guess that the thing it's. Puzzling to me is is is you're saying that understand the tear and white what the tear is impacting the dual service I mean if somebody's a higher tier in one category lower tier in another the other category. They're both getting they're getting both types of services so right. Help me understand what if I may so I think it's because when we say duly recognized it's kind of a turn at the time of our around our office in terms of you know a lot of my clients they'll say one ninety nine percent of clients with ID date is the fact people throw out have some sort of behavioral health we have some anxiety they might have been some issues that manifest that following the behavior health we don't call those clients to be diagnosed delay diagnosed in our world is you know profoundly intellectually disabled with schizophrenic that are mobile personality disorder we've got a better thousand. Of those people in under the pass but we have a lot of people like mark was saying that could have some intellectual disability and having fatty and could benefit from both sets of services. So that's why we're not restricting at work we're we're actively trying to stop restricting services to this population that's the whole goal of the pass it is the whole goal of this new provider type. Thank you thank you all right three nine number persons I'm gonna ask and Mr Joel mentor now the purpose of that correctly and Carol more to come up and you may speak on this and then DHS will be available for comments or questions after they speak. The address you today on on this provider type and the discussion about the rules adopting it. it is the sensations view that these rules due to things that absolutely have to happen and you heard de um dem well described by Mr stone first is that it resolves the over regulation of therapeutic communities and it also breaks down the silos between the two types of home and community based services both on the DD side and the behavioral health side. Because it does those two things it's only with great reluctance that we ask for them to not be adopted until further action is also taken and here's the reason why our concern is that the behavioral health agency certification rules. will still apply to behavioral health agencies who want to provide services to tier one clients. And so if a behavioral health agency chooses to get the new CISSP certification to serve tear to enter three clients through it they will still be subject to the same rules that are imposed upon them in the behavioral health agency certification manual what the CSS P. manual does is allow for other folks who are not subject to behavioral health agency amendments to also get CISSP certified for example independent licensed practitioners. So that an individual practitioner who sets up a practice and opens in office could get CISSP certified under this new manual and once they do they could have access to serving tier two and tier three clients while only meeting the requirements contained in the CSS P. manual and only meeting the requirements contained in their independent licensed practitioner manual and the differences between I LP and behavior health agency manuals are very substantial. For example behavioral health agencies have to have a medical director they have to have a medical records librarian they have to do quarterly quarter quarter quality reviews on each client's case in consultation with a psychiatrist they have to do training of their yup per professionals they have to do supervision of their parents professionals by licensed mental health therapist for example they have to do and I monthly observation of service delivery. Of the para professional in addition to a near weekly US supervision of a paper review none of those supervision requirements are contained in this manual our concern therefore is that the C. S. S. P. manual opens up the possibility that you would have a new provider type that doesn't have the same types of restrictions that apply on paper health agencies. And it would be a fast lane to mediocrity unless those two are harmonized and that's what we think should happen we think the application of this manual should at least be limited to do the only entity behavioral health Kumar but. Until it can be done where the behavioral health agencies and the intent licensed practitioner manuals can be harmonized because when you think about it they will be serving essentially the same client the tier ones with the council level behavioral health services. There's no reason why the two different provider types who serve the exact same type of client with exactly the same type of service should be governed by standards that artist is protest those. And so for that reason we would ask that at least the application be limited to DD behavioral health comorbid RDD only until the paper health agency manuals can be reconciled with the internet licensed practitioner and. Thank you madam chair for allowing us to come and speak today there are several and I'm approaching this from a clinical standpoint I've been a therapist since nineteen eighty four I've done nine years with working with the T. S. NH T. say's I'm behavioral health as well as a license at. Substance abuse counselor so in reviewing these I look at these things from that particular standpoint as some of the questions that have been asked for very specific to the areas that we looked at today we uh the current continuum of care is a huge concern when behavioral health services are being provided by a pair professional under B. H. there is at as Joe mentioned a very specific level of supervision that is required. There is very specific training that is required under B. H. under the CSS pee which we are not saying this is one hundred percent. Not a good thing that is not what we're here to say we're here to say that maybe we can slow this down and make some more modifications as needed or if needed but they're there is absolutely no behavioral health training and this is a model that is supposed to provide both those levels of services ID and behavioral health there is no behavioral health training requirement for these pair professionals underneath the under this program there is some excellent I'd ID training but no behavioral health there are no quarterly reviews there other behavior management program is done without clinical oversight in developing a behavior management plan these can be. High school. Some college level and not a professional level involved in that behavior management programming a review of restraint procedures that there is no indication that there is clinical oversight in regards to that although that may. At the it should I'm sure it must be in there in some form or fashion. The quality of care For the behavioral health clients outside the therapeutic communities popular community population really there is it does not exist one of the questions that was asked previously during the public. question what what is it called barbican. The the not no not the when they put him out for questions or comments thank the public comment thank you I'm sorry and we're next to me yes one of the questions that was asked initially was does this. Help with clients that fall under the autism spectrum disorder and the response was that falls under the autism It does not fall under this. Okay so that leaves that very native that population out of multiple provider ties with income growth expectations for training supervision service provision the question that Senator hammer asked regarding the differences and requirements for the exact same services some of the exact same services that fall under mental health fall under this plan as well under this certification or licensure. But the there is a very specific written definition of that service and the expectations of what it provides to the clients that we serve. And. For that exact same service under this licensure sliced certification. The supervision the training those things are not there so there is a huge difference in that area for some services the heck There was something else that I want to mention and now it's gone because I've just talked on so I appreciate the time I'm available for any questions any concerns Thank you I appreciate that and I I I do hear you eight I I guess you know trying to understand a balance here we want to we want we have a problem finding people that will go into homes and do X. Y. and Z. E. X. Y. NZ. you may be over qualified to perform explains the the providers we have are over qualified to perform Excellency. But. Nobody is there to do it so we're trying to create something new to go in and help these individuals so and I do hear you about not having a medical director and a medical plan and I understand that but. I am concerns that. You know we want to deregulate but then you're kind of asking for not enough regulation and so you know that the balance and. I'm not quite sure if you're cleaning somebody's kitchen is really going to be a requirement for behavioral health training requirements if I'm just going and to help them or teach them to clean the kitchen or to do their laundry or. Those kinds of things so for me I have a I have a question about that I do hear you the similarities and that this manual and and and you want them to be cohesive yes I'm not sure if I really do want them to be cohesive because I don't necessarily want to have to over train somebody we we need to hire people today to go in and help people to me I want there to be safety I want there to and and I'm sure I mean GHS can come back up and ask the certain questions about restraining treatments if there's teaching them you never strain meant techniques as different kinds of things but. You know I'm I'm supportive of moving this direction because I know that the need is huge and it's great and I think it would be wonderful if the organizations that are part of your association would step up and do this I'm I guess I'm not necessarily opposed to independence practitioners coming in and doing this type of service because we just don't have enough people right now working in this space anyway and so. You know I hear you but then I can also hear and I'm just being honest I'm hearing existing providers going no we don't want anybody knew coming in right because that's competition for us and so I'm just trying to understand the concerns in the balances and trying to you know understand and perhaps there needs to be some sort of clarification about what services were actually talking about if that's the case then the maybe we need to have that conversation but I'm a little I'm just a little concerned about kind of. One a nice to deregulate but then wanting us to regulate more that makes so if you can answer either one can answer that be fine it's not a matter of expe wanting more regulation it is more a matter of the quality of services to be. Provided to the clients if you have the exact same services that are allowed in B. H. and we and many providers may choose to. Also become licensed under CSS PT we still might have must maintain R. O. B. H. we you know we can't let that go and move to a new provider but it the exact same services are allowable in CSS P. as are all are allowable and provided under B. H. then the expectations of the staff providing those in the oversight should be equivalent okay I hear you now okay I hear you and so well as CHS for that clarification so if you'll bank notes back there Mr white's miss them thank you senator hammer you're recognized for a question thank you major maybe that goes to what I asked to the agency about a while ago and that is if there's an area that the new provider manual has made it easier or less restrictive say in your world B. H. was that in the manual that you are going to have to continue to operate under giving consideration to where it will be less restrictive on you. That's that is our concern Senator hammer whether or not an agency chooses to take an existing behavioral health agency chooses to go the CSS be route they will still have to have the baby oral health agency certification because that's what enables them to see the tier one clients who aren't included in this manual on the other hand if an infant licensed practitioner wanted to go the CSS B. route they also could get qualified under this manual but they wouldn't they would only be in the tier one client realm they would only be governed by the IOP manual and there's large disparities between what is required of them to see tier one clients and what is required of behavioral health agencies who will still have to have that B. H. a certification to see tier one client and it's that disparity hi to senator prince point it it does put me in a curiously novel situation to be in front of you in arguing for more regulation and I'm not necessarily arguing for that I'm arguing for the same regulation for the same service be a render to the same population and this produces a disparity in that regard thank you. Go ahead Senator him I'm sorry thank you thank you measure. So can you come up you know you hers asked DHS for less well go because why would you be arguing for more regulation why would you be sit at the table saying will give us what you given the middle manual. Instead are are my confusion I think what needs to happen in my view is that the behavioral health agency manual needs to be revised. Okay if they're not wanting a medical model. And if they're not going to impose a medical model in the independent living practitioner manual didn't mean it it's Davis the same service render the same population we are we are to be under the same manual so that there's a level playing field social to simple to think that we would just want to pass a rule out and say that what you find in this new manual would apply equally to be H. schen because you're you're only one side of the equation right at the table arguing I wonder where the other side of the equation is that they're not since the table arguing for the same thing that you're arguing for. I can only speak for the people I represent okay we'll wait away for DHS's comments manager thank you okay and just both of you are employed correct with certain organizations do you mind just stating who they are just that we can get a list and put on record yes I'm I'm I employed by pinnacle point outpatient behavioral health services. And I'm employed by the paper health association which is made up of a percent of members and substitute use and paver Health okay thank you. I have people listening Representative that couldn't be here that are visiting their families. representa Payton. Thank you madam chair so. Just to be clear I'm not a doctor I just play one in Little Rock I'm trying to get to the cost of your concerns and and whether it's a fairness issue that you're talking about or whether it's concerns about. Not giving adequate services to the to the clients that we're talking about so when missed on says that that we're talking about non clinical services are you concerned that it's going be broader than that or you are you challenging her own on it being non clinical services exactly where is your concern there right now with the behavioral healthcare professional services the home and community based services on the behavioral health side are tied to the implementation of a treatment plan and it's been drilled into our heads for years now that the pair professionals are only service extenders that they work under the supervision of clinical staff and so clinical staff for the ones in charge the treatment plan drives what they do and the it the licensed therapist supervises that toward a therapeutic accomplishment therapeutic goal our so I would say our concern is is both in the fairness slash disparity and whether or not there's adequate supervision of even when you're cleaning somebody's house you're also interacting with somebody who has perhaps a mental health diagnosis and we think there would be some treatment of training that would be required of the people who interact with those folks in the know how best to interact with them have not to trigger them and so forth and so on. So you actually believe that. The services that we don't think require the clinical training there's a good argument that they do they probably do need some training and how to work with people who have mental health challenges yes okay so to put in something I understand and owned a Chevrolet store and I was franchised by the factory in licensed by the state of Arkansas to phone sales and service and warranty and things like that but I couldn't stop some mechanic from going down the road now open up of a service department of its own and operating without all the training and without the franchise agreement without a dealers license you know we did the same work as far as servicing and repairing automobiles but you know I chose to be at a higher level and and more training and franchised and things and and I didn't try to prevent them from doing the work that they do so. I guess we may need some more clarification or narrow it down some would you be satisfied with this. Proposal if it had better definitions of what of what work what scope of work we're talking about. I think what I'm asking for is to limit its application to DD only RDD behavioral health co morbid until we can get to the point where we can harmonize the two underlying manuals paper health and IP we don't we like the idea that the silos are being broken and we really like the idea that the over regulation of therapeutic communities is being addressed there were other potential ways to do that besides this but the department has decided to go in this direction We think that there if you Division for combining these two sets of services is the future okay you're gonna have I need to have some crossover between people who need both sets of services that's not the objection I we would just like to see that the rules that apply to I'll peace and rules that apply to be a write health agencies all are made the same if they're doing the same thing so when you say harmonize you're talking about bringing down some of those standards are bringing I'll piece up and maybe that's where the conversation would be to go but we haven't gone there DHS has done a lot of work with working with the two agencies that do therapeutic communities and they actually made quite of a quite a few changes to this draft working with them but they didn't have that level of communication with the rest of us who are also affected and and that's one of our concerns and that is it addresses that problem but our concern is whether or not it creates new problems by creating an easier path to get to the tier two tier three population without the level of of of scrutiny that that we have to face as paper health agencies thank you thank you madam chair I'll hang up and listen thank you in just that question for DHS to answer to when you come back up to the table for me as this rule begins the process I mean this starts a new provider I mean with every single thing that we do we are back up here adjusting rules and regulations as they go forward so. That's gonna be a question that I have for you when you come back to the table but thank you Representative great last question thank you madam chair. so you've got the B. H. which can medically service tiers one two and three you've got high LP who can medically served here one correct and what you think is going to happen is with this new C. S. S. P. that you'll still be able to D. one two and three medically but you also think that it's going to medically change the I. L. P. two tiers two and three is that kind of what I'm hearing you just summarize my statement better than I did okay so that's what I guess my question to you Director stone would be is either tell me how the rules are clarified enough so that the ideal piece can't medically step outside their regulations in that manual with this and if we don't have that is there a way that we can fix that so that everybody stays in their lane does that make sense this time if you will just come to the table and just so we can move this along and that this can if you don't if you don't mind as well. I'll peas are already able to serve tier two and tier three clients for their mental health needs but they do not fall within the O. B. H. A. where they can provide. I'm so sorry. Where they can provide the a pair professional services and those others because they don't have the oversight that is required under B. H. so they can serve tier two and tier three but there's no continuity of services there by having the para professional by having the physician by having the therapist that the continuity is not there but they can serve them for mental health therapy individual family and group services for tier one tier two and territory third I just get more confused. Okay and if you all would just find Mike right here on the front row that's fun. Go ahead and answer at represent grace questions no miss down you can sit there Mr grant and Mr why if you'll just sit on the front row Kappa Mike and let's get through the. Go ahead miss down. So at Carroll tried answered to answer that so I hope he's can do tier two and tier three now I think we've gotten ourselves looking he's with the tearing. And I don't really understand why independent like licensed practitioner is fed heated topic but the Dennis could go open one of these if they met the credentials and started a business and hire the right staff and got accredited. Any provider there's no restriction just you know the only way you know with we have a moratorium on the provider side then of course there's a restriction there's no moratorium on OB eight there's no moratorium on I'll peas there's no more torment Dennis doctors and fees yes waiver this new CSS pee and we're trying and we don't want there to be we don't have enough. Support that's the whole point so we're the more the merrier if you start a business hire your staff need the certification requirements we want you we have people for you to serve right now. So I mean that's the question on that does that help that isn't no so my question is if. Based on what I'm reading in this what I'm understanding is that the medical piece and then you got the home and community based fees and what I want to make sure is that by doing this so my community based this new waiver that you've got it's not essentially allowing the I. L. P. to step outside the regulations that they currently have to go through in that they can serve an additional population now absolutely not they have to meet the aisle piece certification to be and I'll P. if they want to be this new provider type then they have to be calm this new provider type and meet all the criteria and credentials and standards on this new provide tight just like any other person off the street so what I'll have is a behavioral health coming up the one channel I will have an I. OP coming up to another channel they have totally different regulatory standards to get there but they're offering the same services it's not the same services that that the disconnect we will respectfully disagree on so under B. H. there's a whole set of medical services that are not in this provider type so under B. H. they can do acute hospitalization subacute counseling partial prices units in detox this is not that none of that is in this the provider type this is your old CDS waiver how many they services in your I hope you have a services and we are not touching anything to do with those clinical based services that is B. H. services right now all under the age they can do all that I am community based and all these clinical and that's where the confusion lies but in my opinion it's very different and you would have higher criteria under B. eight if you can do these other services that's what this criteria looks very different this is a very different service package that we're pitching under this new provider type we're not treating people like pinnacle point is treating people and hospitals that's not what this says it's extremely different is in your house this is what Senator Irvin keeps referring to his house cleaning budgeting assisting make sure you take your medication. Sometimes spend the night because you get for example nine one one the other night we have cut the data all the time you know this is a very different set of services than what OB eight there are rate allows them to do right now okay that helps me thank you. K. A. M. I was just gonna ask me again on this one if you want to comment I think the the difference between the services is important and then making sure that the training that lines up with the services is appropriate so could you answer that question. At. If you say yellow button sorry. Okay there you go. Thank you can you hear me now yes okay good could you please repeat after that question I was so I think that that would along the lines of questioning of all the services. Is the training appropriate for the services that these folks are going to be doing and I think that was one of the questions so we want to know the services are different. Under this versus that and then if the training is a matching those services in other words I think there was some questions brought up about. Training for restraint procedures and then there was question about supervision. So could you address those two points about training and supervision what that training looks like and what that supervision looks like anybody can answer that the stone or. Canner Mr what I can start and then Melissa can talk some more about this so what we try to do when we remember we're trying to reduce regulations and we're trying to make services meet demand of fisheries needs and so under the C. S. S. P. program we were not as prescriptive with the training requirements however and those benefit those employees who are providing services under this particular provider type these are employed so employees assigned to a specific beneficiary or group a specific beneficiaries must receive training specific to such beneficiaries as is required to meet the individualized needs of those beneficiaries so though we do have less training and we are training is less prescriptive we do under this requirement require that if you're going to serve particular beneficiaries for instance someone with schizophrenia you would have to have training according to this me know that is specific to those beneficiaries that you're serving okay so so basically you're putting it on to the provider themselves to say okay who are your clients that you're going to serve and you've got to submit a plan that says these are who we're going to serve these we and because we're serving these certain individuals we're gonna train them specifically for these instances is that correct so you're leaving it up to the providers to provide. What that looks like beyond the basics of safety and yes okay and then each of the beneficiaries that are under this program must have an individualized treatment plan so that in the individualized treatment plan is going to have the the prescription for services that these beneficiaries are provided in has to be detailed as to the services that are provided okay and if that and and that can't be medical because it is in the medical plan so that within shift them over to something that would be under medical director in a medical plan and a clinical plan of care you're talking about a functional. Plan of care and the art of omitting and part of the training requirements must include term care planning for behavioral healthcare plan for developmental disabilities care planning for those with intellectual disability social determinants of health behavioral modifications intervention training and training for autism spectrum disorders so depending on what what population you're serving these individuals must be trained on the populations that are being served I'm also for those beneficiaries who are at highest risk aggressive who are suicidal who are homicidal who have acting out behaviors they also require behavioral management plan so you have to develop a behavioral management plan in addition to the individualized treatment plan in in this manual it specifically states that if that behavioral management plan is not working that you must refer or consult must referred to a mental health professional all of these beneficiaries here in the House only come in the two doors they come in the door number one and that Dorsey DDS the other door they come into is to be the I. B. herbal health agency or an independently licensed practitioner some no one can come into the past who is not receiving behavioral health services in the passes when they enter the house based on that died and based on the independent assessment I'm sorry did receive a person centered service plan that includes all of the services that it is believed this beneficiary needs in order to maintain in the home and community based setting so we really feel like there is a lot of monitoring but we are trying to reduce some of this kind of regulation that has caused us to have the silos and for the silence to continue so hopefully that helped answer some of those questions yes yes they're not going to be the in other words this isn't gonna be a brand new person has zero system services and support this is going to be somebody who's already in the system with X. finds the and then this is an additional. Type service yes ma'am okay. All right thank you represent of grated you have any questions okay Senator hammer had you listed. The government represent let me get a represent of Ladyman for. Thank manager. I've got a question from represented Ferguson is listening in here and that I think I agree with her assessment here she says that she thinks we're losing sight of the real issue here. It seems like there are a thousand people that are not being properly served. Is that correct. Yes or more and are at least a thousand people juvenile and then you all have identified in a I think I agree with that so wire that passes serving them now. and are there any a deals not allowed by the certification. What we're trying to serve them now so this is not a new problem and this is something that we talk about internally all the time we've always struggled. To get appropriate service for a certain population of people I mean that is one reason why we put them under the passing is that the service that like we did. And this is the next step so these are the people that you probably get calls on that go to that like go to E. ours or sitting in jails get arrested you know that we have Sam sitting at children's were we just move on from place to place and fortunately depending on how many beds that we can get each time and work and there's no it's not ideal and it's not what they need and and so that's what we're trying to come up with a solution on and I liked what Senator Irvin said earlier is you know we're in front of you all the time I feel like I am a lot being rules and so this this really is that first step and I think the mark interest not made that commitment over and over to the providers of. We let's throw it down and we let them get the groundwork and then let's go in and keep working it just like we do all things and so that's what that's what we're presenting here today but if I will have a minute I would like to say this this does care for people with autism hundreds of people with autism I'm not program that are on the C. S. waiver these are these are the services they get one of the trainings that is in the standards is on autism so that is that he's per population I think people get confused because we have another autism waiver program outside of the pass so and that's for children. This seems to be it seems to me that we all agree besides this issue that they're thousand people that are not being adequately or properly served and you know as you said you know I hear from people like that that Hey you know my child is is getting this the D. but they have this other behavior that nobody's doing anything about so we know there's a problem we know there's a thousand people that's not being properly served and I think we all agree to that I don't hear anybody object and so but what we're can what we're delivering on or not understanding or not agreeing on is the rules. The rules around how we do this. And it seems like you're trying to do this at the. Lowest. level and regulation cost and all that but we can we're we're we're we're not understanding each other on the rules here I'm not understanding it I don't know about everybody else but How do we I mean do we need to modify the rule do we need to add something to we just need to clarify something How do we solve this problem we've been talking for an hour and a half year and I don't know where this clarification here. The sticking point on well I did talk to Carol I talked to him. Lobbyists but the sticking point seems to be that this lack of clinical oversight. We did not change the service descriptions they don't require any clinical oversight this is the transition that version I continuously talk about which is we have gone from I. S. P. M. I. from a clinical based model we've put these coming committee based model in place they require no clinical oversight for the services that we're talking about in this but we keep pushing to have clinical oversight. And and so the it was kind of to the point where it's like well. They don't need these services do not need clinical oversight they want clinical oversight said that's kinda where we stead before you today where that's the disconnect interest and I am the department on. I'm not willing at this point to give on changing the entire model back to a medical based model when we put it under the pass as a function of home and community based model and that's the services were trying to get reviewed today. So so have you all been offered any language to put into this to clarify the the concerns. Written language. I just okay ever Fisher yellow button Mr white. Okay you're recognized. It resolution there was some language those offered by the least one provider what we're done is we have limited this number of people to be served by this waiver to very small number of people. It would have yes Sir that was that was that the purpose that language was to limit the only just a very small group. Thank you okay thank you all right M. folks I know we have got a lot of Kate let's see I've got three more questions and I'm wrapping it up so I have Senator hammer represented brown it represent Payton and then we're gonna we're gonna move on this issue senator hammer one question H. coach a. What has to be H. been at the table any sooner the now you made reference a while ago that it seems like you all were lagging behind as far as getting to the table and interacting with DHS what what's the time frame which you entered the discussion and. Senator hammer the first meeting that I was aware of that our agency members had with the conversation with DHS about what was the comparable comment period I personally was able to attend a meeting that DHS had with that they're pretty communities of people back in September and we've had a number of meetings with DHS over the course of the summer aimed at changing some of the paper all health definitions in the Medicaid manual but as far as the CSS pee of the regulations themselves. As far as I was where most of the conversation took place with those agencies that are doing therapeutic communities. Photo I would respectfully disagree so I bought my two page handout of all our provider outreach that started on August the third than happy to provide so we per we and gave notice to all DD and B. H. providers FOR a Z. meeting where we whenever the power point presented the name prototype for this new provider and I had over ninety eight provide instruction I had show up we answered questions for over an hour and a half on September third and from that point forward we run a bombarded with calls individuals then meetings emails we didn't in formal public comment period before we ever put it out for formal we answered over a hundred questions and input that online for people and then sent out notice reminding them to resend back and whatever we didn't answer damn formal ended fifty pages worth the responses to that as well. They seem like it's clinics I think it was you know they thought like that we didn't in Norma's amount outreach for this providers high. Mr Gannon I think we spoke about this on this a year ago this is not correct that is correct. And I know that there have been certain folks that I've spoken to me about this over a year ago. That are in the space. That are not here today speaking for it but there are people out there lots of people that I've heard from that are for this so. On the B. H. side manager yes okay you and let me get one short one would you and I thank you represent a brown. Thank you madam chair of reprieve I think the only concern here is not with services being provided but simply in the language of the rule thank the behavioral health providers would simply like a clarification in the rules that the people with the new CISSP certification will not move beyond what that certification will allow them to do on into other behavioral health services and can we not include. The language tighten it up that's I think that's the only ask right now okay Mister white you respond a reserve role over for the briefly and certainly missed on risk and can you to correct me or add to it when we are in place at up Medicaid provider they're limited to providing the services that they are certified for licensed for so at this cannot do you know gastric bypass surgery you know they have to follow number one scope of practice rules I have but also the rules within our farming and so I don't know I don't know what purpose to be served by adding additional language to this rule because the only individuals who can provide the services under the C. S. S. P. provider top would be those that actually go through the process of getting that certification I'll be cannot provide those services unless they go through that process appear health agency cannot provide these services under this provider top without going through that process. Thank you thank you okay represented Payton last question thank you madam chair in my question may have just been answered I mean I was going to ask where in this rule the services are defined under listed I mean number one are I really respect all the work that you all done into the put into this and it seems like it's. Very necessary I just was sitting here thinking it was incomplete in regards to the fact that I can't find where the services are restricted or listed. But based on your answer to represent Brown. They're restricted in other places other than in this rule in this language. I think it's fair to say wasn't paid and and they're limited to the services that are listed in the proposed manual itself so would like to add to that man on sidewalks brushing provide this other service unless it specifically mention an authorized within that CS is P. rule. So you would argue that there is a well defined. Service set of of services that any provider would be able to write. It's not murky it's not gray area is well defined somewhere and having represented I know exactly what your meaning so you know we've started taking out codes and fees out of the manuals because we get so behind on updating our codes now we pull amount paid on a promulgated fee schedule so just like that the services will be listed on that promulgated fee schedule under this provider type with the codes and fees that they're allowed to bill we're having and coated and and then I ask right now in the passes are having them coded into their IT systems but you will not find and then what you're saying you will not find a S.. The top of that rule you just won't be on that promulgated are on the online fee schedule with the services that code and what the what Medicaid pays. And it's already difficult I mean you already know what services we're talking about is not up for negotiation or you know adding to the list or taken away from list hi Sir okay thank you madam chair all right thank you members I'm going to review this but not without objection I'm going to review it with objection this will go to administrative rules and rags subcommittee and then C. A. L. C.. All right thank you thank you both for your participation in being here to speak on this issue and I'm sure that they're all going to going to be continuous work and we we ask for that to occur with you and with DHS thank you so much. All right moving on to the next item in. In other committees table members I really do appreciate the questions and that from all of you that have engaged on this issue and I think it's very very important that that's the role that this committee may have and you as members hearing from constituents is very important I really want to thank all of you who engaged in a conversation that was long but that's our work that's our job that's what we're supposed to do here so just very much appreciate all of the members that engaging and obviously if you want to continue to please continue to engage if you didn't have your questions answered here at you know you can do that with with DHS and follow up with them thank you okay if you will state your name for the record you might add you're recognized thank manager mark what with the H. S. J. hill with agent behavior health with the H. S.. Thank Franklin with the Division of County operations at DHS. And service next rule this is a rule to a change to see make some simplification to the eligibility revaluation process an appeal process for ARChoices and living choices Medicaid waivers it just as a reminder our choices that is our Medicaid waiver that provides home committee based services for adults with physical disabilities and also for the frail elderly living choices is the our waiver the provides assisted living services for those same individuals just that that is provided in an assisted living facility as opposed to at home and so all as ms Franklin just briefly described in the Mr hill the changes made and then we'll be happy to answer questions. Good afternoon of this proposed rule seeks to change the way appeals and evaluations are handled for long term care and home and community based waiver programs in order to simplify the process for beneficiaries the changes that we are proposing include removing the required annual independent assessment independent assessment will continue to be required at initial application and the DHS are and will be able to request a reassessment whenever it's necessary or when a change in condition warrants a change to the person centered service plan. and the second proposed changes during the appeal process a beneficiaries case will automatically remain open when an appeal is filed timely unless the beneficiary affirmatively opt not to continue excuse me not to continue benefits during the appeal. That summarizes at a high level are proposed rule all right are there any questions regarding this rule fifteen nine thank you this item will stand reviewed next. Thank you Mr chairman the next rule this is related to hospital acute crisis units I want this rule does is it's very simple and if you'll call back one sector Gillespie was talking about your first of this about the need to expand that acute crisis capacity around the state we do have our for across a stabilization user C. as use in place what you're doing a fantastic job in the heirs place are we know we need some similar types of services available throughout the state and so this rule is one part of an effort to help expand that capacity in the state this would allow hospitals to establish an acute crisis units this will go ahead of him some other changes that are in the works include one this was sector let's be mentioned along the lines of waving the ninety six hour limitation for AC used to hold an individual also waving the limit on number of business person can make and will also be looking at the rate schedule for acute crisis units are in the first half of next year I will that'll have to answering questions okay member members I'll just remind you again how important this one is this is huge game changing a lot of the because we're not building brick and mortar thanks to stabilization units we have built several around the state but this is utilizing existing structure and supporting rural hospitals and those beds that may be available and I think this is critical and I want everybody to understand how innovative creative this is I think it's awesome I would encourage the trauma com system to be able to be utilized for mental health beds we have to get that done with UAMS because that's the system that is sitting there I was stated from day one of the coveted pandemic that we should use that system and I know that doctor Patterson also recommended that to the governor and he did act on that within the last couple months or last month perhaps but you know that is a system that's built. For trauma and triage basically And getting the patient or the patient needs to be as quickly as possible so that their survivability can be increased and clearly that is something that can be utilized during this pandemic which is important we that we're doing that but it's also critically important in the area of mental health getting a schizophrenic patient to a place where they can actually be served the best as quickly as possible will help save lives you know the other issue and this issue is very important to me I know very I have friends who have a brother who is severely schizophrenic and they did everything they could to take care of their brother that he was a large man and he would beat them up regularly and it was not his intention to do that but it's just part of what happens because of his condition so no really I mean you had some I have broken ribs and a broken nose I mean just because they're trying to help you know that their brother and so just I think this is critical are there any questions. All right the N. nine this item stands refute. I was exciting to hear updates about that next one is item P.. Thank members share this next item this is a fee increase for positions I'm fine with that this man come here. I have. We've actually already heard the this is but may you may go ahead yes this is if your call we can't we brought up a five percent increase earlier and we told you that we're going to raise an additional three percent there's there's some discussion about how exactly to do that and what we do we end up just adding it in in addition to the five percent. And that that would have injury questions represent Bentley. Thank you. You pushed really hard represent billing press really hard this with her through this because very hard on this represent that when you're recognized I know it's long time I was going to hold off that thank you very much for following through this I think we need to continue to do more we continue C. R. my constituents Arkansas agents not able to reach to get care because we we pay so low so thank you for this this continue to work on this and and increases even more because I think our physicians is over thank you very much appreciated thank you thank you. Yes she is always advocating for rule Arkansas and their economies and this is a key component of that okay next item P. I'm sorry Q.. And then our next item and final outcome for rules this is an increase in the personal care right I make all this came back for you earlier and we did do a another look at it what worked with our actuaries direction we take account of the wage increase I will resign today is a thirteen point seven two percent increase in personal care rate which will increase the amount of twenty dollars and forty seven cents an hour and I believe I believe all the controversy of imposter I'm not aware of any opposition to the right so but offered was mismanagement we did receive very Many thank yous but not quite it maybe it's the first start but most of the comments for positive day all rights represent of gray you're recognized Okay percent greater than represent Ladyman sorry yup the head of the xact thing. Thank you madam chair question M. it seems like it I'm just gonna pull infirmary here that there are some personal care services that are getting the increase in some personal care services that are not is is an overall broad increase or did we just hand pick a few codes. In the very beginning we did pick several codes to review for personal care and I think some of the differences that you're referring to is personal care and attending care attendant care is under the waivers and we are starting to do those now in hindsight is twenty twenty I probably should have included them and and that was my mistake but all personal care essentially is all fee for service personal care is included I think it's two or three very specific codes that we are doing the increase on it advised ad for ten Kerr says for the waiver there's several logistical issues there committees CMS approval and I commend the waiver and so that's what is push that behind someone as opposed to this rate we can change this on our own and move forward okay but that is we are looking at the end okay thank you. Important to note. At our end and just with this remember me naturally going to fashion but we we are having the the write reviews and there is a schedule of those And so it may be a good idea to present or send out the he was on that right review schedule what's already been done and what's going to be currently coming and just that would be probably helpful. Yes ma'am I'm and I do we do have a schedule now we've never had that in the past I presented it last week when we speak at the FMC conference and it will be going up on the website it is done by year for nineteen and twenty and twenty one and we are doing some catch up on twenty because we did lose a few months with reallocating work and things of that nature the public health emergency we're trying to get that back on track in full steam ahead and twenty one so our intent is to honor the executive order and have this done corrects thank you that was my question represent Ladyman at that was the question I ask okay never mind. I'm reading minds today Senator hammer thank major I'm just curious what mechanisms do you have in place to show that with the rate increases that we're giving that is actually at some point to future going to tribute to access to care I mean I'm I'm okay with I wanted to give people their full value but I'm just curious what what indicators can you track to show some two three years of these races have actually address the issue am I can speak to one very specific and then several that we are reviewing to add that part of the rate review process is we try to do a map and we look at where the providers are located within the state of Arkansas and even bordering counties outside of Arkansas as it relates to the beneficiary so we actually do a map of billing providers and we try to do The rendering providers that's a little more difficult in the system but then lay that on top of where the beneficiaries and their addresses are located within the system said that goes into part of the rate review process we try to look at a thirty and sixty mile radius and depending upon the service we can get a broader range or shorter radius a distance from service so that is one thing we're trying to do to see where act where the providers are located where the beneficiaries of the clients are located in trying to determine if there is an access to care issue just from looking at the map in addition to that we are looking at different quality indicators that we would like to add to every rate review if they have some national standards or some states standards some things that we can set a baseline to that as we do this every four years we can then go back and compare to see if we are doing any better or if we need to do some improvement in the future I have a data from the last rate review are is just the beginning of a new chapter no Sir we did the maps I am on the thirty and sixty are right mile radius with providers on everyone of the rate reviews said that is up a part of the report that and we're trying to get up and try to get more access to those so that everyone will be able to read them or I'll get off line with you thank you Sir all right thank you all right thing in another question for this item will stand review. And item peel off the stand reviewed in case I did not say that correctly okay thank you thank you for your work again by Christmas thanks thank great working with you guys. all right next item are. M. we have to an arm study proposals Senator Flippo your if you're recognized. Thank you madam chair and thank you members so This ISP would seek to allow pharmacist here in Arkansas the ability to prescribe and monitor medications and just if I can briefly expounded upon that this is in response to an executive order issued by president trump the US department of health and Human Services published a paper in which the stated the healthcare markets could work more efficiently and Americans could receive more effective in high value care of we removed and revise certain federal and state regulations allowing our pharmacists to and other highly trained medical professionals provide some of the same healthcare is positions so currently federal law already allows pharmacist either autonomously or collaboratively prescribing monitor drug therapy and R. V. A. R. Indian health services Arkansas hospitals in our Arkansas pharmacist working hospitals already have the ability prescribe and monitor drug therapy for at least I think the last thirty years and so this is already being done in a handful of other states and there's different you know different mechanisms so which state doesn't go by you know the exact same you know criteria but those states include Iowa Idaho Kentucky Tennessee Texas Ohio and California and so I believe that this would help increase access and freedom of choice and pharmacists are trained to the level of a doctorate and I do believe that they are under utilized in some instances and so I would appreciate a positive consideration by this by this body. I have a quick question for sure the would you support physicians being able to prescribe and dispense. Medications yeah and I think you know Senator Irvin we talked about this last month and that's what I said I would expect this to be part of the part the broader overall conversation in the ins and outs of you know what are not Arkansas decides to move forward with this there's going to be voices on both sides and so I would want to hear more information as well as I'm sure the members of this committee want to hear. Thank you I mean one of my concerns that I spoke to Senator Flippo about was. There are some channels in place on physicians and from prescribing and dispensing they they can't even accept of a writing pen that has the drug company's name on it anymore they used to be able to get certain things like that but they can't anymore and and and that was for good reason so and there's various reasons why so just get out as we move forward you got to be cautious of that patients patients are treated based not on profit margin debt but on an actual medications that they need and you know you and I would be a criminal that yeah I know that I know and we we spoke about that so I think it's really just important you know whatever legislation comes forward that that we have some clarity there I would agree with you unfortunately it's it was abused and and so you don't want to get us the public policy should probably be consistent manner so thank you are there any other questions. Right C. N. nine as eminent take that as a motion on the motion and a second those in favor say aye I am opposed as habit thank you and we have another one from represent of love. He is not here. And. Okay moving on item S.. M. item S. numbers I'm gonna talk about this it is your annual status reports for the prevention of unplanned pregnancy on campus and the prevention of sexual assault on campus if you will look at exhibit asked real quick I'm gonna speak about this real quickly. And we do according to act five sixty three of twenty seventeen we have an annual status report for sexual assault prevention on campuses I've dug into a little bit of this and I'm probably going to bring legislation to have the other side of this presented the reason I say that is because I'm not sure if you'll be familiar with some of the Martha McCallum on fox news did a very intense report about young men who were falsely accused of sexual assaults and fights there was an NFL there was a five star recruit football player from the state of California. He was accused falsely of sexual assault and rape he actually went to prison after he served and was appealed the woman who on the college campus who accused him of it reached out to him on social media and and that with him he and his attorneys taped the conversation she admitted to making it up she admitted to trying to get fame and money. From its this man his entire college career he was a five star football recruit heading to the NFL this young man's entire life was ripped away from him from a false allegation of rape he actually went to prison for it. She made it up to get famous and to get money. That young man actually works for the NFL if you're interested in this you can go to an organization called faith F. A. C. E. there have been over two hundred civil lawsuits have been filed under title nine policies that were put in place by the Obama administration those policies and procedures were rescinded by the trump administration and twenty seventeen New and fair procedures. For instance the only evidence threshold of evidence was a quote unquote preponderance of the evidence that had to be met in order to actually. Q. somebody of of something but there have been over two hundred civil lawsuits have been filed there have been one in courts from that the respondents in these cases. And there was one at the U. S. court of appeals that Now Supreme Court justice Amy Coney Barrett wrote I would encourage you to look that up and read it read the entire opinion that Amy Coney Barrett wrote at the US court of appeals on this issue so I know that we need to be very careful because we know that young women are sexually assaulted and particularly on college campuses we know women are right on college campuses it is a problem but we also know that there have been false allegations and lives ruined over this and so we have to make sure that there is a fairness and that there is a judicial standard in place when we are looking at these things from an administrative law point of view policies and procedures that are forced upon us by the federal government because we take money should not over reaching over stepped into judicial preponderance of evidence and a judicial standard of evidence and so I'm I'm very concerned about this and I want you to If you have questions you can contact me but I just I want I want to say that on this report I mean obviously I believe that this is this is needed and this is something that we need to request but we also need to look at the reality of what's happening on the other side of the issue. C. thirty six. I don't know who you are. You're recognized. Thank you madam chair. Your question what is the difference between what is in place presently and what this right here AS mail would you. This is just a report that we receive I mean I think it's kind of a flimsy a little bit of a flimsy report but this is a report that we that that we receive based on ACT five sixty three of twenty seventeen. Thank you ma'am. The report of of current activities that are happening on college campuses in order to raise awareness. I'm about these two different issues and and my issue though is sometimes after these These types of promotions and these programs are held on campuses. Women are encouraged sometimes it they are encouraged to file reports and what I'm saying is in the past some of those have been false. And so we and you can I'm just going off of you know the news media and what I have done research on. Are there any other questions that's just stands for review okay the last time we have is item T. Senator hammer has done some work and has a hand out And I apologize that I have not been able to be at some of your meetings that. Here and now you can just speak to their I'll let you at. Thank you man chair when. You want to go and get to start whether hand that out I'll be brief is I can't. I'm sorry go ahead all right thank members here the original legislation that was filed and passed that stamp which the Arkansas Pampanga is Advisory Council required to report to the public health committee so this is the report to be given in compliance with that of the handout just kinda outlined some of the work that's been done over the last two years and I'll briefly go through just to get some of the highlights as far as the affiliations that we've been able to establish there has been a relationship established between you and medicine children's and I want to publicly thank you to those institutions for participating in this process as a result two positions doctor and they referred him respectfully start panda because his name actually has a portion of Pandey in it so they referred to as Dr panda doctor Rainey R. The two positions at children who see individuals that are referred to them for diagnosis and treatment of pain and pandas we've also established relationship with the pace foundation which is affiliated with Paula Patricia Ryan they actually had a child grandchild who was diagnosed with panda panda three street receive treatment as a result of that a foundation was established and we were able to connect with that I wish before the legislation was passed we knew about them but they've been great asset to the state of Arkansas on the partnership we developed as a result we are in conjecture we are in conjunction with universities such as the university of Arizona UCLA Stanford which constant and Massachusetts General Hospital as a consortium working to address this disease and also to bring solutions to getting treatment for probably one of the bigger pieces of news in addition to that is the fact that Arkansas is going to participate in a clinical trial by octapharma that is going to be in conjunction with the patient at work and the other clinics that are at the other. Universities but that's gonna be conducted by the food and drug administration for I. B. IG treatments and with that approval you will open the pathway for insurance companies and Medicaid to begin to make payment for treatment if that's diagnosed by the PCP the you'll see if you get into the report there ninety two children they're gonna be so wrecked that are going to be selected from around the world and Arkansas analogy in that pool of possibility being selected so some of our kids can participate in that some of the challenges that we have been confronted with that some of which we have met is one we established the clinic over there there was no nurse to assist the two physicians away click works is the physician sees patients that are referred by PCPs two Fridays a month and children's and you M. S. have been borrowing or nurse in order to prepare that so when they come in see the doctors they can make the best use of the time one of the bigger chi match that came as a result of this the week before last there was an anonymous donation made to UAMS to staff that position full time for a nurse for one year at that cleaning will so that was that was huge and that was an anonymous donation and they're working on getting that nurse hired between now and January so they can expedite scene of patients that are referred to them the education component that's referenced on the second page of talk to the passes and what the passes are agreeable to do is to provide upon their website we got to work out the details on this but provided as part training under their community development dollars to put that up on their website that is a process in works I'm trying to get the highlights the one thing and I'll get to the backside of it when you talk about the upcoming work that you need to be done. The as I mentioned while ago that trial which involves ninety two male children that's a thirty million dollar trial that will be participating in have the ability to participate in the Well we're also moving toward having clinic at children's diagnosed as a center of excellence which will give a specific designation make it easier for possibility of grants moving forward and also the clinic at the doctor Rick Barnes vice president chief clinical and it academic officer at children's hospital and he will be overseeing the clinic over there in conjunction with a lot of other duties but that's going to fall underneath his direction and madam chair the work that will move forward is I want to submit draft legislation to continue the panda pandas Advisory Council because Kobe kinda knocked the wind in our sails start back in in February we've been limited our meeting we've had to make up ground work's not done so already introduced legislation to continue that and request funding for the nurse position to continue in two years two and three by that time the FDA trial will be approved and the money should hopefully begin to flow through treatment that'll help underwrite that clinic over there so I will be asking for funding to support that nursing position over there publicly I want to thank Dr Richard Smith at UAMS Maurice Rigsby with you M. S. a children's hospital for their participation members of the legislature live in support for this and also Mr Mrs Paul Ryan and the page foundation because it really helped us pioneer through this and manager of the glad to answer any questions. Thank you will you add me as a co sponsor. I think a part where you add me as a co sponsor yes ma'am yes ma'am thank you. At I. and you're you're you're gonna ask for an appropriation for you a mask for our children's it'll be for a UAMS because the the clinic is at children's but the staff is private. Right. Very good work thank you no other questions. I'm sorry thank you. The layman. Okay we'll move to other business yes. Sure thanks a couple people they ask for information on the co with the nineteenth Maxine. And others there was no one here from public health but I did speak to a couple people and I know most people but you here's some information that I got you know fed ex I know up in northeast Arkansas we on our news we saw the fix planes coming in the Memphis with the vaccines they were split up and sent out to through vans into Arkansas Supposedly we get twenty five thousand per accidents today. these keen these things come in one thousand to a tray once a tray of a thousand is open it must be dispensed immediately. So that's part of the plan the large hospitals like UAMS Baptist western regional St Bernard's those will go directly to them those trays of the thousand so hospitals that have more than a thousand workers will get those trays directly. For the smaller hospitals there's five pharmacies in the state that will receive and distribute these vaccines to the smaller hospitals so these five pharmacies will cover the whole state. In a these pharmacies are located in Jonesboro Paragould hot springs Little Rock and Benton so the whole state for small arms bills will be covered by those five pharmacies because they have the ability to store things at very low temperatures just give you an example of the one in Jonesborough would Springs farms is in my district they got nine hundred seventy five vaccines they will distribute that to thirteen small hospitals by the method that they've established their so that's just want to pass that on some bill may not of heard that. members got a question I might be able to answer I might not. All right thank you mentor thank you And this. I don't know the answer this question of a sphere from the department of health but if you've already had because of it are they recommending you get the vaccine or not. Does anybody know the answer to that question no I don't. Senator hammered into the. Better chair the doctor delay Hey and I had a conversation on that and with regards to recommendation get it I think probably by the time the vaccine gets here to the general public because wage tier Dan of the they would advise that they would after they get over the over the signs and symptoms and treatment of it but she's expecting that by the middle of the year that sufficient vaccines will be in the state that everybody that wants one would be able to get one after they go through their tiered system to distribute it. Right so there's not a time that did she give you a time like if you've had it for three months or if you've had it for. She did not give me a time no matter their health some healthcare professionals may have just had it so I was just curious sure okay represent a Boyd governor mind turned herself okay thank you all right thank you represent Ladyman all rights other business. Represent consolidation center question on the procedure on these ISPs if we do not adopt the ISP does that. Completely stop someone from red running the legislation on. Yes according to the rule that's how I understand it okay we'll than staying consistent with my belief on the ISP process of like Vice P. process I think we should probably use it more appropriately but I do not believe it should stop someone from run running legislation so I would like to make a motion that we adopt this last ISP. Twenty nineteen one seventy four. Okay. Another some members that have a lot of issues with the I. S. P. and I'm gonna speak to their concern was just that sessions going to be really and that's fine I mean sessions going to be hard but It's gonna take a lot of time in the committee senator hammer your question no ma'am I have come it to the motion at the appropriate time okay well let me ask if there's a second. Their second okay there's a second okay discussion Senator hammer recommend chair and I respect what up represented Gonzalez is saying and I agree wholeheartedly part of the process so as to have a discussion as to get it out of here this piece of the size P. has been on the agenda I can't remember how many times I think up to three times perhaps and there has not been eighty one there's not been a. Well the Representative has not been here to speak to it and you can call me and check on three times with a thank members three times at this is bit around I think that if a Representative or senator is not concerned enough about it to be here to present it I think we need way that in our decision as far as whether to let it out here or not that would just be my comments thank members here I believe he was here presented in the subcommittee. But at with the here today I mean he was here but yes presented present that's in the subcommittee and the subcommittee all right thank you Mr but I think a motion was. I think what was I think the distinction was there was a motion made that it right that it would require a vote by this committee. And that was what the motion was made in the subcommittee because and. So that's why this one is a it's being treated or dealt with a little differently because of the action that was taken and not subcommittee. Correct yes that's correct and and manager me say something here there there were there was a few people who was opposed to this particular ISP and they were here earlier they've left now because we've gone past that item on the agenda. So I don't know where that matters but those people are not here to. To stay one of the object to it because we've acted on at all we've passed over already just comment. Right. Any other comments I don't know that I agree with that either but I just again staying consistent my beliefs we shouldn't stop someone from running legislation that they choose to run out. Help support person. Okay my comments are the if he if you believe in a in a piece of legislation and you want to be here and you want to discuss that and that's the requirement and the motion was made from the subcommittee that it needed to be discussed fully by this committee then I thank you I think you need to be here in the study the processing and answer the questions that that's my comments I'll call for the vote all those in favor say aye. And opposed no. The nose habit. Thank you. Where adjourns.