Public Health - Human Services Subcommittee - Senate and House
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I call this meeting to order. Thank you for everyone being here today. We've got a short agenda today.
but obviously the discussion during the public health meeting we thought it was appropriate for this subcommittee to convene to discuss it as well so um without any objections from my co-chair uh we'll have the department of health and human services come up and explain the division of medical services discussion on the rules for urgent care clinics miss pitman just come down and introduce yourself and feel free to begin
Chair
Unverified
2:47
oh sorry good morning Elizabeth Pittman division of medical services and we are here today to further discuss the rule on urgent care that we attempted to promulgate I believe last week sorry I was not able to be here sorry I was not able to be here for that but I know miss Smith gave you all the information that that you needed at that time the rule itself was designed to help create better access to urgent care for for people that were really being forced to go to the ER when they otherwise didn't want to by allowing some urgent care visits outside
of a PCP referral. We did look at whether or not it would take away from the PCP relationship. That was not our intent. We still believe that primary care relationship is central to managing good care, which is why we limited it to only two visits for those that haven't assigned PCP and four for those that don't. We have some other policies in place that ask for hospitals and we can even add urgent care to that to assign PCPs if a person does not have a PCP additionally we even have some funding for that now I know some of
that funding name may need to be looked at again but we do pay about 15 14 to $15 for a hospital to assign a PCP if there is not one otherwise assigned so again this rule was not about trying to erode that a relationship but rather about trying to create better access for people who may need to seek care when a PCP doesn't have an appointment available or it's outside of their normal hours because otherwise a PCP requirement, a referral was required. I know during the committee meeting, which I went back and watched, so if I miss anything, please remind me and I'll
try to address it. There were some questions around definitions of urgent,
Speaker 11
4:27
or I believe it was emergent clinics and walk-in clinics in our rules as they were written. We have gone back and looked at that, and I'm going to be very transparent today. We looked at what an emergent clinic was, there is not a definition of emergent clinic, nor does it appear to be something that is being billed in our system. We've looked for place of service, provider types, all of those things. So it feels like that is just an old term that is left over in our manuals that probably needs to
be cleaned up at some point. Walk-in clinics have been billed as a place of service. We've only seen it billed, though, about 30 times in the past three years. So it's a pretty minimally used service and the primary biller of that it turns out was actually a pharmacy walk-in clinic and they were
Chair
Unverified
5:15
billing for vaccinations so it does not appear that that is being used for urgent or emergent care either so just wanted to give you that information um is there anything else that you
Speaker 11
5:24
would like me to address about this rule before we get into your questions
uh representative johnson do you have a question i just have questions okay um if you're okay pitman sorry you were fine i'm used to everyone calling me pitman so
Speaker 15
5:40
feel free i'm sorry about that um we'll just we'll
start with questions representative johnson you're recognized thank you mr chairman appreciate it appreciate people being here
Representative Lee Johnson
Unverified
5:50
today feels i told representative rose it feels like a wednesday night church service not a sunday morning we got everybody spread out and all over the place and there's only a handful of us here
um but i do have some questions so uh and i you know obviously if you want a definition of emergency clinic I'm happy to gin one up for you okay I've got some ideas around what we might call that I support this idea I mean I didn't mean in
the in the committee to act like I didn't support it I think it's you know I think we have an access issue for patients in Arkansas and I think the urgent cares provide a good outlet for that but I also think it's important to recognize that there are you know urgent care deserts I suspect in our state where people don't
have access to go to an urgent care they don't have that option and so my question was really more around you know from an emergency care visit standpoint um you know is there a space like first of all do we uh reimburse without referrals for emergency room visits if they don't have a pcp so my understanding is that if they
Chair
Unverified
6:59
have do not have a pcp yes you can get reimbursed for that there are some requirements around making referrals to PCPs after the fact
Speaker 11
7:08
but there is reimbursement for that for that visit so tell me
Representative Lee Johnson
Unverified
7:11
about the when you say making referrals to
PCPs and I realize you might have the answers to all these questions and you know I don't mean to be adversarial I just want to try to have a good dialogue we're all down here so let's try to walk
through the issue when you say there's some stipulations about seeking referral later what what
Senator Fredrick J. Love
Unverified
7:28
do you mean by that hold on hold on for just one second representative Johnson I want to I want to just
be clear just just for a clarification before you answer that you continue to say and I heard it the last time we had I mean you said emergency you keep saying
emergency so I yeah and what I mean is by space yeah go ahead okay but emergent clinics and emergency are two different they're two different things and so when you when you continue to say emergency i'm thinking er yeah you're thinking er and that's what you mean 100 so you know but urgent care and emergent clinics are not well it sounds like if i understand right we don't have a definition of emergency clinic we don't
Representative Lee Johnson
Unverified
8:09
know what that is correct but see we don't have any
Senator Fredrick J. Love
Unverified
8:14
emergent clinics i would argue that an emergency room is an emergency clinic hold on for
a second emergent you say an emergency emergent clinics and urgent and urgent clinics are synonymous but i would disagree senator
Representative Lee Johnson
Unverified
8:30
because it sounds like there is no definition of emergency clinic and if they're synonymous why do you need two terms in the rule why wouldn't you just say urgent clinic i don't understand that i mean it sounds like the one walking clinic we have was a pharmacy
So why can't an emergency department be an emergency clinic? We have many emergency departments in the state. We have Fast Tracks. We have non-emergent care centers in the ER. Yeah, I hear what you're saying,
Speaker 31
8:56
but you're saying emergency clinic. That's what the rule said. If you read
Speaker 39
9:01
the rule, it says emergency clinic. There is
Speaker 11
9:05
a term emergent clinic in our rule. I think it says emergency clinic. I think
Chair
Unverified
9:12
it says emergent. Emergent. it's emergency um i mean it's but it's not a it's not a defined term anywhere and we don't have
anyone operating as an emergent clinic and i'd have to pull the rule to know if it's emergent or emergency but i think they're designed to mean the same thing but there's not anything operating
Speaker 33
9:30
as that so we are bringing urgent care clinics which is a step down from emergency room okay
Senator Fredrick J. Love
Unverified
9:36
all right so that's i guess when i'm hearing when i'm hearing you're talking about emergency and you're talking about urgent care, which is, but go ahead. I appreciate the latitude of this, and I hope
Speaker 29
9:46
we can have this kind of dialogue. No, no, no, no, no.
Representative Lee Johnson
Unverified
9:49
Because, like I said, we were all down here to try to talk through the
issue, and I know that we're foregoing some of the formalities. I appreciate the chairs doing that, but, like, it's geography. There's two issues, right? There's the geographic term of emergency department, emergency clinic, urgent care clinic, And then there's like, is the problem an emergency or not? Those are two different things, right? So in Arkansas-- correct me if I'm wrong, Ms. Pittman-- but I believe in Arkansas, we have a prudent layperson
definition around emergency and non-emergency. Is that correct? Yes, sir, that
sounds correct. And so my understanding of that law is that if a prudent layperson is defined My understanding is if you're a prudent layperson, it's an average Arkansas 8th grade education. If you show up to an emergency department and your perception is that it could be an emergency.
I got home from work today, my child has a temperature of 104. That's kind of freaked me out. I'm going to the emergency department. should be able to in an emergency department treat that person and get reimbursed for that care regardless of whether it turns out to be a cold the flu which isn't an emergency but the perception of the condition is one of emergent is that correct i also
Speaker 48
11:21
lost my mic yes that is my understanding of the standard now i you know defer to you
Representative Lee Johnson
Unverified
11:26
as a physician like what i'm getting at is
that if we're going to pay urgent cares, which I support. I support this rule. To be clear, I'm in favor of this rule. I think there's a real access issue in Arkansas, and I want patients to be able to access the system when they feel
like they can. And it's not your fault if you've tried to get a PCP. One of the questions I have is, how long does it take for a person
to get assigned a PCP once they start the process?
Speaker 9
11:59
So we don't auto assign PCPs. We have a phone line connect here.
Chair
Unverified
12:03
I'm not sure the exact time, but you can call that phone line at any point and
Representative Lee Johnson
Unverified
12:08
get assigned a PCP. They'll assist you in that. Do we know how many
Speaker 9
12:12
Medicaid recipients in Arkansas don't have a PCP assigned? Of the ones that are required to have an assignment,
Representative Lee Johnson
Unverified
12:18
it's around 145,000. That don't have a PCP assigned? That seems like a big number. How
Chair
Unverified
12:26
many people are on Medicaid in Arkansas? There are about 800-and-something thousand, but not all eligibility categories are required to have a
Representative Lee Johnson
Unverified
12:33
PCP assigned. Of the eligibility categories required to have PCP, how many of those people are there?
Speaker 53
12:38
I don't know the total number of that. I can get it for you. We have about 300-and-something. So roughly a third of the people
Representative Lee Johnson
Unverified
12:46
that need a PCP don't have one in Arkansas? 400 why don't you just come up here yeah let's get everybody at
the table please come to the front and introduce
Speaker 48
13:01
yourself she uh she's worried that she's wearing friday attire but i
Representative Lee Johnson
Unverified
13:04
think she looks lovely i've got on a v-neck t-shirt from target i threw this jacket
Speaker 60
13:08
on out of my car so it's all good um i'm nell smith i'm the deputy director for the division of medical services and as a former blr staffer this is just um unacceptable to me no
Speaker 62
13:24
it's all good the question was how many are have a
Representative Lee Johnson
Unverified
13:28
PCP my question was how many require a PCP eligibility she said there were 800,000 people on Medicaid
Speaker 60
13:35
but not all those people require that's right and so we have about 140,000 without that require
one that don't have one and we have about 400,000 392 that have one and so roughly it so roughly a fourth
Representative Lee Johnson
Unverified
13:46
of the people in Arkansas that need a PCP don't have a PCP. 145,000-ish people don't have a PCP. And so how do those people access the system?
How are they expected to access the system? If they try to access the system, let's say
Speaker 64
14:00
they try to go to a specialist, the specialist will say, you'll need to
Speaker 60
14:04
have a PCP referral. And since they don't have one, how do they get that referral? They get assigned.
Speaker 67
14:12
How do they get that assignment? They call ConnectCare. The onus
Speaker 60
14:18
is on them to call ConnectCare. Yes, and I believe clinics can request, I shouldn't say that, I'm not sure that they can request an assignment. We did find that hospitals can request an assignment and get paid, can bill for that request of a referral. And Mr. Chairman, I have
Representative Lee Johnson
Unverified
14:35
a whole, I'll just keep asking questions. Well, I mean, I
appreciate the discussion and I did not want to slow you on this, but I do have some other people in the queue.
Speaker 19
14:48
I'll back off. I do have one specific question for the Department of Health. You're just going to keep going. Okay, I got you.
Representative Lee Johnson
Unverified
14:54
No, I'm just telling you I have a question for the Department of
Health. I know they're here. I don't know how long they plan to be here, but I'll get out.
Representative R. Scott Richardson
Unverified
15:05
Let's get to Representative Richardson next, and then we'll go back to Representative Johnson. Thank you, Mr. Chair. Thank you, Representative Johnson, for letting me speak. So the rule makes sense to me, right? So I understand what you guys are trying to do. and i'm not on medicare medicaid but i don't have a pcp i recently had pneumonia for two weeks and
all i need to do is get a checkup but because i don't have a pcp i can't find a doctor who's accepting new patients and it's been a pain in the butt so the opportunity to walk into an urgent care and get a quick checkup that would be potentially covered seems like this makes be a ton of sense so i applaud you guys of what you're doing and i can really appreciate the in-depth that Dr. Johnson is going in to try to really understand how the payments are made back for those individuals on Medicare.
My big question is, is when you had open public comment, how was that notification granted? I mean, how do people know to come and speak on this or have questions
Speaker 22
16:08
about that? Sure. So we follow the typical state process as
Speaker 75
16:10
required. We put it out in the paper for public comment in the Arkansas Democrat Gazette. We also put it on our website. I believe we might have sent, did we send this to the association? Sometimes, and we might have done it in this, I'd have to go back and check,
but a lot of times when we work closely with medical associations, for example, the Arkansas Medical Association in this
Chair
Unverified
16:32
case, we send it to those groups to see if they have any comments. And again, I would have to go back and check, But we are pretty sensitive about our primary care providers in the state. We know that they have a lot of pride in that program. And so a lot of times if we think a rule is going to impact them, we'll share it with them as well to see if they have any feedback. Now, again, I don't know for sure whether we did that in this instance. I do not believe we received public comment on this rule, though.
Representative R. Scott Richardson
Unverified
16:57
Yeah, that was my question or concern that people weren't aware to come in and make comments. So thank you for your response. Representative Springer, you're recognized. Good morning.
Representative Joy Springer
Unverified
17:08
And thank you, Mr. Chair, and I'm happy that I came to this meeting today because I can echo what Representative Richardson has stated. A few weeks ago, I was at a conference, and I stepped off the sidewalk, and I hurt my back. And I wanted to go to someone that I knew that could help me with the pain that was in my back.
I was told that I could not go to that person until I was able to go to my PCP. I have a PCP, and they had to give a referral to that person in order for me to go to have something taken care of my back. So I'm trying to understand why is that sort of thing there for me to have to – I have a PCP, but yet still I can't
go to another person to be cared for. So I'm trying to understand the difference here.
Speaker 75
18:00
Sure. So in that case for Arkansas Medicaid, where you have a specialist need, now had you fallen off and just needed
Chair
Unverified
18:06
to go to urgent care, that's what this rule is designed to address. Like, for example, I have stepped off a curb incorrectly and sprained my ankle and had to go to urgent care to get it taken care of because there were no same day appointments available for my PCP. But if I needed long term treatment for that, I also would have had to go to my PCP. I think in that instance, I did to get a physical therapy referral so that I could get physical therapy. Medicaid is, this rule would allow Medicaid to operate the same way as what I was allowed
to do in that situation. When I, that day I sprained my ankle, I could go to the urgent care to get that immediate treatment, but follow up for that ankle sprain, I would still, the Medicaid client would still have to go in and see a PCP and get that referral. And that is designed, again, to preserve the case management aspect of our PCMH and PCCM program so that that PCP really understands everything that's going on with that patient's care. The goal of those programs is that that PCP is responsible for managing the quality of that care, making sure to do the follow-up and things of that nature. In the PCMH program, they're paid
Speaker 33
19:06
based on the risk of that client, and so we really want them to coordinate that care
Representative Joy Springer
Unverified
19:12
and really understand what's going on with that patient. Well, thank you. I've had the same PCP for years, almost as old
Senator Fredrick J. Love
Unverified
19:25
as I am, so, you know, thank you. I appreciate it. So, Ms. Pittman, all right, so here we are. Take me, kind of walk me through the Medicaid patient. So, as of right now, the current rule is that I'm a Medicaid patient.
I don't have a PCP. I go into an urgent care clinic. I get seen. No, sir. I can't get seen. Correct. So, I have to. Go to an emergency room. I have
Speaker 52
19:49
to go to the emergency room. Or an urgent
Senator Fredrick J. Love
Unverified
19:57
care affiliated with a hospital. Yes, sir. Or an urgent care affiliated with a hospital. So that's the current. Yes, sir. So really, that means people are kind of, we're forcing people to go into the ER.
Speaker 52
20:09
I would say that. I think that's, I think what I did say earlier is forcing people to go into the
Senator Fredrick J. Love
Unverified
20:16
ER. And when that's the only thing available, that is appropriate. Yeah, and that's what I was going to say. So when, you know, I guess you get outside of Little Rock or northwest Arkansas or somewhere like that, you know, you might have only the emergency room. Right. Okay. So now this rule is going to say, hey, we're going to, if there's an urgent care available, I'm a Medicaid patient, I can go see an urgent care without a PCP.
Speaker 52
20:42
For a limited number of visits. And then we would ask that you have a PCP.
Chair
Unverified
20:48
And the minimum number of visits is two? For someone with a PCP, it's two. For someone without a PCP, it's four. Gotcha. And again, that's designed to preserve that PCP relationship because we do find a lot of value in that. It's allowed us to, with the PCMH program, allowed us to really address some health disparities in Arkansas. Not to say there couldn't be some improvements to that as well. I know I've talked to Representative Johnson about that. But we do find a lot of value in that relationship and in that program
Senator Fredrick J. Love
Unverified
21:13
and want to preserve that. Okay, so then why are we saying four visits instead of just two? For someone
Speaker 32
21:24
without a PCP? Yeah, without a PCP saying that, hey, you know what, you're going to, you know, you can go once, you can go twice, any time
Chair
Unverified
21:31
past two then. So we originally started with just no PCP assigned. You could have up to four. We added the two for those without a PCP and decided to limit that to two instead of making it also four because we wanted to preserve that existing relationship.
Again, you might sprain your ankle or have a cold and need to get in. And so we just wanted to have some allowance for that without saying you don't need to have a PCP and have that relationship. So that's how that
Senator Fredrick J. Love
Unverified
21:58
came about and the reasoning why. Well, I'm saying, though, if we want to really get to establish, have a patient establish a relationship with a PCP that can follow their care, then would we not say that after the second visit they need to have a PCP? I mean, wouldn't that be – I do understand.
That would be better coordinated and quality of care if we said, hey, you get two visits, you have to have a PCP. Wouldn't it – I mean – No, I do understand, and I
Speaker 48
22:29
mean, I was going to talk to you guys today and hear what the questions were. We may
Chair
Unverified
22:34
end up actually, after we review all of this and what you're saying, pulling this rule back and making some of these changes, I think, that you're suggesting. But I really wanted you guys to weigh in on that before we made that decision on how important you felt like this was to go ahead and implement and then make changes after versus holding and making changes before.
Yeah, and I appreciate the rule. I think I'm very much the camp of Representative Johnson. I was asking a lot of questions. I do see the need for urgent cares. And my feeling is kind of the same with, you know, I think like a 26-year-old who probably sees the doctor one time a year, maybe four times. It's like, I'm never going to get a PCP because I can just use the urgent care as much as I want. And we don't want those people to not get into the system. And then I guess as we've kind of had this discussion, and I'm curious what your take on it is, you know, we have these 145,000 Arkansans who should have a PCP but don't.
Is there not an ability for us to, like, auto-enroll them with providers? I mean, I know with the past is we do that. I mean, is there not a way to say, hey, if you live in Johnson County, we have these PCP providers that are accepting Medicaid patients. We are going to give those to you. And then, I mean, the onus is on those providers to reach out to those people and to establish a relationship. And then, of course, if they want to change their PCP at any time they can, I mean, I just feel like that would be an easier way to kind of get through this. Once again, I like the rule. I think it's a good step. I mean, obviously, I think, I mean, I've stepped through a nail.
nails gone through my foot working in the yard and i've gone to the you know urgent care before like so i get it i've got young kids trust me i've rushed to urgent care it's quite a bit uh so i mean i i totally am with this i just i do like with the way we've done pcmh i just want to make sure that we are getting those people right and so they build a relationship with those providers so i don't know if you could talk a little bit about auto enrollment if we can do that through a rule or something
Chair
Unverified
24:25
like that so please just kind of help so we have explored auto-assignment. Our system does have the capability, you're absolutely right, to auto-assign
individuals to a PCP. We have not pulled the trigger on that yet. I don't know that a rule would be required, or if we could do it absent one, that's something we would have to explore. There are a couple of reasons we haven't. Obviously, those 145,000 people are not currently engaged with their health care for whatever reason. Auto-assigning them means that that PCP automatically gets that PCCM fee of $3 per month and as of today that is paid for that case management with the expectation and I believe rightly so I believe most physicians are doing
this but that they're managing that care for each one of the people on those panels however these are people that are not engaged and may not come and so we'd be paying that $3 automatically so we wanted to look at really what does that mean for that program and those 145,000 people before we pulled that trigger and started spending that that it seems like a small amount of money three dollars per person but when you it's a lot of money when you add it all up and so you know just making sure we're being responsible before we we do something
like that is there a way though to um to do the auto assignment and then saying you're not going to receive that fee until you
have an initial visit with that patient so that they do become into the system i mean i get it we don't want to enroll someone who's maybe living out of state this time but it's considered an arkansas resident we're paying for their medicaid they're not seeing the doctor and then this money just going to a provider who's just sitting back and collecting um is i mean is that possible i
Speaker 48
25:54
think that would be possible with the rule change um i don't know i think the way the rule is
Chair
Unverified
25:59
written now for that for pcmh there are obviously requirements to get you get a basic payment but then there are requirements on top of that for pccm you you get that three dollars for
everybody on your panel sure no matter what and so i think without a rule change no that's not possible. With
the rule change, yes, of course, all of that is possible, and that's why we haven't pulled that trigger yet. Okay, great. I'll bring
it over to some of my colleagues. I think Representative McGee, you recognize? Oh, sorry, Representative Allen was first, but his button's not on here. I am
Representative Richard McGrew
Unverified
26:32
with you today. Oh, gosh. Sorry. Thank you. Thank you for being here this morning. I have a question. Can you explain to me the
Speaker 109
26:40
difference between urgent care and the emergency
Chair
Unverified
26:42
room sure um i will try my best so an emergency room is obviously the hospital affiliated uh emergency room they can provide all of the services that the hospital is allowed to provide under an emergency room which i'll defer to your colleague representative johnson and my colleague mr gilmore in the back there for exactly what that is um but they are also required under mtala and and i used to know what that stood for and might know again after we get done talking today, but to treat and to screen and stabilize every patient that walks in the door. An urgent
care clinic is a physician's office. They're not licensed as a hospital. It's usually staffed with a physician supervisor and then APRNs and physician's assistants. They're not usually a PCP, although lately I think some have started to become PCPs. That's not something Medicaid is intending to doing. They offer extended hours, are usually open on Saturdays and Sundays, and you can walk in they don't require appointments and be seen at any time for pretty much any any reason
Speaker 33
27:43
they do uh workers comp physicals they do flu and strep tests i've gone for several
covid tests during covid um i've gone because i sprained my ankle so that's what
Representative Richard McGrew
Unverified
27:55
they do okay so in an ideal world uh if a person is ill would it be more advantageous for them to
Representative Lee Johnson
Unverified
28:02
try to go to urgent care or try to go to the emergency room? So we
Chair
Unverified
28:09
would like them to have the option to go into urgent care if, for example, they're experiencing respiratory symptoms and think they might have the flu or strep throat or COVID, but it's not rising to what we would consider to
be an emergency room, you know, something you would want to go to the emergency room. If you're like me, you try to avoid the emergency room. No offense to all our wonderful emergency room physicians out there but I don't like to go it's long wait times and it smells like a hospital and it's just not my favorite place to be so I would prefer to go to urgent care so we want to have that available where it is available for our clients I would go to an emergency room like when my stepdad I'm going to share his story of falling off a 50-foot cliff he clearly needed to go to an emergency room for that so you know I think I think there's some very clear examples
and then there's also what representative Johnson said you have to use sort of a reasonable standard of if I'm sitting at home and my child is sick with 105 degree fever I'm probably going to take my child to an emergency room I'm probably not going to I'm probably going to go straight there you know the monopoly don't pass go do all that stuff don't go you know go directly to jail kind of thing I'm going to the emergency room because it feels like an emergency
Representative Lee Johnson
Unverified
29:20
I appreciate you appreciate you too Dr. Johnson for the work that you're doing in this area thank you all so much for
allowing me to ask the question representative johnson you're recognized
Representative Lee Johnson
Unverified
29:29
thank you mr chairman appreciate the committee's patience with
all the questions i do have a few more so uh when we talk about urgent cares and and i know the department of health's here do we have a sense of how many urgent cares
Speaker 53
29:46
operate in the state and where they operate i do not and i will defer to mr gilmore but i'm not sure urgent cares are
Representative Lee Johnson
Unverified
29:55
licensed as urgent cares can we get the part of health coming
address that please come to the front and identify yourself
Matt Gilmore
Unverified
30:03
Matt Gilmore Hartman Health I apologize I didn't wear a tie today but um to your question uh you're recognized i'm sorry thank you to your question representative johnson uh we don't have a licensure process for urgent care uh clinics facilities whatever
you want to call them uh we do for hospitals with emergency rooms as you well know but it's similar to you know i mean they're not in my mind i kind of liken them to a a physician's uh clinic you know we don't license physicians clinics we don't license pt clinics we don't license um various types we license the provider the health care professional and so if there's issues there we so that's how we would track um but i don't know we have a way to track the number of urgent care clinics either just because of there's not a licensure or registration
process for that but um as far as the oversight it would be through that health care professional but as far as a number, I don't have a number for
Representative Lee Johnson
Unverified
31:13
you. So we do license pharmacies. We do, yes, sir. And so there was a lot of discussion in the last year about pharmacy deserts, correct? But we don't have
any way of knowing whether there are urgent care deserts in our state or not. Not that I'm aware
Matt Gilmore
Unverified
31:25
of. I'm not aware of a process that I've asked around a little bit this morning just checking, but there's not a way for me to get a number for that. I mean, I don't
Representative Lee Johnson
Unverified
31:33
know. I think common sense would tell me as I drive through rural Arkansas
that there's not a lot of urgent cares operating in rural Arkansas. And when you look at a map of Arkansas and you get outside the urban areas, most of the state is rural. And so my concern about limiting this to urgent cares, and again, let me be clear, I support this rule. I think it's the right rule to do. I just want to make sure we're acknowledging that there are places where the only urgent care, in big air quotes, is the emergency department. And we shouldn't be penalizing patients for showing up there.
We shouldn't be penalizing hospitals for, to your point, the Emergency Medical Treatment and Active Labor Act, EMTALA, requires us to see patients at a hospital setting for free. We can't even ask for information. We can't even ask them if they have Medicaid until we have seen them and done a medical screening exam. So we don't even know. Like, we don't even know until after the fact. And a medical screening exam includes EKGs, chest x-rays, lab work, urinalysis, CTs.
I don't know if you're having an emergency until I've ran some tests to find that out. And until I've decided whether you've had a life-threatening emergency or not, anyone that shows up on a hospital campus, we're required to take care of them. And we can't even ask them. And then once we've gone through all that process and we go back in and we say, hey, do you have insurance? Oh,
yeah, I have Medicaid. It's at that point that I have to get a referral from a PCP to say, hey, oh, by the way, I just saw this kid, did a chest x-ray, did bottle signs, did a flu swab, did a strep screen.
They've got an ear infection. I think they need some antibiotics for their ear infection. Can you give me a referral? What if I can't get a hold of that doc? What if it's 2 in the morning? That doc, I know they're supposed to have somebody on call, but I'm just telling you, you can't
always get a hold of these people. What if I get a hold of them and they're like, no, you can't see them. Send them to the clinic. Okay, I'm going to
take this prescription for antibiotics for this kid that I know needs it, and I'm not going to give it to them because I'm going to have to send them to their primary care doctor?
Does that make any sense at all to me? I don't think that makes any sense. That's a rhetorical question. You don't have to answer that. But, like, I don't understand why we've created this process around care management when we've got whole swaths of the state where the only access point is the emergency department. We shouldn't punish the hospitals. We shouldn't punish the patients. We should be able to reimburse for that in a fair mechanism. I don't want to break the bank of the state of Arkansas if there's an outside-the-box way to reimburse for non-emergent problems in the emergency department.
I'm all for that. But I don't have any more questions for Department of Health. That was my main question. know you showed up here and I didn't want you to feel left out so I just want to make the point that while we're looking at this rule and when we're talking about when I have colleagues who you know I appreciate it's a Friday we got a scarce farce turnout I'm grateful for the people be here but when I have colleagues sitting in here talking about patients showing up to the emergency room where they don't need to be and it creating a burden on the system that's
not factual for a lot of Arkansas. There's a lot of hospitals right now in Arkansas. The ones that are converting to rural emergency hospitals, they want these patients. They're happy to take care of them. They're, you know, there's a big difference. And to your point, I appreciate that a lot of hospitals in Arkansas, if you show up, there's going to be a long emergency room wait. That's primarily urban hospitals. If you show up in most of the rural hospitals in Arkansas are seeing 20 or less a day in 24 hours, less than one patient an hour, you're not
going to wait in a rural hospital in Arkansas because there's not a waiting full of people. You're going to just show up and get seen. And so, I don't know, it felt important to me at the time when this rule came up to make this point. I do have more questions, and I'm happy to talk to, let other people chime in. So, the question about auto enrollment so do you have a concern about workforce when it comes to auto enrollment if we have 145,000 arkansans on medicaid who don't have a pcp are there enough pcps to accommodate
145,000 if you yes tomorrow turn around and auto enrolled all those is there capacity on the question
Speaker 9
36:09
we would have to i think analyze that um and just so
Chair
Unverified
36:14
that we're clear um for who can be a PCP in Medicaid, and I know you didn't ask this, but that includes physicians that are pediatricians, family physicians, I believe they're required to be, obstetricians, APRNs, FQHCs, and now we are about to open it up to physician's assistants as well.
So there's a large number of provider types that can be PCPs in Arkansas. I would have to look at exactly how many have full panels already and how many have open slots. That's something, when we decided on the other basis not to look at auto assignment, that's not something we explored further, but it is definitely something to explore before we decided to do that auto assignment. I'm going to go out of
order for a right. I would like to explore that idea. Absolutely. Just for
Senator Fredrick J. Love
Unverified
37:03
the record. Okay. All right. So I guess my question is going to go to Representative Johnson.
So are we not reimbursing when we see patients in the ER? No, we do. Can I make a caveat of that? Yes. If they have a PCP
Representative Lee Johnson
Unverified
37:21
and I don't seek a referral, do you reimburse? We reimburse for the screening, but we
Speaker 15
37:26
would not reimburse for the subsequent care. If I see
Representative Lee Johnson
Unverified
37:30
this kid in this scenario and I diagnose him with an ear infection, that's not a medical screening exam. Right. The medical screening exam is I don't do any treatment by definition.
The only way I can bill for a medical screening exam is say I screened you. It's non-emergent. I'm not treating you. So I take issue with that point because the majority of hospitals in Arkansas are not getting reimbursed for these visits. Okay. So the only way they get reimbursed is if it's the only way they get reimbursed is AFMC reviews them. And if AFMC says it was an emergent condition based on a prudent layperson's assessment, then they call it an emergency and they'll reimburse us without a referral.
If AFMC reviews them and says this was non-emergent, then you don't get reimbursed. I don't get paid. And I've spent a significant portion of my career reviewing AFMC denials and appealing those denials. And I can tell you that I, you know, I take issue with the fact that at AFMC, you've got medical professionals, doctors, nurses, reviewing and assessing prudent layperson perceptions and denying them because a prudent layperson.
Don't tell me that a mom doesn't think it's an emergency when a kid's had a fever for three days. We deny this because the duration of the symptoms has been too long and they could have gone to their primary care doctor and denied. you know and you say well i came in because i thought my kid got bit by a spider i know that that's no big deal i know there's no antivenom for black widow or brown occlus spider bites in our there's no treatment but if you're just a mom at home you don't know that
well i showed up and it was a spider well spider bites on an emergency denied so so like a question that i have of many is like what is the denial rate for emergency department visits for prudent lay person non-emergent and what's the condition which they don't know how many of these these are i don't know that or expect you to have the answers but i'd love to have another committee meeting where we look at the volume of these denials and you bring that data back because i would love to see what i'd love to have afmc here to talk about their process
and how many denials are given and how many
patients seek care in the emergency room and we don't reimburse. We can definitely get
Speaker 41
40:01
you that information and that process. He is right about the process for
Chair
Unverified
40:05
payment, to answer your question. So we pay for the screening. If you do have a PCP and they do not do the referral, we don't pay for that visit if it's not considered emergent. If we treat
Senator Fredrick J. Love
Unverified
40:21
them, it's not a screening. So, just so I can get this clear, for those that have a PCP, you
will reimburse for, but for those that do not have a PCP.
Representative Lee Johnson
Unverified
40:30
That's the reverse. Okay. But I want to clarify that. Okay. They'll reimburse if you have a PCP only if I
get a referral. If I don't get a referral, they won't reimburse.
Speaker 48
40:45
For someone without a PCP, we do reimburse.
Chair
Unverified
40:48
Reimburse, okay. But there is a requirement that they help the person get a PCP, and we pay the hospital, I think, $15 to call Connect Care and help that person get a PCP assigned. Again, we probably need to talk about whether that's adequate process or not,
but that's how that works today. For someone that has a PCP assigned, what he is talking about would apply. The
Representative Lee Johnson
Unverified
41:12
only way that we get paid in the emergency department is if we don't get a referral, It goes to AFMC for review. AFMC reviews it. If they say this was not, a prudent layperson wouldn't consider this an emergency, they deny the claim. And I would need, I'm happy to look at that
Chair
Unverified
41:29
particular issue and have more information. If you have specific examples you could send us, I think that would help us.
Representative Lee Johnson
Unverified
41:35
You can talk to any hospital and say, I mean, most of us, most hospitals in the state, like, I'd be curious, hospital association is not here, but like a lot of hospitals, my hospital, I mean, have decided that the referral process is too onerous and we'll just eat the cost because we've already incurred the cost by the time we see them and take care of them. And at this
point, you know, the, the process of trying to what, because a good question is, you know, what do we reimburse to an ER visit? I don't know that off the top of my mind.
And how does that compare to what we reimburse for urgent care? Give me a minute and I'll get that. Ms. Smith has that. I can't even read that without glasses.
Speaker 59
42:36
It might take me a minute, so if you wanted to
Representative Lee Johnson
Unverified
42:41
carry on. It's okay. I have more questions. okay with that uh well
i know listen uh no no you're good i just i've got other members and i know representative johnson you're gonna be on a roll i'm
Representative Lee Johnson
Unverified
42:53
happy to let let me just make it clear i'm happy to let other members talk i'm not leaving here today till i've had a full conversation
because i drove five hours you know round trip on the friday before memorial day and so i'm here
yeah and so i'm happy to like take turns and i want to take turns but don't say hey it's we've been here 40 minutes no no we're going
to be here as long as we need to be here i'm i'm i'm fine with that i just there's some people waiting in the queue and and and i with your extensive knowledge of expertise i just know we can go down a lot of rabbit holes and which we should representative barnes uh
Representative Glenn Barnes
Unverified
43:31
you're recognized thank you chair i have a question when it comes to urgent care and
the emergency room for its prices, the cost? Would it be fair to say normally the emergency room cost is much higher than urgent care? I mean, I don't want to give you exact numbers, but
Chair
Unverified
43:52
yes, we typically see higher costs in an emergency room than in a physician's clinic, which is an urgent care setting. So that is one of the things. It's primarily, though, about access. And I think we are open to the idea of looking at how we could reimburse for non-emergency visits in a hospital that is closer on parity, I guess is the word I'm trying to say, with urgent care clinics in hospitals
Speaker 35
44:18
so that we can create this access that Representative Johnson is talking about.
Representative Glenn Barnes
Unverified
44:23
Okay, follow up. So from a management purpose, the administrative side would be pushing more for urgent care if it's really not an emergency. yes sir we always push for the appropriate level of care
Chair
Unverified
44:36
um where appropriate yes sir and that's in any setting so yes we would always prefer urgent over emergency if that is appropriate yeah okay thank you representative rose you're
recognized thank you mr chairman i want to go back
Representative Ryan A. Rose
Unverified
44:54
to uh a portion of the conversation from just a few minutes ago
uh, we were having a discussion about, uh, the clients being referred to a PCP or getting a PCP. And I can't remember, so I'm not going to quote who, I can't remember which side of the conversation said it, but there was, there was some kind of an understanding, I believe anyway, that in order to have the hospital be reimbursed, they needed to more or less get the client connected with a PCP. Is that accurate? No,
Speaker 6
45:31
sir. There is a separate reimbursement for helping a
client get connected with a PCP.
Chair
Unverified
45:37
We do require that you refer that client to a PCP to get reimbursed, but I don't know that there's a requirement that the client actually
Representative Ryan A. Rose
Unverified
45:49
get the assignment and that
I would have to clarify. So in that same vein, who is technically by rule or by department policy who is responsible for getting these medicaid clients who require a pcp
who's responsible for getting them a pcp so
Chair
Unverified
46:12
to do connect care um it is a phone line i think it used to be operated by the health department but when we rebid it it went to afmc it is a phone line and they they connect individuals with primary care providers who have open positions on their panel. That's who's responsible. So it's the agency's responsibility and we've taken that
Representative Ryan A. Rose
Unverified
46:35
on. So how does the client know that that's supposed to happen?
Speaker 75
46:40
How did they, I mean, they get a packet that tells them that they need a PCP assigned and how to do that. But as Ms.
Chair
Unverified
46:48
Smith said, you know, and as we all know, a lot of people don't, 26-year-olds, as Representative Pilkington said, who don't think they're ever going to need a doctor are probably not going to call that line and get a PCP assigned. So then when they do engage with the health care system, they have a lot of difficulty accessing
Speaker 33
47:04
that care. That's when they then come back. But our welcome packet does tell them that they need
Representative Ryan A. Rose
Unverified
47:10
a PCP assigned and how to get that information and do that. So if I'm understanding
correctly, the process is that once they become a Medicaid client,
They receive a packet, and they need to communicate
Speaker 168
47:22
to AFMC and say, hey, I need a PCP, and then that happens. They can get their
Chair
Unverified
47:29
own PCP, but yes, if they would like assistance, they can use the ConnectCare line to help get a PCP. They can go to their own primary care physician and get on their Medicaid panel. They could walk in, but they can also call our line to know who is available in their area, who's taking clients, that sort of information who sees patients with disabilities or has a Spanish speaking
person on staff that can help them. They have all that
Representative Ryan A. Rose
Unverified
47:57
information. And so, and I'm going to quit, I'm going to stop on this point after this, but what I remember is that there was a significant challenge communicating with Medicaid clients when we began having a conversation about disenrollment three years ago. And I remember, I remember asking then like, How are we communicating this to Medicaid clients? And there was a discussion about a PR campaign and some other things.
What I'm hearing is somewhere between a third to a fourth. I think I heard somebody said 174,000. Somebody else said 145,000, more or less Medicaid clients who require a PCP and don't have one. And I guess my thing is you say we're giving them a packet. Well, for at least 25% to 30% of the time, that's not effective. what are we
going to do about it? Yes, sir, we hear you,
Chair
Unverified
48:48
and we've had concerns around that as well, which is why we've looked at the potential of doing auto assignment,
which was where they would automatically get a PCP assigned. But again, we have to communicate that to them. So as an agency, we are looking at better ways to communicate with our clients. We're targeting specific groups. For example, pregnant women have been a big emphasis. So we're starting some new information campaigns for pregnant women. If these prove to be effective, there are things like text messaging to the women about what services are available, call centers that are available to them throughout the state, things of that nature. It involves focus groups with women to find out things that they think would be beneficial.
So we'll take those things and apply them across all our population groups as we learn. So we're working to make more effective means of communication with our clients. We realize that just mailing packets is not always the best way to do it. Has
Representative Ryan A. Rose
Unverified
49:40
there been any effort to reach out to that 140,000 to 170,000 people and say, hey, you need a PCP? I don't know that there has. Have they had any kind of secondary information delivered to them? I don't know that there has.
Chair
Unverified
49:52
We're happy to explore ways we could do that. That would be more effective than another mailed packet,
Speaker 60
49:57
but I don't know that we have done that, no. Okay, I'm going to hop out. Thanks, Mr. Chair. We also did, as part of the – when we were building out the auto assignment, Um, uh, in our system, we had notices, notices were part of that to say, Hey, you're, you haven't been, you haven't been assigned. Um, we, um, we're about to auto sign you and you have a chance to choose somebody, uh, if you'd like. So that was part of that, that whole process. Representative Beatty, you're recognized.
Representative Howard M. Beaty, Jr.
Unverified
50:31
Thank you, Mr. Chair. Um, not a member of the committee, but, but wanted to come in. heard some discussion today and i want to follow up uh kind of along representative johnson's point i heard you say earlier we could look at some type of reimbursement for the hospitals uh similar to the urgent care he makes a valid point uh once you once you cross that interstate headed south there aren't many urgent cares down in in my neck of the woods in south arkansas and so the the The hospital ER is the resort on weekends or after hours for our citizens to go.
All the hospitals that we have, the ones that we have problems in the state right now, financial strain on the hospitals, my question is, why are you telling me we could look at that? Why haven't you already looked at that? Why don't you already have a plan before us that we could look at that would help these hospitals and address this problem on reimbursement? Why don't we already have that? Are you waiting for the legislature to tell you that you need
Chair
Unverified
51:37
to do that? No, sir. We were not. I was speaking specifically to the urgent care issue that was raised last week.
So we were not aware of that particular concern from Representative Johnson until last week. So we're working on that now. We're aware now. We're working
on that. Yes, sir. Representative B, I think we're going to have a follow-up committee meeting to talk about these issues with the emergency rooms and everything. So just FYI, I don't know if you were here earlier when I think Representative Lee had suggested that idea, and I think we're going to run with that. Sounds good. Thank you, Mr. Chair.
Chair
Unverified
52:05
All right, Representative Johnson, you're recognized again. Thank you, Mr.
Representative Lee Johnson
Unverified
52:12
Chair, and thanks to the committee for the latitude.
And I'll try it like I don't
want to be here for another hour and a half either, committee. But we are here, and we referred this to subcommittee for a reason. We were all here on the day of the Public Health Committee, and we had a relatively short meeting that day. I was happy to have the discussion that day, but if this is the format, then I want to take advantage of that. I do have quite a few questions, and I know that these meetings are recorded, but I'd like to have some data that I don't think you have ready today, and a lot of that is around
145,000, whatever that number is. It would be great to see demographics on
that. What percentage of those people are children versus adults uh what's the age breakdown sure uh are they male or the female what are the demographics what's their backgrounds um and then how long have they been enrolled in medicaid
without a pcp sure have they been in have they been in the medicaid program for five years and they still don't have a pcp how many times have they tried to access the system okay i mean that's important data right if we're sitting here saying that you know if a
if 145,000 Arkansans can only we're saying look the condition for you to access the system is you have you have to have a PCP and the only information we're giving them about how to get a PCP is the initial enrollment packet with the number to call how many times are they butting their head against the wall and how many times are they getting frustrated and show up at the are knowing that we are leveraged and we have to see them right and so you know how many visits
are you know and where are these visits um what is the reimbursement difference between an urgent care visit and an emergency department visit and is there a way to come up with a new definition around how we define emergency department to visit like i'm sure our hospitals like something's better than nothing and and you know the the the 13 15 whatever the dollar amount is there that we're reimbursing for a professional fee for that service if we didn't have to have a pcp referral
to get it because we have to take care of anyway that'd be great so like what is the price difference what are we really saving by not allowing our hospitals to bill for these services especially in rural areas. Is there a way to designate our critical access hospitals and make a difference and say, hey, if you're a critical access hospital, you don't have to get a PCP referral. How many PCPs are taking
Medicaid in the state? So that's knowable, right? So every PCP that
takes Medicaid is enrolled in our PCCM program. Is that correct? Yes, sir. And those people, if i'm correct they get three dollars per member per month for every patient they have whether they see them i understand the intent is to do care coordination but do we have any accountability around care coordination do we know that they're and i'll wait for an answer on that one do we have a system where we can say i mean is the three dollars conditioned on some sort of connection with the patient or do they just get it automatically i believe they just get it
Speaker 75
55:34
automatically to date there is no quality measure associated with that three dollars are pcps capped can we can can
Representative Lee Johnson
Unverified
55:40
they get it can they enroll as many people as they want in pccm they cannot we have a default number that we enter into for them
Chair
Unverified
55:46
they can lower or raise it depending on their own ability to see patient do you know it off the top of your head i think it's two thousand it's i
Speaker 35
55:56
thought that was lower than that but we will get it for you well i
Representative Lee Johnson
Unverified
56:00
guess the point i'm trying to make is is that if there's that there's a finite number of pcps taking
medicaid in arkansas if they're capped at whatever that number is if it's you know 2,000 pcps at 2,000 that's really hard math this time of the day but it you know it we may not have the capacity to
auto enroll 145,000 people because we don't have enough providers but there are sub providers that
are not allowed to cap their Medicaid. Is that correct?
Not allowed to? You mean FQHCs? Yes. My understanding is special equivalent health centers cannot cap their amount of Medicaid.
Representative Lee Johnson
Unverified
56:45
I'd have to check that. That begins to know for the next month. Also a good question. I'll check all of that. I'll check all the cappers. And I'm assuming, like, these questions that I'm asking, they're not rhetorical. No. Like, I want us to have another committee meeting where, and y'all know they're not adversarial. Like, I'm not trying to be a jerk up here. I just think this is, you know, I'll lean over to Representative Rose. I mean, of all the things we've discussed, I knew the answer to all these questions,
except I did not know that there was 145,000 people in Arkansas that didn't have a PCP. Like, that number shocks me. That number shocks me. And so, like, how long have they been waiting? And are we really going to punish them if we don't have enough PCPs? Like, let's not give them four urgent care visits. Let's give them 100. I mean, let's send them to FQHCs. How do we not, how do you say to someone, like, you need blood pressure medicine, but we don't have, we can't give you a PCP. Like, the other question I would have is, how often are people calling Connect
Care and the PCP they're assigned is more than 30 miles from where they live?
Speaker 22
57:49
I don't know the answer to that either. We will get you metrics on all of the PCP caps for different provider types and limits, what
Representative Lee Johnson
Unverified
57:57
we think the capacity is. If you're living in rural Arkansas and we're saying to you the only way you can access the health care system
is if you have a PCP and there's not a PCP within 45 miles of your house, how's that person going to get out health care? And apparently there's 145,000 Arkansans that aren't accessing the system
because we won't let them because they don't have a PCV.
And if the math doesn't work and that's a dead-end game, there's no way to, I mean, how are we going to be so healthier if we can't get people
Speaker 75
58:33
to providers? No, I hear you. We'll come prepared to discuss all of
Representative Lee Johnson
Unverified
58:37
that for the next time. The other question I would have is,
like, When it comes to PCCM and patient-centered medical home, one of the questions that I heard was, I think Representative Springer may have said, why do
we have this set up where you have to call the PCP?
I mean, the spirit of that is this idea that the PCP
is the care coordinator, right? That's the captain of the ship. That's the person that knows what's going on with their
patients. Well, if we're not getting that from the PCP because the PCP has 2,000 Medicaid recipients and can't keep up because the PCP participates in PCCM but doesn't participate in PCMH and doesn't have
any accountability back, like, what's the point? And so how many primary care docs are actually participating in PCMH versus just PCCM?
And of the ones that are participating in PCMH, how many are meeting their metrics, and how many of them are pediatricians, and how many of them are
family practice docs, and how many of them are seeing adults, and what are the criteria for that? And I believe, and this is not a rhetorical question, the Medicaid Sustainability Review report made some recommendations around updating, consolidating our PCMH and PCCM program. Is that correct? Yes, sir, it did. And how much progress have we made on following through with those
Chair
Unverified
1:00:05
recommendations? Well, those were recommendations, so we haven't decided which recommendations to adopt or not in the PCMH program today.
Representative Lee Johnson
Unverified
1:00:11
So I would encourage us, if we're going to have follow-up meetings, to specifically look at that section of the Medicaid Sustainability Review Report and try to dive into, you know, what were these recommendations. We paid a lot of money to GuideHouse to come in and make some recommendations around, you know, creating sustainability, which I think as responsible stewards of the budget, we need to make sure we're doing. um and
so how many of those recommendations have we followed and this is a very specific one you know and this ties into this idea of like how how do people access the system so um i i don't have
any more questions today i would love to have a follow-up meeting and i want to be respectful of everyone's time i i uh i would ask like i would like to have a follow-up meeting yeah i think that'd be beneficial
um but as far as that goes I'm I guess I'm done asking questions today we
will have a follow-up meeting um I'll work with DHS and the committee to find a time that allows you to get the data you need to answer these questions and so I mean I know we've asked
a lot of you today um who would have thought urgent care
Speaker 71
1:01:23
clinics visits would create I did I will make a motion.
Representative Lee Johnson
Unverified
1:01:28
I don't know if we need a motion out of this committee for this rule. I'll ask Caitlin. But I'm perfectly fine taking action on this rule. I would make a motion that we recommend we approve and review this rule and send a recommendation back to the public health committee that, like, I agree. We ought to make it four.
I think the rule is a good rule. I think that we ought to move
forward with that rule. And I would make that motion if that's something we need to do. I don't want
to take your motion at this time because I've got three other people in the queue. And since this is the only item on our
agenda, as soon as we approve or not approve of this, we're done. So I would just, I will take it at the proper time. I appreciate the latitude of
Representative Lee Johnson
Unverified
1:02:11
the chair and the committee, and I don't have any more questions today. Thank you. Representative Barnes,
you're recognized. Yes, if you think it's sure if you would.
Representative Glenn Barnes
Unverified
1:02:21
Can you get us information on, especially those rural areas,
those doctors that are close to them that do not take Medicaid? We can get information on
Speaker 53
1:02:29
who is enrolled as a Medicaid provider, and we can try to get a percentage of
Chair
Unverified
1:02:34
how many physicians. I think we'll have to work with the health department to find out how many physicians are licensed to make sure we get that information. And then we'll slice and dice those metrics
Speaker 35
1:02:43
as best we can and try to provide you that before the next meeting. Yeah,
Representative Glenn Barnes
Unverified
1:02:48
thank you. I think that's important because some doctors have opt out.
There was a small percentage, probably somewhere like 9%, but if that's in our rural area, normally that's the area that's affected by these metrics. I'd like to know that number. Yes,
sir. Thank you. Representative Rose, you're recognized. Thank you, Mr. Chairman.
Representative Ryan A. Rose
Unverified
1:03:09
There was a discussion earlier about the reimbursement difference between, if I understood correctly, urgent care and emergency room. Yes, sir. reimbursement rate, you said you could get that. Were you guys able to get that?
Speaker 60
1:03:22
I'm going to defer to Ms. Smith. Yes. So an emergency room coverage flat fee
Speaker 62
1:03:30
is $51. For non-emergency services in an ER, it's $12. Wait, say that again. $51, it's a flat fee for emergent. And this is not in addition to the treating. You know, there are procedure codes based on what happens to the patient once they're there.
But it's a flat fee for emergent conditions of $51 versus $12 for non-emergencies. Wait, hold on. Sorry. I don't mean to cut
Representative Ryan A. Rose
Unverified
1:04:03
you off because I asked her to repeat it because I'm still wanting to make sure I understand it. You said it's
Speaker 62
1:04:15
$51 for? That is the emergency room coverage condition code, emergency room coverage. And then it's $12 for?
Care at the ER that is considered non-emergent services. So the way we pay hospitals,
Speaker 9
1:04:31
I just want to be clear, is we pay a facility fee and then we pay a professional
Chair
Unverified
1:04:36
fee. So all this is is the facility fee. So I don't want it to come across as that we're paying for an emergency at $51. That's not accurate. They would then bill us for the labs, the tests, and the physician's time on top of that. So before we can answer that, can we review that and get back to you? I just don't want this committee
Speaker 6
1:04:53
to think we're paying emergency rooms $51 when somebody walks in with a heart attack or something of that nature.
Representative Ryan A. Rose
Unverified
1:04:58
That's not accurate. Sure, and I follow that. What I'm still trying to get at was the primary question was the reimbursement rate for an emergency room visit versus an urgent care visit. And that's something we're going to have to get back to. I just, I don't think we have that today. Okay. So can we, can we absolutely have that? In clear language for the lay person, I'm sure Dr. Lee follows all of this very clearly, But for at least me, maybe everybody else on the committee would get it, too.
But at least for me, I'd really like it to be clearly delineated so that we know exactly the difference. Yes, sir. And I understand that it may be reimbursed slightly different because of maybe urgent care does it this way and ER room, emergency room does it this way. I would just like to see that break down. Yes, sir. We'll get you that as best we can. Very clearly. And thank you. And I appreciate that. But I had a follow-up.
I think the follow-up was that you discussed that you were exploring ways to communicate to those 100-some-odd thousand-plus clients who do not have a PCP. Can you, when we have our follow-up meeting, can you share with us the ways that you're contemplating doing that? And then maybe the roadmap for how you can then begin implementing those. Because I'm good with us discussing, hey, we're going to have some ways, but I'd like to know what the ways are and how.
No, I understand. I think Representative Beatty may have made the point. Do you need us to take action and make that happen?
Are you waiting on us? Or can you
Chair
Unverified
1:06:43
do it? And let's figure that out. Yes, sir. We can. And I just want to be clear. We're working on ways to communicate with all 870,000 of our beneficiaries. We feel like we need
Representative Ryan A. Rose
Unverified
1:06:54
to work on that across the board. And I'm more than understanding that
some of this is an individual responsibility. You cannot force people to make good decisions. But for those who are trying to make good decisions, I want to make it available to them in the best way that we can.
Thank you, Mr. Chair. Representative Ferguson, you're recognized. Thank you, Mr. Chair. Just for clarification, would this rule affect individuals? Yes. Right in front of you. Would this rule affect individuals who are in Arkansas Works? I ask that question because some people in Arkansas Works do pay a premium based on certain criteria. So how
Chair
Unverified
1:07:35
does that? So the individuals on Arkansas Works, which is now our home, that are in a qualified health plan,
they get PCPs through their qualified health plan. So what we're talking about today does not impact them. Also, we no longer require premiums on our home. The federal government said we can no longer do that. So they do not pay a premium any longer. They just pay co-pays. Just pay co-pays.
Speaker 208
1:07:56
Yes, sir. So it doesn't affect them at all?
Speaker 33
1:07:59
Not to say it doesn't. This rule does not affect them. They do get a PCP assigned through their qualified health
Speaker 62
1:08:05
plan. All right. Okay, thank you. Just one caveat to that. It does affect people who are in our home who are not in a QHP.
Speaker 60
1:08:13
So medically frail individuals are required to have a PCP. Okay. All right. Thank you. Thank you, Mr.
Representative Joy Springer
Unverified
1:08:24
Chair. Representative Springer, you're recognized. Thank you again, Mr. Chair, for allowing me to participate and answer questions. And thank you all for being here. And thank Dr. Johnson for all those questions that he asked because I was kind of following along with him. I do have one more to add to the data that he requested. Knowing that we have a maternal health problem, another good thing would be how many of those
140,000 persons are women of childbearing age. So we may be able to address that by knowing that and getting them registered for the program way in advance of them having to have problems. Absolutely. We'll get that. All right. Seeing no other
questions, I believe Representative Lee Johnson has something he'd like to say. Yeah. Sorry. Thank you. And I
Representative Lee Johnson
Unverified
1:09:12
want to be considerate of DHS in this process.
Like, I don't want to move this rule forward if you think there's an opportunity to improve the rule before we move it forward this is not an we've used the word emergency a lot this is not an emergency that we get this rule out of this subcommittee if there's benefit in holding the rule and waiting till after the next meeting I'm happy to pull down my motion and we can just hold this rule and we can let the chairs of the public health committee know we're still in the process
of reviewing it would that give y'all more time to look at the rule it would give us more time to
Speaker 9
1:09:48
look at the rule and determine whether or not to pull the rule but i will i will be
Chair
Unverified
1:09:53
again completely transparent if we pull and change the rule we will have to start over with
Representative Lee Johnson
Unverified
1:09:56
public comment i understand that so okay i'm happy to hold my motion if you can commit to not pulling the rule because i'm not ready to say this
isn't the right rule yet because i'm like as it stands i like it send it forward but but if we you know i don't want to miss the opportunity to make it better yeah so so you're pulling
down your motion I'm waiting for them to say
Speaker 137
1:10:23
they're not gonna pull the rule we won't pull the rule in less we've I mean hold
Speaker 105
1:10:33
one let me let me ask it this way miss
Pittman some of the changes and ideas that have been brought up today, we could just require a new rule in addition to we wouldn't necessarily add on to this. Basically, if the urgent care rule passes, it's not like doors close, you can't do anything. That is
Chair
Unverified
1:10:51
accurate. And I do think we need to come back in and clean up the emergent care and walk in clinic
language regardless because that means nothing. So I think that gives us an opportunity to work on some of these other rules as well.
Representative Lee Johnson
Unverified
1:11:04
So I'm willing to pull down my motion and then give them a chance to look at the rule closer if everyone in the committee
is okay with that. Okay. Do I hear any objection from the committee on that? All the senators? Don't hear them? Okay. Yes, Representative Ray, you're
Representative David Ray
Unverified
1:11:25
recognized. Just a question to that, and I would lean on Representative Johnson on this,
but did you get the commitment from them at
Representative Lee Johnson
Unverified
1:11:36
the table that you were looking for? I would say sort of what I heard is, is this rule needs to be cleaned up because we don't have a definition of walking clinic or emergent, the emergency clinic, whatever it says. It's emergent. I did find that out. So this rule needs to be revised to reflect that. Does that revision require a whole new public comment period or is that technical cleanup? That
Speaker 104
1:11:58
revision by itself, I'm not giving the firm legal opinion of it.
In my legal opinion, it's not a substantive change to the
Representative Lee Johnson
Unverified
1:12:07
rule. So, you know, I'm looking for a commitment that I recognize you only need to clean up the rule that you're not going to pull this down and let us start from scratch because this committee may decide that this is the absolute right rule to move forward with. We already have the public comment. You know, I don't want to lose the opportunity to pull trigger on this rule that I think is a good rule. So I understand Secretary Putnam is not here, the governor is not here, you work for people.
Just understand that I think it's my expectation and maybe the expectation of the committee that this rule will not get pulled down until we can meet again. We'll just hold it until the next meeting. Okay, and I would make one request to the chair. You know, I would love to attend the next meeting, how and when that gets scheduled. I have a pretty – my July schedule is a little rough. And so June or August, you know, I don't know how urgently we want to look at this.
I know we were trying to get this on the next ALC. So – but let me – I mean, I've made the commitment to work with DHS and this committee to find a time in which we can meet. So it won't be, you know, the Friday after ALC or something like that. So I'll we can work as the committee to try to find a time that works for y'all. Cause obviously I know you've got a different timeline and things have to go through a certain process. So it's not like you could just show up Monday with, you know, post-it notes on it and it changed. I get that. So we'll, but I will represent Johnson and we will work to make sure that you're able to
attend that meeting. Thank you, Mr. Chairman. Okay. all righty see no other questions I appreciate y'all being here today sorry for for I'm sure this was more than you thought you're gonna get into today on urgent care clinics but I appreciate your your time and I appreciate all the
information you're gonna be providing this committee so I think think we can tell it's gonna be a pretty active subcommittee during the interim so but We're excited to work hand-in-hand with y'all and try to find the best outcome for Arkansans. With that, with no objections, we are adjourned. Thank you.
Agenda
A. Call to Order
B. Department of Human Services (DHS), Division of Medical Services, Discussion and Recommendation of Rule, Urgent Care Clinics [Exhibit B]
C. Other Business
D. Adjournment
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH - HUMAN SERVICES SUBCOMMITTEE - SENATE AND HOUSE, May 23, 2025 | Agenda | 1 | Official source ↗ |
| Exhibit B- Urgent Care Clinics | Exhibit | 20 | Official source ↗ |
Speakers
Representative Aaron Pilkington Chair
Unverified
Chair
Unverified
Speaker 11
Speaker 15
Representative Lee Johnson
Unverified
Senator Fredrick J. Love
Unverified
Speaker 31
Speaker 39
Speaker 33
Speaker 29
Speaker 48
Speaker 9
Speaker 53
Speaker 60
Speaker 62
Speaker 64
Speaker 67
Speaker 19
Representative R. Scott Richardson
Unverified
Speaker 22
Speaker 75
Representative Joy Springer
Unverified
Speaker 52
Speaker 32
Representative Richard McGrew
Unverified
Speaker 109
Matt Gilmore
Unverified
Speaker 41
Speaker 59
Representative Glenn Barnes
Unverified
Speaker 35
Representative Ryan A. Rose
Unverified
Speaker 6
Speaker 168
Representative Howard M. Beaty, Jr.
Unverified
Speaker 71
Representative Kenneth B. Ferguson Chair
Unverified
Speaker 208
Speaker 137
Speaker 105
Representative David Ray
Unverified
Speaker 104