Public Health - Human Services Subcommittee - Senate and House
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- October 2, 2026
I call this meeting to order. Uh, thank you for everyone being here today. We've all got a short agenda today, um, 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, um, Ms. Pittman.
Chair
Unverified
2:51
Oh, sorry. Good morning, Elizabeth Pittman, Division of Medical Services. Um, and we are here today to further discuss the role on urgent care, um, that we attempted to promulgate, I believe, last week. Sorry, I was not able to be here. Uh, 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. Um, 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, um,
by allowing some urgent care visits outside of a PCP referral. I, we did look at whether or not it would uh take away from the PCP relationship. That was not our intent. We still believe that primary care relationship is central to managing good care, uh, which is why we limited it to only 2 visits for those that haven't assigned PCP and 4 for those that don't. Um, we have some other policies in place that ask for hospitals and we can even add urgent care to that to assign PCPs, uh, if a person does not have a PC.
Additionally, we even have some funding for that. Now I know some of that funding may need to be looked at again, but we do pay about 15 $14 to $15 for a hospital to assign a PCP. Uh, if there is not one otherwise assigned. So again, this rule was not about trying to erode that 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, uh, 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. And there were some questions around
Speaker 11
4:32
definitions of urgent. I believe it was emergent clinics and walk-in clinics in our Rules as they were written. Uh, we have gone back and looked at that, and I'm going to be very transparent today. Um, 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 built in our system. We've looked for a 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. Um, walk-in clinics have been billed as a place of service. We've only seen it built though about 30 times in the past 3 years. So it's a pretty minimal, minimally used service. And the primary pillar of that, it turns out, was actually a pharmacy walk-in clinic and they were billing for vaccinations. So
Chair
Unverified
5:20
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 would like me
Speaker 11
5:29
to address about this rule before we get into your questions. Uh, Representative Johnson,
do you have a question? OK, um. If you're OK, Pittman, Mr. Pitman, sorry. You were fine. I'm used to everyone calling me Pitman, so feel free. I'm
Speaker 15
5:45
sorry about that, um, we'll just, we'll start with
questions. Representative Johnson, you're recognized. Thank you, Mr. Chairman. Appreciate, appreciate people being here today. It
Representative Lee Johnson
Unverified
5:57
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. you. 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, um, and I think the
urgent cares provide a good, uh, 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 uh 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 with that referrals for emergency room visits if they don't have a PCP.
Chair
Unverified
7:03
So my understanding is that if they have, do not have a PCP, yes, you can get reimbursed for that. There are some, uh, requirements around making referrals to PCPs after the fact, but
Speaker 11
7:11
there is reimbursement for that, for that visit. So tell me about the, when you say making referrals to PCPs,
Representative Lee Johnson
Unverified
7:16
and I realize you may not 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 a referral later. What, what do
you mean by that? Hold on, hold on for just one
Senator Fredrick J. Love
Unverified
7:33
second, Representative Johnson, I, I wanna, I wanna just be clear, just just for clarification before you
answer that. You continue to say, and, and I heard it the last time we had a meeting, you said emergency. You, you keep saying emergency, yeah, go ahead. OK, but Emerging clinics and emergency. are two different. There, there, there're two different things. And so when you, when you continue to say
emergency, I'm thinking ER. Yeah, you, you're thinking and that's what you need so and uh but urgent care and emergent clinics are not sounds like if I understand right we don't
Representative Lee Johnson
Unverified
8:14
have a definition of emergency clinic. We don't know what
Speaker 33
8:17
that is, correct? We don't have any emergent clinics. I would argue
Senator Fredrick J. Love
Unverified
8:22
that an emergency room is an emergency clinic hold on for a second.
Emergent. You see an emergency. Emergent clinics in urgent. In urgent clinics are
Representative Lee Johnson
Unverified
8:34
synonymous, but I would disagree, Senator, 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, why can't an emergency department be an emergency clinic. We have urge, we have, uh, many emergency departments in the state, we have fast tracks, we have a non-emergent care centers in the, in the ER? No, yeah, I,
Speaker 31
9:01
I, I hear what you're saying, but you're saying emergency clinic. That's what,
Speaker 39
9:04
that's what the rules said. If you read the rule, it
Speaker 11
9:10
says emergency clinic. There is a term emergent clinic in our, in our role. I think it says emergent, but
Chair
Unverified
9:17
it's, 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 roll 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 as that. So we are
Speaker 33
9:36
bringing urgent care clinics, which is a step down from emergency room. OK, all right, so that's,
Senator Fredrick J. Love
Unverified
9:41
I guess when I'm hearing, when I'm hearing you're talking about emergency in, in, and you're talking about urgent care, which is But go ahead, go ahead the latitude of this, and I hope we
Speaker 29
9:51
can have this kind of no no no no because like
Representative Lee Johnson
Unverified
9:53
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,
appreciate the chairs doing that, but like it's geography, there's two issues, right? There's the, the geo
geographic term of emergency department, emergency clinic, urgent care clinic, and then there's like, is the problem and emergency or not, those are, those are two different, different. things, right? So in Arkansas, correct me if I'm wrong, Ms. Pitman, but I, 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 lay person is defined. My understanding is if you're a prudent layperson, it's an average Arkans in 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. We 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 emerging. Is that
Speaker 48
11:26
correct? I also lost my mic. Yes, that is my understanding of the standard now. I've, you know, refer to you as a
Representative Lee Johnson
Unverified
11:31
physician like what I'm getting at is that like, if we're gonna pay
urgent care, which I support, like I support this rule, uh, to be clear, I'm in favor of this rule. Like 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 know, you've tried to get a PCP like one of the questions I have is like, how long does it take for a person
to get assigned a PCP once they start the process. So
Speaker 9
12:04
we don't auto assign PCPs. Uh, we have a phone line, Connectare. I'm not sure the exact time, but you
Chair
Unverified
12:09
can call that phone line at any point and get assigned a PCP, they'll assist you in that. Medicaid recipients
Representative Lee Johnson
Unverified
12:13
in Arkansas don't have a PCP assigned. Of the ones that are required to have an
Speaker 9
12:20
assignment, it's around 145,000 don't have a PCP
Representative Lee Johnson
Unverified
12:23
assigned. That seems like a big number. How many people are on Medicaid in Arkansas? Uh, there
Chair
Unverified
12:31
are about 800 and something,000, but not all eligibility categories are required to have a PCP assigned categories required at PCP.
Representative Lee Johnson
Unverified
12:38
How many have, how many of those people are there? I don't know the total number of
Speaker 53
12:43
that. I can get it for you. Um, we have About 300 and something.
Representative Lee Johnson
Unverified
12:52
So, so, uh, roughly 1/3 of the people 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.
Speaker 48
13:06
Please come to the front and uh introduce yourself and she's worried that she's wearing
Representative Lee Johnson
Unverified
13:09
Friday attire, but I think I've got a V-neck t-shirt from Target. I threw this jacket on out of my car. So it's all good. Um, I'm Neil Smith.
Speaker 60
13:18
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, it's all good. Uh, the question was how many are,
Speaker 62
13:29
have a PCP? My, my question was how many require
Representative Lee Johnson
Unverified
13:33
a PCP eligibility. She said there were 800,000 people on Medicaid, but not all those people require.
Speaker 60
13:40
That's right. And so we have, um, about 140,000 without that require one that don't have one, and we have about 400,000, 392, uh, that have one and should have roughly, so roughly 4th of the
Representative Lee Johnson
Unverified
13:53
people in Arkansas that need a PCP don't have a PCP. 145,000-ish people don't have a PCP. How and, and so how do
those people access the system? How are they? expected to access the system they will if they try
Speaker 64
14:05
to access the systems, let's say they try to go to, um, a
Speaker 60
14:09
specialist, um, the specialist will say you, you'll need to have a PCP referral. And since they don't have one,
Speaker 67
14:16
how do they get that get that assignment? They call Connectare and or they.
Speaker 60
14:24
Yes, and I believe, um, clinics can, can, um, request, uh, 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 that request of a referral. I'll just keep asking
Representative Lee Johnson
Unverified
14:40
questions. Well, I mean, I I I appreciate the discussion and
I did not want to slow you on this, but I do have some other people to queue I'd like to I'll
Speaker 19
14:55
I do have one specific question for the department. OK, I got you. No, I'm just telling you
Representative Lee Johnson
Unverified
14:59
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 let's get, let's get to Representative Richardson next
Representative R. Scott Richardson
Unverified
15:10
and then we'll go back to Representative Johnson. Thank you, Mr. Chair. Thank you, Representative Johnson for letting me speak. Uh, The, so the rule makes sense to me, right? So I understand what you guys are trying to do. And I'm not on Medicare and Medicaid, but I don't have a PCP. I recently had pneumonia
for 2 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 a ton of sense. So I applaud you guys of what you're doing, and I can really appreciate the in-depth that, uh, Doctor Johnson is going in to try to really understand how the, the, the payments are made
back for those individuals on Medicare, um, My big question is, is when you had open public comment. How was that notification granted? I mean, how do, how do people know to come and speak on this or have questions
Speaker 22
16:13
about that. Sure, we follow the state process as required,
Speaker 75
16:15
and 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
16:37
case, um, We, 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 our role 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
Representative R. Scott Richardson
Unverified
17:02
rule though. Yeah, that was, that was my question or concern that people didn't weren't aware to come in and make comments. So thank you for, for your response. Representative Springer, you're recognized. Good
Representative Joy Springer
Unverified
17:13
morning and thank you, Mr. Chair, and I'm happy that I've, I came to this meeting today because I can echo what Representative Richardson has stated a few 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 a a third, you know, someone that I knew that could help me with my, the pain that was in my back, I was told that uh 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, you know, my, my back, so I'm trying to understand why is, why is that, you know, that sort of thing there for me to have to, I have a PCP but yet and still I can't
go to a another person to be cared for. So I I'm, I'm trying to understand the difference here. Sure. So in that case
Speaker 75
18:05
for Arkansas Medicaid, where you have a specialist need. Now, had you fallen off and just needed to go to urgent care. That's
Chair
Unverified
18:11
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. Uh, Medicaid is this rule would allow Medicaid to operate the same way as, 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 programs, so that that PCP really understands everything that's going on with that patient's care at 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 based on the risk of that client. And so we really want them to
Speaker 33
19:12
coordinate that care and really understand what's going on with that patient. Well, thank you. I've had the same PCP for
Representative Joy Springer
Unverified
19:17
years, so almost as old as I am, so you know thank you I appreciate that. So Ms. Pitman, all right, so here we are. Take me kind of
Senator Fredrick J. Love
Unverified
19:35
walk me through the Medicaid patients. So, uh, as of right now, the current rule is that I'm a Medicaid patient. I don't have a PCP. I go to urgent care clinic, I get seen. I can't get seen. So I have to go to an emergency room or go to the emergency room or an urgent care affiliated with
Speaker 52
19:54
a hospital. urgent care affiliated with the hospital,
Senator Fredrick J. Love
Unverified
20:02
so that's, that's the current, so, so really.
That means people are kind of we're. I'm not forcing people to go into the ER. I would say that
Speaker 52
20:16
I think that's, I think what I did say earlier is forcing people to go into the ER and when that's the only thing
Senator Fredrick J. Love
Unverified
20:21
available, that is appropriate, but that's what I was gonna say, so, so when that's when, you know, I guess you get outside of Little Rock or Northwest Arkansas or somewhere like that, you know, you, you might have only the emergency room. Right. OK. So now this rule is going to say, hey, we're going to, if
it's an urgent care available. I'm a Medicaid patient. I can go see. In urgent care without a PCP for a limited number of visits and then
Speaker 52
20:47
we would ask that you have a PCPs is 2. For someone with a
Chair
Unverified
20:53
PCP it's 2 for someone without a PCP it's 4. Got you. 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 and want to preserve
Senator Fredrick J. Love
Unverified
21:20
that. OK, so then why, why were you saying 4 visits instead of just 2. For someone without a PCPC
Speaker 32
21:29
saying that, hey, you know, you're gonna, you know, you can go once, you can go twice anytime any time past too then we originally started with
Chair
Unverified
21:36
just no PCP assigned, you could have up to 4. We added the 2 for
those without a PCP and decided to limit that to 2 instead of making it also 4 because we wanted to preserve that existing relationship. Um, again, you might sprain your ankle or have a cold and need to get in, um, 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, that's how that
Senator Fredrick J. Love
Unverified
22:03
came about and the reasoning why we want to really get to establish, have a patient establish a relationship with the PCP that can follow their care, then what we not, would we
not say that? After the 2nd visit, they need to have a PCP. I mean, wouldn't that be I mean that would be better coordinated and quality of care. If we said, hey, You get 2 visits, you have to have a PCP. Wouldn't it, I mean, No, I do understand, and I mean, I was gonna talk to you
Speaker 48
22:34
guys today and hear what the questions were, um, we may end up actually after we review all
Chair
Unverified
22:39
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, 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 and making changes before. I mean, 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, um, and, 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 4 times. It's like I'm never gonna get a PCP because I can just use the urgent care as much as I want, and we don't want those people, uh, to not get into the system. And then I guess as we kind of had this discussion, and I, 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. I They're not an ability for us to like auto-enroll them with providers. I mean, I know with the passes, 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 patient,
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, uh, I mean, I just feel like that'd be an easier way to kind of get through this. Once again, I like the rule. I, I think it's a good step. I mean, obviously, I think, I mean, Step through a nail, uh, 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 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 like that. So
Chair
Unverified
24:30
please just kind of helped assignments, uh, our system does have the capability. You're absolutely right, to auto assign individuals to a PCP and we have not pulled the trigger on that yet. I don't know that a rule would be required, um, 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 healthcare for whatever reason. Ao 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's seems like a small amount of money, $3 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. Patients so that they do become into the system. I mean, I get it. We don't wanna enroll someone who's maybe living out of state at 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 is just going to a provider who's just sitting back and collecting, um, is, I mean, is that possible? I think that would be
Speaker 48
25:59
possible with the change. Um, I don't know, I think the way the rules written now for that, for PCMH, they're
Chair
Unverified
26:04
obviously requirements to get, you get a basic payment, but then there are requirements on top of that. For PCCM, you, you get that $3 for everybody on your panel. 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. OK, great. I'll bring over some of my colleagues. I think, uh, Representative McGee, you recognized. Oh, sorry, Representative
Allen was first, but he is his button's not on here. I don't I, I am with you. Sorry. Thank you. Thank you
Representative Richard McGrew
Unverified
26:37
for being here this morning. I have a question, uh, can you explain to me? The difference between urgent care in the
Speaker 109
26:45
emergency room? Sure. Um, I will try my
Chair
Unverified
26:48
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, um, my colleague, um, Mr. Gilmore in the back there for exactly what that is, um, but they are also required under Itala, and, and I used to know what that stood for and might know again after we get done talking today. Um, but to treat and to screen and stabilize every patient that walks in the door. Uh, in 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. Uh, they're not usually a PCP although lately, I think some have started to become PCPs. That's not something Medicaid is intending to do. They offer extended hours are usually open on Saturdays and Sundays, and you can walk in, uh, they don't require appointments and be seen at any time for pretty much any, any reason. They do, uh, workers' comp.
Speaker 33
27:48
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 they
Representative Richard McGrew
Unverified
28:00
do. So in an ideal world, uh, if a person is ill, would it be more advantageous for them to try to go
Representative Lee Johnson
Unverified
28:07
to the urgent care, uh try to go to the emergency room. So we would like
Chair
Unverified
28:14
them to have the option to go into urgent care if, for example, they're experiencing respiratory sys 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, you know, something you would want to go to the emergency. I, 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. Um, 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 with my stepdad, I'm going to share his story of falling off a 50 ft 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, 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 gonna 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. I appreciate you too, Doctor Johnson, for the work that you're doing in this area.
Representative Lee Johnson
Unverified
29:28
Thank you all so much for allowing me to ask
a question. Representative Johnson, you're recognized. Thank you Mr. Chairman. I
Representative Lee Johnson
Unverified
29:35
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 here. Do we have a sense of how many urgent cares operate in the state and where they operate. I do
Speaker 53
29:51
not. And I will defer to Mr. Gilmore, but I'm not sure urgent cares are licensed as urgent cares.
Representative Lee Johnson
Unverified
29:58
Could we get the Department of Healthca. Address that. Please come to
the front and uh identify yourself and. Matt Gilmore Hart Health,
Matt Gilmore
Unverified
30:21
I apologize. I didn't wear a tie today, but, uh, um. To your question, uh, 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, uh, we do for hospitals with emergency rooms as you well know, um, 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, A clinic, you know, we don't license physicians clinics, we don't license PT clinics, we don't license, um. various types what we license the provider, the healthcare professional, and so there's
issues there we, so that's how we would track, um, but I don't know that 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 healthcare professional, but as far as the number, I don't, I don't have a number for you. So we do license pharmacies.
Representative Lee Johnson
Unverified
31:18
We do, yes sir. And, and so there's 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 of. There's not a, I, I'm not aware of a
Matt Gilmore
Unverified
31:33
process that I've, I've asked around a little bit this morning just checking, but I don't, there's not a way for me to get
Representative Lee Johnson
Unverified
31:38
a number I don't 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, 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, you know, limiting this to urgent cares. And again, let me be clear, like, 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 in TAA requires us. To see patients at a hospital setting for free. We can't even ask for information. We can't ask them, 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. In 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 vital 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. Oh, what if I get hold of them? They're like, no,
you can't see him, send him to the clinic. OK, I'm gonna take this
prescription for antibiotics for this kid that I know needs it. And I'm not gonna give it to them. Because I'm gonna have to send them to their primary care doctors. 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, I don't understand why we've created this process around care management. When we've got Whole swaths of the state were 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, uh, I don't have any more questions for the Department of Health. That was my main question. I know you showed up here and I didn't want you to feel left out. Yeah 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, I appreciate it's a
Friday. We got a scarce sparse turnout. I'm grateful for the people to 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, 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 gonna be a long emergency room wait. That's primarily urban hospitals. If you show up and I mean most of the rural hospitals in Arkansas are seeing 20 or less a day. In 24 hours, less than 1 patient an hour. You're not gonna wait. In a rural hospital in Arkansas because there's not a wedding full of people. You're gonna just show up and get seen. And so, I don't know, I, I, 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, you know, 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, turn around and auto-enrolled all those? That's an excellent capacity on the system.
Speaker 9
36:13
We would have to, I think, analyze that, um, and just so that
Chair
Unverified
36:19
we're clear um for who can be a PCP and Medicaid, and I know you didn't ask this, but that includes physicians that are pediatricians, family physicians, um, 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 um
PCPs in Arkansas, I would have to look at exactly how many um have full panels already, um, 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 to
order. I would like to explore that idea just for the record, OK. OK All
Senator Fredrick J. Love
Unverified
37:08
right, so, so I, I guess my question to is, is gonna go to. Representative Johnson. So, are
we not reimbursing, are we not reimbursing? When we see Patience in the ER? No, we do. Well, can I make a caveat of that? If they
Representative Lee Johnson
Unverified
37:26
have a PCP and, and I don't seek a referral, do you reimburse? We reimburse for the screening, but
Speaker 15
37:31
not, we would not reimburse for the subsequent see this kid
Representative Lee Johnson
Unverified
37:35
in this scenario, and I diagnosed him with an ear infection. That's not a medical screening exam. The medical screening exam is, I don't do any treatment by definition. The only way I can build for medical
screening exam is say, I screened you, it's non-emergent. I'm not treating you. So I want, I take issue with that point because the majority of hospitals in Arkansas are not getting reimbursed for these visits. OK, so the only way they get reimbursed is if, is the only way to 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 AMC AFMC reviews them and says this was non-emergent. Then you don't get I don't get paid. I 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 of prudent labor. Don't tell me that I'm, that I That a mom doesn't think it's an emergency. When the kids had a fever for 3 days? We deny this because the duration of the symptoms had been too long and they could have gone to their primary care doctor denied. You know, and, and you say, well, I came in because I thought my kid got bit by a spider. I know. That's no big deal. I know there's no end of venom for Black Widow or Brown and spider bites in, there's no treatment.
But if you're just a a mom at home. You don't know that. Well, I showed up and it was a spider. Spider bite's not an emergency, do not. So, so like a question that I have. Of, of many, it's like, what is the denial rate for emergency department visits for prudent layperson non-emergent. And what's the condition which they now 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, you know, how many, how many
patients seek care in emergency room and, and we don't reimburse. We can definitely get you
Speaker 41
40:06
that information in that process. Um, he is right about the process for
Chair
Unverified
40:10
payment. I would, to answer your question. So we pay for the screening, if you do have a PCP and they do not do the referral, um, we, we don't pay for that visit if it's not considered. It's not a screening.
Senator Fredrick J. Love
Unverified
40:26
So, 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 that's the reverse, but I
Representative Lee Johnson
Unverified
40:36
want, I want to clarify that 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. For so for someone
Chair
Unverified
40:53
there is a requirement that they help the
person get a PCP and we pay the hospital, I think $15 to call Connectare and help that person get a PCP assigned, um, 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. Yeah, the only way that
Representative Lee Johnson
Unverified
41:17
we get paid in emergency department is if, is if it gets, if we don't get a Referral, it goes to AFMC for review. A she reviews it, if they say this was not the prudent
layperson wouldn't consider this an emergency. They deny the claim. And I would need, I'm happy to look
Chair
Unverified
41:34
at that 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
41:40
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, 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 and how does that compare to what we reimbursed for
urgent care. Give me a minute and I'll I'll get that. Miss Smith has that.
Representative Lee Johnson
Unverified
42:46
have more questions. I mean, if the committee's OK with that. Uh, well, no,
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 happy to let, let me just
Representative Lee Johnson
Unverified
42:58
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 5 hours, you know,
round trip. On the Friday before Memorial Day. And so I'm here and so, 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. I think we're gonna 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 uh extensive knowledge of expertise. I just know we can go down a lot of rabbit holes and which
Representative Glenn Barnes
Unverified
43:36
we should representative Barnes, uh, you're recognized. Thank you, chair. I have a question. When it comes to urgent care and emergency room. for prices, the cost. Uh,
would it be fair to say normally the emergency room cost is much higher than urgent care. I mean, I don't want to
Chair
Unverified
43:57
give you exact numbers, but 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, um, it's primarily though about access and I think, 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 to pay
on parity, I guess is the word I'm trying to say with urgent care clinics in
Speaker 35
44:23
hospitals so that we can create this access that, that Representative Johnson is
Representative Glenn Barnes
Unverified
44:28
talking about. OK, 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, we always push for the appropriate level
Chair
Unverified
44:41
of care, um, where appropriate. Yes, sir. And that's in any setting. So yes, we would always prefer
urgent over emergency, if that is appropriate. OK.
Thank you. Representative Rose, you'll recognize. Thank you, Mr. Chairman. I
Representative Ryan A. Rose
Unverified
44:59
want to go back 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 gonna 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 the PCP. Is that accurate? No, sir. There is a separate reimbursement
Speaker 6
45:36
for helping a client get connected with a PCP, um, we do require that you refer that client
Chair
Unverified
45:42
to a PCP to get reimbursed, but I don't know that there's a requirement that the client
actually get the assignment, and that I would have
Representative Ryan A. Rose
Unverified
45:54
to clarify. So in that same
vein, uh, 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 we actually have a contract with AFMC to do Connectcare. Um,
Chair
Unverified
46:17
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, and we've taken that on. So How does the client know that that's supposed to
Representative Ryan A. Rose
Unverified
46:40
happen? How did they, we, I mean, they get a packet that tells them
Speaker 75
46:46
that they need a PCP assigned and how to do that, but as Miss
Chair
Unverified
46:51
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 or probably not gonna call that line and get a PCP assigned. Um, so then when they do engage with the healthcare system, they, they have a lot of difficulty accessing that care. That's when
Speaker 33
47:09
they then come back. But our welcome packet does tell them that they need a PCP assigned and how to,
Representative Ryan A. Rose
Unverified
47:15
to get that information. And do that. I'm understanding correctly, the, the process is that
Once they become a Medicaid client. They receive a packet and they need to communicate to AFMC and
Speaker 168
47:27
say, hey, I need a PCP and then that happens. They don't, they can get their own PCP, but
Chair
Unverified
47:34
yes, if they would like assistance, they can use the Connectare 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 um person on staff that can help them. They have all that information.
Representative Ryan A. Rose
Unverified
48:02
And so, and I'm, I'm gonna quit, I'm gonna 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 3 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 1/3 to 14th, I I think I heard somebody said 174,000. Some 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 gonna do about it? Yes, sir.
I, I, we hear you and we've had concerns around that
Chair
Unverified
48:55
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, um, we're targeting specific groups, uh, for example, pregnant women have been a big emphasis. So we're starting some new information campaigns for pregnant women. I, if these proved to be effective, there are things like text messaging to the women about what services are available, uh, call centers. that are available to them throughout the state, things of that nature, um, 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, we're working to make more effective means of communication with our clients. We realize we that just mailing packets is not always the best way to do
Representative Ryan A. Rose
Unverified
49:45
it. Has there been any effort to reach out to that 140 to 170,000 people and say, hey, you need a PCP. Have they had any kind of secondary. Information delivered to them. I don't know that. We're happy to
Chair
Unverified
49:58
explore ways we could do that. That would be more effective than another mailed packet, but, um, I don't know
Speaker 60
50:07
that we have done that, no. OK, I'm gonna hop out. Thanks, Mr. Chair, we'd also did as part of the, um, when we were, um, 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 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 Howard M. Beaty, Jr.
Unverified
50:30
Represented Beatty, you're recognized. Thank you, Mr. Chair. Um, Not a member of the committee, but, but wanted to come in. I heard some of the discussion today, and I want to follow up, uh, kind of along, um, 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 caress down in, in my neck of the woods in
South Arkansas. And so the, the hospital ER is the resort, uh, on, on weekends or after hours, uh, for, for our citizens to go. All the hospitals that, 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. Um, why don't we already have that? Are you waiting for the legislature to tell you that you need to do that. No, sir. Uh, we
Chair
Unverified
51:42
were not, I was speaking specifically to the urgent care issue that was raised last week. So, uh, we were not aware of that particular concern from Representative Johnson until last week. So we're working on that now. We're now we're working on that. Representative
Beatty, I think we're gonna have a follow-up committee meeting to talk about these issues, uh,
with the emergency rooms and, and everything. So just if I don't, I don't know if you were here earlier when I think Representative Lee had suggested that idea and I think we're gonna run with that. Sounds good. Thank you,
Chair
Unverified
52:10
Mr. Chair. All right, Representative Johnson, you're recognized again. Thank you,
Representative Lee Johnson
Unverified
52:17
Mr. Chair and thanks to the committee for the latitude. Um, and I'll try like, I don't want to be here for another hour
and a half either committee. Uh, but I, 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, you know, 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. Um, I do have quite a few questions, and I, I know that these, this, these, uh, your meetings are recorded, um, but I'd like to have some data that I don't think you have ready. Today, um, and a lot of that is around the 145,000 and whatever that number is, um, like it would be great to see demographics on
that. What percentage of those people are children versus adults, uh,
what's the age breakdown? Uh, are they male or they're female? What, what are the demographics, what's their backgrounds, um, and then how
long have they been enrolled in Medicaid without a PCP? Have they been, have they been in the Medicaid program for 5 years and they still don't have a PCP. How many times have they tried to access the system? OK. I mean, that's important data, right? If we're sitting here saying that, you know, if a 145,000 are Kansans 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. Uh How many times are they butting their head against the wall. And how many times are they getting frustrated and to show up at the ER knowing that we are leveraged and we have to see them. Right? And 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 in 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, the. 1315, whatever the dollar amount is there that we're reimbursing for 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 you anyway, it'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. Um How many PCPs? are taking Medicaid in the state. So that's knowable,
right? So we, 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 $3 per member per month. For every patient they have, whether they see him, I understand the intent is to do care coordination, but do we have any accountability around care coordination? Do we know? That there. And I'll, I'll wait for an answer on that one. Do we have a system where we can say, I mean, is the $3 conditioned on some sort of connection with the patient, or did they just get it automatically? Believe it, they just get it automatically today. There is no quality measure
Speaker 75
55:42
associated with that $3. Our PCPs capped? Can we,
Representative Lee Johnson
Unverified
55:45
can, can they get, can they enroll as many people as they want in PCCM? They cannot. We have a default number that we enter
Chair
Unverified
55:51
into for them. They can lower or raise it, depending on their own ability to see I think it's 2000. It's I thought that was lower than that,
Speaker 35
56:01
but we will get it for you. Well, I guess the point I'm trying
Representative Lee Johnson
Unverified
56:05
to make is, is that if there's a, 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, 2000 PCPs at 2000, um, that's really hard math this time of the day, but, but it, you know, it, we may not have the capacity to auto-enroll.
145,000 people because we don't have enough providers are subproviders that are not allowed to cap
their Medicaid. Is that correct? Not allowed to, you mean FQHCs
health centers cannot cap their amount of Medicare I'd have to check that. Um. That
Representative Lee Johnson
Unverified
56:50
also, also a good question. I mean I'll check and I'm assuming like these, these questions that I'm asking, they're not rhetorical. Like, like, I want to have another committee meeting where and 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, of our lean over Representative Rose. I mean, of all the things we've discussed, I knew the answer to all these questions, you said that I did not know.
that there was a 145,000 people in Arkansas 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 gonna punish them if we don't have enough PCPs? Like, let's not give them 4 urgent care visits, let's give them a 100. I mean, let's, let's send them to FQHCs. Let's, you know, 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
Connectcare and The PCP they're assigned is more
than 30 miles from where they live. I don't know the answer to
Speaker 22
57:55
that either. We will get you metrics on all of the PCP caps, um, for a different provider types and limits what we think the
Representative Lee Johnson
Unverified
58:02
capacity is in rural Arkansas, and we're saying to you, the only way you can access the healthcare system is have, if you have a
PCP and there's not a PCP within 45 miles of your house.
How's that person going to get a healthcare? And apparently there's 145,000 Arkansas that Aren't accessing the system because
we won't let them because they don't have a PCP. Um, and if, if it's, if the math, I mean if I'm, if the math doesn't work and there's just not a, that's a. Did in game, there's no way, I mean, how are we gonna Arkansas healthier if we can't get people to providers. No, I hear you. We'll, uh, we'll come prepared to
Speaker 75
58:38
discuss all of that for the next time the other question I would have. It's like how when it comes to
Representative Lee Johnson
Unverified
58:48
PCCM and patient centered home. Uh, one of the questions that I heard was, uh, I think Representative Springer may have said why, why? Did, um You know, why
do we have this set up where you have to call the PCP. I mean, the spirit of that is that the, the, 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 2000 Medicaid recipients and can't keep up because the PCP participation in PCCM but doesn't participate in PCMH and doesn't have any accountability back, like, what's the point? And, 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 the metrics and how many of them
are pediatricians and how many are family practice docs, how many of them machine
adults and do you, what are the criteria
for that? And I, I, you know, I, I believe, and this is not a rhetorical question. The Medicaidanability Review report made some recommendations around updating consolidating our PCMH and PCCM programs. Is that correct? Yes, sir, it did. And how, how much progress have we made on following through with those recommendations, those were recommendations, so we have haven't decided
Chair
Unverified
1:00:10
which recommendations to adopt or not in the PCMH would encourage us if we're gonna have follow-up meetings to
Representative Lee Johnson
Unverified
1:00:16
look at to 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 Godhouse to come in and make some recommendations around, uh, You know Creating sustainability, which I think is 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'm going to be respectful of everyone's time. I, I. Uh I would ask like, I would like to have a follow-up meeting. 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 clinics visits would create.
Speaker 71
1:01:28
I did not do one like I will make a motion that I
Representative Lee Johnson
Unverified
1:01:33
don't know if we need a motion out of this committee for this rule. I'll ask Caitlyn, but, but I, like I'm, I'm perfectly fine taking action on this rule and said I would make a motion that we And we, we, you know, approve and review this rule and send a recommend, recommendation back to the public health committee that.
Like, I agree, we ought to make it 4. I, I think the rule's 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 the time because I've got 3 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 the chair and the
Representative Lee Johnson
Unverified
1:02:16
committee, and I don't have any more questions today. Thank you. Uh, Representative Barnes, you're recognized. Yes, if you
Representative Glenn Barnes
Unverified
1:02:22
thank you chair, if you would. Um, can you get us information on especially those rural areas, uh, those doctors that are
close to them that do not take Medicaid. We can get information on who is enrolled as
Speaker 53
1:02:34
a Medicaid provider, and we can try to get a percentage of how many physicians I
Chair
Unverified
1:02:39
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 as best we can and
Speaker 35
1:02:48
try to provide you that before the next meeting. Thank you. I think
Representative Glenn Barnes
Unverified
1:02:53
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, uh, I'd like to note that number. Yes, sir. Thank you.
Representative Rose, you recognize. Thank you, Mr. Chairman. There was a
Representative Ryan A. Rose
Unverified
1:03:14
discussion earlier about the reimbursement difference between, if I understood correctly, urgent care and emergency room reimbursement, right? You said you could get that. Were you guys able to get that?
Speaker 60
1:03:27
I defer to Miss Smith. Yes, uh, so, a, um, uh, an emergency room coverage, um, flat fee
Speaker 62
1:03:35
is $51 for non-emergency services in an ER it's, it's $12. Wait, say that again. Um, $51. It's a flat fee for a merchant, and this is, this is not, in addition to the, the treating, um, you know, there's, there're procedure codes based on what happens to the patient once
they're there, but, uh, it's a, it's a flat fee for emergent, um, uh, conditions of 51 versus $12 for non-emergency wait hold on, sorry. I don't mean to
Representative Ryan A. Rose
Unverified
1:04:08
cut you off because that's, I asked her to repeat it because I'm still wanting to make sure I understand it. He says it's $51. For
Speaker 62
1:04:20
That is the emergency room coverage, uh, uh, condition code 80, uh, sorry, yeah, emergency
room coverage it's $12 for uh care at the ER that is considered non-emergent services. So the way we pay
Speaker 9
1:04:36
hospitals, I just want to be clear, is we pay a facility fee and then we pay a professional fee. So
Chair
Unverified
1:04:41
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 lab. 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 don't, I, I just don't want this committee to think we're paying emergency rooms $51 when
Speaker 6
1:05:00
somebody walks in with a heart attack or something of that nature. That's not accurate.
Representative Ryan A. Rose
Unverified
1:05:04
I follow that. What I'm still trying to get at was the, the primary question was the reimbursement rate for an emergency room visit versus an urgent care visit. And that's something we're gonna have to get back to. I just, I don't think we have that today. OK, so can we, can we have that. And Clear language for the layperson. I'm sure Doctor Lee
follows all of this very clearly, but for at least me, maybe everybody else on the committee get it too, but at least for me, I'd really like it to be clearly delineated so that we know exactly the difference, and I understand that it may be reimbursed slightly different because of maybe urgent care does it this way, and ER room. Uh, emergency room does it this way. I would just like to see that breakdown. Yes sir, we'll get you that as best we can. Very clearly, uh, and thank you, and I appreciate that. Um, I had a follow up, um,
I, I think the follow up was that you discussed that you were exploring ways to communicate to those. Um, 100 some odd 1000 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, the road map for how you can then begin implementing those cause I, 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. I think Representative Beatty may have made the point. Do you need us to take action to make that happen? Are you waiting
on us or can you do it? And let's
Chair
Unverified
1:06:48
figure that out. Yes sir. We can. And I just want to be clear, we're working on ways to, to communicate with all 870,000 of our beneficiaries. We feel like we need to work on that across
Representative Ryan A. Rose
Unverified
1:06:59
the board. And I'm, and I'm More than understanding that that some of this is
an individual responsibility, right? You cannot force people
to make good decisions. But for those who are trying to make good decisions, I want to make it, you know, available to them in the best way that we can. So, all
right, thank you, thank you, Mr. Chair. Representative Ferguson, you recognize. Thank you Mr. Chair. Uh, just for clarification. With this rule affect individuals, yes, right in front of you. Will this rule affect individuals who are Arkansas works. I asked that question because some people in Arkansas works do pay a premium based on certain criteria. So how does that
Chair
Unverified
1:07:39
So the, the individuals on Arkansas are Arkansas Works, which is now our home, they, uh, 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 AR home at the federal government said we can no longer do that. So they do not pay a premium any longer, they just pay copays and we, yes sir. So it doesn't affect him at all.
Speaker 208
1:08:01
Not to say this world does not affect them. They
Speaker 33
1:08:04
do get a PCP is signed through their qualified health plan. OK, thank you.
Speaker 62
1:08:09
Yeah, I would just 11 caveat to that, it, it does affect, um, people who are in our home, who are not in a QHP so medically frail
Speaker 60
1:08:17
individuals, um, are required to, uh, have a PCP. OK. All right. Thank you. Thank you, Mr. Chair. Representative Springer you recognize? Thank you
Representative Joy Springer
Unverified
1:08:29
again, Mr. Chair, for allowing me to participate and answer questions and thank you all for being here and thank Doctor Johnson for all those questions that he asked because I was kinda following along with
them. I do have one more to add to the data that he requested, you know, knowing that we have the maternal health problem. Another good thing would be how many of those 140,000 persons or women of childbearing, childbearing age, so that may be able, we may be able to. address that by knowing that and and getting them registered for the program where in advance of them having to have problems. Look at that.
All right, uh, see no other questions, I believe Representative Lee Johnson has something he'd like to say. Yeah, sorry,
Representative Lee Johnson
Unverified
1:09:17
thank you, and I, I 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 roll out of the 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
Speaker 9
1:09:52
time to look at the role and determine whether or not to pull the role, but I will, I will be again, completely transparent if
Chair
Unverified
1:09:58
we pull and change the rule, we will have to start over with public comment. OK, I'm happy to
Representative Lee Johnson
Unverified
1:10:01
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, um. So you, so you're pulling down your
Speaker 214
1:10:27
motion I'm waiting for them to say they're not gonna pull the rule.
Speaker 137
1:10:32
We won't pull the rule unless we. Yeah, I mean, hold on. Let me, let, let me ask it
Speaker 105
1:10:38
this way, uh, Ms. Pittman. Some of the changes and ideas
that have been brought up today would not, would, we could just require a new rule 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 accurate and I
Chair
Unverified
1:10:56
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. I'm down motion and
Representative Lee Johnson
Unverified
1:11:09
then give them a chance to look at
the rule closer if, if everyone in the committee is OK with that. OK. Is
that, do I hear any objection from the committee on that? All the senators. Don't here, OK. Yes, Representative Ra recognize just question of that, and I, I would lean on Representative Johnson on this,
Representative David Ray
Unverified
1:11:30
but did you get the commitment from them at the table that you were looking for? order We, we can say sort of what I, what I heard is is this rule
Representative Lee Johnson
Unverified
1:11:44
needs to be cleaned up because we don't have a definition of walk-in clinic or mergent emergency clinic, whatever. 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 clean up. That revision by itself, I'm, I'm not giving the firm legal opinion of it in
Speaker 104
1:12:03
my legal opinion is not a substantive change to the rule, you know, I'm looking for a commitment that I recognize you
Representative Lee Johnson
Unverified
1:12:15
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. It, 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, uh, just to 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. OK, and I would make one request to the chair, um, you know, I, I would love to attend the next meeting, um, how, how and when that gets scheduled, um, I have, I have a. Pretty My July schedule is a little rough, uh, and so June or August, you know, I don't know, I don't know how urgently we want to look, look at this, but I was, I
know we were trying to get this on the next ALC. So, but let me, I mean, I 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 because obviously, I, 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, posted notes on it and it changed. So I, I get that. So we'll, but I will represent John and we will work to make sure that you're able to attend that meeting. Thank you, Mr. Chairman.
All righty, uh, see, no other questions, uh. I appreciate you all being here today. Sorry for, uh, for I'm sure this was more than you thought you're gonna get into today on urgent care clinics, but uh I appreciate your your time and I appreciate um. All the information you're gonna be providing this committee. So, um, I think, I think we can tell it's gonna be a pretty active subcommittee, uh, during the interim. So, but we're excited to work hand in hand with y'all and trying to find the best outcome for Arkansan. So with
Unknown speaker
1:14:27
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 33
Speaker 31
Speaker 39
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 214
Speaker 137
Speaker 105
Representative David Ray
Unverified
Speaker 104