Alzheimer's Disease and Dementia Advisory Council
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Unknown speaker
0:00
Thank you.
Thank you.
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Thank you.
Thank you.
Representative Les Warren
Unverified
3:00
Good morning, good to see everybody here this morning. We'll call this meeting to order, Alzheimer's disease and
dementia advisory council. We're glad to have a meeting and get to dive into some things this morning.
First item, though, we need to get a motion to approve our minutes from the August 12th meeting, which I'm sorry that I had to miss. My wife had a doctor's appointment, and I was her driver. She's not driving yet. So anyway, has anybody, have you had a chance to look at the minutes? Okay. Can I have a motion? Any discussion? Any questions? Corrections? Okay.
Kenya, did you have a question? Oh, okay. All right. We've got a motion. All right. Motion is second. Any discussion? All those in favor, say aye. Any opposed? Same sign. all right motion carries all right uh all right next item item c is a discussion of arkansas state plan
so where's my mr cook there you are do you want to come to the table or you want to just do it from there all right come to the table and introduce yourself and we'll begin our discussion and now everybody should
Speaker 10
5:09
have been handed two handouts the first is are you talking this
Speaker 19
5:36
Oh, I'm sorry. You should have an Exhibit C. All right, Exhibit C, guys. Let's go to that first. David Cook
David Cook
Unverified
5:56
with the Alzheimer's Association and the Director of Government Affairs here at the Arkansas Chapter. So everyone should have Exhibit C. This is the handout that was made available to you at the last meeting.
There was some changes requested because Senator Clint Pinzo was actually referred to as Senior Perez, so I had to change that, so I did get your name corrected. This also reflects the priority areas that we approved in a previous meeting in July, And so the updated state plan priorities that we approved as a council were, again, to advance risk reduction, brain health, early detection, diagnosis.
Again, we singled out the importance of enhancing family caregiver support. And the other two priority areas, again, are ensuring access to diagnostics and treatment as that landscape changes and then supporting access and quality of care. And when we picked these priorities and voted on them, I did preface it by saying we want to make sure our state plan reflects what's happening in the research space. Also shared that we were in a very different place than we were when we wrote the first state plan or the second state plan that was published in 2021.
Now that we have biomarkers and we also have treatments, it's very essential that we make sure our plan is following what's happening in the research space. And so I wanted to make sure that, you know, we just, you had time to review this and make any kind of additions or any suggestions for, or any corrections that you might have seen. But I'll just kind of walk through this really quick. Of course, the beginning is just an executive summary.
And then we get into just the priority areas. I did, on page 7, just talk about some of the things that we improved during the last state plan. We really did a good job collectively just advancing those priorities, and so I appreciate all the work and the support of the council. We made quite a bit of headway, which was different than the first state plan that the state adopted in 2011. And then, of course, there's a membership list there, and then what I have done in this version is to just give the summary areas for each priority area, and so I just kind of gave some background.
I talk about prevalence, and then, of course, the objectives section is left blank for us just to discuss that further today as well. And that's really the gist of this, and so what I would like to ask the council to do is to approve at least this portion of the state plan as written, unless there are amendments or questions or things that you see that might have been omitted that I didn't recognize.
Representative Les Warren
Unverified
9:03
Okay. Does anyone have any questions? okay
uh jody ann hitcher okay where am i missing it oh there you are green there you go david thanks
Speaker 29
9:24
know i ask this question pretty much every time but i'm going to ask it again are you considering or how should we consider making one of the objectives
that insurance companies actually have to pay for the treatments and the therapeutics and the tests that we find that are actually working for the people and and should that be an objective that we consider including in this or should it be education to insurance companies etc as you know with the big changes we're about to have with our home ending at the end of the year and then some other things as we're trying to figure out how we're going to keep our hospital stable and patients with access to care how can we make sure that those insurance companies are pulling their weight by paying for the things that we know our doctors are prescribing for our
David Cook
Unverified
10:09
patients? I really appreciate that question, Jodi-Anne. I think that's exactly an objective that I'm looking for, especially when we look at access to diagnostics and treatment. If someone provides insurance coverage for treatment, but they're not covering diagnostics, that's not adequate treatment. You know, if they're vice versa as well, if they're covering diagnostic tools and not the treatment, then that's not adequate coverage as well. So I think there's a component to educate clinicians. You know, one thing that I did share last month is that we know the Blue Cross and Blue Shield is actually covering one of the treatments and the diagnostic services.
And so I think looking at insurance coverage, public and private payers, making sure there's adequate coverage in place, because that certainly is an access barrier that we're seeing in the state. So, yeah, in the objective section, I think I have one specific to that thought. okay
Representative Les Warren
Unverified
11:05
i'll just i'm going to follow up on that jody and i really appreciate you bringing that up and i don't think this is any surprise to the committee but hospitals are trying to just keep it in the black and we've had a number of hospitals who have shut
down in the last year. And providing care for the state of Arkansas is becoming very difficult. The number one problem is the reimbursement rate in Arkansas is lowest of any state and lower than Puerto Rico. It's insane that we are looking at that. But it is making it extremely difficult for even the best managers to keep hospitals in the black.
Then you have issues like we have drugs that I think are starting to have definite positive results, especially for Alzheimer's, and yet we can't get them approved for patients to take so it may not happen but i appreciate you bringing that up jody m because i'd love that to
be an objective for us because if it's out there we need to at least fight the battle to see what we can do to get it approved uh where insurances take it i and i know the other battle is that insurance rates are just continuing to go up. I know companies are looking at who do we go with? This is the cheapest, but it is thousands more than what we paid last year. So we've got
multi-faceted issues within the healthcare field that we are dealing with across the state, hospitals, doctors. It's getting difficult to attract top-level doctors to our state because they can go across the state line and get paid more. It's hard to compete. So I'd love to see that as an objective,
and thank you. And Dr. Jordan, you have something
Speaker 36
13:45
to share yeah i just i um you've already just mentioned my point of my you mentioned the lack of neurologists i know over here in the conway area it's hard to get in you know you have a person that's experiencing memory problems and just getting to see a neurologist might take six months and given the need for rapid um evaluation in order to be put on some of these medications that's a real access problem so providers the number of providers that can actually give the
medication is part of the access problem but i also concur with the insurance uh issue i was in a support group just last night and a family member was telling me that she has to take her husband off the casu i think it's casunla is how you pronounce it but she's not going to be able to have him take that anymore because of the cost so she was looking at thousands of dollars a month um and that's with insurance so it was reimbursing but it wasn't reimbursing what they needed and so
i concur with that issue of having insurance step up to the plate and pay for these treatments just in terms
David Cook
Unverified
15:01
of a follow-up to that i would draw your attention to page 14 um the second paragraph um it starts with health plans where that was the phrase i was looking for Jody Ann earlier I just I pulled it from our report this year but health plans that cover the medication but not the services need needed to qualify a patient or administer it safely
do not provide meaningful treatment access so that was that was where I tried to highlight that there and to Dr. Jordan's point
I think in addition to the insurance barrier access to to specialists and diagnostics is a challenge. I think with the
diagnostic space evolving so quickly, we're going to move some of these biomarker tests in the primary care. It's very important that PCPs, APRNs, and PAs that are filling that gap
are educated on how to use the diagnostics and when to refer on to a specialist. We just had the FDA approve another blood test for PTAL-217, so now being able to test for amyloid and the tau protein is going to be significant, and that's all great, but there's many reasons why, you know, your tau levels could be elevated or you could have positive for amyloid. You could have a cardiac issue, and tau gets elevated when you have kidney issues, and
so it's very important that doctors understand how to use a blood test and when to refer on because not knowing how to use them is also creating a bottleneck to get into diagnostics. We have some clinicians in the state that, again, I haven't surveyed all of them, but there's three that, you know, are regionally located, all of them facing the same issues, getting a lot of referrals from primary care and realizing that, you know, some of these tests and these patients won't qualify for treatment. And so understanding when to order and when to refer on is another piece of this that we need to kind of look at.
And I think one of the other things that Naomi and I have discussed and I've discussed with others is how do we expand access to treatment sites? And is there some existing infrastructure in the state using hospitals, especially rural hospitals that may have been able to, you know, like in Van Buren County just where I live we we do chemotherapy there well that's an infusion based therapy so why can't that hospital be qualified to you know provide access to those
treatments and will that create some sort of money stream for the rural hospitals that they'll be able to recoup some of those things I mean those are I think the novel ideas that we have to look at here in Arkansas to get creative and that's really been our approach to mitigating
Speaker 40
17:55
this disease here is how do we utilize um our existing infrastructure to
Representative Les Warren
Unverified
18:02
push forward some of these priorities so i will uh follow up uh after dr jordan's comments on objectives should one of
the objectives be to recruit more neurologists to arkansas how is that just And Jodi-Anne may be more
Speaker 42
18:17
qualified to speak to this than me. Go ahead, Jodi-Anne. You see how I punted that over there? I think one of
Speaker 29
18:31
the problems we have with recruitment is, once again, the reimbursement. So you've already said it really well. You can go across state lines. The average discharge patient in Texas, they get $17,000 on the average discharge.
Here in Arkansas, it's $8,800. So when you think about those things, recruiting specialists means you have to be able to cover the cost of the professionals who are taking care of our patients, and that's super, super important. I'll add that premiums that employers pay, to your question earlier, are about the same in Arkansas, Texas, Oklahoma, Missouri, and yet our reimbursement is just significantly lower. So we've got to figure out what that delta is and then use that delta to recruit the professionals who are going to take care of our patients. I think most of you know this, the most expensive
part of a hospital isn't the building. It's the professionals in it who are the healers and the caretakers and so we've got to be able to recruit the best and the brightest and then we also have to work with the medical board to make sure that the credentialing process that then the physicians have to go through is timely enough to that when we recruit the doctors they're in networks in insurance networks and they're in the ability to get privileges inside those hospitals and also to be able to work in the community on their own and get reimbursed for the stuff that they do even
outside of the hospital space so there are a lot of hurdles there I think if you're going to build yourself an objective that you're going to measure you have to take into account what we have control of and what we don't have control of so it might be that your objective is you know to strive toward or identify barriers to the recruitment process versus having the objective being that we have more neurologists actually in the state because I think that's going
Speaker 32
20:13
to be a long-term process that's way more complicated than just what our recommendations
Representative Les Warren
Unverified
20:18
and this state plan can do. The more I dig into this, Jodi Ann, the more I'm realizing that
this is probably going to be a federal issue because we can't fix the reimbursement issue at the state level. The reimbursement issue has got to be fixed at the federal level. And, of course, I would just do a blended reimbursement rate across the country.
But there are some states that would really object to that. But that's too bad because some states are really getting CUSH payments and states like Arkansas are getting really low payments, and that's really sad. The doctors are performing the same procedures and not getting the same reimbursement for those procedures. I don't understand that. But I think that maybe, probably, some of our effort is going to have to be put into advocacy at the federal level.
So, okay. Anybody else have anything on that? Okay. i'm sorry um
Speaker 49
21:39
kimberly kinder um with alzheimer's arkansas but one of the things that i have seen historically is within orthopedics neurology within the pain system advanced practice providers are what fill the gap so orthopedists have enormous loads of patients they cannot see them all but they see them and then they pass them off in a pa or an aprn or someone sees them and pretty
much sees them throughout that cycle after that until they need to follow back up with the actual physician. So what I don't see is any initiative or objective to get APPs to be a big piece of this puzzle. One, they're out there and willing and able to get the training, I think. So part of the difficulty is in enticing a neurologist, especially a geriatric specialized neurologist, to come to the state of Arkansas, but APPs can fill a huge gap
in being able to already be present in Arkansas, residents here, and it would be the training that would be required to get them up to par to be able to fill
Representative Les Warren
Unverified
22:50
that gap. Okay, thank you. Any other comments or questions? Okay, David, do you want
Speaker 53
22:56
to proceed? Yeah, I think that's where my head is too, is
David Cook
Unverified
23:01
at least to help. It doesn't help with access to specialists,
but what can we control? What can we move the needle on? And I think it's really just
making sure those allied health professionals have access to training and how to do a cognitive test, how to use these biomarker tests. And I mean, PCPs have heavy caseloads and they're diverting it out. We've expanded scope here in Arkansas to allow APRNs to fill that. And so education of the paraprofessionals, I think, is critical for us. If they're going to be the front line, many of our patients' first stop is an APR.
And so do they know that they have to have a cognitive test before they order a blood test? And how do you do that and when to refer? I think those are the things where my mind is. If we can help
streamline some of these diagnostics in the PCP space, that will help. But you've got to be able to chew gum and walk at the same time. So you've got the specialist issue, too. I think Arkansas has 56 geriatricians. We're way behind. We need to increase it by 130% by 2035, and I just don't see the path there yet
because you definitely can't legislate more bodies. Okay. Do you feel
Speaker 56
24:10
like you've got enough for your objectives? Well, I think that's a separate discussion that we
David Cook
Unverified
24:19
can get to the objectives because some of the objectives that have been mentioned are included in handout number two, so we can get into that in just a minute. I think our first step is what I would like is I would like to make a motion that we approve
at least the general outline of the state plan as it is written and the objective areas so that at least this piece of the
state plan is approved and we can focus on the objective piece next. Okay.
Representative Les Warren
Unverified
24:50
Do you all have any more questions before we proceed with that?
okay then I will entertain a motion to approve this part of the state plan all right
got a motion have a second all right Jody in all right any discussion
all those in favor say aye aye okay I heard that that's good I was just looking where that came from okay uh any opposed same sign okay motion carries all right so do you want to proceed then with the uh item d if
David Cook
Unverified
25:36
you do have handout one um this is a document that has been um put
together by uh the the bold center of excellence that the Alzheimer's Association has
and the CDC. And this is just a resource about advancing dementia risk reduction for people who are doing state plans. So here's some suggested recommendations that I do encourage you guys to review. I did pull some of these things out and put them into the objective section that you have in handout two. I am not asking for approval of the objectives that are written. I just wanted to give you these as some possibilities for us to get started and what it could look like.
I certainly have other ideas that we could add into that. But just kind of going through these section at a time, we'll start first on risk reduction, brain health, early detection and diagnosis, and also the care planning services. So the first objective, we mentioned some of this in the first state plan or the last state plan, just how do we integrate brain health and risk reduction into some of the chronic disease mitigation that the state's already doing really well
so you don't have to necessarily create a new program or plan. We can integrate some of this messaging into our existing campaigns, and I know that Christy and Naomi have had some conversations about this already, and so I thought that was an important objective. Um, also, um, we continue to use the, the BRFSS, um, CDL and the caregiver modules on a rotating basis, um, that's already embedded at the health department. So I wanted us to continue to do that.
Um, and then how do we use that data to help move forward some of our other priorities as well? So making sure that we, uh, not only collect the data, but we're using it to inform our decisions too. And then the other one is just increasing use of the medical annual wellness visit. When someone's age 65 and they go in every year for their wellness visit, there is a cognitive screening. That's part of that benefit plan. And so making sure we continue to educate consumers about the importance of being proactive in your brain health and your cognition as you age.
But in addition to seniors, we need to take that to people under the age of 65 because we know that, you know, dementia and Alzheimer's is getting diagnosed earlier. And as we get better at diagnosing the disease, we'll see more of those trends continue to follow because we just have so much public health risk here in Arkansas. So prevalence is not going to slow down. And then number four, again, that goes back to just expanding provider education on the importance of early detection, diagnosis, and how do they incorporate brain health into their regular practice.
Based on the science I shared before, there's a lot of things that we know about risk reduction. And so how do we get that into everyday clinical practice as part of a clinician's just, again, they do it. They try to warn their patients all the time to quit smoking, but you can be proactive to increase your brain health as well. So how do we integrate that in the PCP space? And then just ensure that people who have received a dementia diagnosis, they have some care planning services,
and they can get connected to community resources. These, again, are broad enough areas that gives us some flexibility. But just as an example on this last one, one of the ways we're trying to bridge that gap is by establishing these dementia resource centers across the state. One of the things that legislators have asked me for is how do we have a or create a one-stop shop where someone who is preclinical, doesn't have any symptoms, and to the very end of life care can go to get resources and services throughout the continuum of the disease.
And how do we make sure people are referred to specialists? And a referral is good, but how do we close those referral loops and make sure patients have the caregiving services that they need and the care navigation that
they need? Because we say at the Alzheimer's Association all the time, this is a devastating disease, and I don't think anybody should deserve to have to go through it alone. There should be access to
services in these care planning services across the continuum, and so how do we expand that? So these first are just broad enough that, again, gives us flexibility inside,
but happy to take questions on this first section,
see if there's anything that you guys see or notice or other things that we need to be thinking about. Dr. Jordan,
Representative Les Warren
Unverified
30:38
did you have a question? We may have lost connection with her. Okay. All right, so David and I had a visit last night. Did she hear?
Okay. And I'm going to bring
this up because I think it's a good point of discussion for us. I love that we get included in the other diseases, heart disease, diabetes, some other diseases, but I also want to see us get information out that is specific to Alzheimer's. And as I was talking to David last night, you know,
it's been 10 years since I lost my mom to Alzheimer's, but I think there's a lot more out there you know he was talking about how smoking also is a factor with Alzheimer's well I know my mom smoked for 40 years before she had three sons and a husband who dogged her into quitting at about 45 years old so it's the education could still improve out there
As far as everything that we could do, I told David that because of my connection, I have these mind games that I play multiple times a day because I'm trying to make sure I keep the mind sharp. But I want us to be sure that we are getting our own story out there as to, okay, here are things that we can be doing, you know, diet, exercise.
And one thing that he hit me with that it really just hit hard because of having gone through COVID is the interactive part that is so important for keeping you talking to people, doing things with other people. The isolation that we had during COVID and how many kids are just at home in front of a computer.
We've lost so much of the interaction of childhood. And I know that there's still a lot. I'm not saying that's all been lost. But I think there are things that we could be saying and sharing that things can be done to help us avoid Alzheimer's and dementia. Are we really doing everything from childhood forward to make sure we do that?
Get out of your apartment and go interact. So, I don't know if I'm the only one that's, like, thinking, are we really doing everything to get the Alzheimer's story out there? So, am
I the only one? I just think that we
need to make sure we get everything we can be doing to slow this disease down.
let's get our story out there. So, anyway,
I just had to put my two cents in. Any
other comments on that? Yes. Mindy? Let me try that again. How do I go back?
Speaker 68
34:48
okay you're good I wanted to add I believe that it's part of all of our due diligence for the for the people that we have so my members that I have that we put out that message and say we need to generate as much awareness and education as possible so that's something that I realized that my association was probably lacking and that is a new thing that I've incorporated in our administrator program is that we do two hours of dementia training so i want to challenge everyone
to do that to kind of take on that your piece of where you're at and your professionalism that you teach your neighbor what they need to know that's all i wanted to add
Representative Les Warren
Unverified
35:38
thank you that's good information you know we started when when this
committee or council first formed we had this big push about how are we going to get information out to all parts of the state and we had a big
push for uh data uh or sheets to be sent uh so i don't know if we ever really got that information out or
David Cook
Unverified
36:11
a lot of that's happened programmatically just with with non-profits just trying to do work and expand reach across the state just as another comment to what you you said representative warren is i think one of the
things that we we sometimes overlook is that there's still a stigma attached to alzheimer's and dementia. Those are like buzzwords. And I think framing it as being proactive around brain health is a lot less intimidating. And so, I mean, I've been at health fairs before, you know, we've got Alzheimer's Association branded stuff and people will kind of walk past our table and just kind of do an X like, cause nobody wants it. Right. But brain health is a very different
conversation um you know and so how do we you know by raising awareness we reduce stigma and when you reduce stigma people are more proactive to go out and seek help i mean look at what we've done to revolutionize the mental health space over the last 10 or 15 years when i was a kid we didn't talk about depression anxiety we certainly didn't talk about mental health but now it's a it's a pretty normal conversation um we some of you that have been in this room for
a while i may sound like a broken record i've been harping on this but that's one way we we do encourage
people again to just be more proactive around their brain health how do we again reduce the stigma and again do the same thing in mental health and brain health yeah
Speaker 75
37:51
what i meant kenya sure thank you i wonder as it relates to community programs and education what the plans
Speaker 77
37:58
are for translating the the information into marshallese as you know there's a large marshallese population in northwest arkansas and expanding into northeast arkansas and so i wondered if there are plans to translate the information into marshallese i see where it's being translated into spanish language but what about marshallese yeah that thank you for that question
David Cook
Unverified
38:21
um i know i can't speak for others but our association's really made some inroads in the marshallese
community um and what we've been
trying to identify as a marshallese educator that can deliver some of this content because relationships are critical and and not only the marshallese community but even some african-american communities how do you find those champions that can help you know introduce you to that so we've made some inroads um it's just really slow but it's certainly something that we need to think about and and how do we um continue our partnership with you as well to make sure we're getting out to those underserved communities too
but that's something that we we we are definitely working on
Representative Les Warren
Unverified
39:09
all right other questions of david okay
now i don't think this is an action item so um greatly appreciate your work on this and our state plan uh so we
just need to continue to move forward uh is there anything else that you see that needs to be done david
David Cook
Unverified
39:34
oh yeah we still have three more priority
David Cook
Unverified
39:41
well continue on So the enhancing caregiver support, again, I was very moved and proud of our council for singling this out as a single priority in the first state plan. So I thought it should continue in terms of support services that are funded by the state. You know, we do have our 1915 C waivers that provide a variety of services for people with dementia diagnosis.
But we also have a pilot program that is, uh, concluded its fourth year, um, that provides dementia respite, uh, grants, micro grants to family caregivers of individuals with dementia. Um, this has been a very successful program, um, with incredible reach. And I certainly want to give our partners at All Summers Arkansas, uh, a mention just of all the work that they've done to get the grants out. And they've done this without any kind of admin costs recouped.
So they've really taken it out of their own personal budget the last four years. And despite those challenges, I've been able to maintain a 36% rural threshold. So what we told the legislature when we asked for this initial funding is that we would try to target those families who typically fall through the gaps of services. So those are families that maybe make too much to qualify for Medicaid, but not enough to be able to afford the cost of in-home care. And over 94% of our recipients, they fall within those income brackets.
And so we are reaching the people that we promised to reach. We also wanted to make sure that those funds didn't stay concentrated in the urban areas. And so we established a 30% rural threshold. So that means 30% of the funds had to go to rural communities, and we've averaged 34% to 36% over the last four years, or I should say Alzheimer's, Arkansas has averaged that. It is currently being funded by a social services block grant, and so the SSBG funding has traditionally been $200,000.
The future of SSBG is uncertain, and so if that goes away, then so does the program. And when we think about comparing our funding amount with other states, Mississippi funds their grants at $350,000. We were kind of stuck at the $200,000 mark, which was fair for the pilot, I would say that. Kansas appropriated $850,000 annually last year. And then Missouri is kind of an outlier because they do a lot more with their program, but they started with a half a million.
and they're up to $4 million annually now, but theirs also has opened up for other services. What we would like to see in the future of the dementia respite grant, we would like to see an annual appropriation that's adequately funded, and also we would like to give the caregivers a little bit more flexibility in how they spend. We know the majority of our recipients use it specifically for respite, but when you get into the stories of why these people take respite, it's even more heartbreaking. Some of them are, you know, they're just trying to
get a break so they can go to the doctor themselves.
That's a majority of the recipients say that, or they're taking care of other family
duties that they hadn't. But the most impactful, sometimes you're very lucky to work on a policy, and then you can feel the impact right away. It's very rare, but sometimes you do something and you feel it pretty quick. Within the first month of this program being active, we had a woman who was 84 years old come into our
office with her husband, who was obviously in late-stage Alzheimer's, and she told me with tears in her eyes that this is the first time in eight years I've been able to go on a girl's trip with my daughters because of this.
And so it's those kind of people
that we are helping across the state, and so I want you to be mindful of that. We would like to see this become permanent. And again, in terms of flexibility for caregivers, we'd also like them to be able to use some of these funds to be able to pay for some of the other ancillary caregiver expenses. Maybe it's adult diapers. Maybe it's a co-pay for a doctor's visit. And so we just haven't been able to open that up because the funding limit is so low. But we would need more funding to increase even the grand amount to $750.
That would be more help for caregivers and kind of give them a little flexibility. Second to that, again, this is broad, but I would like for us to collectively work with DHS and dementia service coordinator and JSHOP on how do we build more of a comprehensive caregiver support network. So in addition to the RESPIC grant, if we get an application that someone may be Medicaid eligible, how do we push them over to waiver services to make sure this is reserved for that pocket of
family so taking a more comprehensive approach to respite in addition to the funds making sure they have knowledge about support groups and other support services as well
so that's certainly a high priority of of ours at the association and i would expect
Speaker 53
44:59
legislation this next year for that one um i'm comfortable saying that
Speaker 31
45:05
because clint said yes so senator penzo said yes the other again um
David Cook
Unverified
45:12
uh really focusing on caregiver navigation and caregiver supports
um you know some some don't know who
to call and so again that's the important part of i think expanding dementia resource centers and making sure that people know what services are
available to them and also i think some states are also investing in care navigation care navigators one of the the programs we see launching across the states are this role of a dementia care specialist so don't don't confuse it with a dementia services coordinator what the care
specialist does is really just they just help families navigate the health care system they you know, they provide referrals. They make sure those referral loops are closed. They help get them connected to services.
Maybe a family comes in and says, hey, I don't, you know, my husband could stay home, but I need a ramp built. And so who in the area can do that?
And how do you bring people together to provide those, those other ancillary services that are needed?
And then in addition, just expanding access to caregiver education that's more programmatic that the nonprofits are partnering to do, and then expand access to dementia resource centers. We do have a pilot in northwest Arkansas. It is a collaborative effort with the Schmieding Center, which is part of the U.S. Centers on Aging. They were much more equipped than some of the other centers to provide some of these services, So we have launched a dementia resource center.
And so families can come in and have access to some of their education. But any nonprofit or any program that's providing service to aging communities is represented in that resource center. And so if families have a need, they get connected to those services as well. In the Schmieding Center, we do also provide support groups, and they do some caregiver education. some other things as well it is our hope that we expand that model across the
state so that again people have access to these these service points in the support system all right
Speaker 64
47:37
any questions on priority two David I think you're doing well I'm leaving out anything you don't have
David Cook
Unverified
47:48
to answer today that's why I I wanted to give you some runway to think about these things in the
Representative Les Warren
Unverified
47:54
next couple weeks. Well, you definitely got Clint and me thinking.
I'm sorry. I said you definitely got Clint and me
David Cook
Unverified
48:04
going. I should have said Senator Penzo. I apologize for that. Good. Priority number
three, this goes back to ensuring access to not only treatments but diagnostics. So I think one of the things we need to continue to review how Medicaid's, you know, the state benefits plan, commercial providers, how are they providing coverage for diagnostics and treatments, not just the treatments, but also the diagnostic services.
Just on that note, we did have legislation last session to require the State Employee Benefits Division to cover FDA-approved treatments, and we're able to get it through one chamber. We couldn't get it through the next, but the goal of that was just making sure that our state employees had access to treatment. It's covered on the Medicaid portion, but not on the state employee benefits. So one
of the asks I do have outstanding to the benefits division is whether or not the coverage determination that was made by Blue Cross
and Blue Shield has impact on state employees.
Because it's a medical benefit, they are still trying to find that answer for me. But that's something I'm interested in. We should be interested in looking at as well. And this really gets to the heartbeat of Jody Ann's question, making sure that there's adequate coverage. If you have coverage to treatment but not diagnostics, you don't have adequate coverage. One example of that is our state Medicaid program. Medicaid, because of the CMS ruling, has to cover treatments,
FDA-approved treatments, but our Medicaid program does not currently cover diagnostics.
The Medicare billing code also exists in the Medicaid space, and that would give people under the age of 65 access to cognitive screening and also care planning services. And so
diagnostics is really not adequately covered under Medicaid at this time, but treatments are. And so that's really an example of one payer that is not really providing sufficient access. Just continue to address some of the inconsistent coverage of the FDA-approved amyloid therapies
that we're seeing across Arkansas payers. trying to expand access to rural access to cognitive evaluation through telehealth, provider support and referral networks. I made that broad, but what I'm really getting at here is we've talked about establishing something like memory net so that physicians in rural areas have access to specialists. Similar to what we have done in stroke, we've done a really good job in the state to mitigate stroke. And so why can't we take that model and apply it to our space and create more of a memory network so these clinicians have access to education and guidance and support, whether it's diagnosing a case or trying to figure out how to use the biomarker testing.
This model has been very successful in states like Georgia. They've had
theirs for a while. It is a long-term goal for the state, something that we should look at. during the next version of the
state plan. Again, education of PCPs, the paraprofessionals. I think this gets to what Kimberly had mentioned a moment ago, just making sure that these paraprofessionals understand how to use a blood test.
And then I think more of a study on our part was just really try to map out where access to
PET is currently here in Arkansas. I am really excited to share with you pet imaging is expanding
here in the state. Eli Lilly is now manufacturing, I can't even remember the name of it. But anyways,
the dye, the tracer dye starts with an A that they use for amyloid pets. So now that it's being manufactured in the state, that increases access
to pet that we didn't have before.
And then also try to figure out where MRI monitoring is, where the infusion services are. And so this is something that the dementia coordinator, Naomi, is starting to collect in her shop. And so I think a larger study just to be able to see where those access points are will help us see where the gaps are and how do we use some of the existing infrastructure to cover some of those gaps. And then making sure that, again, our residents in the state understand, you know, the benefits of treatment
but also the risk associated with that because there are some risk. But, again, we feel really confident about the clinical protocols that are in place to screen patients that may have a higher
risk of developing ARIA or brain bleeds on treatment. So we feel
really comfortable how clinicians are screening that. What is happening in the space now that is probably going to change the way treatments are prescribed, There is some clinical trials happening now that will allow us to, or now clinicians, to biologically stage Alzheimer's disease.
And so you get into stage one or stage two. If you can biologically stage the disease, then you can figure out which patients you should target and get on treatment quicker and who's going to have the higher success rate. so research is changing every day that's going to also impact all these priorities but especially priority number three so as we look at these it's important to keep them broad enough that gives us flexibility over the next four years and
with that I'm happy to take questions on
Representative Les Warren
Unverified
54:05
priority number three. All right. Do we have any? Oh, I know we do. Uh, Dr. Jordan, do you have a question? No. Oh, okay. I thought you did. I'm sorry. Okay. Does anybody else have a question
on priority three? Okay. Continue on to priority four. Priority four is very
David Cook
Unverified
54:35
similar to one of the priorities we had in the first or the last state plan. And so just supporting access and quality of care. I would really like us as a council to try to figure out a way to evaluate some of the dementia training standards that we've put
in place we've changed dementia training standards for home care providers for assisted livings for memory care and so I'm trying to
figure out and would love the council's support on just studying what
the impact has been on quality of cares there's quality improvements with the training we do hear from providers quite frequently about implementation challenges they've had, and so we've, as the association, have tried to provide some no-cost training to satisfy some of these requirements. And so now I think just spending some time evaluating what impact it's had across the state.
There is a gap in the home care space that I think I didn't address in this objective section, but it's something that we need to consider. One of the gaps that does concern me is that on the home care space, the dementia training requirements that we've passed through statute, they only apply to those providers in the state that are required to have a license. And right now, the way that Arkansas statute is written,
only providers who accept Medicaid are required to be licensed in the state of Arkansas. And that does concern me because we talk quite often about the importance of protecting the border. And I don't think there's a border that's more sacred than the threshold of our homes when we let somebody come in and care for our loved ones, especially vulnerable adults. So that's something that we need to think about cleaning up as well. because the private pay folks aren't required to have their folks trained
and not subject to the same screening that the Medicaid providers who have to have a license are. So I think the playing field should be leveled there. Again, this gets back to strengthening recruitment, training, and retention of direct care workforce, certain people with dementia, so from, you know, CNAs all the way up to the specialist. We've already shared about the challenges that are involved in that. Again, how do we improve care coordination and information when an individual is transferred between care settings?
So especially if they're institutionalized and are having to transfer for behaviors, how do we protect that patient and resident, making sure that it's not something that keeps them from getting placed somewhere else? And so continuing to work with the Ombudsman Office just to make sure that there's some care coordination in place. And I think you guys could be a really great ally in that because of the stories that they see. And then how do we strengthen protections of Arkansans with dementia from abuse, neglect, and financial exploitation?
The Attorney General's Office has done a lot to push some legislation. You know, Representative Wing a few sessions ago enhanced some protections for aging and those who are diagnosed with dementia. And so making sure that the vulnerable folks are protected from the different types of exploitation that happens. I think also looking at expanding HCBS services, whether that's increasing reimbursement rates on the HCBS side or just making sure that there's access points for home and community-based services
that empower families to make care decisions and may prevent premature placement and long-term care. And then just ensure that, you know, on the first responder side, they're prepared to serve individuals with dementia. And so when we think about crisis management, how do we make sure our first responders are trained? The UAMS Centers on Aging and Dr. Irvin McCoy has done a really good job of training some of these first responders in terms of how to address wondering issues and has a really amazing program, training program that I would love for her to share at some point just so you can see what content they are getting.
Um, they're actually able to do, um, virtual reality scenarios, uh, just like regular law enforcement. And I think
that's, that's going to pay huge dividends. Um, as we've, uh, again, increased, um, dementia training standards for our law enforcement personnel and first responders
here, um, interested to also look at the impact that that's
Representative Les Warren
Unverified
59:39
making across the state. Okay, any questions, David, on priority four?
Okay, now maybe I can say you're through. Yes, I am through without any
questions. Yes, sir. Well, now let me say we appreciate the entire report and your work on the plan. So does any action need
David Cook
Unverified
1:00:06
to be taken on this? Not today. I wouldn't really just ask the council members. Um, and with your permission, Brandon, to email this out to the council members who weren't able to attend a day, um, and ask for their, their
feedback ahead of the next meeting. So we can think about approval. Again, these are very broad. Um, there's some other specific ones that I would like to include in a future report. Um, and, but these are again, broad enough for us to, and measurable as well. I tried to make a measurable to
you as well um i would actually specifically ask you guys to look at the partner list because i just kind of um pulled the likely partners that could help move some of these things
Representative Les Warren
Unverified
1:00:49
forward too as well so okay no other questions thank you very much
david all right so that takes us to
item D which is a discussion of legislative changes to the
existing statute which that was something that I brought up I wanted to see who all was actually taking part in our council and if we had people who were not so what I want to do is go through our list and I'm just going to go through and give me your feedback i know rachel bunch has been involved uh kimberly kinder
is she involved okay that's you okay that's what i thought i didn't check you off though okay david christopher mccoy he's been involved he's
David Cook
Unverified
1:01:50
not here today is he Coy satisfies AARP's slot on the board.
And I know he works out of state, but I have contacted him trying to get him to engage.
But he does fill that role for AARP.
Speaker 18
1:02:23
sir. Okay. Okay. Okay. Kenya, Jodianne, Gohar, Azhar,
Representative Les Warren
Unverified
1:02:29
Doctor. He's, okay. All right. Jennifer Hallam. Okay.
Speaker 14
1:02:36
All right. Toots Lamberth. Anybody know Toots? do we know if toots has attended a meeting
Representative Les Warren
Unverified
1:02:53
none okay that's what i'm wanting to find out oh david sorry okay i know dr genie way
amy lee we're good dr sue
griffin does anyone know dr. Sue Griffin yes
Speaker 93
1:03:21
sir I do she is a dementia Alzheimer's researcher at UMS okay so it's we know if she's been here she has but it has been a while okay so we
Speaker 65
1:03:33
need to give her okay I can just make a call
Representative Les Warren
Unverified
1:03:43
All right, thank you. Carrie Jordan, Christy Sellers, Jay Hill, Mindy Brigance, Tatum O&B, Charlotte. Okay, Naomi Atkinson. Okay, that's good. We just
have a couple. i actually visited with someone on the broils foundation they act like they want to get
involved so i've got one person we've got a group at baptist they have a an alzheimer's dementia division dr davis would like to uh join us i know he's from russell uh and you speak very highly of him uh so i'm just looking for if someone's not going to be involved i'd like for us to tweak
the legislation to make it where we can get people who are involved uh because i don't want a wasted spot on this. So if you have anybody else that you think would be a good contributor to this, please let me know. But I am going to look to try and add someone from
the Baptist uh program uh to our council so
okay so rachel is watching online rachel um i hear you so dr jordan would you like to say something what about the dementia care coordinator for the state
who is that um david can you tell me who
Speaker 99
1:05:39
the she's here okay and i'd like to just apologize that i
Speaker 36
1:05:54
have not been able i came down to hot springs but i thought the meeting was at one last week so i apologize for missing that meeting last last month well no problem i hope i will be coming i I will be coming in person from now on as best I can. Well, you're
Speaker 59
1:06:11
here today, and we appreciate that, and we'll look forward to having you here. I hope you enjoyed Hot Springs last week anyway. All right.
Speaker 103
1:06:20
Anybody else? It was kind of a shock when I went down there. It was like, where is everybody?
Representative Les Warren
Unverified
1:06:25
But anyway. Okay. All right. Any other comments
on that? I'll work with Clint, and we'll see what we can get done in the legislative session. That should
be a pretty easy tweak if we need to do something there. So, okay,
let's talk about future agenda items and meeting dates. I know that we need to, our deadline for our report is due October 1st,
So we'll need to have one more meeting before October 1st so that we can get the report voted out, approved. So what does, I guess, September look like for everybody? Y'all want to meet toward the end of September? Last week of September, how does that look for everyone?
Speaker 107
1:07:28
okay so when is ALC week so give me the dates that are open that
Speaker 108
1:07:53
last week We're working on it.
Hold on one sec. So
Speaker 106
1:08:14
that would be AOC week. The week of the 21st through
Representative Les Warren
Unverified
1:08:28
the 25th, what does that look like for everyone?
Today's a Tuesday. Do you want to do it on the September 22nd? Does that work for everybody?
10 a.m.? Okay, let's just aim for August 20, I mean, I'm sorry, September 22nd at 10 a.m. Back here. All right. What about agenda items?
Speaker 73
1:09:10
Anybody got any requests? Mr. Cook? I just think it needs to be state plan heavy because it's, you know, we're up against the deadline of
Representative Les Warren
Unverified
1:09:30
October 1st. my opinion that's good by me uh why don't we just focus on state plan only and we can have a short meeting that's good and if anybody wants to bring up anything else we'll do it okay anything else
Speaker 33
1:09:42
to come before our council if not we stand adjourned thank you for being here Thank you.
Agenda
A. Call to Order
B. Consideration to Approve Minutes from August 12, 2026, Meeting [Exhibit B]
C. Discussion of Arkansas State Plan [Exhibit C]
D. Discussion of Legislative Changes to Existing Statute
E. Discussion of Future Agenda Items and Meeting Dates
F. Other Business
G. Adjournment
Documents
Speakers
Representative Les Warren
Unverified
Speaker 10
Speaker 12
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Speaker 19
David Cook
Unverified
Speaker 27
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Speaker 33