Task Force on Autism
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- October 4, 2026
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0:00
Thank you.
Thank you.
Thank you.
Thank you.
Thank you.
Good morning.
Representative Denise Jones Ennett
Unverified
3:00
All right. Call to order. How are you doing, Senator Boyd? Doing
well. All right. Let's see. Consideration of motion to approve the minutes from June the 4th. Can I get a motion? Can I get a second? Second? All in favor, say yay. Yay. Yeah. All opposed, say no. Okay. Minister, approve. Okay. Next on the agenda, we have Justin Brasher from the Attorney General's office. He's going to update us about the medical fraud investigations dealing with ABA services. Come on up. And can you introduce yourself? Thank you.
Justin Brasher
Unverified
3:56
Justin Brasher: Yes, thank you so much for having me, everyone. My name is Justin Brasher. I'm a senior assistant attorney general with the AG's office and I'm really thankful that you all gave us an opportunity to come here and talk about what we do with Medicaid fraud and we're very appreciative of the work that you all are doing. And you also gave me an opportunity to brag on some of the stuff that we do regarding Medicaid fraud. And then at any point, if you all have questions, I'm more than happy to do the best I can to answer them.
I might not have the answers to everything, in which case I'm more than happy to go back, talk to our people, and then get you an answer afterwards. So the first thing, I'm going to just give a sort of a general overview of how our office handles Medicaid fraud. And then if there's specifics that you all want answers on, I'll do the best to answer that. It's obviously something that our office takes very seriously. Our attorney general was actually down in Washington, D.C. in May at a roundtable that was convened by the White House task force on fraud.
And so we've taken a really forward approach on that. And he is in communication with the individual, Scott Brady, who runs that task force on a regular basis. So we're doing the best we can to leverage federal partnerships as much as possible. We work with federal partners in HSI, which is Homeland Security. We work with DHS. We work with the, or with HHS, I'm sorry. We work with the U.S. Attorney's Office on a lot of these things. What we can do as a state Medicaid fraud control unit,
where we get some of our money from the federal government and then some of our money is state government to fund our investigations and our prosecutions, We can go after the providers. We can't go after the beneficiaries, and that's important. That's the way the law is structured. There is currently a federal legislation that would allow state Medicaid fraud control units to also go after beneficiary fraud. We have signed on to a letter supporting that bill, but currently the way the law is structured, we are allowed to go after providers.
So that's what we do. What we look for is the term is a credible allegation of fraud. That's the terminology. We need a credible allegation of fraud in order to open an investigation. We get those through numerous ways. We have a fraud hotline that people call. I like to say, we like snitches. Go ahead. Call us, and we'll take it from there. We love that sort of information. We're more than happy to investigate it. We also, while we need that credible allegation of fraud, we need some sort of complaint in order to start looking into things.
Unless we have a waiver from the federal government that allows us, if it's through data mining in our collaboration with the state DHS, with human services, we get claim data from them. And so we can take a look at things that stand out that we know couldn't possibly be true. For example, you know, an extreme case, but we've seen things like this, is someone's billed 18-hour days for 30 days in a row, right? And we've had cases like this, and we're like, that can't be right.
And that is the sort of thing, okay, we're going to take a larger look at this. And then when we do that, that involves things like subpoenas for things like bank records, right? Are you making money other ways? You say you're billing 18 hours a day. Are you also, do you also work at the 7-Eleven? Like, if both of those things are happening, something's fishy, right? So things like that, we will subpoena workforce services and get records from them. Again, are they employed somewhere else? We also, we have a team of investigators who do a wonderful job, and they're boots on the ground.
They'll, you know, they'll get a warrant to do it, but they'll observe the house. And they'll be like, hey, you know, is the person actually here? They'll go on people's social media. They'll see what they're posting. You know, they posted that they were at a park at 2 o'clock yesterday, and then the billing says that they were also doing this. So it really is, it can be as elementary as that. We've even used some GPS technology, again, to kind of figure out where people are, again, using the proper warrant process and all of that and subpoenas and all of those things. But those are all techniques that we use once we have that credible allegation of fraud.
We also, again, working with the federal entities is really important. And so we get things referred to us, for example, from the VA. The VA will say, hey, we're seeing VA benefits fraud. And where there's one kind of fraud, there's often other kinds of fraud, too. We'll get that from Medicare, right? The federal Medicare will get in touch with us. And they'll be like, hey, we found Medicare fraud. There's probably Medicaid fraud, too. So those are, again, those sorts of connections are important. And we've been able to work with the U.S. Attorney's Office on prosecutions because what will happen, and I'll talk about in a minute, one of our higher profile cases involving Dr. Brian Hyatt, which I'm sure you all are at least somewhat familiar with.
We've been able to work with the feds, and we have a state-level prosecution, but they've also deputized, made it as a special assistant U.S. attorney, one of our attorneys, so that she's working with them on that federal case as well. And that collaboration, a lot of the evidence that we gathered, the feds have been able to use, and vice versa. That sort of collaboration is really important, and so we thank our partners there at the U.S. attorney's office.
Once we have gathered evidence, right, then we have a choice to make. You can bring a case civilly, you can bring a case criminally, right? And we like to start our cases criminally because there's legal, for lack of a better word, legal procedure involved, but a criminal subpoena can be used in a criminal or a civil case. A civil information gathered from a civil subpoena can't always be used in a criminal case. So you start criminal, and if you don't have the evidence, then you bring it civilly. There are considerations involved when determining whether to bring a case civilly or criminally.
Things like statute of limitations are involved because the statute of limitations differ for a civil or criminal case. And they also differ based on the amount involved, right, because that determines whether it's a misdemeanor. So, for example, criminally, if it's under $2,500, then it's a misdemeanor. If it's $25,000 to $5,000, it's a C felony. If it's 5 to 25, it's a B, and then over 25 is an A. And I apologize if I got my numbers slightly wrong, but I believe that that's it.
So that, again, in the statute of limitations, varies depending on if it's a misdemeanor or if it's felony and those sorts of things. So those are all considerations that go into whether bringing a case civilly or criminally. You also, there's certain penalties that you can put on a civil case, certain restitution you can ask for. You can't necessarily ask for in a criminal case. again there's just procedure involved so those always those are part of the considerations that we have to make the flip side of that is that when an individual gets a criminal conviction for Medicaid fraud they are immediately
they are put on a federal list that they are not allowed to be a provider anymore and that's important there's also statewide it's DHS policy 1088 There's also statewide, and not necessarily a list, but you are kicked off as a provider for violating certain things criminally. And that list, that Venn diagram is not a complete overlap with the federal one. There's certain things, like if you get convicted of a rape in Arkansas, you're also not allowed statewide to be a Medicaid provider, right?
Something like that. So in getting that sort of exclusion criminally is important, but criminal is also higher bar, right? You got to prove beyond a reasonable doubt. Civilly, you only have to prove by a preponderance of evidence. The evidence we colloquially refer to that as 51%, right? So you have to evaluate the evidence that you've got and then make a determination about what the best way to go forward is based on that. So that's just kind of walking through sort of our process.
Some of the things that we see and one of the things that the attorney general wanted to emphasize is there's the big name stuff that gets all the headlines and stuff. Dr. Hyatt, I'm also going to talk about Dr. Schwartz a little bit. That stuff gets in the news or the things we see in Minnesota or Ohio or whatever. Those get the really the big name stuff. But it's important to also focus on the everyday stuff because that also that's still a drain on our system. It's still illegal behavior that affects people in their day-to-day lives.
And it's people who are supposed to be getting real treatment from people that aren't because people are taking advantage of the system. And so we call them impossible hours cases. That's the kind of case we see. And it really is, you know, someone billing 18 hours for 30 days straight, things like that. We also see situations where people will sign up someone else because they can't be the caregiver. So we had a situation where a father couldn't be the caregiver for his disabled son.
So he convinced another one of his sons to sign up to be the caregiver. And then that son wasn't actually providing services at all. And so that ended up with a conviction for both the son and the father because both of them were lying about what they were doing. So those are situations like that. We also have had instances where it's been a company that's been trying to defraud. So one example of that is we call it DME fraud, so medical equipment, right? A big case that we had a couple years back was a company that basically you have ostomy wipes,
which go about not for nine bucks or so a container. And you have baby wipes that go for about a dollar a container, right? The ostomy wipes are a specific sort of thing that you got to use, you know, for a specific sort of care. You had a company that was buying baby wipes for the dollar and then billing Medicaid for the nine dollars for the ostomy wipes. And that's a that's a heck of a margin. I would love any business that could get that sort of margin. And so that that was a big deal. And we went after those people.
And there were certain people that had to pay some money back and are doing, you know, have criminal convictions now because of that. So those are sort of, those are just two examples of the kinds of cases that we see and go after. And I can provide a couple more examples if you want, but that's sort of, you get the idea. A couple of the big name cases, so for example, a quick update on what's going on with Dr. Brian Hyatt, which is, he was the former chair of the Arkansas Medical Board, and then we obtained a large amount of evidence,
And this is really credit to our investigators in our office who did a wonderful job of this, who who found that he was both basically entrapping his patients and not not allowing them to leave as well as, you know, was on billing Medicaid for services that, again, weren't be provided. And we had good video evidence of this. So, yeah. So we, he's currently, what's going on is he has a state court case and a federal court case running concurrently.
The federal case is for kidnapping. The state court case is for Medicaid fraud. He is currently being evaluated whether he is fit to stand trial, right, sort of colloquially we refer to that as like an insanity sort of thing. The more legal term is whether he's fit to stand trial or not. And so that is currently in limbo at the moment. He's changed attorneys a couple times, which has kind of kicked the case out as well. But we're currently working on that. We're working really hard, and we're working with our federal partners, who, again, have been fantastic.
And so we're sharing evidence back and forth as much as we can on that. So that's kind of where that is. We have a hearing coming up where we're going to be addressing more directly the is he fit to stand trial issue. Joseph Schwartz is an individual who, back in 25, pled guilty to Medicaid fraud in an attempt to evade or defeat tax. That was back in April of 25. What happened was he was also sentenced federally. So the state sentence, which was 12 months that he was supposed to serve, was set to run concurrent to his federal sentence.
Then he got pardoned by the federal government. The way a federal pardon works, you're pardoned for your federal charges. You're not pardoned for the state charges. So he was pardoned from the federal charges, our office took it upon ourselves to go back in front of the court and say, okay, he's been pardoned by these federal charges, he still needs to serve his state charges. And we were able to win that, he had to go back and serve another month, then he met his parole requirements, he is currently making restitution payments, however, of about $200,000 a quarter, and he has been making those payments.
So that's money that we're recouping back for the state of Arkansas based on his malfeasance. So, again, I just kind of give that as an overview. That's kind of the 30,000-foot view of what our office does and some examples. And I wanted to close with we have a fraud hotline that anyone can call anonymously if they want and, again, and give us some information that we can take and run with. And that hotline is 1-866-810-0016. And anyone's free to call that.
And believe me, we get plenty of good tips off of that hotline. So with that, free to, I'll take anyone's questions. Like I said, I'll do my best to answer them. And if not, I'll go back and see what the information is and then get back in touch with you. Thank you so much for having
Senator Justin Boyd
Unverified
18:13
me. Thank you. Thank you, Madam Chair. I just thank you for your presentation. This is good. This is helpful. I'm glad to know that we're putting an emphasis on the fraud aspect. of of care um we've all been watching it in the news just wanted to make sure you know you know
this might be more important for medicaid or you know dhs but in 20 august 2026 the federal government did release a toolkit on aba fraud and how to catch and identify and so on and so
Speaker 30
18:39
forth so i just want to make sure you you're aware of that yes
Justin Brasher
Unverified
18:46
and thank you senator and yes we are There have been meetings occurring in our office regarding that toolkit and exactly how to implement that going forward.
ABA is something that we are very much aware of what's going on around there. We, as I'm sure you've heard before, I'm not going to speak to any open investigations that we have. But it is certainly a sort of fraud. And I don't want to besmirch the practice of ABA, which I think is great. But we're certainly aware of the potential for fraud around there. It's been brought to our attention, and we are aware of the toolkit. We've had some meetings about it, about how we're going to go forward
Representative Denise Jones Ennett
Unverified
19:26
implementing some of those things. I have some questions. Yes, absolutely, Representative. Okay, so to piggyback
off of what Senator Boyd mentioned about the toolkit, when you go with the Attorney General and figure out how you're going to implement this, can
Justin Brasher
Unverified
19:47
you keep us updated? on that absolutely not a problem okay yeah to sorry to
Representative Denise Jones Ennett
Unverified
19:51
the extent that i can of course yes okay so here's my question um what safeguards is the office recommending to distinguish fraud
enforcement from access restriction so that tightening oversight does not create service gaps for families who really need the services sure that's a
Justin Brasher
Unverified
20:09
that's a great question and very important and i think one of the the big things we do is because that threshold before we are opening an investigation you need the the allegation of fraud needs to be credible right and i think that's really important our people take that very seriously um so we don't just we're
not just roving around going i think there's something here let's throw the book at them and see what we can do there needs to be something that's a trigger and so even you know i mentioned the fraud hotline we're not going to just again go and throw everything at something just because one person called and said I think my neighbor I don't like my neighbor and they're committing Medicaid fraud we need to see something like uh what we talked about where there's there's claims that are you know impossible or we we've had plenty of situations uh we subpoena records from hospitals right and we look and you build for these five days and that person was in the hospital
those five days that you know again that doesn't line up we need something like that before we're going in so we are not um again we we don't the last thing we want to do is the people who are most vulnerable and are most hurt by this fraud are the last people that we are trying to take away their ability um to get these services that they need so i think that threshold needing that credible allegation of fraud is really important i hope that that answers your question
Representative Denise Jones Ennett
Unverified
21:35
all right do the task force y'all have any questions for him
okay I'd like to recognize representative Clowney she is visiting us from Fayetteville and she has a question for you
Representative Nicole Clowney
Unverified
21:47
I'm sorry thank you madam chair just real quick question are the cases that you just mentioned Medicaid fraud in general or were those ABA cases specifically those are all Medicaid fraud in general okay I just wanted to clarify
Justin Brasher
Unverified
22:00
that thank you absolutely any other questions from
Representative Denise Jones Ennett
Unverified
22:08
the task force all right all right thank you for your
test so much I appreciate it all right next on the agenda we have let's see miss Ms. Dotson?
Rachel Dodson
Unverified
22:50
if you could state your name yes ma'am my name is Rachel Dodson and I have brought with me today Jessica Linehan who is a clinical director at Every Little Step ABA where my daughter receives services all
Speaker 51
23:11
right thank you to begin I would like to tell you all the reason that I'm here and it is for my daughter Ella Grace. Ella Grace is nine years old. There we go. My daughter is
nine years old. She has level three autism and was diagnosed nonverbal in 2022. She also has juvenile idiopathic arthritis, eosophilic esophagitis, which is a chronic and allergic inflammation of the esophagus caused by a buildup of white blood cells. And she suffers from very severe eczema. These medical conditions severely impact her daily quality of life. Ella takes 18 pills or doses of liquid medication a day to remain in medical remission from her JIA, her EOE,
her severe iron deficiency, and eczema. I'm disclosing these things publicly because I want to let you know what Ella needs from us to take care of her, but also Ella is so much more than just her diagnosis. Ella loves singing and swimming and everything Disney. She laughs at her siblings and everybody she is around will tell you she's friendly, she's loving, and she's silly. But she's also impulsive and will follow through with actions before thinking it through.
Because of her behaviors, Ella needs someone to attend to her one-on-one every minute of every day. It's not uncommon for Ella to decide she needs something from the outside refrigerator in our garage and she'll walk out quietly while maybe changing her baby sister's diaper or she may put herself in the shower because she's decided she's ready to be clean and I'm in the laundry room flipping laundry. I have to be able to hear and see her at all times to keep her safe. We rely on
our insurance providers to be able to care for Ella and need insurance to afford all of her medication and provide her with ABA therapy. I'm advocating for change for her on her behalf for how insurance providers communicate with families and how they allow families to participate in their own care and how they determine any child's needs. When Ella was diagnosed with autism in 2022, we were referred to try ABA therapy to help her.
She was in preschool, and her teacher told me that she could not get Ella to participate with the rest of the class, and they allowed her to sit in the window and stare out the window while the other students were being challenged to participate. They simply told me they could not get Ella to join in with her peers. After talking with our ABA provider, they were confident that they could get Ella to join in and be a part of the class instead of just being a bystander. They did help Ella succeed, and I got the amazing opportunity to see her thriving and even walk as a pre-K graduate, which would have been impossible for her the year before.
Then she went to kindergarten, and ABA was not allowed to attend her school at first in her classroom. Her gen ed teacher and her SPED teacher tried to evaluate Ella and knew that they could not get her to show them that she knew the alphabet. I asked if her BCBA and her RBT could come to the classroom and assess her positive reinforcements or use positive reinforcements to assess her because they had worked really well in pre-K. They were allowed to come in and do the assessment, and as a result, Ella was able to show she knew the entire alphabet as well as numbers 1 to 20.
The school had to completely write her IEP because she had met all of her goals in one assessment that was facilitated by ABA. Her team was there and is there as Ella's translators until Ella can communicate for herself, by herself. I'm a teacher. This is
Speaker 56
27:10
my 11th year teaching in the public school system. I've experienced autism outside the realm of being
Speaker 51
27:17
a parent. what I always struggled with as an educator is that I was not always able to communicate with
nonverbal students effectively. I wasn't able to determine what they wanted or what they needed or why they were upset and why they were showing discomfort. Why I have learned, what I have learned through parent trainings with my own child is that the ABA team is able to translate her needs and by showing Ella that she's understood, then in turn the ABA team can show her how to effectively communicate and advocate her needs for herself. I fought tirelessly for Ella Grace to have ABA because her BCBA and her RBTs are her translators.
They do not do the work for Ella, but they give her the ability to communicate with others and help her understand what it is exactly that she is supposed to do in the classroom setting. She is now in a private school because my husband and I felt this was the most appropriate setting for her to receive ABA, OT, and speech. With ABA, Ella has made improvements in several areas of her life. When Ella started school, she was struggling to sit and attend for two minutes.
Now she participates in class for up to 35 minutes. This took from kindergarten to second grade. Ella's ABA goals sometimes take months to years to fully accomplish. it's hard as a parent to accept how long it takes sometimes for your child to successfully achieve a goal but the joy of seeing them do that is unmatched by anything else. Ella can now also tolerate different tasks at the table something that she struggled with at first will listen to multiple instructors and follow one-step directions. At home Ella used to require someone next to her
at all times to stay seated at the table and for someone to physically help her hold utensils to eat. Now she'll sit with us as a family and eat meals using her utensils, and she's able to join into church activities. Ella also previously required someone to take care of all of her hygiene needs by doing them for her or physically helping her. Now Ella can take a shower by listening to verbal cues, using the restroom with assistance in verbal cues. She can brush her teeth,
She can put her clothes on, put her shoes on, which promotes long-term independency and her own dignity. Before ABA, Ella would help herself to anything she wanted, including getting too much food from the fridge or the pantry. Now Ella will come find me and tell me what she wants before she helps herself. Or she may go find her brother and sister and ask them because she knows they'll give her ice cream for breakfast and I will not. Health. When it comes to her health, Ella understands and feels so much more than she can
express. Even with multiple medications she takes,
Speaker 56
30:11
Ella experiences pain and discomfort daily. Sometimes so much that she cries for long periods of time or becomes physically aggressive because she is desperate for health
Speaker 51
30:21
and relief. For us, teaching Ella to recognize how she is feeling is critical for us being able to help her. Now Ella can tell us when she needs eardrops, when she wants a heated blanket for her arthritis, and when she needs medicine generally. This has been huge for helping us to be mindful of not just giving her medicine and seeing if it works,
but rather knowing specifically from her communication what she needs. And so long-term medication management for all diagnosis has improved. Ella's current needs. Ella has shown so much improvement since she started ABA, But we know she has so much more room left to grow and to reach her full potential. At school, we have requested for insurance to allow Ella Grace to have an RBT with her in her current classroom. For us, Ella being able to participate in school and get as much of an education as possible is our top priority.
It's actually listed as a service on her IEP. No teacher can devote all of their time and attention to one student. Having ABA therapists in the classroom to work with Ella one-on-one allows her to participate in ways that a teacher or a paraprofessional who are responsible for an entire class just cannot provide. Recently, outside of ABA therapy, Ella eloped from her classroom and was found in the library near the front of the building, and this is a safety concern.
Speaker 56
31:50
Because of Ella's medical condition, because of Ella's medical comorbidities, she experiences extreme discomfort and will take
Speaker 51
31:57
off all of her clothes regardless of where she is or who she's with. This has happened in her classroom. This has happened while she's been in the van that transports her to school. And she is learning now where she can and cannot take off her clothes and is learning to ask for help when she needs it. But without someone there to stop her while she's learning, Ella's dignity is compromised.
Ella's safety can also be compromised if someone were to take advantage of her, which as a mom is terrifying and a very valid fear for me. At this time, Ella's ABA therapy is working on increasing joint attention, increasing the amount of time she participates in teaching her how to follow more complex instructions. At home, with the help of our BCBA, we are working towards what we can do in home to promote her independence while also keeping her safe.
One of our biggest goals right now is continuing to teach her how to express her wants and widening her vocabulary so she can broaden her world. While she has improved so much from where we started, the garage example I provided shows she still has room for improvement. We want Ella to be confident
Speaker 56
33:12
in coming to us to communicate her needs in order for her to be safe. As for her health concerns, Ella still cannot identify all of her body parts to let us know exactly where she hurts so that we can specifically help and target that medical condition.
Speaker 51
33:29
ABA data allows us to communicate with Ella's doctors in a way that they will actually listen. This has been huge for us to better advocate for her, being able to track how often she hurts herself and specifically where on her body she harms herself, how long she cries, what time of the day she has her behavior episodes, has validated to medical professionals what we are reporting as parents. For instance, Ella pinched her chest for several months. We could not figure out what was
causing this behavior. After speaking with the RBTs and the BCBA, looking over data, we started to consider this was related to her digestive system versus her arthritis. We were able to get her to have a scope done, and we found out that she did indeed have EOE, and the pinching and bruising immediately stopped when she started taking medication. This is the fourth year that Ella Grace has received ABA. Until this year, we've been approved for goals, hours, service
locations that we've requested. She has had ABA in her Pediatric Early Intervention Day program. She's had ABA in kindergarten at her public school. She's had ABA in our home. She's had ABA at our church. She's had ABA at her current school
Speaker 56
34:50
for children with disabilities since May of 2025. In February of this year, we began receiving denials of services for a
Speaker 51
35:00
variety of reasons for the first time. Sometimes goals were not considered medically necessary. For
example, Ella started holding her pills in her mouth and spitting them out when nobody was looking. We didn't figure
Speaker 56
35:12
this out until we found the pills and realized this is why she was suddenly acting like she was in pain. It's because she was. She wasn't taking her medication. I asked my
Speaker 51
35:24
BCBA for help. She created a goal for Ella to learn how to tolerate swallowing pills, swallowing candy that was the same size and shape as her pills during the next authorization insurance sent me
a partial denial letter which included that teaching ellison ella to take medicine and i quote was not medically necessary taking medicine was not medically necessary because it didn't address any of her current challenging behaviors and aba had to agree to stop helping us with this daily debilitating challenge in order for ABA services to continue. Dealing with our insurance providers has become our biggest barrier to helping Ella.
Insurance providers are not good communicators, often sending us the same information they send to ABA professionals, worded in ways that are difficult for us to understand and interpret. Insurance has also changed some of their processes and guidelines in ways that have made it more difficult for us to get services that ella needs it used to be will the school let aba the aba provider come in and now it's become will insurance let us continue having aba i would like to tell you about our most recent instant recent experience with insurance to give
you a glimpse into what this process has been like for me as a parent on july 28 the insurance coordinator for our current ABA therapy provider called our insurance Blue Cross Blue Shield specifically a department within Blue Cross Blue Shield called Lucid they deal with ABA services and coordinate with ABA providers the call was made concerning Ella's continuing authorization for treatment and our clinical insurance coordinator was notified at that time that
Ella's plan was scheduled for physician's review on July 30th, which was two days after being notified. I was not informed of this review by my insurance company. My ABA insurance coordinator was told having Ella's BCBA, and I quote, was optional. She was optional to be a part of the physician's review. The day of the call, the insurance coordinator asked if I as Ella's caregiver could be a part of the call, and she was informed that caretakers were not typically
invited to these calls, and I would be informed of the decision 24 hours after it was made. I was not able to speak to my child's needs or advocate for her during this call. On July 30th, the decision was made to reduce Ella's therapy hours to 25 hours a week. I was not given this determination notice of determination by lucid when i called lucid myself four days later the bcba that determined ella's plan should be under physician's review told me after reading her plan
she determined that multiple goals in ella's plan um for instance showing aggression chewing inedible objects eloping disrobing etc all these behaviors went down so she didn't need as intense therapy. I argued with the BCBA that the reason there was a decrease in frequency was because of ABA intervention. I argued one time eloping could be fatal. At the end of the school year, as I mentioned, Ella walked out of her classroom and she ended up in the library that has a direct
door access to the parking lot. Again, as a mom, this is terrifying. She needs support constantly to be able to discern what is safe and not safe until she can independently do this on her own she has to have support in regards to decrease in chewing inedible objects we did up in the emergency room a few years ago because she swallowed a quarter again another instance had it been
Speaker 56
39:18
a battery could have been fatal so even though the frequency is going down
the severity of what she's doing is still a safety concern ella attends school
Speaker 51
39:32
for 37.5 hours a week we requested for ella to receive 34 hours a week of aba therapy to support her during school and allow her to have speech and occupational therapy she was approved for 25 hours citing that anything more was not medically necessary because her challenging behaviors had reduced from where they started my bcba was told you can make
progress with less intense services. My BCBA was also told if we see regression, we can include data in a new request for additional hours. According to the Council of Autism Service Providers in their guideline for the treatment of ASD, evidence of failure at a lower level of service intensity should not be required to access higher intensity of care. Ella shouldn't have to fail for us to meet her where she's at. Ella received a psych evaluation in kindergarten that
Speaker 56
40:28
she was that was inconclusive because she did not have the ability level to be able to complete the assessment. We
Speaker 51
40:36
tested again in May of this year and Ella's results showed that she was performing at the level of a normative three-year-old. My BCBA informed me it was mentioned during the physician's review by the physician, how would my BCBA work to close the gap between the developmental age and her chronological age? And it was asking how she was working to do that. My question to
insurance is, how are you working to do that if you reduce her hours? This is just the most recent instance of us battling with insurance. Over the past eight months, we've had multiple appeals with multiple denials. I think it's relevant that Blue Cross Blue Shield
Speaker 56
41:16
also referred in one of their denials of Ella they referred to her as a hem in formal paperwork. At
Speaker 51
41:25
this time I'm going to have the clinical director and our previous BCBA Jessica Linehan take over to give
you more context about the insurance process. Thank
Speaker 71
41:40
you, Rachel. As Rachel mentioned, I am a clinical director for an ABA clinic currently. I have been a BCBA for two years and prior to that I actually did work with Ella as her RBT. Today I'd actually like to speak with you about the general process of getting services approved to help you understand how insurance processes
impact families. When a plan is submitted to any insurance provider for review, they either accept the plan as is, or they provide us with feedback on changes to make, or they request more information to provide so services can be approved. Nowadays, despite our best efforts, almost none of our plans are approved at the first submission with most plans requiring some change. Changing these plans delays care. The same form we receive is sent both to us as therapy providers and to families
as a notice of a pending decision. Oftentimes the feedback is unclear even to us as service providers with portions of the insurance guidelines quoted that include multiple options of improvements that could be made and no direction on which portion of the guidelines the plan does not meet. If this is unclear to me as a BCBA, it is infinitely more confusing to families. The language of a denial, even a temporary denial, is scary and can send many families into a panic.
I have talked many stressed parents down after receiving a letter from their insurance. While insurance is also willing to take these calls and answer questions, a change in the way this information is provided to families would solve this problem. If a family has more than one insurance provider, their treatment plan is sent to both providers. Sometimes, one provider accepts a plan, the other denies, and services are often put on hold until both providers are in agreement to prevent a family from being charged.
If a family doesn't want to wait for services or pause their current service indefinitely, they have to accept the risk of paying out of pocket, and this is a cost many people can't afford. Each insurance provider also has their own timelines and guidelines for submissions, appeals, and denials. I'm going to give you an overview of the timelines for both of Ella's insurance providers, just as an example of how this can differ from provider to provider. For Blue Cross Blue Shield, our direct contact is Lucid.
After a plan is submitted, Lucid may accept it as is, fully deny it, or additional information may be requested. LUCIT's deadline for additional information is two weeks from the date of request. This is actually one of the longer windows of time we have experienced with an insurance provider and was very helpful for Ella's most recent request for additional information as we submitted a 33-page document to address all seven of LUCIT's requests. If the additional information requires further review, the request is referred for physician review.
Again, caregivers are not permitted to participate in the physician review call even if they request to do so. If services are denied, we can file a formal request to Lucid asking them to look at the decision again. If the internal appeal is denied, we can ask for an independent review by an outside group with no ties to the insurance company and their decision is final. For Medicaid, a treatment plan is typically reviewed within two business days of submission.
If additional information is requested, we have two calendar days, including weekends, to respond. Failure to submit the requested information within the two-day time frame results in an automatic denial. Depending on the information or changes requested, this can be several hours' worth of work with no time left for review, I'll remind you, we sent 33 pages to Lucid. If we feel it is necessary, a peer-to-peer review
may be requested during this process, but the timeline for scheduling varies and can further delay services. In our experience, Medicaid has denied some of our requests based on reasons not identified in the original request for additional information. Even when all requested information is submitted timely, the authorization may still be denied Medicaid determines the documentation does not support the request. If the request is denied our last option is to file an appeal with the state and argue
our case in front of a judge. Current appeal scheduling is approximately two and a half months before a hearing or review is conducted. Services are placed on hold during this time to prevent caregivers from being charged. Over the past year guidelines have changed in ways that we as therapy providers are still trying to decipher. Some plans that were previously approved have been denied when we submit to continue services based on new criteria or new interpretations of old criteria. Sometimes we receive feedback and send an
amended plan only to receive new feedback on things that didn't change between the original and the amended plan. However, we only get so many chances to make changes before a plan is fully denied. When we receive new feedback our Our best option is to pull the plan, fully resubmit from square one, and hope the new reviewer is in agreement with the previous reviewer. But even then, the best case scenario can delay care for, in our experience, up to two or three months. Furthermore, if two reviewers can look at a plan and be in disagreement on whether or
not it meets criteria, how can we as providers get it right? This is a portion of Ella's most recent decision from Lucid, which was sent to her ABA provider and to her parents. Underlined are portions of the letter both Rachel and I found difficult to interpret upon first reading. You can note that services for our six-month treatment term, July to January, were decided to be "medically necessary." However, services following this treatment term have already been deemed not medically
necessary. While both Rachel and I are able to reach out to Lucid for clarification, this letter is meant to convey a decision and the decision is unclear. The letter is not doing its job. Sometimes despite our best efforts, plans are only partially approved. For example, during the physician review on July 30th, Ella's treatment was approved for 25 hours per week, which is a reduction of her previously approved hours and meets the
criteria of a focused plan rather than a comprehensive plan. The physician recommended splitting Ella's reduced hours between school and home, 15 hours in school, 10 hours in home. In her treatment plan, Ella's BCBA has included a plan to transition her services from school to home and to fade her ABA services overall. Using this fading plan, the intention is for Ella to eventually be able to participate in school enough so ABA can reduce hours and we can work with her in-home to continue learning.
There are specific, measurable criteria Ella will need to meet to show that she is ready for services to transition and stop. According to the plan created by Ella's BCBA, for Ella's overall ABA hours to reduce to 25 hours per week, Ella will need to reduce her challenging behaviors including elopement to a safer level, have no instances of injury to herself or others, increase her ability to communicate her specific needs and answer questions to a certain level, and show greater independence with her
hygiene skills and daily living routines. We provide an insurance with Ella's progress towards transition for each of these domains and at this time Ella has not met the measurable criteria for any of them. As a BCBA I like to say that I am constantly trying to work myself out of a job. I would love for all of my clients to be discharged from ABA because they have accomplished everything and no longer need our support. A fading plan is our way of figuring out how to do that.
When insurance makes a decision that forces us forward, it compromises care. Fading too soon often results in regression in skills and a resurgence of challenging behaviors. For some kids like Ella, these behaviors present a concern for their own safety. At this time I would like to review some highlights from the CAASPP guidelines with you all. For those of you who don't know, the Council of Autism Service Providers, or CAASPP, is a national nonprofit trade Association that represents organizations that provide services to autistic individuals.
Its purpose is to improve the quality, consistency, and sustainability of autism services by providing guidance to providers, payers, regulators, and other stakeholders. This is a section from their ABA Practice Guidelines for the Treatment of Autism Spectrum Disorder, which outlines consensus standards for assessment, treatment planning, implementation, revision, documentation, and evaluating outcomes. On pages 33 and 34, they say, multiple studies have shown that 30 to 40 hours of direct treatment per week
produces better outcomes than treatment at lower dosages in comprehensive programs for young children with autism. Similar intensities would typically be medically necessary in comprehensive programs for adolescents and adults to meet treatment objectives. focused ABA typically involves fewer domains than comprehensive treatment models, with services often compromising 10 to 25 hours of direct treatment per week. However, there are exceptions. For example, treating challenging behaviors or severe feeding concerns that threaten the
patient's health and safety or significantly interfere with their progress may be so complex that it requires substantial intensity to achieve an acceptable outcome, i.e., greater than 10 to 25 hours of direct treatment per week. For those of you who are not familiar with CAST, I would encourage you to investigate them as an organization. They have a lot of great resources and are very mindful about the overall ethics of providing care to individuals with autism,
especially with their independence and dignity in mind. At this time, I'm going to
Speaker 55
52:36
let Rachel conclude her statement ABA therapy is typically offered for individuals
Speaker 51
52:41
up to 21 years of age Arkansas Medicaid specifically states ABA services are available to qualifying children with autism diagnosis who are between the ages of 18 months and 21 years of age I've also researched that ABA services can extend into adulthood, although not every insurance reimburses after 21. My daughter is nine.
She's going into the third grade starting on Monday. She was denied the entirety of her behavior plan in her therapy minutes in February. After appeals court in May, we resubmitted and were awarded her therapy hours back. In the meantime, me and my husband paid for services for her. Two months later, my ABA provider was asked how we would begin to quote transition her from services she's nine she has nine more grades to complete until she graduates high school how is it possible when
she's still needing assistance to use the restroom she cannot write independently she cannot initiate a greeting with a peer she cannot state her address or her full name the list goes on and on we are not done with ABA therapy. In reality, we have just begun to experience the incredible support it brings in Ella's classroom, and we now get to watch the independence she is now seeking for herself and beginning to achieve. We, like so many other families, depend on insurance.
Ella's care is at the mercy of her insurance decisions. I hope that by showing you who Ella grace is how aba has helped her and what we continue to need help with to help her you will understand that our experience is just one example of a family in need i'm able to advocate for my daughter but so many other parents don't have the time or the resources to help themselves disagreements with insurance that's my biggest barrier to getting illa help and this complicated
process has only gotten harder. I believe change needs to happen in ways that insurance providers communicate with families and how they allow families to participate in their own care and how they determine any child's needs. Thank you.
Representative Denise Jones Ennett
Unverified
55:03
Thank you for that wonderful testimony about Ella grace and um and your guests
for explaining the issues uh senator boyd has a question to ask
Speaker 80
55:14
thank you for being here and presenting your
Senator Justin Boyd
Unverified
55:19
your testimony um so and and just so everybody knows i have an unavoidable conflict at 10 30 so i'm about to leave that's why i asked representative in it to let me go so just to clarify when we we say blue cross blue shield but is it specific is it the teacher's insurance the public school education system it is okay I ask that for a specific reason because if they're you know if you're advocating and saying
hey we want to change this there are specific rules in place on changes to state employees public school educator insurance so there are timelines that have to be followed and so on and so forth and so you know if they're moving forward if if if there's legislation drafted understand that it's there's commercial insurance there's ERISA insurance which we can only do certain things then there's state funded insurance and the rules are are going to
be different on all of those and have to be considered um I
Speaker 28
56:27
think that's all I just wanted oh yeah I think that's it thank you thank you again do we
Representative Denise Jones Ennett
Unverified
56:34
have any questions from the task force
I have a question this break breeze hey did I say your name
right can you offer any guidance with this since you work for the state
can you offer any guidance as far as the Medicaid
Representative Denise Jones Ennett
Unverified
57:04
regards to the suggestions or the problems that they're having with
Speaker 90
57:10
billing. I definitely appreciate you being here and sharing your story. Under Medicaid, specifically,
Speaker 91
57:15
we have the passes, and there's four of them, and then we have Medicaid fee for service, And so all of those entities cover
Speaker 90
57:25
ABA and some do have, you know, different notifications and just sharing that we continue to work with our passes and our partners that do our Medicaid fee for service authorizations on that language and making it more clear and more plain.
And so if a constituent has a concern and gets an unclear notice, we appreciate bringing those to our attention so we can address that and continue to work with our partners on making sure that that is more understandable on those notifications. I know myself, like, it is, like, my own insurance denials. I'm like, what does this mean? And so anything we can do to help continue to make that more clear, we're here for. All right, thank you.
Representative Denise Jones Ennett
Unverified
58:18
All right, well, next on our list we have Courtney
Slack from Empower Healthcare Solutions. You're recognized. Thank you. We invited Empower
Speaker 91
58:38
and Ms. Slack here today in case there were any questions specifically related to the PASS. I don't know if there was a formal presentation, but we wanted a PASS representation here
in case the committee had any PASS
Representative Denise Jones Ennett
Unverified
58:54
questions. All right. If you could recognize
Courtney Slack
Unverified
58:56
yourself, please. Hi. Good morning. My name is Courtney Slack. I'm the Associate Vice President of Clinical Services at
Speaker 95
59:02
Empower. We're one of the four PASSes. I oversee our pharmacy services, care coordination, and utilization management. And so I'm happy to answer any questions about ABA authorizations. I'd also love to catch up with you after this. So I'm open to any questions. Ms. Dawson,
Representative Denise Jones Ennett
Unverified
59:20
you have any questions for her?
Anybody have any questions for her? All right. All
Senator Justin Boyd
Unverified
59:33
right. You're recognized. Thank you. Just to clarify, so the passes normally would cover autism services.
Courtney Slack
Unverified
59:40
Yes, sir. All four passes do cover ABA for autism specifically. Yes,
Senator Justin Boyd
Unverified
59:45
sir. Okay. And are there just any clear-cut limitations with your pass on, you know, hours of treatment or limits that we all would want to know ahead of time that we would want to consider?
Speaker 95
59:59
Sure. So, we utilize Interqual criteria. It is a national recognized medical necessity criteria. For ABA specifically, it's based on age, functioning, adaptability. There's all kinds of things that go into that. we work closely with our aba providers especially in situations where there's a third party insurance company they have commercial as primary we're secondary to to help with some of the burdensome we have these timelines they have those timelines and so we we don't have any hard limits
per se it's based on medical necessity criteria through interqual however if there is a request that would be denied or a request that looks like it would be partially denied that would go to our physician up front so before we before that letter ever goes to a member that is reviewed by a physician and then we also write all of our letters at a sixth grade reading language so that they can help understand and some of those what's going on but then also our providers
have access to our provider portal so that they can see the doctor's rationale directly
Senator Justin Boyd
Unverified
1:01:18
as well so just out of curiosity do you do you or dhs or some third party ever survey your clients and
or providers to see you know how how efficient how how well it works
Speaker 95
1:01:30
on the the other side of it yes sir so we do a provider survey we conduct a provider survey every year we reach out to providers regarding empower members specifically utilization management their care coordination
you know how that relationship works um utilization management we also have a provider relations department um so our providers are always welcome to come through our provider relations and they will get them to the right department and connect it as well okay i think that's all
Representative Denise Jones Ennett
Unverified
1:02:01
i have thank you i have a question i don't know if you can answer it since you work for empower since we have four passes um is there a standard that each pass uses is in regards to this subject area
is it apples to apples are you talking
Speaker 95
1:02:16
about the medical necessity criteria and the limits yes I cannot speak for the other passes I'm so sorry all right thank
Speaker 106
1:02:29
you Dr. Taylor you recognized thank you so as my understanding from guidance we've received from arkansas medicaid in the schools is that we cannot bill for those services in the school setting for students who are
Courtney Slack
Unverified
1:02:41
under a pass that is new and surprising information to me so that is
not our that is not empower stance on aba we do not have a
Speaker 95
1:02:48
specific limit of not being able to provide you know we've been
Speaker 106
1:02:52
the schools have been told we have not been successful in billing any students through medicaid in the schools for um for aba services we had a lot of hurdles that we confronted last year at Bryant at least for the kids we were trying to serve we have several students under a pass but MITS did tell us that the students who have waiver and students who have the pass that we cannot seek reimbursement for those services in the
Speaker 105
1:03:13
school setting I can take that back in and get you and
Speaker 108
1:03:16
take a look at that you recognize miss Brizay
Speaker 91
1:03:24
I may ask my boss over there to jump in so I think there is some confusion on that when the school is the provider of services that the pass is excluded from that and it has to go to Medicaid I know that that can be confusing sometimes and would be more than happy to look if you have a specific case you'd like us to look into it does so if the school has the Medicaid ID and they are the Medicaid provider that has to go
Medicaid for even past members and I don't know Melissa anything to add to that okay you recognize miss Brizay
Representative Denise Jones Ennett
Unverified
1:04:23
any more questions for the task force all right right thank you so much thank you
Rachel Dodson
Unverified
1:04:35
okay I'm sorry can you come back real quick I'm sorry my button I
Speaker 51
1:04:40
didn't push fast enough so something that I I'm noticing with ABA because my my daughter's got OT speech she's had all the things so in that process of all of that she's always had to have a prescription written from a PCP to get those services and
then she also has to be observed you know physically observed by the PCP obviously to write the script and then also she does an in-person evaluation with a therapist to get to be able to start the services. So my question is for a child to receive ABA is it do y'all ever
Speaker 56
1:05:14
do a in-person for like actually see them physically see them in person or is it all just through documentation and
Speaker 95
1:05:23
paperwork so the purpose of utilization management is to evaluate from a
clinical perspective we have care coordination which is the lifeblood of the past obviously and they advocate for members and help connect those and so we coordinate utilization management and care coordination from a strictly utilization management perspective that those are clinically trained folks that are looking at clinical information and evaluating it against clinical criteria and then if that is going to result in a denial or a partial approval we also are looking
at the care coordination piece that PCSP we're looking at the notes that are interactive with that family but utilization management stays in a clinical fashion. So an in-person seeing the child
Speaker 51
1:06:14
physically seeing them in person that never happens? It does from our care coordination yes. Okay so who who would that be because like for my daughter I don't know that anybody came and
Speaker 56
1:06:28
and physically observed her in order to determine services so who would I specifically be looking to see who that
Speaker 95
1:06:36
was so our care coordination department is not going to do a clinical observation for services they are not trained to be like clinicians they are going to discuss your needs with you discuss what services are available for your daughter what services she would benefit from They develop that person-centered service plan, and that helps guide utilization management.
The utilization management relies on our providers. We have providers that are contracted with us to complete the standard evaluations. For autism specifically and ABA, we require an ABA assessment that part of that assessment is that they have autism or another qualifying diagnosis to be eligible for ABA services. so based on that provider's assessment we review that and then that is what determines how many hours of ABA are in the plan and and those kinds of things
that what I think her name was
Speaker 51
1:07:45
Jennifer was talking about submitting so you said and I'm I tried to write down but I don't think I did but they're not
Speaker 56
1:07:51
clinically trained to make an observation they're just clinically trained
Speaker 95
1:07:55
to read and decipher paperwork to make a decision so care coordination are not clinically trained to to perform like autism assessments care coordination their job is to talk to the
families meet with the members identify their needs help them coordinate the care to services and access to services help you find a provider all of those kinds of things and they also develop the person-centered service plan which is specifically tailored to each
Speaker 56
1:08:24
member okay so the care coordinator is not the one that decides if
Speaker 51
1:08:30
they receive it or not no ma'am okay so but no nobody in using pat if i have a pass in power no one is coming to actually physically observe her
Rachel Dodson
Unverified
1:08:41
like through any of the process before making the determination if she should receive
Speaker 119
1:08:46
or not receive No, ma'am, we rely on our providers, our clinically trained
Representative Denise Jones Ennett
Unverified
1:08:52
providers to do that. Okay. All right, any other questions?
All right, thank you. Thank you. Next on the agenda, sorry, we are going to discuss the legislative priorities that are going to be
submitted to the General Assembly, and it's in your handout.
Oh, okay, I'm sorry. It's not in your handout. you will receive it
in your email um but i do have a question since this issue has come up is this something that we want to put on our legislative agenda priorities is that is that something
miss barnett you think this should be on our legislative priorities i'm sorry we don't have i mean it's in your email sorry but we have to submit a priority list to the speaker
and a pro tem and so my question to the task force is this something that we want to look
Senator Missy Irvin
Unverified
1:09:55
into okay new policy that dhs has been working tirelessly on that will affect this that is just about i'm not sure the timeline but pretty soon is going to go out for public comment and so that is going to affect all of the how the and how it all works and they're they've been really working with a large task force of people to try to get input from folks to make sure that
communication is clear and that if there are limits people understand what they are and they understand the criteria for exceeding those and so I think that is a pretty significant outcome that's about to happen that may impact that so the this group may want to just you know stay
Representative Denise Jones Ennett
Unverified
1:10:39
in touch with that activity that's going forward
Speaker 124
1:10:42
you recognize miss weatherford thank you um melissa weatherton thank you karen no worries it's hard it's everybody messes it up um we are working on aba manual but i think what um
rachel is talking about is uh larger than aba so i just want some clarification like when you asked do you want this on the legislative wish list like what what is that exactly what what are we can we frame up the topic or the request possibly okay and i'm
Representative Denise Jones Ennett
Unverified
1:11:14
going to defer to miss dotson um i think and
Speaker 51
1:11:19
i'm excited to hear that there's more conversation going on and there's
a bigger piece coming out. I think the thing about that is, is I, I, I have a nine-year-old that every day is growing. So a year of something to be done in a year may seem fast to a committee, but for a mom of a child that's doing this every day, like next week would be, it's coming out quickly. So I guess I need a little clarification too, as far as like, when you say that, is that, Are we talking, is it going to be close to completion in a year? Is it close in a few months?
Speaker 91
1:12:07
big difference. You recognize Ms. Brise. Thank you. Actually, we are very close to starting the promulgation process, but I want to call out the CMS toolkit that did come out. We are digesting that and making sure that our changes are in alignment with the publication that CMS just released, and so that may take a minute, and then the process will start with internal approvals,
then we'll come to legislative approvals, and so it does take a minute for all of
Speaker 128
1:12:35
our new policies to work their way through the process.
Representative Denise Jones Ennett
Unverified
1:12:43
Ms. Weatherton, does she need to be more specific? We should
Speaker 129
1:12:50
not have, like, supervisory roles on this. It's going to be six months. We can't run any role faster than six months.
Speaker 124
1:13:01
And so we are, they have been working at DD tirelessly, but she's right. We're going to have to take that toolkit, which is, like, this thick, and make sure that we're in line with what CMS is recommending. And then run that back through her work group that Karen was referring to, She's an active member on it, which we really appreciate. And then internal approvals, and that goes to the governor's office, and then it goes over to the legislature for two different committee meetings. So same thing, though, Rachel, though.
If we can frame up the topic of what you wanted to add to the wish list, that also takes time, right? That won't be close either, unfortunately. So I think I'm glad that Empower was present today. I just want to say that I extremely appreciate them being here. They're a great partner with DHS. Courtney Slack is amazing to work with. And I know she's been keeping me updated on paying secondary for you when Blue Cross Blue Shield denies hours.
So I know that that's a recent discussion you've been having with her. So I'm glad that she's here and wants to connect with you afterwards to make sure that she understands and Empower
Speaker 129
1:14:18
understands the hours that you're needing right now, because I think that's your most immediate way to get some assistance. All right, Mr.
Representative Denise Jones Ennett
Unverified
1:14:29
Taylor, you recognized, or Dr. Taylor, sorry.
Speaker 106
1:14:31
Thank you, thank you, Michael's fine, thank you. Can I just try to frame up from the school perspective what I see the issue as being, you know, we're talking about ABA a lot today,
but like Melissa had mentioned when we're talking about all the kids with disability we're talking about so many different domains and I think the challenge in general for schools is just the cost that we're facing I just got back from DC visiting with Center Cotton and Bozeman and all of our congressmen and I was talking about so many of these things that we're talking about today are taking us back to federal issues that we're trying to solve but there are some there are definitely some definitely some components to this work that are and some guidance that's coming out the state level that are creating what seems to be
some additional barriers and you know we spend 12 million dollars in state and local dollars at bryant taking care of kids with disabilities we get about two million dollars in our federal grant to help absorb those costs and so we were not successful with billing aba last year and we did confront a lot of barriers that were in place and i want to work with everybody we have a lot of great people in here we have the department of ed we have dds we have dhs we have the right minds this room to help solve some of those issues but i think just in general it's the cost that it's taking to provide these services because we're providing those services at a direct cost to the
district and how can we support districts and be able to recoup some of these very you know high expenditures that we're having to
Representative Denise Jones Ennett
Unverified
1:15:59
occur all right thank you for all the robust robust discussion on this subject i am going to make a motion let me find my motion i make a motion that the final approval of the report go through the chairs prior to the final submission to the General Assembly. I need a first. I need
a second. Second. Okay. All right. All in favor
say aye on post they know all right and we got the got it
got approved any other business before we conclude this meeting yes I just I think I just got a little lost so did we
Speaker 134
1:16:53
just we just approved to move forward the proposals but we haven't seen them okay I would really
Speaker 124
1:17:02
like to see them before I cast a
vote on what moves forward okay unless I'm the only task member that wants to read them before we vote on them okay
Representative Denise Jones Ennett
Unverified
1:17:16
miss Washington said that you will receive them prior to submission and then if you have some concerns then we can work on that before we submit it
Speaker 136
1:17:31
is that okay miss weather miss Weatherton representative and
Speaker 124
1:17:34
I just don't I'd really like to take the vote
then unfortunately if we can I just don't want to do unless I'm the only one on the committee that is not comfortable with we
Representative Denise Jones Ennett
Unverified
1:18:02
all just voted on something that we haven't seen Okay,
Speaker 67
1:18:14
Miss Washington told me that this is,
Representative Denise Jones Ennett
Unverified
1:18:18
this is, okay, so this is, so since we have
not met consistently in four years this is how it's miss washington told me this is the procedure and this is how it's done so but we're open to suggestions i'd like to record that my vote is
Speaker 124
1:18:39
no only because i'm not trying to be adversarial i just have not read it so i'm uncomfortable and i have been on the task force since it was enacted as well as Ms. Burnett and I don't I don't remember how we did this in the past Karen might
Senator Missy Irvin
Unverified
1:18:56
you recognize Ms. Burnett um I understood earlier that they had been distributed via email but I don't think I got them either I got an agenda and the minutes from the last meeting but I and I didn't see them in the packet today so I'm a little confused as well I think typically what I remember in my memories not as good as it once was but what I remember is that typically this group reviewed them and then they were
Representative Denise Jones Ennett
Unverified
1:19:26
the chairs submitted them miss Washington informed me that it's not emailed yet but it will be in your
emails sorry and then we can make revisions after the meeting we are making revisions to it after this meeting that's why it's not available right now
Senator Missy Irvin
Unverified
1:19:56
go ahead so if there's if it is going to be distributed via email if there's a time frame issue in terms of when it's a deadline for it to be submitted could
there be a vote then taken by email after people have reviewed the document
Speaker 86
1:20:13
we can schedule another meeting okay mr.
Speaker 142
1:20:18
Adams going to go on record as well I did I refrain from saying that I was in approval because I was unsure of what we were actually voting for and and so I similar to miss Weatherton would like to go on record until we have seen what it is that we're actually recommending and
And once we see it, I'll be glad
Representative Denise Jones Ennett
Unverified
1:20:54
to participate. Okay. Just a second. I'm going to make a
motion to expunge that vote. Those in favor say aye. Those opposed say no. The ayes have it. Thank you. and this meeting is sorry okay would you all like to schedule another meeting before we
okay so I've been informed by Miss Washington that this report is due by the 31st of this month so we will have to meet before the 31st is that okay with everybody on the task force All right, well, we'll email you some dates, and we will email you what we have already, and we will meet before the 31st of this month, and I'm sorry for all the confusion.
I want to thank Ms. Washington for being right here holding my hand as we go through this. Again, and I want to recognize Representative Burks for attending the meeting this morning. We are adjourned. Thank you. Thank you.
Agenda
A. Call to Order
B. Consideration of a Motion to Approve the June 4, 2026, Meeting Minutes [Exhibit B]
C. Update from Office of Arkansas Attorney General Regarding Medicaid Fraud Investigations - Justin Brascher, Senior Assistant Attorney General, Department of Intergovernmental Affairs, Office of Arkansas Attorney General
D. Discussion on Applied Behavior Analysis Behavior Plans [Exhibit D] 1. Rached Dodson, Member, Arkansas Legislative Task Force on Autism 2. Jessica Lenehan, Clinical Director, Every Little Step ABA, LLC 3. Courtney Slack, Associate Vice President of Clinical Strategy and Care Integration, Empower Healthcare Solutions, LLC
E. Discussion of Legislative Priorities to be Submitted to the General Assembly
F. Other Business
G. Adjournment
Documents
No documents posted.
Speakers
Representative Denise Jones Ennett
Unverified
Justin Brasher
Unverified
Senator Justin Boyd
Unverified
Speaker 30
Representative Nicole Clowney
Unverified
Rachel Dodson
Unverified
Speaker 51
Speaker 56
Speaker 71
Speaker 55
Speaker 80
Speaker 28
Speaker 88
Speaker 90
Speaker 91
Courtney Slack
Unverified
Speaker 95
Speaker 106
Speaker 105
Speaker 108
Speaker 119
Senator Missy Irvin
Unverified
Speaker 124
Speaker 128
Speaker 129
Speaker 134
Speaker 136
Speaker 67
Speaker 86
Speaker 142