Public Health, Welfare and Labor Committee - Joint
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- October 2, 2026
Representative Jeff Wardlaw
Unverified
2:22
Members will grab your seats we'll go ahead and get started represent ladyman will you open us up a prayer please?
men I don't want to mislead the lord but we're gonna look at rules not bills but but we're good thank youpresentativeembers we would need a motion to approve the minutes. I need a second they got a motion that second all does a favor sayy aye all opposed ayes have it you don't have to be excited OK? with that we'll move on to see Department of Human Services looks like we're looking forelizabeth Pittman.
I hope you packed a lunch today it looks like you're gonna be
Speaker 12
3:39
up there for a while if you would introduce yourself for the record and you're ready to present
Speaker 14
3:47
Good afternoon Elizabeth pittman director for division of medicalical Services and Iate before I came so we are ready the first rule I have for you today is repeat from when we
brought to you in June it is a role to put continuous glucose monitors back in our durable medical equipment benefit as well as our pharmacy services benefit. We had pulled it to address some concerns that Representative Wardlaw had raised in the last meeting we immediately took down our official notice, met with the providers and we have been piloting with certain providers the systems to make sure that they are on par with our DME systems. they seem very happy with them after they approved that system they worked with us on the messaging to make
sure that it reflected the role appropriately and what you had passed in the last session and so they approved that messaging as well and we are ready
Speaker 17
4:36
to send it out upon our approval of this body and happy to
Representative Jeff Wardlaw
Unverified
4:41
take any questions. Any questions on and no rule is reviewed without objection we'll move on to Rule D does two things
Representative Ryan A. Rose
Unverified
4:52
and it is for acute rehabilitation units within a hospital and it also updates our medicaid utilization
management programme policies. So the first portion of that is we currently do not have any way to reimburse for rehabilitation services that are only rehabilitation services within an acute care hospital. If they do not provide any acute care services during that day what currently we do is we deny that day as an acute hospital day with this role would allow us to do is pay for those services at a rehabilitation level of care the same as we would pay in a rehabilitative hospital in the state. it has been approved bycms. The second portion of
this rule is currently we have something called mump or medicaid utilization Managementgrame review. it's quite a mouthful so I just say mump but what that is is after day four all hospitals have to get approval to continue that hospital stay. The majority of those stays are approved and so we looked at that and and did some analysis and determined that a more appropriate level of mum review would be at day seven that will encompass the majority of hospital stays and really only leave us reviewing those that are extraordinary. the
only exception to this would be rehabilitative hospitals which we will give 10 days because that is the standard Medicare time frame and happy to take any questions.
Speaker 17
6:11
are there any questions from members of the committee
Representativewooldridge recognized thank you madam chairir. I
Representative Jeremy Wooldridge
Unverified
6:25
just had a, I think a clarifying question for me to understand the process so you said it's been approved bycmS so what what is the process
for coming here for rule of view orr review if it's already been submitted to Cms and approved so if we were to hold or deny this rule what would happen? We would not effective effectuate it until it was approved by you the way
it works with Cms we actually put on our after in that language so if you don't approve it we won't effectuate it and we would have to go back to them ultimately and make changes but we do like to go there first because
Speaker 14
6:58
if they make changes then I would have to come back to you as well. OK and one follow up
Representative Jeremy Wooldridge
Unverified
7:05
so you talked about the rehab services versus acute services. so what specifically would be the difference there. So if a patient in the hospital is getting rehabilitative services because they don't meet the medical I guess specifications to be released into a healthalth South or a offsite rehab would they not be an acute patient? Right they would at that point the concern here is that these patients would
have they're not being they're not receiving in any any
inpatient hospital services. they're receiving therapy only but not able to discharge home yet and so they are more or more appropriately cared for in a rehabilitative hospital. OK so but we're talking about
Representative Jeremy Wooldridge
Unverified
7:47
we're talking about young kids here if I read through this you said that they're children's is referenced in here in the comment yes our children's did provide a comment in our
Speaker 17
7:57
first round of of public comment. OK, so I could see this making sense for
Representative Jeremy Wooldridge
Unverified
8:03
maybe any a baptist where they could discharge to Health South
but if is there a provider that children's can discharge an adolescent to for rehab services so there is not another rehab unit for adolescents in
the state we have placed adolescences in other rehab units that are willing to take them but there's not another exclusively rehab unit for adolescents in the state. so so this would require those kids to then be transferred out of state
Representative Jeremy Wooldridge
Unverified
8:26
for rehab? No sir we were hoping to be able to leave them in children's
and not have to deny those days where they're only providing rehab because we don't have a way to reimburse them. right well appreciate that I may
Representative Jeremy Wooldridge
Unverified
8:39
have a follow up but I I appreciate the answer. Representative Schultz thank
Representative Bart Schulz
Unverified
8:46
you madam Chair. I've got a couple questions if if you'll provide me the leeway madam chairir. My first one to you is do you have any idea how many patients this might impact off the top of my head
Speaker 17
8:57
no sir I do not. We could run some data analysis for you and try to find that out. and my
Representative Bart Schulz
Unverified
9:02
second question kind of ties in with what Representativewooldridge was was talking about my concern is
there's not a hospital per se that provides this service. So potentially we're going to be transferring these children out of the state of Arkansas which would put a huge burden on the families not to mention the system you're going to tie up an ambulance all day long taking them to Oklahoma or Missouri. so I don't know I I feel like we we probably ought to address those issues before we just pull the trigger on this yes sir I understand your concern we have the same concern and that's why we do work with
Speaker 14
9:41
other facilities to try to find other locations for children that are not going to children's
hospitals and as I stated, I mean we worked with the office of medicaid inspector general on this to try to come up with a solution. What we had been doing in the past is just denying days where there were no acute hospital services provided if it was only the the rehab therapies we were having to deny that because it did not meet our ins our inpatient level of care. and so what we're hoping to do here is avoid that denial process with having a separate level of care that they can
Speaker 17
10:12
provide as an inpatient hospital. OK. I get all that
Representative Bart Schulz
Unverified
10:16
but I still feel like we're putting the cart ahead of the horse a little
bit here thank you madam chair. thank
youpresentative ladyman you're recognized thank you ma'am chair. well thank you for being here this there's gonna be some discussion on this but you said the word we hope that we can address this issue of requiring families to go out of state to get rehabilitation for their child well
we can't put hope in this rule. it's got to be a fact so I agree with what's been said that we need to put an exception in here for those children that might have to go out of state until we don't have to say hope and we say we have so that's that's kind of my stand on that is now does this rule address that issue concretely or are we just hoping we can get something
for these children the purpose of the rule was
to address that issue to allow any hospital, not just children's hospital to provide rehabilitative services and get reimbursed for them because it is a lower level of care and so unless they're willing to go and get a completely different enrollment type as a rehabilitative hospital there was no other way for us to reimburse them. so we're hoping with this rule that we can and I say hope because you know I haven't, I have no guarantees right with what other providers are going to do but the goal of this role was to allow hospitals
Speaker 17
11:45
not just children's hospital but any hospital in the state to provide those services.
so how would that be addressed with this if we pass this rule out of here and we saw a family has a child and children's or labanner's and Lebonners would be the same way and you know after so many days the diagnosis is that they need to go to rehab and there's nothing available
so if we pass the rule out, what happens with that? today what happens is so for example
they would submit a claim for the entire hospital stay. we would look at those days. Today if there's any inpatient service provided at all, anyone, any sort ofivV administration or any other test that's done that we can say this meets the inpatient level of care. We pay that at the inpatient rate. If it doesn't meet that we deny it. So what this would allow us to do is now
say those days can be paid at a lower level of care and we're going to pay them at this rate, this rehabilitative hospital rate which is set by looking at the cost of rehabilitative hospitals across the state as there been
discussion with children's bonner's whether they will take patients under those conditions. I mean we have had ongoing discussions with children's hospitalstal about this issue prior to
Speaker 14
13:09
trying to do this role and post and they did make a comment in the first public comment period which I
believe is in here. so you can you can see that but we have had ongoing discussions with them for quite a while now. so what was their response?
are they gonna take patients or not that is a usually made on
a case by case determination. We talk to them about each individual patient. may get back in the queue. thank you.
mean I think we could go down the whole gamut of how children's is actually paid a lot more and a lot of circumstances and a lot of areas
from our Medicaid program. So, you know, I think what the rule is seeking is the ability to say we can keep these kids here, provide rehab setting for them within this hospital at a lower per diem rate there are beds available. there are the people there to do that and we're paying for what is an appropriate level of care versus inpatient full hospitalization which is not what they're receiving
and so the rule opens up a pathway for that So I would I would think that that would be beneficial and I'm not quite sure where the pushback is on opening up a pathway for rehabilitation within a hospital because it is very difficult sometimes to find a bed in a placement for rehabilitation for your patients particularly from these other hospitals that can provide that level of rehabilitation at a lower rate and they're going to
be better for the patients. I mean let's talk about Stone County Medical Center I mean that means that a patient then could could transfer from inpatient care to rehab care in those beds that are sitting there ready and available where you have full physical therapy you have full speech therapy you have full occupational therapy and then they get paid for a lower rate per diem but that's all that they're using they're not using intensive treatment with nurses, skilled nurses and all of that that goes with
inpatient care. Is that my understanding yes ma'am that's the intent behind this rule.
Representative Ryan A. Rose
Unverified
15:26
OK, so that's going to be incredibly
beneficial to a lot of hospitals because it's going to open up another pathway for them to continue. it's like transitioning them probably down to like a swing bed right option so this should be a beneficial pathway for a lot of our rural hospitals. Thank you for the rule.
Representative rose you recognized thank you madam Chair miss pitman, thank you so much
Representative Ryan A. Rose
Unverified
15:53
for taking the time to join us today. couple of quick questions the what is it the review trigger time is changing typically it looks like from4 to7 days and with the free standing hospitals it's it's gonna be more like 10 days is that correct sir so one of the questions that came to my mind when I was reviewing this is could the the the less frequent review period lead to more in some cases nonmedically necessary days that patients may
remain in a hospital I mean again I hate
to try to give a definitive answer to that we did a lot of analysis on what we were
Speaker 14
16:34
approving and denying beyond day four before we picked a day. you know we didn't just go7 sounds great. we talked to to our review physicians that do these reviews and determined that se did seem like a a a number where we were going to land in a safe place and not have a large number of medically unnecessary days billed things beyond that got more
questionable. it also left our review contracts at a reasonable rate and so we really felt like that was a good place to to be based on the data that we were seeing beyond day four when you led me into my
Representative Ryan A. Rose
Unverified
17:05
next question and you may have already answered this and if you did I apologize. do we have have you sent us or can you send us whatever that data was that showed this to be necessary yes sir let me make sure it is deidentified but yes sir
Speaker 14
17:18
I could send you that and then moving forward should this
Representative Ryan A. Rose
Unverified
17:21
pass will you have a mechanism in place that allows you to
monitor whether or not these extra days that that may take place if they are medically necessary or if they are not and if there's a kind of a a way to clean that up we can always go back anything we have
Speaker 14
17:39
not prior authorized or already authorized we can always go back and review it's called a retrospective review and we do that now on the first4 days of hospital visits some certain percentage of them get reviewed. we will continue to do that for up to day7. and from what it looks like to me, I mean the
Representative Ryan A. Rose
Unverified
17:55
state seems to be getting a good deal on this you
know the the the increase in
costs seems moderate this year and in the next year but I wondered if you could speak to this this one line that indicates that there's a new or increased cost or obligation of at least $100,000 per year to and you know what all of these are private, individual, entity, business, state government, county government municipal government etc etc. could you speak to what what that $100,000 increase is
annually for those yes sir so what we did is we
Speaker 14
18:31
took you know we will pay fewer contractors to review these claims now because there will be fewer of them but we also know that that it could lead to more hospital days being paid because some may have been denied unnecessarily or whatever it may be so that's balancing those out. we don't expect to see a huge increase in utilization or a huge increase in paid days and because we do believe this to be the right number that's why that number is so minimal but that is what that number is reflective of is additional
Speaker 13
18:56
payments to hospitals thank you may jump back in
Chair
Unverified
18:59
but I appreciate the time Representative Wwooldridge thank
Representative Jeremy Wooldridge
Unverified
19:02
you madam chairir and my question is really a follow up follow up of the chairman's question. So I just want to make sure that I understand correctly so two paths now exist if this rule changes so we've used children's while we're talking so they could they could bill for an acute setting rehab if medical necessity is met or they could build a lower level of care if it's not medical necessity for it to be the other I guess my question would be and this may be a question for them that we would
have to ask later but I know they're obviously an acute care hospital so providing that service in an acute care hospital at a lower rate. I've assumed they have all the same cost and everything associated or they would just need to discharge that patient into rehab somewhere else right? yes you will need to ask them about their cost for that patient but the path does exist so what what would constitute medical necessity that would require someone to stay in an acute care setting to get rehab services so
we look for anything that meets that institutional level of care like I said it could be an IV administration, it could be a an MRI or some other type of test. I'm not the nurse reviewer so she would know more of those examples than I do but I do know they look for anything like that for that day and if they find it they authorize it. So this
Representative Jeremy Wooldridge
Unverified
20:22
dual path exists then for every hospital in the state ok thank you ma'am thank youpresentative Moore thank you madam
chairir. I just wanted to clarify I think I heard this earlier that there
Speaker 73
20:36
are no acute care hospital specifically for children in the state of Arkansas. Acute care hospitals
Speaker 17
20:43
for children other than children's hospitalstal? no ma'am, not in the state. We also do have Labonner in Memphis and
Speaker 75
20:51
our network which is a children's hospital. OK. and then I think earlier you
Speaker 73
20:56
had stated that your calculations were done on rehab hospitals in the state that reimburse for similar rates but those would be rehab hospitals for adults not specifically for
children that is correct yes ma'am. OK, so a little bit apples to oranges or I'm
Speaker 74
21:16
not that cost expert but they are adults not children you are that is an accurate assessment.
OK thank you all right anybody else? all right seeing none thank you without objection
this rule is reviewed. adam F
Speaker 79
21:59
Good afternoon madam chairir. I'm Jay Hill with DHS vision of agging and
Adult Services thank you for being here
Speaker 83
22:12
today. Please pro Thank you have a few rules to present to you this afternoon starting with exhibit F on your agendas this is a an
Speaker 82
22:20
update to the manual for state planned medicaid service program for all inclusive care for the elderly our pace program the manual changes are responsive to
federal requirements regarding the nomenclature for the services provided withinpace plans of care medical personnel requirements care coordination requirement s timelines grievances appeals and licenger exemptions for pace providers and secondarily the manual change will allow us to be compliant with Act 144 passed of the previous general session which exemptspace providers from licenger as a personal care agency through the Arkansas department of Health.
with that happy to take any questions madam chairman rights are there any questions from members of the committee? right seeing none thank you. this rule is
Speaker 83
23:18
reviewed without objection? adamg thank you ma'am. Moving to exhibitg this is an update to the
Speaker 82
23:24
rule establishing the right methodologies utilized for the pace programs in our state the implementation of a rape methodology change does require
a state plan amendment.pace is not a waiver service it is a state planned medicaid service provided in our state and primarily what this what this rule what this will this spa this state plan amendment will allow is for the projected cost of providing comparable services to medicaid beneficiaries outside of the pace program will remain at or below the amount of our capitation payments and so what it does is it simply guidelines gives us guidelines for how pace rates are determined those
are presented to Cms and it's significantly requires specificity increases that we provide on how settings are determined and justifies the pace rates that we do prepare to that we present to the federal government the pace capitation rates must as I said must remain below the amount that is now called and otherwise that would an amount otherwise that would otherwise be paid a lot of odd nomenclature and acronyms used in this in this
uhr this rule presentation but we no longer use the phrase upper payment limit we'll use the amount that would otherwise be paid and that establishes the guideline with which our capitation payments must remain below are there any
questions from members of the committee? all right see you then thank you. this rule is reviewed without objection. Itemh thank
Speaker 83
25:01
you ma'am our last presentation is for our provider manual for state
Speaker 82
25:08
planned personal care and we're presenting to you today a request to repeal the current promulgated personal care manual and create a new version there are some changes to the presentation that we brought a few months ago when we came to to committee to present there were a couple of requests that were made for us to look at and we feel that we have been able to address both of those both of those requests initially we had a much greater involvement from our primary care providers our
pcps in the state with our pace populations we removed that requirement and really streamline this manual to focus on standalone state plan personal care we are proposing to transition a away from the Arkansas Independent assessment which is not a tool that is required for a state planned service that is a tool that's required for our waiver services but not in our state plan so we are proposing to eliminate the necessity for an aria an Arkansas independent assessment
for eligibility for for state planned personal care and replace that with a medical eligibility review a claims data analysis that will be conducted by our current vendor which at this time is Optum so they it would transition away from pcp involvement to opptum that would have access to and utilize the state's MMIS system for a claims data analysis to look at medical diagnosis codes to help make that medical determination for eligibility for applicants to state planned personal care does
not do away with it does not replace the financial eligibility piece for Medicaid that still occurs within the agency but it does streamline that medical eligibility review we believe that we'll speed this up and we'll save a significant amount of funding that the state that we do pay for an
Speaker 79
26:59
independent assessment average yes ma'am so
the I just thank you for listening to us because they have the access to
our our claims, correct? They they will
be able to access that they have access to it they can pull that in they can utilize even AI tools or whatever they need to in order to really expedite medical necessity and determine eligibility for the program without having to go through a whole and additional independent assessment which I think is a great use of technology and smarter pathway forward. and involves less people in the mix. so I think that's going to be beneficial for everybody involved. I just wanted to make
sure I clarified that with you. go ahead. thank you ma'am thank you madam
Speaker 78
27:45
chairir and you are correct in what you are in
Speaker 82
27:50
in in what you're saying the this this process we feel will really give a greater level of control over what we call the front door the entry into the program to allow persons who truly do qualify for personal care service for the for that home and community based service to have access to the program but for those persons that are applying that could be redirected to a more appropriate program that would better serve
their needs. Our claims our our medical claims analysis should give greater insight on how to direct beneficiaries to the correct to the more appropriate program that the state has to offer without just a blanket an open door into state planned personal careue would that also have
the ability to determine if they were a if they had eligibility
under federal programs of any kind like they were if they were a veteran and they weren't taking
advantage of a federal that because there is a federal personal care program yes ma'am you're you're correct about that no I
Speaker 82
28:52
don't know that our claims data analysis would simply say that you are also eligible for a federal program. Now our involvement it this does require registered nurse to complete a assessment of the individual to develop that plan of care there would certainly be opportunities to have conversations around the the individual's eligibility
requirements for instance if you are a veteran if you are service connected through the VA is this a better option for you our services are somewhat are are very similar but there are some some some nuances that are allowed through the federal system that the state plan may not necessarily exercise and so we always make those you know anywhere that we do have an awareness that an individual particularly in veterans side that do have access to the VA system we make sure that they know that they have that as an option and that should they want to pursue that
to certainly make those inquiries if that is a viable program yeah I think that'd be
a great idea to be able to say hey you've got
this under your federal benefit. let's push let's let's get you connected there and not on the state
Speaker 83
29:59
benefit. Thank you. Ke there are there are two additional a additions or changes to the manual that I
Speaker 82
30:05
wanted to to make aware this brings the manual into compliance with Act625 of the general session which allowed for an abbreviated independent assessment for past beneficiaries that was
again that was Act625 and brings into compliance with Act853 which moves the certification for personal care from DHS to the department of healthalth and both of those are codified in the are or clarified in this manual change. thank you madam chairman with
Speaker 79
30:34
that happy to answer questions are there
any questions from members of the committee I
appreciate the the public comments. I know there's a
lot of folks had a constituent reach out to me just in flexibility on a weekly basis versus a daily basis
as far as our and so my only just ask is perhaps just looking or if there was any kind of reasoning that we decided to do more of a day regulatory instead of a weekly regulatory. I mean I know that we want to make sure that there's a consistency with the care that these people are receiving. we
don't want whatever their hours are to be all eaten up in one week or two weeks we need more consistency both monthly, weekly and daily. but is there like an appeal process if somebody needs a little bit more extra time on that day versus another day during a week time or month time so you're correct madam Chair we we do expect and
Speaker 83
31:39
want the hours to be divided equally among the month so that there is a cognitive care throughout the
Speaker 82
31:46
month for our beneficiaries now we also understand that there are times when you may not be able to deliver all of the hours that were allocated to a specific day and we're not at we're certainly not in a position where we would ever say that well you forfeit those hours you forfeit the day's services for today Wednesday there are times when our beneficiaries may admit to a hospital, may have clinical visits that prevent them from being home during their service hours and so we have communicated our bit to our provider networks and we'll continue to do so that in those events
a simple request to us to the agency to say we're going to operate outside of our scope of hours for today August5th Wednesday August5th do too beneficiary was unable to receive services may be returning home for instance from a hospital stay well that may necessitate a greater need of services for a short period of time and we have we have both stated and will continue to grant exemptions to those hourly limits to allow for the care to be provided to the beneficiaries perfect that I think those the question they just wanted
some clarification on that so you provided that. thank you so much. Any other questions? Representativeightdymann makes perfect sense. thank you madam chairir. well thank you for this rule I'm
I think it helps the the complaint that I got from people was it was just too cumbersome the process and this is gonna help that a lot and I appreciate you bringing these. It was thank you for thank you thank you
Speaker 100
33:11
any other questions? All right see you then
without objection this rule is reviewed itemte I.
Good afternoon umm please go ahead identify yourself for the record and you may go forward
Speaker 103
33:53
thanks Miss Franklin. I'm Mary Franklin, director of the division of county operations for the Arkansas
Speaker 104
34:00
Department of Human Services. the rule I have for you today relates to medicaid eligibility it does about three different things. The first thing clarifies that foster care and adoption
subsidy income is excluded for the income eligibility determination for age blind and disabled eligibility groups this rule also um, makes it clear that for529 educational accounts that the those assets are counted for the person who owns the account not the named beneficiary of the educational benefits once the benefits are distributed.
also we're clarifying that interest earned from tax refunds or advance payments of tax refunds are not excluded. The interest itself if it's retained it is counted as an asset although the tax refunds and advance payments are excluded as an asset for 12 months and the other thing that this rule does is a little more clarification on independence accounts. These are accounts that individuals who
are eligible in our workers with disabilities category can establish we're clarifying that these accounts even if the individual moves from workers with disabilities to other categor other age blind disabled categories including long term service and supports that they will continue to be excluded for those other eligibility determinations, um, more than one account can be designated as an independence account that can be funded with employment income
or retirement income they must be established while the person is receiving workers with disabilities medicaid and they must be approved by DHS and no additional deposits can be added to those accounts after the person is no longer in workers with disabilities but the amounts in those accounts will continue to be excluded if the individual is eligible in other categories. Those are the clarifications for our the
changes that we are bringing with this rule there is a fiscal impact 485000 in year one586,000 in year two and there were no public comments. Happy to take any questions. Representative rose you're recognized for a question. thank you thank you
for your presentation as I
Representative Ryan A. Rose
Unverified
36:38
just wanted to clarify for my sake as I understood by and large this is kind of clarifying
and eliminating some ambiguity that may have been
present in in each one of the cases that you went through is that is that the the gist of
this that that some of this was unclear and maybe was more on a case by case basis and this makes it uniform
Speaker 104
37:06
moving forward is that right with the additional we had originally done independencec account I mean independence accounts are not new but the specificity that the it carries over to other the
exclusion carries over to other categories is it is a change I mean it's clarifying but it's also a change and I asked Miss pittman
Representative Ryan A. Rose
Unverified
37:27
pretty much the same thing I understand that this is more or less it's a good deal for the state in the in the in the way that these these funds are paid out at the federal from the federal dollars versus what we pay but there
is an added cost it's it's moderate but there's an added cost and then there is that expectation of at least 100,000 per year to all the the private entities and the government could you speak to
that just briefly So these costs would
Speaker 104
37:55
be related to claims that may be paid for individuals who are eligible with these changes and and these are estimates so the cost would be accumulated through claims being paid for possibly people being eligible or additional
Speaker 112
38:14
assets being excluded based on this rule change and I
Representative Ryan A. Rose
Unverified
38:21
think as I understand it it's it's some
of this was in some cases these were not being counted against individuals in some cases they were and so some of these associated costs will just be getting everybody over into the same category is that right ok all right thank you representative ladyman thank you
ma'am chair. this may not be part of the rule but it these independence accounts is there a cap on that or accumulative cap or
you know no maximum amount there's no minimum or
Speaker 104
39:04
maximum limit to establish the account and there's no minimum or maximum limit that can be deposited into the existing account, withdrawals and actions involving the independence accounts are subject to standard eligibility rules when the money is withdrawn but independencec account is is different than a five than an able
accountndependence accounts are allowed by Cms but they are not they are not in like tax code or established at
Speaker 119
39:32
the federal level but they are allowed by Cms for states and there had there was a state law that requested us to establish the
Speaker 104
39:42
ability for individuals who were in that workers with disabilities category to be able to establish those independence accounts and we had worked with Cms and did implement the independence accounts but we had implemented
it pretty narrowly at first and we were asked when we brought the rule to consider if we could expand it to include that it didn't necessarily have to be just one account and that it could be other accounts and that that exclusion could move on if the individual was you know retired or was no longer able to work
Speaker 119
40:13
and applied for other categories and so that's what we've done so are there any limitations
on withdra you know no other than that you know withdrawals once
Speaker 104
40:28
we would we would treat it as you know, income and whatever impact that
Speaker 111
40:36
had to eligibility we would evaluate that
thank you thank you p re s ent ative Ennett thank you madam chairir. I have
Representative Denise Jones Ennett
Unverified
40:49
a quick question can you elaborate what is an independent account or this account that we're talking about, I've never heard of it before and how it
deals with people with disabilities or how the people with disabilities tap into this so independence account
Speaker 104
41:05
is an account that must be created while someone is eligible in our workers with disabilities category and to be eligible in that category you have to meet the Social Security definitions of disabled. they may or may not be receiving a benefit but they are disabled and they are working sometimes disabled individuals who are working are no longer eligible
to draw that that benefit but they still meet the definition of disability so this this this was created so that those individuals as they earn and save money like others or contribute to their retirement accounts or their employers contribute to their retirement accounts so that that those assets would not cause ineligibility for the person who is disabled and working still
though to be able to continue to get services that they may need so that that's the point of them it it is allowed and we were asked by state law to to create this pathway for these
Representative Denise Jones Ennett
Unverified
42:14
individuals I have another question madam chair so is this automatic for a person with disabilities who who qualify for this is it do they automatically qualify to do they have to ask to be on this particular account they would have to
Speaker 104
42:31
establish an account and get it approved by DHS and that would have to happen while they were in the workers with disabilities categoryies so not before and not after but while they're in the workers with disabilities category they could they can reach out and they can say I want to establish an independence account or I want these two accounts of mine to be my independence accounts and then DHS would approve those accounts and document those accounts and then assets in those accounts would continue to be exclu
Speaker 119
43:01
d ed if the person retired or was no longer able to continue working and applied for other categories of medicaid. thank you you're welcome right are there
any other questions from anyone so we
received no public comments but the rule is in response to Cms request basically is that correct my takeaway well and and things that we have learned that we needed
Speaker 103
43:26
to clarify in our policy. right perfect any other questions from members
of the committee? OK if not this rule stands reviewed without objection thank you Miss Paula Stone she thank you Adam J
Speaker 129
44:02
Good afternoon Paula Stone Department of humanman Services officefice of Substance abuse
Speaker 130
44:09
and mental healthalth this rule is you you will approve the emergency rule for this in June but this is the permanent role that's coming through and this will allows general hospitals or medical surgical hospitals to open and provide services on an adolescent substance abuse unit to treat substance abuse issues with adolescents and we have
one hospital that has decided to open this unit but this gives them the ability to bill Medicaid for the service and then for other hospitals if they see a need in their community, to open the same type of program and so any
changes between the emergency rule and this rule no ok Representative rose you're recognized for a question. Thank you I'm over here on
Representative Ryan A. Rose
Unverified
44:56
your right thank you. So I I think the hospital you're referencing is that the is that incersei at the
Circy hospitals you mentioned that this would potentially qualify for other hospitals or facilities that would be dedicated to this kind of care or do you know if there's any in the works if this is opening or helping any of that to take place. I have not been contacted by any other hospital stating an
Speaker 129
45:21
interest in opening up a unit so I hope when they see that unity
Speaker 130
45:24
has opened up a successful unit and and what they're able to serve that there may be some other interest in other areas of the state.
Representative Ryan A. Rose
Unverified
45:37
obviously it's a it's a terrible thing that is needed is is if this were to be successful or because it will be successful are are there
any types of controls or monitoring in place that will keep the state's share manageable if it were to exceed expectations. think one of the things for most
Speaker 130
46:01
mental health or substance use disorder services for which we have you know availability to
your claims that we process for those services the thing that works the best is to make sure that the follow up services are there. so we don't get recidivism so we don't get people coming back in so one of the things that we've done is we have a grant that we have for substance use disorders and we've allowed UAs to have some of that funding to go out and do substance use disorder training for therapists across the state so it's been a lot of interest there to make sure
that the services are available in those communities because they'll only be in that unit for30 to45 days, receives some intensive treatment but going back into the community and receiving the appropriate services is what keeps those kinds of services from exploding. now you just pique my interest I apologize to take more
Representative Ryan A. Rose
Unverified
46:56
of your time. Is that ad is that adHS grant that you referenced that UAMs is utilizing? Yes it was a grant
Speaker 130
47:03
we have atoSam it's through the substance abuse and mental healthalth Services Administration and it's
called stateoppiid Respongrant, and and we had some funding that we could use for training. OK. all right. Well, thank you. thank you
Representative Waoldridge you're recognized for a question. thank
Representative Jeremy Wooldridge
Unverified
47:22
you madam chair and thank you Paula for being here. So how does the hospital setting for this treatment differ from just a regular residential treatment facility that may be independent of a hospital. it's just a unit
Speaker 130
47:34
within a hospital you know some hospitals have units for jerryyke or they have a psychiatric unit so it's
functioning much like that the rules for all hospitals psychiatric hospitals and and units within hospitals are regulated by the department of healthalth. so this is a separate licensure for substance use disorders so they followed those regulations and they have all the rules about how to set up those units whether those children have to go to school, and they do have a school there so I think there's it's regulated in that way so I don't think it's going to look a lot different than freestanding psychiatric
Representative Jeremy Wooldridge
Unverified
48:13
hospitals. OK. so to RepresentativeRose's point if this is successful and and again it's a shame that this is needed around the state there may be a path in the future where there could be some independent facilities that popped up around the state and have an opportunity to
Speaker 129
48:30
partner with DHS and medicaid? This one is specifically for hospital s general
Speaker 130
48:34
hospitals we do not have a rule at this time to specifically allow psychiatric hospitals to have substance use disorder specific units but
that has not really prevented them for treating as you know d told diagnosis kinds of things yeah so I think that they're treating a lot of dual diagnosis. I think one of the things we'll see with this is what we see a lot of youth that are that have been in psychiatric hospitals and received treatment that are coming there and they're fully prepared there they have psychiatric psychiatrists on staff so they're also fully prepared there that they know that there's going to be dual diagnosis so they're looking to refer out once they complete their treatment course to to
someone who can care for both sides of the issue. Great thank you ma'am
appreciate you thank you again like it's just opening up another pathway, utilizing an existing infrastructure some of the hospitals in order to meet certain criteria for critical access or whatever
have to have a certain bed limit you know like a 25 bed limit to reach a certain category and whether they're fuller all the time with those beds or not it gives them the pathway of being able to utilize those unused beds for
these more directed purposes and so I I just think it's great. Do do you know if unity or Cersei had to do any kind of physical changes in order to meet any kind of criteria to establish this unit they they've fully built out a new unit so they didn't they
Speaker 130
50:03
a way that allowed them to serve girls on one side and boys on the other so they have 1el beds each so they made those decisions we were there
for the opening last week and it's it's really
nice so the grant money that you're referring to is there any opportunity for those grants that
you're receiving I assume from the federal level to assist with any kind of that physical change and buildout that's required generally most
Speaker 130
50:31
of the grants we have now have restrictions on construction but we'll keep our eyes open for any other grants and then if there's any ability within those grants to allow for construction that's something we can explore. I think that would be really really great to help
explore because it might open up and you know additional units around the state that could step in and dod to do this important work but hats off to
unity I'm just thank you so much for stepping up and meeting the needs of these kids. I can't say enough and I I'm sure that sentiments expressed by everybody here so publicly I just want to thank unity for doing an incredible job in stepping up and thank you for working with them on this rule change. Any additional questions from members of the committee seeing none without objection
this rule is reviewed and last item no not last itemm K
Thank you if you'll just state your name for the record and then we will you
Speaker 143
51:58
may proceed huck Thompson attorney Arkansas Department of Health. Shane David department of healthalth. Craigsmith
Speaker 144
52:08
attorney for department of healthalth he guys go ahead the first rule is the list for a controlled substance as a reminder Arkansas code564-216 requires that the department of healthalth update this list annually. the proposed amendments to the list at this
time or adding substances that were identified under Act9342025 regarding prohibition of intoxicating hemp as well as current DE scheduling and substance identified of concern in Arkansas. The public notice was published on Apri l 25th last day for comments and a public comment hearing was held on May26th and no comments were received with that open to any questions are there any questions from members of the committee?
all right seeing none thank you so much. this rule stands reviewed without objection. Next one item l ma'am this
Speaker 144
53:06
is a proposed repeal of a rule for the rules and regulations regarding synthetic marijuana products the products that are mentioned in this rule have been added to the list of controlled substances for some time so this rule is redundant and so we're proposing repeal of the entire
rule in itself. notice was published on May3rd last day for comments was June5th and no comments were received. with that open to any questions Thank you are there any questions members of the
right seeing none the stands reviewed. thank you thank you madam Chair.
there is no other business to come from the committee right we will stand adjourned
Agenda
A. Call to Order
B. Consideration to Approve the July 1, 2026, Meeting Minutes [Exhibit B]
C. Department of Human Services (DHS), Division of Medical Services (DMS), Review of Rule, Continuous Glucose Monitors Billing Amendment [Exhibit C]
D. DHS, DMS, Review of Rule, Clarification of Requirements for an Acute Rehabilitation Unit Within a Hospital and Update to the Medicaid Utilization Management Program (MUMP) [Exhibit D]
F. DHS, Division of Aging, Adult, and Behavioral Health Services (DAABHS), Review of Rule, Program of All-Inclusive Care for the Elderly (PACE) Provider Manual Update [Exhibit F]
G. DHS, DAABHS, Review of Rule, PACE Rate Setting Methodology SPA+ [Exhibit G]
H. DHS, DAABHS, Review of Rule, Updates to the Personal Care and Arkansas Independent Assessment Provider Manuals [Exhibit H]
I. DHS, Division of County Operations, Review of Rule, Medical Services Policy Updates Related to Resource Determinations [Exhibit I]
J. DHS, Office of Substance Abuse and Mental Health, Review of Rule, Hospital Based Residential Treatment for Substance Use Disorder [Exhibit J]
K. Arkansas Department of Health (ADH), Division for Health Protection, Pharmacy Services Section, Review of Rule, List of Controlled Substances [Exhibit K]
L. ADH, Division for Health Protection, Pharmacy Services Section, Review of Rule, Repeal of Rules and Regulations Pertaining to Synthetic Marijuana Products [Exhibit L]
1. Shane David, Branch Chief, ADH
M. Other Business
N. Adjournment
Documents
No documents posted.
Speakers
Representative Jeff Wardlaw
Unverified
Speaker 12
Speaker 14
Speaker 17
Representative Ryan A. Rose
Unverified
Representative Jack Ladyman Chair
Unverified
Senator Missy Irvin Chair
Unverified
Representative Jeremy Wooldridge
Unverified
Representative Bart Schulz
Unverified
Speaker 50
Speaker 13
Chair
Unverified
Speaker 73
Speaker 75
Speaker 74
Speaker 79
Speaker 83
Speaker 82
Speaker 78
Speaker 100
Speaker 103
Speaker 104
Speaker 112
Speaker 119
Speaker 109
Speaker 111
Representative Denise Jones Ennett
Unverified
Speaker 129
Speaker 130
Speaker 143
Speaker 144