Public Health, Welfare and Labor Committee - Joint
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Thank you.
Representative Jeff Wardlaw
Unverified
2:00
Members, we'll grab your seats. We'll go ahead and get started. Representative Ladyman, will you open us up with prayer, please? Father, thank
Speaker 5
2:29
you for this time that we've come together
and worked on policy and problems for our state and for all our camps. I ask that you would give us wisdom and give us deliberation as we consider these bills. Thank you for all that you do for all of us here in the state of Arkansas. I ask these things in
Representative Jeff Wardlaw
Unverified
2:50
your name. Amen. Amen. I don't want to mislead the Lord, but we're going to look at rules, not bills. Well, we're good. Thank you, Representative. members we would I need a motion to approve the minutes I need a second I got a motion a second
all those in favor say aye all opposed eyes have it y'all don't have to be excited okay with that we'll move on to C Department of Human Services looks like we're looking for Elizabeth Pittman I hope you packed the lunch today it looks like you're gonna be up there for a
Speaker 12
3:34
while if you would introduce yourself for the record and you're ready to present
Speaker 14
3:38
good afternoon elizabeth pitman director for division of medical services and i ate before i came so we are ready and the first rule i have for you today is a repeat from one we brought to in June. It is a rule 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. 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 rule appropriately and what you had passed in the last session and so they approved that messaging as well and
Speaker 17
4:31
we are ready to send it out upon approval of this body
Representative Jeff Wardlaw
Unverified
4:36
and happy to take any questions any questions on c c9 rule is reviewed without ejection we'll move on to d
Representative Ryan A. Rose
Unverified
4:44
rule d does two things and it is for acute rehabilitation units within a hospital
and it also updates our medicaid utilization management program 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 what
this rule 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 by cms the second portion of this rule is currently we have something called mump or medicaid utilization management program 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 did some analysis and determined that
a more appropriate level of MMP 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 uh time frame and happy to take any
Speaker 17
6:06
questions are there any questions from members of
the committee representative wildridge you're recognized thank
Representative Jeremy Wooldridge
Unverified
6:20
you madam chair i just had a i
think a clarifying question for me to understand the process so you said it's been approved by cms yes sir so what is the process for coming here for rule review or rule 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 affect it effectuate it until it was approved by
you the way it works with cms we actually put on or after in that language okay so if you don't approve it we won't effectuate it and we would have to go back to them ultimately and
Speaker 14
6:53
make changes but we do like to go there first
because if they make changes then i would have to come
Representative Jeremy Wooldridge
Unverified
6:59
back to you as well okay and one follow-up 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 health south or a off-site rehab would they not be an acute patient right they would at
these patients would meet that level of care we don't 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 more or more appropriately cared for in a rehabilitative hospital okay
Representative Jeremy Wooldridge
Unverified
7:42
so but we're talking about um we're talking about young kids here if I read through this you said their children's is referenced in here in the comment yes yes
Speaker 17
7:52
our children's did provide a comment in our first round of a public comment okay
Representative Jeremy Wooldridge
Unverified
7:58
so i could see this making sense for 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 adolescents 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
Representative Jeremy Wooldridge
Unverified
8:21
then be transferred out of state 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
Representative Jeremy Wooldridge
Unverified
8:31
because we don't have a way to reimburse them oh okay all right well I appreciate that I may have
Representative Bart Schulz
Unverified
8:41
a follow-up but I appreciate the answer representative Schultz thank you madam chair I've got a couple questions if if you'll provide me the leeway madam chair my first one is do you have any idea how many patients this might
Speaker 17
8:52
impact off the top of my head no sir I do not we could run some data analysis for you and try
Representative Bart Schulz
Unverified
8:57
to find that out okay and my second question kind of ties in with what representative Wooldridge 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 feel like we we probably ought to address those issues before we just pull the trigger on this yes sir
Speaker 14
9:33
i understand your concern we have the same concern and that's
why we do work with other facilities to try to find other locations for children that
are not going to children's hospital. 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 rehab therapies, we were having to deny that because it did not meet our inpatient level of care um and so what we're hoping to do here is avoid that denial process with having a separate
Speaker 17
10:07
level of care that they can provide as an
Representative Bart Schulz
Unverified
10:11
inpatient hospital okay i get all that but i still feel like we're putting the cart
ahead of the horse a little bit
here thank you madam chair thank you representative ladyman you're recognized thank you madam chair well thank you for being here uh 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 have no guarantees, right, with what other providers are going to do. But the goal of this rule
Speaker 17
11:41
was to allow hospitals, not just Children's Hospital,
but any hospital in the state to
Speaker 50
11:46
provide those services. Well, we do need the hope.
I agree. So how would that be addressed with this? If we pass this rule out of here and a family has a child in Children's or Le Bonheur's, and Le Bonheur's 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?
So 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 is any inpatient service provided at all, anyone, any sort of IV 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. So has there been discussion with Children's Le Bonheurs whether they will take patients under those conditions? I mean, we have had ongoing
Speaker 14
13:04
discussions with Children's Hospital about this issue prior to trying to do this rule in post, And they did make
a comment in the first public comment period, which I believe is in here. So you can see that.
But we have had ongoing discussions with them for quite a while
now. So what was their response? Are they going to take
patients or not? That is usually made on a case-by-case determination. We talk to them about each individual
patient. I may get back in the queue. Thank you. I mean, I think we could go down the whole gamut of how Children's is actually paid a lot more in 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 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 and 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 transfer from inpatient care to rehab care in those beds that are sitting there ready and available where you have full physical therapy,
of full speech therapy, of 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
15:21
Okay, 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 um this should be a beneficial pathway for a lot
of our rural hospitals thank you for the rule representative rose you're recognized thank
Representative Ryan A. Rose
Unverified
15:45
you madam chair uh miss pitman thank you so much for uh taking the time to join us today a couple of quick questions the uh what is it the review trigger time is changing typically it looks like from four to seven days, and with the freestanding hospitals, it's going to be more like 10 days. Is that correct? Yes, sir. So one of the questions that came to my mind when I was reviewing this is
could the less frequent review period lead to more, in some cases, non-medically 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 approving
Speaker 14
16:29
and denying beyond day four before we picked a day um you know we didn't just go seven sounds great we talked to to our review physicians that do these reviews and determined that seven did seem like 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 um it also left our review contracts at a reasonable rate and so we really felt like that was a good place to be based on the data that we were seeing beyond day four well
Representative Ryan A. Rose
Unverified
17:00
and you led me into my 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 let me make sure
Speaker 14
17:13
it is de-identified but yes sir i could send you that
Representative Ryan A. Rose
Unverified
17:16
and then moving forward should this 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 way to yes sir clean that up we can always go back anything we
Speaker 14
17:34
have 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 first four days of hospital visits some certain percentage of them get reviewed we will continue to do that for up to day seven and from
Representative Ryan A. Rose
Unverified
17:51
From what it looks like to me, I mean, the state seems to be getting a good
deal on this. You know, the increase in cost seems moderate this year and in the next year. But I wondered if you could speak to this one line that indicates that there is 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, et cetera, et cetera. Could you
speak to what that $100,000 increase is annually for those?
Speaker 14
18:25
Yes, sir. So what we did is we 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 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 because we do believe this to be the right number. That's why that number is so minimal, but, um, that is what that number is reflective of is
Speaker 13
18:51
additional payments to hospitals. All right. Thank you. I may
Chair
Unverified
18:54
jump back in, but I appreciate the time.
Representative Jeremy Wooldridge
Unverified
18:57
Representative Wildridge. Thank you, Madam chair. And my question is really a follow up, follow up with 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 okay 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 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
Representative Jeremy Wooldridge
Unverified
20:17
and if they find it they authorize it so this dual path exists then for every hospital
in the state yes sir okay thank you ma'am thank you
Speaker 73
20:27
representative moore thank you madam chair i just wanted to clarify i think i heard this earlier that there are no acute care hospitals specifically for children in the state
Speaker 17
20:36
of arkansas acute care hospitals for children other than children's hospital no ma'am not in the state we also do have
Speaker 75
20:46
lab honor in memphis and our network which is a children's hospital okay and then
Speaker 73
20:51
i think earlier you 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 okay so a little bit apples to oranges or
Speaker 74
21:09
i'm not the cost expert but they are adults not children you are that is
an accurate assessment okay thank you all right anybody else all right
seeing none thank you uh without objection this rule is reviewed item F
Speaker 79
21:55
Good afternoon, Madam Chair. I'm Jay Hill with DHS, Division of
Aging and Adult Services. Thank you for
Speaker 83
22:07
being here today. Please proceed. All right. Thank you. I have a few rules to present to you this afternoon, starting with Exhibit F
Speaker 82
22:15
on your agendas. This is an update to the Manual for State Plan 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 within PACE, plans of care, medical personnel requirements, care coordination requirements, timelines, grievances, appeals, and licensure exemptions for PACE providers. And secondarily, the manual change will allow us to be compliant with act 144 past of the previous general session which exempts pace providers from licensure as a personal care agency through the arkansas department of health
okay with that happy to take any questions madam chairman all right are there any questions from members of the committee all right seeing none thank you
Speaker 83
23:13
this rule is reviewed without objection Adam G thank you ma'am moving to exhibit G this
Speaker 82
23:19
is an update to the rule establishing the rate methodology utilized for the pace programs in our state the implementation of a rate methodology change does require a state
plan amendment pace is not a waiver service it is a state plan Medicaid service provided in our state and primarily what this what this rule what this will this fall the 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
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 rule 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 okay are there any questions from members of the committee all right c and none thank
Speaker 83
24:56
you this rule is reviewed without objection item h thank you
Speaker 82
25:01
ma'am uh our last presentation is for our provider manual for state plan personal care and we are 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 streamlined this manual to focus on standalone state plan personal care. We are
proposing to transition away from the Arkansas Independent Assessment which is not a tool that is required for a state plan 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 plan 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 would transition away from pcp involvement to optum 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 plan personal care. It 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 independent
i just thank you for listening to us um because they have the access
to our our claims correct that 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 Chair. And
Speaker 78
27:40
you are correct in what you are in what
Speaker 82
27:45
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 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 um an open door into
state plan personal care question yes would that also have the ability
to determine if they were uh 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
Speaker 82
28:47
correct about that. No, I don't know that our claims that analysis would simply say that you are also eligible for a federal program. Now, our involvement, this does require a registered nurse to complete an assessment of the individual to develop that plan of care.
There would certainly be opportunities to have conversations around 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 very similar, but there are 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 veteran's 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 would
be a great idea to be able to say hey you've got this under your federal benefit let's push with
Speaker 83
29:54
let's get you connected there and not on the state benefit. Thank you. There are there are two additional
Speaker 82
30:00
additions or changes to the manual that I wanted to to make aware. This brings the manual into compliance with act 625 of the general session which allowed for an abbreviated
independent assessment for past beneficiaries that was again that was act 625 and brings into compliance with act 853 which moves the certification for personal care from dhs to the department of health and both of those are codified in the are clarified in this manual change thank you madam chairman
Speaker 79
30:29
with that happy to answer questions okay
are there any questions from members of the
committee and I appreciate the the public comments I
know there's a lot of folks I had a constituent reach out to me just in flexibility on a weekly basis
versus a daily basis as far as hours 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 uh 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 um 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 you're correct madam chair
Speaker 83
31:34
we we do expect and want the hours to be divided equally among the month so that there
Speaker 82
31:41
is a continuity of care throughout the 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 are not at we're certainly not in 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 will 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, August the 5th,
Wednesday, August the 5th, due to the beneficiary, was unable to receive services, maybe 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 both stated and will continue to grant exemptions to those hourly limits to allow for the care to be provided to the beneficiaries. Okay, perfect.
I think that was the question. They just wanted some clarification on that. So you provided that. Thank you so much. Any other questions, Representative Laineyman?
Makes perfect sense. Thank you, Madam Chair. Well, thank you for this rule. I think it helps. The complaint that I got from people was it was just too cumbersome, the process, and this is going to help that a lot, and I appreciate
Speaker 100
33:06
you bringing these. It was. Thank you for
that. Thank you. Any other questions? All right, seeing none, without objection, this rule is reviewed, item I.
good afternoon i'm please go ahead identify yourself for the record and you
Speaker 103
33:48
may go forward thanks miss franklin i'm mary franklin director of the division
Speaker 104
33:55
of county operations for the arkansas 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 makes it clear that for 529 educational accounts that 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 advanced 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 advanced 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 age-blind disabled categories, including long-term service and supports, that they will continue to be excluded for those other eligibility determinations 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 are bringing with this rule there is a fiscal impact 485,000 in year one 586,000 in year two
and there were no public comments happy to take any questions representative
rose you're recognized for question thank
Representative Ryan A. Rose
Unverified
36:33
you thank you for your presentation as i 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 some of this was unclear and maybe was more on a case-by-case basis and this makes it uniform moving forward
Speaker 104
37:01
is that right yes um with the additional
we had originally done independence account i mean independence accounts are not new but the specificity that the it carries over to other um the exclusion carries over to other categories is is a change i mean it's clarifying but it's also a change and i asked miss pitman pretty much the
Representative Ryan A. Rose
Unverified
37:22
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 a hundred thousand per year to all the private entities
Speaker 104
37:50
in the government could you speak to that just briefly so these costs would be related to claims that may be paid for individuals who are eligible with these changes and these are estimates so the cost would be
Speaker 112
38:06
accumulated through claims being paid for possibly people being eligible or additional assets being excluded based on this rule
Representative Ryan A. Rose
Unverified
38:16
change and I think as I understand it
it's some of this was in some cases these were not being counted against individuals in some cases they were so some of these associated costs would just be getting everybody over into the same category is that right yes okay all right thank you representative ladyman
thank you madam chair this may not be part of
the rule that these independence accounts is there a cap on that or a cumulative cap or you know no the maximum amount there's
Speaker 104
38:59
no minimum or maximum limit to establish the account and there's no minimum or maximum limit that can be deposited into the existing account withdrawals uh and actions involving the independence accounts are subject to standard eligibility rules when the money is withdrawn but independence account is is different
than a five than a able account independence accounts are allowed by cms but they are not a they are not in like tax code
Speaker 119
39:27
or established at the federal level but they are allowed by cms for states and there there was a state law that requested
Speaker 104
39:37
us to establish the 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,
Speaker 119
40:08
retired or was no longer able to work and applied for other categories. And so
that's what we've done. So are there any limitations on withdrawals
Speaker 109
40:19
that you know of? No, other than that, you know, withdrawals, once the money comes out of that
Speaker 104
40:25
account, we would treat it as, you know, income, and whatever impact that
Speaker 111
40:31
had to eligibility, we would evaluate that.
Thank you. You're welcome. Thank you. Representative Ennett? Thank you, Madam Chair.
Representative Denise Jones Ennett
Unverified
40:44
I have 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 do people with
Speaker 104
41:00
disabilities tap into this? So independence account 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 benefit, but they still meet the definition of disability. So 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 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's the point of them. It is allowed, and we were asked by state law to create this pathway for these
Representative Denise Jones Ennett
Unverified
42:09
individuals. I have another question madam chair so is this automatic for a person with
disabilities who are who qualify for this is it do they automatically qualify to have do they have to ask to be on this particular account they would have
Speaker 104
42:24
to establish an account and get it approved by DHS and that would have to happen while they were in the workers with disabilities category 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 excluded if the
Speaker 119
42:56
person retired or was no longer able to continue working and applied for other categories of Medicaid thank you you're welcome all 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 take away well and
Speaker 103
43:22
and things that we have learned that I needed to clarify
in our policy all right perfect any other questions from members of the committee okay if not this rule stands reviewed without objection thank you thank you miss Paula Stone she thank you Adam J
Speaker 129
43:57
Good afternoon Paula Stone Department of Human Services Office of Substance
Speaker 130
44:04
Abuse and Mental Health. This rule is you you will approve the emergency rule for this in June but this is the permanent rule that's coming through and this rule 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. Okay and so any changes between the emergency rule and this rule? No. Okay. Representative Rose you're recognized for
Representative Ryan A. Rose
Unverified
44:51
question. Thank you. I'm over here and you're right. Thank you. Thanks. So I think the hospital you're referencing, is it the,
is it in Searcy? It is. The Searcy Hospital. You mentioned that this would potentially qualify for
other hospitals or facilities that would be dedicated to this kind of care. Do you know if there's any in the works, if this is opening or helping any of that to take place? I
Speaker 129
45:16
have not been contacted by any other hospital stating an interest in
Speaker 130
45:19
opening up a unit. So I hope when they see that Unity has opened up a successful unit and what they're able to serve, that there may be some other interest
Representative Ryan A. Rose
Unverified
45:31
in other areas of the state. And obviously it's a terrible thing that is needed.
If this were to be successful or because it will be successful, are
there any types of controls or monitoring in place that will keep the state's share manageable if it were to exceed expectations? I think one of the
Speaker 130
45:56
things for most mental health or substance use disorder services for which we have, you know, availability or 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 UAMS to have some of that funding to go out and do substance use disorder training for therapists across the state. So there'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 for 30 to 45 days, receive 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
Representative Ryan A. Rose
Unverified
46:51
just piqued my interest. I apologize to take more of your time. Is that a DHS grant that you referenced that UAMS is
Speaker 130
46:58
utilizing? Yes, it was a grant we have at OSAM. It's through the Substance Abuse and Mental Health Services Administration, and it's called State Opioid Response Grant, and we had some funding that we could use for training. Okay. All right. Well, thank you.
Thank you. Representative Aldridge, you're recognized
Representative Jeremy Wooldridge
Unverified
47:17
for question. Thank 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
Speaker 130
47:29
be independent of a hospital? It's just a unit within a hospital. You know, some hospitals have units for gerry psych or they have a psychiatric unit, so it's functioning much like that. The rules for all hospitals, psychiatric hospitals and units within hospitals are regulated by the Department of Health.
So this is a separate licensure for substance use disorder. So they follow 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 it's regulated in that way. So I don't think it's going to look a lot different than freestanding psychiatric hospitals. Okay. So to Representative Rose's
Representative Jeremy Wooldridge
Unverified
48:09
point, if this is successful, 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 partner with DHS and Medicaid. This
Speaker 129
48:25
one is specifically for hospitals, general hospitals. We do not have a rule
Speaker 130
48:29
at this time to specifically allow psychiatric hospitals hospitals to have substance use disorder specific units but that has not really prevented them for treating as you know dual diagnosis kinds of thing 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 well we see a lot of youth that are that
have been in psychiatric hospitals and received treatment that are coming there right 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 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 just think it's great do you know if unity or searcy had to do any kind of physical um changes uh in order to meet any kind of criteria to establish this unit they they fully
Speaker 130
49:57
built out a new unit so they didn't yeah they did and and did it in a way that allowed them to serve girls on one side and boys on the other so they have 12 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
Speaker 130
50:26
and build out that's required generally most of the grants we have now have restrictions on construction okay 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 do to do
this important work but um hats off to unity um i'm just thank you so much for stepping up and meeting the needs of these kids i can't say enough and i'm sure that sentiment is expressed by everybody here um 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, item K.
thank you if you'll just state your name for the record and then we will
Speaker 143
51:53
you may proceed chuck thompson attorney arkansas department of health shane david
Speaker 144
52:03
department of health craig smith attorney for department of health hey guys go ahead the first rule is the list for a controlled substance as a reminder arkansas code 5-64-216 requires that the department of health update this list annually the proposed amendments to the list uh at this time are adding substance that were identified under act 934 of
2025 regarding prohibition of intoxicating hemp as well as current dea scheduling and substance identified of concern in arkansas the public notice was published on april 25th last day for comments and a public comment hearing was held on may 26 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 yes ma'am this is
Speaker 144
53:01
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 substance for some time, so this rule is redundant, and so we are proposing repeal of the entire rule in itself. Notice was published on May 3rd. Last day for comments was June 5th, and no comments were received.
With that, open to any questions. Thank you. there any questions members of the committee all right seeing none the stands reviewed thank you thank you madam chair there is no other business to come from the committee
Unknown speaker
54:07
All 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 5
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