House Public Health, Welfare, and Labor Committee - Health Services Subcommittee Meeting
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Representative Bart Schulz
Unverified
6:30
good morning this house health services subcommittee meeting is called to order our first order
of business is the consideration of the approval of minutes
from october 7th 2024 if members would like to review that i would accept a
motion to approve you got a motion second does anybody have a second all right all in favor
any opposed like sign all right minutes are
approved okay members uh when we convened this meeting we had three interim studies before us since that time two
of the sponsors have decided to hold their interim studies for the time being and the third sponsor is out of town so a while back we were tasked with just for a little history here there the house has had a behavioral health working group for quite some time this subcommittee has been tasked with kind of absorbing that work and maybe we can pick up the ball
and move it down the field so we're going to start off with a presentation by Representative Wooldridge and Representative Vaught on the work that the behavioral health group has been doing this
Speaker 7
8:30
far if you would introduce yourselves for
Speaker 13
8:36
the record you may begin representative dm bot uh state representative district 87 jeremy woldridge district one
Representative Jeremy Wooldridge
Unverified
8:44
thank you mr chairman we appreciate the opportunity to uh present to the committee appreciate you and the subcommittee taking up this work i know representative vott can speak to the working group far more than i can but just kind of an overview like you mentioned of behavioral health and the need in Arkansas so I am a licensed behavioral health therapist practiced for a number of years while I don't currently practice I do remain licensed but I think one of the things that COVID taught us or exposed at least was that there's a huge disconnect
with behavioral health care in Arkansas and services in Arkansas and Ms. Stone who's behind me who will present next I just want to applaud the work that she's done on behalf of the people of Arkansas through the Department of Human Services. It is not a small or easy task, and she's done a good job, but it's time that the legislature really expose and look at the deficits and the gaps that exist in behavioral health in Arkansas. We have for a long time, through no fault of anybody, been somewhat of a reactive state, and we've reacted. When patients have a
crisis, we throw a lot of resources and money and a little bit of time at them, and then we pay for a higher level of care. We discharge them right back into an environment or a community that they were not successful in in the first place. So it's time that we be a proactive state when it comes to behavioral health. As I said, I think that COVID taught us a lot of things. One of the things that it taught us was this is a huge need in the state of Arkansas. There's a huge need for access to behavioral health services. Providers are just as strapped as the patients who are
receiving services so it is time that we collectively come together as a legislature as a provider and as a state agency through dhs and collaboratively work together to figure out what we can do to like you said carry that ball down the field my goal or my hope for this group and i appreciate you chairing this and overseeing this my my goal and hope is that we come together collectively and we work to establish some real attainable goals for the 27 session so
i don't think we need to try to produce 10 to 15 pieces of legislation i think that we need to collectively work towards three to five pieces of legislation true policy changes that make it easier for providers and patients to have access to behavioral health so that's what i hope to see as an outcome of this committee and i look forward to be a part of the discussion part of the working group and however i can be helpful in this
process so representative buck so when we started the working group um the whole purpose of it was from
covid we found out how quickly kids were falling
through cracks um and not only that the mental hospital is the beds are always full and it keeps our jails from being able to house people that don't necessarily need to be inside the jail but be somewhere where they could be safe and get the medicines that they need. We still have those same issues today. We have lots of children who need lots of help and our teachers are drowning in trying to figure out how to help those students because that's not what they go to school to do. They go to school to teach not to be a therapist for somebody. I think they've done a good job
trying to fill that gap, but we need to find students sooner so that we can help them to learn to cope with or what their cope mechanisms need to be to help them to be productive citizens for our state. And I think if we can find them sooner rather than later, you quit with the revolving door of the jail, prison, jail, prison, jail, prison, back into the community and back and forth and back and forth and we have a lot of that that happens um i think the working group
has done an amazing job over the last several years bringing everybody to the table giving everybody a voice and we still want them to be able to have a large voice but for this to move forward we really need more of the legislature to be involved in helping with these decisions instead of it coming from the working group and you being lost we want y'all to all be very aware of what's going on I look forward to this group I'm very thankful Mr. Chair that you're going to allow me even though I'm not on public health to still be here and be very active in the group
for the for those that are watching that are therapists I want them to know we're not just turning it over we're not giving up we're still working very hard to move the ball forward and we still want them to have a voice because that's one thing I think they've enjoyed most of all is that they've had a voice at the table whenever they didn't feel like they were being heard before. Those are still things that are still going to happen. It just won't be happening as it has been happening in the last several years.
Representative Jeremy Wooldridge
Unverified
13:48
That's exactly right. And just to kind of conclude this and then allow you to move on with business, I just want to echo what Representative Vought said for all those providers that are listening, for those that are part of the associations. You know, we want you here. We want you participating. We want you to have a chance to be heard. We want to figure out a way that we can collaboratively partner with you and make sure that we're providing a safe environment for you to speak freely about what you're experiencing as a day-to-day boots-on-the-ground frontline provider,
but also give you a seat at the table to help shape policy as we move forward. So our goal here is to reduce the bureaucracy, the red tape, and allow behavioral health providers to do what they do, and that's care for Arkansans. So with that, we appreciate your time. Thank you both very
Speaker 22
14:35
much. Anybody have any questions for the representatives? Okay. Representative Pilkitt, can
Representative Aaron Pilkington
Unverified
14:45
you recognize? I appreciate all the work you guys are doing on this. It's vital.
Could you give me some examples of some red tape that we might be able to this next session? I mean, you don't have to go into detail, but I'm just curious because I know, you know, just we all work in health care. You know, the broad spectrum is reimbursions are too low, costs are too high, not enough work for us. Those are kind of similar themes we see everywhere. So I just was kind of curious if there were some unique things maybe y'all had found in this working group that you could share. If not, that's okay. I just, I was, you piqued my interest at that last line, and so I just was kind of curious. So there were some things we can start looking at now. Absolutely, and I appreciate that.
Representative Jeremy Wooldridge
Unverified
15:21
You know, I think the process from getting someone once a problem has been identified to a viable billable patient for a provider has been hurdles to some extent, especially if you're dealing with a kid in a school system. So figuring out a way that we can get that person identified with a need and then access to treatment a little bit quicker. DHS does a great job if you've got a contact there where you can call and say, hey, here's what the situation is. But for all providers across the state, DHS doesn't have the manpower to deal with every provider indirectly or directly.
So we've got to make sure that we're creating a process that flows a little bit smoother to allow that access to care, especially in rural parts of the state. That's been a hurdle that I have had and dealt with in the past. And I think that there are things that we can do maybe to expedite and ease that process. and then along with you know payable services there are a lot of services that need to be paid and you're having to creatively try to figure out as you know what codes those things fall under we need to broaden the spectrum and allow providers to provide services and if there are ways that we
can expand that access or different codes to allow them to service other populations i think that could be helpful so those are kind of a couple of just off-the-cuff examples that i'd like to see us
work towards yeah I think can I think something else that we can look at
is how Arkansas compares to other states how quickly we get people into the working force because I think we do have a large shortage of people who work in this field and like
there are some states that don't make
you have as many hours of practice before you actually get to be your own person you know what main hang your own shingle or whatever but um i think we require certain things that other states do not require and i think that's another thing is trying to figure out how we can get people to the workforce for this exact need sooner okay awesome thank you guys appreciate it vice chair richardson you're
Representative R. Scott Richardson
Unverified
17:27
recognized thank you mr so i think representative vaughn you you almost
i think you answered my question i was i was about to ask do we have enough providers and
do we have do we have access to enough providers and are we making it easy to meet the need that our people need in terms of the help that's out there so
Representative Jeremy Wooldridge
Unverified
17:46
I'll answer for you no obviously we could use more providers there's always a shortage as representative Pilkington said in all fields of health care we recognize and realize that what I don't think we have done as good a job as we maybe could do as a state is utilizing all the players that are on the field so making sure
that we are reducing the things that prevent current providers from being able to provide services providers that move into the state because their spouse has relocated here for work that process is cumbersome to get you licensed in the state of Arkansas supervision for LACs to become lpcs is a little bit more difficult than supervision for lmsws to become lcsws and and everything in health care is acro you know acronym suit but um for those people that are in the field
they recognize and realize those barriers that's one thing that i think from a red tape perspective that this committee can really hopefully put some tangible legislation together that eases that burden and then we can just start as a state taking access or utilizing all the players on the field at least accessing all the folks that are out there in the state currently awesome thank you guys thank you sir representative gremlin i i guess
Chair
Unverified
19:02
just you know piquing interest and stuff like i mean are there compacts and stuff that we could enter into i mean that's definitely something
we've done a lot in the last session access is always something i'm interested in what are ways that we can you know low hanging fruit
Representative Jeremy Wooldridge
Unverified
19:16
on that we we have done that in the last session so we've we've entered into compacts. We've started that process. Um, those compacts don't always account for people that transfer into the state because some states have different credentialing hours as representative mentioned than we do. So there's still some thresholds and bars that have to be met there. So I still think that there are some tweaks that we can make to, to make that a little bit easier, but we are, we have started the process.
We're in the right direction. We're in
Representative Kenneth B. Ferguson
Unverified
19:52
the right direction. That's good here. Representative Ferguson, you're recognized. Thank you, Mr. Chair. Just a quick question. Has any of the providers ever gave any information regarding reimbursements? Has that been a problem? Yes, sir. Because in my area, that's been a problem for particularly certain services, particularly towards the youth, and also for people who are incarcerated and then not being able to
those services and those people are let back out into society without receiving help right yeah so obviously
Representative Jeremy Wooldridge
Unverified
20:20
um i think representative pilkington hit on this too in his question you know there are reimbursement challenges across the board we recognize that we realize that that there are reimbursement challenges and i always say you can equate that to every industry so copy that to teachers and to every other industry in the state of arkansas while i'm always going to advocate for
increases for providers across the board for health care we also believe and recognize that money is a temporary solution sometimes to a complicated problem and there are things that i hope that this group can focus on where we can solve broader issues than just throwing some additional money at it i'm hoping if we're able to solve some of these other issues that will allow dhs and the state the opportunity to realign some additional funding there when they see that
we're truly making progress with the service we're delivering thank you mr chair can i add something to
that so i know like i talked to my sheriff like two weeks ago and there's somebody that's been in the jail for almost three years and the reimbursement rate that we give to the to the county jails is not enough to cover the services that these people need that they would be getting if they were somewhere else besides the county jail and so that is like a huge issue probably in every single one of our
areas is the reimbursement rate for someone that they're just holding for maybe the state hospital or wherever that rate doesn't cover what what our sheriffs are losing out of
Representative R. Scott Richardson
Unverified
22:15
Richardson yeah thank you represent Woolridge do you think the
CCBHC helps access behavioral health? I absolutely believe
Representative Jeremy Wooldridge
Unverified
22:23
in the CCBHC model. I hope that that's something that the state of Arkansas is willing to look into and adopt. I know during our regular public health meetings, we have visited with them about that. I have visited with DHS about the planning grant that's open. I'm hopeful that DHS will take advantage of that. We're one of few states in the nation that is not participating in that ccbhc model to me maybe it's not an answer
or a solution to the entire problem but i definitely believe it's a step in the right direction and a piece of the puzzle i'm hopeful that dhs is open to that as we move into the 27 legislative session hope that that may be something that we can develop and work for out of this group i know
Representative R. Scott Richardson
Unverified
23:07
it's been a very positive piece in my part of the state and i know our groups down there really really support that so i was thank
Representative Jeremy Wooldridge
Unverified
23:14
you for that fort smith has done it extremely well and it is a model more time fort smith fort smith representative gramlic and richardson have done
that very well rusty has done a great job uh and that's definitely a model that we need to be replicating across the state thank you
Speaker 22
23:32
guys yes sir seeing no other question oh hold on they're popping up turn my mic off
sorry you're recognized thank you mr chairman besides the state hospital y'all mentioned earlier what other facilities are available from the state to house these people to keep them out of the county jail
Representative Jeremy Wooldridge
Unverified
23:49
so this is a complex problem again a lot of layers to this
onion a lot of folks when they are waiting trial the attorneys will ask for an evaluation to see if they're competent or fit to stand trial i think that's what representative ott's referring to there's a huge backlog there we've had several committee meetings not only in public health but in state agencies and some others trying to work and address that backlog so again piece of this puzzle like so many different pieces that are going to come together and make a picture here but there's not enough providers out there that's willing to provide the services the reimbursements
you know i've heard from providers that the reimbursement for that service is is not really adequate in terms of creating a need for providers to step out get the credentialing required to provide that service so it's it's created an additional backlog then i'll also add this is jeremy's opinion i don't have any proof of this but i would assume if i were a defense attorney and i were wanting to buy time for my client and i knew there was a backlog i'd probably request one and continue to clog the system up and let that wait so again i think there's a whole lot of
things at play here but nobody's solely responsible for it and now
when you talk about backlog that's a backlog waiting for an evaluation waiting for
an evaluation yes determine if they're mentally competent to
stand trial correct and we really don't have very many of those in the state providers
in the state of arkansas so what's the current cost approximately per day in a facility like the state hospital or something similar
Representative Jeremy Wooldridge
Unverified
25:25
to that dhs would have to answer
that for i'm not sure and you know about what the current rate is for for reimbursement for the county uh
Representative Jeremy Wooldridge
Unverified
25:35
county jails dhs would need to answer that the agency is going to present
Representative Mark Perry
Unverified
25:46
after us okay thank you yes sir representative perry thank you mr chairman we had a working group our interim study before covid on the non-emergency behavioral health transportation and covid kind of shut that down and it was never reformulated but that would be something that we this working group could address on that because it's a severe problem throughout the state and would love to love to
Representative Jeremy Wooldridge
Unverified
26:10
see it absolutely definitely something that we need to make a focal point of this you know from a provider's perspective you're wanting to get a critical patient that's in crisis to a higher level of care so they're going to call an ambulance and they're going to ask for transport and there's really not a good path currently for a medical provider to transport that patient so definitely something that we need to work on agree as an
Representative Bart Schulz
Unverified
26:39
ambulance provider i can speak to
that there's a there's a gap we we fill that on a regular basis
but that takes already limited resources especially from the rural areas away from the citizens that's right and and these mental health facilities are all over the state that's right it's a huge problem yep representative gramley recognized uh thank you just
Chair
Unverified
27:01
a couple comments i think you know you've spoken a little bit about uh you know reimbursements for uh services being provided in our county jails but But, I mean, I guess you're fortunate because ours are so packed over.
I don't even know if we're able to provide any meaningful services. But another thing we kind of talked about as well was, like, Arkansas State Hospital backlogs. And it seems to me that it's just incredibly too expensive to expand that. And I don't know if it's true, but it doesn't seem like there's any real other option. Like, there's not really a step down for individuals who don't necessarily need the Arkansas State Hospital but need more than jail. And so, you know, like, I've heard of community treatment centers and stuff like that where people can go.
It's almost the equivalent of, like, human development centers, but for a different, you know, there's a lot of places that we need to expand or at least look at how we handle this. And I was actually having a conversation with some people over in the Capitol this morning about this. And it also really affects, like, our homeless population and how do we interact with that. And, you know, because we don't have, you know, real systems to help those people, you know, it's just a cycle of getting worse and worse and going in and out of jails, which is a waste of resources. I heard one person has been arrested like 17 times just for, in the last couple weeks, just for not being where they're supposed to be.
And it just seems like there's a lot of issues. And I'm glad y'all are doing work in this
and, you know, whatever we can do. We've talked a lot about a step-down service. That's right. where they don't need jail but they do need help um and there was like five nursing homes in the state of arkansas and we were like why
can't we take those and renovate them and these people aren't really um a danger to the communities but why couldn't we fix something like that to help
people do step down um it's creating
Representative Jeremy Wooldridge
Unverified
28:57
and and again we'll allow dhs to speak to this over the course this work group because they they can better than we we have the ability to but we've got to create an environment in which providers can have a business model and then fulfill that business model i mean it's just like health care at a hospital you can't do it for free providers can't provide behavioral health services for free they love their community they love their neighbors they love arkansans they want to help solve a problem but they can't do it for nothing so we
We have to allow a model in which these providers can provide a service, they can care for their friends, their neighbors, their communities, but they can also make a living for their family. I always say people are motivated by two things. It's either mission or money. And if you're motivated by money, you probably don't need to be in health care, behavioral health especially. But if you're motivated by mission, helping other people, and providing a living for your family, then that's a good fit for you. And there are places, IDT is one in West Little Rock, that they do a step down from the state hospital.
I know they're one of very few providers in the state that the state hospital will transfer patients to. When you have a serious mental illness, if you're schizophrenic or you're bipolar, that's not like having the flu and getting better. It is a continuous battle for the life of that person. person so we need providers who are able to walk along that path with them through the course of their life and help them be the best version that they can be that version may not be the best version that representative gramlet can be but it's the best version that that person can be and
we've got providers out there now who are trying to walk alongside those patients and keep them stable and help make sure that they are able to do menial chores or menial tasks throughout their life but it's big for that person so progress looks different for everybody and it looks different for every provider but focusing on creating a path that is sustainable for providers to be able to provide services like that you're exactly right that's cheaper than adding on to the state hospital also providing adequate outpatient services is cheaper than
residential services at a residential hospital they all have a place or a part to play in the services but obviously that's the cheaper option so we want to make sure that we as a state i believe are positioning ourselves to care for as many folks in their home as possible thank you very
Speaker 22
31:30
much yes sir all right seeing no other questions thank you both very much
Representative Bart Schulz
Unverified
31:35
director stone the director is now going to give us kind of an overview of the state of behavioral health with
DHS. Director, if you would introduce yourself for the record, you may begin. Good morning. My
Speaker 87
31:55
name is Paula Stone. I work for the Department of Human Services. I'm the Director of the Office of Substance Abuse and Mental Health. So I'm going to skip a couple of slides because I feel like I got such a good lead in that I don't need to cover all of that. So that was nice to make sure that I'm going to do it.
Speaker 89
32:14
Okay. Let me do. I'm just going to jump over here to
Speaker 86
32:21
this slide and just kind of give you all just the foundation of
Speaker 87
32:28
what DHS and OSAM, our role in the system. Let's see if I got the right slide. There we go. So we have two bits of work that we do.
One is Medicaid. So we are the policy driver for Medicaid payer as the Medicaid entity. And why Medicaid is important in the mental health system is that while we are paying just like for counseling services, just like commercial insurance, my commercial insurance, my insurance company, that has state insurance pays for counseling services for me or any of my family or anybody who needs that but Medicaid pays for over 75% of all the
behavioral health services that are delivered in Arkansas so just knowing that the policy that's set for Medicaid and how we provide those services the rates we pay the individuals who are providers that are willing to enroll in the arkansas medicaid program that really builds a lot of the foundation for behavioral health in our state so that's where we all work together and that's why it was so important when we were doing the working group that they brought together legislators providers and dhs as the payer and the
policy entity builds policy so you know there were so many days that we were there where one it was a provider that I didn't know what they were doing around the state, and two, it just kind of led to some better conversations that we had, both in that working group and then having some advisor groups that we formed after that. You can see commercial insurance only pays for about 11.4 and Medicare 11.9% of the total. We have some updated numbers coming from ACHI, so I may need
update those are non-medicaid programs i think you were already talking about a bit so when somebody goes into jail or into our state hospital their medicaid is turned off their commercial insurance is turned off and so we have no payment source other than state general revenue um to pay for those services um so that that becomes a critical piece of this is that we we don't have another payer i think the other thing that we have are some services that we are using to treat substance
use disorders and we were not able to pay for it through medicaid previous to this we were using a lot of block grant dollars to pay for substance use disorders particularly for adults so just thinking about how that system is moving forward and what we can do as an agency but those are two levers we can pull is the money that we have um to pay for services outside of medicaid but medicaid is the largest driver i'm going to skip
Speaker 87
35:39
because i think this is exactly what you all were talking about and i completely agree access access is the key getting everyone identified with the right service and providing it at the right time for so many mental health services and particularly substance use disorder services if you don't catch somebody at the right time you lose them and just like Representative Vaught said once you lose them where do they go they get arrested they go to jail or they go to a hospital and they end up in
institutions and so just making sure we catch people at the right time one of the things that I see that is particularly difficult and I don't think we've solved for and I hope we can focus on in this working group as well is the providers that serve difficult to serve populations. I know Representative Wooldage referenced that. Difficult to serve populations are adults with serious mental health conditions. They don't generally stay in the same place. They
move around. They don't respond as well to come into the office and let me give you an hour of therapy. So those populations are very difficult to serve. Also, rural areas. If you think about that, I don't think this is any different than any other health care, but there's not a volume of people in the rural areas. And so some of the clinics that we have that are behavioral health clinics they have a volume of Medicaid beneficiaries and they can provide services to a large number of beneficiaries which kind of gives them
stability their business model stability so then they can't also treat those hard-to-serve clients but if there's not a volume of services they really really struggle to stay open so I think thinking about that is we don't have a differential in rate you get the same rate for an hour of counseling in in Little Rock or Fayetteville that you get in an area like DeWitt. So we just haven't solved for that. How do we support those rural providers that are not going to have the volume of services
and be able to provide services and be able to provide that in their areas? Back to the adults with serious mental health conditions, you know, they don't always come to an office. and in every county it's not easy to have an office open in every single county because you don't have enough people there to provide the service and you don't have enough people coming in to obtain the service so we think about with our trying to divert from the state hospital so we have our community mental health centers going out to 71 jails in 75 counties and so
thinking about what the time that takes for them to drive around rural areas and you know how far is the difference the distance between those jails of saying okay whereas if you have 20 people or 50 people in the plaski county jail you can send somebody over there and they can round for the day this makes it a little bit more difficult so i want to go over some of the services i was asked to talk about some of the services that came out of the working group and then just our ongoing
work that we're doing. And so here's our children's system of care initiatives. I'm going to highlight one called family-centered treatment. So we have providers in all 75 counties with family-centered treatment now. We started it out as a pilot. Now our passes pay for that under the managed care organization. They pay for that. And we built this up as a team-based approach. It is an evidence-based practice. It is a six-month intensive work where a provider goes into the family's home.
So this meets the family where they are. They're also on call 24-7 for crisis services. And it's crisis services that are delivered by somebody who knows your family. I love this model. At the end of this, towards the end of the model, after the families have received treatment, they have some time where they're giving back to their community. So thinking about that, that they started out with needing the help and now they're giving back to their community. So this is a place where we've been able to have workforce
that's going out across the state and treat families and children with serious emotional disturbance. It's also a step-down, a good step-down program from our institutions for children. And it also prevents children from going into institutions and keeps them in that community. As we talk about high-cost services, a day in a psychiatric residential treatment facility is $500, and I think we're paying $502 a day for that. Average length of stay is between four and six months,
and children are there and they're not with their families. They may be in a completely different area of the state, so we want to make sure as they go back into their communities that they have a service that wraps them up. The other one we're doing is the Community Reintegration Program. And so that's a step-down service. We have a number of providers that have started providing that service. It's more like a group home, and Medicaid can pay for that as well. And it's less than 16 beds, but it also gives those children a chance to go to school in their community
while being in this group home and providers are providing that service and overseeing that So instead of just going from an institution right back into your home, we can step you down. So those are two, and that helps a little bit with workforce as well, because then you have those children together, and you can bring a workforce in to provide them services. The last thing I'll talk about on children and youth is—
Representative R. Scott Richardson
Unverified
41:41
Ms. Stone, can I cut you off for one second? I wanted to go back a little bit to what you mentioned about when individuals go in or become incarcerated, their Medicaid benefits are cut off.
That's right. But they still need those in order to help them get better and get out. What can we do to ensure that they're still getting the treatment that they need even though they're incarcerated? I'm sure this isn't the first time you've heard that, I'm sure. So
Representative Sonia Eubanks Barker
Unverified
42:12
are you guys working on something to do that? Yeah, so we definitely have
Speaker 87
42:17
that as one of our pieces that we're working on. So we're responsible for completing the forensic evaluation for somebody who's in jail,
and there's a belief by the judge or the prosecutor or the defense attorney that they have committed that crime based upon symptoms of a mental health condition and those need to be treated. So we do those forensic evaluations. there had been a backlog of forensic evaluations one of the things we did there was we moved from the community mental health centers doing those forensic evaluations in 12 different community mental health centers they were really struggling with keeping those people hired and and working and delivering that service timely and we moved that to one single contract
so we had seen some good results with that that we had the responsibility for them and we did that with our independent assessment entity. So we've got that going on, but then once they're found that they cannot go to trial because of that mental health condition, that's really where we're having some difficulty in providing those services. So we changed the community mental health center contract and rebid that. We're announcing, well, that was approved that we have
new providers in four of those areas but we have specific scope of work in our community mental health center contracts for them to go into those jails just for those limited people that have received that forensic evaluation and provide some services so they provide a service a service called restoration but then they also provide some services like mental health assessment it is not a service that it could be very intensive because we just don't have the
workforce the time or the money because again Medicaid can't pay for that so we're using state general revenue through our community mental health centers to provide those services I'm sure that there are other individuals in those jails that need mental health services that haven't gone through that forensic system and so I think that's where we think about what can we do in a crisis situation to divert them from going to jail in the first place. So that's really the focus of that is how do we provide those crisis services? And I know you talk a lot with Western
Arkansas and Rusty Holwick. And so I know that there's been some work there on mobile crisis response. So responding with law enforcement and really thinking about how do we divert them to a treatment instead of to jail. And so we only have those people that are going to jail that really can't be diverted because they're they just have their
Speaker 94
44:55
symptoms or their issues are just too severe so then right now
Representative R. Scott Richardson
Unverified
45:00
so there's no there's no answer there's no way to fix those individuals
that are incarcerated whose benefits have been cut off because they're incarcerated that's
Speaker 94
45:09
right that's a federal regulation so we have to work around that with those two issues is to say okay we either have to use state general revenue to provide the treatment while
Speaker 87
45:20
they're in jail and use some resources like telehealth services, so provide some of those. All of those individuals that are receiving those services in jail that have been through that forensic evaluation for which we're responsible, I mean, we're trying to also move them out of jail so we can get them into the community.
We get them back in the community, we can turn their Medicaid back on. Okay, okay. Thank you. Thank you for that. Absolutely. Absolutely. So with youth and adolescent, we're also opening up a substance use disorder unit. Unity is our partner in that. It's in Searcy. That should be open in August. This is our first residential substance use disorder treatment. Medicaid can reimburse for that service. I just talked to somebody, and we have 255 clinicians that are at UALR right now getting trained,
because one of our concerns were that it's in Searcy, it's one unit, it's 24 beds, all those kids are going to go back to their own community. And do they have the services available there? Do they have access to services and people that are trained to provide substance use disorder services to adolescents? And so we're doing a big push this summer to say how many clinicians, how many people can we get trained? So I'm really excited that there's 255 clinicians at UALR right now. But that was a big project, and we're bringing that to a closed.
Medicaid will be able to pay for that probably in August. We had to amend some manuals. So here are our adult services. We talked a little bit about that with the community mental health centers. Our community mental health centers, we've really narrowed the scope of what they do. They used to do more broadly services for adults and children, and they would do services for people who were uninsured. We're really focusing on that seriously mentally ill population
and making sure that they can get those services in jails. They can get crisis services that divert them from jails and that they get those services in the community. We have another project that we're doing. it is an eligibility category for seriously mentally ill adults making them eligible for Medicaid so all those things that we're trying to do to allow access is trying to get people on Medicaid to make sure that they can access those services or if they have commercial insurance
because obviously we would love people all people to have jobs where they have insurance through their their jobs and so really thinking about how do we move that forward in that area one of the things we're doing I think somebody asked about is there a step down from the state hospital so our areas of step down from the state hospital are here on this so therapeutic communities is one of our biggest step downs Medicaid pays for that there's 16 better less units and we can
either divert people and get them in those therapeutic communities instead of going to the state hospital. The state hospital is about $1,000 a day. It is very expensive. And that is because we are licensed as a psychiatric hospital and we pay for therapeutic communities about $500 a day. I think some of the challenges there that we continue to have as challenges, we've had a reporter asking us a lot of questions so you may see some of this in the in in some reports is that
again just like jail the state hospital their medicaid is not on when they're in the state hospital because they're considered an inmate of a public institution because they've been court ordered there so we can't bill medicaid so that thousand dollars a day is state general revenue every bit of it so one of the things we did there was also open up a unit that is a smaller unit within the state hospital and it is called secured restoration we ran a pilot of that and so what we're trying to do is filter
people into the right place so everybody that's in jail we only now have about 30 people waiting for a hospital bed we have another 25 people waiting for a secured restoration bed so those are people that don't need hospitalization they need something a lesser kind of service and our goal is there to have them treated within 90 days most of them are going back to jail and awaiting trial because we've restored them to fitness and now they can stand trial so we've
got that working and then the other individuals that are there in jail we're looking for community resources because we think that they can be restored in the community so back to that piece of do they live in a rural community and it's a very difficult to serve population you know that is making sure that the providers that we have that are providing that therapeutic community service are willing to take someone who's committed a crime because therapeutic communities is for
all of our beneficiaries all of our Medicaid beneficiaries that have a need for that service but some of them have committed pretty serious crimes when there are people coming out of the state hospital I mean we have people coming out of the state hospital who have committed murder and so just that community safety piece of this is difficult you know there's all kinds of regulations with Medicaid, that people have these choices of where they can get the service and choices of can they be in a locked facility and can we pay for something in a locked facility.
So those are some of the things that we're navigating, but our work on therapeutic communities is key there. And then also we'll call out that Medicaid is not allowed for adults to pay for services in an institution for mental disease. And an institution for mental disease is defined as more than 50% or more of the individuals in that institution, more than 16 beds, are receiving services and are there because they have a mental health or a substance use disorder condition.
And they're above the age of 21. So there is a disallowance that says Medicaid cannot pay for a substance use disorder service if those conditions are in place. So that's all of our psychiatric hospitals, including the state hospital, our psychiatric hospitals across the state, our residential units for substance use disorder. We cannot pay for those with Medicaid dollars, but we are pursuing an institution for mental disease waiver. So we are in the midst of that, so we'll be able to provide that service and pay for that service for individuals.
Representative Dwight Tosh
Unverified
52:24
captain tosh do you have a question i do mr chair and i appreciate you allowing me to ask a question i know i'm not on the committee but you know i've been listening and i i've not heard any mention and maybe you're referring to it by another name but you know the state of arkansas we invested a lot of money in these crisis stabilization units and but i'm not hearing i'm not hearing how that's being utilized and you know and I'm sure I know you know the the reason we really uh got involved
with that was some of the things that you've alluded to here to make sure that people that are actually in a mental health crisis and especially when they're encountered by law enforcement or whoever that they have a place that they can go and be in and spend the night in the hands of a mental health expert instead of spending a night in the county jail and but i'm not and i may i maybe i missed it but i'm trying to figure out why the crisis stabilization units are not a part of this formula or this uh that you are mentioning here today and i'm just curious
about that because absolutely you and we all know we we really have invested a lot in those units i I think there's four of them around the state. And the reason we did that, or one of the reasons, there's a lot of reasons, but one of them is because, as you said today, the state hospital is backlogged. And, you know, there was no place for law enforcement or others to be able to take those individuals that were in a mental health crisis other than put them in a jail because of the state hospital. So I'm just trying to figure out why that has been left out
or if it has been left out to crisis stabilization units.
Representative Sonia Eubanks Barker
Unverified
54:12
Thank you, Mr. Chair. Yes, I will update you
Speaker 94
54:15
on the crisis stabilization units. So we did have four, and we provided support. So we
Speaker 87
54:22
provided each of those crisis stabilization units $90,000 in state general revenue per month, and we had four. We had one in Fayetteville. We had one in Little Rock, one in Fort Smith, and one in Jonesboro.
And the one in Fayetteville started out with our community mental health center at the time, ERISA, was running that. They could not run it. They decided that that was something that they couldn't do any longer, and then UAMS came in and took over running. So those CSUs are a partnership between the county. We filtered the funding to the county. The county then partnered with a mental health provider. UAMS also pulled out of Fayetteville, and they've never found another partner to reopen that.
The Fayetteville unit was not heavily utilized, and we really tried to do a lot of analysis on why. Why was that Fayetteville unit not heavily utilized? So they had empty beds. I think they were averaging maybe two people a day that were in 16 beds. And we think that there were a couple of reasons for that. And one is that its location, and so, you know, where sheriffs and police were taking people was not as easily accessible.
But the second reason for issues with the CSU is they don't take involuntary patients. and so when you don't take an involuntary patient what would happen is that a sheriff would bring somebody there and they had the choice that person had the choice of staying or being taken to jail so I think there's a big issue there Little Rock also happened is that UAMS was running our Little Rock unit in partnership with Pulaski County and they also determined that they would not
proceed and they they think that was last July that they decided to pull out and that they would no longer be staffing that unit that unit stayed a little more full I think that there were issues there around just keeping it staffed and having beds either filled completely, so filled beds again, or filled with people that had insurance because you can bill, for our CSU, you can bill
insurance for that CSU, you can bill Medicaid for that CSU, and then again we were giving that um $90,000 per month to support that so what we looked at was a lot of what was going for that support was to pay for because you have to staff it whether you have a bed filled or not right and so it's almost like a firehouse model um you have to wait for somebody to come in so but we still have those in Fort Smith and I think part of the success we've really looked at like why are some
of the CSU's more successful. The Fort Smith success, I think, is because it's located on the grounds of Western Arkansas Counseling and Guidance, and they have that full array of services, so they have people that are coming in for services, and they can send them over to the CSU. They do a lot of work around withdrawal and detoxification for substance use, so they've kind of diversified, and then I've just got to say that they have really got a good, good relationship with law enforcement there you know they just have a long-standing partnership there
and so I think that there's that piece of why they've been successful a lot of times the success of any of our projects is based on the person who's leading the project you know and and who has that passion and advocacy so and then Jonesboro the partnership is with St. Bernard's And so St. Bernard's also has a psychiatric unit and a hospital, so they have a broader workforce, and then they have other places for them to go.
So those are our two successful units that we have left, and we're still using state general revenue to pay for empty beds and to pay for uninsured individuals. so yeah and I think you know back to that that crisis pieces is that is you're exactly right that's key is how to how to divert them from from a jail situation I'm just gonna I think this is the
last slide let's see it's just our forensic behavioral health services I think we've covered a lot of that talked about our competency evaluation our restoration services that we've just really focused on community mental health but I think I think we've arrived at this whole piece of this is access is key here crisis services are key here how do we do things like support a crisis stabilization unit that's not going to be filled even though that provider has
to fill it up what do we do for people who are that need to be committed somewhere and I think that's that's one of the things is that there can be civil commitments so involuntary commitments to services before they get to jail and they're involuntarily committed to our state hospital so how can we do that and I think part of the solution is going to be this institution for mental disease waiver is we'll be able to accept people in hospitals and Medicaid can pay for those services so i think those are some of the solutions but we we're excited about working with
this committee and our providers again to say are there other solutions we've developed a lot of them we're working on some of them you're going to see some new services come before you in the form of a manual a home and community-based services manual so i think those things are on the way just wanted you to know what we're doing and if there are other questions that i'm missed that were asked that i was going to
Speaker 94
1:00:31
address while was when i came up happy to do that as well
Speaker 28
1:00:38
representative grammock you're recognized for a question thank
Chair
Unverified
1:00:41
you mr chair um this is a member of the committee who couldn't be here today had a question and i think you spoke a little bit about it but i'll go ahead and let you reiterate um so what are we doing for adults in crisis if a family member knows that someone who struggles with mental health is in trouble but refuses to get help what steps can they do to help get them to care i
Speaker 86
1:01:03
think it's back to that civil commitment thing and i and i think you know
Speaker 87
1:01:07
one of the things we're doing is having some um
look at who's doing those civil commitments um on the mental health side so right now i think it's a little diffuse like maybe some if you come to a hospital they can do a civil commitment we have have our community mental health centers doing civil commitments. We've got this piece where now that we have this waiver coming and Medicaid can pay for a psychiatric hospital stay, we have some potential partnerships there where they can do a civil commitment. But I think that focus of do we have a single entity saying that a family can come to and say, the person that my family
member has a mental health condition that's so severe or substance use disorder condition that's so severe I need the court to be involved to court order them to treatment again not in jail and not at the state hospital and I think that's a big piece of work that we still have to do is is to make sure that we have a like a number to call where it's clear now right now they can call the each of the community mental health centers have a crisis line that they can call but I think
Speaker 48
1:02:18
there's more work so like someone with just horribly unmedicated schizophrenia refuses to get help the situation like that
Chair
Unverified
1:02:24
I wanted to thank you for your youth treatment stuff I've been talking about that for years middle school teacher I've seen kids who should not be near drugs doing things they should not be doing ever but it's really good to hear that y'all are investing in that and I just had one other question I know we have the Arkansas State Hospital but you said psychiatric hospitals how many units do we have in
Speaker 87
1:02:48
the state outside of Arkansas State Hospital so we have private psychiatric hospitals I don't
have that number off the top of my head again because right currently we can't pay for them for adults and so as we start moving towards being able for Medicaid we'll have a have a number for you but it's it's probably not as many as we need. There's also psychiatric units within acute hospitals. So, you know, we have those plenty. We have a number of those in Little Rock. We have a number of those in
some of the other areas. I'd say I mentioned Johnsboro has, St. Bernard's has some units. Baptist has some units and probably will be willing to open up some more units as they move into other communities like monticello and el dorado um but um in some of that south arkansas area
Chair
Unverified
1:03:48
just make one more comment this is representative tosh talked about our crisis stabilization unit and really just you know guidance center is doing great
things in fort smith and then the region you know i know she's watching right now so i don't want don't want them to get their head too big but they're doing amazing things and if you ever want to come see the crisis stabilization unit in fort smith please come out we got a really good thing going on out there so
Representative Sonia Eubanks Barker
Unverified
1:04:12
um and and ask and ask why it works there you know yeah i think that's always the question
Speaker 87
1:04:17
is why does it work there and it it didn't work for us in other areas you know what are some of those key ingredients thank
Representative Tippi McCullough
Unverified
1:04:30
you mr chair um can you tell me where we are in the
process of offering, of finding providers for the communities that ERISA was servicing? Yes, ma'am.
Speaker 87
1:04:39
So we had, we put that out for rebid and we were able to find providers that are moving into those communities. So Centers for Youth and Families is taking over that North Little Rock area and then they're also moving into Fayetteville, that whole Fayetteville area that was Ozark Guidance Center. We've been talking a lot about Western Arkansas and Rusty, and she's moved
in and taking over the area that used to be Counseling Associates, so Conway Moralton. And then our provider from Delta Counseling is going to take that whole big piece that was ERISA, Mid-South, Jonesboro. I mean, it's a big area of the state. So that was a special contract that we awarded them because we did not have a qualified bidder they came in and said we'll take this so trying to support all of them as they move into those new areas I mean they've got a big piece
of work so they've got to find places they got to lease spots so if there are people that you know that they can co-locate or do anything with we just are trying to support them we've connected that delta partner that's going to go in with st bernard's you know to say okay they already have a good presence across those counties in the hospitals and in physicians offices so they can provide some mental health
Speaker 94
1:06:04
services so what kind of partnerships can we get as they move in
thank you representative long you're recognized thank you mr. chairman um he mentioned earlier the cost about a thousand dollars a day for someone to stay in the state hospital i was wondering on average how long are
Speaker 87
1:06:30
people usually detained in the state hospital yes sir so um i think we're still sitting at about 14 months so that is one of the reasons we opened up that secured restoration unit to see if we could get that down, that length of stay down
to about 90 days or six months or less. But our 14-month challenges are based, and that's an average across all of them. So we have some people that are going to be there for years because they've committed, the crimes that they've committed are so severe. We also have real challenges of finding a place and someone to treat and a place for them to live for our sex offenders that are there that that becomes a big challenge so that kind of varies that number um but i think our we're looking at also of how many of those people that are um are they clinically ready to
leave to the state hospital but we've got some sort of barrier in the way so we've been doing that whole look at the barriers for why they're still stuck at the state hospital even if they're clinically ready to leave. So is the barrier that no provider will take them because they just don't think they can add them into the mix of their services? Is the barrier that we can't get their Medicaid turned back on for whatever reason? Is the barrier that a doctor doesn't want to follow the medication? So trying to move and getting that length of stay a little lower by looking
at the back door right so front door is diversion and not getting in there in first place and then back door is what's keeping
them there so long what would be the cost of detaining a person without the
the treatment it's just for us the the cost per day of housing yeah i think i think and
Speaker 87
1:08:19
i'm i'm trying to remember we work very closely with the sheriff's association association of county government and the jailers association but i think in jail it's more like don't i'm not
100 sure but more like a hundred dollar ish a day now if we put services there because some states do that some states have like a pod within the jail uh and services are are then provided there at the jail we're not doing that as a pod but we're doing that somewhat through our community mental health centers, although the services are pretty limited. So some states do secured restoration in a pod in the jail at a much lower cost. So they're sending mental health
providers that work in that jail. So I think economies of scale would be, you know,
a little better there. The reason I was asking,
you know, you mentioned some people just never can go home, basically, due to the seriousness of their past crimes or whatever. And I was kind of wondering, would we be better off having, like, adding an extra unit there that's basically for people that are just, that they're not really suited for prison, but they can't go back into society where we could, you know, keep them there, take care of them,
but not be, I guess, basically expending the money on treatment. You know, just basically it's more of a holding facility. How many people currently would that take away from y'all's, your current setup? Yeah, I would have to get back to you on how many
Speaker 87
1:09:58
people have been stuck there basically for, like, sex offender or somebody who wouldn't take. let me let me get some numbers together and it could be a variety of issues I mean sometimes
it's it's somebody who's elderly we've had somebody who's in a wheelchair that's been stuck there because every time we try to to move him out into a nursing home he does some really questionable things and offends everybody and he gets arrested and then he comes right back so some of those are you know very challenges which you know I always thought I don't know how somebody in a wheelchair is doing, but he, he, he finds a way, um, to upset everybody and get himself kicked out of a nursing home. So some of them are that some of them are intellectually
disabled. Some of them have committed a very serious crime and then in some, and some of them are sex offenders. So let me kind of just get a breakdown for you of why people are stuck. And then I think
Speaker 94
1:10:55
you're, you know, if we could create a unit that's not like this expensive at the hospital right they can
Speaker 86
1:11:01
stay long term yeah if you could send that
maybe to to our staff they could send it out to the members thank you very much representative will did you recognize thank
Representative Jeremy Wooldridge
Unverified
1:11:16
you mr. chair and thank you miss stone for being here appreciate your presentation and look forward to learning more from you kind of about the agency's perspective how you guys think and make decisions this is just somewhat food for thought i guess maybe there's an answer to maybe there's not but as we plan future meetings you had mentioned the rate disparity in terms of you know it pays the same to see somebody with an adjustment disorder as it does with bipolar schizophrenia is there something that prevents DHS from having multiple rates based on severity
Speaker 87
1:11:48
of illness um so what I've seen from other states and what CMS centers for Medicare and Medicaid services will allow as far as differentials is I've seen differentials for in-home versus in clinic. I've seen differentials for a higher licensed person, so an LCSW as opposed to an LMSW. I'm sorry, I'm also an LCSW, so we're talking acronyms. I've seen differentials for
evidence-based practices as opposed to non-evidence-based practices. And those are the differentials that medicaid will usually do i have not seen a differential for level of severity of the diagnosis um and and i i'm not sure that cms would approve that there have been other ways i think the differential like between rural and urban um i think other states have addressed that And I think that's one of the concerns here is that, or one of my concerns is just what we see at DHS is just the providers that are in rural areas and just don't have that support.
So I think one of the things we try to do is to add some things to the community mental health center contract, which starts July 1st. So we'll see if that actually helps what
Speaker 94
1:13:14
we are trying to do. But yeah, differentials, I have not seen any differentials based on diagnosis.
Representative Jeremy Wooldridge
Unverified
1:13:19
follow up Mr. Chair so I appreciate that I wasn't aware of that either you know it stands to reason to me or it would make sense I guess I'm just thinking as a provider if I were going to go hang a shingle I know the clients that I'm probably going to see right I mean I'm just
being real about that which then forces this difficult population into our behavioral health agencies right because they're they're what's left to pick up the pieces for those folks that are they're not getting services or not getting moved up a wait list in a private practice so i guess my thought process or question is do you see that as a problem is that a problem that's happening around the state and then what would the agency see as a solution to that problem because it puts our behavioral health agencies at a little bit of a disadvantage right because
they're not able they've got more overhead than a private practice that just is a fact and then they're kind of what's left to provide that service so what are we doing to incentivize I guess agencies to be able to provide a higher level of service knowing that they are going to have more overhead does that make sense my question makes
Speaker 87
1:14:30
sense it does and you know we've tried to do a couple of things there you know one is for those that are not part of an agency they're only terminally licensed people that can enroll so there was a big push during the working
group to say oh we want to be able to have those independently licensed practitioners
Speaker 94
1:14:50
also employ those non-independently licensed practitioners and and you guys supported us because we said if you do that then then we're we're in big trouble with access to services and we'll never get that back
Speaker 87
1:15:04
and so you all thank you so much for that support as is we were very concerned about that so we we know so we've got the independently licensed so agencies can hire the non-independently
licensed people so um that's one thing we've done the other thing we've done is to say for those agencies in those very serious mental health conditions you could also provide those paraprofessional services so um that's an additional service that those other independently licensed practitioners cannot provide they cannot provide the paraprofessional service and then just really trying to get those services down. So I know with Inspiration Day Treatment,
they're one of our only providers, you mentioned them. So I'll mention them as well. They provide services to seriously mentally ill adults, and they provide a service called Day Rehab. They don't provide, like, outpatient counseling. And so they've got a narrow focus on our population. So we tried to rework that rate. They worked with us. We had a serious mental illness advisory group, and now we're going to be, in January, we'll be paying a daily rate and a partial day rate. So I'm hoping that that will help them.
It kind of gives them some cushion that they don't always have to have an LCSW there that gives them some cushion of they don't have to have that level of clinical involvement, and then they can provide some services in the community that they're doing. so we'll see how that works as well for some of those daily rate services we've not moved to daily rate services other than family-centered treatment on the kid side but on the adult side those are the kinds of things that we think I know that a group is also looking at are there
any other kinds of you know daily rate team-based approaches for these populations the the difficult serve populations that could be brought forward and i think people are
Speaker 94
1:16:58
bringing those forward as well well i appreciate that i think that's a great answer i'm grateful
Representative Jeremy Wooldridge
Unverified
1:17:04
for your willingness to at least think outside of the box and try to solve this problem differently and i also understand it's a balancing act because we don't want to reduce or give on quality but we've got to provide an adequate service in kind of the confines of what we have to to offer and work with so thank
you for that and i appreciate the answer
representative barger recognized thank you chair thank you for your difficult work thank you i want to ask this question i've been in the juvenile system for a while i did like 14 years with juvenile court and many of those kids had mental issues about 90 or more yeah i wonder what uh how big of a backlog is it causing from those children who won't take the medicine we had a big problem with them having medicine but not wanting
to take it and it was just creating turnover turnover turnover so i was wondering are you being
Representative Sonia Eubanks Barker
Unverified
1:18:08
really affected by that you know i where i see that as much as
Speaker 87
1:18:15
anything is it's just the families right the families that may not have that support um and in families that are not you know i think with juveniles who are are are involved with with the court system oftentimes
you see them being raised by single parent right yeah grandparents they have a long family history of having family members in jail and in prison. And so thinking about how do we provide that support, either for the family, so that's one of the things we've really been pushing on family-centered treatment. And so family-centered treatment started out with child welfare and with DYS, with the Division of Youth Services. They brought that service in, and we were able to say,
okay, can we pay for that with Medicaid dollars, you know? so we did this big pilot one of the things that director Michael Crump told me when he goes out and talks to judges is that judges are telling him family-centered treatment is the best thing y'all have ever done the best thing DHS has ever done so I'm getting some good response there the other thing we're doing with Medicaid dollars is called community reintegration I mentioned it in the presentation it's on there um those group homes so one of the things we did with the dys
is they we leased um some property that we had um in saline county that were cottages and we got a provider to come in and take over the cottages we leased it to them for a dollar and then med the medicaid service they're providing is community reintegration and they are doing such a fabulous job. It's one of our community mental health centers there in Saline County. And those kids are like, I don't want to go back home. So they're really trying to get them to the place
of they're doing all kinds of job training with them. So as they turn 18, some of them are going into the military. Some of them know that if they go back home, they're just going to get right back into that cycle um so those are where we're seeing some successes of saying okay how do we you know support them in seeing that there's a different life
Representative Sonia Eubanks Barker
Unverified
1:20:32
for themselves you know um outside of what they've been exposed to and using medicaid money it's kind of tricky right to say
Speaker 87
1:20:41
because then you have to dig up a diagnosis but but i think we've been able to do that
Speaker 66
1:20:47
so great thank you representative vault you're recognized thank
you mr. chair does dhs have a dashboard i know like the hospital association has a dashboard that can tell them what beds are available where they're at um does dhs have such a thing for people who we do not
Speaker 87
1:21:09
we do not and that is i know one of the
things is we're talking about crisis services is is that and I know there's been some work in northwest Arkansas of can we do a dashboard but of saying which bed and which beds available and I think that would be really important part as we got this IMD waiver coming in you know of making sure that we have
Speaker 94
1:21:31
the dashboard and the response system right like making sure that we have people that are going to go
out and respond yep so I think it was in Arizona I went to I am right right
that's where it's at and they do have that it's fabulous what and the response time is nil to none how quickly they can get to people and help them with that's right the situation and they divert 70 percent
Speaker 94
1:21:54
of the people who call their call on 70 percent get diverted right off the bat and then another 70 percent get diverted with mobile crisis and then the rest of them go to a crisis stabilization unit and that's something i think
we need to probably look at be looking at for the state of arkansas and us being able to kind of create something similar to that thank you ma'am
Representative Bart Schulz
Unverified
1:22:19
members if there's no other questions thank you director for your
great presentation and thank you for what you do thank you members we've had a great conversation today this this meeting is just a jumping off point tentatively in august we're going to get into the meat and potatoes of this issue and hopefully we can move things forward
with no other business before us we stand adjourned
Agenda
A. Call to Order
B. Consideration to Approve the October 7, 2024, Meeting Minutes [Exhibit B]
C. Presentation by the Behavioral Health Workgroup
D. Report on the Status of Behavioral Health in Arkansas [Exhibit D] ̶ Paula Stone, Director, Office of Substance Abuse and Mental Health, Department of Human Services (DHS)
E. Other Business
F. Adjournment
Documents
No documents posted.
Speakers
Representative Bart Schulz
Unverified
Speaker 7
Speaker 13
Representative Jeremy Wooldridge
Unverified
Representative DeAnn Vaught Chair
Unverified
Speaker 22
Representative Aaron Pilkington
Unverified
Representative R. Scott Richardson
Unverified
Chair
Unverified
Representative Kenneth B. Ferguson
Unverified
Speaker 45
Representative Wayne Long Chair
Unverified
Representative Mark Perry
Unverified
Speaker 87
Speaker 89
Speaker 86
Representative Sonia Eubanks Barker
Unverified
Speaker 94
Representative Dwight Tosh
Unverified
Speaker 28
Speaker 48
Representative Tippi McCullough
Unverified
Representative Glenn Barnes Chair
Unverified
Speaker 66