Public Health, Welfare and Labor Committee - Joint
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- October 5, 2026
Speaker 2
0:30
Since the way we do presumptive eligibility in Arkansas is we are getting a full application at the same time we are taking the presumptive eligibility application so our end date must coincide with the end date of the final determination on that full application. was a fiscal impact it's one time fiscal impact based on system changes of 96,800 total happy to
take any questions okay it would make sense to me that we would want a full and complete application for anybody on Medicaid that's better for the Medicaid recipient and for anybody that's providing any services of care to that Medicaid recipient so I read the comment as well but to me it makes perfect sense that we should have a complete application anyway and that should be our end goal any other questions or from members of the
committee all right seeing none without objection this rule
Speaker 2
1:41
is reviewed okay I'm D this next rule does two things in the Medicaid program one change is adding the definition of fictive kin for establishing relationship for our kids eligibility and this is mainly for when foster children are placed with individuals that are not family and don't
meet the relationship but they do meet the definition of fictive kin so we have added that change to our policy and system so that those children can continue to be served by medicaid And the second change is to comply with Act 875 in 2025, which raised the disability onset age for ABLE account holders from 26 to 46. This was a change that had earlier been authorized under federal law, and state law passed in 2025, adopted that new onset age.
And so we have made that change to our policy. Okay. Are there any questions from
members of the committee? Seeing none this rule
is reviewed. Thank you. Thank you. All right, Miss Pittman
Speaker 14
3:13
good afternoon good afternoon Elizabeth Pittman director for division
of medical services thank you and I believe we're skipping over e and going to f is that correct yes I mean I we're skipping over e you pulled that one correct so we're just we're on to
f yes ma'am rule f is the rule for continuous glucose monitors this came out of a bill that was passed in 2025 correcting a bill that was passed in 2023 it allows for cgms to be billed by both pharmacy and durable medical
equipment providers it is already live with our system per the statute this rule just follows up and clarifies that that is the new rule both providers have the same pa process approved by the same vendor magellan that information then automatically goes over
Speaker 19
4:01
to our medical billing system and they have the same forms that they will be using as
well okay are there any questions from members of the committee. Yes. Uh, representative Woodridge, you have a question? Yes,
Representative Jeremy Wooldridge
Unverified
4:15
ma'am. Thank you, madam chair. So the PA process, I know we debated this back and forth
during the legislative session. So is that process the same? Yes, sir. What about turnaround time? Is it the
Speaker 19
4:27
same turnaround time? So we are using the same vendor and the same process and the same criteria. So yes, sir, it should all be, be the
Speaker 28
4:33
same. So we'll, we'll use our pharmacy vendor to do the prior authorizations and they have a an api which is the terminology for a connection between the systems that will send that information over to our medical billing system okay follow
Representative Jeremy Wooldridge
Unverified
4:46
up so i appreciate that so dme will have access to this pharmacy vendor will it cost them anything
Speaker 28
4:51
to have access to that they can sign up for that
Representative Jeremy Wooldridge
Unverified
4:54
just like anybody else okay so what about the turnaround time that's i think what i'm curious about and some of the dme providers in my community that i visited with are curious about so my understanding i'm you correct me i hope is that it's instantaneous basically for pharmacy that's correct and if they're using
Speaker 19
5:08
the same system it should be as well the problem is it will have to go over to the medical
Speaker 28
5:12
billing system where they will have to bill it so that's why we're using the attestation to let that member know we're also setting up a process by which we allow the pharmacy alert the pharmacy that they cannot
bill that as well so we're also setting up within our system once the dme provider gets that attestation on file that in both sides of the house it knows hey this person is using this provider that's why we're using that attestation to let the member know that they can't just switch back and forth between pharmacy and DME the way that you know a lot of people can because of the way our systems are working to let everybody know they'll have to go through the attestation process and everything again right
Representative Jeremy Wooldridge
Unverified
5:48
okay so I appreciate that so that's way more information than I
understand and I'm grateful for the explanation but here's what I do want to make sure that I'm clear on and what i want you guys to commit to if you will is looking at this system i think that everything we do has potential for unintended consequences if there becomes a lag time having to send this from the pharmacy vendor to this other system what would be steps to correct that they would just need to alert us to let us know
so that we could get with both of our vendors to try to work through
Speaker 28
6:16
and make sure that we have everything in place that we can to make sure the pa turnaround time itself should not create a lag it's the same vendor the same turnaround time
will apply. It's the way the billing systems work, and a pharmacy adjudicates a point of sale and medical doesn't, which is why we're indicating in both that there is a prior authorization in place to try to make sure that we don't have that problem. If there is a problem that comes from that, they just need to let us know so we can go back to
out. I appreciate that. Thank you very much.
Representative Aaron Pilkington
Unverified
6:50
Thank you, Madam Chair. Thank you. Representative Pilkington, you recognize for question? Thank you, Chair. Good afternoon. So I saw on the financial impact that's going to be $1.1 million year one, $1.9 million year two, for a total of $3 million over two years to implement this rule.
So can you break down, you know, what those costs are? I mean, $3 million is a bit of a chunk of change to implement this. And then, of course, from year one to year two, it's an $800,000 increase. On year three, will there be an additional $800,000 increase? Because that would bring it to $3.7 million for this rule, or does it cap out after year two? So
can you kind of walk me through those numbers? Because that's quite a bit of cash. Let me
Speaker 39
7:36
see what we've got here explaining that.
If we don't have it on me, I will get it to you, Representative Pilkington. I know I have the fiscal
Speaker 28
7:48
impact statement, but I don't know if I have the breakdown. Uh, we typically include, um, the difference in the cost. So, you know, we, there is a little bit of a difference in
how they're paid. So there's a little there and then any systems changes, but let me get that breakdown for you specifically. Okay. Do we know the difference in cost
Representative Aaron Pilkington
Unverified
8:02
between using it as a pharmacy benefit or using it as a DME benefit? What is the difference in total cost? We do know. We, we do know. I'll have to get that for you.
Speaker 39
8:11
We do know, but I don't have it with me.
Representative Aaron Pilkington
Unverified
8:16
I'll get it for you. Okay. Yeah, some kind of, I just wasn't briefed on this, so I would appreciate getting that information before I approve this rule. Thank you. Are there
any other questions from members of the committee? All right, so you can just send that information to me, and I'll make sure to forward it to all the
members of the committee. All right. Any more questions? All right, seeing none without objection.
Speaker 39
8:46
this rule is reviewed. Thank you. Item G. Yes, ma'am. Rule
G is the increase to the administration fee for the RSV vaccination for children. This was also the result of an act that passed in 2025. It increases the administration fee only to the same price as what is currently allowed for under the federal regulation for the vaccines for children program um it is an increase to to the administration fee the vaccine itself is gotten through the
vaccines for children program um by the provider and so we do not cover that through medicaid and that's why that is not included in this
okay happy to take any questions are there any questions from members of the committee any questions all right seeing none without objection
this rule is reviewed next item the next rule is the telemedicine exemption for treat triage and transport services this was another act that was passed by the legislature in 2025 and the rule the et3 program
treat triage and transport allows ambulance providers to treat on site without cons and
Speaker 28
10:01
this rule then carries that forward to allow for them to treat without consulting physician or behavioral health practitioner in certain circumstances where the medical director has signed off um this again was passed by the general assembly in 2025 and this implements it i'm happy to take any questions are there any questions from members of
the committee can i see h i'll have it
okay are there any questions from members of the
committee Seeing none, this rule is reviewed
Speaker 14
10:49
without objection. Item I. Item I is the dental rate increase. This is Act 1025 of
the General Assembly, passed again in 2025. The act had two parts. If you'll
Speaker 28
10:59
recall, we have discussed this before, I believe. This act had two parts. there was a rate increase for certain populations, including children, individuals with special
needs, and what was described as oral surgeons' dental services. Those three rate increases have been implemented
via this rule. The other piece of that act was to increase the limit for dental benefits for individuals with special needs. CMS came back and told us that that was not allowed to define an increased benefit limit tied to a diagnosis
Speaker 28
11:31
like that. so we've actually split those two we're carrying the rate increase forward now and we're working with cms and the dentists on how to move forward with the other piece of the coverage
so this is just the right piece doing the rate increase for those three populations we did receive numerous comments you probably have those summarized in your packet i'm happy to take those the main the main comments were regarding the coverage regarding um trying we had unintentionally dropped the orthodontic rates because when you look at the publication that was being used for this rate increase it it dropped the orthodontic rates from where we were previously that was not our intent so we it was not the intent of the bill so we excluded orthodontic
services from this the language of the bill allowed for that to happen and did not address orthodontic services at all and so we felt that that meant we should
leave orthodontic services alone. So we did. The other comment that we received was regarding the oral surgeons dental services. The commenters believed that that applied to a set of codes that is billed by oral surgeons and that any practitioner that billed those should be included. The department's position is that based on the black letter language of the way the bill was written
Speaker 28
12:48
with it saying oral surgeons dental services we could not use that interpretation. So we have not made that change based on the comments and that's the rule that we're bringing forward today there is a fiscal impact i believe of about 38 million for this rule uh yeah 29 million for this year 39 million for next year and cms has approved the rate increase so we are ready to implement with a um july 1st start date sorry i had to remember what month it was
so yes okay thank you um i know
there's questions about this um and i know that uh the dental association wanted to make some comments so um i think what i'll do is go ahead and bring them up to the table um just to allow their testimony to be part of record um and i've we've had some discussions about this and looking at the language of the of the law um representative mayberry if you'll light back up you're the primary sponsor of the legislation so you and senator penzo um but i'll go ahead and invite
the dental association to the table as well to go ahead and give testimony if you'd prefer that'd be fine
representative mayberry you're recognized thank you madam chair i i just first of all wanted to say thank you to dhs because i know that you've been working really hard on all this and we appreciate the work that you are doing as you've noted there's one still kind of key thing that we're trying to fix and just to remind legislators that sometimes when we have amendments
and various things some key words may not be clarified as much as maybe they should have been but I believe that the intent is just as the dental association will share is that we were trying to increase the fees that would be paid to dentists who are doing certain procedures for our adult with special needs population and that's where we're kind of we need a little bit more explanation as to how we we've gotten here but I think the overall goal and what we've said the
whole time with this bill is that we're trying to help the adult special needs population and I'll let you share. All right. If
you will just state your names for the record, please, both of you, before you proceed, and then you are recognized to proceed with your testimony.
Speaker 56
15:21
Thank you. Yes, I'm Dr. Terry Fidler. I'm with the Arkansas State Dental Association. I'm the senior advisor as well as the executive director of the Arkansas Mission of Mercy. Thank you.
Excuse me. I'm Trevor Hawkins. I'm with Mitchell Black Law Firm. I'm a counsel for
Speaker 55
15:49
ASDA. Thank you. Please proceed. Again, we'll compliment and thank DHS for helping us
Speaker 56
15:54
through many of these codes. We're so thankful because we've gone a number of years without any increase, and we are to the finish line on this, and we're so appreciative.
working with our legislators as well as the DHS in this bill in the description of this we interpret this as increasing a group of procedures which are oral surgeons also do. We have about 700 general dentists in this, in our Medicaid program who
provide oral surgery procedures. My degree is DDS. I prefer, I performed oral surgery procedures in the hospital with, under general anesthesia for years and years. My degree is doctor of dental surgery, DDS. So we do surgery procedures. We understood this bill to identify that these
surgery procedures could be done by general dentists. I can see that the way that it is written, it says surgeons. I am not a surgeon. I am a doctor of dental surgery. And so I perform Many of these procedures, if you were to look at this group of procedures, the CDT from the American Dental Association, 2026, pages 65 through 78, it lists procedures from D7000 to D7999.
So there are quite a few procedures. I did a considerable number of those procedures. Some of them I knew better than not to do them. And so this is what our intent is, that we wanted the rate increase for a group of procedures that fall under the title of oral surgery. And I'll be glad to
take questions. Thank you. So are there any questions from members of the committee?
So, I think, and it could be also a
question for DHS or for their attorneys too, but I think the issue is on page 1, line 30, where it states that it's oral and maxillofacial surgeon instead of surgery. However, and I know that I'm not sure if there is a definition that exists in state code defining an oral and maxillofacial surgeon as somebody who has a DDS license. That's something DHS can see.
I'm not sure if that exists in state code. But, you know, regardless of CPT codes or anything like that, it's the letter of the law. And you as an attorney may want to answer this question, too. And so my understanding is DHS is reading it as a surgeon, an oral surgeon, is different than a general dentist and that the reading of the language of the law as a black and white of the act was just specific to one
class of providers and not to general dentistry.
Speaker 60
19:28
Do you want to comment on that? Yes, Senator Irvin, if it's fine. And, you know, we're looking
at the intent, and that it's pretty clear when you look at the CDT, which stands for Common Dental Terminology, the language was pulled from there, and we're talking about the services that are provided under that category. And if you compare that with, you know, that's A1A, B and C are talking also about pediatric dental services, dental services with adults with special needs.
those aren't denoted as special categories or particular provider groups under the manual. It's the services that were intended to carry the weight here and what we were talking about. And to answer your question, the Arkansas Dental Practice Act specifically defines the practice of dentistry to include valuation, diagnosis, prevention, and treatment of non-surgical, surgical, or related procedures of diseases disorders and conditions of oral cavity and maxillofacial area
adjacent to associated structures including the administration of anesthetics in connection with those services and so any general licensed dentist can perform the uh these services and so the kind of the implication of just a plain black letter reading is we're limiting these to 39 or around 40 oral surgeons in the state rather than the center the 700 broad general dentist and it's common services like extractions and stuff like that that the general dentist that's that's one of
the more important services that's provided under this and that any general dentist could perform and so you're kind of directing them to those 40 oral surgeons rather than the broader population but that's the kind of the broader intent of the of the act is what we're trying to get out there
right now i understand the intent i think
we all agree on the intent no but i mean we all agree on i have two for full disclosure i have two sons that have dds licenses now as of last monday too
um one's orthodontist and one's entering into orthodontic residency so for the record and so um i know the
intent and everything that you testified absolutely is accurate um it's just the language of the law itself and i think representative mayberry was 100 right because this bill did go through processes of several amendments um and and i think the bill was trying to specifically focus on adults with special needs however medicaid can't splice out
once you're medicaid eligible we can't splice that special needs diagnosis out to receive a better benefit or whatever, uh, I think is, is what CMS came down with. So, um, I think that's where the rub is. Um, uh, before I go any further,
I can tell you that I'm committed to making sure that this is fixed, um, moving forward. Um, and I think that's probably the sentiment of the legislature, um, that we can fix this going forward so that we don't leave the general dentist
off the list so to speak representative Mayberry you're recognized
thank you so let me just kind of ask this question and might need DHS to to kind of fill in so if it is that strict interpretation that DHS wants to use though so we have someone who is performing two different people performing the same procedure we have an oral surgeon and we have the general dentist doing the exact same extraction and one will be paid more and one will be paid the other rate is that would that be correct
yes that's what would you call a bifurcated rate they would be the two different and then so the incentive is who who do we they send that person to to
adequately cover that service so The overall, and without a doubt, when this is presented, what we kept talking about was the need for a dentist to be able to receive the proper compensation, and we were talking about that special needs population, right?
Now we've kind of separated the oral surgeons from the other, and I would think it's the same code, though, if I understand correctly. it is the exact same code that both will be doing so is that not sort of in this might be dhs is that not sort of a a difficult thing to distinguish okay it's the same code but this doctor is going to be paid more than this doctor is that not a difficult paperwork problem
And then to also follow it up, that DHS has the ability to raise a rate without law being specifically, without us as lawmakers specifically saying do that. So I guess that would be the second part of the question is, can't DHS just say, okay, yes? Sure. Let me take the first part of that first
representative. So the bifurcated rate, to use Mr. Hawkins' terminology, is something we do have the ability to do in our system and actually have in place in many areas.
A prime example being we pay a nurse practitioner less than we pay a physician for the same CPT code. They get 80% of the physician rate. That's just their rate. That's just one example. They'll build the same code, but they'll get a different rate, and our system does allow for that. So that is not a problem within either the Medicaid rules or the Medicaid systems, the way it operationalizes, and it's something that is commonly done depending on the licensure level of the person doing the service. We don't commonly have the same level of licensure getting billed separate,
but when there's different levels of licensure, yes, you will see that. To the second point, yes, we can raise a rate without a statute. You're absolutely correct. Unfortunately, we're in a position right now where we're not looking at any budgetary increases absent a mandate to do so. I think you've heard us all testify as to
Speaker 19
25:59
that before, and so that's sort of the department's position on any rate increases
or budgetary increases right now. Okay. I believe that follow-up, I'm sorry. Is that okay? Okay. I believe that that's what the entire testimony was
when we were presenting this and this issue was not brought up in testimony that those doctors those dentists would not be included with the oral surgeons and so I think it left all of us with the impression that it included everybody and so therefore I just kind of asked DHS that the intention was we're all on board with making this increase and what would that increase be
what what's left out how much more are we talking oh it's about 1.5 million dollars a year 1.5 million dollars and and from the dental association how many more families will be serviced by keeping dentists continuing to do these extractions and and all
Speaker 56
27:14
well again as i was saying about 700 general dentists participate in the medicaid program
and you have about 40 oral surgeons and arkansas is obviously a very rural state and so so many general dentists have to be called upon to do those procedures so how many i don't have a number but i can give you the number of dentists that could do that and if i may i'll step outside a little bit as a former provider we're going to do it whether the procedure is paid at a certain level or not we're going to take care of the kids we're going to take care of the families that can't do it so but anyway there's quite a few more general dentists than
And then there are oral surgeons.
Okay. I appreciate the testimony. I
just still, I'm standing strong that that's what the intent was. Whether we want to go word for word on what this is, you know, that'll be up to other legislators and ALC to decide. But, you know, I feel that the wording and what we shared with the committee was the intent of it. And DHS does have the ability to go beyond what the law says
and open it up to all dentists, and I would make that
request. Okay. So Jessica Biel is our staff attorney for public
health. Does a fabulous job, by the way. Thank you, Jessica Biel. So I'm having her over there research it, But oral and maxillofacial surgeon is not defined in state code, which also makes this more complicated. So this is what needs to be done to fix this.
It needs to have a definition of oral and maxillofacial surgeon needs to be defined clearly in state code, number one. Number two, this legislation needs to be changed to encompass all general dentistry, uh, to include, um, oral and maxillofacial surgical procedures as, as they are, um, practiced under CPT codes or what have you. Um, that would then, uh, fix the problem from the way I see it, because the, the, the language in the law as Act 1025 is written on line 30 does state surgeon.
And that's not defined except for as a specialty of general dentistry. So that's, that is the issue here. regardless of intent if you're looking at the black and white language of act 1025 and i honestly don't think that there was any intention of that occurring i think that this was just um just happens to all of us so to speak but i understand that it's not ideal for our general
dentists but we do want them to practice at the very maximum of their license and make sure that they help all of their population um and so those are the two things that need to be fixed
for next session and I personally make a commitment to carry that legislation forward um to address this issue in the future
representative Wildridge you're recognized thank you madam chair I'm just trying
Representative Jeremy Wooldridge
Unverified
30:39
to understand um I think representative Mayberry made some good points that I just want clarification on I guess so if this would have been written with and I'm going to ask these to
DHS if this would have been written with the correct terminology we would be spending that 1.5 million dollars and paying the other 700 dentists correct yes
Speaker 17
31:01
sir we will follow legislature legislature of mandates yes sir so
Representative Jeremy Wooldridge
Unverified
31:05
now we're debating a technicality on language correct we're not I mean I'm not debating I'm
just simply much like we did with the pointing out unfortunately trying to follow the law. Sure I understand
Representative Jeremy Wooldridge
Unverified
31:18
that. Yes sir. But I think
that the question that I would like an answer to is if you intended to you to pay this 1.5 million to dentists to provide this rate and you have the unilateral authority to raise the rate and spend the money to pay them adequately why would you not? Well unilateral might not be the right word but
we also have to have the funding and so we when we have a legislative mandate we have a way to go and ask for that funding absent that, you know, we are, we are very, I know it sounds like not a lot of money. I understand that when we talk about the dollars that we talk about.
Speaker 28
31:52
But we are unfortunately in a position where we are not able to authorize any increased expenditures absent
Representative Jeremy Wooldridge
Unverified
31:59
a mandate. Okay. So if this would have been written with the correct terminology, who would you, where would you have had
Speaker 28
32:05
to ask for that money from? Well, you and
Representative Jeremy Wooldridge
Unverified
32:09
the, you and the governor's office, obviously. Okay. But my point is we've already approved to representative Mayberry's in the intent so there's no need to even make an ask now i'm sorry i don't understand but we obviously approved this legislation so our intent was to pay the other 700 dentists and spend that
money i don't i don't know i don't i mean unfortunately as dhs we don't try to guess the intent we simply try to carry what we see as the page
Speaker 75
32:38
right on the page representative folders representative ward
law sure i can answer that for you we studied this last couple days knowing the discussion was coming to answer that question is no okay black and white letters of the law are the black and white letters of the law the other side of this and i just explained this to senator ervin because we wasn't directly talking the last two days but we were um the financial
impact is 100 wrong the way it is today because are the inception of it is wrong from the legislature standpoint because once you fix this language the financial impact will be much greater than where it is today because you're in you're opening it up to 700 something more dentists i think that has to be spoken and understood i do agree it needs to be fixed i do agree the intent was that that was there but the language is what the language is and it's not there in the language so you cannot pay those dentists for this service until that language is fixed
i wish it wasn't this way and i wish it was in there but it's not and it's 100 correct the way dhs has it today based on the language of the bill regardless of the intent well i appreciate that clarification that's basically what
Representative Jeremy Wooldridge
Unverified
33:47
i'm trying to understand and learn is is is there you know i'm i guess looking at how do you solve a problem with what you have in front of you and if there is an avenue or a pathway for you to raise a rate and that solves a problem six months in advance I just want to make sure we were exploring every angle so that's helpful thank you
all right thank you thank you any other questions
from members of the committee all right seeing none thank you uh this rule is reviewed I will state though that we have testimony not necessarily an objection
but testimony on the on the rule itself but it does stand reviewed thank you thank you for being here and thank you for your testimony and I appreciate you coming
forward and we will work together on this issue thank you so much okay
Speaker 14
34:36
next item still me this next rule is again
something that was passed in 2025 legislative session this was to increase access to physical therapy services per the bill in that bill it increased access to physical therapy services in a clinic-based setting. The bill only limited it to physical therapy. However, there was no fiscal impact to doing so. We reviewed the documentation provided by occupational therapists as well immediately following the passage of that legislation determined that it likewise would not result in a fiscal impact increase and have
included occupational therapy in it as
well. I'm happy to take any questions. Are there any
questions from members of the committee on item J any questions all right seeing none this rule stands reviewed without objection thank you Adam
K and item K is the healthy moms healthy babies bill which was passed in 2025 as well it also includes the lactation consultants bill
that was passed in 2025 this piece of rulemaking is quite large and it does quite a number of things but a summary is that it allows for doulas and lactation consultants to bill for Medicaid services provided to Medicaid clients. It also includes remote monitoring. We were already providing blood pressure cuffs and continuous glucose monitors to pregnant women but per Healthy Moms and Healthy Babies this covers the remote monitoring and we lifted any limits per that bill as well on ultrasounds and fetal non-stress tests for high-risk pregnancies
and other pregnancies and so that is this rule in front of you today and happy to take any questions we did receive numerous comments i'm not sure that we would be here for hours if i tried to summarize them all um but we did make several changes um in response to those comments related to how the benefits are provided i will say the one comment that we received regarding not paying higher rates uh we did not change the rates we did however go back in do another study with our actuaries looked at all the surrounding states again and determined that our rates that we had proposed were on on par with where we needed to be and happy to take any
questions. Okay, are there any
questions regarding this rule? I mean I think this is also like another example of a difference in rates but it's also based on what's being provided and level of and I think anyway I appreciate your
comments on this are there any other questions from members of the committee seeing none without objection this item stands reviewed okay miss Pittman we're I'm going to take a motion to expunge a vote by which we reviewed the glucose monitoring so that representative warlaw can ask some questions because we've already done that but he wants to ask some questions so i'm going to go to representative wildridge to take your motion i'll make that motion okay so we're expunging the vote by which i reviewed without objection
the rule regarding a glucose monitoring billing amendment is there a second second all those in favor say aye and opposed eyes have it uh representative warlaw you are recognized for
questions thank you thank you miss thank you madam chair this is a subject i have a little experience in
i used to be in the dme business for full disclosure not in it now i have nothing to do with it but i was going to run the bill representative willbridge ran he ran it i'm glad he ran it great bill but the understanding behind his bill when he ran it is it would put dme
providers back in the same billing system that they've always used through medicaid in the same system everything would be the same there was an amendment added in the senate that added um two words basically and the second word was paperwork and the assurance we got from dhs but that would not change the fact that it would be billed the same as any other dme equipment and we took that amendment we we passed it in the house after it came back from the senate and went with it. This rule explicitly separates that billing back out to the same system that pharmacy
uses and forces DME to use that system. Yes, it does. And that's a problem. It also sets in here a PA system that makes a customer wait two weeks from a DME store and they would wait 24 hours from a pharmacy store the whole purpose of that bill was to make those two platforms equal again the way they were prior to the rule that was passed last year so why are we doing this and why are
you you're not staying black and white here so it's hard to be consistent when you're black and white on the dentist and we back you up to be black and white
and then you go completely gray over here so what are we doing to clarify we are going back to the mmis billing system And we are doing a 24-hour turnaround time on PAs. So what we are doing is the PA will be submitted to Magellan. And I can have Cynthia explain exactly, or Director of Newhoff, our pharmacy director, explain exactly how that will happen. Magellan, or Prime Therapeutics now, I'm sorry, they used to be Magellan, is our pharmacy vendor.
And they will be reviewing everyone's PAs with the same 24-hour turnaround time that everybody, that they do for all pharmacy PAs. But DME
providers submit to AFMC for their PAs, and the whole premises behind the bill was they were going to stay on the same system as all other DME items, and now what you're saying is they're going to go through pharmacy for these, and that's my whole point. You're forcing them to do something they're not used to. They don't do on a daily basis. Yes,
Speaker 31
40:47
sir, we understand that, but we're changing.
Okay, but you can't understand that. The law didn't
Speaker 19
40:52
do that. Well, yes, sir, what I'm saying is once that PA is reviewed so that they can be consistent, have the same criteria and the same turnaround times, because AFMC reviews under a different contract with different criteria and different turnaround times, that information will then go into MMIS so that they can bill using the medical system to get paid for their claims. you're
missing the point so the whole point of the bill was that they build the same as they
bill the other dme items quit quit varying that's what the bill did so because the rules split them we agreed on the rule last summer and it split them so we ran a bill to put it back the way it was prior and now you're still splitting them with this rule i'm not gonna let this rule go through as long as it splits them they should bill under the same dmmi system that dme bills them their stuff they're they're billing that they're not yes
Speaker 102
41:48
sir they the billing will read your own chart
you sent out it does not do that it sends them through a different billing system than they're used to billing under through the prior authorization the
Speaker 19
41:59
billing is going through mmis that's not what it says here i've got in your
signatures on this letter that i'm sitting here reading and it's not in this packet is that the official notice i'm sorry yep it is it goes into effect on june 1 which we're june 3rd today yes and talking about it which i find kind of weird that you're putting it in effect before we ever review it it's another problem i
got with it first sentence effective june 1 2026 yes sir we we
Speaker 102
42:33
couldn't back the systems changes out so we went on ahead under the language of the law and and put it into place you didn't go
on with the law because the law done exactly what i've already
referenced the law opened it up for them to be the same thing they've always been and not have to be under the rule that passed last year that split them out yes sir
Speaker 102
42:51
and they're not we are putting them back under the medical billing system well i'm going
to hold this until you can prove that to me because that's not what
these charts show yes sir uh it shows them having to bill it under a pharmacy code under medical and that's not what the law was intended to do or written to do and i've already read the law to make sure i could say that today because i knew we had stuff that was the other way around yes sir and
Speaker 19
43:14
i agree they are meant to build back under hicks picks codes under the mm for the record madam chair
i will hold this rule until council two weeks from now to make sure that it follows the letter of the law
are there any other questions from members of the committee all right
okay all right thank you i appreciate that and um we will move on to item l welcome item
l is the adverse decisions rule also a piece of legislation passed in 2025 this adverse decisions rule did several things one of which that is being implemented by this rule change here is to change the time frame for providers to appeal from 35 to 65 days
and that is what this rule does i'm happy to take any questions so um
does that change though they still are paid at they can they can delay but they are their their payment's not delayed basically they have
to elect to to continue got you to receive payment but yes ma'am they can okay got are there any other questions
from members of the committee all right seeing none this item will stand reviewed without objection item M and I think
yeah okay thank you miss Pittman appreciate it all right if you'll state your name for the record please proceed
Speaker 111
45:05
hi good afternoon I'm Linda white I'm the deputy director for the division of provider
services and quality assurances and this rule is related to the Arkansas long-term care facility nursing assistant training program so this rule the changes were due to act 105 of 2025 there are some technical corrections in this bill there are changes to the requirements for the primary instructors for the cna programs and it also increases the annual training hours for the primary instructors
there is no fiscal impact and there is no known opposition it also repeals the internal management requirements for the criminal background checks those are still being conducted under another rule so it doesn't affect that it's just the management piece okay and I'll be happy to take questions all right are there
any questions from members of the committee on this rule all right seeing none this item
will stand reviewed without objection thank you item n the stone
Speaker 117
46:22
Good afternoon, Paula Stone, Department of Human Services, Director of Office of Substance Abuse and Mental Health. This rule is because of Act 301 of 2025 and the act sought to ensure that the potential and actual enrollees of the risk-based provider organization, which is our passes,
have the right to know whether a direct service provider is or will be in network. So our rule has three component parts that says that there is no marketing violation if a direct service provider informs the client of their network status in any of the passes. Those providers are also not prohibited from answering questions from any of their clients, and they are not required to provide separate information about their network SATIC,
separate from anything that they provide for open enrollment. Any questions I can answer? Thanks. Thank
you. Are there any questions from members of the committee?
do you have any comments on the on
the general comments that you received about
Speaker 117
48:02
the language we did receive two comments and made adjustments to the rule related to those comments okay
got it yeah I see
that okay any other questions all right see none without objection this rule is reviewed without objection okay item oh thank you miss
Speaker 119
48:47
Christy Sellers, Director for the Division for Health Advancement at Department
Speaker 124
49:03
of Health. Thank you. Craig Smith, Attorney for the Department of Health. Thank you. Madam Chair, our first rule is a new rule that we are proposing to enact, Act 965 of 2025, for the certification of community-based doulas in Arkansas. This rule was open for a public comment. A few were received, generally positive comments in support of the rules.
As a note, the department has been available to receive and process applications for doulas for several months now while we were promulgating the rules. And with that, open to any questions. Thank you.
I appreciate the work. Representative Pilkington, you're recognized. Thank you, Madam Chair. just curious how many dual
Representative Aaron Pilkington
Unverified
49:43
applications have we currently received we've received seven we have six that have been approved
Representative Nicole Clowney
Unverified
49:50
and one's in process okay do we expect more
Representative Aaron Pilkington
Unverified
49:53
or we hope so okay appreciate
it thank you what about with the the community health workers how many do we have
Representative Nicole Clowney
Unverified
50:06
of them we've received we have received zero applications and we've only had one phone call inquiring and it's
not for us it was for reimbursement okay all right thank you um all right any other questions comments all right seeing none without objection this rule is reviewed item p
Speaker 122
50:28
yes ma'am this rule is another new rule this is enacting act 435 of 2025 regarding certification
Speaker 124
50:35
of community health workers as similarly stated this was open for public comment few were received were generally on the scope of practice which cannot be addressed by rules outlined in the act itself and then as stated we prepared to receive applications for some time now while we were promulgating these rules as well and with that open any questions okay but you haven't received
any applications okay so which makes me question why this person made the comment that they made
to include to expand this is not a question for you this is just a comment for me to expand services when we have zero applications i'm like so you know i i just i want people to understand you know in the health care spectrum and the health care landscape that we have in the state of arkansas let's all work cooperatively as best we can um there's space for everybody and everybody has different needs and so let's try to accommodate them that's not a question for you
it's just a comment based on the comments of that were received on
these different rules um let's be intentional and thoughtful when we're making our comments
and public comment all right any other questions seeing none without objection this rule is reviewed item
Speaker 133
52:23
q Good afternoon, I'm I'm Charles Bedell
with the Arkansas Department of Health, Division of Health Protection, the Cosmetology, Massage Therapy, and Body Art
Section. Thank you for being here. Please
Speaker 124
52:37
proceed. Thank you, ma'am. The next rules are the proposed amendments to the rules for cosmetology and body art in Arkansas. The proposed amendments are to comply with Act 484 regarding the posting of the National Human Trafficking Resource Hotline, as well as other minor changes and reviewing life for multiple modalities of body art rules for open for public comment no
comments were received so with that open
to any questions okay thank you any questions from members of the committee all right seeing
none appreciate you being here item stands reviewed without objection item
Speaker 124
53:19
R thank you ma'am these rules are the rules for massage therapy in Arkansas these were to enact the changes pursuant to act 265 regarding the interstate massage therapy compact act 484 regarding the national human trafficking resource hotline and act 629 regarding registration for establishments
rules were open for public comment a few were received generally were items that could not be changed by rule that are outlined in statute okay
are there any questions from members of the committee all right seeing none this item stands reviewed without objection item s thank you for being here sir
Speaker 142
54:24
Good afternoon. Rebecca Davis, Environmental Epi Supervisor with Arkansas Department of Health.
Speaker 122
54:32
Thank you. The next rules are the rules pertaining to lead-based paint activities. Pursuant to
Speaker 124
54:37
rule changes by the EPA, the department is mandated to enact certain changes regarding our rules for lead-based paint activity, regarding risk assessments, abasements, et cetera, and these changes are pursuant to those EPA rule changes. The rules were open for public comment and no comments were received.
Okay. Thank you. Are there any questions? So this is based on what
changed at the federal level, EPA level. Okay. Any questions from members of the committee? Seeing none without objection, this rule is reviewed. Thank you. Item T. Shane David branch
Speaker 145
55:34
chief health systems licensing and certification department of health thank you
Adelia Oldenbrook radiation control section thank you the next rules are
Speaker 122
55:49
the changes for the rules for control of ionizing radiation these
Speaker 124
55:53
amendments first started with act 854 regarding diagnostic mammography as well as other changes that are recommended or requested by the u.s nuclear regulatory commission these rules were open for public comment there were several comments received generally are there comments requesting
changes that would require a law change or notes that were unrelated to the proposed amendments but that the program will take an intervisement for future changes with that
open to any questions okay are there
any questions from members of the committee seeing none this item will
Speaker 122
56:35
stand reviewed without objection thank you ma'am the next rules are the
Speaker 124
56:39
rules pertaining to radiologic technology licensure These rules were amended to enact Act 695 of 2025 regarding qualifications for certain limited scope licensure as well as other cleanup language.
The rules were open for a public comment. A few comments were received, again, generally noting requesting changes that either require law change or did not relate to the current proposed amendments but would be taken under advisement for
future changes. All right. Thank you. Are there any questions regarding
this rule? Seeing none without objection, this rule stand reviewed. Item V. Thank you both.
Speaker 150
57:38
Good afternoon, I'm Terry Paul the environmental branch manager for the Department
Speaker 124
57:54
of Health. Thank you for being here. The last rules we have are the rules for mobile homes and recreational vehicle parks. These amendments are introduced to update regarding industry norm and changes for the current living standards and facilities
regarding mobile homes and RV parks. These comments were open for public comment. One comment was
Speaker 138
58:13
received and notes were taken for future promulgation. - Okay. All right, any questions? Representative Long.
- Thank you, Madam Chairman. Mr. Paul, could you tell
Representative Wayne Long
Unverified
58:29
me a little bit about what the changes were force is it water usage per day or what were the changes uh we didn't uh representing long we
Speaker 150
58:40
didn't change uh much on the water uses we did clarify uh between uh a situation where you
Speaker 156
58:48
have pre-treated effluent and the current fill line situation most of what the changes are were related to old language that included old terminology, and there was some language in the rule about maximum lengths of RVs, et cetera, that made no sense for the Department of Health to try to regulate.
We did clarify some things on RPZs and when they're needed and when they're not. That's reduced pressure zones for water systems, and again, it took out a lot of old language. We
Representative Wayne Long
Unverified
59:24
really didn't know what it meant for sure. How much water usage
Speaker 156
59:29
are you allowing on the RVs? I believe it's in that rule there, in our on-site rule, it's 60 gallons per day pre-treated. And if it's not pre-treated, it's 120 gallons per day. And I'm going off memory, but I believe that's correct.
Representative Wayne Long
Unverified
59:45
And now that what I've observed, a lot of people are just living permanently in RV
parks now. Have y'all seen any increase in number of failures due to the increased amount of water usage? I don't know that
Speaker 156
1:00:00
we're having a lot of increase in water usage, but we did try to distinguish that there are three potential kinds of RV parks or mobile home parks, one being the standard mobile home, one being a mix, one being a true recreational vehicle park for recreational purposes.
And then, as all of you know, you ran into situations where we have large building projects, et cetera, that go on. And there are temporary parks that come in that don't necessarily need all the accoutrements of a normal recreational park. So we tried to clarify that if they have both public water and sewer at each connection, they don't necessarily have to have some of the other parks that you would see at a state park, et cetera. the mobile home
Representative Wayne Long
Unverified
1:00:46
parks are they still based upon the number of bedrooms yes
sir they're sized on the number of bedrooms okay thank you thank
you madam chairman are there any other questions from members of the committee all right thank you
for your work on this seeing none without objection this
rule stands reviewed thank you ma'am all right all right folks really appreciate the folks that traveled to our meetings that we held in Conway and other places through the state thought they were great meetings we will try to continue to do
that around the state we enjoy visiting our hospitals out there so look to the schedule for that is there any other business to come before the committee all right seeing none without a I mean CNN we are adjourned Thank you.
Agenda
B. Consideration to Approve the May 19, 2026, and May 21, 2026, Meeting Minutes [Exhibits B1-B2]
C. Department of Human Services (DHS), Division of County Operations (DCO), Review of Rule, Updates to Presumptive Eligibility [Exhibit C] ̶ Mary Franklin, Director, DCO, DHS
D. DHS, DCO, Review of Rule, Fictive Kin Addition and Act 875 ABLE Account Age [Exhibit D] ̶ Mary Franklin, Director, DCO, DHS
F. DHS, DMS, Review of Rule, Continuous Glucose Monitors Billing Amendment [Exhibit F] ̶ Elizabeth Pitman, Director, DMS, DHS
G. DHS, DMS, Review of Rule, RSV Administration Fee for Children [Exhibit G] ̶ Elizabeth Pitman, Director, DMS, DHS
H. DHS, DMS, Review of Rule, Telemedicine Exemption for Triage, Treat, and Transport Services [Exhibit H] ̶ Elizabeth Pitman, Director, DMS, DHS
I. DHS, DMS, Review of Rule, Dental Rates Increase [Exhibit I] ̶ Elizabeth Pitman, Director, DMS, DHS
J. DHS, DMS, Review of Rule, Arkansas Medicaid Reimbursement for Physical and Occupational Therapy in Clinic-Based Settings [Exhibit J] ̶ Elizabeth Pitman, Director, DMS, DHS
K. DHS, DMS, Review of Rule, Maternal Health Providers and Remote Monitoring [Exhibit K] ̶ Elizabeth Pitman, Director, DMS, DHS
L. DHS, DMS, Review of Rule, Adverse Decisions [Exhibit L] ̶ Elizabeth Pitman, Director, DMS, DHS
M. DHS, Division of Provider Services and Quality Assurance, Review of Rule, Rules for the Arkansas Long-Term Care Facility Nursing Assistant Training Program & REPEAL Rules for Conducting Criminal Records Checks for Employees of Long-Term Care Facilities [Exhibit M] ̶ Linda White, Division Administrator, Division of Provider Services and Quality Assurance, DHS
N. DHS, Review of Rule, Marketing Activities by Managed Care Network Providers & REPEALS: APM 905 – Social Services Block Grant Program Manual; PUB-408 – Notice of Privacy Practices [Exhibit N] ̶ Paula Stone, Director, Office of Substance Abuse and Mental Health, DHS
O. Arkansas Department of Health (ADH), Division for Health Advancement, Review of Rule, Rules Pertaining to Doula Certification [Exhibit O]
P. ADH, Division for Health Advancement, Review of Rule, Rules Pertaining to Community Health Workers [Exhibit P]
Q. ADH, Division for Health Protection, Cosmetology, Body Art, and Massage Therapy Section, Review of Rule, Rules for Cosmetology and Body Art in Arkansas [Exhibit Q] ̶ Craig Smith, Attorney, ADH
R. ADH, Division for Health Protection, Cosmetology, Body Art, and Massage Therapy Section, Review of Rule, Rules for Massage Therapy in Arkansas [Exhibit R ] ̶ Craig Smith, Attorney, ADH
S. ADH, Lead-Based Paint Program, Environmental Epidemiology Section, Review of Rule, Rules Pertaining to Lead-Based Paint Activities [Exhibit S]
T. ADH, Division for Health Protection, Radiation Control Section, Review of Rule, Rules for Control of Sources of Ionizing Radiation [Exhibit T]
U. ADH, Division for Health Protection, Radiation Control Section, Review of Rule, Rules Pertaining to Radiologic Technology Licensure [Exhibit U]
V. ADH, Division for Public Health Practice, Environmental Health Branch, Review of Rule, Rules Pertaining to Mobile Home and Recreational Vehicle Parks [Exhibit V]
W. Other Business
X. Adjournment
Documents
No documents posted.
Speakers
Speaker 2
Senator Missy Irvin Chair
Unverified
Speaker 14
Representative Jeff Wardlaw Chair
Unverified
Speaker 19
Representative Jeremy Wooldridge
Unverified
Speaker 28
Speaker 35
Representative Aaron Pilkington
Unverified
Speaker 39
Representative Julie Mayberry Chair
Unverified
Speaker 56
Speaker 55
Speaker 60
Speaker 17
Speaker 75
Speaker 31
Speaker 102
Speaker 111
Speaker 117
Speaker 94
Speaker 119
Speaker 124
Representative Nicole Clowney
Unverified
Speaker 122
Speaker 133
Speaker 142
Speaker 145
Speaker 150
Speaker 138
Representative Wayne Long
Unverified
Speaker 156