Meeting Name: Joint Senate and House Committees on Public Health, Welfare, and Labor Date: November 25, 2024 Location: Room A, MAC, Little Rock, Arkansas
The meeting covered a range of topics related to public health and welfare policies, including presentations on healthcare services, regulatory reviews, legislative studies, and program proposals. Key areas of discussion involved prior authorizations in the PASSE programs, services for individuals with disabilities, the state's Poison Control Center, and work requirements for SNAP. The committee also deliberated on legislative proposals for healthcare professional licensure and improvements in mental and behavioral health systems.
Arkansas Poison and Drug Information Center
Purpose: To inform the committee about the role and impact of the APDIC. Overview:
Speakers: Howell Foster, Director, Arkansas Poison Control Center
The center operates 24/7, handling over 21,500 human exposure cases annually, providing statewide services.
Significant increase in pediatric and adult suicide cases was reported (e.g., 800% rise in suicide attemps among children under 12).
APDIC provides cost-saving benefits, avoiding approximately $22 million in emergency costs.
Collaborative efforts with state agencies and national organizations were highlighted.
Follow-up Items:
APDIC will provide granular suicide data by county and per capita.
Additional data on Alpha Gal-related issues and poison trends will be shared with committee members.
PASSE Program Discussion
Summary of PASSE Discussion
This section of the Arkansas Joint Public Health Committee meeting focused on reviewing policies submitted by Provider-Led Arkansas Shared Savings Entities (PASSEs) as mandated by Act 575 of 2023. The act requires PASSEs to adopt policies that reduce or eliminate prior authorization requirements for certain services, with an emphasis on providing efficient care while maintaining the legislative intent of the PASSE program.
Overview
Purpose: To evaluate PASSE compliance with Act 575, particularly regarding "gold card" policies that exempt providers with a proven track record of approval from prior authorization requirements.
Participants: Representatives from Summit Community Care, Empower Healthcare Solutions, CareSource, and Arkansas Total Care presented their policies and addressed committee questions.
Outcome: The committee unanimously approved all PASSE policy submissions (D2-D5) after discussion.
Follow-ups: Legislators requested follow-ups from PASSEs:
Clarify exemptions added in response to Act 575 versus prior practices.
Provide lists of services that will always require prior authorization.
Detail appeals processes for rescinded gold cards.
Various Approvals
Used Tire Program
Lauren Ballard and Bailey Taylor, representing the Department of Energy and Environment, presented amendments to rule 36 of the Pollution Control Ecology Commission concerning the Tire Accountability Program (used tire program).
The amendments:
Align the rule with Act 713 of 2023.
Reduce tire districts to four.
Allow interlocal agreements.
Require business plans from boards (already submitted).
Limit fees for permittees seeking reimbursement.
Include technical corrections for names and changes after transformation.
Outcome: The committee reviewed the rule without objection.
Emergency Medical Technicians (EMTs) as Other Licensed Practitioners
The discussion revolved around a follow-up rule to formally recognize EMTs as "other licensed practitioners" under Arkansas Medicaid, allowing them to be reimbursed for services. This rule was initiated following CMS (Centers for Medicare & Medicaid Services) guidance and aligns with a prior triage and transport rule.
The rule establishes EMTs as a recognized provider type within Medicaid, enabling them to bill for their services.
This designation ensures continuity in reimbursement from the effective date of the previous rule to avoid discrepancies.
Outcome: After a brief discussion, with no questions or objections from the committee members, the rule was approved.
Item F: Updates to Autism Services Programs
This item focused on updates to two autism-related programs under Arkansas Medicaid: the Autism Waiver and Applied Behavior Analysis (ABA) therapy services. These updates included renewing the waiver and integrating ABA services into the Medicaid state plan.
Autism Waiver:
Provides intensive, one-on-one intervention services in natural environments for children with an Autism Spectrum Disorder (ASD) diagnosis.
The waiver was renewed for five years, effective July 1, 2024, per CMS requirements.
ABA Therapy Services:
Integrated into the Medicaid state plan as required by CMS, with an effective date of January 1, 2025.
Includes detailed parameters for eligibility, service delivery, clinician qualifications, and other compliance factors.
Public Comments:
A provider comment during the public feedback period pointed out that some services could be provided via telehealth, which the agency agreed to incorporate.
Behavioral Analyst Certification Board Oversight:
Senator Missy Irvin: Raised concerns about the lack of communication between Arkansas Medicaid and the national certification board for behavioral analysts.
Highlighted the absence of a state-level oversight board for ethical violations or investigations into providers.
Emphasized the need for consumer safety and a formalized process for reporting and addressing provider concerns.
Follow-Up Requested: Senator Irvin requested DHS reach out to Mr. Rocky Hayes, a stakeholder, to discuss oversight concerns further and ensure these issues are addressed.
Outcome: The rule was approved without objection, with the caveat that DHS follow up on the communication process with the national board.
Disability Services Arkansas
Tom Masseau, Executive Director of Disability Rights Arkansas (DRA), and Thomas Nichols, Director of Legal and Advocacy Services, presented an overview of DRA's mission, programs, and advocacy efforts. The organization aims to protect and enforce the rights of individuals with disabilities across Arkansas, focusing on areas such as abuse prevention, education, employment, and access to Medicaid.
Key Points Discussed
DRA’s Background and Mission
DRA is a nonprofit advocacy organization and part of the national Protection and Advocacy (P&A) network.
Established in Arkansas in 1977 and renamed Disability Rights Arkansas in 2014.
Operates with a $2 million budget and nine federal grants to provide advocacy, monitor facilities, and investigate complaints of abuse, neglect, and exploitation.
Key Exchanges with Legislators
On Human Development Centers (HDCs):
Representative Jack Ladyman and Representative Jim Wooten expressed concerns about DRA’s perceived role in advocating for the closure of HDCs.
Masseau and Nichols clarified that while DRA advocates for reducing abuse and neglect in HDCs, they do not have a goal to close these centers.
Masseau acknowledged ongoing concerns among constituents about DRA’s position on HDCs and reiterated that their primary focus is ensuring proper care and safety for residents.
On Oversight of DRA’s Activities:
Representative Ladyman questioned the oversight mechanisms for DRA and its alignment with state priorities.
Masseau explained that DRA submits annual performance and financial reports to its federal funders but is not overseen by state authorities.
Ladyman and Wooten emphasized the need for greater communication and transparency between DRA and the state legislature.
On Physical Accessibility Issues:
Representative Julie Mayberry raised concerns about barriers to accessibility in public spaces.
Nichols acknowledged the challenges, particularly in older buildings, and supported the idea of creating a state-level enforcement authority to address such issues.
On DRA’s Goals and National Affiliations:
Representative Ladyman cited historical actions by the national Protection and Advocacy network, including opposition to sheltered workshops and alleged lawsuits to close facilities.
Masseau and Nichols clarified that DRA operates independently and does not necessarily align with national P&A policies.
Challenges in Rural Areas:
Senator Linda Chesterfield asked about the state’s performance in supporting individuals with disabilities.
Nichols highlighted a lack of services in rural and economically disadvantaged regions, particularly in southeast Arkansas.
SNAP Program Work Requirements
Lori McDonald , Chief of Staff at DHS, provided an update on work and training requirements for the Supplemental Nutrition Assistance Program (SNAP), focusing on general requirements, specific rules for Able-Bodied Adults Without Dependents (ABODs), and related program data.
Key Points:
General Work Requirements:
Apply to individuals aged 16 to 59.
Requirements include:
Registering for work.
Accepting suitable job offers.
Avoiding voluntary reductions in work hours or job termination.
Able-Bodied Adults Without Dependents (ABODs):
Subset of SNAP recipients aged 18 to 54 without dependents.
Subject to a three-month limit for SNAP benefits within a 36-month period unless:
They meet the work requirement.
Are exempt for specific reasons.
Engage in approved activities.
Recent Data:
Closures:
Since October 2023 (post-pandemic adjustments), 4,907 individuals have lost SNAP benefits due to not meeting ABOD work requirements.
Employment and Training Program:
Participation is voluntary.
In fiscal year 2024, 2,561 individuals have been served, with 20,519 referrals made.
Committee Response:
The presentation was acknowledged without further questions or comments from the committee.
